It’s sad to see as a healthcare system we still have not adopted the collaborative-care model of medical care where psychiatrists and primary care physicians work hand-in-hand with patients who require both types of speciality care.  Sadly it is nearly impossible to make this system work in the rigid, broken health-care system we have today.  I started a collaborative care clinic as a 4th year resident (last year) and it was embraced as a completely “novel” concept and gained much support.  While this was great, it was sure disapointing to realized this model still seemed “novel” to most clinicians and adminstrators.  I combined psychiatrists with internal medicine physicians in the same office.  We would both evaluate patients if necessary, have a discussion about the patient, coordinate care and assure that the patient was recieving the absolutely best care possible by combining the knowledge of two physicians who each had specific expertise.

The idea is so obvious and the benefits do not have to be explained yet why does this not exist? Not surprisingly, the answer lays in the medicare/insurance system we utlized.  Insurance companies and medicare has become such unstoppable jugernauts in todays healthcare system that they dictate what is allowed to happen and what will not happen.  The beauracracy is ludicrous and most people cannot imagine how many “Middlemen” are involved in providing care through this system.  Ideally insurance would realize it is not only better for patients (tons of evidence exists for the benefits of collaborative care) but also realize it will save them tons of money!  Since the savings will not be immediatly realized they cannot look past this and thus have long resisted any change in how physicians deliver care.

Well-again the solution lies in removing the insurance companies from the equation and leave it to some savvy concierge doctors around the country to start the movement of truly integrated collaborative care.  As my practice grows I am finding that I have some great internal medicine/family medicine primary care colleages who are taking on a much more collaborative approach. One physician I work closely with is Carrie Bordinko MD of ConsolareMD who operates a personalized house-call practice providing top primary care services and she has a very similar model as mine and we both have very similar approaches to how we treat patients. This has led to the first and only true collaborative care model with a personalized psychiatrist and primary care physician in the country.

The problem with traditional medicine is insurance and ultimately the lack of time physicians have. In a traditional medical practice, patients have 10 minutes with a primary care physicians.  Typically they have 15-20 minutes at most with a psychiatrist.  The doctors see 3-5 patients per hour, then have to file insurance papers, complete their documentation, make phone-calls etc etc. This leaves no time to go above and beyond to discuss cases with other physicians and truly collaborate.  So while physicians need to take responsibility for changing and providing better care, they cannot be held completely responsible for the conditions in which doctors are forced to practice in order to survive-this was managed care and medicare’s fault.

The solution-quite simple. You take a top primary care physician like Dr. Bordinko MD who operates a concierge practice and team up together in order to provide the most absolutely comprehensive care that is imaginable.  This recipe has been a huge success in terms of our patients healing both mentally and physically in a manner that they have never been able to do in the past.  We are confident that we provide the best and most unique service in the country and we are proud to continuing growing together as a team.

Thankfully there are some other great concierge primary care doctors I have had the privelage of working with.  We all work closely together anytime there is a need for medical-psychiatric care as we both believe strongly in the importance of the mind-body approach.  Although that term is often thrown around and overused, we truly do provide the highest level of both aspects of care and we continue to see the incredible success of our patients time and time again, which reinforces the importance of our approach.

Carrie Bordinko MD has her practice Carrie Bordinko MD-Personalized house-call primary care


Michael Yasinski M.D