Interested in starting an integrative psychiatry practice but don’t have a formal certification? Worried that you don’t have enough experience to start a practice on your own?
I started Zen Psychiatry, my integrative psychiatry practice, in 2017, and absolutely love my work. In this post (and video) I’ll be sharing some of the basic principles that have helped me establish a successful private practice, and how you can start one, too.
Yes, I am a psychiatrist, and yes, I am an entrepreneur with a successful private practice. Yes, you can be BOTH!
Business is a huge passion of mine. In fact, I struggle to find anyone to talk to about it because most psychiatrists (and physicians in general) see it as a dirty word (much to their detriment).
Running a successful private practice doesn’t mean that you don’t care about your patients, that you’re money grubbing, or that you’re enabling patients in an unhealthy way or succumbing to market pressures. In fact, I’ve found that market pressures are what drive me to constantly improve my clinical skills.
The thing is, there is so much patient demand for psychiatrists that you can be pretty average and still get a job. But to be successful in private practice — especially a fee-for-service, cash-based private practice — you have to be exceptional.
In private practice you have to deliver care at such a high level that patients are more than happy to pay your high fees, to come back to you repeatedly, and to refer you to their friends. More so than any of my formal training, that “pressure” has driven me to be the best psychiatrist I can be, and has helped me build my private practice to where it is today.
What Does It Mean to Practice Integrative Psychiatry?
Integrative psychiatry is about combining traditional allopathic psychiatric treatments (such as prescription medication) with holistic approaches to treat a patient as a whole — mind, body, environment, and spirit. Optimal wellness is the goal — not just the absence of disease.
In integrative medicine, the goal is to exceed the standard of care by honoring patients’ individuality and developing a treatment plans based not only on what the evidence shows, but on what the patients believes in.
Like most psychiatrists, I went through residency learning a “disease-based” approach to diagnosis and treatment, but quickly started to question the efficacy of treating a patient using a approach that put an algorithm or diagnostic criteria in the DSM over the story the patient in front of me was sharing.
I began to shift my conversations with patients to spend more time understanding who they were:
What was their story?
What do they believe went wrong?
What do they believe led them to this point?
It led to an epiphany, and new personal belief, that we have to change the way we approach psychiatric mental health.
After going to the annual conference of the Academy of Integrative Health & Medicine (AIHM) in my 4th year of psychiatry residency, I finally felt like I had found my home and had discovered the kind of medicine I wanted to practice.
Inspired by AIHM’s principles of integrative medicine, I wrote a blog post titled The 10 Principles of Integrative Psychiatry (also shared on The Huffington Post). These philosophies are pillars of my private practice and have given me the opportunity to offer an individual-centric approach for my patients.
Integrative Patient Demand
Simply put, there are just not enough psychiatrists practicing integrative medicine.
Many patients are no longer satisfied with the level of conventional care that most psychiatrists offer. I know this because I have patients willing to travel from other states, and even other countries, to work with me. It’s not because I’m so special, but because patient’s perceive what I do as so rare! There is a lot of demand out there for integrative psychiatrists, and we need more likeminded practitioners to join the field.
Connection matters. Trust matters. Empathy matters. Patients want doctors who are willing to dig a little deeper to understand the bigger picture and how it’s all connected — their relationships, trauma, work environments, physical and nutrition dysfunction, ecological and environmental exposures, activity level, and spirituality. The relationship between the doctor and patient matters.
I think this quote from Florence Nightingale sums it up well:
“The needs of the spirit are as crucial to health as those individual organs which make up the body.” –Florence Nightingale
About two years after I started my private practice, my cancer unfortunately relapsed, and I had no choice but to close my practice as I underwent chemotherapy and then a stem cell transplant in 2019,
I was devastated. I had already survived cancer once (and took an extra three years to graduate residency because I was receiving chemotherapy at the same time), and now it felt like all of the time and effort I had spent building my practice was for nothing as everything I had worked so hard to build was ripped away. The idea of rebuilding it all from scratch seemed completely overwhelming.
But, what happened after proved just how valuable individual patient rapport is. Once I had the energy to start opening up my schedule again, most of the patients I had referred out came back because of the relationship that we built.
And it wasn’t because I was so special or unique — it was because when you have your own practice, and have more time and space to give more to your patients, which makes them happier. And you will be happier, too.
If you want to be successful in psychiatry, practice integrative psychiatry.
What I Love About Integrative Psychiatry Private Practice
Diverse Treatment Modalities
Integrative psychiatry is not about prescribing St. John’s Wort instead of Prozac; it’s about offering a range of holistic options that work together to improve the mental health and wellness of our patients.
When you practice integrative psychiatry, you have so many more tools in your tool belt than just prescription medications and therapy. Here’s a glimpse at the integrative treatment modalities I offer to my patients:
- Medication Management
- Lifestyle Coaching
- Herbal & Plant-Based Medicine
- Customized vitamin & nutrient supplement regimens
- Functional Nutritional Testing
- Advanced Hormonal Testing
- Gut Microbiome Testing
- Food Allergy and Sensitivity Testing
- Genetic Testing
- Mind-Body Medicine
- Integrating Psychedelic Experiences
I’ve found that building a private practice inclusive of these modalities has been extremely rewarding, but I didn’t learn these strategies overnight. You don’t need to attend an integrative psychiatry institute, or receive an integrative psychiatry certificate to integrate these to your practice.
I’m highly compensated for this work, and you can be too. Because integrative psychiatry is so specialized, patients are more than happy to pay for the time required to provide thorough care.
I set my own fees, charge what I want based on patient demand, and don’t have to work too many hours to make a good living. I can provide my patients with really in-depth care and be available to them when they need me (no more cutting them off at the 15 minute mark). This also gives me bandwidth to provide much better care because I’m not burned out trying to manage high patient volume. It’s a win-win.
I have complete autonomy over everything in my practice, which may scare some people, but it’s one of my favorite parts.
I get to decide how many patients I take on, what conditions I treat, when I’m on schedule and when I’m off, the type of documentation I do, etc. It’s all determined by me.
There’s no bureaucracy, no higher ups telling me what to do, no endless checkboxes on a nonsensical EHR, and no requirements to follow a process that doesn’t make any sense (where are all my colleagues in residency or working for an institution at?! ;-)).
Of course, there are challenges to owning a private practice, but what I love is that I can solve any problem myself. Receiving too many calls on the weekend? I set a new policy that I was no longer available after hours. Spending too much time managing my email inbox? I set up auto-scheduling so patients could do it on their own time.
In my opinion, problems are a lot more tolerable when you have the autonomy to solve them. In an institutional setting, you don’t always have that flexibility.
Okay, okay, now all of this may be sounding right up your alley. So now to the good stuff… where do you start?
How To Start Your Private Psychiatry Practice
1. You Do Not Need A Fellowship to Practice Integrative Medicine
First and foremost, you do not need any formal training to start practicing integrative medicine!!
This is a trap we get caught in because we’re professionals with several degrees and get stuck on the idea that we need a certain number of letters after our name. If you’re reading this, you likely already have the letters you need to get started (or you’re about to get them).
You do not need any more formal certifications or a fellowship to practice integrative psychiatry. The mindset shift you need is to start learning by doing.
When I started my practice, I was just recovering from three years of cancer treatment (the first time). I literally had not practiced medicine in four years, and as you can imagine, I was pretty rusty. No matter how new you are to integrative medicine, just know that I started at a time when I couldn’t remember how to prescribe Prozac.
Feeling better now?
The first patient who called me suffered from trichotillomania, and asked me if I was experienced with this condition. I said yes, of course I’ll be able to help, and then when we got off the phone I immediately started looking up trichotillomania. I spent the next 3 days studying, and by the time she came in, I really did know what I was doing.
I had read books about it, knew all the nutrition supplements that are used to treat it, and had created an integrative protocol for it. I started the protocol on her, and adjusted here and there based on what she was responding to.
This is exactly how I grew into integrative psychiatry. Over promise a little, rise to the occasion, and over deliver for my patients.
It’s okay to not have all the answers; patients don’t expect you to be perfect. But an “I’m not sure, let me look it up and get back to you response” will always go much, much further than being condescending or speaking in a disrespectful tone.
The rapport you build with patients will allow you to go through a learning process where you are growing in parallel to providing excellent care.
2. Know The Difference Between Evidence-Based vs. Evidence-Informed Medicine
There is nothing that pushes my buttons more than when I hear a doctor ask “Is that evidenced-based?”
First of all, what does “evidence-based” even mean? Does it mean that there is no evidence that a given treatment works or doesn’t, meaning the question has not yet been researched? Does it mean there is evidence that it doesn’t work? Does it mean there is evidence that there is no benefit, but that it’s harmless? Does it mean there is evidence that it’s actively harmful?
Usually when I ask these follow up questions I just get a blank stare.
The problem with “evidence-based” is that it is a binary question and there is not room for nuance. For example, what’s the harm in supporting a patient who wants to use a treatment that doesn’t have strong supporting evidence for efficacy, but has no side effects (such as homeopathy)? If a patient believes in the approach, why not support them, as long as the approach won’t harm them? The rapport you will develop by being open to the nontraditional approaches the patient wants to use will make them more open to other options you may want to offer them.
As they say in business, “Sell them what they want so you can give them what they need.”
Instead of evidence-based medicine, consider practicing medicine that is evidence-informed. If you’re recommending a treatment that has potentially high toxicity, high side effects, and/or is very expensive (like ECT or an antipsychotic), you want to have good evidence for it because the risk factors are moderate to high.
However, if you’re recommending something that has little to no downside, then you don’t need the same burden of proof in order to feel comfortable recommending it to your patients. You can defer to their belief system when offering treatment that can feel personalized to them. I ask a set of questions during a new patient intake, then cater my services to what they want and need.
Just being present and offering hope to your patients will help them. When I look my patients in the eyes and tell them, “You will get better,” I can instantly see their body relax. Healing starts on day one, before you actually treat them with anything.
When you can offer treatments that align with the patient’s belief system, they feel heard and trust that they’re going to get better. To me, that is evidence-based.
3. Surround Yourself With The Right People
Unfortunately, if you work in a traditional academic or institutional center, people are not going to understand integrative psychiatry or medicine.
Even in some of the psychiatry-related forums and Facebook Groups there are a lot of judge-y comments from people who haven’t thought about treatment in nuanced way. I’ve actually had to mute the notifications and comments on several forums where comments fly about what other community psychiatrists are doing and if they should be reported for unconventional approaches. Really?
It should be our priority to serve our patients, not a research study that says something different than what the patients sitting in front of us are saying.
Of course, practice responsibly, but also practice with humility. In 100 years our field will look back on what we’re doing now and think it’s barbaric. So wouldn’t you rather treat patients in a way that you can feel proud of, knowing that our standard-of-care treatment approaches are imperfect and will most certainly change and evolve in the decades to come?
In summary, to practice integrative psychiatry you should:
- Submit yourself to market pressures with the goal that it’s going to help you improve as a clinician
- Be okay with thinking outside the box, in a responsible way
- Understand the difference between evidence-based and evidence-informed medicine
- Be willing to grow, be uncomfortable, and be imperfect knowing that your relationship with your patients will protect you
- Surround yourself with people who have an entrepreneurial mindset
I know it can feel challenging to find a community who can support you through a career transition like this, especially if you’re working in a conventional environment now.
I absolutely love sharing the knowledge I’ve acquired along the way to help others, which is why I created a webinar training that covers the business principles and integrative medicine best practices that have helped my mentees build their own private practices in 3-6 months. You can enter your email into the form below to access the webinar right away.