Mental Help

Richard G. Frank, a health economist with a specialty in mental health issues who is a professor at Harvard, said: "Clearly, the earnings of mental health professionals — medical doctors, psychologists, social workers and counselors — have either been flat or been declining for the past five to eight years."

"It's not so much the number of visits allowed by managed care to mental health professionals has changed," he said. "It's that fees paid to the mental health professionals have not been rising."

Ms. Hinterman, too, observed that patients found prescription medicines a quicker fix than "prolonged and thorough introspection."

"We just live in a culture that values speed and efficiency and wants to see complex problems resolved in half an hour," she said. Given those changes, she no longer wants to rely on the profession she trained for as her sole source of income.

No chit-chat, just gimme a pill. Drive through therapy is the name of the game.

So how is Ms. Hinterman dealing with reduced fee schedules?

An experienced seamstress, in January 2004 she started Fiber Embellishments, a company that makes scarves, table linens, chefs' aprons and one-of-a-kind bags made of boiled wool; local retailers are already selling her goods.

Wonder what Dr. Bob Hartley would do in a situation like this? Probably stand up comedy . . .