About us
Our History
Rittenhouse Psychiatric Associates’ parent organization was founded in 2012, by Dr. Chris Pagnani, upon completion of his Psychiatric Residency at Johns Hopkins Hospital. Dr. Pagnani had served as “Chief Resident” within his training program, and although he wished to remain involved in academia, his primary focus and career interests were always in direct patient care. This led to his continued involvement with Johns Hopkins on Part-Time Faculty as an Instructor of Psychiatry (a position that he has maintained since 2012) and the opening of his private practice “Chris Pagnani MD PC” in Philadelphia.
Dr. Pagnani credits his decision to open his own medical practice to his father (Alexander M. Pagnani, MD, 1949 – 2020), who was a private practice Urologist in Cape May County, NJ for over thirty-five years. Dr. Pagnani Sr. provided a great deal of mentorship, and when his son had trepidations about starting his own practice, his dad would often be quoted saying “there’s always room for another physician, who takes great care of their patients.”
Even still, Dr. Pagnani thought that it was important to find consistent per diem work, while he built his practice. Afterall, student loan repayments were due, and starting a practice from scratch, had its expenses. Thus, he juggled part-time work at the Philadelphia Maximum Security State Prisons, the Philadelphia VA (emergency work and 24-hour overnight shifts), and at a community mental health center called “The Wedge,” with locations in inner-city Philadelphia neighborhoods. These experiences allowed for educational growth (particularly regarding severe and chronic mental illness), and a further understanding of some of the flaws regarding mental healthcare, in the US. They have also given rise to his current involvement in charities that help a population that may not be able to utilize fee-for-service private practice, such as serving on the Young Professionals Board (2019-2022) and the Board of Directors (2024- Present) of Uplift – The Center for Grieving Children, which provides free grief therapy to predominantly inner-city children, who are grieving the loss of a parent, by death or incarceration.
As per usual, Dr. Pagnani Sr. was right, and Chris Pagnani MD PC filled within 9 months. There was never any thought or intention of growth beyond being a solo practitioner. However, in 2015 Jessica Plocher, RN (a colleague of Dr. Pagnani’s from Johns Hopkins inpatient Psychiatry) reached out, as she was finishing her master’s as a Psychiatric Mental Health Nurse Practitioner at The University of Pennsylvania, and soon to become a CRNP. She was interested in establishing her own caseload, within a private practice. Although her focus was on direct patient care, she had excelled academically and was slated to continue at the University of Pennsylvania as an Instructor (a part-time position that she held for several years after her master’s). Within 6 months, her practice was booming, and she asked Dr. Pagnani if he would consider hiring another colleague and friend – who also trained at the University of Pennsylvania. In 2016, Elizabeth Milburn, CRNP joined the practice. Ms. Milburn fit in well with its academic culture, and similar to Dr. Pagnani and Ms. Plocher, had a focus on direct patient care. Ms. Milburn brought additional expertise in student mental health, having worked at the University of Pennsylvania’s Student Counseling Program (CAPS) during her training.
Dr. Pagnani knew that if he continued to bring individuals into the practice, who were academically oriented (published within the field, graduated from the nation’s top programs, and/or held academic appointment) yet focused on clinical care, the culture within the practice, and the quality of its treatment, would flourish.
He also made an observation (which he continues to assess as fact) – the Psychiatric Nurse Practitioners within the practice provided longer and more thorough psychiatric evaluations and follow-up appointments, were more extensively trained in Psychiatry, were more likely to collaborate with a patient’s psychotherapist and family, and delivered a higher quality of psychiatric care, than the primary care physicians, internists and OGBYNs who often treat psychiatric illness in our community. He also noted, that he trusted the CRNPs at the practice, even more-so, than most local Psychiatrists, when friends and family asked for recommendations for their own mental health treatment.
Richard D’Amato, CRNP and Rachel Reis, CRNP (both trained and appointed Instructor at the University of Pennsylvania) joined the practice in 2018. James Yi, MD, PhD, a graduate of Johns Hopkins Psychiatry (Dr. Pagnani’s class) and Assistant Professor at the University of Pennsylvania also joined that year. We also began hiring therapists and psychologists around this time, to increase mental health services, case collaboration and discussion among peers. As the practice continued to grow by 1-2 providers per year, it needed a new name, representative of the collective, not just one provider. In 2019, Rachel Reis, CRNP coined the group “Rittenhouse Psychiatric Associates” (RPA).
For the first 6 years of the practice, providers answered all calls, emails and faxes, scheduled their patients, and handled all billing and other administrative work. It became apparent by 2018, that help was (desperately) needed. Amy, who had attended high school with Dr. Pagnani, had married his close friend Chris, and who worked for Dr. Pagnani Sr. at his Urology Practice, was brought onto the team, as the practice’s Office Manager. She has become an integral part of RPA since, and now handles our HR and payroll, and leads a team of administrators. Even so, she’ll answer the phone when you call.
We believe, that our practice has continued to operate with the same mission, values and quality care that Dr. Pagnani established in 2012. We believe that the academic culture that we’ve created among our providers promotes personal and occupational growth, and an ideal work environment. While Dr. Pagnani Sr’s quote is still applicable, we believe that we can now make a small edit: “There’s always room for another Physician, Nurse Practitioner, Psychologist or Therapist, who takes great care of their patients.”
Our Concerns
During the Covid Pandemic, large national mental healthcare companies began purchasing private psychiatric practices, at an astounding pace. While these companies often advertise “high quality” and “evidenced-based care,” many seem driven by growth. Just search for a psychiatrist on Google, and you’ll see website homepages gloating about “thousands of providers,” “hundreds of locations,” and (literally) “millions” of visits. While our practice has grown, to address the need for quality mental healthcare treatment throughout the US, there seems to be a “flip” mentality with our competitors, particularly those backed by private equity.
Private Equity is rapidly purchasing private psychiatric practices, rolling them up into larger conglomerates, stripping down costs (often at both provider and patient expense), and then selling to larger conglomerates in 3-5 years. Providers working at these companies may note mandates for shorter patient visits, an increased volume of patients in their caseload, pressure to make certain diagnosis (and write certain prescriptions), and virtually no time to collaborate with a patient’s family or other medical providers. There’s a shift in primary focus from direct patient care, to maximizing profits, and a quick return on investment.
We believe that the mentality that big business has regarding healthcare in the US, is often rather different from the mentality that a physician, nurse practitioner or Psychologist has, when caring for patients.
Many mental health on-line companies are now hiring non-psychiatric providers, as their “specialists” for Anxiety, ADHD and other mental health treatment. For example, hiring physicians or nurse practitioners who never completed psychiatric residencies or received psychiatric mental health nursing degrees. They may also hire a large number of providers who are not Board-Certified Psychiatrists, or not even board eligible. The public at large, often has no idea to even ask about such things, and we believe that because of this (in addition to their enormous advertising and public relations budgets), the quality of mental healthcare treatment in the US is rapidly declining, and unfortunately, very few are taking note.
We’ve also seen an explosion of large on-line companies who focus on only 1 or 2 mental health conditions, and are quick to prescribe controlled medications, with a high potential for abuse. On-line “ADHD,” “Anxiety,” and even “ketamine” companies, with limited patient interaction and follow-up, “subscription plans” for controlled medications based on short on-line surveys, and “same day” evaluations by non-psychiatric specialists, not only seems like poor quality care, but dangerous care.
We are proud to be advocates of not only mental healthcare treatment, and its normalization, but the normalization of “competent, thoughtful and conscientious” mental healthcare treatment.
Rittenhouse Psychiatric Associates is 100% Physician & Founder owned, has never had a relationship with private equity, and has never even utilized a business loan. Our Executive Team and Directors are all providers as well, with their primary focus being patient care. RPA has grown based on its reputation for delivering quality psychiatric care, and the autonomy and academic environment that it has created for its providers. Operating in this manner is best for those whom we care for, and we plan on staying this way. It’s what our patients deserve.
