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Title: Psychiatrists Prescribing More Drugs, But Not Psychotherapy
URL: http://www.pslgroup.com/dg/2276BA.htm
Doctor's Guide
August 7, 2008

CHICAGO -- August 7, 2008 -- A declining number of office-based psychiatrists appear to be providing psychotherapy to their patients, according to a report in the August issue of Archives of General Psychiatry.

Psychotherapy has been part of the practice of psychiatry for generations. "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 US psychiatrists -- a trend attributed to reimbursement policies favouring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects," the authors wrote.

Ramin Mojtabai, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Mark Olfson, MD, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York, analysed trends in psychotherapy provision using data from national surveys of office-based psychiatrist visits from 1996 through 2005.

Over the 10-year period, psychotherapy was provided in 5,597 (34%) of 14,108 visits lasting longer than 30 minutes. The percentage of visits involving psychotherapy declined from 44.4% from 1996 to 1997 to 28.9% from 2004 to 2005. "This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications," said the authors.

The number of psychiatrists who provided psychotherapy to all of their patients also declined over the same time period, from 19.1% to 10.8%.

"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 authors wrote.

"These trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalisation of psychiatric practice."

"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," concluded the authors.


SOURCE: Journal of the American Medical Association

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