worried about future of psych?

[alina_s]

I'm really interested in psych but it is disturbing that everyone I know in the mental health field outside of school is quite pessimistic and discouraging. One social worker said that the psychiatrists in her agency spend so little time with the clients, do so little, that she could do their job. Most seem to expect the insurance coverage and government programs to get far worse in their mental health coverage before they get better. There's certainly a need for psychiatrists in our health system but I can't imagine helping anyone with a five-minute visit. Is there hope for finding a satisfying job outside of the relatively protected academic medicine?

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[anaismd]

dont listen too much to pessimistic people cause they're usually half wrong about the glass being half empty and so on and so forth

ALL of the psychiatrists i know are happy with their field
see pts for 45min for therapy or 15-30min for med management
some teach, some do research, some are in administration
The best thing about psych is that you can do so much
There are probably situatons where the pt load is so great you only have 15 minutes per pt, but thats more a reflection on the shortage of psychiatrists just like there are clinics where docs only see pts for 5 minutes

we still get more time than most other fields

 

[Histrionic]

One social worker said that the psychiatrists in her agency spend so little time with the clients, do so little, that she could do their job.

There will always be non-physicians that feel that they could function as well as physicians. If they want to do the job, then put in the 8-9 years post-grad work.If you want to be a physician then go to medical school!! New Mexico recently passed legislation that allows psychologist to prescribe medications due to the shortage of psychistrists in that state. We will see how well this works after a few hundred TCA overdoses.
Most of the psychiatrists that I know in California have too much work.

 

[Olanzapine]

Originally posted by Histrionic
There will always be non-physicians that feel that they could function as well as physicians. If they want to do the job, then put in the 8-9 years post-grad work.If you want to be a physician then go to medical school!! New Mexico recently passed legislation that allows psychologist to prescribe medications due to the shortage of psychistrists in that state. We will see how well this works after a few hundred TCA overdoses.
Most of the psychiatrists that I know in California have too much work.

Yes, I'm sure that there will be a few hundred TCA overdoses because psychologists are unable to read drug manufacturing labels about proper dosing and cannot afford to purchase PDRs. Never mind the fact that there are probably only a few hundred people in all of New Mexico and the western US coast that were even prescribed TCA's for use as an anti-depressant. I'm in med school, I see a psychiatrist, and if I had it my way, the whole field of psychiatry would be handed over to a more competent profession. At my med school, we get 1 month of learning psych meds during 2nd year, and our required 3rd yr psych rotation is for 4 weeks. If a psychology graduate school that lasts for 4-6 yrs is truly unable to incorporate the 2 months of psychiatry training that I will have when I graduate with my MD (which is all we need to write for all the psych medicines we want), then more power to us. The 3 yr psychiatry residency could easily be incorporated into a 4-6 yr psych grad school program with a 1 -3yr internship/post-doc that most psychs are expected to do anyways. Don't bother responding with how dangerous MAOi's are either, I'm sure that psychologist could eventually learn, with proper and extensive training, to tell their pt's to avoid cheese too.

 

[gyri]

Olanzapine, it's not reasonable to malign the entire profession of psychiatry based upon your individual experience. In any given field, of course there will be more competent and less competent people.

Becoming a psychiatrist requires a four-year residency, by the way, with training programs offering various emphases on different therapeutic modalities (including pharmacotherapies and psychotherapies,) psychobiology, neuroscience, and research.

I'm not sure whether psychologists should have prescriptive privileges or not, but I do think that any good psychiatrist should have a solid foundation in medicine first. This is essential in order to be able to discriminate between psychiatric illness and psychiatric manifestations of other systemic illness, to understand the best side effect profiles for people with various co-morbidities, and to prescribe medications appropriately given potential interactions with a patient's other meds.

I imagine that if a psychologist were to undertake all of a patient's psychiatric care (perhaps via assuming prescriptive privileges?), there would be the risk of overlooking something significant, simply because the provider did not have a medical background. Furthermore, as psychiatry (or at least some part of the discipline) moves towards an increasingly biologically-based orientation, it doesn't seem practical or efficient to expect psychologists to jump aboard and develop expertise in neuroanatomy, neuroimaging, etc (nor do I imagine that many would want to.)

In mental health, as in so many fields, the work seems to function most smoothly with a multi-disciplinary approach. There are plenty of opportunities for psychologists, psychiatrists, social workers, nurses, etc., to all make important and valuable contributions.

 

[Thewonderer]

Originally posted by Olanzapine
At my med school, we get 1 month of learning psych meds during 2nd year, and our required 3rd yr psych rotation is for 4 weeks. If a psychology graduate school that lasts for 4-6 yrs is truly unable to incorporate the 2 months of psychiatry training that I will have when I graduate with my MD (which is all we need to write for all the psych medicines we want), then more power to us.

Olanzapine is simplifying things so much.

Just because you are qualified as an MD to prescribe psych meds, that does not mean you are comfortable or SHOULD prescribe psych meds.

When is the last time you heard of any family doc, even after practicing for 30+ years, prescribe TCA or MAOI? rarely if never. They are only comfortable with SSRI and that's it.

When is the last time you heard of a family doc screw up benzodiazepine and get their patients hooked onto it? probably occasionally but often enough.

It is the same as a general surgeon being able to prescribe TPA for stroke patients but do they ever really do it? No, the risk of malpractice is way too high. They will get sued out of their a$$.

Psychiatrists do have their niche that a newly graduated MD cannot replace.

 

[Delvonik]

Originally posted by Histrionic
There will always be non-physicians that feel that they could function as well as physicians.

No Kidding ! I know a guy who seems to believe he knows everything you need to know about medicine. When I broke my arm,he openly critisized the Orthopedic Techs (not doctors) and the surgeons on the quality of the cast.He also seems to have a grudge against lawyers,buisnessmen,fine artists and others with professional training. Hmph !

 

[Kluver Bucy]

One problem with psychologists trying to do a psychiatrist's job is that they aren't properly trained in meds and that will result in more deaths.

Also, people are going to die because of the limited diagnostic ability of psychologists. If your only tool is a hammer, every problem looks like a nail. For example, consider a case in which a pt presents to a psychologist complaining of palpitations, paresthesias, hyperventilation, diaphoresis, chest pain, dizziness, trembling and dyspnea. The psychologist is going to be thinking "anxiety" but the MD will more often catch mitral valve prolapse and ventricular fibrillations, which could be made worse by certain psychotropic meds.

And suppose a person shows presents to a psychologist's office complaining of fatigue? What sort of differential diagnosis can the psychologist create?

From the Journal of Family Practice:
"Of 100 patients presenting to a primary care physician with fatigue, approximately 25 will be depressed; 25 will have another psychiatric diagnosis, such as dysthymia or anxiety; 15 will have an infection, such as hepatitis, cytomegalovirus, or mononucleosis; 15 will have another physiological cause of fatigue, such as undiagnosed diabetes, anemia, or hypothyroidism; and 20 will remain undiagnosed."

The psychologist is a valuable professional, but they aren't qualified to do a medical doctor's job. The only people who are going to benefit from the New Mexico ruling are the malpractice attorneys.