When a psychologist gets sick
By Jewel Edwards-Ashman
If you’re Democratic presidential nominee Hillary Clinton, running a campaign in one of the most contentious elections in recent U.S. history, getting sick is probably one of the last things you’re worried about. The same could be said for a psychologist working as a solo practitioner or helping run a successful group practice.
As a psychologist, you may be in the middle of a “busy season” for your practice. You have a consistent level of clientele and you’re making a steady income. Most importantly, you’re fully invested in providing your patients with the best health care you have to offer. Then, in an unexpected turn, you’re hit with a medical diagnosis that forces you to reevaluate how much time you can commit to working. Your physician may even instruct you to take some time off.
Few psychologists entering private practice, or even working in an institutional setting, ruminate on that scenario, according to Jeff Zimmerman, PhD, ABPP, a co-founder of The Practice Institute and co-author of “The Ethics of Private Practice: A Practical Guide for Mental Health Clinicians.” As a consultant for health practices, Zimmerman says he finds that falling ill in the midst of running a practice isn’t a common concern for many psychologists. “There are often many immediate pressing priorities,” says Zimmerman. “Also, denial can kick in and we say, ‘This won’t happen to me. I’ll deal with it later.’” Similarly, Clinton probably didn’t consider that she would contract pneumonia just a couple of weeks before the first debate against her outspoken opponent, Republican nominee Donald Trump.
Everyone gets sick at some point. But what happens when a psychologist has to take a break from practicing to seek treatment for a prolonged illness or undergo a major surgery? How can psychologists protect their business and their patients? “Many practices have someone leave for an extended period of time for one reason or another. The key is whether or not the practice has a protocol or a management plan in place for such an occurrence,” says Zimmerman. He recommends that psychologists in solo and group practices work out a plan for addressing these three facets of practice that could be affected in the event of a prolonged absence:
- Front-end issues. Zimmerman says psychologists need employment contracts written that address the fact that the clinician won’t be working forever, either due to retirement, disability, illness or death. He says psychologists should also write contracts “for service that is being provided to outside entities that allow for other providers in the practice to offer that service if the primary provider is not able to work.” Zimmerman suggests that partnership and operating agreements for the practice need to specify what would happen if a practitioner has to miss work for an extended period of time.
Additionally, Dan Abrahamson, associate executive director at APA and APA Practice Organization, recommends that psychologists obtain key person life and disability insurance to shield their practice from any loss of income due to death or disability. When he started a group practice 30 years ago, Abrahamson and his partners purchased key person insurance. After several years of running the practice, they dropped the key insurance and took out individual disability policies because the practice had enough cash flow to survive a loss of revenue. Psychologists should assess their income needs regularly and make sure they have the right type of coverage in the event that illness prevents them from working, Abrahamson says.
- Business policies and procedures. Practicing psychologists should have a process in place for accessing important files and information. This includes passwords for electronic health records, voicemail and email. Zimmerman says there should also be instructions on how to do billing and handle compensation during an absence.
- Clinical decision-making. If they have to take time off, psychologists need to have a plan in place that ensures appropriate continuity of care for their patients, Zimmerman says. If there is advance notice of an absence, psychologists can plan more easily for the coverage for patients. Psychologists can determine how treatment would be provided, make decisions about handling former and prospective patients and figure out what to tell their patients.
Being upfront with patients and yourself
Zimmerman emphasizes that psychologists should tell their patients about any time when they might miss an extended period of work. “A general rule of thumb is to take great care and be very mindful of what and how patients are told. It matters how the information is presented and how we anticipate the patient will take the news. This will vary across patients,” Zimmerman says.
Finally, Zimmerman says, self-care for the psychologist experiencing the physical health problem is crucial. He says psychologists should evaluate, seeking input from trusted colleagues, how much work they can confidently and competently take on while not putting themselves or their patients in danger, as they cope with their illness and hopefully recover.