Any Kaiser Docs?

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Does anyone have info on working for Kaiser? Pay looks great according to glassdoor, but looking for lifestyle, type of work, and wondering what psych testing looks like. Thanks!
 
Dont they have alot of lawsuits and strikes and such?
 
cara susanna said:
I don't work for Kaiser but I know people who do/did. It sounds like they have unmanageably large patient panels. I believe that's what the strikes were about, saying that it was impossible to provide quality clinical care with those workload expectations.
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Remember that Kaiser is large system with quite a few health plans, which each function as their own separate entity and standards for access to care are regulated by state authorities. So, Kaiser will do what the state lets it get away with. My experience is that the wait-time to get in for services is longer than return visits because Kaiser's contract with the union only allows for so many intakes per week.

I'm enjoying my postdoc here. I'm paid much more than what's typical for psychology postdocs. I also get a lot of supervision and have had some really cool opportunities to do things that I didn't get a chance to on internship. If I didn't stay, it would be due to my own career goals and not anything Kaiser has done.
 
My understanding of Kaisers is that I’ve you’ve seen one, you’ve seen one. I’ve met psychologists that rave about their site, others that couldn’t run far away enough after their internship/postdoc/job.

My more assertive understanding is that generally their specialty psych clinics (peds neuro, ARMS, etc) tend to have a better reputation than their general outpatient services, which is where diploma-mill graduates have to go to get livable salaries while still paying their 400k student loans off.
 
Kaiser has a reputation for creating major burnout in psychologists, and for providing minimal individual therapy (I.e. clients see therapists like once every 3-4 weeks, per report to me, and they get funneled into groups instead of individual therapy usually because they’re backlogged and refuse to hire enough psychologists). I see clients who have Kaiser insurance but will pay out of pocket for quality services on a regular basis because they’re fed up with the subpar care there.

Kaiser psychologists tend to have negative things to say about the job, at least in my experience. Overworked with heavy caseloads is typical in most outpatient roles (and only having room in your schedule to see people ~once every 3 weeks or so). Not sure if this is still going on, but an acquaintance who worked at Kaiser years ago said they saw clients back to back all day but only 30 minute sessions and they never had time to chart during regular hours.

And yes, as an organization, Kaiser is known for not respecting their psychologists, punishing them for going on strike years ago. Kaiser has also been fined for their subpar mental health care.

That said, if you get into a highly sought after niche area, like the gender clinic in Oakland, I’ve heard that it is better than general outpatient work. But those roles are fewer.

Edit: by the way, Kaiser partners with Magellan and Beacon to pay (underpay) private practice psychologists for therapy to see Kaiser clients instead of hiring full time psychologists. They offer half of my full fee to do so, so they underpay psychologists quite a bit in the community. I don’t take those insurances.
 
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I'm not going to defend Kaiser's behavior in terms of the strike. It's unacceptable and more needs to be done. I do think it's unwise to discredit an entire entity for what's happening in one state. A lot of these complaints can be easily said of some VAs and other large insurance plans. Complaints do not automatically translate to poor outcomes everywhere all the time. People are also more likely to say something when they've had a bad experience than a good one.
 
R. Matey said:
I'm not going to defend Kaiser's behavior in terms of the strike. It's unacceptable and more needs to be done. I do think it's unwise to discredit an entire entity for what's happening in one state. A lot of these complaints can be easily said of some VAs and other large insurance plans. Complaints do not automatically translate to poor outcomes everywhere all the time. People are also more likely to say something when they've had a bad experience than a good one.
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Perhaps I should clarify that I'm only referring to Kaiser in California, and am unfamilliar with any Kaiser systems outside of the state.
 
R. Matey said:
I'm not going to defend Kaiser's behavior in terms of the strike. It's unacceptable and more needs to be done. I do think it's unwise to discredit an entire entity for what's happening in one state. A lot of these complaints can be easily said of some VAs and other large insurance plans. Complaints do not automatically translate to poor outcomes everywhere all the time. People are also more likely to say something when they've had a bad experience than a good one.
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In general, this is what will continue to happen as that it the business model, so I am not sure the strikes will matter in the long run. Whether it is Kaiser, the VA system, the corporate geriatrics companies, large outpatient clinics, etc. does not matter. When you are in the business of caring for large groups of people with low fees and the need to turn a profit, quality of care will always suffer. None of these systems is really shooting for the gold standard of care. What @foreverbull and other private practitioners are offering is a different (arguably better) level of care for those that can pay.

This is no different than being shocked that a $16k Nissan is not as nice as a $60k Lexus. I would bet that the folks at the Lexus factory, those selling Lexus cars, and even the Lexus mechanics car are not hustling like anyone working for Nissan. Because one is following a business model of low individual margins and high turnover and the other is following a model of higher margins with better quality and a better customer experience.

If one is okay working within the former model, Kaiser seems to pay decently compared to other high volume systems.
 
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Sanman said:
In general, this is what will continue to happen as that it the business model, so I am not sure the strikes will matter in the long run. Whether it is Kaiser, the VA system, the corporate geriatrics companies, large outpatient clinics, etc. does not matter. When you are in the business of caring for large groups of people with low fees and the need to turn a profit, quality of care will always suffer. None of these systems is really shooting for the gold standard of care. What @foreverbull and other private practitioners are offering is a different (arguably better) level of care for those that can pay.

This is no different than being shocked that a $16k Nissan is not as nice as a $60k Lexus. I would bet that the folks at the Lexus factory, those selling Lexus cars, and even the Lexus mechanics car are not hustling like anyone working for Nissan. Because one is following a business model of low individual margins and high turnover and the other is following a model of higher margins with better quality and a better customer experience.

If one is okay working within the former model, Kaiser seems to pay decently compared to other high volume systems.
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Agreed with this, although the VA's issue is more the focus on access to the detriment of f/u care.
 
cara susanna said:
Agreed with this, although the VA's issue is more the focus on access to the detriment of f/u care.
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That is definitely one of the VA issues. The VA also has less concerns in terms of profitability. In the end, access at the detriment to follow-up care, seeing patients monthly rather than weekly, limiting individual treatment to manualized, time limited interventions for everyone, large group treatment etc. are just different reactions to the too many clients and not enough providers problem. This will always be qualitatively different than a model that properly assesses an individual and tailors treatment to their issues that is not concerned with volume of treatment. The VA has areas of care where patient volume is less of a concern and panels are capped. This may be less true at Kaiser.
 
What @Sanman has mentioned is accurate; trying to increase profits and keep costs down as an organization (as do many corporations and even non-profits at times) is not unique to Kaiser. It’s simply a common business model of doing more with less.

And Kaiser pays pretty well in my area, so there are some pros for psychologists that may make the job more appealing to some folks. I haven’t worked there so I can’t speak to the benefits and perks of the job. I do not mean to shame any folks who work there, because it’s a job providing mental health services just like any other. Other companies in my area not only overwork psychologists, but underpay them at the same time, which some might consider even more egregious.

For those interested, a link to a related article about the most recent strike (there have been multiple strikes over the years):
www.kqed.org

Kaiser Mental Health Therapists Strike Again Over Long Wait Times | KQED

Mental health clinicians at Kaiser say patients have to wait months to get an appointment — which increases work load and puts patients' health at risk.
www.kqed.org www.kqed.org

It is also helpful to hear from folks who have experience working there. I would be curious to hear about the day-to-day in my state’s Kaiser system and beyond.
 
Sanman said:
That is definitely one of the VA issues. The VA also has less concerns in terms of profitability. In the end, access at the detriment to follow-up care, seeing patients monthly rather than weekly, limiting individual treatment to manualized, time limited interventions for everyone, large group treatment etc. are just different reactions to the too many clients and not enough providers problem. This will always be qualitatively different than a model that properly assesses an individual and tailors treatment to their issues that is not concerned with volume of treatment. The VA has areas of care where patient volume is less of a concern and panels are capped. This may be less true at Kaiser.
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Yeah the access hysteria was annoying, though t didn't hit the neuropsychs too much. We'd just find it laughable when we had a waitlist longer than a few weeks, so they'd apply to see a community provider, get quoted a wait of 6-9 months and come back to us anyway. If anything, teh inflexibility of how they set up our clinics made it so that we'd see fewer patients anyway.
 
foreverbull said:
What @Sanman has mentioned is accurate; trying to increase profits and keep costs down as an organization (as do many corporations and even non-profits at times) is not unique to Kaiser. It’s simply a common business model of doing more with less.

And Kaiser pays pretty well in my area, so there are some pros for psychologists that may make the job more appealing to some folks. I haven’t worked there so I can’t speak to the benefits and perks of the job. I do not mean to shame any folks who work there, because it’s a job providing mental health services just like any other. Other companies in my area not only overwork psychologists, but underpay them at the same time, which some might consider even more egregious.

For those interested, a link to a related article about the most recent strike (there have been multiple strikes over the years):
www.kqed.org

Kaiser Mental Health Therapists Strike Again Over Long Wait Times | KQED

Mental health clinicians at Kaiser say patients have to wait months to get an appointment — which increases work load and puts patients' health at risk.
www.kqed.org www.kqed.org

It is also helpful to hear from folks who have experience working there. I would be curious to hear about the day-to-day in my state’s Kaiser system and beyond.
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Reading this article, the situation around the strike is very similar to the VA problem actually:
https://www.kqed.org/news/11760375/...rike-in-san-francisco-over-staffing-shortages
But therapists say Kaiser is crunching the numbers to make the situation look better than it is on the ground. For example, one of Kaiser’s solutions to improving wait times for initial appointments, which they must provide with 48 hours for urgent needs and 10 days for non-urgent matters under state law, is to do intakes over the phone through its Connect 2 Care program.

Clinicians say this means patients get quick access to an initial 30-minute phone appointment, but are still waiting weeks or a month to start therapy in earnest with a clinician who can see them on a regular basis, and are then waiting months between appointments.
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Well, with the VA there's also the fact that we can't really "deny" care to anyone. So people are getting therapy who don't really need it, or even if they need it aren't willing to engage in actual treatment. I'm guessing Kaiser doesn't have that problem.
 
cara susanna said:
Well, with the VA there's also the fact that we can't really "deny" care to anyone. So people are getting therapy who don't really need it, or even if they need it aren't willing to engage in actual treatment. I'm guessing Kaiser doesn't have that
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The article mentions that the providers cannot deny services and there is no cap on patient loads, so more similar than we may think. Though, there may be other gatekeeping mechanisms. At least at the VA, we are better shielded from liability cause federal government. The jobs actually seem very similar and salaries do as well. I would opt for VA given only those two choices due to liability concerns.
 
foreverbull said:
It is also helpful to hear from folks who have experience working there. I would be curious to hear about the day-to-day in my state’s Kaiser system and beyond.
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Here's mine:

I live in a beautiful, but semi-rural area where Kaiser is THE biggest name in town for mental health services next to the county services. We have a surprisingly large mental health team comprised of all mental health professionals. Psychologists are definitely in the minority, but we are fairly represented. Reasons I chose this postdoc to train in are 100% practical: it's fairly close to where I did my internship and I didn't want to uproot my family during the pandemic. I had some other offers, but this was the best decision for the circumstances. We plan to leave the area next year.

Access to care could be better. Kaiser in this area has two routes. The first is via our triage system, which is a little slower. If the wait times are too long, then the triage team will write an authorization for outside services for a fixed number of sessions (usually 10-12) to be used at the provider's discretion. I don't know what the reimbursement rate is, but the state's health authority puts 90834 at $102 and 90837 at $150. The second is via the rapid access mental health team, which is usually reserved for emergencies. It's a group of therapists plus a psychiatrist who evaluate the patient prior to them being transferred to outpatient services. Like the name implies, these are a faster way to gain access to services. There are also a number of other specialty services offered like groups, IOP, residential treatment, DBT, TMS, ECT, etc... None of these are seen as services to replace individual therapy.

I can't speak to other people's experiences, but mine as a postdoc is that my caseload is large, but hardly overwhelming. I see people for 45 minutes and I dictate or have templates for everything, which significantly cuts down on my documentation time. The paperwork is very simple to do (Kaiser uses Epic) and there is a dedicated team for everything else. Other people schedule my patients, do case management, and handle client crises between sessions. As a postdoc, my job is simply to provide individual therapy and do some assessment. My patients are seen every 2-4 weeks depending on need and I see roughly 28 patients/week. I get two dedicated hours a supervision/week and a generous PD fund, which covered all of my EPPP expenses. My pay is the same as the psychiatric residents within Kaiser and I work four days a week. I also work from the comfort of my home full-time due to the pandemic. Kaiser bought me new equipment when I started for a home office.

If I was a psychologist who wanted something stable with a retirement plan and didn't mind doing therapy all the livelong day, then I probably would stay with Kaiser for a few years before transitioning into a private practice. However, I'm unfortunately too ambitious for such a cozy life and while I'm not sure if that's going to lead me anywhere productive, but I wouldn't mind returning to Kaiser in a different role. My experience here has been very comfortable so far.
 
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I should note that a not-insubstantial amount of time in VA is spent on administrative tasks that other large systems may not have as much of an issue with, including charting in an older and inefficient EMR system, handling numerous required reminders, and fixing scheduling issues. Sounds like this may not be as big a problem with Kaiser.

On the flip side, you generally can spend much less time worrying about everything billing-related.

As with any position/environment, it makes sense to get a feel for the specific site(s) you're interested in.
 
R. Matey said:
Here's mine:

I live in a beautiful, but semi-rural area where Kaiser is THE biggest name in town for mental health services next to the county services. We have a surprisingly large mental health team comprised of all mental health professionals. Psychologists are definitely in the minority, but we are fairly represented. Reasons I chose this postdoc to train in are 100% practical: it's fairly close to where I did my internship and I didn't want to uproot my family during the pandemic. I had some other offers, but this was the best decision for the circumstances. We plan to leave the area next year.

Access to care could be better. Kaiser in this area has two routes. The first is via our triage system, which is a little slower. If the wait times are too long, then the triage team will write an authorization for outside services for a fixed number of sessions (usually 10-12) to be used at the provider's discretion. I don't know what the reimbursement rate is, but the state's health authority puts 90834 at $102 and 90837 at $150. The second is via the rapid access mental health team, which is usually reserved for emergencies. It's a group of therapists plus a psychiatrist who evaluate the patient prior to them being transferred to outpatient services. Like the name implies, these are a faster way to gain access to services. There are also a number of other specialty services offered like groups, IOP, residential treatment, DBT, TMS, ECT, etc... None of these are seen as services to replace individual therapy.

I can't speak to other people's experiences, but mine as a postdoc is that my caseload is large, but hardly overwhelming. I see people for 45 minutes and I dictate or have templates for everything, which significantly cuts down on my documentation time. The paperwork is very simple to do (Kaiser uses Epic) and there is a dedicated team for everything else. Other people schedule my patients, do case management, and handle client crises between sessions. As a postdoc, my job is simply to provide individual therapy and do some assessment. My patients are seen every 2-4 weeks depending on need and I see roughly 28 patients/week. I get two dedicated hours a supervision/week and a generous PD fund, which covered all of my EPPP expenses. My pay is the same as the psychiatric residents within Kaiser and I work four days a week. I also work from the comfort of my home full-time due to the pandemic. Kaiser bought me new equipment when I started for a home office.

If I was a psychologist who wanted something stable with a retirement plan and didn't mind doing therapy all the livelong day, then I probably would stay with Kaiser for a few years before transitioning into a private practice. However, I'm unfortunately too ambitious for such a cozy life and while I'm not sure if that's going to lead me anywhere productive, but I wouldn't mind returning to Kaiser in a different role. My experience here has been very comfortable so far.
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I work at Kaiser and it has its pros/cons. I work with some talented therapists but would say that most are unhappy and therapists are definitely overworked. I feel like im running a marathon each day as i see up to 9 a day and have many messages and phone calls to return each day.My caseload is massive, I see 9 pts a day and don't have even 5 minutes between each of them but I do get a 15 minute after my 3rd session. My coworkers and I have loved the benefits (INCREDIBLE salary and benefits) but everyone is burned out beyond belief. I'm tired. So are my coworkers. Caseloads are huge, I see pts every 5 weeks and its awful having to deal with having to apologize for my booked schedule that is just beyond my control. I don't feel like i can do my best work when isee pts so rarely. I am a busy mother and I agree with R. Matey in that i enjoy that i dont have to deal with after hours crisis management or case management . Prior to virtual sessions, i had many more no-shows and saw maybe 6. a day. That felt sooo comfortable! Now that the sessions are held virtually i can say that i have extremely few no shows or cancellations a week and i see at minimum 7 a day and regularly 8-9 (and please keep in mind so many messages from pts to respond to daily..) Feel free to send me a PM if you have questions.

R. Matey- i am going to send you a message i have a question about testing
 
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R. Matey said:
As a postdoc, my job is simply to provide individual therapy and do some assessment. My patients are seen every 2-4 weeks depending on need and I see roughly 28 patients/week. I get two dedicated hours a supervision/week and a generous PD fund, which covered all of my EPPP expenses. My pay is the same as the psychiatric residents within Kaiser and I work four days a week.
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28 patients in four days seems like a lot for a post-doc. However, maybe it's more feasible since you're not doing any scheduling or case management and documentation sounds like a breeze. All those elements create a massive burden that's hard to overstate.
 
I have knowledge of this system. The game is access to care (intakes). They have been fined before for not meeting some metrics and following parity laws for this stuff. This is all public. Once patients are in the system group therapy is the name of the game. Groups for everything. I know of clinicians running groups who are now calling them classes, because they are. 30+ patients in a 90 min group. That is real. Think of treatment like being a conveyor belt at a factory moving people along. Good salary, great benefits, but people seem exhausted. You hear the phrase "golden handcuffs" from people who have worked there awhile. Not much testing aside from Neuropsycholgoy and some kid stuff, but I could be wrong. I know people at various Kaisers and its all so different at each place. Trainees are definitely protected with different expectations and they are not held to the contractual demands for patient care metrics that staff are. Seems to be a good place to train.
 
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At the current pace, I suspect we may see more and more of a divide between the "haves" and "have nots." In this case, the "have nots" being folks pursuing services via many/most insurances and in large healthcare systems (which are of course overtaking small, independent groups), and the "haves" paying out of pocket for boutique-level practices.
 
AcronymAllergy said:
At the current pace, I suspect we may see more and more of a divide between the "haves" and "have nots." In this case, the "have nots" being folks pursuing services via many/most insurances and in large healthcare systems (which are of course overtaking small, independent groups), and the "haves" paying out of pocket for boutique-level practices.
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I have to say that I agree with this. I have worked as a therapist in the insurance system and for cash. What everyone is talking about in Kaiser (9 patients/day and lots of large groups/classes) is a model I am seeing in many places from large private practices utilizing insurance to high need hospital populations at the VA (general mental health, PTSD, etc). This is in stark contrast to the cash PP experience, which allowed for more time for planning and tailoring services. I also think that the divide will continue to get worse and is something that we will likely see if the U.S. gets a form of universal healthcare.
 
Sanman said:
I have to say that I agree with this. I have worked as a therapist in the insurance system and for cash. What everyone is talking about in Kaiser (9 patients/day and lots of large groups/classes) is a model I am seeing in many places from large private practices utilizing insurance to high need hospital populations at the VA (general mental health, PTSD, etc). This is in stark contrast to the cash PP experience, which allowed for more time for planning and tailoring services. I also think that the divide will continue to get worse and is something that we will likely see if the U.S. gets a form of universal healthcare.
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Yup, large groups are something I'm starting to see more and more of in the VA.
 
AcronymAllergy said:
At the current pace, I suspect we may see more and more of a divide between the "haves" and "have nots." In this case, the "have nots" being folks pursuing services via many/most insurances and in large healthcare systems (which are of course overtaking small, independent groups), and the "haves" paying out of pocket for boutique-level practices.
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We'll have to see how it goes in the next few years with the IME work, but I feel like I'll either be treating my clinical work as almost pro bono (CMS continuing to drop rates) or just dropping Medicare and insurance altogether and catering to the cash only evals for those who don't want to wait 6+months.
 
Sanman said:
I have to say that I agree with this. I have worked as a therapist in the insurance system and for cash. What everyone is talking about in Kaiser (9 patients/day and lots of large groups/classes) is a model I am seeing in many places from large private practices utilizing insurance to high need hospital populations at the VA (general mental health, PTSD, etc). This is in stark contrast to the cash PP experience, which allowed for more time for planning and tailoring services. I also think that the divide will continue to get worse and is something that we will likely see if the U.S. gets a form of universal healthcare.
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I’m getting a bit off topic here, but I think there’d have to be a very strong push and commitment from the government for timely and quality mental health care should we transition to universal healthcare, which would take billions but would benefit society in the longterm (need to be proactive rather than reactive to problems they create themselves).

Looking at how things are running now and how companies get away with subpar mental health care and just get a small slap on the wrist (a fine of a few million in a system that might make a billion or more a year), that might be idealistic. I do support universal healthcare, and actually, Kaiser is sort of like this in the microcosm because I actually have Kaiser insurance myself—you do appmts, labs, and get your prescriptions all in the same building on the same day (and can get on the schedule of a specialist right away without having to make phone calls yourself, etc.) , then log in online a day later and see your results, medical records, etc., which is great. That’s a real advantage (and better care if your records are in one place and accessible to doctors without having to contact other providers) over a piecemeal kind of records/appmts system I’m used to with other insurances.

The key is just not shortchanging the public on mental health services if we go to universal healthcare—so NOT following Kaiser’s mental health model nationally. From what I’ve heard from clients, it’s also next to impossible to get to get in to a psychiatrist at Kaiser (months?), so PCPs are the frontline for anx/dep meds, but those with complex histories or more complicated diagnoses aren’t allowed to be prescribed meds by PCPs and sit waiting for a very long time.

I’d be curious to see what the mental health services are like in Western European countries and Canada are like with regard to wait times, frequency, ease of getting to see a psychiatrist, etc. Anyone know?
 
foreverbull said:
I’m getting a bit off topic here, but I think there’d have to be a very strong push and commitment from the government for timely and quality mental health care should we transition to universal healthcare, which would take billions but would benefit society in the longterm (need to be proactive rather than reactive to problems they create themselves).

Looking at how things are running now and how companies get away with subpar mental health care and just get a small slap on the wrist (a fine of a few million in a system that might make a billion or more a year), that might be idealistic. I do support universal healthcare, and actually, Kaiser is sort of like this in the microcosm because I actually have Kaiser insurance myself—you do appmts, labs, and get your prescriptions all in the same building on the same day (and can get on the schedule of a specialist right away without having to make phone calls yourself, etc.) , then log in online a day later and see your results, medical records, etc., which is great. That’s a real advantage (and better care if your records are in one place and accessible to doctors without having to contact other providers) over a piecemeal kind of records/appmts system I’m used to with other insurances.

The key is just not shortchanging the public on mental health services if we go to universal healthcare—so NOT following Kaiser’s mental health model nationally. From what I’ve heard from clients, it’s also next to impossible to get to get in to a psychiatrist at Kaiser (months?), so PCPs are the frontline for anx/dep meds, but those with complex histories or more complicated diagnoses aren’t allowed to be prescribed meds by PCPs and sit waiting for a very long time.

I’d be curious to see what the mental health services are like in Western European countries and Canada are like with regard to wait times, frequency, ease of getting to see a psychiatrist, etc. Anyone know?
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Not sure about wait times, etc. in universal healthcare systems. As far as psychotherapy, they seem to be facing similar situations with similar systems in place as we do at the VA and with insurance based systems. I recall a group of psychotherapists in UK/Australia that were psychodynamic lobbying to be included for NHS coverage because they were only covering time-limited CBT type therapies that are the EBPs we all know. When it comes to the best care for the individual vs better care for the group large systems always choose the latter. No matter what system we choose, luxury healthcare will be a thing in the future. Just as you can pay high prices for Birkin bags, custom kitchen cabinets, and Porsches in customs colors with special interior stitching, you will be able to pay a lot of money for psychoanalysis, 30-60 min visits with an experienced psychiatrist, or pick your luxury.
 
Sanman said:
Not sure about wait times, etc. in universal healthcare systems. As far as psychotherapy, they seem to be facing similar situations with similar systems in place as we do at the VA and with insurance based systems. I recall a group of psychotherapists in UK/Australia that were psychodynamic lobbying to be included for NHS coverage because they were only covering time-limited CBT type therapies that are the EBPs we all know. When it comes to the best care for the individual vs better care for the group large systems always choose the latter. No matter what system we choose, luxury healthcare will be a thing in the future. Just as you can pay high prices for Birkin bags, custom kitchen cabinets, and Porsches in customs colors with special interior stitching, you will be able to pay a lot of money for psychoanalysis, 30-60 min visits with an experienced psychiatrist, or pick your luxury.
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People don't though. My experience is that psychotherapy is become less, not more, valued as a service I think because of some of the confusion about what a makes a good psychotherapist and the giant swell of psychotherapy providers that exist in any given metropolitan area. We may have an idea of what we think a quality psychotherapy experience is, but my experiences in university counseling and now at Kaiser is that SES doesn't stop people from taking a "good enough" service on the cheap.
 
R. Matey said:
People don't though. My experience is that psychotherapy is become less, not more, valued as a service I think because of some of the confusion about what a makes a good psychotherapist and the giant swell of psychotherapy providers that exist in any given metropolitan area. We may have an idea of what we think a quality psychotherapy experience is, but my experiences in university counseling and now at Kaiser is that SES doesn't stop people from taking a "good enough" service on the cheap.
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Most people opt for "good enough" anything on the cheap and will not be interested in anything else. It is the minority that consume any luxury good. Most people will not opt for concierge medicine either. However, a minority with the means will do. Similarly, a minority of folks with the means and need will do so. Having done this in the past, there will always be a need if you know how ti find the market.

It will likely lead to an ongoing divide for patients and providers with the haves paying a minority of providers $150-200+/hr and the rest being paid insurance fees for less and less every year for limited cookie cutter treatments.
 
I think the biggest concern is whether clinicians at Kaiser feel that they have the opportunity to do their "best work/best interventions" within the case load requirements. I've seen a lot of clients who previously got mental health services at Kaiser and it seems like the majority of what is offered is "eclectic" supportive therapy. I never once heard of a single patient with anxiety disorders having even one session of an exposure-based treatment. I imagine that planning and setting up interventions like this would be very challenging when you are expected to see 7-9 pts per day and when you see people so infrequently that it would be hard to spend the session doing an intervention when you need to spend so much time just catching up with what has happened since the last session. Also, where is the time for solid adjunctive family therapy/parent management training when seeing youth? It would be a deal breaker for me as a clinician to know that the best I'm able to do in that setting is still not what is most likely to help the pt.

There has also been a big issue with the Kaiser in our area doing "cookie cutter" psychiatry with very different and complex patients all being given the same exact diagnosis and being put on the same exact medication, regardless if it is was contraindicated for the pt or was previously tried and not effective. I've had pts ask the psychiatrists (in my presence) what the criteria would be for evaluating that the medication was not working and discontinuing it and the psychiatrist could not give them an answer- just said that if the symptoms were still present they could not stop the medication until their symptoms improved. This thought process was horrifyingly unethical and illogical.
 
Mindfulpsych22 said:
I never once heard of a single patient with anxiety disorders having even one session of an exposure-based treatment.
Click to expand...

I've done it (edit: not in-vivo because of the pandemic, but imaginal exposure) but my productivity requirements are lessened so that might play into it. I have at least an hour of intervention prep time per day. Kaiser hires lots of mid-levels so that might be why you're hearing that.
 
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cara susanna said:
I don't work for Kaiser but I know people who do/did. It sounds like they have unmanageably large patient panels. I believe that's what the strikes were about, saying that it was impossible to provide quality clinical care with those workload expectations.
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I'd be interested in operational definitions of unmanageably large panels. While at VA during the past year my active caseload in my main clinic has vacillated from a high of 126 (pre-COVID) to a low of around 60 (post-COVID). We just had two providers leave so everyone else will absorb their caseloads of course. The one time that I had the temerity to ask if there even was a theoretical maximum caseload number I was told 'no...but it is every provider's responsibility to manage their own caseloads.' That, ladies and gents, is VA 'leadership' in action.
 
Fan_of_Meehl said:
I'd be interested in operational definitions of unmanageably large panels. While at VA during the past year my active caseload in my main clinic has vacillated from a high of 126 (pre-COVID) to a low of around 60 (post-COVID). We just had two providers leave so everyone else will absorb their caseloads of course. The one time that I had the temerity to ask if there even was a theoretical maximum caseload number I was told 'no...but it is every provider's responsibility to manage their own caseloads.' That, ladies and gents, is VA 'leadership' in action.
Click to expand...

Yeah, my panel is getting pretty large lately too. But the intakes keep coming. Gotta love the VA.
 
cara susanna said:
Yeah, my panel is getting pretty large lately too. But the intakes keep coming. Gotta love the VA.
Click to expand...
And one of the most pernicious and dysfunctional aspects in an organization like this (where everyone gets the same pay regardless of workload) is it seems that those who survive are folks who find tricky ways to 'game' the system to get out of responsibility rather than those who shoulder more responsibility (they seem to burn out). In a dysfunctional system, dysfunctional values/habits are actually 'functional' for the individual but harmful to the system. I mean, if my caseload doubles over the course of the next year, it'd sure ease the burden (a bit) if I got, I dunno, a commensurate 30% pay raise. But that ain't gonna happen.
 
Fan_of_Meehl said:
And one of the most pernicious and dysfunctional aspects in an organization like this (where everyone gets the same pay regardless of workload) is it seems that those who survive are folks who find tricky ways to 'game' the system to get out of responsibility rather than those who shoulder more responsibility (they seem to burn out). In a dysfunctional system, dysfunctional values/habits are actually 'functional' for the individual but harmful to the system. I mean, if my caseload doubles over the course of the next year, it'd sure ease the burden (a bit) if I got, I dunno, a commensurate 30% pay raise. But that ain't gonna happen.
Click to expand...

They'll be glad to use wRVUs as the "stick" when needed, but never as the "carrot." Now, if psychologists got performance pay commensurate with physicians, it might be another story.

But yes, it does seem to punish any tendency to want to overachieve. At least, again, in psychologists. Which is a shame.
 
Fan_of_Meehl said:
I'd be interested in operational definitions of unmanageably large panels. While at VA during the past year my active caseload in my main clinic has vacillated from a high of 126 (pre-COVID) to a low of around 60 (post-COVID). We just had two providers leave so everyone else will absorb their caseloads of course. The one time that I had the temerity to ask if there even was a theoretical maximum caseload number I was told 'no...but it is every provider's responsibility to manage their own caseloads.' That, ladies and gents, is VA 'leadership' in action.
Click to expand...

I was also curious about the research on dosage in psychotherapy. I think weekly therapy should be offered when it's necessary, but I've observed some therapists to have unscientific reasons for believing that every patient needs to be seen weekly.
 
R. Matey said:
I was also curious about the research on dosage in psychotherapy. I think weekly therapy should be offered when it's necessary, but I've observed some therapists to have unscientific reasons for believing that every patient needs to be seen weekly.
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pubmed.ncbi.nlm.nih.gov

The dose-response effect in routinely delivered psychological therapies: A systematic review - PubMed

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesize the literature on the dose-response effect in routine psychological therapies delivered to adult...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Recent review, has some cites which may be useful
 
Statistically, most of these patients are likely to have MDD, anxiety disorders, PTSD, SUDs, etc, no?

I don't know any evidence-based treatment protocols that have providers treating these disorders with individual therapy every 5 weeks? At least on the front end. Kaiser is also a managed care organization. Thus, it is especially in their interest (not to mention the patients!) to advocate for and render best practices. I'm sure their current practices are costing them money by extending treatment to ridiculous lengths, reducing clinician ability to render highest quality care, and likely contributing to overutilization of higher levels of care (IP, PHP, case management, ER visits) to deal with the disorder and its inevitably associated peripherical issues and flare-ups.
 
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Fan_of_Meehl said:
And one of the most pernicious and dysfunctional aspects in an organization like this (where everyone gets the same pay regardless of workload) is it seems that those who survive are folks who find tricky ways to 'game' the system to get out of responsibility rather than those who shoulder more responsibility (they seem to burn out). In a dysfunctional system, dysfunctional values/habits are actually 'functional' for the individual but harmful to the system. I mean, if my caseload doubles over the course of the next year, it'd sure ease the burden (a bit) if I got, I dunno, a commensurate 30% pay raise. But that ain't gonna happen.
Click to expand...

I agree with this as one that has helped in the past and been burned. During COVID, I have watched as myself and colleagues have helped other areas of the service (supervising students on VVC sessions, taking extra patients to help with overload, volunteering for Saturday work, etc) and gotten screwed by those that we are helping when issues arise and we need help managing their patients or to stop helping to focus on our primary positions. I am rather hidden away and forgotten about, so I plan to slowly remove myself from extra responsibilities as I get no support in navigating these issues. I will stick to what I know and forget about the rest.
 
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WisNeuro said:
pubmed.ncbi.nlm.nih.gov

The dose-response effect in routinely delivered psychological therapies: A systematic review - PubMed

The dose-response effect refers to the relationship between the dose (e.g., length, frequency) of treatment and the subsequent probability of improvement. This systematic review aimed to synthesize the literature on the dose-response effect in routine psychological therapies delivered to adult...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Recent review, has some cites which may be useful
Click to expand...
Thanks! That's helpful
 
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