Fewer psychiatrists providing psychotherapy

Fewer psychiatrists providing psychotherapy

Fewer office-based psychiatrists are personally offering psychotherapy to their patients according to an article released on August 4, 2008 in Archives of General Psychiatry, one of the JAMA/Archives journals.

The intervention of psychotherapy has been a strong part of the practice of psychiatry since its inception. Usually involving verbal communication, it is used to help patients live to a higher potential independently or in addition to medication. Psychotherapy in one of its many forms are used for the treatment of many conditions, such as major depression, post-traumatic stress disorder, and bipolar disorder. However, according to the authors of the article, this practice as performed by psychiatrists has declined in recent years. "Yet, despite the traditional prominence of psychotherapy in psychiatric practice and training, there are indications of a recent decline in the provision of psychotherapy by U.S. psychiatrists, a trend attributed to reimbursement policies favoring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects," they write.

To investigate the magnitude of this impact, Ramin Mojtabai, M.D., Ph.D., M.P.H., then of Beth Israel Medical Center and now of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and Mark Olfson, M.D., M.P.H., of the Columbia University Medical Center and New York State Psychiatric Institute, New York, examined trends using data from national surveys of office-based psychiatry visits between the years of 1996 and 2005.

In the ten years examined, 35% of the visits that lasted more than 30 minutes (5,597 of 14,108) were used for psychotheraputic sessions. This indicates a decline from 44.4% in the period beginning in 1996 progressing to the lower 28.9% in the period beginning in 2004. The authors point out that many changes occurred in the health care field at this time: "This decline coincided with changes in reimbursement, increases in managed care and growth in the prescription of medications."

The total number of psychiatrists providing psychotherapy to all of their patients also declined, from 19.1% at the beginning of the peiod to 10.8% at the end. The psychiatrists who did offer it had certain common features, say the researchers: "Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often."

The researchers point out that this marks a shift in the practice of psychiatry in the U.S. "These trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalization of psychiatric practice," they say. "A key challenge facing the future generation of psychiatrists will likely involve maintaining their professional role as integrators of the biological and psychosocial perspectives while working within the constraints of the strong market forces of third-party payers and managed care to implement advances in the diagnosis and treatment of mental disorders."

National Trends in Psychotherapy by Office-Based Psychiatrists

Ramin Mojtabai, MD, PhD, MPH; Mark Olfson, MD, MPH

Arch Gen Psychiatry. 2008;65(8):962-970.

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Section Issues On Medicine: Psychiatry