Referrals

My private practice is currently full and not accepting new referrals. I am winding down this practice over time and will focus on seeing patients through Hong Fook Mental Health Association and the Primary Care Team at Sioux Lookout First Nations Health Authority.

There are many reasons to close the private practice but the most compelling reasons include the fact that keeping a private office in Toronto is becoming economically less and less feasible over time, as expenses increase and fees decrease. Multidisciplinary care has also become the standard of care, and this is difficult to create in a private practice setting. I believe patients receive better care when psychiatrists work as part of a team and indeed the trend seems to be for psychiatrists to work in hospitals or larger clinics. 

5 thoughts on “Referrals

  1. Michelle

    Hello,

    I am looking to get a full assessment done. However, I recently lost my job and was wondering how much is the cost of an assessment. With doctor referral. could the assessment be covered?

    Thanks

    Michelle

    Reply
    1. admin Post author

      Hello Michelle,

      Psychiatric services are covered by OHIP, including consultations / assessments (with a referral from a physician). However, as described in the webpage, I do not have a private practice anymore, and only do assessments for the health team I work with in the Sioux Lookout area. I think the best way to get an assessment is to have your family doctor refer you either to the psychiatry department of the local hospital, or to a psychiatrist they know / have a connection with.

      Regards,

      Dr. A

      Reply
  2. Bob Johnson

    Hello,

    If these services are OHIP covered, I don’t understand how a former clinic of yours is legally allowed to charge people to perform these assessments. It seems like they are extorting people by charging large sums of money and effectively charging people to see a doctor. This feel especially egregious when the MD’s services are OHIP covered.

    That former clinic should also be providing alternative options to people who openly admit that they are low-income. It feels criminal to charge high fees for an ADHD assessment, and not even offer a sliding scale for low-income patients.

    Please share your thoughts.

    Thank you.

    Bob

    Reply
    1. admin Post author

      Hello Bob,

      These are very good points that you have raised. I take it you are referring to an ADHD assessment clinic. I would not presume to speak about or on behalf of any particular clinic, as it has been a while since I worked in that setting, but I could offer some general suggestions from my experience. I believe the issue at hand is services that are not insured under OHIP, being bundled together with psychiatric services that are covered by OHIP.

      According to my understanding, there is guidance from the College of Physicians and Surgeons of Ontario (CPSO) that physicians (including psychiatrists) must not bill patients for the provision of insured services under OHIP, such as a psychiatric consultation. However, psychiatrists may work in settings where uninsured services are provided, such as services of a psychologist, which are not covered by OHIP, and these services would be billed separately from the insured service provided by the psychiatrist. With ADHD assessments, the scenario I am familiar with is that a psychologist (whose services are not covered by OHIP) does psychological testing and the psychiatrist does a consultation around diagnosis and medications (which is covered by OHIP). The psychologist fees would be billed privately, and the psychiatrist is billing OHIP; the psychiatrist is not or should not be charging an extra fee beyond what OHIP covers. When uninsured services are bundled together with insured services (as in an ADHD assessment that involves psychological testing), the CPSO directs that these situations can be particularly confusing and the physician / psychiatrist must be careful to be clear to patients about what the options are, about the alternatives, and which services are associated with a fee and which are not. Also, physicians / psychiatrists are not permitted to charge fees in exchange for preferential access to insured services – that is to say, charging people for uninsured services in order to get access to the psychiatrist is not allowed.

      Therefore, my interpretation of the CPSO guidance is that at clinics that provide bundled psychological and psychiatric services, there needs to be an option to see the psychiatrist for the OHIP-covered service only. The psychiatrist in some cases might not be able to make a clear diagnosis when additional information like psychological testing is not available, but patients should have the same access to the psychiatrist for a consultation regardless of whether they opt for the psychological services or not.

      Regarding the option for a sliding scale for non-insured services, the CPSO also provides guidance to doctors to take into account the patient’s ability to pay uninsured fees, but as far as I know it is not mandatory to offer a sliding scale. Also, in the specific case of ADHD clinics, the extra fee is most likely going to the psychologist at the clinic, and not to the psychiatrist, so the psychiatrist may not have discretion to set the psychologist’s fee.

      Again, I can’t speak for the various ADHD clinics because I don’t work at any of them, and it is not my intention to comment on the practices of any specific clinic. I am also not presuming to speak on behalf of the CPSO; my interpretation of the CPSO’s guidance should not be construed as legal advice or anything more than my own personal opinion. This is the link to the original source document re: CPSO’s advice to the profession about uninsured services. If dealing with a particular clinic my suggestion would be to ask them about the fees and to break it down as to what the uninsured services are for and what the benefits would be, and to find out about the option of getting a consultation with the psychiatrist without additional uninsured services, if paying for those additional services is not an option, in light of what the CPSO has said on the matter. I hope that helps.

      Regards,

      Dr. A

      Reply
      1. Bob Johnson

        Hello Dr. Allen,

        Thank you for providing such a detailed explanation. I wish that I had known this information before getting my diagnosis. As I mentioned, my experience is based on a clinic where you used to work (which shall remain nameless). Based on my research, there are several clinics that follow a similar model for diagnosing ADHD. While they may not be officially charging people to see the doctor, this is what it feels like in practice. If one can not afford the fees, they are usually not allowed to see the doctor. This is what I meant by my statement in my original message and I apologize if this was unclear.

        Unfortunately, I was not provided adequate alternatives for lower cost options for getting a diagnosis. Feeling debilitated by ADHD symptoms, I felt that I had no other option but to pay the high assessment fees. The clinic wouldn’t offer a sliding scale or an option that excluded the psychological testing either.

        I will fax you a more detailed version of the above. I hope that you can further clear up some issues that I have. Please note that I do not expect you to comment on the practices of a specific clinic. However, I hope you understand the frustration of feeling that an ADHD diagnosis is only accessible to those adults with financial means.

        Thank you.

        Bob

        Reply

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