Any truth to this comment about psychiatrists vs psychologists on quora?

[Attending1985]

Maybe you spend a little longer but I actually asked Psych residents at my program how long their clinic is and they say it's typically 10 mins initially with the patients, spending 5-10 waiting for the preceptor, 10 discussing with the preceptor, and then another 5 discussing the plan with the patient. That takes up the 30 min time slot for the appointment. I also don't think many (if any) psychiatrists are performing therapy. Curious, are you trained to do this in residency?

Many psychiatrists may try to understand the cognitive processes involved, but again it's not their primary focus. It sounds like you're doing an extensive job on your patients and wanted to commend you on that @Stagg737

In my geographic location 60 minute intakes and 30 minute follow ups are the norm. But i
I think only 2 in my small city perform therapy.

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[TelemarketingEnigma]

why's it always an onion when someone mentions layers?

 

[Redpancreas]

In my geographic location 60 minute intakes and 30 minute follow ups are the norm. But i
I think only 2 in my small city perform therapy.

The rates per appointment for Psychiatric services are generally $300/hr. How much is therapy?

 

[Stagg737]

Maybe you spend a little longer but I actually asked Psych residents at my program how long their clinic is and they say it's typically 10 mins initially with the patients, spending 5-10 waiting for the preceptor, 10 discussing with the preceptor, and then another 5 discussing the plan with the patient. That takes up the 30 min time slot for the appointment. I also don't think many (if any) psychiatrists are performing therapy. Curious, are you trained to do this in residency?

Many psychiatrists may try to understand the cognitive processes involved, but again it's not their primary focus. It sounds like you're doing an extensive job on your patients and wanted to commend you on that @Stagg737

Oof, sounds a bit like our 3rd clinic, although I typically spend more time with the patient and less with the attending at this point. That's the problem with this set up. In our other clinics we see all patients alone and have an attending available if we have questions, then have 30-60 minutes of supervision at the end of the day to discuss things. I understand the issue when you have to check every patient out, and I think it's prohibitive to a learning environment having experienced 3 different forms of outpatient supervision.

Training in psychotherapy, specifically CBT, psychodynamic, and supportive, are ACGME requirements for every residency program. My program is a pretty light program in terms of education on therapy, but I still have two 60-minute slots blocked every week for my therapy patients. At this point I'm fairly confident in performing basic CBT and supportive therapy and can perform psychodynamic though am much less comfortable. There are also many other forms of therapy including ACT, DBT, or motivational interviewing and I've been very comfortable with MI for a while now.

Therapy is not the primary focus for most psychiatrists, but we're all trained to do it. Also, keep in mind that you don't need to schedule a patient for an hour every week to do therapy. There are many forms which can be briefly utilized even in 15-20 minute med checks (MI, CBT, supportive). Just making 1 or 2 well targeted statements can make a huge therapeutic difference for some patients. So when I said mentioned that many psychiatrists do therapy, this is what I'm referring to. I'd guess I do some brief therapy with about 50% of my patients, though my panel is very heavy with Cluster B and anxiety, so that may significantly skew that number.

 

[sloop]

Maybe you spend a little longer but I actually asked Psych residents at my program how long their clinic is and they say it's typically 10 mins initially with the patients, spending 5-10 waiting for the preceptor, 10 discussing with the preceptor, and then another 5 discussing the plan with the patient. That takes up the 30 min time slot for the appointment. I also don't think many (if any) psychiatrists are performing therapy. Curious, are you trained to do this in residency?

Many psychiatrists may try to understand the cognitive processes involved, but again it's not their primary focus. It sounds like you're doing an extensive job on your patients and wanted to commend you on that @Stagg737

Therapy training is a requirement for maintaining certification of a residency program. The degree and focus of this can vary depending on the program but residents are taught to perform therapy.

A non-exhaustive list of types of therapies I’ve provided in residency includes: Exposure therapy for social anxiety, prolonged exposure for PTSD, ERP for OCD, CBT for depression/anxiety, CBT for insomnia, CBT for chronic pain, parts of DBT for self-injurious behavior, family therapy, group therapy for chronic pain and eating disorders, and psychodynamic therapy. My program is not even particularly known for its therapy emphasis.

The other thing I will say is that I think attending psychiatrists often just practice therapy in a different way than psychologists do. Psychologists are often very learned in the details of therapy modalities and tend to be pretty by-the-book or manualized from what I’ve seen, which has its advantages. Psychiatrists are often more flexible and may employ aspects of various types of therapies for the same patient. I know that psychologists often look down on the latter type of practice but the reality is that there is a decent amount of evidence (a la Jerome Frank) that the most important aspect in psychotherapy is the therapeutic alliance and that the particulars of therapy, while useful, are less important than this concern.

 

[Redpancreas]

Oof, sounds a bit like our 3rd clinic, although I typically spend more time with the patient and less with the attending at this point. That's the problem with this set up. In our other clinics we see all patients alone and have an attending available if we have questions, then have 30-60 minutes of supervision at the end of the day to discuss things. I understand the issue when you have to check every patient out, and I think it's prohibitive to a learning environment having experienced 3 different forms of outpatient supervision.

Training in psychotherapy, specifically CBT, psychodynamic, and supportive, are ACGME requirements for every residency program. My program is a pretty light program in terms of education on therapy, but I still have two 60-minute slots blocked every week for my therapy patients. At this point I'm fairly confident in performing basic CBT and supportive therapy and can perform psychodynamic though am much less comfortable. There are also many other forms of therapy including ACT, DBT, or motivational interviewing and I've been very comfortable with MI for a while now.

Therapy is not the primary focus for most psychiatrists, but we're all trained to do it. Also, keep in mind that you don't need to schedule a patient for an hour every week to do therapy. There are many forms which can be briefly utilized even in 15-20 minute med checks (MI, CBT, supportive). Just making 1 or 2 well targeted statements can make a huge therapeutic difference for some patients. So when I said mentioned that many psychiatrists do therapy, this is what I'm referring to. I'd guess I do some brief therapy with about 50% of my patients, though my panel is very heavy with Cluster B and anxiety, so that may significantly skew that number.

This was very enlightening. I was not aware of this.

 

[Attending1985]

The rates per appointment for Psychiatric services are generally $300/hr. How much is therapy?

I’m employed so I don’t know. The private practice charges 306 for one hour of medication plus therapy. At that clinic the fee is the same for the np and the md.

 

[singasongofjoy]

The bipolar disorder really get me the most. People coming to me expecting to be placed on a mood stabilizer which is supposedly going to transform them into an idealized version of themselves. The diagnosis is often based on bizarre things like intermittent episodes of racing thoughts. I’m not kidding. It seems like a lot of the times when therapists aren’t effective they refer for medications or give them another diagnosis.

if a misdiagnosis by a psychologist or other similar MH non-prescribing provider had the same physical ramifications as misdiagnosis of general medical conditions, I bet we would see a lot fewer bipolar diagnoses. At least in my neck of the woods. But then people go and present with a diagnosis and a report and sometimes I wonder how closely the prescribing provider read / scrutinized the report etc.

 

[Redpancreas]

if a misdiagnosis by a psychologist or other similar MH non-prescribing provider had the same physical ramifications as misdiagnosis of general medical conditions, I bet we would see a lot fewer bipolar diagnoses. At least in my neck of the woods. But then people go and present with a diagnosis and a report and sometimes I wonder how closely the prescribing provider read / scrutinized the report etc.

Interesting perspective. I agree it's easy to check off some criteria and call a disorder something because then at least you're doing something, but unfortunately there are tons of consequences.

 

[Attending1985]

if a misdiagnosis by a psychologist or other similar MH non-prescribing provider had the same physical ramifications as misdiagnosis of general medical conditions, I bet we would see a lot fewer bipolar diagnoses. At least in my neck of the woods. But then people go and present with a diagnosis and a report and sometimes I wonder how closely the prescribing provider read / scrutinized the report etc.

It does have really serious ramifications because of the toxicities of bipolar treatment. I think there needs to be legislation designating who can diagnose a serious mental health condition.

 

[robellis]

It does have really serious ramifications because of the toxicities of bipolar treatment. I think there needs to be legislation designating who can diagnose a serious mental health condition.

If you’re prescribing medication based on someone else’s evaluation and not your own then there are bigger problems here

 

[Matthew9Thirtyfive]

Maybe you spend a little longer but I actually asked Psych residents at my program how long their clinic is and they say it's typically 10 mins initially with the patients, spending 5-10 waiting for the preceptor, 10 discussing with the preceptor, and then another 5 discussing the plan with the patient. That takes up the 30 min time slot for the appointment. I also don't think many (if any) psychiatrists are performing therapy. Curious, are you trained to do this in residency?

Many psychiatrists may try to understand the cognitive processes involved, but again it's not their primary focus. It sounds like you're doing an extensive job on your patients and wanted to commend you on that @Stagg737

I can tell you it’s nothing like that here.

 

[Attending1985]

If you’re prescribing medication based on someone else’s evaluation and not your own then there are bigger problems here

I as an individual don’t do that but on the whole I perceive this is happening a lot. In my opinion it’s not a small factor in over diagnosis and treatment.

 

[NickNaylor]

There's so much generalization and so much variability in the quality and clinical focus of psychiatrists and psychologists in the OP's post that they're essentially meaningless. As others have mentioned, there are many psychiatrists - many of whom are analytically trained - that do nearly exclusive psychotherapy practices and very thoughtfully think about a patient's presentation. There are psychiatrists who do 10-minute follow-up appointments who have no diagnostic skill and push drugs for things that shouldn't be treated with drugs. There are psychologists who do an excellent job with diagnosis and are able to form strong relationships with patients. There are psychologists who are absolute garbage and spout all kinds of nonsense pseudoscience that ultimately is not helpful for patients. There are some kernels of truth in the generalizations - psychiatrists tend to be more pharmacotherapy-focused with shorter visits and a more "medical" approach to diagnosis and treatment, which generally isn't the case with psychologists - but any competent psychiatrist should be able to perform psychotherapy at some level and recognize when pharmacotherapy is unlikely to be helpful for a patient.

As with all professional fields, there's lots of variability.