More on Finding a Psychiatrist – From a Colleague

We attach this information, which was provided to us by a trusted colleague, for those who are trying to find a particular kind of help and have not had luck so far.

If you are interviewing psychiatrists (or therapists) who will work hard to help you achieve the results you are looking for, on your terms, consider the following approach.

I recommend checking out psychologytoday.com to filter by the interests/foci of providers, insurance they take if that’s important to you, and reading their bios – then cross-checking Yelp and Google for others’ takes on their work.

Check all of California – particularly Los Angeles, the beach cities in Orange County and all down the coast, and San Diego. Talented psychiatrists may live in these places, and they may charge less than we do in the Bay Area, if cost is important to you.

SOME QUESTIONS TO ASK

• If cost is important to you, look for someone who has just started a practice, and therefore is charging less or taking insurance in order to launch – they may be very good. Each of us was in that position at one point in our careers.
• Interview by phone asking their orientation/what is the foundation of their work – philosophy, training, certifications, etc.
• Ask how they maintain their skill set and knowledge base – workgroups/consultation, readings, listservs, which scientific meetings or trainings they attend, do they teach/consult/speak, do they publish, and also –
• If you live with depression, anxiety, or a trauma history, will they flexibly help you to achieve the outcome you desire without using SSRI or SNRI antidepressants? Do they have a deep armamentarium that addresses your particular, individualized asks, or do they treat DSM-defined syndromes on a general template?
• If you live with sleep disturbance, do they have a broad array of safe tools, and a non-pharmacologic knowledge base as well?
• For ADHD: are they familiar with all FDA-approved options on the market, or do they only write their favorites? Are they familiar with the many pharmacologic and non-pharmacologic off-label options available?
• Ask about how they handle emergencies – do they carry a pager/cell?Who covers their practice when they are away?
• Ask how all of this plays out with individual clients, “Tell me about a client who presented with X, how did you work together and what were the outcomes?”

ARE YOU CONSIDERING USING YOUR INSURANCE?

I don’t especially recommend this. If you need to budget for care, consider instead locating a clinician who works in a less-expensive locale.

People who take insurance are not building a practice for their ideal client – they are taking whomever calls them off a list, whose main reason for seeing them is not their special skill set, but their $30 copay. A colleague who opened a volume practice (lots of patients, lots of clinicians) three years ago says that her current clients are not nearly as bright, inquisitive, particular, or demanding as her former private practice clients. She doesn’t have the opportunity for growth she once did. She is also very, very busy with the wrong activities…

Docs who take insurance are accepting less income, spending hours in billing and audits, this steals from the time it takes to bring quality. There are advantages to being seen out of network.

• Your doctor can get to know you: in an insurance model, the intake is necessarily one hour. The follow-ups will be 20–25 minutes, sometimes only 15 minutes, as payment for these visits is more advantageous than is payment for a 45 or 50-minute visit, and so there is never time to complete a truly thorough intake evaluation.
• Access: Appointments can last as long as they need to and can be as frequent as necessary
• Privacy: your chart is completely confidential and will never be released without your permission; it is not subject to audit
• Resources: a clinician who sees clients whose priority is to save money may not have the very best referrals for you to other clinicians as they may not be investing time in making these relationships, or they may not feel you will engage with the referrals. They may not be willing to do prior authorizations to secure brand name medicines for you if they cannot get paid for their time in doing this. They may not have written protocols for integrative medicine if they don’t believe their clients will purchase these treatments, or if they are too busy managing the administrative day-to-day to invest in the study of new tools.
• At least in my practice, there are activities many other practices forego, and you want your clinician to take part in some of these: 
  • Time to study and write new treatment protocols and materials for publication
  • Attendance at several scientific meetings yearly 
  • More between-visit communications with clients
  • Shared knowledge and cases with colleagues in study/consultation groups and on listservs 
  • Expert consultation retained for the practice, and provided to other practices, in three areas of medicine

Also, if interviewing at practices that take insurance, be aware that many people who are listed on an insurance panel

• Haven’t added to it for years and may quote a very long wait list if you mention insurance
• Are attending at the university and supervising residents, but not seeing clients
• Are working for a volume practice and clocking in and out on another’s brand of which they take little ownership, and there is a lot of turnover, or
• They are solo but cannot attract clients with their reputations

Almost all actual specialists in the Bay Area are out-of-network.

Again, consider other cities in Southern California, and consider finding people with newer practices, who may be charging less.

BE PARTICULAR

Decide whether you want traditional or integrative medicine or both, a deep interest in physical health, fantastic referrals for building teams. Expect these from your clinician, and ask about them.

You are looking for knowledge base and broad armamentarium, acumen, facility, and sense of being thorough with assessment, and very personalized and flexible with formulation – and you are looking for more than knowledge and skill, you want alchemy. This is your mind. Be particular.

Demand a new baseline, without side effects. You are not paying for a service, you are paying for an experience, and results.

And recognize that the person who can co-create this with you is not taking insurance rates, nor are they filling their practice with people who are not their ideal client – who found them on an insurance roster.

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ANOTHER WAY TO FIND CLINICIANS WHO ARE EXPERT

Write to researchers in your state and ask who they love in the community, who is brilliant and flexible– This woman did this, and found her best ever doc.

Here is an example, which I wrote for a client living with a bipolar spectrum presentation.
 Affiliation in PubMed is tagged at [ad], so you can search for the names of schools or the cities where they are. Try:
(san diego[ad] OR los angeles[ad]) AND (mood[ti] OR depression[ti] OR depressive[ti] OR bipolar*[ti] OR mani*[ti] OR anxi*[ti] OR panic[ti] OR trauma*[ti] OR obsess*[ti]) NOT (teen*[ti] OR adoles*[ti] OR child*[ti] OR pediatric*[ti])

Then you can search the index at each school for the email address if it isn’t listed with the articles you find. Most universities make the contact information of professors public.
How to find the email address in PubMed:
Open up a paper and look at the affiliations: Vieta is a favorite author of mine, so I chose his.

There is only one corresponding author per paper. They are usually the first author.
The first author is in San Diego, where I want to look for a psychiatrist.

If you find an author in a city where you want to search, and they are not the first author on the paper you are looking at, find them. Say I want to look for Mike Gitlin at UCLA. I would write the search as:
Gitlin m[1au] AND los angeles[ad]

Using the search, I find a paper by Gitlin, and indeed he is the corresponding author. 

Sometimes the email address will be listed with the abstract, as it is here – usually not.
If the paper is open source (you don’t have to purchase it), download the paper, look for the email address in the full text.
Do a few of these searches and write to a bunch of people and you will get some terrific answers about who in town is really worth seeing.

If you are not finding the email addresses of authors listed with their papers, you can find them in the people directory. Universities have public directories of their staff, including adjunct professors. Google for the virtual address book of the institution you are targeting, with terms such as “people search” or “directory” and the name of the institution.

I hope you are able to find someone fantastic!