My plan and ideas with psychotherapy - please comment/advise

[hanksquirrel]

I plan on going into psychiatry but my plan entails having a psychotherapy based practice with the option to prescribe meds. I realize that psychologists are trained in therapy, but their inability to prescribe meds leaves them paralyzed in the full spectrum of care. I think a good psychiatrist needs to know when/why to prescribe meds. Does anyone feel similarly? Does anyone know psychiatrists that focus more on psychotherapy? I thought about becoming a psychologist but they ARE limited.

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[psydoc]

Hanksquirrel, your views are supported, if not by all the psychiatric establishment, at least by a growing number of practitioners and opinion leaders who publish regularly on the leading journals of the field. Amongst them, probably one of the best known is Glen O. Gabbard, author of "Psychodynamic Psychiatry in Clinical Practice", which is one of the most widely read books published by the American Psychiatric Association.
You coud be interested in reading something by this author to gain insight into what can be the role of psychotherapy in modern psychiatry.
What year of medical school are you in at the moment?
One of the things that Gabbard says that I found paticularly interesting is that training in psychotherapy is useful not just for treating the patients who are candidate for the most expressive forms of therapy (e.g. psychoanalitically oriented therapies), but also for planning a pharmacological treatment plan taking into consideration the kind of care that suits better the needs of the patient.

 

[Thewonderer]

Originally posted by hanksquirrel
I plan on going into psychiatry but my plan entails having a psychotherapy based practice with the option to prescribe meds. I realize that psychologists are trained in therapy, but their inability to prescribe meds leaves them paralyzed in the full spectrum of care. I think a good psychiatrist needs to know when/why to prescribe meds. Does anyone feel similarly? Does anyone know psychiatrists that focus more on psychotherapy? I thought about becoming a psychologist but they ARE limited.

If you are willing to make below the average psychiatrist salary, you can do whatever you want and bill whatever you can. No one, including the insurance company, can stop you.

 

[ckent]

Pyschiatrists who do significant amounts of psychotherapy are now the exception rather then the norm. Out of the entire psych intern class at Maryland (the largest psych program in the nation), only one psych intern is interested in incorporating a large amount of psychotherapy into his practice. I would also suggest that insurance companies can dictate what you can and cannot do in your office, because even though you might not mind not being reimbursed for your time, your office staff, rent, malpractice insurance premiums, etc are not quite so forgiving. On a side note, have you guys seen the recent news on reimbursement for therapy? One insurance company is trying to get their money back for therapy notes that they claim were "inadequate". Here is a link to the article, you have to register at nytimes.com to get it (which is free).
http://www.nytimes.com/2003/09/27/health/27OXFO.html

 

[psydoc]

Ckent, I don?t know what you mean by ?significant amounts of psychotherapy?. If that is an attitude like ?I?ll be a full-time analyst and never prescribe a drug? that is hardly news, given the current guidelines for the treatment of most psychiatric disorders: it would be an anachronism. But I think that most residents in psychiatry acknowledge that a sound training in psychotherapy is useful to any psychiatrist, not just the practitioner who looks forward to private practice as the ultimate goal of his career. Just look at the messages posted in this forum: aspiring residents seems to be very interested in being trained in a place where psychotherapy is taught.
I have not a precise idea about how the Healthcare system works in the US, and about the role of insurance companies in dictating acceptable practices, so I can?t answer to that. Here in Italy it is very different: the health care system is funded centrally from taxation.
However, not all authors are so sure about the fact that assigning patients who require both psychotherapy and medication to split treatment (e.g. therapy done by a psychologist psychotherapist or social worker) means to reduce costs. Mantosh Dewan, for example, investigated the issue in a Brief Report published in the American Journal of Psychiatry and found that for those patients who needed both treatment modalities, combined treatment by a psychiatrist cost about the same or less than split treatment.
This is the abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9989575&dopt=Abstract

I?m curious about what are the interests of other residents, and I?d like to read some other opinions.
What are you guys looking forward to learn?
What training is provided by your psych residency program?

 

[ckent]

I would describe "significant" psychotherapy as a psychiatrist meeting with a patient more then once a month for a half hour visit (which is the norm for most psychiatrists here in the US, half an hour ~every couple of weeks per patient). I call that medical management, people may disagree. Significant psycho- therapy takes at least an hour per week. I am well aware of the studies demonstrating that therapy + medication is superior to therapy or medication alone, but when you get reimbursed $50 for an hour visit vs $70 for a half hour medical visit (ie $140 per hour), most choose the latter. Sadly, insurance companies do very often dictate who gets what care here in the US. Money=standard of care for many diseases. Callous as that may sound, I do know of many wealthy people in Europe who come to the US for health care needs that cannot be provided in socialized medicine due to lack of technology/skill/facilities and equipment/finances there in Europe.