I am a psychiatrist practicing general psychiatry in Toronto, Ontario. I finished my residency at the University of Toronto in June 2013 and I completed medical school at the University of Calgary.
I currently spend about two days per week in private practice, one day per week at Hong Fook Mental Health Association where I see Vietnamese-speaking patients, and about one day per week consulting at an ADHD clinic. Some of my patients have commented that it has been helpful to read about how I think and why I make certain decisions, so I’ll explain a bit here:
Every clinic I work at is different, and I think they complement each other. Hong Fook is an Asian mental health clinic where I see Vietnamese-speaking patients who would likely not be able to get treatment elsewhere, so I try to see everyone who gets referred and treat as many as I can. It is high-volume, but mostly focused on medications. I enjoy the work because it allows me to stay in touch with the breadth of psychiatry and the acute cases, and I can experience the joy of serving my community. One day per week is good for me, but more would be too much. It may be different for other psychiatrists, but that’s how it is for me.
At the ADHD clinic where I work, I can see many new patients – but it only works because I don’t provide follow-up care and the business model allows for the psychiatrist’s time to be maximized by using allied professionals. I’m learning many things about how to run a clinic by working there and I enjoy the team.
In my private practice, I tend to try to build relationships over time and see how cases turn out in the long term, and I get to furnish it as I like. My private practice might be, as far as psychiatric practices go, something along the lines of what the neighbourhood custom tailor shop is to clothes. I imagine they see their work as an art, but let’s face it – they just can’t see as many people working that way. It’s nice, but mass-manufactured clothing is a miracle too.
Working at the three clinics, I get the service, the art, and the business of medicine, and without the balance, I don’t think my overall career would work well.
The other thing I believe is important to comment on is how I understand my profession. From my perspective, psychiatric care is different from other types of medical practice in that treatment is labour-intensive, requiring longer appointments, and over long periods of time, even for a case that responds well to treatment. So, we have a strange industry where demand vastly outstrips supply and we haven’t really found a way to manage this. My opinion (at least based on reflecting on my experiences so far) is that we psychiatrists often try to deal with that dilemma by denial and wishful thinking (i.e. “every patient can be treated with 12-16 weeks of time-limited, evidence-based treatment; if we just did that, we can treat everybody”) or the guilt trip (“it’s heroic to work long hours, see patients for shorter appointments, do research, teach, subspecialize, go to meetings, and juggle more cases – the more stress you take on, the better a doctor you are”). Those solutions don’t work for me because at least in my hands, evidence-based treatment does not cure most of the people who get referred to me within 12-16 weeks, and I get too burnt out and resentful over time to keep playing the hero. So, I decided I’ll help the people I can help while still enjoying the work, and try to find some creative ways including technology to expand my reach and efficiency. What that means practically is I generally see my patients every 2-4 weeks, for a half-hour or full hour appointment slot depending on what is appropriate, and I don’t take more new referrals than I think I can comfortably handle.