Lots of psychiatrists do not take any insurance, as documented by a recent paper in JAMA Psychiatry and written about in Newsweek.
I have a wonderful psychiatrist who has provided excellent, successful treatment to me and members of my family for nearly 20 years. Two years ago, Florida’s BC/BS carriers directed all mental health care claims to a subsidiary with a reimbursement rate so low as to be insulting. This is why many psychiatrists had to insist on costly copays just to keep their doors open. All physicians seem to be struggling during uncertain reimbursement times, but internal medicine and family practice doctors as well as psychiatrists are especially threatened. No wonder there is a shortage. Also, fewer students are considering medical school, so future lack of psychiatrists is almost a given. You cannot blame them. It is just not worth the financial risk. They also realize the mindset and demands of the current patient care delivery system have all but eliminated personal satisfaction.
In the reimbursement climate of uncertainty and frustration along with increasing reporting demands that often erode precious time scheduled for quality patient care, I am not surprised that physicians are simply quitting, if only because the fixed costs of operating a practice remain a daily and monthly reality and tend only to increase. I feel especially sorry for the doctors who have been in practice for less than ten years. My brother has enjoyed nearly 30 years of a satisfying, lucrative practice, but even he is uncomfortable with the current domination of corporate and nonprofit hospital administration policies and speculative reimbursement strategies. As he provides employment for over 40 people, he knows the reality of his survival extends to the financial viability of many other families. Yet he is one of the lucky ones because he started early enough to be able to expand his practice into a facility that has been capable of providing job opportunities for so many medical professionals and support personnel. For young physicians, today’s arena is unfortunately quite different.
Although there is no immediate solution, I honestly feel that there needs to be a new, uniform acknowledgment of medical science and public opinion involving mental health. We first need to respect and address the brain is an organ. Like the heart and lungs, the brain is responsible for human survival. As a organ, the brain can get sick, suffer trauma, experience biochemical fluctuations, and influence many types of outcomes. Like other areas of the body, it may be predisposed to medical emergencies and subsequent conditions. It remains the most complicated, wondrous, and difficult territory of medical science, always challenging modern medicine with unexplored possibilities. Factor in the dynamics of human behavior and cultural expectations, and the brain becomes the stage for a cast of thousands. Ethics, environment, and politics influence its image. In our culture, I feel we must start to give mental health medicine the same emphasis and importance we attribute to emergency medicine and surgery. We need to provide for this through our government, private, and personal support just as we would for a condition involving life and death. The health of our society depends on this. Unfortunately, recent tragedies no longer surprise me. What surprises me is that there are not even more.
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