Why This Psychiatrist Chose Direct Specialty Care
Meet Patrick.
Patrick is an adult with the classic fingerprint of ADHD tangled up with anxiety. He is disorganized and terrible at time management. He is easily distracted and forgets important obligations, then works twice as hard to make up for the mistakes. He over-promises and under-delivers, gets overwhelmed quickly, and overreacts faster than he would like. His sleep and his diet are out of whack. He has been stressed for so long he no longer remembers what relaxed feels like.
Patrick is not one patient. He is a composite of several, all with strikingly similar stories, and every psychiatrist reading this has met him a hundred times. What matters is what happened when Patrick went looking for help.
Every in-network psychiatrist who came recommended had a six-month waitlist. That is not an exaggeration; it is Tuesday. When he finally got in, the appointments were 20 to 30 minutes, once a month at best, in a fee-for-service practice built to see as many patients as possible. He could not address multiple concerns, ask about different treatment options, and raise side effects in a single visit. His disorganization, the very thing he came in for, made the rushed appointments even less productive. He forgot his questions. He could not reach his provider between visits. And the treatment for his executive dysfunction, the thing that would have made his appointments go better, was the hardest thing of all to obtain.
Dr. Jess Levy watched this cycle repeat for years, across thousands of patients and families. Then he stopped waiting for the system to fix it and built A+ Psychiatry instead.
What is broken in insurance-driven psychiatry
Jess is careful, and right, to aim his critique at the structure rather than the people inside it.
“The problem is not the clinicians themselves,” he says. “On the whole, we psychiatrists are competent, hardworking, dedicated professionals who have a passion for providing outstanding care. And yet the same problems keep recurring.”
The standard outpatient model works acceptably when a patient has one straightforward concern and responds well to the first treatment. But psychiatry is rarely that patient. The moment there are hiccups, and there are almost always hiccups, the 20-minute monthly visit falls apart. There is no time to untangle overlapping conditions, no bandwidth between visits, and no room for the collaborative, detailed exploration that complicated psychiatric care demands.
ADHD makes the failure vivid. The diagnosis is genuinely tricky, and psychostimulants like Adderall and Ritalin carry real abuse and misuse potential. Prescribing them safely requires a long, nuanced history, exactly the thing a volume-driven schedule cannot accommodate. So the system produces two bad answers at once: the overloaded in-network psychiatrist who is understandably hesitant to prescribe stimulants at all, and the online prescriber who zealously hands them to anyone with a credit card. Neither one is care.
“There are countless Patricks out there,” Jess says, “who have been turned off from psychiatry based on a history of frustrations accessing the care they need.”
The turning point: designing the practice the system refused to be
Jess did not leave medicine to escape his patients. He left the model to reach them.
“I realized that in order for better psychiatric care to happen, there needed to be a system in place that supports better psychiatric care,” he says. “One that rewards quality over quantity, incentivizes the clinician to provide more support between visits, and encourages patients and doctors to collaborate and explore complicated psychiatric concerns in detail.”
That system already exists. It is direct specialty care, and Jess is blunt about the fit: “DSC is so well designed for psychiatry that I can’t see myself doing anything else.”
A+ Psychiatry is the result. After months of building, the practice is open, and Jess describes it the way a new parent describes a newborn, with a mix of exhaustion, pride, worry, and hope. He knows everything there is to know about his practice, and he is guarding it like a hawk.
What is direct specialty care psychiatry?
Direct specialty care is board-certified specialist medicine practiced outside the insurance billing system, with transparent pricing and direct access to the physician.
In psychiatry, the model translates into the specific things Patrick could never get. Visits are as long as the concern requires, not as long as the billing code allows. The psychiatrist is reachable between appointments, so a side effect or a setback becomes a message, not a six-week wait. The nuanced history that safe stimulant prescribing demands actually has room to happen. And because the practice is not funded by volume, the incentive finally points the right way: quality over quantity, depth over throughput.
The economics answer to one person, the patient, which is precisely why the medicine can too.
Why psychiatry may be the specialty DSC fits best
Every specialty benefits from removing the middlemen, but psychiatry has a particular claim. The core technology of psychiatric care is not a scanner or a scalpel. It is a conversation, sustained over time, between two people who trust each other. That is the exact resource the fee-for-service model rations most aggressively, and the exact resource direct specialty care restores.
Complex diagnoses like adult ADHD, treatment plans that need adjustment, medications that require careful monitoring, patients whose symptoms make short rushed visits least productive of all: these are not edge cases in psychiatry. They are the job. A model that pays for time and continuity is not a luxury here. It is the treatment.
How A+ Psychiatry helps patients
For the Patricks of the world, the practical differences are simple to state. No six-month waitlist to be seen. Appointments long enough to cover the diagnosis, the options, and the side effects in the same conversation. A psychiatrist who can be reached when something changes. Careful, honest stimulant prescribing that is neither reflexively withheld nor recklessly dispensed. Transparent pricing known before the visit, not discovered weeks after it.
None of that is exotic. It is what psychiatric care was always supposed to look like, before the billing system decided otherwise.
The mission: making DSC business as usual
Jess is honest about the road ahead. He is establishing a new practice and introducing patients to a new model at the same time.
“Not only do I need to establish myself as a new provider, but I also need to sell the DSC model,” he says. “I’m thankful for the DSC Alliance in helping get the word out. Hopefully one day DSC will be business as usual.”
That is exactly what the Alliance exists for. One transparent psychiatry practice helps the patients who find it. A community of them changes what patients expect, what physicians believe is possible, and what the market is forced to offer. Every specialist who makes this leap makes the next one’s leap shorter.
“In the meantime,” Jess says, “for all the Patricks out there, I can’t wait for you to meet my baby.”
How to work with Dr. Jess Levy
A+ Psychiatry is open and welcoming new patients. If you are a patient searching for a specialist in any field who practices this way, browse the Find a Specialist directory at dscalliance.org. And if you are a physician who has felt what Jess felt, become a DSC Alliance member and build this with us at dscalliance.org/membership.
Key takeaways
Direct specialty care psychiatry is board-certified psychiatric care outside insurance billing, with transparent pricing, longer visits, and direct access to the psychiatrist.
The standard 20-to-30-minute monthly med-check model fails precisely when patients need it most: complex diagnoses, treatment adjustments, and conditions like ADHD that demand time and nuance.
Safe stimulant prescribing requires a long, careful history. Volume-driven schedules push clinicians toward two bad extremes, reflexive hesitancy or reckless online prescribing. DSC restores the middle: careful, accessible care.
The problem is the structure, not the clinicians. DSC changes the structure so the incentive rewards quality over quantity.
A+ Psychiatry, founded by Dr. Jess Levy, is now open, and the DSC Alliance is helping connect patients to it and specialists to the model.
Frequently asked questions
What is direct specialty care psychiatry? It is board-certified psychiatric care delivered directly to the patient, outside the insurance billing system, with transparent pricing, longer appointments, and direct access to the psychiatrist between visits.
Why are psychiatrist wait times so long? Most in-network psychiatrists carry full panels in a volume-driven system, and demand far exceeds supply. Waitlists of six months for recommended in-network providers are common. Direct specialty care practices, which are not constrained by insurance panels, can typically see new patients far sooner.
Is direct specialty care psychiatry the same as concierge medicine? No. Concierge medicine adds a membership fee on top of insurance billing. Direct specialty care replaces the insurance billing relationship entirely, with transparent prices paid directly for the psychiatrist’s time and expertise.
Can a direct care psychiatrist prescribe ADHD medications like Adderall? Yes, when clinically appropriate. In fact, the model supports safer prescribing, because longer visits allow the detailed history that responsible stimulant prescribing requires, without the rushed hesitancy of volume practice or the recklessness of prescription-mill telehealth.
Do I still need health insurance if I see a direct care psychiatrist? Most patients keep their insurance for hospitalizations, labs, imaging, and other care. The direct relationship covers the psychiatrist’s professional time, visits, and management.
Who is Dr. Jess Levy? Dr. Jess Levy, MD, is a psychiatrist who has treated thousands of patients and families and is the owner of A+ Psychiatry, a direct specialty care psychiatry practice.
Who writes for the DSC Alliance blog? These features are written by Dr. Diana Girnita, MD, PhD, FACR, a double board-certified physician in rheumatology and internal medicine, founder of Rheumatologist OnCall, and co-founder of the DSC Alliance.
What is the DSC Alliance? The DSC Alliance is a physician-led community and national directory for board-certified specialists practicing direct specialty care. It educates, mentors, and advocates for specialists building independent, transparent, patient-first practices. You can become a member at dscalliance.org/membership.
How do I find or join direct specialty care specialists? Patients can search the Find a Specialist directory at dscalliance.org. Physicians, employers, and brokers can learn more and join at dscalliance.org/membership.
About the author
About the author, Dr. Diana Girnita, MD, PhD, FACR. Dr. Diana Girnita is a double board-certified physician in rheumatology and internal medicine, and the founder of Rheumatologist OnCall, the first direct specialty care rheumatology practice, caring for patients across multiple U.S. states through telemedicine and in person in California. She is a co-founder of the Direct Specialty Care Alliance (DSC Alliance), a physician-led organization that educates, mentors, and advocates for specialists building independent, transparent, patient-first practices. A national speaker and educator, Dr. Girnita helped define and popularize the direct specialty care model and is a leading voice for transparent, accessible specialist care. Learn more or join the movement at dscalliance.org/membership.
