December 13, 2023

How to Thrive in Private Psychiatry Practice: Overcoming Challenges and Embracing Change

Written by

Carlene MacMillan, MD

For the forward-thinking mental health clinician, the promise of private practice is alluring: More autonomy, no cap on pay, and flexibility to see your preferred patient population. But between regulatory changes and innovative treatments like psychedelics reaching dinner table conversations, how do you stay ahead of the curve without burning out?

Osmind gathered three entrepreneurial private practitioners from our Community Advisory Board, including Dr. Kristin Budde, Dr. Erick Sheftic, and Dr. Raghu Appasani, to discuss how you can thrive—whether you’re in the planning stages of launching your private practice or already taking patients.

Read on or listen to glean their insights on not just surviving, but thriving in private psychiatry practice— from emerging research and practice trends to addressing burnout and niching down.

The expert panel is comprised of a sample of Osmind’s Community Advisory Board:

  • Dr. Kristin Budde
  • Dr. Erick Sheftic
  • Dr. Raghu Appasani

Moderated by:

  • Dr. Alison McInnes, VP of Scientific Affairs at Osmind
  • Dr. Carlene MacMillan, Chief Medical Officer at Osmind

The Rise of Interventional Psychiatry and Holistic Treatments

In pt. 1 of this breakthrough series, experts discussed how “Interventional Psychiatry” will likely simply become “psychiatry.”

Dr. Kristin Budde echoes this shift, mentioning the growing importance of treatments like Transcranial Magnetic Stimulation (TMS) and Ketamine. She expressed hope for these treatments to become more democratized, akin to the evolution of Suboxone.

Furthermore, Dr. Budde advocated for versatile models of care in private practice.

"I like the idea of having a holistic clinic...really like think about what’s best for [the patients],” she remarked, highlighting the need for a comprehensive treatment approach.

Shift to Metabolic Psychiatry and Collaborative Care

Dr. Raghu Appasani, focusing on the intersection of metabolic health and psychiatry, spoke about the transformative impact of incorporating nutritional and lifestyle changes into patient treatment.

Drawing from his own experience, he shared how this integrative approach has enabled many patients to taper down or discontinue certain medications, improving their overall quality of life.

“It’s allowed me to get a lot of individuals off of certain medications or taper down on medications and just improve overall quality of life,” he shared.

Dr. Raghu Appasani emphasized the critical need for resources and ongoing education on metabolic psychiatry.

He highlighted the following as great starting points:

  • Chris Palmer’s book “Brain Energy”
  • Dr. Drew Ramsey’s Brain Food Academy
  • Metabolic Mind initiative
  • Courses from the Integrative Psychiatry Institute as great starting points to go beyond traditional psychiatry training and sharpen your metabolic psychiatry toolkit.

Dr. Appasani also highlighted the importance of building a network of diverse health professionals, including nutritionists and functional medicine doctors, to provide a more comprehensive and collaborative care model.

This approach, he believes, is essential for psychiatrists, who often become the primary care providers for their patients due to frequent interactions. Dr. Appasani’s insights and experiences advocate for a shift towards a more holistic, integrated form of psychiatric care that goes beyond medication management.

Addressing Challenges in Private Practice: Navigating Accessibility and Education

Accessing life-saving mental health treatments remains financially out of reach for those who need it most.

Dr. Kristen Budd recounted specific instances from her practice to underscore inequity in access, especially with ketamine treatments, which aren’t covered by insurance, and cost as much as $600-$1200 for an infusion, with 6 infusions being the standard clinical protocol.

"I have an outpatient who has good insurance that doesn’t cover ketamine. So if he wants Ketamine, he has to drop four grand to get a series of ketamine in the community," she shared.

Another poignant example Dr. Budde provided was of a pregnant patient in dire need of TMS:

"I have a woman in her first trimester who really needs TMS, and the MGH TMS clinic will not treat her in the first trimester for reasons that frankly aren’t clear to me," she explained.

These stories from her practice vividly demonstrate the barriers in accessing mental health interventions, reinforcing Dr. Budde's assertion that "Access to these interventions remains problematic," and emphasizing the critical need for broader accessibility and affordability in mental health care.

How can we address these insurance and access burdens?

Read next: The State of Innovative mental healthcare pts. 1, 2, and 3.

Burnout in Psychiatry: Causes and Solutions

Dr. Sheftic delved into the issue of burnout, characterizing it as a widespread and systemic problem in psychiatry and medicine at large. He described the disillusionment many psychiatrists experience upon realizing the lack of autonomy and decision-making power in their roles. “The light at the end of the tunnel of attending hood is kind of dim,” he reflected, highlighting the mismatch between expectations and reality.

"Burnout is a systemic problem... these systemic problems require systemic solutions and workplace solutions,” he argued, underscoring the need for comprehensive approaches beyond superficial wellness initiatives.

Is Private Practice the Solution?

Exploring potential solutions, Dr. Sheftic proposed private practice as a way for psychiatrists to regain autonomy and self-efficacy.

“How do I get autonomy and self-efficacy back?... The way to do that is to strike out on your own,” he suggested, pointing out the empowerment that comes from creating and managing one's own practice.

He shared his experience, where making decisions based on patient care and personal wellbeing brought a sense of satisfaction and control often missing in larger healthcare systems.

Collective Action and Unionization

In addition to considering private practice, Dr. Sheftic spoke about the importance of collective action in addressing systemic issues. He proposed strengthening professional organizations and considering unionization as means to combat external constraints and advocate for the rights of psychiatrists. “Whether that’s unionization or, you know, strengthening our professional organizations to fight for us, is gonna be the way to do it in these larger structures,” he stated, advocating for collective efforts to enhance autonomy and reduce burnout in the field.

Psychotherapy as a Path to Professional Fulfillment

Dr. Alison McInnes shared her personal experience in combating burnout, emphasizing the pivotal role of psychotherapy in her professional rejuvenation. “It was finding my way back to psychotherapy that has saved me,” she stated, underscoring the therapeutic value she rediscovered in this practice. Dr. McInnes initially re-engaged with psychotherapy through ketamine-assisted sessions but soon realized her preference for traditional psychotherapy. This return to the fundamentals of her training provided her with renewed purpose and satisfaction in her work.

The Impact of Integrating Therapy and Medication Management

Dr. McInnes also spoke about the transformative decision to integrate psychotherapy with medication management in her private practice, moving away from medication management alone. “Now I only see in my private practice patients who I'm doing both psychotherapy and med management. I'm not doing any med management by itself,” she explained. This integrated approach allowed her to form deeper connections with her patients and engage more holistically with their treatment, significantly enhancing her professional satisfaction and helping to mitigate feelings of burnout.

The Importance of Defining a Niche in Private Practice

In a dynamic healthcare landscape, defining a niche has become crucial for private practitioners. The panelists shared their experiences in identifying and establishing their niches, weighing the benefits and challenges of being a specialist versus a generalist.

Dr. Sheftic emphasized the significance of understanding the needs of the community when defining a niche. “What are the needs of your community? So practicing in a rural area versus an urban area... would influence how necessary it would be to develop a niche,” he explained. He illustrated this with an example, noting that being a generalist might be essential in a rural setting where you're the only psychiatrist, while in urban areas, there's more room to specialize.

Reflecting on his own experience in starting an interventional psychiatry clinic, Dr. Sheftic discussed how identifying unmet needs in the community can lead to defining a niche. “We were coming from a generalist stance... And then we looked at each other, my business partner and I, and said, why not us?” he shared, describing their decision to meet the demand for specialized treatments.

Balancing Specialization with General Psychiatry

Dr. Sheftic also addressed the personal aspect of choosing a niche, and aligning it with individual preferences and visions for one's practice. “When you envisioned yourself as a psychiatrist, what kind of patients did you want to see? What kind of boundaries did you have in your clinic?” he asked, highlighting the importance of personal satisfaction in one's practice. He shared his preference for specialization, “I like being a specialist because it feels good to be an expert.”

However, he acknowledged the ongoing need for generalists in psychiatry, especially considering the shortage in the field. “Being a generalist and having all these different options available to you... is still totally needed,” he stated. Dr. Sheftic concluded by tying the choice of a niche to overall job satisfaction and burnout prevention, advising clinicians to align their practice with their values and what feels fulfilling to them as professionals.

While specialization allows for deeper expertise in certain areas, being a generalist offers the flexibility to address a broader range of mental health issues. The panelists agreed that this decision often hinges on personal interests, community needs, and market demands.

Embracing a Specialized Focus to Provide a Specific Type of Care

Dr. Raghu Appasani shared his perspective on establishing a niche, particularly in the context of his focus on metabolic health and nutrition in psychiatry. “Establishing a practice was the route to take to really provide this kind of care,” he mentioned, discussing how this specialization was a response to the tension he experienced during his training regarding treatment approaches. Dr. Appasani's decision to start his own practice stemmed from his desire to integrate these specialized areas into patient care.

Navigating Challenges and Learning from Community

Acknowledging the challenges of solo practice, Dr. Appasani emphasized the importance of transparent conversations and learning from others. “There’s a lot of unknowns that we don’t learn about and how to do this type of work,” he said, highlighting the value of communities like the Osmind practice community in offering support and advice. Dr. Appasani also touched on the importance of setting boundaries and understanding one's capacity as a solo practitioner. “Who are you ethically able to provide the best care for?” he questioned, underlining the ethical considerations in patient care.

Building Networks and Staying Open-Minded

Dr. Appasani advised on the importance of staying open-minded and building a supportive network. “Make sure you create that network, and also just a consultation group too,” he suggested, stressing the significance of collaboration and consultation in private practice. He also noted the shift in patient care dynamics when moving from a residency or group practice to a solo practice, especially when dealing with complex, high-risk patients.

Adapting to Community Needs

The discussion highlighted the importance of adapting to the needs of the community, whether in rural or urban settings. This adaptability not only ensures that practitioners meet their patients' specific needs but also allows them to carve out a unique space in the mental health landscape.

Facing Your Fears of Starting a Practice

Dr. Kristin Budde shared her personal reflections on the daunting aspects of starting a private practice, especially for those unfamiliar with entrepreneurship. “It is incredibly scary to start a practice,” she admitted, relating to the apprehension many feel when venturing into the unknown territory of running their own business. Her experience resonates with many who come from backgrounds where such a leap is not commonplace.

Leveraging Support Networks and Part-Time Opportunities

Emphasizing the value of support networks, Dr. Budde mentioned how connecting with peers who were also starting practices was beneficial. “I have some friends from residency who sort of started private practices at the same time, and that was really helpful,” she said, highlighting the comfort and guidance found in shared experiences.

Dr. Budde also discussed a pragmatic approach to easing into private practice, as advised by a seasoned psychiatrist. “Get a part-time job or many part-time jobs and like get one and then build up your private practice and then quit,” she shared, suggesting a strategy to mitigate anxiety and financial risk. Interestingly, Dr. Budde found satisfaction in her part-time role and chose to continue it alongside her practice, underscoring the potential for diversifying professional experiences. “I got a part-time job and I really like it, so I’m probably not gonna quit,” she revealed, illustrating how balancing different roles can enrich a psychiatrist’s career.


The Breakthrough Mental Health Treatment Forum offered a wealth of knowledge and guidance for current and aspiring private practitioners. The insights shared by the panelists underscored the dynamic nature of psychiatry and the need for a forward-thinking, patient-centric approach in private practice. As the field continues to evolve, embracing innovation, collaboration, and continuous learning will be crucial for those seeking to make a meaningful impact in mental health care.

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