A Conversation with Dr. Ashok J. Bharucha on Change, Growth, and Possibilities

Dr. Ashok J. Bharucha was born in India but raised in the USA for most of his childhood. He graduated with a B.A. in chemistry and German, Cum Laude, with departmental honors in German from Bucknell University in Lewisburg, Pennsylvania. He also completed his M.A. in English from the Bread Loaf School of English, Middlebury College. After completing his residency in psychiatry at Harvard Medical School and fellowship in geriatric psychiatry at the University of Washington School of Medicine, Dr. Bharucha has practiced adult and geriatric psychiatry for nearly thirty years in academic and private settings. He has been the recipient of multiple teaching awards and nominations, has been involved in research funded by the National Science Foundation and the National Institute on Aging, amongst others, and has been listed amongst the Best Doctors in America and Top Doctors in America. He currently operates a private practice, Transformations: Adult and Geriatric Psychiatry, PC.

  1. Where did the idea for Transformations come from?

I wanted to choose a name for my practice that reflected progressive change, growth, and possibilities. Moreover, a title with a spiritual undertone rang true for what I hope to bring to the table. Thus, Transformations: Adult and Geriatric Psychiatry, PC.

  1. What does your typical day look like, and how do you make it productive?

I start work typically around 8 am. A great freedom of private practice is that I am able to flexibly schedule appointment durations based on each individual’s needs at that particular time. This is a rarity in organized medicine, where physicians are on relatively tightly controlled schedules. I spend anywhere from 60 to 90 minutes on a new intake and 30 to 60 minutes on a follow-up visit, but I always take as much time as I need with each patient and make sure not to box them into my time constraints. I determine, at each visit, how much time we might need for the next appointment, so I can schedule accordingly. My day usually ends around 6 pm.

With private practice, I focus most of my work time on clinical matters, but occasionally, trainees from various clinical disciplines reach out to me for shadowing experiences, and I present in community settings whenever I receive a request to speak about topics relevant to my expertise.

  1. How do you bring ideas to life?

In my line of work, bringing ideas to life translates into a keen understanding of the patient’s problems—biological, psychological, and social—and collaborating with the patient to understand their hopes and dreams and the obstacles they encounter. It is through this collaborative dialogue and development of mutual trust and understanding that opportunities for growth and healing present themselves. Not uncommonly, this process also requires the inclusion of significant others and families. Bringing ideas to life in my line of work means a great deal of reflection and internal processing of the material presented by the patient and incorporating that into treatment at appropriate moments.

  1. What’s one trend that excites you?

The recognition by the medical community that holistic approaches have a major role to play in comprehensive treatment, not merely as adjunctive therapies or desperate measures, but as an integral part of care, is a truly exciting trend—intense research efforts directed towards identifying novel molecular targets for various forms of psychopathology. For example, psychedelic-assisted psychotherapy will expand our treatment arsenal.

  1. What is one habit of yours that makes you more productive as an entrepreneur?

Discipline and persistence are key. As in any endeavor, there are likely to be setbacks and unforeseen challenges, but the ability to learn and adapt is vital to success as an entrepreneur.

  1. What advice would you give your younger self?

When I entered medicine, the business end of the enterprise was largely invisible to trainees. Over the last thirty years, however, business management skills have become nearly as important as academic and clinical medical skills. I wish I had pursued some training in business management earlier in my career to better understand that side of it.

  1. Tell us something that’s true that almost nobody agrees with you on?

I think most of my colleagues in the field would challenge or outright refute my view that psychiatry is still a relatively “soft” science in its infancy and that the idea of “evidence-based medicine” is still a bit premature for our line of work. I think there are many psychiatrists who would be very defensive about that. For hundreds of years, psychiatrists have wanted to be taken seriously as doctors and scientists, but I think that we often oversell how much we know about the mind and how little that is compared to what we need to know. That’s not to say that we haven’t come a long way in understanding some of the basic neurobiological mechanisms in mental illness, but it is to say that we have a very long way before we get to a point where we can pin down specific diseases with specific underlying biological mechanisms. Considerable research efforts need to be expanded to further our understanding of the neurobiological, psychosocial, and genetic underpinnings of mental illness.

  1. As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?

I pay very close attention to feedback regarding my clients’ experience with me and my practice. I openly discuss any negative feedback that my clients may have conveyed in post-visit surveys and such. Client input is critical to refining one’s practice regardless of the line of service.

  1. What is one strategy that has helped you grow your business? Please explain how.

Although my website has been helpful in growing my business, my outreach to local psychologists, counselors, primary care physicians, and other members of the community has been indispensable. I punctually share my visit notes (with the client’s written consent) with all referring clinicians. For me, this has opened up dialogues with my colleagues that establish trust and generate further referrals. Much of my business growth is directly attributable to positive recommendations my clients make to their families and friends. I believe a warm, collaborative relationship where the client feels heard has been vital to this. I think that’s also where allowing the client to collaborate with you in treatment, rather than directing the treatment, has been a good business strategy as well. Your clients will be your best advocates as you’re growing your practice.

  1. What is one failure you had as an entrepreneur, and how did you overcome it?

I really had very little understanding of the business side of medicine when I entered private practice. I invested a great deal of time familiarizing myself with coding and billing practices and reaching out to more established practices when I was in doubt. It’s quite easy for physicians to overlook the business side of their lives because their desire in entering the field of medicine was to treat, and if possible, heal patients, not manage their billing accounts.

I think the mechanics of how one sets up a private practice, how one incorporates a private practice into the state and federal bureaucracy, obtaining a tax ID, and so forth, was a big part of it. Then developing various documents for the practice, including the release of information forms, HIPAA privacy consent, treatment consent forms, all of that was new to me. Fortunately, I had an attorney with a background in healthcare law who had copies of things he had developed over the years that I was able to use as models. All of the business aspects of starting a practice were very new to me because that’s not the type of thing that is typically taught in a psychiatry residency. So, unless you stay in academia in some sort of employed position where all of this is taken care of for you, you have to learn all of this for yourself.

  1. What is one business idea that you’re willing to give away to our readers? (this should be an actual idea for a business, not business advice)

With the booming demographics of the aging population, one business idea which I wish I had the time to pursue with someone with investment capital would be to develop assisted-living facilities that meet the needs of different ethnic communities in the US, particularly those that have not fully assimilated into US culture and society. For example, there are now some very successful care facilities for individuals from India. In addition to healthcare, these facilities provide ethnic meals, which these individuals are accustomed to, and socialization with others from the same cultural, linguistic, and spiritual/religious backgrounds. Currently, the long-term care market offers very little that is essential for the well-being of ethnic minorities.

  1. What is the best $100 you recently spent? What and why? (personal or professional)

I recently spent $100 signing up for an online payment portal that my clients can use to make payments for their visit copays and related expenses. This has hugely reduced the amount of time I was investing in sending billing statements and getting paid for services rendered.

  1. What is one piece of software or a web service that helps you be productive? How do you use it?

I use the Kareo electronic health record software, which is user-friendly, intuitive, and allows me to document clinical notes as well as generate billing statements that are electronically forwarded to insurance companies.

  1. What is the one book that you recommend our community should read and why?

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions by Johann Hari is a highly sophisticated account of depression that takes into account the often overlooked psychosocial and developmental factors in favor of neurobiological disease models.

  1. What is your favorite quote?

“I must be the change I wish to see in the world.” 

I try to be very self-sufficient, and I take charge of anything that is within my hands to do. I don’t wait for other people to do things for me. I will delegate responsibility when it is important to do so, but when I can take care of something myself, I tend to do it.

Key Learnings

  • Discipline and persistence are key.
  • Continually learn and adapt.
  • Pay keen attention to client feedback; resolve impasses proactively.
  • Never become settled in your ways; challenge your assumptions regularly.
  • When all else fails, be more human, not less.
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