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It’s important to understand the state of Los Angeles Psychiatrists and mental health care today so you can understand and appreciate what our group is about.
Access to Outpatient Mental Health by the Numbers:
- Los Angeles Population: 4 million
- Psychiatrists in Los Angeles: 800
- Psychiatrists in Los Angeles that Accept Insurance: 200
- Psychiatrists in Los Angeles that Accept Insurance and Are Taking New Clients: 20
There is an extreme shortage of qualified mental health professionals in this country. I am far from the first person to make this statement. This crisis has been brewing for quite some time, and there is a myriad of factors contributing to this shortage. I want to talk openly and transparently about what we are doing to fight this crisis and increase access to mental health today.
I personally took a long path to become a psychiatrist. I pursued several other careers, some within medicine like surgery, some outside, before concluding that being a psychiatrist was the ideal career for me. As a psychiatrist, my empathic curiosity is satiated on a daily basis. I am able to truly help people and feel like I am making a difference in the quality of my clients’ lives. The vast majority of us who choose to become physicians do so because we fundamentally want to help people. However, there are not enough psychiatrists.
Because there are so few psychiatrists, even in the 2nd largest city in this country – Los Angeles – and demand for our services is so high, the vast majority of psychiatrists choose not to accept health care insurance. The majority of Los Angeles psychiatrists that focus on providing outpatient care, do not work in groups with other colleagues, but instead work independently on their own.
They choose NOT to accept health insurance. They have no support staff to speak of and handle all billing and scheduling matters directly themselves. In order to schedule an appointment with most Los Angeles psychiatrists, you typically pay upwards of $600 for an initial appointment and $300 for follow-up appointments. You have to pay upfront before you are scheduled or seen (for perspective most attorneys in Los Angeles bill at rates of $800 per hour and higher, and require that you provide a minimum of a $5,000 deposit or retainer to secure their services).
My father was born in 1935. He and his parents escaped Poland as the Nazis invaded. My Aunt was born on the run in Germany. They were hidden at times in stacks of hay as Nazis searched the farm they were hiding in. Eventually, my father, his little sister and my grandparents emigrated to the US through Ellis Island as refugees of World War II. I am the son of a refugee and a first-generation American.
My father met my mother when they were both college students in NYC at City College of New York. He was 24, she was 21. They enjoyed a marriage that lasted for 53 years until his death in 2014. Both my father and mother dedicated their professional lives to working with children and adolescents as educators. They each spent over 40 years working in the public school systems of New York City in the South Bronx.
These were and continue to be some of the toughest inner city schools in the entire nation. At Taft High School, my father spent his career as a teacher, a guidance counselor, and dean. One of his colleagues was the son of the President of Time Warner at the time – Gerald Levin. To give you a sense of the violence and hardship this environment engendered, Gerald Levin’s son, Jonathan Levin was kidnapped and killed by students at the school.
My father worked at the high school, and a mile away in the shadows of Yankee Stadium my mother worked as a teacher, teacher trainer and ultimately assistant principal at P.S. 29, an elementary school. During the school year, they commuted to the South Bronx every morning over the George Washington Bridge from New Jersey and back every evening for over 40 years.
They could have chosen to work in much safer schools with children who had many more resources in New Jersey. However, my parents understood the nature of the struggle and were driven to help those they believed needed help the most. Public service and fighting for those who don’t have a voice are values that were instilled in me at a young age, and when one considers the number of social workers, nurses and doctors in our family, they are values that are shared by our entire family.
It was paramount to me from the beginning that I accept insurance. I grew up in New Jersey, the product of educators and was provided with a middle-class upbringing. I knew that there were some resources for the indigent (although not enough), and those with lots of money would always have access to care. However, I was and continue to be viscerally aware that just because you have insurance does not mean you have access to mental health care. I was and remain committed to changing this.
I started this group of mental health professionals working nights and weekends on my own. I was working as a child and adolescent psychiatry fellow at Children’s Hospital of Los Angeles when I saw my first clients. I rented a room for $15 by the hour and immediately made an effort to ensure that I was able to accept health insurance. I started on my own with no support staff and no colleagues. The room I started in was a gigantic 70 square feet (that might be too generous).
I remember one of my earliest clients questioned me about the fact that Group was part of our name as it seemed clear there was no one else in the Group at the time except me. We enjoyed a good laugh about this observation and I shared that we (“we” being me), were small but I had a dream of building a team of dedicated mental health professionals.
As a psychiatrist, we are trained as experts in both psychotherapy as well as psychopharmacology. Too many people believe there is a pill for everything. That simply is not true. One of the reasons that we ask all clients who are taking medications to visit with their psychiatrist on average once a month, is to optimize medication treatment plans and ensure that clients take the least amount of medication as is necessary.
While medication might be appropriate for some people, for a period of time – therapy can be helpful for all of us, always. Therapy is about examining the why behind the choices we make. It is about visualizing the life we imagine, setting goals, changing our perspective and taking the necessary action to realize this vision.
My practice grew because of this clinical philosophy and approach. My clients realized positive changes in their lives and they experienced greater joy and happiness. Some shared their experiences with friends and colleagues and word spread. As my practice became more full, I worked to add colleagues to our team who shared my vision.
We grew from a little practice of one, from that 70 square foot room to a slightly larger practice today. As of this writing, we now have 3 office locations, two in Los Angeles County and one in Orange County. Between psychiatrists, Therapists, client support, front desk colleagues and other team members there are over 50 of us dedicated to the cause.
We are very much engaged in a struggle to increase access to mental health. Where as the majority of Los Angeles psychiatrists do NOT accept insurance and have no support staff or colleagues to speak of, we are one of the only groups in the 2nd biggest city in the US to embrace the challenge of taking health insurance.
We are one of the only organizations of our kind in Los Angeles – an integrated group of psychiatrists, Therapists, and nutritionists. Clients are able to work with both a psychiatrist and psychotherapist that are part of the same team. After every session with a clinician on our team, our clients receive a survey that provides us with insight into the quality of your experience ranging from clinical matters to customer service.
Every week our clinical team meets. These weekly meetings enable professional collaboration and enhance our team’s camaraderie. In a day and age of increasingly fragmented health care, our integrated team approach provides our clients with the benefit of different perspectives that share a common goal – helping our clients achieve their goals for happier living.
Most mental health practices have no front desk staff to speak of and instead offer a drab waiting room with the convenience of a button you press to inform the doc that you are present. There is no one to greet you, answer any questions or assist you in any fashion, and most medical practices’ staff is located at the front desk. Behind this front desk, this staff is typically answering phone calls, talking with the pharmacy, talking with billing companies and talking with other patients.
Instead, at our practice we have invested in ensuring we have front desk colleagues whose primary responsibility is to greet you warmly, help check you in for your appointment, handle the collection of payment and assist with scheduling follow-up appointments. There is no other business conducted at the front desk. They do not answer phone calls.
We have a team of intake coordinators and dedicated client support who work at a different location from our medical practice sites. These individuals are dedicated to answering the phone, emails and providing our clients with great customer service. Further, we have invested in systems that record every phone call and log every email to consistently monitor and improve our customer service.
Taking insurance and providing the level of customer service we provide is associated with significant expense. We do it because we want to be able to deliver the highest quality of clinical care, matched with the highest level of customer service. Yet we do not have unlimited resources and we’re not perfect, nor do we claim to be. If you call American Airlines or American Express you may have to wait to talk to someone – and those companies generate billions of dollars and are publicly traded.
By any definition, our group is a small business and like any business, we have to pay our bills. The clinicians who work for our group do so for a myriad of reasons. Our clinicians and team members all expect to get paid. Our ability to do so requires that we receive payment for our services.
You wouldn’t think to eat a meal at a restaurant and not pay for the meal. You wouldn’t try and stay at a hotel without paying or attempt to take a flight without paying. You wouldn’t leave the grocery store with some food without paying, and if you buy a car and a bank finances your purchase, they’ll repossess your car if you stop paying. Therefore, why should receiving services from our medical group be any different, simply because we make an effort to accept health insurance?
It is important to mention this because we understand that some clients of our group have been disappointed – typically around matters related to health insurance and paying for services. If we did not accept insurance and required every client to pay the full price for our services up front, we would never have a client disappointed to discover they, in fact, have to pay for a bill when their insurance company fails to pay.
Disappointment is the result of failed expectations. In an effort to exceed your expectations it’s important to share our story and provide a context to the services we offer, the nature of our group and the state of mental health in the US today.
If we did not accept insurance, we would never have any clients who were ever disappointed that they had to pay for the services we offer. However, just because we accept insurance does not mean that insurance companies are always good actors. Too often insurers intentionally deny or delay payment. That is part of their business model. If you accept insurance premium payments and limit claim payments, you can have a very profitable business, and that is why insurance companies make billions in this country. I believe our health care system in its current form is broken, and we want to change it.
We’re not doing it by lobbying, tweeting or playing politics. We’re doing it by actively working to increase access to care. In order for us to be successful and help as many people as possible, it’s critical that all of our clients, past, present, and future understand a bit about us and why we do what we do. It’s important that you appreciate the outsized role our small group is playing in trying to increase access to care and our commitment to customer service.
Ensuring that you have realistic expectations about paying for services you receive if your insurance does not is important. We hope that you appreciate we are doing the best we can as it relates to providing customer service and working hard every day to improve. We appreciate that we might not be the best fit for everyone. We provide access to highly skilled, empathic clinicians at reasonable rates. We ask that you have reasonable expectations and appreciate that the experience we are providing is a pretty good experience, especially when compared to the state of mental health access in Los Angeles.
We are working hard to do whatever we possibly can to improve the customer experience and increase the breadth of our offerings. We are currently in the early stages of establishing a foundation whose focus will be on providing care to some of the most vulnerable patient populations including the severely mentally ill and homeless. Further, we are investing in software that will improve both the customer and clinical experience.
I invite you to provide us with feedback. Get involved in the fight to increase access to mental health care. Be honest with yourself and engage in psychotherapy. The world can be a much better place if we appreciate that being more self-aware and kinder to each other enhances our pursuit of happier living.
– Dr. Lawrence Genen