Adam Tripp, MD, PhD
Dr. Adam Tripp is a psychiatrist with extensive experience in clinical practice, research, and academia. He earned his doctor of philosophy and medical doctorate in 2006 from the State University of New York Upstate Medical University. He completed his Psychiatry residency training and a postdoctoral fellowship in the Psychiatry department at the University of Pittsburgh Medical Center (UPMC). Since 2011, he has been a co-owner and psychiatrist at Better Stories, a private practice currently with two locations serving approximately 3000 patients annually across all of Pennsylvania.
In addition to his clinical work, Dr. Tripp is an adjunct assistant professor at UPMC, where he lectures to psychiatry residents and supervises geriatric psychiatry fellows. He is also the medical director for the in-home geriatrics support program, an Allegheny County funded community program addressing the needs of geriatric patients with psychiatric disorders in their homes. Dr. Tripp has numerous peer-reviewed articles, oral presentations, book chapters, and poster presentations. He also does advocacy work, speaking with a local men’s group in Pittsburgh, NAMI, and as a Pennsylvania delegate in the American Psychiatric Association Assembly.
Outside of his professional life, he enjoys time with his wife and four kids, photography, and is an avid endurance runner, having completed multiple marathons and ultramarathons.
On Becoming a Pirate: A Guide to Private Practice
Starting private practice is like becoming a pirate. One day you're in the Navy, predictable, with someone else worrying about toilet paper. The next day you're on your own ship, wondering if Blue Cross needed your EIN or SSN for credentialing. Medical school teaches neurotransmitters, not EHR systems or chasing copays without betraying your Hippocratic oath.
For residents and fellows: start part-time. Keep one foot on the Navy ship. Building a practice takes six to eighteen months, and you'll need to eat and maintain health insurance. You're also still learning to be a psychiatrist, that doesn't end until at least year three when you stop panicking about cPTSD and personality disorders. Plus, someone else handling your 401(k) and malpractice coverage beats endless phone calls with customer service.
Freedom means decisions. Insurance or cash-pay? Virtual or in-person? Which EHR? Patient communication boundaries? Coverage during vacation? How to explain to your brother-in-law that you cannot diagnose his cousin over Thanksgiving? Some people love this, the color-coded spreadsheet types. If you avoided choosing a phone plan so long the company decided for you, reconsider.
But you also choose your psychiatry style. Want meditation and yoga? Psychodynamic therapy? EMDR? You can. The freedom is genuine and terrifying.
Nobody warns you about loneliness. In hospitals, you discuss challenging patients over coffee. In solo practice, you're alone with your thoughts and patient thoughts, a lot of thoughts. You need a peer consultation group; a mentor, residency classmates still in town, or other private practice psychiatrists who can appreciate gallows humor and the need for connection.
Success requires contradictory traits: confidence to work without a safety net (you are the safety net) and humility, recognizing the business learning curve is steep and stupid. You need to know a little about accounting, marketing, billing, employment law, just enough to avoid accidentally committing fraud. And you must ask for money without feeling you've betrayed your calling. The lights don't pay for themselves.
Medicine, like gas, expands to fill all available space. In institutions, there are boundaries. In private practice, you are the boundary. Without them, you'll check your portal at midnight or during your kids’ recital. There's no boss to send you home. Most of us are terrible bosses to ourselves.
Private practice isn't for everyone. If you want psychopharmacology without worrying about printer toner, choose steady paychecks and benefits. But if you want control over your schedule and clinical approach, can tolerate uncertainty for flexibility, and don't mind being captain, navigator, cook, and bathroom cleaner, then maybe piracy suits you.
Sometimes, on good days when you've helped someone and the billing is sorted, you stand on deck thinking, yes, this is exactly where I'm supposed to be. Just stock up on toilet paper first.