What is the future of psychiatry?

[PsyDr]

People will continue to believe that there are only two potential solutions to any problem.

Media will continue to put forth narratives that define personality through consumerism. People will accept these narratives as normative values, and work harder to buy more things.

Corporations will try to increase profits, reduce costs, and increase productivity. They will say things have always been this way. People will continue to accept workplace demands, and believe that their failures to meet productivity goals are their fault, while their social relationships go away. Like the NFL's foray into primary school education, we will see more brands that try to sell a wraparound "lifestyle".

Using social issues, people will be pitted against one another. While they are distracted, congress will pass laws that benefit whoever can afford the right lobbyist. People will not understand why they are angry.

Because society likes to medicalize social problems, psychiatry will slowly get more and more patients. Large groups will "acquire" small groups, and force increased productivity and use of "extenders". CMS will eventually decrease rates to the intersection of operating cost, and then no outpatient place will take it.

You know... pretty much how Japan ended up.

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[Mad Jack]

I don't know, and I hope to be retired before I find out

 

[whopper]

It's an interesting theory but Richard Hofdstater wrote The Paranoid Style in American Politics in the 60s. This was not a novel insight to the GOP or anyone working in politics.

And totally agree with Sushirolls, again pushing that all political groups are dipping into the crazy-pot. Natural immunity of course was a factor the L was not utilizing, nor looking to the fact that in some areas suicide rates were higher than COVID death rates, and it's easy to see that much of that suicide was directly related to the depression caused by social isolation.

Add to the problem that academic performance of children with home schooling plummeted and then it turned out that while children could still catch COVID, their risk of the disease was much smaller.

The nuances of Trump Derangement Syndrome. etc. It goes both ways,

A patient of mine brought up the so-called "Trump Derangement Syndrome," which existed with every popular politician ever. The guy was a Trump fan who believed Obama wasn't born in the country, which Trump pushed as a conspiracy theory and later recanted. So I told him, "so when Trump said Obama wasn't born in the USA, is that Obama Derangement Syndrome?"

I try not to get political with patients, but I have no problem in tit-for-tat. The guy froze for a few seconds as if befuddled. I told him the bottom line is every popular politician, Trump included, is going to have an impassioned and partisan demographic that hates that politician. So while yes there were people who were, in an unobjective manner and partisan manner, trying to bash Trump, there's Trump defenders who can only point out the most extreme critics, and then try to whitewash the situation to make it as if all criticisms are BS when in fact, like anyone, some criticisms are valid.

This isn't a paranoid bloc. This is a group of people who are upset, shocked, and dismayed by things that are eroding the economy, their freedoms, the way of life they have known, the sense of community that has been but now fractured by the perpetual Racist Monster - despite America being one of the least racist countries on the planet.

So really, if people here and there latch on to a conspiracy theory or two, I get it. I don't blame them. I see it for what it is, a greater symptom of rebuff to liberal left, and the erosion of accountability to politicians who should have resigned (or been jailed), and the perpetual gaslighting of the media.

1930s Germany was a sitting duck for the craziness then later embraced-the Nazi movement. When people are desperate, they will act more desperate and believe more desperate ideas. Add to the problem education, the biggest vaccine against ignorance, is on a downward spiral in America. College tuitions are becoming too expensive and academic performance in America hasn't been so great in the last few years.

Now I will get a bit political, IMHO the Left's best strategy to keep themselves well off, and the country, for the long-term is to find substantive ways to decrease college tuitions, which have been going up more than inflation for decades. I'm talking substantive and not tuition-loan forgiveness. Real policies that make education effective, cheaper, and not making dorms like high quality hotels or have more administrators than students which is happening in several universities today

 

[Merovinge]

Now I will get a bit political, IMHO the Left's best strategy to keep themselves well off, and the country, for the long-term is to find substantive ways to decrease college tuitions, which have been going up more than inflation for decades. I'm talking substantive and not tuition-loan forgiveness. Real policies that make education effective, cheaper, and not making dorms like high quality hotels or have more administrators than students which is happening in several universities today

This needs to be done by expanding the number of overall seats at all our institutions of higher ed while also making jobs that can be done via apprenticeship/certificates/focused certifications better. We have the best university system in the world, but because of that the demand is high and supply is being constrained, we need to release the floodgates in a stable but accountable manner. Funding (for public) and non-profit status (for private) need to be in jeopardy if freshman seats is not expanding, period.

 

[whopper]

Tuitions have been going up, higher than inflation, and no professor's salaries haven't gone up in a corresponding manner. Which begs the question Where the eff then is this money going? Education is the foundation of how we advance as a society but also not fall in the craziness we're already falling into.

Unfortunately all the things I see, such as more administrators than students, having a Dean for every single social cause that students protest about, putting amusement park type things on a campus, football teams, are a large part of the problem, and it's making it harder for people to get an education.

 

[Mad Jack]

Tuitions have been going up, higher than inflation, and no professor's salaries haven't gone up in a corresponding manner. Which begs the question Where the eff then is this money going? Education is the foundation of how we advance as a society but also not fall in the craziness we're already falling into.

Unfortunately all the things I see, such as more administrators than students, having a Dean for every single social cause that students protest about, putting amusement park type things on a campus, football teams, are a large part of the problem, and it's making it harder for people to get an education.

The easiest way to make tuition affordable is to, unfortunately, end the current system as it stands. The student loan system created this crisis, because schools adjusted their expectations of payment to match what the federal government would guarantee, more or less. Drastically cutting the guaranteed student loan amounts and having a system of fiscal responsibility that schools are required to meet in order to qualify for student loans would be ideal. This would likely cause the collapse of many smaller schools, likely hundreds of them, and a lot of pain in the ones that remain. But it needs to be done if we want the system to continue functioning.

 

[finalpsychyear]

The easiest way to make tuition affordable is to, unfortunately, end the current system as it stands. The student loan system created this crisis, because schools adjusted their expectations of payment to match what the federal government would guarantee, more or less. Drastically cutting the guaranteed student loan amounts and having a system of fiscal responsibility that schools are required to meet in order to qualify for student loans would be ideal. This would likely cause the collapse of many smaller schools, likely hundreds of them, and a lot of pain in the ones that remain. But it needs to be done if we want the system to continue functioning.

I don't think there is any going back. Will need to be a paradigm change. What i bet will happen is AI in the next decade will literally custom teach future students. It may start as a tutor only mode or something and progress. I look back at how terrible 90 percent of all my teachers were in HS/college/medical school. These days with YouTube and khan academy omg there is no shortage of great resources at minimum cost. I learned more from those damn kaplan videos than I ever did in the first few years of med school. IMO every class should have a pre recorded highly rated instructor with notes more or less provided and paired with some type of office hours or general Q and A portion of the class room setting or virtual q and a and maybe this is already being done to a large degree.

The "college" experience may be available via room and board or joining some frat/sorority only while the educational aspect is done separately. However, the powers behind the scene love to tout how "valuable" a college education is while pouring on mountains of debt and sending you out into the workforce for the next 30-40 years of life.

 

[finalpsychyear]

Tuitions have been going up, higher than inflation, and no professor's salaries haven't gone up in a corresponding manner. Which begs the question Where the eff then is this money going? Education is the foundation of how we advance as a society but also not fall in the craziness we're already falling into.

Unfortunately all the things I see, such as more administrators than students, having a Dean for every single social cause that students protest about, putting amusement park type things on a campus, football teams, are a large part of the problem, and it's making it harder for people to get an education.

These days i would argue most people going to college isn't the best way purely from a learning stand point. The most valuable aspect is the life maturity with others dating, friendships, breakups etc but maybe that can be separated but i doubt they would allow that since its a huge money maker. The future ( 10 years) is going to be replacing many jobs with AI and robots.

 

[Mad Jack]

I don't think there is any going back. Will need to be a paradigm change. What i bet will happen is AI in the next decade will literally custom teach future students. It may start as a tutor only mode or something and progress. I look back at how terrible 90 percent of all my teachers were in HS/college/medical school. These days with YouTube and khan academy omg there is no shortage of great resources at minimum cost. I learned more from those damn kaplan videos than I ever did in the first few years of med school. IMO every class should have a pre recorded highly rated instructor with notes more or less provided and paired with some type of office hours or general Q and A portion of the class room setting or virtual q and a and maybe this is already being done to a large degree.

The "college" experience may be available via room and board or joining some frat/sorority only while the educational aspect is done separately. However, the powers behind the scene love to tout how "valuable" a college education is while pouring on mountains of debt and sending you out into the workforce for the next 30-40 years of life.

I've been saying this for years. Medical school should just have faculty researchers that are available for answering questions or providing guidance about material, but we should curate the best of the best lecturers to create standardized, streamable classes that cover all of the necessary material in medical school. The researchers can focus on staying in their labs as they prefer, while everyone in medicine will receive the highest quality instruction abailable on each topic.

 

[finalpsychyear]

I've been saying this for years. Medical school should just have faculty researchers that are available for answering questions or providing guidance about material, but we should curate the best of the best lecturers to create standardized, streamable classes that cover all of the necessary material in medical school. The researchers can focus on staying in their labs as they prefer, while everyone in medicine will receive the highest quality instruction abailable on each topic.

Agree. The fear that this would amount to reduced tuition and money for the institution is the sad reality why it hasnt or won't happen.

 

[Mad Jack]

Agree. The fear that this would amount to reduced tuition and money for the institution is the sad reality why it hasnt or won't happen.

That and people wanting to protect and justify their jobs, which would be hard to do if their teaching was no longer required

 

[finalpsychyear]

That and people wanting to protect and justify their jobs, which would be hard to do if their teaching was no longer required

Would make too much sense if all of first 2 years med school was standardized with everyone having access to top lecturers and maybe some options per category based on style of teaching then national standardized exams based on the lecture and specific course. Faculty then would just be q and a basically since your being taught by the universally agreed upon best lecturer series.

so basically all med grads have the same top quality lecture and top quality standard exams so everyone can be compared apples to apples. Shelf exams and boards are only part of it but i shouldn't be learning more from kaplan video lectures than my 30-50k/ year medical school lol.

The system is so broken its laughable but the broken part of it creates the need for endless books, reviews, etc because those would all go away if you had an agreed upon source.

 

[tr]

Would make too much sense if all of first 2 years med school was standardized with everyone having access to top lecturers and maybe some options per category based on style of teaching then national standardized exams based on the lecture and specific course. Faculty then would just be q and a basically since your being taught by the universally agreed upon best lecturer series.

so basically all med grads have the same top quality lecture and top quality standard exams so everyone can be compared apples to apples. Shelf exams and boards are only part of it but i shouldn't be learning more from kaplan video lectures than my 30-50k/ year medical school lol.

The system is so broken its laughable but the broken part of it creates the need for endless books, reviews, etc because those would all go away if you had an agreed upon source.

The preclinical years are just a bunch of declarative factoids so I don't think the mode of presentation is so relevant. To my recollection, I didn't go to any lectures in med school after the first week or two. I skipped all the lectures, used that time to read the textbook, attended the labs, and took the exams.

The real meat of the $50K/y education is in the hands-on exposure: lab sessions in the preclinical years, and clinical work in the 3rd and 4th years, and that isn't scalable.

 

[Crayola227]

Healthcare is going to scat.
I don't recommend my own young relatives, nor will I to my kids go into medicine.
ARNPs and PAs will inherit the medical sphere.
And after the stunt pulled by the CDC, Politicians, and Public Health departments recently, faith in the medical establishment is even further eroded.
I predict much of our health system will start to shake apart. Politicians and health Admin and some societies will start to take notice. But rather than get rid of ARNPs and PAs and reverting to a model that utilizes non-resident trained physicians (medical graduates) or Intern trained/licensed only physicians to replace the labor needs of ARNP/PAs, the powers that be will instead push for more rules, more bureaucracy, more 'laws' that regulate health care practice. Making things worse. The bloat will create a weird defacto government care landscape. There will be some tech, some medicine, some device advances that mitigate this and improve population health as a whole, but only slowly delaying the path we are on. With time, the volume of midlevels and the way care is delivered, my future geriatric self will actually be better off avoiding medical care than seeking it.

I am already preparing myself mentally to die of something that should be treatable, or reduceable in the decades to come - simply because going to the hospital to be treated by the ARNP in ED, to then be punted from "Specialist" ARNP to "specialist" ARNP will be a continued blind referring to the blind, and statistically at some point one is going to really fun up, and I get the iatrogenic harm. It will be a better gamble to avoid medical care than to seek it. This is the future. I hope I am wrong. I hope in 20-30 years people can point to this post and laugh at just how wrong I was, and give a solid roasting.

QFPrescience

This will age beautifully.

I hope you do not end up like the Kwisatz Haderach

Spoiler

trapped by your prescience

but I suspect you may.

 

[Crayola227]

The sunnier vision of the future is that we will settle into a system where big packs of NPs have high-quality supervision and education from physicians, delivering good-quality care to many more patients. Like with CRNAs--there always seemed to be a lot of "sky is falling" rhetoric, but I work at a community hospital where the anesthesia docs supervise 4 CRNAs or something, and it seems to work well. They make a lot of money, they see a lot of patients, the outcomes seem perfectly fine. Could that system work for us?

Incidentally, I have also seen local CMHs try to cheap out and run their operation with only NPs, and it just didn't go well. The NPs were stressed out all the time. Our NP colleagues are not insane, they realize they have a giant relative knowledge deficit and the good ones WANT education and supervision.

I don't like or agree with the way the wind is blowing, but we have to admit that there is a massive shortage of psychiatrists, and many of us don't take insurance. Somebody's got to serve the patients, and NPs have stepped up to fill that vacuum whether we like it or not. I don't think we're ever putting the genie back in the bottle, so we should advocate for laws that insist on genuine, high-quality supervision of NPs.

Eh, I think knocking a patient out and monitoring them might be a bit more, I dunno, algorithmic than psychiatric care? Or am I crazy? (Funny thing to ask in this forum)

 

[ObsequiousAplomb]

Eh, I think knocking a patient out and monitoring them might be a bit more, I dunno, algorithmic than psychiatric care? Or am I crazy? (Funny thing to ask in this forum)

I agreed entirely at first, but after thinking about it, maybe not?
While there are some great studies in anesthesia, I'm fairly certain that there are similar regional variations to its practice as psychiatry.
Many anesthesiologists may treat anesthesia as algorithmic / everyone gets the same syringes - and at the same time many anesthesiologists consider this bad practice - just like with psychiatry.
It's probably safe to say that the use of NPs in psychiatry and CRNAs for AAs in anesthesia would perform better medical care if they were to employ an algorithmic-based approach, but that psychiatrists and anesthesiologists are skilled enough that they recognize the algorithm is not written in blood.

 

[Sushirolls]

This needs to be done by expanding the number of overall seats at all our institutions of higher ed while also making jobs that can be done via apprenticeship/certificates/focused certifications better. We have the best university system in the world, but because of that the demand is high and supply is being constrained, we need to release the floodgates in a stable but accountable manner. Funding (for public) and non-profit status (for private) need to be in jeopardy if freshman seats is not expanding, period.

Freshman seats for medical school or all university undergrad?

If university undergrad, the market is saturated. Talk with professors. They are a demoralized bunch. A machine with frequent nudgings to move the meat, pass the students, get them degrees, churn the money. They don't have the academic integrity and support to foster it, to fail students or give out bad grades anymore. They do, they get reamed by students and admin. Enrollments are wide open and universities are sucking up any warm body they can. However, there was a baby drop 2 decades ago, and next year is going to be the first year of an enrollment cliff. Universities are shaking in fear with the shrunken pool of freshman undergrad available next year and the ensuing few years. Lots of universities are going to be hit with the financial crisis of decreased enrollment - they are scared.

 

[whopper]

For professors, and I used to be one, and my wife is one, there's been a mix of 1-tuitions skyrocketing and I bet you that that will likely cause students to be more entitled, and why not? If you're paying something that could cause crippling debt what you're not going to expect students to say WTF if they don't like what's going on? 2-professors pay not going up in the same curves matching what's going on with tuition, 3-professors often times being put into a place where they only get promotions if they publish, so teaching and anything outside of publishing is not financially rewarding and despite this universities are expecting more and more professors to have responsibilities in addition to publications in addition to the new dynamics mentioned above (see what I mean? Students being more entitled and demanding, but you don't get more pay for spending time with students?) 4-The institution tries to lay on (like hospitals do with doctors) this bull$hit guilt trip that if don't work harder despite that they are the ones making money off your hard work that you're not doing right by academia, education, society and your students (for doctors, your patients), all the while that same institution may literally have a few billion dollars in endowments, the administration increases their own pay, and they add yet another Dean of bull$hit affairs to add to the fiscal irresponsibility.

I've never once seen politicians try to deal with this issue effectively. One side just tries to cut education, the other doesn't do anything to reduce the fiscal irresponsibility. Tuition forgiveness? WTF. Telling an institution spending out of control that now their customers get the government to pay for part of the out of control spending is not the solution.

 

[psychemdoc]

For professors, and I used to be one, and my wife is one, there's been a mix of 1-tuitions skyrocketing and I bet you that that will likely cause students to be more entitled, and why not? If you're paying something that could cause crippling debt what you're not going to expect students to say WTF if they don't like what's going on? 2-professors pay not going up in the same curves matching what's going on with tuition, 3-professors often times being put into a place where they only get promotions if they publish, so teaching and anything outside of publishing is not financially rewarding and despite this universities are expecting more and more professors to have responsibilities in addition to publications in addition to the new dynamics mentioned above (see what I mean? Students being more entitled and demanding, but you don't get more pay for spending time with students?) 4-The institution tries to lay on (like hospitals do with doctors) this bull$hit guilt trip that if don't work harder despite that they are the ones making money off your hard work that you're not doing right by academia, education, society and your students (for doctors, your patients), all the while that same institution may literally have a few billion dollars in endowments, the administration increases their own pay, and they add yet another Dean of bull$hit affairs to add to the fiscal irresponsibility.

I've never once seen politicians try to deal with this issue effectively. One side just tries to cut education, the other doesn't do anything to reduce the fiscal irresponsibility. Tuition forgiveness? WTF. Telling an institution spending out of control that now their customers get the government to pay for part of the out of control spending is not the solution.

Both are addressing it in their own blunt manner. Like you said, One just tries to cut education spending, which obviously would succeed in limiting this negative returns to society, which I think everybody would be in favor of. Obviously that comes at the appearance of limiting opportunities to those most needy, which is going to be easy to fight back against. The other side will propose something like making it even more free and obscure the costs even more from students and consumers, which, as we all know, only raises the cost so it looks more generous, but it reality it has a hidden higher cost on society.

 

[smalltownpsych]

For professors, and I used to be one, and my wife is one, there's been a mix of 1-tuitions skyrocketing and I bet you that that will likely cause students to be more entitled, and why not? If you're paying something that could cause crippling debt what you're not going to expect students to say WTF if they don't like what's going on? 2-professors pay not going up in the same curves matching what's going on with tuition, 3-professors often times being put into a place where they only get promotions if they publish, so teaching and anything outside of publishing is not financially rewarding and despite this universities are expecting more and more professors to have responsibilities in addition to publications in addition to the new dynamics mentioned above (see what I mean? Students being more entitled and demanding, but you don't get more pay for spending time with students?) 4-The institution tries to lay on (like hospitals do with doctors) this bull$hit guilt trip that if don't work harder despite that they are the ones making money off your hard work that you're not doing right by academia, education, society and your students (for doctors, your patients), all the while that same institution may literally have a few billion dollars in endowments, the administration increases their own pay, and they add yet another Dean of bull$hit affairs to add to the fiscal irresponsibility.

I've never once seen politicians try to deal with this issue effectively. One side just tries to cut education, the other doesn't do anything to reduce the fiscal irresponsibility. Tuition forgiveness? WTF. Telling an institution spending out of control that now their customers get the government to pay for part of the out of control spending is not the solution.

I just love the guilt trip and manipulation and then how they make us out to be greedy and bad doctors/professors/therapists and they are just helping to protect people from us. The future is more of corrupt and wealthy institutions and politicians conspiring to continue and the people becoming less and less aware of it everyday as they are just turned against each other in an increasingly polarized society.

 

[nolapsych]

Haven’t been on this forum in a while, it’s way more interesting than it used to be