Panel Discusses Tips for Setting Up Successful Virtual Office

The onset of the COVID-19 pandemic in 2020 was a hurricane in many respects, including the rapid and sweeping change it brought to mental health practice. In a matter of weeks, video-based communication grew from a modestly used practice to the standard for both patient care and business practices.

As Jay Shore, M.D., M.P.H., the director of telemedicine at the Helen and Arthur E. Johnson Depression Center at the University of Colorado Anschutz Medical Campus, noted, this sea change has almost completely evaporated all boundaries between the work and home lives of psychiatrists. This constant “connectedness” has contributed to the rising incidence of burnout and depression in the profession.

But while boundaries have shrunk, flexibility has increased in the new virtual world, Shore continued. Even as more people return to in-person gatherings, this is still an opportune time for interested psychiatrists to restructure their practice to be more telepsychiatry focused. At a session today, Shore led a panel that discussed how people can successfully integrate telepsychiatry into their lives. He was joined by Ed Kaftarian, M.D., the chair and CEO of the telepsychiatry company Orbit Health, and Steven Chan, M.D., M.B.A., a clinical informaticist and addiction physician at Palo Alto VA Health.

Kaftarian discussed the federal legal and regulatory landscape of telepsychiatry, which he noted remains a dynamic and convoluted state of affairs. Many of the rules and waivers set up in the early days of the pandemic to make telepsychiatry more manageable are still in place, he said, but psychiatrists should check frequently for any changes. One specific item he cited was the waiver of the requirements of the Ryan-Haight Act during the pandemic that made it easier to prescribe buprenorphine, which will end once COVID-19 is no longer considered a national public health emergency.

Also, while people may be familiar with some of the national laws, each state has unique elements to their telepsychiatry regulations; for example, in Indiana a patient on a telehealth visit waives all rights to confidentiality if a family member or someone else hears any portion of the session. Kaftarian said psychiatrists interested in getting licenses in other states should look at state laws closely, particularly laws related to patient consent.

Once administrative issues are resolved and psychiatrists are ready to start a telepsychiatry practice, they may wonder how to attract patients, especially if they are starting a new career. One option is to join an existing telepsychiatry provider, which is a vibrant and growing field. In addition to Orbit Health, there are groups such as American Well, Wheel, Bicycle Health, and others.

For those who want to be independent, Chan told the audience that the best way to reach people interested in using technology for medicine is to make other technologies work for you. Anyone who feels tech savvy can set up their own website, even with a web domain in their name. Some consumer-focused mental health sites also have sections where therapists can post contact information for people looking for therapy.

Once psychiatrists have an online hub, they should set up professional social media accounts—trying to make sure to use the same name for each platform to avoid confusion. Chan added that there are apps called social media managers that coordinate posting messages across multiple platforms and scheduling posts at set times, so psychiatrists don’t have to spend hours on end on these platforms. Chan also noted that in his experience, it takes only a few introductory posts to get people to notice, which is not surprising given the well-known gap between the supply and demand of mental health professionals.

Kaftarian added that a growing trend, especially among younger psychiatrists, is to include some personal information on their web pages as a way to humanize themselves to prospective patients. He said it’s a worthwhile practice, but psychiatrists should be careful not to reveal too much about themselves on any professional sites.

“If we want to stay sane with all these new technologies, then we have to reclaim some of these boundaries,” Shore said. He suggested psychiatrists set up clear communication rules and make them easily available for patients; for example, listing a dedicated voicemail line to manage all prescription refill needs or explicitly stating that all emails be kept short. Chan added that it is possible to add automated chatbots to websites to answer common questions or help search for topics, which can limit nonessential phone calls.

For additional information, the presenters noted that APA recently posted a comprehensive Telepsychiatry Toolkit, and the National Consortium of Telehealth Resource Centers includes both national and regional information about telehealth practices and regulations. ■