Combined treatment

[Attending1985]

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in light of recent thread about private practice trends, someone had said that you need to set yourself apart for other practitioners. Would people say combined treatment is something that people are desiring? Or are people more comfortable/satisfied with split treatment?

 

[brosa]

What are you referring by combine treatment? Medication plus therapy with the same psychiatrist, medication plus therapy in the same clinic, TMS plus ketamine?

 

[Attending1985]

What are you referring by combine treatment? Medication plus therapy with the same psychiatrist, medication plus therapy in the same clinic, TMS plus ketamine?

Medication plus therapy with psychiatrist

 

[splik]

Not only is there a demand for combined treatment, there is also some demand for physician-delivered psychotherapy. Some patients just see me for therapy alone, either because they don't want/need meds or because they have another psychiatrist prescribing meds.

I've had patients who already have a therapist switch over to seeing me for therapy as well even though it was basically free for them to see a therapist through their benefits. They felt they got more from me than their existing therapists. Fact is, most therapists out there are shockingly bad. They may be fine for problems of living but a lot are not very adept at dealing with anything else. They want to EMDR everything to death.

Round my way, a typical therapist might describe themselves as a "queer non-binary kink-affirming, sex-positive, BIPOC-allied, neurospicy, decolonized, trauma-informed, attachment-based EMDR/brainspotting/IFS therapist". I'm sure that appeals to some people, but it's a massive turn off to a lot of patients.

That said, providing combined treatment would not separate you from other private pay psychiatrists since most private pay shrinks offer this. One of the main reasons people forgo accepting insurance is because it doesn't reimburse adequately for psychotherapy, whereas you can make as much or more with insurance if you focus on pharmacotherapy.

 

[TexasPhysician]

Does not set you apart.

 

[smalltownpsych]

in light of recent thread about private practice trends, someone had said that you need to set yourself apart for other practitioners. Would people say combined treatment is something that people are desiring? Or are people more comfortable/satisfied with split treatment?

I don’t know how much you would market this as opposed to organically growing this type of practice over time. Reason being is most people don’t understand the benefits of psychotherapy and even less why it is beneficial to have a psychiatrist be the person administering it. That being said, if you are good, people with resources will pay for the service provided. I run a concierge type of practice with patients with severe mental illness and would love to have a psychiatrist on the team that understood the practice of psychotherapy and if he or she wanted they could even be the psychotherapist for some cases. When my postdoc was complaining about our current psychiatric treatment options for patients, I said that if I had an extra 500k in annual revenue laying around, I would love to hire one.

 

[Merovinge]

Not only is there a demand for combined treatment, there is also some demand for physician-delivered psychotherapy. Some patients just see me for therapy alone, either because they don't want/need meds or because they have another psychiatrist prescribing meds.

I've had patients who already have a therapist switch over to seeing me for therapy as well even though it was basically free for them to see a therapist through their benefits. They felt they got more from me than their existing therapists. Fact is, most therapists out there are shockingly bad. They may be fine for problems of living but a lot are not very adept at dealing with anything else. They want to EMDR everything to death.

Round my way, a typical therapist might describe themselves as a "queer non-binary kink-affirming, sex-positive, BIPOC-allied, neurospicy, decolonized, trauma-informed, attachment-based EMDR/brainspotting/IFS therapist". I'm sure that appeals to some people, but it's a massive turn off to a lot of patients.

That said, providing combined treatment would not separate you from other private pay psychiatrists since most private pay shrinks offer this. One of the main reasons people forgo accepting insurance is because it doesn't reimburse adequately for psychotherapy, whereas you can make as much or more with insurance if you focus on pharmacotherapy.

Wow I live in a very different geography and somehow I see therapists with very similar descriptors of themselves. Bit sad to know that's how the whole field has moved.

 

[Attending1985]

a couple are saying it’s not unique and provided by most private practice psychiatrists. I live in a 250k town in the Midwest and there is not one psychiatrist providing combined treatment.

 

[Stagg737]

a couple are saying it’s not unique and provided by most private practice psychiatrists. I live in a 250k town in the Midwest and there is not one psychiatrist providing combined treatment.

This will probably depend on geography. Most metros it probably won't make you super unique like where you're describing, but I know plenty of psychiatrists who "don't do therapy" and you could set yourself apart from them. It's definitely not unique, but could be very needed depending on where you are.

 

[calvnandhobbs68]

a couple are saying it’s not unique and provided by most private practice psychiatrists. I live in a 250k town in the Midwest and there is not one psychiatrist providing combined treatment.

So like in the other thread I think we have to differentiate what we mean by "private practice". Some people use this to be synonymous with cash only but I think we have to differentiate between private practice psychiatrists who take one or some insurance plans vs totally cash only (no insurance at all).

In the actual cash only market, this generally wouldn't seem to set you apart from most people but is probably needed as a baseline at this point to have a sustainable cash practice. In fact, many cash only practices market themselves as doing psychotherapy during visits as a way to differentiate themselves from a typical insurance practice. Different people approach this different ways...I've seen some practices where everyone is a 30 minute f/u for X amount or other practices where you can do a 15 minute "med only" f/u for X amount or a 30-45 minute psychotherapy f/u for X amount.

I'll say that if you don't seem to offer anything different besides "come here for your meds", unless there are truly no other options in your area you'll have a hard time marketing to people who could just use their insurance to go see an NP for 15 minute med followups.

In the insurance market, it doesn't really matter, you'll fill up over time if you're taking insurance, it's just a matter of if you want to structure longer or shorter followups.

 

[R. Matey]

Wow I live in a very different geography and somehow I see therapists with very similar descriptors of themselves. Bit sad to know that's how the whole field has moved.

Those of us who are committed to evidenced-based care are sad about it as well.

 

[romanticscience]

So like in the other thread I think we have to differentiate what we mean by "private practice". Some people use this to be synonymous with cash only but I think we have to differentiate between private practice psychiatrists who take one or some insurance plans vs totally cash only (no insurance at all).

I'm in PP, mainly with insurance and some cash. For the most part, I like this setup because I can practice evidence-based psychiatry. I've noticed some weird things happen in cash-only practices. Many of them call themselves "integrative psychiatrists." It seems like a hysteria hive where unconscious anxiety gets assessed for vitamin deficiencies and treated with supplements. It's BPD, where's the DBT? Also, I've seen some folks sort of "force" their patients IMO into unnecessary psychotherapy (e.g., "I'm a dynamic psychiatrist and ONLY make hour-long appointments; you do want your meds, don't you?; want to leave after 20 minutes, well that'll be the full fee").

Yes, there are reasonable and good cash-only patients. Enough for a small side PP. However, I could not FILL an entire full-time practice with them without beginning to pander somehow.

 

[TexasPhysician]

a couple are saying it’s not unique and provided by most private practice psychiatrists. I live in a 250k town in the Midwest and there is not one psychiatrist providing combined treatment.

That you know of. While I do it, I don’t advertise it. I’m upfront with patients. I have a therapist on staff. We can regularly coordinate care and therapy costs are almost 1/3rd my rate with the therapist. When deciding to see me or my therapist, 99%+ choose the therapist. If you ask any of my colleagues, they’d say I don’t do hour long therapy.

The demand for a psychiatrist to do both is incredibly low when the price is a consideration. This may be different in certain suburbs in high net worth areas where money means little.

 

[splik]

Wow I live in a very different geography and somehow I see therapists with very similar descriptors of themselves. Bit sad to know that's how the whole field has moved.

that's the mainstream - it's not uncommon to see therapists integrating witchcraft, Tarot, past life regression, reiki, psychic medium readings, and astrology into their therapy services.

 

[clausewitz2]

that's the mainstream - it's not uncommon to see therapists integrating witchcraft, Tarot, past life regression, reiki, psychic medium readings, and astrology into their therapy services.

I once heard MSW programs described as 'grad school for people who don't want to read', which I think explains a lot of the susceptibility of the graduates thereof to woo.

 

[Attending1985]

That you know of. While I do it, I don’t advertise it. I’m upfront with patients. I have a therapist on staff. We can regularly coordinate care and therapy costs are almost 1/3rd my rate with the therapist. When deciding to see me or my therapist, 99%+ choose the therapist. If you ask any of my colleagues, they’d say I don’t do hour long therapy.

The demand for a psychiatrist to do both is incredibly low when the price is a consideration. This may be different in certain suburbs in high net worth areas where money means little.

Are you insurance based?

 

[TexasPhysician]

Are you insurance based?

I have both an insurance practice and out of network. I don’t do 1 hour long counseling in the insurance based practice as it would reduce my income too much.