Thursday, April 16, 2009

Taxes

In residency, we were all encouraged to be in therapy ourselves. And most grown-up shrinks I know have a shrink of their own, at least on an intermittent basis. I have one myself. I used to see him weekly. But the economy has caused my clients to cut back on seeing me, which has led me to cut back on seeing my therapist (it's not cheap.)

Calling therapy a tax-write-off business expense would certainly make it more affordable for me. That's perfectly acceptable, if the therapy is of the "supervision" sort-- in which one shrink sees another to help get perspective/wisdom/guidance to help manage the strains and interpersonal weirdness of being in this business. But if the therapy is purely of the "personal treatment" sort, it is not a business expense.

Mine falls squarely in between. It helps me personally. But I'm pretty sure I wouldn't need to be there if I wasn't in this line of work. And, more to the business-expense point, I don't think I would function very well in this line of work without checking in for therapy/supervision/whatever it is, now and then.

So I've been mulling the legality/ethics/appropriateness of making this a "business expense". Then I came across this article noting that cosmetic surgery can be considered a business expense for people in "sales, customer service managers/executives, public relations managers, CEOs, and VPs who are involved with business negotiations and other face-to-face presentations."

Yeah? Really? Then I think my involvement in negotiations that involved brain-to-brain presentations should justify the business expense of a little touch-up therapy.

7 Comments:

Blogger The MSILF said...

I wish I could afford a shrink. And find a decent one.

4/16/09, 11:23 AM  
Blogger The MSILF said...

And I forgot to post on one of your old posts, I really do like the tuxedo cats.

4/16/09, 11:25 AM  
Blogger Turboglacier said...

MSILF: Don't you have national healthcare over there? Won't it pay for a shrink?

4/16/09, 11:32 AM  
Blogger The MSILF said...

Interesting point actually. It's one of the huge failings of the system.

1. Mental health is not really covered - it isn't in the HMO system for historical reasons. The only services that are covered are these "community mental health stations" and hospitalization. So you can really only get care if you are bad enough for hospitalization (psychotic, also, not say mood disorders usually).

The community mental health stations are uniformly horrible. It is the worst of the psychiatrists (because anyone decent goes private), and the quality of service is horrific - they treat people like kindergardeners. Terrible support staff, secretaries, etc.

There are almost no therapy services.

2. If I were to go to the national system, if it was covered, I would be afraid for my medical license.
I don't want a record, so anything I desperately need, I do privately.

3. Therapy is not great here, especially in Jerusalem (Tel Aviv is slightly different). Most psychiatrists are still stuck in the age of the Oedipal complex based treatment from my experience. Psychotherapy training in the residencies here is minimal It is also never covered by any kind of insurance. There are very few pragmatic or CBT type practitioners.

Basically the system covers the severe schizophrenics only - and they get the bottom of the barrel as to treatment, except for the occasional very dedicated practitioner that still works in the public system. And to even get into that system, one almost has to go in with a legal involuntary hospitalization order, be picked up by the police psychotic, etc.

For mild depression or anxiety, the family doctors handle meds or refer privately if the people can afford it. For someone like me, who functions well, but does have a psychiatric illness (not to mention plenty of reasons for therapy)...well, we're pretty much fucked.

Mental health is the shame of the Israeli system.

4/16/09, 11:52 AM  
Blogger Rach said...

For someone like me, who functions well, but does have a psychiatric illness (not to mention plenty of reasons for therapy)...well, we're pretty much fucked.When I was in Israel last year in the summer I had a reaction to one of my meds, and needed a different dosage, which I needed a prescription for. So I went to one of the health clinics, and asked a family doc. When she heard the word Wellbutrin (I think I said Bupropion), she told me that she'd have to refer me to the regional psychiatric emergency room.
WTF

That was the end of that. I think I ended up calling my psychiatrist back in North America and figuring out how to deal with the situation with whatever I had on hand... I just had a rather large phone bill.

4/16/09, 8:33 PM  
Blogger The MSILF said...

I can explain that one, actually - Wellbutrin is not licensed here for anything but Zyban/smoking cessation - not as an antidepressant...so no one has heard of it. (And also - I have to pay full price for the brand name one...)

But I heard from the drug rep that it's going into the formulary soon.

4/17/09, 3:16 AM  
Blogger Backdated said...

I see this as an opportunity for some civil disobedience. Some access to mental health services should be available free of charge as part of a nationalized healthcare system. Every empirical study ever conducted demonstrates that this results in a net cost savings for the state.

Until the powers that be get that straight, you'll continue to be hindered in what you can do for your own patients (as with your recent adventures in addictions treatment), and hindered in what you can do for yourself. I say write it off by any means possible.

4/23/09, 2:40 PM  

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