I rent office space for my practice, and I’m not there some of the time (I usually work in my practice on Wednesdays and Thursdays, and in my other job on the other days). The office just sits there empty five out of seven days of the week, and I’ve often thought about how I might do things differently. My issue has a lot to do with convenience. The overhead of scheduling both space and patients is more than I want to do right now—just scheduling the patients is hard enough—and I’m not sure that want to share office space, even though I know plenty of people who do so without many problems.
Up until now, one of the key issues for me was that I sometimes need to see someone for an emergency visit, and, because my office and my residence are within walking distance of each other, I’ve seen patients, at various times, on every day of the week.
Last week something happened that made me realize that I don’t need access to an office seven days a week. I needed to have a session with someone and just did telepsychiatry from my home office rather than my practice office.
I think it may be a little in the future, but I can see a time when I might be able to handle more and more of my emergencies by Skype rather than having to go into my office.
This is a little tricky because some emergencies are clearly better handled face-to-face rather than via Skype, but my experience last week made me realize that as telepsychiatry develops, a different business plan might make more sense for my practice. Right now, my office is sitting empty most of the time, and I can see how a group of psychiatrists doing telepsychiatry could easily get together, rent some space for face-to face-visits with individual patients, and do more and more of their work out of their home rather than their practice office. The default could be telepsychiatry, with office visits no longer being the norm.
Rent is a pretty significant part of my overhead, and cutting it by 50%, say, would really be something worth thinking about.
Psychiatrists (and mental health workers in general) have always had a somewhat different relationship to hospitals and other institutions than other professionals. A surgeon pretty much has to have some relationship with a hospital, and can’t really do surgery without some kind of team behind him or her. Mental health work is different. The institution doesn’t tend to do much for psychiatrists seeing outpatients (as opposed to inpatients) other than feed them patients and, ideally, do enough work for the psychiatrist to justify the overhead that the institution adds.
I’ve been in a lot of situations where the overhead from the institution (rules, regulations, meetings, visits from JHAHO, fees for administrative services, poor collection policies) far far exceeded the value they brought to the outpatient setting.
I’m not trying to say that institutions don’t provide some value on the inpatient side, because clearly they do, but one of the best things about a solo private practice with no employees other than myself is that my overhead is much less than I think it would be if I were attached to some institution.
Telepsychiatry might just bring that overhead down some more. I need to think about setting up my home office a little better than it is….
Post a Comment