Psych Residency Interest Rising, But Challenges Remain
There’s a new wave of psych professionals showing interest in the profession but integrating them into the primary care setting where most of us go first for care for ourselves or our kids is difficult - even if this integration can’t come soon enough.
Bet you didn’t know that primary care providers prescribe 80% of antidepressants and see 60% of people being treated for depression in the US and yet they are able to determine the need for the prescription during such as short window of time - the average length of a PCP visit is only 18 minutes, according to the Yale Journal of Biology and Medicine.
“Comes from a lot of systemic challenges facing doctors - they have been encouraged for a long time to be productive, and have been paid that way, and there is a fear that if you don’t prescribe, you face some liability - you could lose the patient or there could be an even worse outcome,” says psychologist Chandler Sparks.
Medication should ideally be prescribed in combination with some form talk or cognitive behavioral therapy for most mental health issues, but finding available psychiatrists is difficult. Just 56% of psychiatrists accept insurance, compared to 90% of non-mental health physicians, according to a CNBC report.
Some physician groups have tried to “embed” therapists on the staff or partner with a telepsychiatry business to offer immediate “virtual consults” down the hall. “It’s not ideal, but it’s the next best thing and it allows me to focus on other patients and let a psych professional really assess whether a script is necessary,” says Pat Connors, a pediatrician. About 75% of the time, it’s not, she says.
Integrated care where interdisciplinary teams engage the patient can be the most successful particularly to limit the downsides of a referral since wait times for psychiatry can be extremely long, even to see an in-network therapist.
Average wait time to see a psychiatrist is more than five weeks for 80% of people, according to a Psycom report and up to 5 months for sub-specialists according to a BRG study.
Health insurers have tried to pick up some slack by offering telehealth as a covered benefit during the COVID-19 pandemic and thankfully most still cover these services, but the process is imperfect. Kaiser Permanente psychiatry was “averaging less than 18 minutes for appointments” and “doing appointments by telephone” rather than video until around November 2020, according to a anonymous source.
Better engagement with a therapist overall will likely help provide better care and, obviously, increasing the number of mental health providers in the US will ease strains on the system.
In a positive sign, the number of medical students entering into psychiatry continues to climb, up to 1,537 in 2021—more than two times the 685 who entered these programs in 2014. The percentage of allopathic graduates matching in psychiatry also is rising, up to 6.5% vs. just 4% a decade ago. Psychiatry is becoming more interesting for med students.