After nearly two decades in psychiatry, I made a deision that surprised some of my colleagues: I left a high-volume practice to build something smaller and more intentional.

The move wasn't about working less. It was about working differently.

The problem with volume

In traditional psychiatric practice—especially one that accepts insurance—the math works against you. Reimbursement rates push you toward shorter appointments and larger panels. You end up managing a caseload rather than treating people.

I've been on both sides of this. I've run a practice seeing 50 patients a day. I know what that looks like operationally. And I know what gets lost: continuity, nuance, the kind of relationship where a patient can tell me something is off before it becomes a crisis.

Insurance-based psychiatry also creates a paper trail that follows people. For some patients, this matters. Executives, public figures, professionals in sensitive industries—they think twice before seeking care when they know it goes on a permanent record that insurers, employers, and licensing boards can access.

What membership changes

A membership model flips the incentives. Instead of maximizing volume, I can optimize for the kind of care I actually want to provide.

That means a small panel. I personally see every patient—no handoffs to nurse practitioners or physician assistants. When you message me, you're messaging me. When you have an appointment, you're seeing me.

It means defined boundaries. I'm not on call 24/7, but when I am available, I'm fully available. You know what to expect.

And it means privacy. Private pay means your care stays between us. No insurance claims, no diagnosis codes in a database somewhere, no prior authorizations.

Who this is for

This model isn't for everyone. It's not the right fit if you need emergency psychiatric services, if you're looking for the lowest-cost option, or if insurance coverage is a priority.

It's designed for adults who want a direct, professional relationship with their psychiatrist. People who value continuity and discretion. People who are willing to invest in their care because they understand what that investment buys.

The tradeoff I'm making

I could see more patients. I could generate more revenue. I chose not to.

What I get instead is the ability to practice the way I think psychiatry should be practiced—with attention, with consistency, and with the time to actually know the people I'm treating.

That's the practice I wanted to build. If it sounds like the kind of care you're looking for, I'd welcome your application.

Dr. Faisal Rafiq is a board-certified psychiatrist practicing in New York. Learn more about membership at Private Psych MD.