* * Anonymous Doc

Sunday, March 6, 2011

Hey, a beacon of light from today's New York Times. Hard to feel bad about the work you do when you read stuff like this. An article (link here) about a psychiatrist who has stopped providing talk therapy because insurance companies won't pay enough, and now all he does is 15-minute visits to write prescriptions for meds.

It's an appalling article, not so much because the doctor feels conflicted about the limited service he's able to provide in order to make a living-- but because he doesn't really seem to be very conflicted at all. At least he's aware that he's turned his practice into a medication mill. His wife (and office manager) seems to lack any compassion or self-awareness entirely, if her quotes are representative.

Some bits from the piece:

"He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,”"

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

[Y]ears ago, he often saw patients 10 or more times before arriving at a diagnosis. Now, he makes that decision in the first 45-minute visit. “You have to have a diagnosis to get paid,” he said with a shrug. “I play the game.”

“The sad thing is that I’m very important to them, but I barely know them,” he said.

I get some of this is necessary-- or at least necessary if you want to make as much money as you can-- but at least feel ashamed of yourself, right? Being a doctor isn't the same as being a guy who pushes paper in an office, it just isn't. You can't process a patient the same way you can process a tax return. Yes, there are things about the system that suck. And residents are sheltered from the concerns of insurance companies and reimbursement. But how can you not feel profoundly ashamed of yourself to be a psychiatrist who refuses to listen to his patient's problems and won't even try to squeeze someone in when they're having an emergency?

If you want to be rich, be a specialist. Perform procedures. Align your practice with the kinds of work that insurance companies pay for. This way you can serve your patients and at the same time make the kind of money you want to make. But I don't think it's fair to your patients to become a psychiatrist and then decide that the competent practice of psychiatry won't make you rich enough, so you have to cut corners.

Maybe this is a naive reaction to the article. I mean, I feel like I'm usually inclined to sympathize in the other direction and then deal with commenters who say I'm proof that doctors are terrible. So if I'm feeling like this guy is a joke... I'm guessing you have words even harsher in mind.

My biggest question though-- why did he agree to this interview? Can anyone possibly read this article and think, hey, I want *THIS GUY* to be my doctor! It's like he's *TRYING* to sabotage his practice!

Enough from me. Read the piece. Tell me what you think.

Oh, and while I'm at it-- I threw that Facebook "Like" button up on the right-hand column of the blog a while back and can't tell if anyone has ever clicked on it. If you like the blog, do me a favor and click on the button if you don't mind. I don't know quite what it does, but I figure it might be neat to find out. Thanks.


  1. It says that he was initially conflicted, but that he's essentially gotten more used to it. He does lament the way his practice must be run throughout the article, so I'm not sure how you got the impression that he doesn't care. While it is sad that his practice has had to change so much, talk therapy is still available to the patients in the form of psychologists, who are actually very good at it. A lot of patients may not choose to go to a psychologist, but that is their own choice.

  2. I pushed the Like button and it gave me an error message.

  3. I also got the impression that he was very conflicted. He and his wife sounded like they lost a lot of money with the market downturn in 2008, so they probably aren't actually doing as well as you think. To me he sounded regretful that he couldn't afford to practice like he wanted to.

    The thing that surprised me the most was that the patients they interviewed at the end actually seemed satisfied. I totally was NOT expecting that.

  4. Thanks-- I think it must have been giving the error ever since I put it in, so maybe people were pushing it all along.... I probably should have tested it first. Ha. I tried something else, so hopefully it works now. This is also how one decides what medications to give.

  5. Well, everyone knows that doctors make a lot of money. So if this guy wasn't making a fortune, he must have thought something was wrong. I'm all for doctors making an adequate income in line with their training and work, but those who are in it solely for the money make me sick! I was a teacher, and had lots of education and training too, and affected children's lives, but NO ONE in teaching gets a fraction of what they should be worth. So I feel no sympathy for money-grubbing doctors (which is certainly not all of them, though!).

  6. This guy seems conflicted, and upon my first read of the article I had more sympathy for him than you seem to. But that statement about living the lifestyle he's accustomed to did jump out at me. Mostly the article made me go, "oh primary care.. what a cluster*&@#"

    To Natalie - yes, "everyone knows that doctors make a lot of money." When most medical students graduate with around $200,000 in debt, unfortunately, it's something we have to think about. It's why people are being driven away from primary care. It's why articles like this make me cringe and worry about patient care vs. finances just like with this physician because the last place I want to end up is in his shoes. I would be appalled at myself.

    The whole reimbursement system needs to change. We need to get paid to keep people healthy in the first place.

    Oh and there was no link for me to click to like - just a title "Facebook like box."

  7. "I want to retire with the lifestyle that my wife and I have been living for the last 40 years." sounds to me like he really wants to say that "Earnings have shifted, so I'm now making less money than before if I continue a proper practice."

    However, in order to make that claim, he should show us the numbers. I think numbers are important here.

    While I see that drugs do have a place, I feel that they are useless without the talk therapy as well. Now, if only insurance companies would turn their attention to Yoga instead of medicine...

  8. Doc, I have been following your blog for a while. What's going on with your personal life apart from the hospital? Any girlfriends? Are you dating? Do you have time to date? It would be nice to get that perspective as well. Are you even getting some action??!

  9. Hmm... I don't think a lot of this is his fault. The insurance companies are not offering to pay him for his services; and if he's seeing 40 patients in each 11 hour day, with his wife doing the front of house work, there's a reason for it.

    With their youngest son in school for psychiatry, they obviously have debt and bills. And at 63, the 11 hour days are long.

    I can clearly see his frustration with the situation, but he doesn't have a way to fix it without it costing him financially - and there's little he can do about that.

  10. You seem to have a problem with the fact that he wants to retire with the same lifestyle that he's been living. I don't see anything wrong with that sentiment. He's worked his whole life for the things that he has, and to expect him to be happy to give up what he's earned is unrealistic. He earned his life.

  11. This would be giving up the things he hasn't earned yet, and wouldn't have earned because no one wants to pay him for them. He wants what he was expecting, and is willing to practice rubberstamp medicine to get it if psychiatry won't do.

  12. If you have a house that is x square feet, with x car, who is able to go out to dinner x times a week and pay x amount of money for your children's education, would YOU give it up?

  13. >>With their youngest son in school for psychiatry, they obviously have debt and bills.>>

    Not necessarily. His son may be paying for medical school himself.

  14. -->"If you have a house that is x square feet, with x car, who is able to go out to dinner x times a week and pay x amount of money for your children's education, would YOU give it up?"<--

    People are doing it every single day - people who get downsized, have their salaries frozen, etc. It's reality for so many right now. So I think it's understandable that people would be disturbed that a physician acknowledges practicing half-assed medicine so that he can KEEP everything that others WOULD have to give up. He's keeping his goodies at the expense of patients. He should retire and get a different gig. Medicine doesn't need him.

  15. Wow, a lot of self-righteousness here. Condemning a guy who doesn't want to take a near 40% pay cut! Listen, it's not a travesty. It's the market, and it makes sense. The "supply" of people who can do talk therapy is pretty vast: PhD's, PsyDs, MSW's, and a host of other MH professionals can do--and get paid for--psychotherapy. Psychiatrists, as the only MH folks who've gone to medical school, provide a service--psychopharmacotherapy--that others can't, and *that* is in short supply. If anything, the market is pushing each to do what they're best suited to do. With the shortage of psychiatrists to prescribe psychotropics, do we really want to divert their efforts to psychotherapy, thus worsening the shortage of script-writers? Think about it.