Having a Raid Mentality

Lately I’ve been speaking about Epic Therapists and some of the qualities they have.  I’ll be doing more of that in the future, but I wanted to discuss today the concepts of gearing up and raids as they apply to your practice.

Why do gamers try and fail and try and fail and try when they raid?  To feel the optimism Jane MacGonigal refers to in her book “Reality is Broken,” is one.  The loot is another.  Loot often consists of higher level “gear,” armor and weapons than you already have.  So the idea of gearing-up is to fight harder and harder bosses to gear you up so you can see the higher level game content.

Players can’t fight those higher monsters alone, so they participate in Raids.  Raids are groups of 5, 10 or 25 players who choose to group up so that they can explore the higher level dungeons, defeat the more powerful bosses, and share the loot.  For raids to be successful the individual players need to be able to learn from each other, know what their job is, strategize, and get along.  When I first starting playing my mage, a wizard-type character with weak armor, I didn’t understand that my role wasn’t to get close to the boss, so I’d run in and start attacking the boss up close and get killed instantly.  Over time and with the help of other raid members I learned that the role of the mage is to run away from big things, hide, and shoot very dangerous spells from a great distance.

Once gamers can do that, they begin to be aware that each boss has a different strategy, and they begin to talk, think and plan with other raid members how best to defeat it.  And people listen, think and perform best when they are feeling a sense of camaraderie rather than a sense of hostility.  So often if a player is nasty or selfish they won’t be invited to raid with a group.  So if you want to get geared up, you need to be a team player.  You need to commit to work with others for hours at a time, do your research, strategize, and play nice and fair.

So what can therapists learn from gamers?

1.  Commit to Work with Others

Therapists have been notorious loners in many ways.  Once we get into private practice we are often very isolated, and when we meet up with our colleagues we often don’t engage with them as members of the same team.  There is a certain amount of oneupsmanship and caginess that I have often experienced.  An example of this is how there are times when everyone I meet has a practice that is full and going well.  Business is booming, and yet, at the end of the conversation I or my colleague will mention casually that we “still have a few openings,” available and are accepting referrals.

Come on.

First let’s ask all of those private practice folks who are full up to stop reading, because you really don’t need to hear anything else that’s coming up, given you have a flourishing business.  So go have a coffee or something.

Ok, for those of you who are still here, let’s get real for a second, you and I.  We’re not full up, we just don’t want to sound like we are empty.  Of course we want to keep getting referrals, and even if we are busy for the next couple of weeks we may have a suggestion about who else could see the person.  And we’re not alone, or else why would there be all of these workshops and consultants (including yours truly) offering to help us learn how to grow our practice?  Nope, we may have a full schedule for the week, but if someone were to give us a referral, we’d probably take it if the patient sounded like a good fit.

Look, health care reform is heating up, and we are undergeared.  We therapists need to get a raid mentality.  We need to find and connect with our peers and have a sense of community.  We need to network and reach out and get to know each other.  To do that we need to be honest with ourselves and others, and let each other know when we have openings and not posture like we’re the next Freud.  We’re not, our business will ebb and flow and there are lots of therapists out there, so to grow and have a flourishing practice means we’ll always need to acknowledge that we could cultivate more business.

2.  Know Your Class

What are your talents and abilities?  Who do you work well with?  If you tell me that you like to work with everyone I will never EVER refer to you.  Promise.  I do not believe that a therapist can excel in treating every age group and every diagnosis.  I don’t refer to Jacks-of-All-Trades-and-Masters-of-None, because there are too many excellent therapists out there I meet and know who are Masters-of-a-Few-or-One. And the same applies for me:  If you are looking for a gamer-affirmative therapist, an LGBT therapist, or an adolescent therapist who does psychodynamic therapy, I’m your guy.  If you are looking for an expert in DBT or CBT, it is not me.  If you are looking for an expert in geriatrics, I do not have that expertise.  And if you are looking for someone who is good with “trauma, anxiety or depression,” I can take your referral, but there are probably 500 other people who are able to work with that vague population.

Now that you know your class, get to know the class of others.  That way when someone wants to refer someone to you for EMDR, you can recommend a good colleague, and you’ll probably get future referrals because you were helpful to boot.

3. Do Your Research

Epic therapists are always researching what they need to learn to get better geared to do therapy.  For me getting geared up means regular supervision with someone I trust, an ongoing peer group or class such as the MIP Fellowship, reading articles recommended to me, keeping an eye on Twitter, reading KevinMD.com, having coffee with colleagues, downloading and playing free trials of video games, going on Harvard Med Schools eCommons for current articles, and reading Hendrik Hertzberg in the New Yorker every chance I get.  Yes that’s a lot of work, but notice how much of it can be social in nature.  And really, so much of it can be fun too!

Another great way to do your research is to teach a workshop.  Few things clarify and educate me the same way that preparing a workshop for my grad students or colleagues does.  If you can’t think of what you could offer a talk on, please go back to number 2.

4.  Strategize, strategize, strategize

Health care reform is on the way.  It is ramping up in MA already, with our Governor’s push to have MA lead in reform.  ACOs are being developed.  The insurance companies are strategizing how to maintain their profitability.  Our second and third largest announced a merger this week.  Our professional groups are strategizing to have a place at the table when it comes to legislating.  Some providers are forming ACOs or trying to, because they realize that whoever gets there first has an edge.  Protesters are strategizing as well.  Those of us in solo or small practices need to get our raid group ready, and to do that we need to strategize:  What do we need to do to support our patients? What’s our business plan?  How can we help each other?  This is something you hear my colleagues Susan Giurleo and Juliet Austin talking about a lot, and for good reason.  We are about to see a seismic shift in how we can make money as therapists, and without a strategy we are going to “wipe,” as the say in WoW.

5. Play Nice and Fair

Things are about to get a lot more competitive out there, but they don’t have to get adversarial.  There are lots of people to help, lots of ways to do it, and we have our fellow raid members to help us.  Share those referrals with the colleagues in your raid.  Write emails introducing them and their specialties to your referral sources.  Pay it forward by helping them publicize their work and workshops.  Take one out to coffee when s/he is having a hard day.  Listen to their challenges, and talk about yours.  I firmly believe that the more authentic and supportive you are to your colleagues, the better it is for the whole raid.

As gamers say when their raid is about to rush into battle, “Incoming!”  We are about to engage in perhaps the biggest battle to maintain our businesses and protect the work we do with our patients.  None of us will be able to fight those battles alone.  If you are in it for the win, group up!

Comments

  1. Mike,

    Thanks for this most informative post. It contains important gold nuggets of career advice for anyone who is already in practice or considering opening up a practice a few years out.

    The idea of working together with one’s colleagues to act as sources of referral, as people with whom one may brainstorm and share resources, as supportive friends when one has had a hard day doesn’t just make sense career-wise, it is probably going to be the only way to survive in the changing health-care environment (plus it makes the whole journey sound much friendlier).

    I also appreciate how you find a way to indirectly educate those of us with non-gaming experience on how gaming works 🙂

  2. You are seriously broadening my horizons. Ugh, I can tell this is going to be SUCH a stretch. And thank you.
    Question; How do you think this seismic shift will impact therapists who are cash pay and do not work with insurance?

    • Glad to hear you are finding the blog useful. Here’s my predictions, based on recent thinking and conversations with my colleague Susan Giurleo and others:

      The magic number I am hearing for ACO structure is 10-15 clinicians along with 50 doctors per 5K to make ACOs work. This really does raise the question of whether mental health is scaleable, even when it is just the more chronic mentally ill.

      I doubt most folks in ACOs will be able to get 8 sessions at that ratio, because if my math is right (always a big if) 10 therapists times 40 hours is 400 sessions a week. And if we take those figures from my blog and estimate that 10-20% of people in a given population have mental illness, that would require 500-1000 appointments the 5000 need. So weekly Tx is out, because the ACO can only offer 400 a week, let’s see about even your 8 sessions a year: 4000-8000. Looks to me that at best biweekly or monthly treatment would become to norm. And of course there will be the pressure to discriminate on the one hand, and if the MH benefit is capitated separately overtreat some on the other. Not the work environment I want. Those of us not in ACOs will be working with more people presenting needing self-help rather than medically necessary treatment, and need to self-pay.

      And I also therefore predict that all of us will be pressured to lower our fees to be competitive just because of simple supply and demand. Alternately those of us who can brand ourselves and get known for good work may be able to avoid reducing our price, but it will be very competitive. Those of us who grow our online therapy practice may fend this off a little longer by working with straggling states, but ultimately that will become as competitive.

      When I tell many of our colleagues this they think I am being Debbie Downer, and I’d love to be wrong about this. But our professional organizations are focusing on being at the table to help shape legislature, not protecting private practices.

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