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I enjoyed the article "Starting a Private Practice Despite Managed Care" by William E. Callahan Jr., M.D., which appeared in the Early Career Issues column in the October 17 issue.
This is the first time I have seen in print my own private practice guidelines, which have served me well for over 26 years. As Dr. Callahan recommends, I never advertise my practice but prefer to rely on word of mouth derived from patient satisfaction. I use shorter rather than longer term psychotherapy (I have twice as many active patients as the number I see each week). I also never bill my patients but collect each payment at the point of service or session. I am not, nor will I ever become, a member of an HMO - the least important reason is that I believe the posture of HMO’s on providing psychiatric care is wholly inadequate. However, I will see HMO patients as a nonprovider and often with the blessing of their HMO, but on my terms regarding confidentiality and at my usual fee. As a service to my older patients, I have devoted 25 percent of my practice to Medicare recipients, but I am not a participator - preferring to be paid by patients first, and arranging for their reimbursement later on - even if I am therefore required to charge a few dollars less.
I augment my activities with teaching at the university level and participating in professional organizations - medical hypnosis in any case - to get out and mingle in the world.
Most importantly, I spend less money than I make (no second homes, and so on) and have saved for my retirement while also paying for college tuitions and weddings for my three children.
Finally, I, too, have learned to trust myself and the process of private practice. While I am realistic about the ebb and flow in income, I value my freedom to do what I think is right.
The purpose of this letter is to support Dr. Callahan’s practice guidelines for they are appropriate for middle- and late-career psychiatrists as well. These guidelines have worked well for me for many years and are far better responses to the political and financial forces swirling around us all than "running for shelter" to salaried positions. While not for everyone, private practice absent managed care works. The final proof: Most patients are willing to pay for excellent care themselves. If necessary, we can simply lower our fees. It is as simple and wonderful as that!
Peter B. Bloom, M.D.
Bryn Mawr, Pa.