Caring for patients outside the public system

Ever wondered what it's like to be a psychiatrist? This series explores a day in the life of psychiatrists who work in different areas of psychiatry.

In this article, we hear from Dr Michelle Atchison who is a psychiatrist working in private practice.

A Day in the Life of a Private Practice Psychiatrist

What is private practice psychiatry?

About half the psychiatrists in Australia practice in private psychiatry, some in addition to public psychiatry work, but most as clinicians in a private practice. There are a growing number of private psychiatrists in New Zealand.

During training, psychiatry trainees have little exposure to private practice, and I have found, as someone trying to promote private practice, that there is a great deal of mystery and anxiety about ‘going out into private practice’.

Private practice psychiatry is different to public practice psychiatry in several ways. Private psychiatrists rely on income from seeing patients. In Australia, there is a subsidy from the government through Medicare, but it is usual to charge a co-payment (gap) on top of this. Sometimes patients are seen where a third party assumes responsibility for payment, such as after a motor vehicle accident or through WorkCover.

Because of this, private practices work as a small business with all the pros and cons of doing so. If you are working sessions in a private practice, you usually pay a per-session-rate to the practice owner. If you own the practice, as I do, you have the challenges of hiring and paying staff, purchasing equipment, and paying the bills that come with owning a business. Your accountant becomes your best friend.

What types of patients do private psychiatrists see?

Private psychiatrists manage patients who do not need the services of a public hospital system. As such, they are likely to be different to those patients seen during training. One of the major differences is that the patients want help and are keen to keep seeing you.

Patient diagnoses range from high prevalence disorders such as Major Depression, Persistent Depressive Disorder and all the anxiety disorders, to people with bipolar disorder and schizophrenia. Patients with comorbid severe drug dependencies are less likely to be seen, only because they are less likely to engage in longer-term therapy.

One of the pleasures of private practice is that you can choose an area of specialty. For example, I see many ex-servicemen and women and specialise in military psychiatry.

What is the workload like for a private psychiatrist?

I have never worked fulltime but having said that I have a pretty full week. I work all day Tuesday to Thursday and Friday mornings.

I see new patients for an hour and generally see follow-ups for half an hour. I have three or four patients who I see regularly for an hour of psychotherapy. I make sure I have an hour for lunch for sanity, but also to squeeze in an emergency consult if required.

This means that on a usual day I would see about 12 to 16 patients. This is one of the reasons I don’t work fulltime, as this is a heavy load to carry.

Private psychiatrists will often have inpatients in a private hospital. I see these patients after work, which usually takes about an hour and a half. Because of this I try to finish by 5 so that my day isn’t expanded too much.

Private psychiatrists are available to their patients after hours in case of an emergency. After all, we are their specialists.

What do I enjoy most about my career in private psychiatry?

One of the most rewarding parts of private psychiatry is being able to see patients in the long term, getting to understand their life, their illness and their particular vulnerabilities. You come to know their families and are part of the highs and lows of their lives. You see them through family celebrations, births and through physical illness. I have some patients who I have seen now for over 25 years.

I often say to patients that as a private psychiatrist it is a privilege to be part of someone’s life.

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About the author

Dr Michelle Atchison

Elected Director

Dr Atchison is an Adelaide based private psychiatrist who works with a clinical focus on trauma and military psychiatry. She provides civil medicolegal reports as a treating psychiatrist and as an expert. Dr Atchison owns her practice at Hawthorn in Adelaide and works alongside other psychiatrists there.

Dr Atchison has a long involvement with the RANZCP, initially on committees for training and as an examiner. She was the SA Branch chair for six years. She has been a member of the Adult Faculty committee and currently supports the Adult Certificate trainees in Adelaide. As a Director of Advance Training, Dr Atchison participates in the SA Psychiatry Branch Training Committee and the Australian Government Funded Training Programs Committee.

Dr Atchison has been a strong advocate for private practice within the College and has chaired the Section of Private Practice Psychiatry for some years. She has represented private practice psychiatry on the Membership Engagement Committee and the Members Advisory Council. Dr Atchison has also supported the College’s work through participating on working groups that considered the College’s response to climate and sustainability and the Medicare Benefits Schedule Review, and in 2022 supported College advocacy for an accessible, affordable and equitable telehealth system.

Dr Atchison was elected to the Board in May 2024 for a two-year term and can be contacted via michelle.atchison@ranzcp.org

Dr Atchison is an Adelaide based private psychiatrist who works with a clinical focus on trauma and military psychiatry. She provides civil medicolegal reports as a treating psychiatrist and as an expert. Dr Atchison owns her practice at Hawthorn in Adelaide and works alongside other psychiatrists there.

Dr Atchison has a long involvement with the RANZCP, initially on committees for training and as an examiner. She was the SA Branch chair for six years. She has been a member of the Adult Faculty committee and currently supports the Adult Certificate trainees in Adelaide. As a Director of Advance Training, Dr Atchison participates in the SA Psychiatry Branch Training Committee and the Australian Government Funded Training Programs Committee.

Dr Atchison has been a strong advocate for private practice within the College and has chaired the Section of Private Practice Psychiatry for some years. She has represented private practice psychiatry on the Membership Engagement Committee and the Members Advisory Council. Dr Atchison has also supported the College’s work through participating on working groups that considered the College’s response to climate and sustainability and the Medicare Benefits Schedule Review, and in 2022 supported College advocacy for an accessible, affordable and equitable telehealth system.

Dr Atchison was elected to the Board in May 2024 for a two-year term and can be contacted via michelle.atchison@ranzcp.org

Disclaimer: Any patients mentioned in this article have been deidentified and created for the purposes of this article. This article may represent the views of the author and not necessarily the views of The Royal Australian and New Zealand College of Psychiatrists ('RANZCP'). By accessing the article you also agree to the RANZCP Website Terms of Use Agreement.