A COLLABORATIVE MODEL OF PRIVATE PRACTICE AS AN ALTERNATIVE TO MANAGED CARE AND THE MEDICAL MODEL

Over eleven years ago, I left all of the managed care networks. While I have been fortunate to have been able to maintain a full private practice on Long Island for these years, today most clinical social workers labor under the yoke of an insurance industry that has not raised fees for our services in 10 years. In fact, has reduced them by 30% over that period and at the same time added significant administrative expenses and time for us to simply be paid.

The purpose of this article is not to describe the flaws in a system that we all know is broken and destructive to the psychotherapeutic process and the clients we serve; but rather to encourage social workers to explore the possibility of the development of a new approach to private practice. We need to begin a movement to take back our profession and re-define our scope of services .In addition, we must build relationships with one another and our clients that are dictated by our value system and not by an industry that is based on the limitation of quantity, quality and access to services. In order to do this, we must take a hard look at ourselves even though it is painful. As in marriage it is very easy to point out how our partner’s limitations are contributing to our misery and depression, but it is a lot more difficult to become aware of our own shortcomings.

Where did we go wrong?

  1. We were and still are in denial. (Initially, we believed that our clients would never accept the dictates of managed care and now we believe that they would not choose to go outside their networks)
  2. We have become isolated from one another. (Each of us was frightened that we would be left out in the cold and would not be able to earn a living)
  3. We have become victims.( We complained, whined, tried to fight back but ultimately became a part of a system we abhorred)
  4. We have accepted our new titles of “providers” and “vendors” instead of therapists. We were pressured to become proponents of the medical model.
  5. We have stood by as our clients’ confidentiality was compromised and treatment decisions about their well being were made by individuals who did not know us or our clients
We must call forth our courage, creativity and resilience to set forth a new model that can help us reclaim our dignity and develop our identity as therapists who offer a model of healing, education and growth that is based on the human spirit and connectedness to one another and our communities.

A group model based on collaborative efforts is the only way for large numbers of therapists to free themselves from the oppression of managed care and the limitations it places on our therapeutic efforts and our ability to make a decent living. My belief is that an ideal number for such a group would be 50-100 therapists.

What could such a group accomplish?

  1. Provide a sense of connectedness and safety to counter the feelings of isolation private practitioners often experience.
  2. Provide training in Practice Building and Education in the “business aspects” by holding monthly seminars.
  3. Provide education, peer supervision, encouragement and support to learn new skills which are marketable to our communities and are beyond the scope of managed care.
  4. Begin a publicity campaign in local communities and eventually at national levels to promote awareness about the loss of confidentiality and the impact of having a diagnosis that is part of one’s insurance history.
  5. Build a positive image of clinical social workers as professionals who can help to develop skills for the prevention of divorce, addiction, depression and anxiety as well as dealing with stress and its impact on our immune system.
  6. Provide a network for therapists to refer to one another.
  7. Create an atmosphere for brainstorming and emotional support for new ideas.
  8. Build lending libraries of Practice Building books and newsletters and educational CD’s and DVD’s.
  9. Hold Social Networking events-bringing together people from different geographic areas for personal contact.
  10. Develop Speaker’s Bureau to provide talks to the community on different aspects of mental health services available.

My model can be adapted:

  1. By entrepreneurs who want to build a group for profit and develop and provide the services in exchange for fees from its members.
  2. By groups of therapists who are working together to create an organization that provides services for its members and use the fees only for expenses and operating the network. Since each member is an independent contractor running his/her own practice and there is no central referral system, there are no legal ties or responsibilities of the members to one another in either of these two approaches.

Victor J. Goldman LCSW

V & W Networking Group are a group of independent practitioners who collectively advertise to enhance community awareness of the treatment options and services available for these issues. Each practitioner is solely responsible for his/her own practice, services and/or products.