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An MBA Journey in the World of Psychiatry

In this, my first contribution to the BioPsychoSocial field journal, I will introduce myself and my journey as a business administrator in the oft-confusing and frequently not-so-business-like field of outpatient psychiatry. The introduction will take the form of a list of seven facts.

  1. I have an MBA. I’ll write more about that later. You may think you already know what having an MBA means, but you may be surprised about how I’m using mine. True fact: most outpatient psychiatry practices don't have an MBA on staff. I'd like to change that!

  2. I have professional experience in the field of health care quality improvement: I like to measure things and work to make them better. When I was the manager of a quality improvement research program at Dartmouth-Hitchcock Medical Center, for example, I worked with health care providers and staff, from a myriad of departments and specialties. All shared a goal of improving patient care and/or reducing costs. Under the guidance of a committee of published researchers and a statistician, I provided support for 18-month long trials designed to observe, measure and report on the impact of new health care ideas. That experience, "putting legs on" clinical ideas and finding ways to track processes and outcomes, informed the culture we created at Pondworks.

  3. I’m married to Bernard Kim, the psychiatrist who founded Pondworks. In the beginning of his practice, straight out of residency, I was “just helping out." I created forms, met with a CPA, and set up billing and bookkeeping systems. I imagined hypothetical patients—since that was all he had back in those days—and mapped out the office systems we would need as they flowed through the process. Since then, my role has grown significantly. I now oversee office operations and business development, which means I am very busy and get to work on many different aspects of running and growing Pondworks. It's a challenge!

  4. I genuinely care about people. I feel like that is important to say, since it's not hard to find folks who blame administrators in general, and MBAs in particular, for everything that's wrong with health care. All of my work comes back to the patients, whether it's supporting Pondworks' providers, managing staff, choosing software, arguing with insurance companies, working on our website, or writing letters to elected officials. I stand up for the best care—based on what's possible, not just "the way we've always done it." I never want to forget that investing in one's mental health is a big deal. Whatever the circumstance that led them to Pondworks, I want patients to feel comfortable, gain trust, and feel supported. Above all, I want them to grow through and beyond their past and current challenges. I want our patients to have great lives and to help make high quality Psychiatry available for greater numbers of people I am curious, driven to create, and very determined...As far as I know, I have had the opportunity to do things no other business administrator has done.

  5. I have a strong bias about “orientation.” When we started, while my husband drew from his residency experience with established psychiatric patients in various settings, I took a different tack by considering newcomers who had never before sought mental health care. I thought about how their only experiences with psychiatry might have been from watching TV characters, like Frasier, Bob Newhart, or Tony Soprano, or in movies, like (heaven forbid!) “One Flew Over the Cuckoo’s Nest.” I wanted to de-mystify psychiatry and somehow persuade potential patients that it could meet them where they were, just as they are. I wanted to simplify jargon into terms anyone could understand. I wanted them to feel like "mental health care" was for them.

  6. Over the last 14 years, I have discovered that there are many confusing things about this field! To rattle off yet another list, there’s

a) the way medicine doesn’t always operate like other consumer businesses; b) the arbitrary and counter-intuitive division between the mind and the body; c) the collection of weird rifts and turf battles—like the one where other types of doctors don’t always take Psychiatry seriously or treat its practitioners or patients particularly kindly. And just within the specialty of Psychiatry, there are rifts between those who prioritize psychotherapy and those that prefer medications. Further complicating my work (and often obstructing it), there’s

d) the rift between providers and insurance companies, and e) the fact that many patients do not understand how their insurance works. Of those that do, many patients with insurance still can't find or book an appointment with a psychiatric provider.

Also confusing, there's

f) denial. For example, an estimated 64 million Americans are diagnosed each year with a psychiatric diagnosis, and large numbers take psychiatric medications prescribed by their primary care doctors. But when we as a society conjure up an image of a person who suffers from a mental illness, an institutionalized or homeless person is most likely to come to mind. Last, but definitely not least, g) it's challenging to prove that psychiatry "works," at least by the most esteemed empirical standard, the randomized controlled trial. Now you probably feel confused! Don’t worry, I will write more later about each of these confusions. We're just getting to know each other!

7. The seventh thing you should know about me, and the last one I’ll share for now: I am curious, driven to create and very determined. Since 2004, and to a higher degree since 2013, I have tried to both help patients to access high quality outpatient mental health care and create a great workplace. Those simple goals have led me on an adventure that I look forward to sharing more about in future posts. Stay tuned to read about bridging the rifts, bucking the trends, pulling out my hair, occasionally saving the day, and asking “why?” more times than I will ever be able to count. As far as I know, I have had the opportunity to do things no other business administrator has done. If you know differently, please comment and put me in touch with others—I’d love to have company and compare notes!

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