Child and adolescent psychiatrist bucks the trend, goes solo
By Chris Motola
Q: While more and more physicians are joining groups and hospitals, you’re leaving one to start your own private practice. What was the appeal for you?
A: What did it for me was, these groups are getting larger and, while there are a lot of advantages, there are some disadvantages. Some of the big disadvantages is the emphasis on profit and the emphasis on procedure. For every eventuality, there’s a procedure.
Q: Was it too restrictive?
A: Unfortunately, you sometimes have to be flexible where the human condition is concerned, especially in my field, pediatric psychiatry. I work with kids and families. There are no blood tests in psychiatry that will give you a definitive diagnosis. So it’s very hard to have bureaucratic procedures in place for such a nebulous field. Every clinician is going to be a little different, so it’s hard to get everyone to conform to the same standards. In my experience, sometimes the emphasis on productivity and profit can be detrimental to both the doctor and the patient.
Q: One of the common challenges I hear cited is navigating the complexity of insurance, as well as the uncertainty of healthcare legislation. What, if any, kind of support staff do you require?
A: Insurance can be pretty complicated. I try to keep up-to-date on it myself, but I’m going to be hiring an office manager really soon. It really helps to have people who have your back. I’ve been working with the Monroe County Medical Society. They’ve been fantastic. They give you a checklist of things to do. They have courses you can take and a listserv you can access to talk to other physicians. I also have friends who have done this: one in New York City, one in Westchester, and one in Jersey. We all exchange information and help each other. So there’s still a community, I’m just my own boss, which is nice.
Q: You mentioned your particular field being harder to integrate into a large group practice. Can you give an example of how that can play out?
A: Off the top of my head? This is going to sound a little strange, but one of things was that I had candy in my office. At the end of the session, I would give kids a piece of candy. The last office I worked at, they weren’t sure about that. The other doctors didn’t do that. There was an actual medical reason I was doing that, as crazy as it sounds. There are two different nervous systems in your body: sympathetic and parasympathetic. The sympathetic is your fight or flight, your parasympathetic is rest and digestion. So if you’re adrenaline is going and you can’t calm yourself down, you can try smelling something nice, sucking on a lemon drop or even picturing and thinking about a food item you like. Kids aren’t as good at abstract thoughts, so I used the candy to help them calm down after they were talking about something that was very upsetting to them. That wasn’t part of procedure though, so I was told that wasn’t a great idea.
Q: What challenges have you run into so far?
A: Getting the phones to work. I think not having a buffer between myself and patients, even with an office manager. So I think part of it will be sticking to company policy. With a big practice, it’s easy to just have someone say, “the building’s closed and everyone is gone after 7.” Without that buffer, it’s easy asking me directly, “Hey, can you see my kid at 7? You’re the only doctor here, so you can make the rules.” There’s also security. It hasn’t come up yet and hopefully it won’t, but it might.
Q: Do you think we’ll see more physicians following in your path?
A: I can absolutely see more physicians doing this. I’m hoping it comes back to this. This is how it used to be. When you have your own practice, you can shape the philosophy to what you want. Like, I don’t like to just do the 20-minute med-management. Some people like seeing 30 people a day for 20 minutes. “How’s the medication? OK, good.” I like to do med-management and therapy. That’s my philosophy. I get to know the patient better and they’re more comfortable telling me if there are problems in their life or with their medication.
Q: What kinds of psychiatric issues tend to manifest in childhood?
A: Honestly, I see everything. I get kids with anxiety, depression, grief, PTSD, adjustment disorder, behavioral disorder, intermittent explosive disorder, ADHD, kids who are having trouble adjusting socially due to LGBTQ issues, kids with psychotic issues, or who might have early symptoms of schizophrenia. So there are a lot of things kids deal with. One of the things I can provide, in addition to medicine, is evaluate how their medical conditions interact with their psychiatric conditions. For example, kids with juvenile diabetes have a higher rate of depression. Maybe the kid who is having trouble concentrating is getting poor quality sleep and needs a sleep study.
Q: Do you see yourself partnering in the future with another psychiatrist?
A: Yeah, absolutely. I can also see partnering with a psychologist or therapist or two. Not every kid needs to be seen as often for medication management. So they might see the therapist every week and then see me every other week or every month.
Q: You’re working on a novel. What’s it about?
A: I love sci-fi and fantasy, but I think it’s kind of unrealistic that the protagonists are like, “Oh wow, that’s crazy, aliens or demons exist, let’s go handle this” instead of processing this huge shock to their reality. So the book has the heroes doing heroic things, but also needing to rely on each other to deal with the changes to their world. So, as you can imagine, it’s kind of a psychiatric view of the genre.
Name: Allison Giordano, M.D.
Position: Child and adolescent psychiatrist at Flower City Psychiatry in Rochester
Education: Dartmouth (undergrad); University of Chicago (medical); Westchester Medical Center (fellowship)
Affiliations: Formerly with Rochester Regional Health
Organizations: Monroe County Medical Society; American Medical Association; American Academy of Child and Adolescent Psychiatry; American Psychiatry Association; National Medical Association
Family: Married, no children
Help setting up practice: “My parents have been hugely instrumental in helping me set up my private practice”
Hobbies: Reading, traveling, museums, writing