I'm not kidding Reader ,

It does not surprise me that Spirit Airlines 2.0 has gained so much momentum in less than a week. The idea of a properly owned airline where some of the wealth can at least triple back to its consumers and its employees feels like an amazing solution to this economy needs. Most humans are seeing the quiet thing out loud: extractive behaviors taking wealth without a care of what happens to the parts of the economy it effects.

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This has no doubt been its way into psychiatry and psychotherapy as well. There's been a huge rise in 1099 employees - which is different from being credentialed with an insurance panel - in most places. I don't have to name names because you know them, they advertise as a way to make private practice easier and they're really using your labor to generate their own wealth without even giving you any rights as an employee in the hopes to sell what they've built on the stock market. You're labor is building their business, not your own.
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​People talk of collectives and cooperatives all the time. But to start, one is another beast in and of itself. I don't blame you if you've had the desire for something bigger than yourself and haven't done it. It's hard to build something massive, and it feels so small. To lead the charge and feel confident enough to do it is also difficult.

I've seen it in the therapist facebook groups: people starting "collectives" as office space shares to try to build some sense of community, some great organizations starting like the Medical Practitioners Alliance here to try to fight for the reimbursements that these same companies I alluded to before are giving themselves because they are often in part invested by or owned by the individuals who own or invest in the insurance companies. There's even a Facebook group of therapist projects in the United States, and there's a good 20 or 30 of them - but they stay small, local, and don't quite get bigger.

I've been keeping an eye on Peace Health has gone through the trial at the Oregon. A perfectly good physicians group local for greater than 30 years gets ousted because of a CEO buddy buddy who knows a guy in the Managed Service Organization (the type of entity Peace Health Is) knows someone out on the east coast they want to help out, and a few shell companies later ApolloMD shows up to try and take over the hospital. MSO's aren't supposed to have any clinical sway, and Oregon law has some of the strictest in the country. I have confidence the trial will conclude in the local groups favor, but that's the b.s. that you don't want to deal with. And it happens all over the country.

There's a pattern in all of this: There's this tug of war between being dependent on others and still running your own business while being a part of something greater. You left or don't join Big Health because of the nonsense and business that constrains your craft as a business, and yet you are out on your own building your own systems feeding into other peoples wealth, being a contract employer for someone else "group practice" as a potentially mis-classified employee leaving you in the dust to deal with the burden. Finding your own health insurance, struggling to save up for vacation, wishing you had a short term disability policy but hustling day to day. It's awful, and exhausting, and there is this yearning for something different.
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There's a great book called The "E" Myth - it talks about how people leave any sort of big business to start their own craft so that they can be clinically from the theoretical "man". It says you can't practice in certain ways because of reimbursement rates, one that tells you you have to do certain policies. And it usually has something to do with business nonsense like reimbursement rates, documentation, or some level of business policy you're not quite sure. So people leave to be independent. Whats at the core is that people don't necessarily want to run their own business, but be their own manager in their work. Ideally they choose what to do, and the other business stuff takes care of itself. It'd be nice if it worked that way but someones has to manage it. So they pay someone else to do it.

And the wealth you generate off of your work goes somewhere else never to be seen again by you. Maybe to some big corporation or company owned by a company backed by venture capital. Hopefully to a small local business. But even then there's capitalism in there too, unless they're a solopreneur.
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Whats missing here is a solution that can manage the business aspects so you can focus on the great clinical work, that also either hire's employees so you know you're wealth goes to someone getting paid a livable wage, or even a business owned by its employees and the clinicians to ensure it is managed by clinicians and employees - and does what is right for the community its in. And it needs to be in existence and led by someone else because who has the brain space to manage something like this behemoth of an ask in a time like this?

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Its a good thing I started a year ago and I'm building it right now. Bridgewell Health​
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In short, I'm taking the same exact model PeaceHealth uses, a managed service organization, but making it owned by the clinicians and the employees. These types of organizations are meant to help manage the business aspects of the clinical practice so that clinical employees can just do what they do best: help the world. It's been Private Equity's playbook forever, and now we're giving it back to the people. We are founded, have clinics starting to do the work, and building out our systems slowly and surely.
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And you can help us: which does mean buying things from us.

We're still early in our stages and starting locally where we're located in Denver, Colorado. We see a vision that we are able to: - expand across the country - unite all the outpatient solo practices - find a way to negotiate fair wages - have data sovereignty - get us the benefits that we need and deserve as part of self-employment. We want you to join us on that journey.

So I introduce our paid newsletter The Bridge: Inside a Developing Cooperative. Regular newsletters that deep dive into special topics like our technical build and the many ways a cooperative can be made or develop, how to get data sovereignty for yourself, peel back the layer of extraction in the systems we use, and how to economically advocate for what we want by no longer paying into systems that don't serve us and into the systems that do. Maybe even a notification or two on when we're expanding before the general public ;)
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Start with us and your first system you want to pay into. We'll show you a new way to business where you can stay clinically independent but be a part of something bigger. We're building the bridge to well clients, well communities, and well economies.

$17.00 / month The Bridge: Inside a Developing Coop As therapists, we have the greatest of abilities to advocate for a different mental health care system that focuses on... Read more Lets Cooperate

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Tim @ Bridgewell Health