I've probably always been too much of an idealist and a dreamer when it comes to social problems and the realities in which we live today.

Avoiding challenges has never been my style. Even when selecting what types of patients to treat, the more difficult cases have seemed to find their way to me. I have learned so much about human behavior, and the world, over the past several years. I have learned my limits much better over time. I went to medical school hoping to one day make a difference. Upon graduation I felt I could do this most effectively as a psychiatrist and set out to meet the necessary requirements for practicing this art. I have engaged in the practice of psychiatry for over a decade now and feel another crossroad is inevitable in the near future.

I chose to practice within the public sector because the need seemed so great and I felt my efforts would be most rewarding here. I have worked in outpatient clinics, hospitals, jails, detox units, nursing homes, and office based. The work was always interesting but the systems did not always agree with me or me with them. Private practice has been the most fun, in most aspects, excluding the business component. Even with above average business skills (which I clearly lack) it has become quite difficult for one to get out and stay out of the red. It almost makes me want to cry when I think of the money owed to me that will never be collected and the ongoing game playing with third party insurers who will do anything to avoid paying you what is owed.

Even the North Carolina General Assembly Members in Raleigh admitted during a public forum on UNC TV Sunday that no doctor can afford to keep their doors open if they treat mostly Medicaid and Medicare patients. One in eight citizens in the state receive Medicaid. Cigarette smoking has been identified as a major contributor to consumption of health care dollars but lobbyist have fought to avoid further taxing of cigarettes. They admitted that North Carolina had taken the biggest hit in the nation in regards to lost and outsourcing jobs. Doctors in the town where I work have begun to go out of business. The ones closing up shop seemed to be seeing similar patients to the ones I see. The writing is on the wall, especially for mental health care. I felt better knowing that the General Assembly at least is not ignorant of the situation. They are quite aware of the fact that our state is screwed big time in continuing coverage for those in need of mental health services. They openly admit to having no solutions to the problem. Meanwhile, the area mental health programs slowly grind to a halt and the state mental hospitals begin to shut their doors  as predicted over the past years.

My hybrid private practice now open to referrals from the Mental Health Center has about reached its capacity. There are zero other providers in town accepting Medicaid or Medicare. Daily, I become more resentful of being told what I can and cannot prescribe. It only gets worse. Most of my joy came from autonomy and having control over major treatment decisions. This was even more important to me than the financial losses. I do not care for managed care organizations in the least. It is quite clear that they run the show. A perfect storm between managed care and the pharmaceutical industry is imminent. At least the pharmaceutical companies provide a useful service and product. Managed care organizations have one goal, which is to save money for their own use. I feel suspicious of any business whose purpose is to deny one their own benefits. In my opinion, that is why 50 million Americans don't have access to health care, the money is being siphoned away for administrative purposes to deny care to those who are insured. The bottom line once again is "who really cares?"

I once hoped I could retire from the type practice I'm doing now but must face the reality that things are not going to get any better than what the current state of affairs are. I really like the vast majority of the patients I treat and most of the time thoroughly enjoy the work I do. Taxes and overhead are unavoidable realities. For most politicians, whether my practice survives or not is irrelevant. When the 2008 election comes, many voters will again vote against their own best interest. According to Comedian Al Franken, voters will likely be swayed again by campaigns of Fear, Smear, and Queers. I have done the job I do out of choice, not necessity. Out of curiosity, I have found employment offers out in the private sector that would offer several times the yearly money I make with what I am doing now. At some point it becomes foolish not to consider entertaining such offers. Why should I struggle if I don't have to? I have no idea what will become of public sector mental health care but I predict it will not be good. It's a fact that funding for prisons has risen as funding for mental health care has been slashed. However, I will not speculate on that matter. I consider myself a voice in the wilderness and though I never found an effective means for changing things for the masses, I always cared about what the fate of the system would be. I still do. I suspect in 30 years after all the foolishness has failed, I'll probably hear of some young genius using my ideas to advise the leaders of how to fix the catastrophic mess they made of the mental health care system.