| Joseph Czekala, Ph.D. | The Suffolk County Psycholgical Association Managed Care Free Support Group
Suffolk County comprises the eastern half of Long Island, NY. SCPA is a regional affiliate of the New York State Psychological Association and has approximately 450 members. The SCPA mcFREE Support Group began meeting in January, 1999 and has met on a monthly basis since then at a diner convenient to most participants. Our meetings last for an hour and a half during which most of us have a bite to eat and then head home with new ideas and challenges to digest. The SCPA mcFREE Support Group grew out of a perceived need to provide a forum for generating ideas for those who desired to move their practices increasingly in the direction of self-pay. It started initially as a small group of six people most of who did not know each other and has now expanded to fifteen as the word has gotten around. Eventually, we may outgrow the restaurant setting and have to find a new meeting place. The enthusiasm for the group stems from its purpose, which draws others in, and in turn helps fulfill that purpose. The current members of the group run the gamut from those whose practices are predominantly managed care to one individual who works completely outside of managed care. Some have full-time private practices and others work part-time. What we share is a deep seated frustration with the current managed care system and a growing conviction that attempting to continue to practice within that system is not viable. We have agreed not to waste time trying to reinvent the wheel. Over the past few years there has been an increasing amount of information available aimed at developing a private pay practice outside of managed care. Many of the ideas presented at workshops by Drs. Dana Ackley and Arthur Kovacs, which some of us have attended, form the basis of our discussions. Dr. Dana Ackley’s book, Breaking Free of Managed Care, has served as a virtual roadmap touching a chord to which we all seem to resonate. In terms of content, we have focused on basic business concepts like developing a business plan, building a niche specialty, marketing, and fees. Each of our situations are unique, as a group we represent a variety of expertise and different financial pressures. We have made use of the DIV42 Listserve, which has been a wellspring of challenging ideas relevant to the group’s direction. Between meetings we try to stay in touch by E-mail so as to stay on task and maintain our level of motivation. We’ve begun to take a careful look at the business of business. Graduate school did not touch on these issues and we realize that in order to survive we will have to become a lot more business savvy. The function of the group is continually evolving. What follows are some observations about its process. It is really the group process that has worked the greatest magic. Those of us who have participated in peer supervisory groups before are aware that it takes time for a group to gel. Members have to get to know each other before they feel safe enough to share some of their most private feelings. What’s been amazing about this group is the almost instantaneous bonding between people who hardly know each other. In hearing each other’s frustration and anger we realize we are not alone, that there are others who truly understand. We talk freely. It seems that so many of our colleagues are either in some process of denial or have minimized the toxic impact that managed care has had on their professional identities. In listening to each other’s stories it is apparent how deeply we have been affected by the rapid changes in our profession. Certainly, the anger is readily apparent. The group provides a vehicle to vent. We’ve agreed not to dwell on the anger, but as good psychologists to interpret it, understand it’s roots, and use its energy in a constructive manner to move on. Some of us have been more affected than others, and the anxieties these individuals feel are real. It is not surprising to hear most of us admit to changes in mood sometimes bordering on depression. Probably the foremost process has been a gradual change in our belief systems. Many of us joined the group looking for a breath of fresh air to counter a prevailing climate of pessimism and hopelessness. The rapid rise of managed care has been compared to being overwhelmed by a huge tidal wave, to being at the mercy of forces beyond one’s control, to being victimized unfairly. The group has acted like a cool breeze to help mellow everyone out while the world seems to be collapsing around us. There is a free spirit, a reassurance not to worry, to relax, that everything is going to be all right. Some of us feel so strongly about the need to change that the only alternative is self-destructive burnout. For others there is a sense of bottoming out, where the taste of managed care has become so bitter, that there is no choice except to change. It’s almost as if we have had to embrace a certain sense of doom before being capable of turning it into a motivating factor for change. The group’s fundamental and primary purpose appears to be to set in motion this inner change, a restructuring of our basic professional beliefs, a self-transformation, an inner paradigm shift. We realize that we have to first face our own fears about change, to be willing to take the risk to leave our individual comfort zone before real change will occur. We accept that there are no quick fixes, that we must continue to face our fears about change, and to be persistent in moving in the direction of our inner convictions. Even if not initially a believer that one can have a viable independent practice outside of managed-care, then one is forced to rebut the challenges of others that do believe. Gradually, we see how others have made it work for them, accepted the sacrifices required, and found their independence. The group process has helped us to reframe this transition in our professional lives, to begin to see it more as opportunity rather than only as a crisis. The ambiguity and uncertainty of the moment has created a professional landscape with more texture than before. It’s a question of feeling comfortable in the midst of impermanence and uncertainty. In summary, what the group is really about is changing our perspective. It is about remaining optimistic inspite of upheaval. It’s about having self-doubt replaced by hope and confidence. As our feelings are validated we find the courage to take bolder steps. Many of us talk about being rejuvenated, as if there is a pool of creative and entrepreneurial talents we never realized we had. We acknowledge that as we move towards realigning our inner convictions with our outward actions we begin to feel stronger and more centered. We begin to find our voice; the voice that can respond to a phone inquiry from a prospective client with a convincing argument that it is in both parties’ interest to work outside of managed care. It is a voice of conviction. The group is also about accountability. It is hard to dig so deep into one’s belief system and then not to practice what one has found. There is a liberating quality to this process, as if one is being set free, that one’s tethers are finally being removed. We realize that we have a long way to go, but the group is a beginning. We are off to a good start and moving in the right direction. The group is still in an early stage of its evolutionary process. I would like to comment specifically on ideas which members have implemented that have led to viable income outside managed care, but most of these ideas are in the their early stages. The majority of ideas have centered on specialty niches, consulting, and marketing the idea of therapist-client relationship free of third party control. As a group we seem to be slowly and gradually moving toward the point where we can respond in our own individual ways. It seems in a way as if we are waking up and becoming ready to take more initiative and control. The SCPA mcFREE Support Group encourages others to consider forming their own group. It may be just the thing you are looking for at this time. Dr. Joseph Czekala is a Clinical Psycholgist who specializes in the neuropsycholgical assessment of learning disorders, forensic evaluations, and the treatment of sexual dsyfunction. He is a former President of SCPA and in full-time private practice in Miller Place, NY. He can be reached at Jczekala@suffolk.lib.ny.us |
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