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Nature of psychiatric work

4EverBluDevils

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    Are there any psychiatrists here who do psychotherapy? How did you receive training? And what do you do when psychologists try to send you dozens of patients for prescriptions which would prevent you from having time to counsel them?:)
     

    whopper

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      A lot of this will depend on where you practice. Urban vs rural psychiatry highly differs in approaches & types of patients.

      Urban--lots of drug addicts, people who don't speak English, malingerers, poor social support

      Rural: lots of family conflicts, depression due to family conflict

      In my neck of the woods, I rarely get referrals from psychologists. I dont' know how much this will differ in other areas. In my own program, our outpatients who have therapists are pretty much most of the time not psychologists. Most of the therapists work in the same program I'm in and we have meetings so we can be on the same page as the patient. I've had no problems in collaborating with them and felt no conflict with decisions for treating patients. Pretty much all the time I've agreed with their assessments.

      As for psychotherapy, in general it seems that psychiatry is doing less & less of this and I don't think this is a good thing. Managed care often times will not pay for psychiatrists to do it.

      However several programs still have a decent psychotherapy training. It depends on the program.
       

      OldPsychDoc

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        I work in a group also. I don't "do therapy", and don't really want to, but I feel that I'm using my psychotherapeutic training constantly. It's all about building an alliance with the patient, properly assessing their needs, and referring them properly to the therapists in our practice and community.

        (Whopper--I have to take issue with your urban/rural split. If you're not seeing addicts in the country, it's because you're working on false assumptions. Meth, opiates, alcohol--it's all out there, even if you're not seeing it on the street corner. Ditto for family conflict and depression in urban areas... We're dealing with human beings here, and they screw up in the same ways wherever they live.)
         
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        whopper

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          You're right.

          for example meth addiction is highly prevalent in rural areas in the midwest.

          However the proportions are very different. I should've clarified that in my post.

          Its funny because in our inpatient unit---the overwhelming majority of patients from one town have a specific problem, and the proportions vastly differ per town, but within towns stay relatively constant.
           

          PsychMD2100

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            It's important to remember that it's possible to set up an entirely independent private practice. Psychiatry is one of the few medical specialties remaining where a physician can open a fee-for-service practice in a remote rural town or a bustling metropolis.

            While it takes some startup money and it involves greater risk, there is significantly higher earning potential in taking the private practice route. Most of the data for psychiatrist earnings have a low skew because of sampling error. Most respondents to the most popular surveys such as MHA are salaried psychiatrists. They don't really survey the private psychiatrists and they would be unlikely to respond openly anyway.

            Psychiatry is very much an in-demand specialty. Nationwide, there are numerous openings. Shortages are particularly acute in rural areas in the West and the South.

            If you communicate well and have board certification, you can essentially go wherever you like.

            To the OP, private practice psychiatry often combines both psychotherapy and medication checks. My goal is to combine the two into an integrated approach to caring for my mental health patients. Many private patients often use their psychiatrist as their primary care physician for basic conditions--yet another reason not to forget your medicine.

            Some common stereotypes that exist do not necessarily apply to private practice, ie Psychiatrists only push meds or Psychologists are the ones who do therapy. Private practice psychiatry is, in my view, the way that mental health should be.
             

            maranatha

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              It's important to remember that it's possible to set up an entirely independent private practice. Psychiatry is one of the few medical specialties remaining where a physician can open a fee-for-service practice in a remote rural town or a bustling metropolis.

              In line with the OP's question, I know a few psychiatrists that do psychotherapy in a fee-for-service private practice. Four of them do psychotherapy part-time and work for an academic center the rest of the time. One does psychotherapy full time. It may depend on the region, but despite some of the prevailing opinions out there, it can be done.
               

              Doc Samson

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                Training in the Northeast, especially Boston and New York means that psychotherapy training is a big part of the residency experience. Many of my former classmates are now in therapy-heavy private practice. Once you get trained, you can make the choice to use it or not. If you don't have the training, you're obviously more limited in your options.
                 

                sophiajoyDO09

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                  You may want to look into the Meninger Clinic for info on their psych residency. I have done a lot of shadowing with a psychiatrist who graduated from there and he is in private practice, sees just one patient an hour, and does plenty of psychotherapy along with prescribing meds as he feels is necessary. He is a very well respected. Just a thought....
                   
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