I went away for a while where everything was warm and relaxed. At the end of a good time I realized that it was one of the very few times that I didn't want to go back to work. This year, 2013, has been different. I knew things were changing but it really feels as if the roof is falling in. When I came home I tried to write it all down and after about six pages of telling myself what was going on I realized that there have been several changes piled on top of each other which reate more confusion, more work and less money. So, I condensed it all into this:
Last November I took a trip to Italy and reflected upon how our profession was changing. Change was coming, but I thought it would be manageable, and that I had a few years to continue to ease toward retirement.
But 2013 hit, and with it the S**t hit the fan. It all comes down to letters and numbers. The first one is something I have been writing to my Senators about at thee to five month intervals, but the issue and the threat of drastic cuts never goes away.
The other four are either hitting us now or are on the horizon, coming rapidly to shore.
EMR
90834
DSM V
PQRS
What all these letters and numbers seem to mean is that an individual independent psychologist, working in his/her own ideal office, who wishes to be able to see the entire range of people who seek services, and that means those people who need to use their insurance to cover the cost, will have a great deal of difficulty to find the time, and to meet the cost of adapting to those changes.
In some ways we created our own difficulties by marketing our services so well. I remember, a long time ago, when I first opened my practice one of the biggest concerns we had was that people were reluctant to come and see us because of the stigma of needing help. Now it seems, everyone comes for help, for almost everything that affects them: stress, relationship problems, work problems,bad judgement, bad behavior, excessive behavior, passive behavior........
Now the problem has become: Who is going to pay for all of this?
It does seem as if, except in upper middle class, well educated neighborhoods, the model of sitting face to face with one patient in your comfortable office and talking about the ripple effects of their parents' interactions is sooooo 20th Century.
I am not saying that what is coming will be better or worse, but it is coming.
I just may not be a part of it. I'm not sure I can afford it.
2 comments:
It makes me sad ---this gutting of the mental health care system. From examples in my own family, I can see how life-saving ESSENTIAL it is for a troubled person to be able to talk face-to-face to a caring professional. What the bean counters don't realize or take into account is that sometimes it takes awhile for the person who's hurting to develop trust in the therapist and the process. No one wants to tell all to a total stranger. Money spent on mental health services is money well spent. And the money works its way into the economy. The professionals use it to buy houses, clothes, food and other goods and services and these purchases create jobs. Hello!
I am a person who uses insurance to get therapy. I read your blog regularly. I think that, more and more, people are being forced to pay for their healthcare on their own, not because they don't have insurance, but because insurance doesn't cover necessary services, or raises deductibles so high that we may as well pay all but the most extravagant expenses ourselves (and there's no guarantee insurance will pay those either). If you want to keep practicing outside the system, I suggest lowering your fees to some amount that reflects the time you'll no longer spend haggling with insurance companies, and then taking 1-2 pro bono or reduced rate clients at a time. This way, your income shouldn't suffer too much, people who have high-deductible plans may even save money going to you (if they wouldn't meet their deductible anyway), and you're spared the gross annoyance of dealing with an industry that has long made money its sole priority.
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