Better Business Model?

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Which is the better business model?


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Which is the better business model? A private practice clinic that is solely Psychiatrists, or one that is a blend of Psychiatrists and Psychologists/therapists.

Is it even possible to declare one a better business model over the other?

And if you voted, why did you vote that way?

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Better business model as in $$$ or quality of service for the patient?
 
I mean, in the area I am increasingly specializing in, there is an absolute gold standard no foolin' this is the thing you gotta do psychotherapy so it's a really easy question to answer, obviously the mixed group. There are a few other areas that come to mind where I don't see how it works otherwise. Gen pop I'm not sure the answer is as clear.
 
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Top end of mixed practice seems ideal to me from both the model and quality of service. I find patients more likely to attend therapy when their doctor can see if they've been coming and vice versa. Much easier to discuss cases that seem to have questionable components or are not making improvements. Office space has some economy of scale and needs for both are quite similar.

This is provided that the psychiatrists are practicing largely E&M style with limited psychotherapy. Psychiatrists only would be my vote in the setting of the MD/DOs doing their own therapy.
 
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This question is too location specific.

Let’s say there are a lot of high end counselors in the area. If you get on their good side and essentially feed the counselors, they will often do the same in return. Start hiring your own counselors and now you are competition. Referrals will go elsewhere. It may be better to add another psychiatrist and keep feeding the counselors.

In other markets, you are creating the higher therapy demand and need to bring in the quality therapy market yourself.
 
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Can't answer and here's why. Some psychiatrists or therapists could be terrible. Depends on the rent, number of offices, whether or not you accept insurance, Medicare, Medicaid, or are private pay.

You have a therapist there and they're good that's great. If they are less than this it's bad.

I have noticed the more "therapy" patients the less the office will tilt towards the severe more physiological illnesses such as schizophrenia. I've also noticed that therapists aren't typically experienced with psychosis in general and if they see your patients they might inadvertently get a psychosis patient.

E.g. one of my schizophrenia patients started seeing a therapist in the office. She complained of his psychosis as if she was inexperienced in dealing with it, and I don't know why she didn't give disclaimers or express the limitations of therapy and continued treating him if she really didn't want to see a schizophrenic patient as if this was completely new territory for her. He started seeing her without telling me and when she got him as a patient she never once approached me to get information on him so I didn't know about it until well after it started. She also wasn't exactly doing a good job with him by the time I found out about it.

The garden-variety therapist in a private office (and yes of course there's exceptions) are dealing with mild issues or personality in a superficial DSM sense. If you have therapists in your office they have to know that you deal with stuff that's outside that unwritten norm, that the two aren't exactly compatible and what both provider types want to share. (That's not to say what they do is easy and there's plenty of functioning people with severe issues that therapy will benefit, hence why I used the term "superficial.")

The pros I thought would happen with therapists in the same location didn't foment often. E.g. there were therapists where they'd refer me someone and never provided me with a heads-up, if I checked the therapist's records most of the time I couldn't even read their notes. Sometimes if they did give me a heads-up and came to my office, instead of presenting it to me like a physician they'd go overboard and talk about the patient for like 25 minutes in between patients when I really only had a few minutes. They never had the "present the patient" in a succinct manner training you get in the hospital. Now this wasn't all therapists but it was enough for me to never expect it to bridge well most of the time.
 
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