As we reported earlier today, psychiatrists are doing less psychotherapy than they were a decade ago:
Over the 10-year period, psychotherapy was provided in 5,597 (34 percent) of 14,108 visits lasting longer than 30 minutes. The percentage of visits involving psychotherapy declined from 44.4 percent in 1996-1997 to 28.9 percent in 2004-2005.
“This decline coincided with changes in reimbursement, increases in managed care and growth in the prescription of medications,” the researchers write.
The number of psychiatrists who provided psychotherapy to all of their patients also declined over the same time period, from 19.1 percent to 10.8 percent.
This is not a surprising finding, given that psychiatry as a profession has enjoyed a general, progressive decline over the past 4 decades. At the start of the 1970s, over 11% of medical students chose psychiatry as their medical specialty. By 1980, that number had been cut by more than half, to under 5.5%. Nearly 14 years later, in 1994, only 3.2% of U.S. medical school graduates chose psychiatry. While the number has since risen to 4.2% in 2002, it’s still a far cry from the 1970s when one in every 10 doctors chose to become a psychiatrist (Newton & Grayson, 2003).
With fewer psychiatrists available, those who do go into practice in most areas of the country are in generally high demand. And the demand tends to be focused on what psychiatrists can do that virtually no other mental health professional can provide — prescription medications.
Coinciding with the great increase in the number of psychiatric medications prescribed over the past decade, psychiatrists have largely been unable to resist the pressure of market forces which reinforce their expertise with these medications over psychotherapy.
Combine that, too, with the vast quantity of master’s level therapists now available (and who enjoy the same insurance reimbursement rates as their medical counterparts for doing psychotherapy), as well as the continuing increase of clinical psychologists, and you can see why psychiatrists have less time to spend in talk therapy.
Sadly, I don’t think the situation is likely to change much in the upcoming years, as medical school students tend to rank psychiatry right up there with proctology. I also don’t think it hurts potential clients, however, as long as they are seen by an experienced psychotherapist in addition to a psychiatrist for their mental health concern.
Mojtabai, R. & Olfson, M. (2008). National Trends in Psychotherapy by Office-Based Psychiatrists. Arch Gen Psychiatry, 65, 962 – 970.
Newton, D.A. & Grayson, M.S. (2003). Trends in Career Choice by US Medical School Graduates. JAMA, 290, 1179-1182.