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Book Reviews   |    
Money and Outpatient Psychiatry: Practice Guidelines From Accounting to Ethics
Reviewed by Jerome Rogoff
Psychiatric Services 2006; doi:
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by Cecilia M. Mikalac, M.D.; New York, W.W. Norton and Company, 2005, 390 pages, $45

Dr. Rogoff has a private practice of psychotherapy, psychoanalysis, and forensic psychiatry in Waban, Massachusetts.

A book with this title, on this subject, should be more effective than zolpidem or temazepam. It is a tribute to Dr. Mikalac that the book is anything but sedating. Although not exactly a can't-put-it-down thriller, it is the book I wish was available when I began practice long ago, and even at this advanced stage of my career, I found much of real use to learn from it.

Dr. Mikalac, a psychiatrist in private practice for over 15 years who teaches a course on these matters at the American Psychiatric Association's annual meeting, has organized her book into three broad areas: "Managing Money Within Your Practice," "External Financial Influences," and "Managing Money With Patients." She finishes with three appendices: a sample introductory sheet to give patients at the outset of treatment, a sample insurance information sheet for patients, and a list of suggested further reading. The first section deals with the economics and financial organization of starting a practice, legal and ethical issues, accounting, taxes, billing, and accepting payment. The second chapter in this section, on legal and ethical issues, is masterful and should be required reading not only for those in training but for every practitioner.

The second section explores in detail health insurance, managed care, the influence of the pharmaceutical industry on practice, monetary incentives and conflicts of interest, and gifts. The third section covers patients and insurance, talking about money with patients, fee reductions and increases, and managing nonpayment. The final chapter in this section, "Money Transferences and Countertransferences," should become a classic, as it is a thoughtful, wise, and helpful entry into an area that is seldom mentioned in training but vital to the understanding and management of self and patients in therapy.

Dr. Mikalac seems to be somewhat optimistically naïve about the insurance industry, voicing a wide-eyed confidence in its generally good and honest intentions, as if the racketeer-influenced corrupt-organizations suit, which alleged criminal behaviors toward patients and "providers," had not been brought and settled by all the big companies. The settlements may have occurred after she wrote the book, but the suit had been brought before. Similarly, she makes no mention of the Health Insurance Portability and Accountability Act and its impact on practice, including an at least partial economic choice about whether or not to become a "covered entity." That discussion would have been helpful.

A few minor quibbles are that either Dr. Mikalac or her editor should look up the difference between "forgo" and "forego," the difference between "less" and "fewer," and the use of the word "assignation" to mean assignment or assigning. Although technically correct, the alternative and more used meaning of assignation makes her use of it risible.

This a very valuable, well-written book of particular importance and utility for those starting out and in their early career and well worth the time for all the rest of us to dip into selected topics. I recommend it highly.

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