If you're going to do the PP telehealth thing, I'd say you need to make your peace with seeing people either before 9 AM or after 5 PM, preferably both. Part of your value proposition is that the appointments don't eat up as much of someone's day which means you need to be accommodating people who have traditional jobs and a premium on their time.
Totally! Unfortunately, this overconfidence comes from the miseducation being doled out by the local training programs (the medical knowledge is great but the career development is an expert course on how to make a donkey out of yourself). I suspect it's not just specific to one geographic area. Maybe the below is tmi, but I was floored at the mentality being promoted in some academic settings and no wonder some physicians struggle with career advancement if the head of the department promotes certain attitudes.
Graduates are coming out thinking they are so hot to trot that they are ready to take the PP risk with ridiculous expectations. I feel for the recent grad I just spoke of--but it's also a complicated story and trouble they invited to themselves. They have massive student debt from private schools, and compounding loan interest. They actually were in an elective at my office and I provided didactics about how to financially prepare for PP but they took none of the advice. I actually offered a job that pays over $300 an hour and they did not take it (because they wanted wfh permanently), confident they could make this thing work on their terms (which is fine but speaks to the degree of miseducation they are getting). As graduation approached, they realized the terrain is pretty dry and DL they were trying to solicit patients out of my practice. I have no qualms of if the patient wants to follow someone elsewhere--but at least be transparent so I know no one is lost in unintentional or neglectful patient abandonment. But there were actually patients who wanted to stay in the practice and when they elected not to follow the resident, the resident
-never told anyone here
-patient was left with no follow up appointment here
-patient called later out of refills and asking why continuity of care was not provided
-no documentation in chart of disposition
Of note, I did tell the trainee if they would not be continuing at the practice, what the protocol is for providing options and continuity. So there were clear instructions but certain practices performed with a degree of secrecy.
Towards the latter part of the elective, I caught on that something strange was going on.
When some patients tried to start to transition out to where the grad was going, they were kind of blindsided by the pricing and under the impression it would be an in network service at the affordable copay they were used to. Patients were upset at this questionable practice they got exposed to and clinical risk in continuity. It made for bad PR of the clinic, and the training program. So one part of the elective was fire fighting and working together with the trainee to clean up the mess that was initiated without my knowledge.
I brought this up to the PD and said this is a good learning point to discuss work place politics, etiquette, patient continuity and all sorts of concepts. Since the trust was lost, I did feel a need to take some of this into my own hands and mitigate the disposition myself to ensure no one fell through the cracks. The PD balked and somewhat accused the practice of trying to retain patients for profit and potentially trying to break the sacred physician patient relationship in the name of money. Despite the overwhelming evidence of why a practice founder would be concerned and lose trust. The PD said the resident was doing me a "favor" because "it's so hard to find a psychiatrist." (I told them any PCP can refill, don't get too comfy). PD was confident this PP the person was pursuing was going to take off and I was just bitter about not being able to add such a high value provider to the practice. I was basically told to let the trainee continue to handle things on their own (telling patients it would be a smooth transition with them at the new place) because "patients have the right to see whoever they want." Which is true but they were in the dark about the cost -- so who's left holding the bag when they try to have their new appt but at 10x the price? And if they decide to not pay up and try to return to Dr. R's office, the practice here needs to prepared for their return--lots of logistics need to be coordinated (patients can't just show up wherever they please, when they please). I told the PD, sounds beautiful if a patient can see whoever they want (tell that to a Medicaid patient--or even a commercially insured one on a tight budget!), but you forgot the economic limitations. And yet, here the PD comes in, with no work experience in the PP setting: making accusations and ordering me how to run my practice? I wonder where the hubris comes from (and that type of learned attitude no employer would be excited to work with, sure a provider may get hired but they won't be rushing to promote that person or pay them more---promise ya that). They also said telecare is the new future. And they transitioned lots of residency functions to remote. I did offer to do a didactic about how to thrive in the market whether in PP or other settings and be in a good negotiation space but the department said they have high quality didactics already and psychiatrists are in hawt hawt hawt demand. I was eventually invited to do a lecture. But it was such a cringy experience I canceled the elective and the didactic. It's odd that the department also told residency applicants of the unique and useful teaching provided at this office to market the program but yet behind the scenes there's these weird politics. It was like, if you find the teaching so valuable, don't be disrespectful of it then.
I really hope training programs add faculty that have more robust work experience. There's many in academia making statements about the terrain that are not accurate in part due to their own limited work experience, let alone good career advice to other physicians. It was a great illustration of advising on something you don't know squat about. Ok, off my soap box and done with the rant.
I don't personally understand patients wanting to ever see a MH provider in person. Unless you live next door, you're going to always be spending almost double the time traveling (during business hours) than you will in any session. That said, there are definitely reasons an employer would want a physician on site. I do think permanent WFH is likely the greatest fantasy current residents have.
I've noticed statistically when given the option, patients opt for an in person experience. They seem to appreciate the full experience and body language. Especially with therapy. Minority of the time I've seen people elect for remote visits is
-tight schedule
-long distance
-transportation issues, especially the impoverished population
