That would make sense if healthcare was a system without extreme information asymmetry where people can barely tell what medication they're on right now, much less what different healthcare providers actually do.
This is also a very marketing/consumer based approach that works fine when you're trying to sell Cheetos and don't actually give a crap about what happens to your consumer long term. Not so fine if you're actually trying to balance beneficence, nonmaleficence, autonomy and justice which can run into a patient's perception of what would immediately feel good for them.
That's a fair point about information asymmetry. But why not look at that as a niche to fill yourself. Why not demonstrate command of your knowledge and insight value. I guess the way I'm thinking about this does not easily map onto managed care model or single payer systems. Which... I suppose, is why I'm looking for an escape vessel from them. If we are in a system that doesn't monetize the slight incremental value add steps of a lifelong learning process and a more substantial, rich, and robust training milieu then I guess we should price ourselves out of the Cheetoh business to extent that we can. But it seems to me, we have to put something more sophisticated on offer to do so.
Does offering Adderall 20mg TID after a 10 minute zoom visit provide value? Because it certainly seems like some venture capital/MBA lead groups employing an army of NPs have found a market for that very service. Healthcare does not respond like selling widgets for so many different reasons that people have literally written books about it. Sure you can keep doing what you are doing and put your head down and pretend nothing else is in your locus of control, I don't that is an entirely unreasonable proposition. It would hard to imagine it not being equally (and likely more laudable) a position to speak out about the problems associated with commoditizing medicine to the detriment of the patient.
No it doesn't offer much value to people who value a healthy, meaningful life. But... if the VC profits are saying something then it does seem to offer lower price points for receiving ADHD treatment. Are we going to yell at the sky for the weather because working people strapped for resources are taking the lowest cost option for what THEY think they need. If not, then it seems to me that competing for lower price point in that market is a lose-lose game. I just emptied out my panel of patients of transactional ADHD treatment clients after working them into a sustainable, safe, but static treatment plan. My stance there is to remain a player congratulator and player facilitator and told them straight up that the value I could provide them in acculturating them into a safe, sustainable, healthy lifestyle to absorb the physiological stress burden of stimulants and to help them with executive function supportive strategies is a front loaded value proposition that had been delivered. They now had the toolkit to protect themselves from unethical *****s with script pads. Value equation complete. I want to focus on more engaging problems where incremental value stored up over the course of my training and the constant pursuit of understanding the complexities of human beings remains a good value offer. For those simple ADHD clients who will abide monthly visits where I can have paid time to solve stimulant supply chain dynamics and steward them through it then I have kept those, and some those we have discovered more complex things to work on.
I hear you about the challenge of selling widgets in a controlled, artificial market. The margin compression of investing in a career in psychiatry is still in it's decay function phase, although it seems to have kept up with inflation and specialty renumerative ranking for all involved. I would imagine this would reach some low plateau around some fixed factor above the salaries of our clinical competition within this controlled market. And yet still many of them will open up some niche for themselves ambitious to be outliers. Or for the same reasons I would do it. For creative, professional freedom. So it's an existential puzzle for sure.
Just because I'm not cut out for That 24/7 Real Health Care Bureaucratic War Life, I don't think that means I'm head in sand.
Unless, by sand, you mean tunneling my way out of this prison. Through getting busy living instead of dying a slow existential death here. To paraphrase the line in Shawshank Redemption.
PS. Can we just pause to observe the irony of us talking both sides of our book in this thread: "How dare they assume we can't offer therapy," followed by "How dare they assume they can offer medication services and therapy."
