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DBT requires teams of people with different types of expertise and so the original operating model developed by Dr. Wheelis was one in which TBC was staffed by a large number of part-time clinicians, known as the “affiliate model.” Changes in the health care environment, particularly the advent of managed care, have put very real pressures on this model and the company is now in a state of crisis.

Dr. Wheelis is trying to decide whether and how to keep it going. The key decision is whether to shift to a “staffing model” based on a larger number of full-time clinicians. This will require a larger patient population to make the economics of greater fixed capacity viable.

TBC is trying to decide whether to join the Blue Cross Blue Shield network, which would increase its patient population but at rates much lower than it currently charges by only taking private patients. Dr. Wheelis is also pondering whether to start a non-profit foundation as a way of getting money to support its teaching and training programs, or even making the company a non-profit itself.