“Do What’s Right for the Patient” – An Interview with Samuel Sharmat, MD

Samuel Sharmat, MD is a New York City-based psychiatrist in private practice. He talked to WTCI via email about how he built his practice–what worked, what didn’t, and what might work for you.

What’s your background? What do you do now?

My background is originally in Family Practice. When I started off, I wanted to be a primary care provider, and so I started down the Family Practice path. Over time, it became increasingly clear that I showed a special talent for Psychiatry, so I chose to specialize in that area. Flash forward ten years, and now I am serving in a bunch of different roles. Clinically, I split my time between my private practice and my clinic practices. Additionally, I teach and supervise Psychiatrists in training, serve on the Executive Council of the APA in New York City, and serve on clinical advisory boards for two top rehabilitation programs. In my private practice, I get to provide high-end patients with psychiatric care that is nonjudgmental and considers their specific needs. In my clinic practices, I get to provide top-quality care to those who will benefit from it the most. The two clinic practices are a HIV/AIDS community program and a community addiction treatment program. In the HIV/AIDS program, I am the sole psychiatrist in a multidisciplinary medical practice, and in the addiction program I am Medical Director. In both clinic programs, patients have not been able to achieve success in their lives for one reason or another. Through closely coordinated care, my colleagues and I assist the patients to lift themselves up to the next level and, hopefully, start to put their lives together. It’s an incredibly rewarding and satisfying experience. My involvement with the APA and the advisory boards is my attempt to help modernize psychiatry. More and more psychiatry is developing a scientific foundation that is helping to destigmatize the various mental health disorders. I am hoping to help increase awareness, acceptance, and support for the various mental health disorders.

How did you first build your psychiatric practice? What worked? What didn’t?

I have to say that I was very surprised by what worked and what didn’t in the process of building my practice. Following advice from peers and friends, I reached out to the psychiatric community and to therapists in my neighborhood with announcement notes. Additionally, I posted a couple of small ads in hobby journals to which I subscribe. From all of this effort, I may have received maybe one referral. What eventually did work was face-to-face contact: I invited colleagues out to lunch or dinner, I attended every professional function I could find, and I made brief visits to neighborhood treatment centers to introduce myself. Within a few weeks of changing my tactics, the phone started ringing with referrals. Once my roster started to grow, I made a point to meet with patients’ psychotherapists. Thereafter, a network for cross-referral began to grow and business started to boom.

As a psychiatrist, what do you most value in psychotherapists with whom you share patients? Which are the therapists you are most likely to refer to?

That’s a question I’m very happy to answer because I am quite fond of the therapists with whom I share patients. They all have three things in common: collegiality, great communication, and a longitudinal approach for each patient. First off, in private practice, our colleagues are the people in our network with whom we interact; therefore, it really pays off to have good working relationships with one another. This is usually reflected by how easily we ask each other questions and tell each other our ideas. I never hesitate to speak with one of my colleagues because I know that the conversation will be easy and I may even learn something! The next thing I look for is great communication regarding my patients. What makes the therapists in my network stand out above the rest is that they give me updates on how my patients are doing — even if I don’t ask. I refer patients for therapy not because I want to deflect that part of the treatment but because I believe my patients will benefit from the additional modality. Therefore, hearing about how my patients are doing enables me to create more comprehensive formulations and thereby provide better care. Finally, and this may be a personal preference, but I like to work with therapists who take a longitudinal approach to formulation. I like to hear what they think in terms of where the patient has been, where the patient is now, and a few projections as to where they think the patient might be headed. Ideally, I’d also like to hear what approaches they would take given the possible outcomes that they suggested. This comprehensive approach to formulation let’s me know that my patients are in the hands of a therapist who has paid attention, has formed an opinion, and is thinking about the repercussions of their various interventions. This is the type of therapist into whose hands I would like to place the care of my patients.

Do you have any additional wisdom you’d like add for therapists starting out in private practice?

Do what’s right for your patients and the universe will do what’s right for you. I know it’s scary to pass a patient on to a colleague when you’re trying to build up your practice and make a living; but refer when appropriate and you will earn a reputation as a practitioner who puts their patients first. When the recession hit and patients decreased their frequency of visits, I felt the familiar pangs of wanting to fill up my practice. An exercise I found helpful in these situations was to imagine my practice full again and the patient in front of me (or on the phone, or being referred to me) as a patient that I would have to go through some machinations to accommodate. In that situation, would I really be the best provider for this patient? If so, then I would take the patient on. If not, then I would discuss referring the patient to a colleague. You’re here to help so do what’s right for the patient and everything else will fall into place for you.

Find Samuel Sharmat, MD on the web at samuelsharmatmd.com.