By Susan Gallagher
Luis Betancourt, MD, and Javier Santos-Cubiñá, MD, became fast friends when Betancourt—then a second-year Child and Adolescent Psychiatry (CAP) fellow at Duke—interviewed Santos-Cubiñá for the fellowship program in 2013. Now, nearly seven years later, they co-own a private practice, Pediatric & Family Behavioral Health, in Charlotte, North Carolina.
Betancourt, a native of Chicago, established the practice with another CAP fellow, David Patton, MD, right after they completed the fellowship in 2014. Patton is no longer part of the practice, but Betancourt notes that “he’s still very much a part of our family, and the doors to our practice are always open for him.” In fact, they’ve continued to work together: Patton is the child, adolescent and general psychiatric emergency department director at Novant Health Presbyterian Medical Center, where Betancourt and Santos-Cubiñá lead the consult liaison service in addition to running their practice.
Santos-Cubiñá, who grew up in Puerto Rico, joined Pediatric & Family Behavioral Health in 2016, shortly after graduating from the program. He has been a partner since Patton left the practice in 2018.
In their clinic, Betancourt, Santos-Cubiñá and a team of 11 other providers specialize in treating children, adolescents and adults through medication management and a range of therapy approaches.
We recently talked with them to learn more about their journeys from fellows to practice partners. Here are some excerpts from our conversations.
Duke Psychiatry: What made you decide to establish your own practice?
Betancourt: While I was training at Duke, I really appreciated the time I was able to spend with our patients and their families and being able to take a very thorough psychodynamic approach to my evaluations, to not be rushed and to collaborate and discuss cases with my colleagues. I knew that it would be very difficult to find a similar type of clinic, so David [Patton] and I started to build it on our own.
Duke Psychiatry: How did the two of you meet?
Santos-Cubiñá: When I was applying to fellowship programs, I reached out to [then-program director] Dr. Gary Maslow, who suggested I talk with Luis, one of the second-year fellows. Luis actually interviewed me for the program, and we hit it off right away. We met face-to-face when my wife and I came to take a look at Durham, and it was great. He was a key factor in me coming to Duke. When we moved to Durham, Luis had already finished the program and moved to Charlotte, but we kept in touch.
Duke Psychiatry: What made you decide to join Dr. Betancourt’s practice?
Santos-Cubiñá: In my first year, Luis asked me to come down to check out Charlotte and the practice. My wife and I took several trips there, and when I finished the fellowship program, we made the choice to come to Charlotte. I started working with Novant in July and then by the fall, I started seeing patients at the practice.
One of the things that I really liked about Duke was that they really nurtured the autonomy and independence you have as provider. The model Luis and David had created was very similar to what we did at Duke in terms of the amount of time we were able to spend with patients and our passion in caring for patients, so those experiences translated really well into the practice.
Another great thing is that we have a very similar approach to how we practice, and we have a collegial relationship where we can knock on each other’s doors at any time to discuss a case. All of these things really attracted me to the practice.
Duke Psychiatry: What do you like most about running your own practice?
Betancourt: I like being able to give my patients the time that they need. I like the independence. I don't have insurance companies telling me I can only spend a half-hour with the patients.
Santos-Cubiñá: We can translate our passion into the way we practice and have that sense of autonomy and independence. We practice like we want to practice, like we were trained: putting our patients first and using that knowledge to serve the community in the best way we can.
Duke Psychiatry: What do you find most challenging about it?
Betancourt: In Charlotte, there aren’t a lot of resources available, even for the insured population. It becomes difficult because you want to offer your clients the best possible care, but they may need a more intensive level of care than what our practice typically provides. But when you can’t find other resources, sometimes you find yourself having to try as much as you can to provide that care. We’re stretched so thin. But on the positive side, my training at Duke was very helpful. For example, I never thought I would use the child forensic work I did with Dr. [John] Looney during training, but when there’s no child forensic psychiatrist and you’re a child psychiatrist and you have child forensic training, you find yourself providing those services.
Santos-Cubiñá: Having enough time. The demand for children’s mental health services and resources is so high. Being able to keep a work-life balance and be present with our families, especially as parents, is a challenge.
Duke Psychiatry: What advice would you give to Duke Child and Adolescent Psychiatry fellows who are considering starting their own practice?
Betancourt: Get a good accountant! Learn as much as you can about the business side of things. Many times, we’ve made mistakes because we’re not accountants and we’re not business-minded. We’re all about giving care. Also, don’t be afraid to launch. Know that you’re an asset and that the community needs you. We’re blessed with the talent of being able to help children and their families. You’re well-trained, you know enough and you’re ready. Also, speak to local government and other local officials about the needs in the community where you’ll be practicing—that will make you a better advocate.
Santos-Cubiñá: Ask questions. We've walked this path, ask us how we did it. Know that there’s a community of fellowship alumni out there that you can reach out to. Also, you really don’t know where you’re going to end up. Things evolve. That’s one of the things Duke prepares you for—you get such a broad frame of training that you’re able to accommodate, be flexible and roll with changes.
Duke Psychiatry: Was there a particular clinic or setting at Duke that inspired you?
Betancourt: No doubt! It was a combination of the Child Development & Behavioral Health Clinic and the Child & Family Study Center. That was just amazing, and that’s where I learned most of my parent management and family therapy skills. It was really valuable. Pediatric & Family Behavioral Health is a fusion of those two models.
Santos-Cubiñá: Oh yes—not only clinics, but also individuals. The Family Studies program really inspired and motivated me. I still find myself channeling some of my mentors, like Dr. [Karen] Wells, Dr. [Susan] Hazlett and Dr. [Christian] Mauro when I’m seeing patients. They really helped us understand how to look at a family as a system and how each family member can impact each other.
The other clinics I thought were fantastic were the autoimmune disorders clinic and the perinatal clinic. It was so great to be exposed to different approaches as well—like Dr. [Marla] Wald is very psychodynamic-oriented, and Dr. Mauro is a CBT [cognitive behavioral therapy] powerhouse.
Duke Psychiatry: Is there anything in particular that you learned or experienced during the program that has stayed with you and informed your practice today?
Santos-Cubiñá: Being trained by very creative mentors has helped me to be able to switch hats quickly and adapt to many different situations. That’s been very helpful to me as a child psychiatrist and I think I learned a lot about that at Duke, because I was doing so many different things. As a fellow, I was given so many tools that I can use in different moments.
Duke Psychiatry: What’s your best memory of the program?
Betancourt: There’s a lot! I really enjoyed the Child & Family Study Center and working in the consult liaison service. Although it was busy, I enjoyed the collaboration and my peers. I had great peer support and a great team, and I think some of those friendships will be life-long.
Santos-Cubiñá: One thing I remember fondly from the program is how accessible everyone was. It felt very homey. It didn’t feel bureaucratic, just very down to earth, where you can sit down with your training director and talk about cases or just have coffee together. That’s how everyone was, and still is. When Luis and I went back there recently, it was kind of like being home again.
Duke Psychiatry: What do you like to do when you’re not doing psychiatry?
Betancourt: I like to play golf and tennis and hang out with my wife. I would say my kids, too, but they’re adolescents now, so I'm not as cool I used to be to them!
Santos-Cubiñá: I love to cook. When I have the time, I like to source the ingredients locally. There are a lot of farms near us, and I like to take advantage of that and to source these ingredients from small producers who are also very passionate about what they do. And if you start with good ingredients, you’re going to end up with a great meal.
Learn more about the Duke Psychiatry & Behavioral Sciences Child and Adolescent Psychiatry Fellowship.