Do any psychiatrists do therapy anymore?

[chauliodus]

I'm a 4th year, who was planning to go into psych and I really like the idea of cognitive behavioral therapy, psychodynamic therapy, ect but on all my psych rotations, I've never had an attending do any type of therapy. All of it is done by psychologists and social workers and we just manage meds and do the initial evaluation. I am not okay with doing 15-20min med checks, and I don't want to do a residency focused on behavioral therapy and never use it, so before I hand in my pathway transfer form, I wanted to get a broader opinion from people who are all over the country. Who knows? Maybe only Philadelphia is like this.

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[Anasazi23]

I know lots of psychiatrists that do therapy.

Some of them do primarily therapy (different psychiatrists use different therapy modalities, and many are well-trained in them), with medication management secondarily.

Remember, you're in an inpatient setting. Attendings generally don't have the time to sit and do therapy with 30 sick inpatients everyday, with hospital beaurocrats demanding increasing levels of paperwork filled out by physicians.

The reason that attending psychiatrists work mostly with medications is because they have to. They have only so many hours in a day to work, and the medication regimins must be fine tuned daily throughout the ward. Psychologists are good at therapy, and they don't have these other responsibilities. Therefore, they tend to do it (therapy).

When you're on your own, you can do whatever you want.

 

[OldPsychDoc]

I'm a 4th year, who was planning to go into psych and I really like the idea of cognitive behavioral therapy, psychodynamic therapy, ect but on all my psych rotations, I've never had an attending do any type of therapy. All of it is done by psychologists and social workers and we just manage meds and do the initial evaluation. I am not okay with doing 15-20min med checks, and I don't want to do a residency focused on behavioral therapy and never use it, so before I hand in my pathway transfer form, I wanted to get a broader opinion from people who are all over the country. Who knows? Maybe only Philadelphia is like this.

I don't do therapy in the sense of 50 minute weekly appointments anymore, but thanks to my residency training, I'd say I do a little bit of therapy ANY time I 'm with a patient. On inpatient, I'm often taking time to go over specific cognitive distortions a depressed patient may be expressing, or doing some individual DBT around a borderline's maladaptive coping skills. In outpatient you're constantly reassessing how the patient's doing on psychosocial dimensions, not just with their D2 receptor occupancy. Every now and then one can see a little bit of psychoanalysis creep in as well. The psychologists and social workers have more time to do this, but many patients will only see me, so I try to give them their money's worth. So don't worry, your therapy training from residency won't go to waste.

 

[banannie]

i did a psych elective with an attending who had plenty of time to do psychotherapy with both inpatients and outpatients. not exactly sure if this practice model is achievable by everyone, but it seemed to work out really well for him.

interestingly though, my dad's wife is a psych nurse in philadelphia and she mentioned working with miserable docs (i think it was at crozer-chester?) who just did 15 min med check appointments all day (and only 7 mins for every peds patient). maybe it is a philly thing? scares me though, since that is where I would like to practice some day!

 

[chauliodus]

well everyone, thanks for your input. I definately appreciate it.

 

[PublicHealth]

Of course psychiatrists do therapy!.....pharmacotherapy.

 

[mdblue]

i did a psych elective with an attending who had plenty of time to do psychotherapy with both inpatients and outpatients. not exactly sure if this practice model is achievable by everyone, but it seemed to work out really well for him.

interestingly though, my dad's wife is a psych nurse in philadelphia and she mentioned working with miserable docs (i think it was at crozer-chester?) who just did 15 min med check appointments all day (and only 7 mins for every peds patient). maybe it is a philly thing? scares me though, since that is where I would like to practice some day!

15 min medck units sounds OK in Philly, but 7 mins is probably not true. For evaluating a kid, you typically need more time. The same holds true for MR pts, where 30 min ck is the usual practice.
To be fair, you can probably do a good job for certain pts in 15 mins, but not all. And I can not think of myself doing 15 min cks for 40 hrs a wk. It's a recipe for disaster and prof burnout.
HTH

 

[PsychEval]

It seems there are a few psychiatrists who provide both pharmacotherapy and psychotherapy, but most do not. There are probably a variety of reasons for this, including: reimbursement issues, perhaps some are not interested (which is fine, no problem with a talented pharmacologist focused on decreasing human suffering with pharmacotherapy), not having enough time, etc. I have noticed many who are involved in both types of treatment interventions really are doing a long med check with supportive therapy. This is not awful, but the problem is when the prescribing provider is seeing the patient only once every three months and doing a 30 minute med check with psychotherapy. Consequently, a maximum of 2 hours of psychotherapy a year for panic disorder or whatever may not be ideal. A typical standard of care for the previously identified chief complaint as related to psychotherapy would be once a week or bi-weekly. Most psychiatrists are very busy and have large case loads, therefore seeing 300 or 400 patients weekly or bi weekly would be impossible. I do know of psychiatrists who are excellent pharmacologists and psychotherapists. However, these guys tend to work in the private sector, and they call the shots. That is, they are not feeling pressure from a Community Mental Health Center director to do 15 minute med checks all day everyday, with psychotherapy being referred to less expensive providers (increasingly social workers). I think a group practice would be an ideal career path for a psychiatrist wanting a smaller case load, a good quality of life, and flexibility with treatment options.