Quality vs. Quantity

The most popular article on nytimes.com right now discusses the changing face of psychiatry in the United States. A psychiatrist tells a sad story of how his practice has changed from one of care and careful attention serving individual patients with names and stories to one of cold efficiency administering medications in a veritable factory of nameless faces. Dr. Levin laments the loss of humanity in his practice due to the nature of health insurance reimbursement. In psychiatry, insurance companies will not reimburse physicians for their time spent getting to know the patient's life and narrative. They pay a set amount per quantifiable action which is often valued quite cheaply forcing physicians (and mental health clinicians) to pack as many patients into as short a time as possible in order to make a living and pay off education and training loans. This makes developing a personal relationship with patients next to impossible which in turn leads to decreased job satisfaction on the part of the healthcare provider. Perhaps this system might make some sense for conventional medical doctors, but a psychiatrist must depend in large part on the personal side of appointments to come to an accurate and appropriate diagnosis and consideration of treatment options.

Psychotherapists who do not prescribe medication, bill insurance companies for the cost of a 50-minute therapy session and often have to fight with insurances to authorize mental health treatment and obtain reimbursement in a timely fashion. The back-and-forth phone calls with insurance companies - being transferred from one operator to another, put on hold, and receiving conflicting information from different people - is arduous, time-consuming, and frustrating.
One time, when I was working primarily with insurances, I spent a good forty-five minutes on hold before I managed to speak with anyone! And, that was only concerning one patient! And, of course, the time spent wrangling with insurance companies isn't reimbursed leaving many therapists wondering if the headache is worth it. When I started in private practice I was advised by numerous people that working with insurance companies will likely kill the joy and passion I have for the work I do. Therapists often choose not to enroll with insurance providers because it gives them a freedom that might otherwise be lacking. A freedom that tends to benefit clients.

At the end of the day, it's sad to me that insurance companies have the power to change the way psychiatry and psychotherapy is practiced, and not necessarily for the good. Quality mental health care should be affordable both for the patient and the practitioner. How have times changed so drastically and how do we rectify the situation in future? I'm not fanatically political but I have to admit, my hopes do get lifted when the topic of nationalized health insurance gets brought up. A perfect iteration of the concept hasn't been created as yet, but to me, how hard is it to agree that all Americans deserve quality affordable healthcare? What do you think?