And as Stigmata and I are always at odds, i respectfully disagree that psychologists get more respect than psychiatrists in primary care settings. That appears to be his experience working in a rural community with limited psychiatric resources that he gets respect. Which is wonderful of him. But not reflective of my working in various hospital settings (academic, VA, county), outpatient clinics (county, academic, VA, correctional).
I've worked in academic medicine, private residental/in-patient, and the VA system, and (unfortunately) more than a few times I've seen psychiatry be actively avoided. The most common critique I've heard is that it is a hassle to get a straight answer
in writing about a case. During my time in the VA system, primary care psychologists (and neuropsychologists on consult) handled all of the evals for competency, suicidiality, etc. because we would provide objective data and document everything. Our psychiatrists (and Psych NPs) were almost exclusively doing out-pt meds management across campus, so trying to get a consult let alone solid documentation for something like competency was a lost cause.
I'm currently in academic medicine (with a Top 5/10 Psych Dept), and I've seen much of the same active avoidance. I personally have had good experiences with the attendings, though they are usually doing research, and the residents have been very hit and miss. The biggest rub I see now is all of the polypharmacy (without supportive research). I work with a non-psychiatric population, and our referrals tend to be very specific, and most of the time the result of the consult is a bunch of unsupported polypharmacy. Giving a patient 2 anti-psychotics, 2 benzos (scheduled & PRN), and a sleep aide doesn't work if you need your patient conscious. Admittedly the referrals are tough, but that is why they go to Psychiatry Dept, because the simple stuff can be handled by our residents. I've been lucky to find a solid resident who has seen a number of my patients, though whenever he rotates off service it is a crapshoot. I've also seen a hesitancy to make a definitive diagnosis (malingering and conversion disorder, in particular), which is a personal pet peeve of mine.
Why? I suspect a little is that physicians can and do use common language, since we have the same foundation of training. Further psychiatrists can teach non-psychiatrists how to manage psychiatric problems, and how to prescribe better. Psychologists ARE often a welcome part of a multi-disciplinary team, but offer supplementary support in terms of testing (less common and less useful in a primary care setting), or offering psychotherapy (which takes away burden from other providers but doesn't necessarily help the physician get better at their job).
I take personal offense at the implication that psychologists don't "necessarily help the physican get better at their job". I know at my hospital our psychologists/neuropsychologists are faculty members at the medical school and regularly teach medical students/residents, present at grand rounds, etc. We also run the largest (multi-million dollar) research grants and mentor medical students, residents, and attendings interested in the academic side of healthcare. We present at Grand Rounds, and often are tapped to speak on topics that are more central to special populations.
A good percentage of my time as a fellow is teaching the medical resident with learning how to better manage challenging patients. We also do in-service trainings, debriefings after critical incidents, informal talks about special populations, etc. I've covered topics like: conversion disorder v. malingering v. other, differences in presentation between delirium and dementia, impact of TBI on executive functioning, managing enmeshed families, behavioral interventions when working with MR patients, working with 1st generation non-fluent immigrants, etc.
