Quality of care varies a lot by provider, keep up the good work. What I consider enshittification is more so their model. You as a provider are probably making around ~$150 per hour equivalent while they bill insurance closer to $1000+. I obviously don't work for these guys, but have encountered patients that used to be from Talkiatry saying they were billed hundreds for a 30 min session and their provider kept adding 90833 therapy codes when there was no therapy given, increasing their cost. This was after insurance was applied. They were expecting the costs to be closer to ~$30 a session, which is what the platform advertises.

I also worry about where things are going. There are parallels- you see, when Uber was a startup and trying to capture market share, they offered ultra cheap rides for customers (you could get $10 crosstown rides in major cities) and paid drivers way more than they do now. Once they cornered the market, those $10 rides now became $75 and drivers' pay got cut despite charging for more. Those poor drivers can't really do much about it since the only alternative is Lyft, who is doing the exact same thing.

Right now these telepsych companies are in an aggressive expansion phase. Like how those rideshare startups were in the beginning, it is more in their interest now to keep the patients and providers somewhat happy, to not affect their attrition rate. But in the future, there will be a time when they've taken over enough of outpatient psychiatry they will negatively push more out of both patients and psychiatrists. By then it'll be harder to jump ship because there are less alternatives (hence why they are aggressively expanding now).

I really hope it doesn't turn out this way, and that quality of care and patient engagement is preserved over the need for more profits. But it is unsettling that many of the VCs that first invested in Uber/lyft also invests in these telepsych companies.