Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Are psychiatrists rushed, uncaring, and in it only for the money?

Dinah Miller, MD
Physician
July 25, 2011
Share
Tweet
Share

Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients.  It’s all about writing prescriptions for medications and the days of “tell me about your mother”  are long gone, or so we’re told.  The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not most — psychiatrists practice, and that medications and psychotherapy are either/or  treatments, rather than complementary.

Is it true that psychiatrists are rushed, uncaring, uninterested, and in it only for the money?  Has it all become about  how fast a prescription can be written, as if the practice of psychopharmacology is something that can be done quickly, thoughtlessly, and without even knowing the patient?  As a past president of the Maryland Psychiatric Society, a former community mental health center medical director, and a general extrovert, I know a lot of psychiatrists.  I was curious, and with some help, I put together a How We Practice survey and had the Maryland Psychiatric Society send it out to the members who have email addresses on file.

Psychiatrists were asked how many people they typically see on their busiest day of the week — please note that this survey was not validated, and data were not collected: it was merely a question we asked in an email survey.  The most common answer was 8 to 11 patients. Of the 16% of respondents  who report they see more than 21 patients in a day, several noted that they work in settings other than outpatient practices: hospitals, group homes, addiction centers, schools, and settings where patients are seen in groups or with the help of a multi-disciplinary team.  Only 10 psychiatrists saw more than 30 patients on their busiest days.  We concluded that in Maryland,  few psychiatrists have very high volume outpatient practices, or perhaps those who do are too busy to take a survey.

Some patients do very well seeing a psychiatrist for 15 minutes a season (once every three months) and psychotherapy is not necessary. That’s  not always the case and we know that many patients do better with a combination of psychotherapy and medications.  There are patients who may do better seeing a single psychiatrist rather than dividing their care between mental health professionals.  Sadly, the insurance industry reimburses best if patients are placed on a conveyor belt to see their psychiatrist. That doesn’t make it good medicine, and even when patients get better, some are dissatisfied and angry.

There are several reasons why psychiatrists may practice outpatient psychiatry in a rapid-care model. Participating with insurance plans is a socially responsible thing to do and there are regions of the country where there are very few psychiatrists and restricting practice size is just not feasible.  Also, it pays well.   That doesn’t make it good medicine, nor does it mean that everyone’s doing it. There is no one-size-fits-all psychiatry.

Many psychiatrists (70%– per Mojtabai and Olfson in the Archives of General Psychiatry) see patients for psychotherapy — if not all their patients, then at least some of them.  And often psychiatrists who don’t practice psychotherapy still listen and evaluate a patient’s symptoms within the context of what is happening in their lives, then take the time to answer questions and explain their treatment recommendations.

Converyor-belt psychiatry works for some, but not for others, and it gives psychiatry a bad name.  It is simply not true that all psychiatrists practice this way, that psychiatry has given up on psychotherapy, and that it’s all about the medicines.  In a field that is hampered by stigma, this portrayal is both wrong and irresponsible, and discourages people from seeking treatment.  If that’s not bad enough, it also discourages doctors from pursuing careers in psychiatry, and that only worsens the problem.

Dinah Miller is a psychiatrist who blogs at Shrink Rap and co-author of Shrink Rap: Three Psychiatrists Explain Their Work.

Prev

Policy makers aren't doctors, and why that's a problem

July 25, 2011 Kevin 10
…
Next

Executive compensation and the rising cost of health care

July 25, 2011 Kevin 7
…

Tagged as: Specialist

Post navigation

< Previous Post
Policy makers aren't doctors, and why that's a problem
Next Post >
Executive compensation and the rising cost of health care

ADVERTISEMENT

More by Dinah Miller, MD

  • What do physician coaches do, and what can they do for you?

    Dinah Miller, MD
  • a desk with keyboard and ipad with the kevinmd logo

    There is no oversight for prior authorizations. There should be.

    Dinah Miller, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why psychiatrists don’t take insurance

    Dinah Miller, MD

More in Physician

  • Why physician strikes are a form of hospice

    Patrick Hudson, MD
  • How a doctor defied a hurricane to save a life

    Dharam Persaud-Sharma, MD, PhD
  • Focusing on well-being versus wellness: What it means for physicians (and their patients)

    Kim Downey, PT & Nikolai Blinow & Tonya Caylor, MD
  • Why hiring physician intrapreneurs is the future of health care leadership

    Arlen Meyers, MD, MBA
  • Love, birds, and fries: a story of innocence and connection

    Dr. Damane Zehra
  • The overlooked power of billing in primary care

    Jerina Gani, MD, MPH
  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Civil discourse as a survival skill in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Focusing on well-being versus wellness: What it means for physicians (and their patients)

      Kim Downey, PT & Nikolai Blinow & Tonya Caylor, MD | Physician
    • Why hiring physician intrapreneurs is the future of health care leadership

      Arlen Meyers, MD, MBA | Physician
    • How the One Big Beautiful Bill could reshape your medical career

      Kara Pepper, MD | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Civil discourse as a survival skill in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Focusing on well-being versus wellness: What it means for physicians (and their patients)

      Kim Downey, PT & Nikolai Blinow & Tonya Caylor, MD | Physician
    • Why hiring physician intrapreneurs is the future of health care leadership

      Arlen Meyers, MD, MBA | Physician
    • How the One Big Beautiful Bill could reshape your medical career

      Kara Pepper, MD | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Are psychiatrists rushed, uncaring, and in it only for the money?
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...