Do you like psychodynamic psychotherapy? These things, IMO, are an immediate rule-in for personality pathology. I find it fascinating how quickly the enactments begin!
Some people just don't read any of the paperwork. It sucks that they look for a "good fit" when it comes to therapists but take any psychiatry appointment they can get. I'm unnerved by the people who are on this crusade to (1) get an appointment and (2) get med. Their chief complaint is literally "med management." With a motivational spirit, I ask, what are your goals? They're like, wtf?
I actually do like psychodynamic therapy and find these initial interactions not just very interesting but clinically pertinent. If only prospective patients knew at least for this office, there's a psychiatrist listening in assessing if it will be a fit from that first interaction (I get a sick/comical pleasure playing "receptionist"). Sometimes drug reps come looking for me and I say "Oh, Dr. Randomdoc1 is not in today, but I'll take a message for her." rofl. The funny thing with our paperwork is we have people initial a few major points about finances. Even in our initial intake on the phone or via email, the financial piece is discussed further and the paperwork requests for a payment method to keep on file. The paperwork has a special place to initial about our strict attendance policy as well and it is emphasized again in the appointment confirmation messages (email and text). So when after all those layers people try to argue the free consultation BS---pretty compelling for personality issues. LOL.
I really hate the business side of medicine. It makes me feel really icky. Private practice just sounds like the worst.
Au contraire, mon cheri. If you work outside of PP, you have no transparency on the finances--and you do get f**ked over. It's amazing how many patients will stiff you if they think you do not know. I've worked with the hospital system models and the pay per hour is far lower than PP. My theory is the factors involved include 1) you are subsidizing other employees/expenses and have no idea if they are pulling their weight, 2)patients get away easily with not paying their bill and can keep racking up their tab and 3)much of the time the insurance information one file is not up to date. In my other thread, I discussed my dad being in a prolonged hospitalization. I was floored that after over a year, they still had the incorrect Medicare number on file for his billing. This was after I told multiple staff to correct it both in the inpatient and outpatient settings (if staff in my office had a pattern of missing stuff that like...they'd be fired so fast). Mostly because I want the hospital to get paid. We never got sent a bill either. How do I know? I set up an online portal to make sure my parents' medical bills get paid. My dad had multiple rounds of chemo, radiation, inpatient, outpatient, blood products up the wazoo and the thought that this hospital missed out on who knows how much pay...makes me shudder. In PP, I run a software to make sure all the insurance is current and paying out. At least half of patients when they change or lose insurance, will never tell you unless you prompt them, and even if you do, they may not prioritize you to give you the info. So I subscribed to tools that search and find their insurance (it's called "coverage discovery" in revenue cycle jargon). So actually...in PP you can make sure you are paid for every minute of work you put in. If a patient has a problem with that model, you can say "get the f**k out of my office." But in other settings, you have to just take it.
Did you ever do after hours or early morning? If you did what was your experience with no shows during those times?
I used to do evening appointments. The attendance was great, much better than standard work hours, which makes sense. Most people are out of work and have less busy stuff going on. But we have lives too. The part that struck me psychodynamically were the reactions that came out when I gradually worked down the evening hours. Used to be every Tuesday. Then 3 Tuesdays a month, 2 a month, etc. etc. Brought out some interesting reactions. "I can't do times outside of evenings, I have work and a family!" And we don't?! And how exactly do they make appointments for their other physicians? I doubt there's too many evening spots to choose from through the hospital systems. Especially since these are not frequent recurring visits but more once every 3-12 months for 25 minutes. And with a large caseload, it's just not sustainable nor clinically advisable to appease every request. Patients who were ready to put on their problem solving hats as opposed to being demanding obviously demonstrated stronger defenses and clinically were less pathological. The ones who somehow implied we owed them evening hours were given referrals and told they are free to call around and look.
It’s also that service industry mentality like we’re doing free estimates for a plumbing business or something. I haven’t had that happen cause like 98% of my patients are insurance but I can see it happening.
That's interesting. Because my practice is about 100% insurance based and our office gets a fair amount the BS (and almost all our providers are at a doctorate level of training). The only time we do self pay is if for a brief window, someone is between insurances. We stick to insurance because we realized with self pay, people try to haggle prices down (interestingly especially with non-Caucasian providers, more so if the provider is also a female) and with insurance you have the convenient response of saying "sorry, we have to stick to the insurance contract." May be my own bias, but I can't help but feel like there's conscious or subconscious prejudice at play (this practice is full of young females with some mix of non-Caucasians). I'm not Caucasian. Physically I'm petit, young, female, have a soft voice, and with a meek appearance. I've had people slip and call me an NP although nowhere does it say I'm an NP. I've also had people try to become patients of mine because they assumed I'm "holistic" or do herbal medicine. Sometimes with delinquent accounts, I step in, introduce myself as Dr. Randomdoc1 and reach out to patients of other providers to resolve it and have met a share of nasty and downright disrespectful responses. When the psychologist/psychiatrist talks to the patient again and informs them I'm the owner of the office and their boss...they apologize profusely and get their sh** together. But there's nothing more telling than how someone treats another person when they assume that other person has no power or means to do anything for them. The other end is interesting too. When people come to me after strong referrals from the community and online interactions with me (but have never seen a picture of me, heard my voice, etc.)...some have also said "I don't know what I was expecting, but you're a lot different in person than what I anticipated." And yes, many expected to see a man...which gets me every time!
We had an interesting experiment happen lately. A new psychiatrist joined the practice. A white male with blonde hair, blue eyes, attractive. No one ever questioned paying their bill with him (even on two occasions when the software in error doubled the cost of the visit) and he was always addressed as a physician. Also, his visits are a lot shorter than the ones I offer and my female counterpart. Again, can't prove or say anything with certainty, but they are interesting observations. And to be fair, I think we all have some bias to varying degrees.
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