From the good news / bad news department: Mainstream media sources are reporting that American psychiatrists have essentially stopped practicing psychotherapy. Rare exceptions occur with private paying clients. The majority of psychiatrists are dealing almost exclusively with medication management.
Over the last twenty years, the percentage of psychiatrists offering talk therapy has declined from a little less than half to a little more than one quarter, according to the most recent National Ambulatory Care Survey. As a result, the success rates for treating depression and anxiety have slipped. This likely because a combination of talk and medicine is customarily the preferred treatment for these common conditions.
The main cause is managed care. Insurance companies prefer the faster and cheaper route to symptom management: pills. This would seem to be bad news for clients, bad news for therapists, and bad news for anyone concerned about the mental health of the general public. So what good news could there possibly be?
Well, if you’re a provider of talk therapy who isn’t a psychiatrist, you may find reason to smile about this. It promises that an increase referrals to psychologists, social workers, and Marriage and Family Therapists (MFT) lie in the future. Although the study did not look at this trend in particular, anecdotal evidence, reports from talk therapists and managed care case managers suggest therapy is still happening. It is just that non-medical (and therefore, not by coincidence, lower paid) professionals are providing it.
An insurance company may not want to pay two to three hundred dollars per hour for the listening ear of a psychiatrist. For example, a lower reimbursement rate given to a social worker may be up to 50% less or lower and limited to perhaps 24 visits per year. Lower rates allow them keep their profit margin while still being able to say they support the proven results of psychotherapy.
So in practical terms, this may not be so bad. Psychiatrists can focus more on training as experts in psychopharmacology, a profoundly dense and complicated field that is only growing in complexity. Meanwhile, other professionals can develop relationships with local psychiatrists and managed care companies to increase our referral base and get paid to do what we love. And continue to be sought and compensated for what we were trained to do: psychotherapy, pill free.
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