Now give me money, that’s what I want

6 03 2011

Dr. Donald Levin feels bad.

The psychiatrist is no longer able to treat patients with talk therapy, is no longer able to meet with them for those regular 50-minute-hour sessions, no longer able to sit and take in the vagaries of human existence. Instead, he must limit himself to 15-minute increments, enough time to write a scrip for meds but not, alas, much time to get to know them, or even remember their names.

As he told a reporter from the New York Times,

“I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.”

“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”

I had some sympathy for Dr. Levin. Insurers are stingy in reimbursing all types of medical care, and can be especially stingy in mental health care. Levin has to pay the bills, which means adjusting to a reimbursement system which pays him more and more reliably for those 15-minute increments than it does for the 5/6 hour.

But then I read this:

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

“Nobody wants to go backwards, moneywise, in their career,” he said. “Would you?”

My sympathy shriveled.

There is still a nugget of fell0w-feeling: The man has lost a way of life which was both congenial and supported him, and loss is loss.

The shrivel comes in, however, insofar as he made a choice: Psychotherapy or money, and he chose money.

A very practical choice, and not one to be gainsaid. After all, as the article pointed out, a psychiatrist can make $150 for three 15-minute med visits versus $90 for 50 minutes of talk therapy. Levin (with help from his wife, a former psychotherapist), now works 11-hour days and sees around 40 patients per day. They charge for missed appointments, faxed refills, and penalize for missed co-pays.

It’s quite a business they have set up, and the patients who spoke to the reporter seemed satisfied with their relationship to Dr. Levin.

But here’s where the shrivel comes in: Levin chose this business. Not a “free” choice, true, but most vocational choices are not. He could have chosen to continue to practice psychotherapy and forgo the money; he could have chosen to mix psychotherapy with the scrip mill, sacrificing some money but keeping some of the “intrigue” of the therapeutic relationship; or he could turn his office into a full-time scrip mill, in order to maximize financial returns—which is, of course, what he did.

He may lament the consequences of this choice, but, as he noted himself, he wanted the money. More than anything else, he wanted the money.

I don’t begrudge him that. Really. There is nothing dishonorable in what he’s doing, and, as noted, he appears to be helping his clients.

But I also don’t know why I should in any way care about Dr. Levin’s lament that “I had to train myself not to get too interested in their problems”—because doing so would mean he’d spend too much non-reimbursable time with them.

He might genuinely feel bad about his loss, but if so, he’s crying all the way to the bank.