Career Choices: Community mental health in an urban/public setting

Dr. Stanciu: What is the typical reimbursement model for your practice, and do you run into difficulties with health insurance providers in this setting?

Dr. Wadhwania: Approximately 40% of the patients we treat have no health insurance, and approximately 60% have Medicaid or managed Medicaid or Medicare. There is no burden of health insurance. Full-time employees are salaried, and part-time employees are compensated on an hourly model. There is also an incentive bonus system based on quality and productivity.

Dr. Stanciu: What model does your clinic use to overcome the shortage of services?

Dr. Wadhwania: There are approximately 37 medical staff members in the agency, most of whom are MDs, but this group also includes nurse practitioners and clinical nurse specialists, so there is no shortage within our agency. We do contract for telepsychiatry services, but because our agency’s clinics are located throughout the county, most of our patients have easy access to any one of our clinics. We have a number of social workers, therapists, nurses, case managers, and pharmacists. We have a crisis center where unstable patients who require admission to an inpatient unit can be admitted; we also are able to refer patients directly to other inpatient psychiatric units. Our agency also has an addiction clinic and a residential substance abuse program catering specifically to patients with substance use disorders. We have educational, therapeutic, and behavioral support services, including residential services, for patients who have developmental disabilities. Our agency also has residential services for patients who are homeless or have a lower income and would benefit from support in a residential setting.

Our therapists are able to refer patients to state-contracted Assertive Community Treatment teams that serve our county. We are also able to set up intensive case management for patients in the community, as well as other community support services, peer support programs, and psychosocial rehabilitation programs.

Continue to: What advice do you have for early career psychiatrists and trainees who are contemplating working in an urban-public setting?