What Is TMS?
Before detailing how to pick a TMS provider, lets be on the same page about what TMS is.
TMS stands for transcranial magnetic stimulation. It is a non-invasive procedure for treating depression without the use of antidepressants. It has been FDA approved since 2008. TMS focuses on one specific area of the brain that is responsible for depression. This limits side effects because the treatment is not systemic.
How To Choose A TMS Provider
Daily sessions are recommended to maximize results. The standard protocol that is covered by insurance requires at least 20 mins per day, Monday-Friday, for approximately 36 treatments total.
This can seem like a daunting schedule. However, after treatment is started, people tend to settle into a comfortable routine. Below I will discuss the factors that can maximize the convenience of TMS treatment.
The most important things to think about for TMS are a good relationship with your provider, an accommodating schedule, location of the practice, and the business structure of the TMS provider. We will cover all of these topics below.
Schedule Of Your TMS Provider & Personality Match
One of the benefits of TMS is that you do not need to take time off work to attend appointments. Most patients prefer to go before, during, or after work. This makes 6am-9am, 12-1, and after 430 prime time for TMS treatment. Depending on the city, such as Los Angeles, the best time might be when traffic is not at its peak (sometimes between 9-12, 1-3, or after 6pm). Some TMS providers are not able to accommodate the very early or late hours, so this is something to consider, even if they live close to the provider.
It is very important to find a regular time that makes the protocol as convenient as possible. Consistency is key to maximize treatment outcomes.
Patient-Provider Personality Match For TMS
One aspect of TMS treatment that people don’t consider is the time spent with your provider during treatment. A half hour a day does not seem like much, but in consideration of 36 treatments over 7 weeks, time can add up. Approximately 20 hours total can be spent working with your TMS provider.
Although HBO, Netlix, Hulu, Amazon Prime, and YouTube are all available for viewing, many people prefer talking. Even in a professional setting, politics, sports, relationships, anime, work, hobbies, etc, are all topics that can come up during treatment.
For the amount of time spent together, it behooves patients to work with someone with TMS experience, and also someone who they feel comfortable with. During your initial evaluation you should think about whether or not this is someone you want to spend the next 20 hours with.
Location Of Your TMS Provider
Large City vs. Rural Areas For TMS
If you near a large city, there is a good chance that a TMS practice is accessible. In some states though, such as North Dakota or Montana, there are only two TMS locations to choose from in the entire state. For rural areas, it could take hours to reach a provider, making it difficult to finish the standard 36 treatment protocol. There are protocols that can shorten the 7 week requirement, but unfortunately, those protocols are not covered by insurance.
If a practice has something, or someone, that you want to work with, it may be worth an extended drive. The most accessible location may sacrifice individualized care. This is most seen when comparing providers part of a corporate entity vs. providers in small practices.
Corporate TMS Vs. Private Practice TMS
Just 5 years ago, it was difficult to hear about something like TMS. Since then, the amount of locations has increased exponentially. The reason for the rapid expansion is that corporations have noticeably invested in TMS over the past decade. This has been of great aid for public awareness, as psychiatrists are not known for their ability to advertise, market, or scale. There are pros and cons to corporate involvement.
Corporations are indeed business savvy, and they are often able to expand access to care while simultaneously lowering the cost of care (i.e. Cerebral and Betterhelp) in ways that private providers cannot (or will not). There are drawbacks to corporate interest, though. For instance, due to large volume patient responsibilities, they often have to sacrifice personalized care for algorithmic care. There are also cost cutting practices that sacrifice quality of care in favor of profit.
In terms of TMS, the larger the entity, the further away you’ll be from regularly seeing the doctor. When you call, a virtual assistant may pick up the phone. For your appointments, you will probably see a doctor on the first day, but only a tech for the rest of your appointments. Furthermore, there’s a big chance you will never see the main doctor of the practice. If the entity is really big, you might see a different tech every day due to employee turnover. This may not impact quality of care, but it could impact the patient experience. You should be aware of this before making your decision.
Some people don’t mind. Others may opt to go for a smaller practice, where there is more individualized care.
Private Practice TMS
The smaller the business, the less likely you are to be considered, “just a number.” The workers at these practices are more accessible, and patients know which doctor they will be working with when calling for services. Often times corporations have a representative/spokesperson that speaks for the company, but have no actual interaction with patients. Spokespeople or paid actors typically cannot actually attest to how good a provider is, nor can they offer much insight about treatment plans. You’re less likely to see this at a non-corporate office. There are drawbacks. For example, calls will likely go to voicemail more often instead of a receptionist. This may not be an issue if calls are returned in a timely fashion.
Frequent feedback that I hear from patients is how much they prefer speaking directly with the doctor. If this is a preference you share, it might be a good idea to approach a smaller practice vs. a corporate provider.
Summary Of How To Choose A TMS Provider
TMS is overall a well tolerated procedure that can give great results if you’re able to consistently make appointments. Therefore, it is still in your best interest as a patient to pick a provider that makes the experience go as smoothly as possible. I hope the above factors were helpful considerations to think about as you decide where to receive your care.
If you are interested in receiving services from The CUBE Mental Health Services, you can use the contact section at the bottom of this page. Dr. Hughes will try to get back to you as soon as possible. Further details regarding the practice are provided here.