In July 1988, I walked into an old building on the campus of the hospital where I did my psychiatric training. The building was well over 50 years old, with an ornate front that included columns. I took the rickety old elevator to the 4th floor, where the residents had their offices, and walked into the one assigned to me. I could not believe my good fortune. It was a nice-sized space with high ceilings, and it was a corner office, allowing for a breeze to come through the windows. We did not have air conditioning in our offices, so the cross breeze was very important.

I spent a few days decorating my space, using discarded pieces of old furniture left behind by the graduating senior residents. I was very careful to follow the rule of “1/3 s”: the first third was where my desk was, the second where I sat, and the final where the patient sat. We would never sit at our desk during a session, due to the imposing nature of such an arrangement. The furniture was old leather and wood. Pictures of family were discouraged, as was anything that might call attention to characteristics of the resident.

Happy with the results, I started seeing patients, and for the next 2 years, I would spend countless hours seeing a mix of patients for medication management and psychotherapy. For supervision, I would visit the supervising psychiatrists in their carefully crafted offices. For my own training therapy, I would visit my analyst’s very Freudian-designed office, complete with a couch. My fellow residents and I would meet in each other’s offices. This space became an important part of my training. The building was old, so the walls were solid and soundproof.

Over the rest of my career, the office became a central part of my identity as a therapist and a psychiatrist. My present space is quite soothing. My love of crystals is evident. I look out upon an old church. It is a reflection of who I am, with books on shelves that allow people to know my interests and the types of treatment I utilize. Although most patients now use telehealth platforms, those who do come to my office have commented on the calmness that the space creates.

Over the past 3 months, I was put in the position where I had to move my program’s residents and outpatient staff to a new space. The decision was not made with much input on my part (well, none). As with all health care systems, they crunched numbers and decided the staff only needed half as much space as they had and that staff did not need their own offices. This included faculty as well as residents.

Although there is technically enough room to see the patients in the clinic they moved us to, they do not understand the implications of this move. Psychiatry clinics do not operate like medical clinics. The ownership of space by the clinician is a key difference between the specialties. The ability for the patient to come to the same space week after week is incredibly important, as is this stability for the clinicians.

My fear is that residents do not get to experience the rite of passage that is inherent in moving into their own office. We celebrate White Coat Day, which symbolizes the entry into medicine. I remember the thrill of using my “black bag.” The first beeper was another rite of passage (and a curse). Nothing marked my entry into the field of psychiatry as much as my first office. That space, with old furniture, no air conditioning, and peeling walls, became a place where I could practice my craft in the tradition of the founders of the field. We have all seen pictures of Freud’s office, complete with a couch and ancient artifacts. I remember the first time I saw pictures of Jung’s tower retreat, which left me with a feeling of awe. There was even a New York Times article showing the offices of a variety of therapists, each one reflecting their unique style.

My residents no longer have this. They cannot decompress in their own room after a session. They cannot create a space that is consistent and safe for themselves and their patients. They cannot even control the noise levels, since the original design is for a clinic, and as such, there are paper-thin walls. Consistency and privacy are lost, but most alarming to me is the identity of the psychiatrist being lost. We are treated no differently than white-coated internists moving from room to room, providing care to a dizzying number of patients.

What is also lost is the sense that we have a leadership that understands our field (or at least tries to). The idea that all clinics are the same, all doctors are the same, and all treatment can be provided in the same manner shows a lack of understanding. Worse is the feeling of being disrespected. By not respecting and acknowledging our differences, leadership creates an atmosphere that runs counter to the wellness literature they all tout as being important.

In the end, we have no option, and we will make it work for the sake of our patients and trainees. I can only hope that someone out there might read this, and when their leadership utilizes a variety of “metrics” to create a more “cost efficient” clinic, someone can show them this article, and perhaps they will read it and pause rather than act.