Clinicians In Private Practice Research Articles

Physician beneficence and profit-taking among private for-profit clinics in China: A field study using a mystery shopper audit

This study employs a mystery shopper audit on a random sample of 96 for-profit private clinics in Jinan, China. We investigate two instruments which reflect beneficence among for-profit clinicians in private practice. The first is whether physicians returned a lost wallet “accidentally” left next to the physician’s table; and the second, whether physicians prescribed antibiotics to pseudo-patients who displayed no symptoms of any illness but had complained of fever the night before. These measures quantify beneficence under two different valence framing: returning a wallet represents clinicians who “do good” at personal cost to themselves, while not prescribing antibiotics represents a choice “not to do harm” to patients. We look at the correlation between these beneficence measures and the physicians’ prescription behaviors, and their revenues from the consultation. We find that whether doctors return a lost wallet or not, and prescribe antibiotics or not, such physicians are still as likely to prescribe medications which increase their incomes.

Update on patterns of use of a genetic expression profiling adhesive test to detect melanoma: a cross-sectional survey of academic pigmented lesion experts and private practice clinicians.

Update on patterns of use of a genetic expression profiling adhesive test to detect melanoma: a cross-sectional survey of academic pigmented lesion experts and private practice clinicians.

Meaningful coproduction with clinicians: establishing a practice-based research network with physiotherapists in regional Australia

BackgroundThe disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians’ motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction.MethodsWe describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians’ motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas.ResultsThrough formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group (n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes.ConclusionsClinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes.

Study protocol for training providers in private practice in family-based treatment for adolescents with anorexia nervosa: A randomized controlled feasibility trial

BackgroundPrivate practice clinicians make up approximately 50% of US mental health outpatient providers and treat a high number of eating disorder patients. While family-based treatment (FBT) is a first-line treatment for adolescent anorexia nervosa (AN), private practice clinicians experience difficulties receiving training in evidence-based treatments such as FBT. This report outlines the study protocol for a randomized control trial (RCT) training private practice clinicians in FBT for adolescent AN (NCT04428580). MethodsIn this study, we intend to recruit 140 private practice mental health practitioners and randomize them to complete either a standard webinar-based online training or an enhanced online training that incorporates additional modules related to the putative mechanisms of treatment effect in FBT (i.e., use of externalization and agnosticism). Following the training, participants will begin expert case consultation for an adolescent with AN using FBT from their private practice. ConclusionBased on preliminary studies suggesting the importance of enhanced skills related to agnosticism and externalization, we hypothesize that feasibility data will support a larger randomized clinical trial (RCT) and that the enhanced training arm will significantly improve FBT knowledge and skills compared to the standard webinar training arm. We also expect that patient weight gain early in treatment will be associated with clinician fidelity to the inventions used in FBT regardless of training type.

Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework.

Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care.

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians’ awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Initial changes in neuropsychologists clinical practice during the COVID-19 pandemic: A survey study

Objective: In light of the COVID-19 pandemic, a majority of clinicians have had to quickly and dramatically alter their clinical practices. Two surveys were administered on 3/26/2020 and 3/30/2020, respectively, to document immediate changes and challenges in clinical practice.Method: Two surveys were administered between 3/26/2020 and 3/30/2020, via SurveyMonkey and Google Forms, asking clinicians questions pertaining to practice issues during the early stages of the COVID-19 pandemic. Quantitative responses from the second survey were stratified by clinical setting (Medical Hospital vs. Private Practice) prior to analysis. Qualitative, free-response items were coded by the authors to better understand immediate changes in practice and other concerns.Results: 266 neuropsychologists completed Survey 1 and 230 completed Survey 2. Results suggest that practices immediately moved towards remote service provision. A meaningful proportion of clinicians and their staff were immediately affected economically by the pandemic, with clinicians in private practice differentially affected. Furthermore, a small but significant minority of respondents faced ethical dilemmas related to service provision and expressed concerns with initial communication from their employment organizations. Respondents requested clear best-practice guidelines from neuropsychological practice organizations.Conclusions: It is clear that field of neuropsychology has drastically shifted clinical practices in response to COVID-19 and is likely to continue to evolve. While these responses were collected in the early stages of stay-at-home orders, policy changes continue to occur and it is paramount that practice organizations consider the initial challenges expressed by clinicians when formulating practice recommendations and evaluating the clinical utility of telehealth services.

Private Practice Social Workers’ Commitment to Social Justice

The privatization of mental healthcare among social workers has situated them under scrutiny by others in the profession who question private practice clinicians’ commitment to social justice. Some social workers accuse colleagues in private practice of a dereliction of duty, while others in the profession contend that the entrepreneurship of mental healthcare is the only way to freely realize real-world social justice change. Hence, this qualitative research study explores how clinical social workers define social justice as well as if and how they integrate it in a private practice setting. This small qualitative research study was designed to begin to illuminate strengths and gaps regarding how clinical social workers define as well as if and how they integrate social justice in a private practice setting.

Authentic Movement as a Training Modality for Private Practice Clinicians

Self/other differentiation and the ability to work symbolically with clients are considered desirable therapeutic skills for psychotherapists whose theoretical orientations are in the areas of psychodynamic, object relations, analytical psychology, or psychoanalysis. Although supervision and individual psychoanalysis have been recommended to enhance these skills, this study introduces authentic movement as an additional training modality. The grounded theory approach developed by Glaser and Strauss (The discovery of grounded theory: strategies for qualitative research, Aldine De Gruyte, New York, 1967) was used to develop the research design for the study. Janet Adler’s (Moving J 4(3):10–11, 1997; in: Pallaro (ed) Authentic movement: essays by Mary Starks Whitehouse, Janet Adler and Joan Chodorow, Jessica Kingsley Publication, London, 1999) approach to training participants in the practice of authentic movement was used to formulate the research findings into a training modality for private practice clinicians. Based upon analysis of the data, authentic movement was considered an effective modality in the enhancement of self/other differentiation and one’s capacity to work symbolically. The capacity for self/other differentiation was also found to have an influence on one’s ability to minimize overidentification. In addition to describing the training models generated from the research, this paper provides examples of other clinical skills attributable to the practice of authentic movement.

Pediatric tuberculosis consultations across 5 CDC regional tuberculosis training and medical consultation Centers

BackgroundThe U.S. Centers for Disease Control and Prevention (CDC) funds five Regional Tuberculosis Training and Medical Consultation Centers (RTMCCs) that provide training and consultation for tuberculosis (TB) control and management. RTMCC utilization for assistance with diagnosis and management of TB in children has not been described. We analyzed pediatric TB consultations performed across all RTMCCs in terms of question type, provider type, and setting. MethodsThe CDC medical consultation database was queried for consultations regarding patients ≤ 18 years provided between 1/1/13–4/22/15 by all RTMCCs (Curry International TB Center, Heartland National TB Center, Mayo Clinic Center for TB, New Jersey Medical School Global TB Institute, Southeastern National TB Center). Each query was categorized into multiple subject areas based on provider type, setting, consultation topic, and patient age. ResultsThe 5 RTMCCs received 1164 pediatric consultation requests, representing approximately 20% of all consultations performed by the centers during the study period. Providers requesting consults were primarily physicians (46.3%) or nurses (45.0%). The majority of pediatric consult requests were from state and local public health departments (679, 58.3%) followed by hospital providers (199, 17.1%); fewer requests came from clinicians in private practice (84, 7.2%) or academic institutions (40, 3.4%). Consults addressed 14 different topics, most commonly management of children with TB disease (19.1%), latent TB infection (LTBI) (18.2%), diagnosis or laboratory testing (18.7%), and pharmacology (9.2%). DiscussionPediatric consultations accounted for approximately 20% of all consultations performed by RTMCCs during the study period. RTMCCs were utilized primarily by public health departments regarding management of TB disease, LTBI, and diagnosis or laboratory testing. The relative underutilization of the RTMCCs by clinicians in non-public health settings, who often manage children with TB exposure or infection, warrants further study. As US TB case rates decline and providers become less experienced with childhood TB, medical consultation support may become increasingly important.

Advancing Telecommunication Technology and its Impact on Psychotherapy in Private Practice

This paper is a report on an informal study by a small group of psychotherapists interested in exploring the impact of recent technological innovations on their work as independent clinicians in private practice. The range of technologies studied included websites, email, mobile phones, and internet‐based banking services for payment and receipt of fees. Some of the group had experience of using internet‐based video software (or Voice Over Internet Protocol/VOIP software) for providing therapy and/or establishing supervisory and training links. The study found that these technologies have had both positive and negative impacts on professional practice and, in particular, records how practitioners have managed these changes within their clinical practice. The study notes the lack of professional training about these matters and highlights some of the issues that need to be addressed in redressing this situation.

Five-Year Retrospective Assay of Implant Treatments and Complications in Private Practice: Restorative Treatment Profiles of Single and Short-Span Implant-Supported Fixed Prostheses.

The aim of this study was to describe and analyze the restoration profiles of 5,491 implant-supported single crowns, fixed partial dentures (FPDs), and splinted restorations prescribed between January 2005 and December 2009. Dental clinicians qualified in or before December 2004, registered in Victoria, and placing and/or restoring implants in private practice were invited to participate in the study. Data was extracted by two trained and calibrated research assistants from dental records. Cross tabulation was carried out in SPSS (IBM) to provide descriptive statistics on clinician profiles, patient demographics, and restoration information. A total of 34 practitioners participated in the study: 25 general dentists and 9 specialists. Clinicians that graduated between 1970 and 1989 (16 to 40 years of experience) prescribed most of the prostheses (82.0%). Female patients were present in higher numbers across most age and restoration groups. Of the implant-supported prostheses, 5,491 fit the criteria for simple basic restorations and were included in this report. The majority of the prostheses (86.7%) were single-tooth restorations. Metal-ceramic was the material of choice for the majority of the restorations (3,382/5,491). The use of single implant-supported crowns in the anterior mandible was rare. More than 65% of the implant-supported restorations in this study were screw retained directly to the implant. The specialist clinicians in this study largely used the screw-retained method to retain single implant-supported crowns (82.0%). General dentists provided 1,066% more cement-retained single implant-supported crowns compared with other practitioners. This report showed that during the period of January 2005 to December 2009, private practice clinicians in Victoria, Australia favored porcelain-fused-to-metal material over all-ceramic for implant restorations. Most implant restorations were single crowns. More female patients received implant-supported restorations in the posterior region of the mouth. The clinicians included in this study, particularly the specialists, generally favored a retrievable design in choosing the retention method for the prostheses.

Aural Rehabilitation in Private Practice

Aural rehabilitation refers to sensory management, auditory speech perception training, and counseling services provided to those with hearing loss and their communication partners. The goal of aural rehabilitation is to reduce the impact that hearing loss has on communication and daily function. There is ample evidence confirming the effectiveness of aural rehabilitation, however, comprehensive aural rehabilitation services are rarely offered in the private practice setting. Lack of time, compliance, and reimbursement have been suggested as possible reasons for the rare provision of aural rehabilitation services. The purpose of this article is to provide the reader with a simple framework for efficiently incorporating aural rehabilitation services into a busy private practice. It is suggested that both client and clinician compliance will improve when clinicians become proficient with a few select tools in the areas of assessment, education and counseling, auditory training, and follow-up. In today's changing marketplace, it is critical for private practice clinicians to set themselves apart from the commodity options by offering comprehensive aural rehabilitation services.

Service Delivery and the Challenges of Providing Service to People Who Are Transgender

An increasing number of speech-language pathologists (SLPs) are working with individuals who are transgender (TG) and gender diverse people. This trend likely reflects a growing number of TG and gender diverse patients seeking treatment. Whilst voice and communication outcomes can be highly satisfying for both the client and the therapist, there can be many challenges associated with service delivery to the transgender population. This article will discuss the challenges for SLPs, both in public state-funded health care systems, and clinicians in private practice. This discussion is informed by my 15 years of clinical experience in both systems and by recent developments in the field of TG voice and communication work.

What’s Your Value? Acute Care Wants to Know

What’s Your Value? Acute Care Wants to Know

Bilingualism and Biculturalism in the Clinical Setting

It is estimated that by the year 2050, Latinos will make up half of the nation’s population. The rise of immigrants over the last decade has resulted in a greater need for bilingualism and biculturalism in the clinical setting. Medical and mental health practitioners are now in the spotlight to meet the needs of the growing clientele. As a result of the growing Latino population, psychologists can now expect more Spanish-speaking patients in their waiting rooms. Clinicians or agencies not providing therapeutic services in the patient’s primary language are violating one of the primary ethical standards: beneficence and nonmaleficence. Whether clinicians in private practice agree or not, they have an ethical and professional responsibility to abide by standards governed by the profession. However, too many clinicians in private practice, outpatient mental health clinics, large for profit and nonprofit settings, and HMOs do not abide by this standard.

Nonsuicidal self-injury disorder: Clinician and expert ratings

Nonsuicidal self-injury (NSSI) is a growing clinical and public health problem that affects individuals from all age groups, most prominently young adults. NSSI involves numerous methods and functions. NSSI has long been associated with borderline personality disorder (BPD), and in fact, it is only referenced among the diagnostic criteria of BPD in the DSM-IV-TR. However, recent studies have provided strong evidence that NSSI occurs outside of BPD. For these reasons, a diagnosis of nonsuicidal self-injury is included in DSM-5 Section-III as a condition that requires further study. The primary purpose of the present study was to identify whether the proposed DSM-5 NSSI criteria adequately reflect the symptoms of a prototypic individual who engages in self-injury. Clinicians in private practice and expert NSSI researchers (n=119) were asked to describe their familiarity and agreement with the proposed DSM-5 NSSI criteria, as well as the degree to which each proposed criterion is a prototypic symptom. Overall, most participants reported that the proposed DSM-5 criteria for NSSI accurately captured the behavior of the prototypic self-injurer. The results of this study provide incremental support for the proposed DSM-5 NSSI diagnostic criteria.

Reports from the Front: The Effects of Hurricane Katrina on Mental Health Professionals in New Orleans

Hurricane Katrina created an unprecedented mental health crisis in New Orleans. Once they could return to work, local mental health professionals attempted to treat survivors of the storm while dealing with the storm's impact on themselves. Those working in public settings were offered in-service training and supervision. But clinicians in private practice often found themselves bearing the brunt of posttraumatic uncertainty alone. The current paper includes four experiential reports from area clinicians describing their early struggles to maintain a sense of continuity in their ongoing clinical work, only to realize how much of the personal is also professional in the aftermath of a disaster of this magnitude, and how personal and professional inevitably inform one another when clinicians and patients survived similar dangers and losses. The introduction locates these four papers in the larger context of post-Katrina New Orleans and a program that was specifically tailored to meet the needs of local clinicians. This program demonstrated the ways in which psychoanalytic ideas can be used to give meaning to a traumatized mental health community's profound disorientation.

Encyclopedia of Family Health

Encyclopedia of Family Health

A Practical Guide to Conducting VA Compensation and Pension Exams for PTSD and Other Mental Disorders

Despite being one of the most common forensic mental health evaluations, no article has ever appeared in a peer-reviewed journal describing how to conduct US Department of Veterans Affairs (VA) mental health compensation and pension examinations. This article rectifies that paucity of information. We outline the legal framework, ethical considerations, and administrative challenges inherent in these evaluations. We provide separate guidelines for private practice clinicians and VA staff or contractors. We pay special attention to the multiple sources of collateral information available for these exams and how to access relevant records. The article alerts examiners to the possibility that they might face resistance from VA officials if they screen for and assess symptom exaggeration or feigning and that they could encounter VA-imposed restrictions on time allotted for exams. Specific suggestions are made for different types of exams: Initial Post-traumatic Stress Disorder (PTSD), PTSD Review, Initial Mental Disorder, and Mental Disorder Review.