How will the economy affect psychiatry?

[Messerschmitts]

Forgive me if this is a stupid question, I am but a lowly 3rd year medical student. However, it appears to me that many people consider mental health to be a "luxury", and not a necessity in the way medical health is. You're not going to "die" of depression. You may take your own life due to the consequences of depression, but there's nothing from having depression physiologically that will kill you directly, not in the same way a heart attack will kill you. I fear with people obsessed with saving money, mental health will get put on the back burner. Do you guys feel the financial recession will cause a great decrease in the need for, and job opportunities for new psychiatrists?

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[Faebinder]

Forgive me if this is a stupid question, I am but a lowly 3rd year medical student. However, it appears to me that many people consider mental health to be a "luxury", and not a necessity in the way medical health is. You're not going to "die" of depression. You may take your own life due to the consequences of depression, but there's nothing from having depression physiologically that will kill you directly, not in the same way a heart attack will kill you. I fear with people obsessed with saving money, mental health will get put on the back burner. Do you guys feel the financial recession will cause a great decrease in the need for, and job opportunities for new psychiatrists?

Well I suppose when a psychotic patient beats someone up while talking to himself.... they will call internal medicine? Maybe when a bipolar manic stabs someone when he becomes aggressive/manic then maybe we will call a psychiatrist in the ER? What about a borderline patient who has cut herself again and is screaming bloody suicide to the world... will they simply tell the police to come get her?

I think we'll be fine my friend. Psychiatrists were not born because the human mind "might benefit" from some soft touch. Their *****e$ need us in the hospitals.

 

[OldPsychDoc]

Forgive me if this is a stupid question, I am but a lowly 3rd year medical student. However, it appears to me that many people consider mental health to be a "luxury", and not a necessity in the way medical health is. You're not going to "die" of depression. You may take your own life due to the consequences of depression, but there's nothing from having depression physiologically that will kill you directly, not in the same way a heart attack will kill you. I fear with people obsessed with saving money, mental health will get put on the back burner. Do you guys feel the financial recession will cause a great decrease in the need for, and job opportunities for new psychiatrists?

I think EVERYONE is looking at some lean years, but by the time you folks are finished with residency...well, who knows. By then, Canada could have invaded us and instituted a rational single-payer system, but that's grist for another mill.

I'll say this right now--there is more stress, more mental illness coming, more substance abuse...AND less treatment AND fewer resources. At my hospital, huge numbers of patients are on some level of publically-funded care--and the state is having to cut costs drastically. Add to this that the group homes, case managers, outpatient treatment for these folks are all dependent on state funding, so there's nowhere to send them when they're discharged. People with private insurance are worried about their jobs, their copays are increasing for office visits and meds, so they're spreading things out. I'm already having more no shows and rescheduled appointments than I used to, and just like in primary care, people are waiting until they are REALLY sick (e.g. floridly in crisis) to come in to see the doctor.

So my answer to your question is that in the short run I think we'll be seeing more demand for our services, with less payment received, but that this is not going to translate to "a great decrease in the need for new psychiatrists".

 

[BobA]

Pure speculation - but I'm predicting an increase in mental health funding at the VA's in the next 5-10 years. (not immediately). This increase probably won't keep up with demand.

However, I'm looking forward to working at a VA with returning vets. (although I might deny this in five years).

 

[whopper]

I do see a decrease in some mental health services, but psychiatrists will not suffer as far as I can see.

They'll cut off the art & music therapist, make nurses work harder but for the most part will leave psychiatrists alone. With the Parity Bill passing, psychiatrists may not even be hurt much in their pay.

 

[hereandnow]

Here are some notes from the domain of private practice and what my friends in the mental health professions are seeing. (Please note, that these are principally psychotherapists -- rather than psychiatrists. There may or may not be a correlation between what I am saying and your original question. So, your mileage may vary.)

(Also note: This is specifically about private practice -- rather than hospitals or agencies. I do not have any inside information there.)

anecdotal findings:

My friends who have high end psychotherapy-based cash-only practices ($185 to $275 per hour) have seen some attrition.

This is consistent with: http://online.wsj.com/article/SB122333797880409755.html

My friends who have insurance based referrals to their practices have actually seen a modest increase in their practices, as people are attempting to deal with the stress of the sagging economy.

Good luck.

 

[Regnvejr]

I'm busier than ever. If you are new to the cliniuc and want to see me, you have to wait 2 months. And it gets worse every week. We're plenty busy. And as what we do takes pressure of the PCPs, they will cry bloody murder if our support diminishes. There was a shortage of psychiatrists even before this, and a terrible shortage of chilod spychiatrists. It is certainly not getting less.

When I came to Wyoming, I was the 3rd Child and Adolescent psychiatrist. Now, we are six, but it still is not near enough. The pediatricians me because I can take the Autistic kids of their hands. THAT is how bad it is right now. When it gets worse, they will fight over access to you.

 

[Messerschmitts]

I'm busier than ever. If you are new to the cliniuc and want to see me, you have to wait 2 months. And it gets worse every week. We're plenty busy. And as what we do takes pressure of the PCPs, they will cry bloody murder if our support diminishes. There was a shortage of psychiatrists even before this, and a terrible shortage of chilod spychiatrists. It is certainly not getting less.

When I came to Wyoming, I was the 3rd Child and Adolescent psychiatrist. Now, we are six, but it still is not near enough. The pediatricians me because I can take the Autistic kids of their hands. THAT is how bad it is right now. When it gets worse, they will fight over access to you.

Thanks for fighting to good fight! You're doing the children of Wyoming a great service. Unfortunately, my dream is to live in the Californian Bay Area, where the lack of psychiatrists is...much less dire.

 

[mgdsh]

I agree that increased stress should lead to an increased incidence of psychiatric problems in general.

OPD beat me to it

 

[Regnvejr]

Thanks for fighting to good fight! You're doing the children of Wyoming a great service.

I love the nature here. I drive right past the resident herd of antelopes about 3 times weekly on the way to work.

Unfortunately, my dream is to live in the Californian Bay Area, where the lack of psychiatrists is...much less dire.

More tricky. When I took the position in Wyoming, I also had an offer from the Napa area, a case load of 90 in the juvenile justice system, and paying less than 150K. With house prices 6 times Wyoming (other than Jackson), it was not financially viable.

 

[medium rare]

I love the nature here. I drive right past the resident herd of antelopes about 3 times weekly on the way to work.
More tricky. When I took the position in Wyoming, I also had an offer from the Napa area, a case load of 90 in the juvenile justice system, and paying less than 150K. With house prices 6 times Wyoming (other than Jackson), it was not financially viable.

Where in Wyoming are you? I have family near Cheyenne and have thought about moving there on occasion.

 

[Regnvejr]

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[Manicsleep]

Here's looking at this a little later. This is what I (well not just me but anyways) have noticed. The "shortage in psychiatry" is being limited to outlying areas and many places that used to have shortages no longer have shortages. Psychiatrists are not retired who had planned to and others are coming out of retirement due to the poor economy and depletement of the savings or because of losses in the housing markets in certain areas.

There has been some benefit to this because it has led to some increased ability to handle the increased (at least I think it has increased) load of patients that are being referred due to the poor economy. Also, it has quelled some of the arguments psych rx people have made because suddenly people are able to find psychiatrists in many areas they were previously unable.

I wonder how this will play out in the long run. Will the economy recover and lead to a sudden drop in psychiarists? Will the increase in residency spots eventually catch up? How will the influx of several million newly insured people impact the mental health landscape?

 

[whopper]

An issue with the economy is a downturn appears to not hurt everyone. Several rich people are actually richer since the economy's gotten worse.

IMHO, psychiatrists that do necessary work in terms of keeping the dangerous off the streets--they'll likely not be affected at all.

Psychiatrists in private practice and doing boutique type work (e.g. out of pocket payers willing to shelve out tens of thousands a year to a psychiatrist) may be hurt, but at the same time, like I said, I haven't seen too many rich people hurt by this economic downturn. It seems to me to be more the middle class hurt.

 

[Shikima]

I think the answer you're looking for about Psychiatry and the economy is a question. How many of the patients where you want to work have commercial insurance vs non-pay/free care, medicare, or medicaid?

When the economy is in the dumps, all the above is true. And reimbursement is even worse yet. Sorry kid... no good news honestly. Just lots of good, honest, hard work for people who are in dire need of our services.

Consider fellowship if you're overly concerned.

 

[Regnvejr]

My waiting list for new patients is now more than 3 mths, and that is only if you are referred from one of our PCPs. Forget it, if you walk in off the street. And returning patients are either scheduled at 6-7 weeks, or I squeeze them into lunch hours.

I have never been this busy. Anybody want to come and work outpatient only at a community health center and have a guaranteed full practice within a week?

 

[Shikima]

My waiting list for new patients is now more than 3 mths, and that is only if you are referred from one of our PCPs. Forget it, if you walk in off the street. And returning patients are either scheduled at 6-7 weeks, or I squeeze them into lunch hours.

I have never been this busy. Anybody want to come and work outpatient only at a community health center and have a guaranteed full practice within a week?

That's pretty good, only a 3 month backlog.... most places I've been looking to work have been 6-8 months of backlog, before you step into the office for the first day.

 

[Manicsleep]

I think the answer you're looking for about Psychiatry and the economy is a question. How many of the patients where you want to work have commercial insurance vs non-pay/free care, medicare, or medicaid?

When the economy is in the dumps, all the above is true. And reimbursement is even worse yet. Sorry kid... no good news honestly. Just lots of good, honest, hard work for people who are in dire need of our services.

Consider fellowship if you're overly concerned.

I am an attending with a stable job kid. I also have a fellowship (hence the sleep part in the nom de plume). I am looking at a bigger picture than just having patients for myself which hasn't been a problem in a saturated part of the country.
My concern is the profession itself and how supply and demand will dictate policy in the long term landscape of mental health and the oncoming universal health care. Psychiatrists need to be wary of these things and be proactive instead of reactive.

 

[Manicsleep]

An issue with the economy is a downturn appears to not hurt everyone. Several rich people are actually richer since the economy's gotten worse.

IMHO, psychiatrists that do necessary work in terms of keeping the dangerous off the streets--they'll likely not be affected at all.

Psychiatrists in private practice and doing boutique type work (e.g. out of pocket payers willing to shelve out tens of thousands a year to a psychiatrist) may be hurt, but at the same time, like I said, I haven't seen too many rich people hurt by this economic downturn. It seems to me to be more the middle class hurt.

In california this is true. There are a lot of jobs in the state. Not sure about private forensics work however but the state continues to hire and pays a starting salary of about 230k. After about 4 years you are at about 270 assuming you have passed your boards etc. A pretty good chunk of change. You can make even more as a contractor.

I may disagree with you about the necessity of this work as these jobs are incredibly overstaffed by psychiatrists, PCPs, nursing, psychologists, social workers, rehab therapists etc.

I would guess california private practice is difficult but it is possible using the right business model. Ours works because we leave administration to a lower paid social workers and a nurse and we cut out the high paid psychologists who did the same work as social workers, MFTs and psych techs. Psych techs work wonders especially if trained properly because of their training in nursing and therapy.

 

[digitlnoize]

You're not going to "die" of depression. You may take your own life due to the consequences of depression, but there's nothing from having depression physiologically that will kill you directly, not in the same way a heart attack will kill you. ?

I understand what you are trying to say...but it's wrong. Suicide is the 10th leading cause of death worldwide, and will kill you just as well as an MI...assuming you do it right, which over 1 million people do each year.

There is also a STRONG argument for most depression being a physiological problem, as there are many studies showing a greatly decreased risk of suicide of depressed patients are placed on anti-depressant therapy (currently, usually an SSRI to increase the amount of serotonin in the synapse, leading to upregulation of the post-synaptic receptors.)

Regardless, my point is more that it doesn't matter so much HOW you die. A person dead of a Stroke is just as dead as the guy who put a bullet in his head.

This is also neglecting the issue of violent crime which is also a leading cause of death. Psych, and particularly child psych, do a decent job at decreasing these rates by treating the psychotic with anti-psychotic drugs (also a physiological problem...this time, Dopamine mostly).

To answer your question: look around you. Do you see tons of parents doing a great job raising their kids? Or, do you see tons of kids who grow up abused, neglected, or just out in front of a TV all day to watch Spongebob? I see tons of kids (and adults) with grandiose dreams of being famous, which aren't going to come true. The next generation is going to have a pretty severe crash in self-esteem, goal oriented behavior, increased rates of ADHD, autism, conduct disorder, etc. And they are going to grow up to be really messed up adults with even more messed up kids. Go watch Idiocracy. Maybe I'm just a cynical pessimist, but we're only a few generations away from watering our plants with Gatorade (it's got Electrolytes!)

Psychiatry isn't going anywhere. In fact, I predict a bigger shortage than expected due to people having more pathology than expected. Look around.

 

[carlosc1dbz]

My waiting list for new patients is now more than 3 mths, and that is only if you are referred from one of our PCPs. Forget it, if you walk in off the street. And returning patients are either scheduled at 6-7 weeks, or I squeeze them into lunch hours.

I have never been this busy. Anybody want to come and work outpatient only at a community health center and have a guaranteed full practice within a week?

Im sure people would not mind paying their way to the front of the line.

 

[notdeadyet]

IMHO, psychiatrists that do necessary work in terms of keeping the dangerous off the streets--they'll likely not be affected at all.

That sure hasn't been my impression. In California, we're getting hammered. Many of our psych crisis units have been shut down and our county mental health centers where we send emergency cases have been losing beds by factors of 50%. Not sure if it's different in other states, but mental health is one of the first public services to get slashed when belt tightening occurs around here.

I can see the argument that private practice jobs may not be affected (if you're taking insurance), but I don't see how the math works out right for folks wanting to work in public psychiatry. Budget gets smaller, beds get fewer, patients seen drops in number = fewer public psychiatry jobs, no?

In california this is true. There are a lot of jobs in the state. Not sure about private forensics work however but the state continues to hire and pays a starting salary of about 230k. After about 4 years you are at about 270 assuming you have passed your boards etc.

Yes, California is great for work in prisons or jails (the only thing we love more than locking folks up is building bright, shiny prisons), but I'd question that public psychiatry jobs aren't harder to come by. I'd love to hear that I'm wrong about that, though...

 

[Manicsleep]

The California penal system is a disaster but there are a lot of jobs for psychiatrists. Actually, its overstaffed at several places but MDs aren't where the problem is the worst.

Psychologists have really taken and run with it. There are psychologists who have to see people once every 2 weeks (in a 40 hour week) and have case loads of approx 25. Most of these visits last 5-15 minutes. For this they get paid 6 figure salaries.

 

[Shikima]

I am an attending with a stable job kid. I also have a fellowship (hence the sleep part in the nom de plume). I am looking at a bigger picture than just having patients for myself which hasn't been a problem in a saturated part of the country.
My concern is the profession itself and how supply and demand will dictate policy in the long term landscape of mental health and the oncoming universal health care. Psychiatrists need to be wary of these things and be proactive instead of reactive.

Sorry, I meant no harm or disrespect, I'm sure my flippant remark struck a nerve. But you are absolutely correct, we do need to be wary and proactive - I'm a strong advocate in dissolving complacency.

Any suggestions since I doubt we have strong lobbyists at various state and the national capitol?

 

[Manicsleep]

A brief overview.

The APA is divide into 7 areas.
New York and California are their own areas while the rest of the country and Canada are 5 areas.

Lobbying is done by the APA-PAC (political action committee) which is separate from the APA itself. Both the APA and the APA-PAC have MIT representatives (Members In Training) from each area. The APA actually has several different ways to be represented at local and national levels while the PAC is more informal and smaller but they always welcome membership (and your money).

I actually give minimally to the APA but contribute annually to the APA-PAC because that is where we get the biggest bang for our buck.

Tell me where you are located and I can tell you a lot more.