15 minute medication visits

[istillbelieve]

Advertisement - Members don't see this ad

Hi,

I am a med student possibly planning a career in psychiatry. I was talking to a psychiatrist about his field. I didn't bring up the issue of money. He did. He mentioned that one can make a lot more money by doing only 15 min medication visits instead of doing medication and therapy together in one visit. This surprised me because I did not go into medicine for the money. I have always had an interest in mental health.

Isn't 15 minutes not long enough to discuss medication issues? I have seen patients on my rotation with many medication issues/major problems, and some went over.

Is it recent that the insurance companies have limited the visits to 15 minutes. Many patients could get frustrated and end up going to their PCP for medication.

Thanks

 

[medicaresucks]

You can spend an hour with each of your patients if you have a private practice. If you do that you won't have a private practice that long. The same problem is in PCP. 15 minute visit for a patient with HTN, COPD, DM2, CAD, and some new issue.. if that can be done in 15 min than certainly psych med management can... how well it can be done is another question.

 

[Ceke2002]

As a patient if I'm going in for a basic med check then I find 15 minutes is more than adequate enough time. I'd say most of my med checks have taken less than that. Mind you if my Psych was doing nothing but 15 minute med checks I doubt I'd still be working with him after almost 3 years. One of the reasons I do like working with him is he has a good knack for knowing how much time I actually need from session to session, whether that's a quick 5-10 minute check in, or a longer session involving more intense therapy, or somewhere in between where we do some therapy and then just end up nattering on about stuff. I've never walked out of a session feeling disappointed that I didn't get more time, and by the same token I've also never sat through a session where I've been thinking 'Geez, just let me leave already'. I think that sort of inate sense/knowledge comes with experience though. I guess what I'm trying to say is some patients you could totally get in and out within 15 minutes for a basic med check, others might need a little longer than that so don't get too hung up on some arbitrary amount of time. Different patients, different needs - Same patient, different needs on different days. Just an opinion from the other side of the table, so to speak. Good luck with your studies. 🙂

 

[nitemagi]

Hi,

I am a med student possibly planning a career in psychiatry. I was talking to a psychiatrist about his field. I didn't bring up the issue of money. He did. He mentioned that one can make a lot more money by doing only 15 min medication visits instead of doing medication and therapy together in one visit. This surprised me because I did not go into medicine for the money. I have always had an interest in mental health.

Isn't 15 minutes not long enough to discuss medication issues? I have seen patients on my rotation with many medication issues/major problems, and some went over.

Is it recent that the insurance companies have limited the visits to 15 minutes. Many patients could get frustrated and end up going to their PCP for medication.

Thanks

15 minute med checks are doable, but can get pretty repetitive. I personally do 30-minute med checks and work to incorporate some brief therapy into it. I have the luxury to do this because I have a cash-based practice.

 

[istillbelieve]

I am beginning to see that it is only cashed based practices and those psychiatrists that accept only private insurances that run their medication visits to 30 minutes. They even include a little therapy.

 

[happygilmore]

Hi,

I am a med student possibly planning a career in psychiatry. I was talking to a psychiatrist about his field. I didn't bring up the issue of money. He did. He mentioned that one can make a lot more money by doing only 15 min medication visits instead of doing medication and therapy together in one visit. This surprised me because I did not go into medicine for the money. I have always had an interest in mental health.

Isn't 15 minutes not long enough to discuss medication issues? I have seen patients on my rotation with many medication issues/major problems, and some went over.

Is it recent that the insurance companies have limited the visits to 15 minutes. Many patients could get frustrated and end up going to their PCP for medication.

Thanks

Welcome to 21st century medicine. Can they go to a PCP? Sure. A PCP will spend 2 minutes on psych and 5 min on other chronic health conditions and a few minutes on a physical exam. PCP are in a shortage situation too, it isn't as easy as you think to just go see a PCP.

I am beginning to see that it is only cashed based practices and those psychiatrists that accept only private insurances that run their medication visits to 30 minutes. They even include a little therapy.

You can do what you want - cash, insurance, whatever. It's your practice, you can run it how you want. If you let other people tell you the only way it can be done, you've already lost.

 

[F0nzie]

I am beginning to see that it is only cashed based practices and those psychiatrists that accept only private insurances that run their medication visits to 30 minutes. They even include a little therapy.

If you work in an inpatient setting you have all day to see your patients. Some psychiatrists will do inpatient driveby visits on 16 patients, be done by noon, then hit up an outpatient practice in the afternoon to bump their salary from the standard 180k to 250k. You don't have to be that guy.

In an outpatient setting, 30 min can be overkill and other times it isn't enough. The VA and certain community mh jobs offer 30 min follow ups. Btw the no show rate in Psychiatry is very high-- you can use that to your advantage to spend more time with patients.

In my private practice I ask patients the length of time they wish to be seen for their appointments. This helps me understand how much time they need to communicate their concerns. I also feel it helps them take the lead in their recovery. Strict no-show policy for boundary setting and accountability.

 

[happygilmore]

If you work in an inpatient setting you have all day to see your patients. Some psychiatrists will do inpatient driveby visits on 16 patients, be done by noon, then hit up an outpatient practice in the afternoon to bump their salary from the standard 180k to 250k. You don't have to be that guy.

In an outpatient setting, 30 min can be overkill and other times it isn't enough. The VA and certain community mh jobs offer 30 min follow ups. Btw the no show rate in Psychiatry is very high-- you can use that to your advantage to spend more time with patients.

In my private practice I ask patients the length of time they wish to be seen for their appointments. This helps me understand how much time they need to communicate their concerns. I also feel it helps them take the lead in their recovery. Strict no-show policy for boundary setting and accountability.

what is your no show policy?

 

[F0nzie]

what is your no show policy?

A 24 hour cancellation policy and signed agreement that the credit card on file automatically charges the full amount for the missed the visit. I have patients review our policies before scheduling their intake. Btw I typically waive the first missed visit and provide a second verbal policy reminder before enforcing it.

 

[whopper]

15 minute checks IMHO work very well if the patient's case is already figured out well and the doc knows the right thing to do next.

Such is not the norm in brand-new cases. New cases require the doc figure out the right dx and treatment.

But as a doc practices more and more in the same location, more and more of the patients will get better.

When I first started private practice, over 90% were new patients and very few were stabilized. The only ones I got that were already stabilized saw me because their other doc retired or terminated care because they no longer took the patient's insurance.

But after about 9 months, the majority of my patients were stabilized and they were now just refills that really took only 10 minutes each. This is even with me making sure I wasn't cutting corners and telling them if they wanted to engage in any psychotherapy and reminding them that I could a heck of a lot more than refill their meds. Most of them told me they felt great and didn't want to engage in psychotherapy, even when I recommended them to do so (they were in a comfort zone and didn't see the need to push it, e.g. a patient with panic disorder where the attacks went from 5x a day then with SSRIs to once a week, and they were fine with that. They didn't see it as cost-effective for themselves to start doing psychotherapy to see if we could reduce it more.)

Bottom line, 15 minutes medchecks work very well for patients already doing well. IMHO, until the patient is figured out, the doc should do 20-30 minutes per session (or more).

A doc makes more money doing 15 minute checks and seeing 4 patients in an hour than seeing one patient for 60 minutes.

15 minute checks IMHO are completely fine so long as you limit the patients to that model that are already doing well and don't want psychotherapy.

 

[istillbelieve]

15 minutes can be short for a patient that has many problems with many of the medications.I worked in a clinic where this has happened. Also, there were patients that were suicidal. Where I worked before med school, patients were scheduled for 15 minutes. But, sometimes the sessions went over. I've seen patients come out in 6 minutes.

As far as seeing a pcp, you don't have to do everything in one visit. Right now it is not difficult to get in to see a pcp, at least where I live. I have a book on my desk with over a 100 available pcp's willing to take my insurance. I am going to look for another pcp, and I have so many pcp's to choose from.

What about hiring PA's to do the initial visit and psychiatrists do the med followups? More patients would be seen. More money brought into the practice. Oh well. This is a long time from now for me, if I even get in to a psych residency.

 

[michaelrack]

What about hiring PA's to do the initial visit and psychiatrists do the med followups? .

The initial visit should be done by the psychiatrist to establish the diagnosis/figure out what is going on with the patient, and then establish a treatment plan. This may take more than one visit.

 

[istillbelieve]

The initial visit should be done by the psychiatrist to establish the diagnosis/figure out what is going on with the patient, and then establish a treatment plan. This may take more than one visit.

The initial visit should be done by the psychiatrist to establish the diagnosis/figure out what is going on with the patient, and then establish a treatment plan. This may take more than one visit.

Actually, it does make more sense to do it this way, and they should see the more complicated medication cases.