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A Brand New Direct Care Psychiatry Practice Inspired By Patients

Happy birthday, A+ Psychiatry!

After months of hard work and preparation, I am open for business.  While it would be presumptuous, for me to compare starting a business with having an actual baby, A+ Psychiatry is nonetheless my baby.  And, just like most new parents, I feel a mix of exhaustion, praise, worry, and hope.  I know everything there is to know about my baby and I’m guarding it like a hawk.

I knew from the beginning that I wanted A+ Psychiatry to be something different and designed it that way (okay, the new parent analogy doesn’t quite work here).  After treating thousands of patients and families, I’ve come to see the standard outpatient psychiatry / medication management model as lacking in some aspects.   With most busy outpatient practices, patients see their provider every month, or even less frequent than that,  for 20-30 minutes.   That is not a big deal if a patient has a straightforward concern and responds well to treatment.  However things quickly fall apart when there are hiccups along the way.

To illustrate my point, I am going to share Patrick’s story.

Actually this is a composite made up of several patients, all with strikingly similar stories.

Patrick is an adult with many symptoms of ADHD and anxiety.  He is disorganized,  terrible at time management, easily distracted, and often forgetting important obligations, causing him to work even harder to make up for his mistakes.  He gets overwhelmed easily, and overreacts quickly.  He is in a perpetual cycle of over-promising and under-delivering.   His sleep and diet are out of whack, and he is so used to feeling stressed out, he does not even remember what it feels like to be relaxed.

Unfortunately things didn’t go so well for Patrick when he tried to access “business as usual” psychiatric care.  For starters,   all of the in-network providers who came recommended were on a 6-month wait list (this is not an exaggeration).  Because most fee-for-service providers are expected to see as many patients as possible, Patrick’s appointments were rushed.  It was nearly impossible for him to address multiple concerns, ask about different treatment approaches, or even address side effect concerns all in one visit. Plus, with his  inclination towards disorganization, his appointments were even less productive.  He often forgot important questions and getting a hold of his provider between visits was difficult.  Ironically, obtaining proper treatment of executive dysfunction (which would help appointments go better) was most elusive.

ADHD can be tricky to diagnose and psychostimulants such as Adderall and Ritalin have abuse potential and can be misused.  Long story short it takes a lot of time to get the nuanced history needed to safely prescribe stimulants.  It is understandable why a busy clinician would be so hesitant to prescribe stimulants.  While there are certain online providers who zealously  prescribe stimulants to any and all patients,  I think we can all agree that this is not any better.

I want to be clear that the problem is not the clinicians themselves.  On the whole we psychiatrists are competent, hard working, dedicated professionals who have a passion for providing outstanding care to outpatients.  And yet the same problems keep recurring.  There are countless Patricks out there who have been turned off from psychiatry based on a history of frustrations accessing the care they need.

I realized that in order for better psychiatric care to happen, there needed to be a system in place that supports better psychiatric care.  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.

Fortunately there are models out there that do precisely this.  First and foremost is Direct Specialty Care. We call it “DSC”.

In fact,  DSC is so well designed for psychiatry that I can’t see myself doing anything else!  For me it’s a matter of getting the word out that there is an innovative alternative to fee-for-service that is high quality and accessible.

A+ Psychiatry is born and open for business, and I have my work cut out for me.  Not only do I need to establish myself as a new provider, but I also need to sell” the DSC model.  For this reason, I’m thankful for the DSC Alliance in helping get the word out.   Hopefully one day DSC will be business as usual.  In the meantime, for all the Patricks out there, I can’t wait for you to meet my baby.

Author: Jess Levy, MD

Dr. Levy is the owner of A+ Psychiatry, a Direct Specialty Care Practice.

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