statistics

Intro:
Last week I began to write this as a blog post.  As I continued with it I thought it would be interesting to post it  on a list read by other practicing psychologists.  Part of this was in response to an editorial that I wrote about last week.  I was curious to see if other therapists would really discuss what happens in their practices.

This is what I posted:

For no particular reason it seems to be the time to gather statistics and demographics.  We Psychologists, especially those of us who still accept payments health insurance companies, have been told for years that we had better be prepared to demonstrate that what we do is effective and efficient, as well as medically necessary.

Of course, there is no agreement on  how to define or measure any of those things.  Over the last four years three different insurance companies devised three different ways to attempt to do this.  They tried to survey either the therapists, patients or both about different ways in which the patients were functioning, suffering, changing, or just wasting time and money.   Within a years time, give or take, all three gave up the effort. All of the therapists were offended, felt intruded upon, and reported that the measures were misguided and not relevant.  The patients all objected to being subjected to Big Brother about confidential information, or else they couldn't understand the questions or where they came from or why they were being asked.

The insurance companies found a better, simpler way to deal with our effectiveness and efficiency: they reduced our pay.

So, tonight I decided to do some statistical evaluation, just to get a reading on how I was doing as a private practice therapist after 30 years.  I looked back to April of 2011 and picked out the first 50 people I saw  (there were 54) that month.  I do not claim this to be hard science.  I admit to nineteen flaws in my methodology, but hey, no one gave me a grant. But I thought it would be of interest to the folks of this division, as few people ever say in much detail what they do, how hard they work, or how it turns out.

Of the 50 people, a year later I am still seeing 29 ( 59%).  Of those, over half (16) of them I have already seen for over two years without any significant break.  But of those, there are only two that I still see weekly. The others are bi-weekly (6), monthly (6), or 4x a year (2).

Of the 21 people who terminated over the last year my rating scales of success in treatment ( held to a standard of consistency over 25 years, with a very high rater reliability, however the N of raters is 1.)  3 of the 21 did not do well at all, despite my efforts and skills.  3 did OK, and 15, in many ways accomplished what they hoped to realize from coming to see me.  Some of them really, really changed during the time they saw me.  Others,(4) I need to add, came with very specific problems such as an isolated phobia, a problem with a grow-up child or such., and they just wanted to sort out that matter.  Four others of the 15 came to get something specific from me, mostly relating to work or school, such as a letter or a report that they were not dangerous, or drug addicted, and could go back to work.

Of the 50 people, the rating scale shows that 36  (72%) did, or are doing well, or really well.  14 (28%)did not or are not.  Of those 14, I still have almost reasonable hope that 4 of them will still show significant improvement.  Of these 50 people, no one in the sample came for just one session, although that happens.  The shortest time in treatment was three sessions, and that was one of the people with a specific family problem.  Everyone in the sample got treatment for something that I feel was clearly "medically necessary."  Five people (10%), less than it feels like to me, have a diagnosis of "completely nuts," and will remain that way.

Yes, the rating scale is based on how I feel my patients did, with some feed-back from them.  But I believe this is fairly accurate.  I can tell that I enjoy seeing the people who are changing and doing well, and much less so when the therapy is not working. This year I have begun to implement use of Duncan and Miller's three question ratings, but not with everyone.

I can also (not) tell you that I averaged  $XXXX ( I wish) per hour of treatment.

I can do more analysis and determine how long I have been seeing everyone, and how severe their presenting problems are, and how that correlates with their socio-economic status (not as much as I thought), or with the success of treatment.  But I'm tired and this is enough for now.

I hope this was of interest and perhaps inspires others of you to evaluate your efforts.  It also helps to see who you work well with and who you don't, and see if that changes.

END OF POST


I was pleased that I did my own analysis and I think I will look at the figures more closely.  I did get several responses, but most of them talked about ways to do an analysis, or questions they were interested in looking at.  However, and this surprised and disappointed me, no one was revealing about their own practice.  No one talked about how long they see patients, or how successful they feel they are, and by what measurement.


I don't want to jump to conclusions, but it makes me wonder.  About a lot of things.