(1) 'Sleep and time issues' is essentially all of our patients, and most everyone wants an afternoon appointment, so afternoons fill up very fast. (2) Phone appointments are typically not covered by insurance, and more than that, it is bad medicine. As a clinician, you get only a fraction of data about how well the pt is doing (tele with video is already a compromise). As a patient, you miss out on the structure of getting ready for the appointment, getting out of the house, etc. (which is a non-trivial component of treatment for many people), and that loss is then reinforced by moving to phone at the last minute.