A patient sitting comfortably, sharing intimate details about their life, the doctor listening, asking questions, taking notes. A typical visit to a psychiatrist, right? It turns out times have changed. These days, going to a psychiatrist can be like going to a primary care doctor. A brief consultation followed by a prescription. A patient can be in and out in a few minutes.
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. It's a field that has rapidly changed over the least three decades, primarily because of advancements in medicine and changes in health insurance. A 2005 government survey found that just 11 percent of psychiatrists provide talk therapy to all patients. Since then, it's estimated that number has fallen even lower.
"An insurance company is going to pay a certain amount of money for a medication visit, so the more medication visits you can do in an hour, the more you can make," Dr. Daniel Carlat said. Dr. Carlat operates a psychiatry practice in Newburyport. He is also the author of the book "Unhinged", in which he takes a critical look at his own profession. Dr. Carlat says many psychiatrists now try to pack as many 15 minute medication visits as possible to maximize profit, instead of taking the time to explore some of the root causes of what might be troubling a patient. Dr. Carlat agrees that anti-depressant and antipsychotic medicines are more effective than ever, improving quality of life with limited side-affects. However, he thinks patients who only receive drug therapy are being shortchanged. "Emotional problems are only part biological," Dr. Carlat said. "They are also part environmental and part social, and so if you are trying to treat these very complex problems with only a medication you are not going to be successful. You might get them 50 percent better but they are going to need something more."
If a patient requests talk therapy, they are often referred to a specialist who is not a medical doctor, such as a psychologist or a counselor. In fact, insurance companies encourage this because the reimbursement rates are cheaper. "Not many people are looking for psychoanalytic therapy now, most people are coming in, they want solution therapy," Dr. Karen Ruskin said. Dr. Ruskin is a Sharon based psychologist who specializes in talk therapy. She believes the changes in psychiatry are just a natural evolution. Dr. Ruskin says she sees no problem with a psychiatrist handling prescriptions and a psychotherapist talking it out. "By having this separate distinction it allows the client clarity on what they are working on and it also allows for the professional to have a true expertise," Ruskin said.
"Clients are looking for expertise and they're looking for immediate results."
Ruskin says in her practice, if one of her clients is on medication she will work closely with the psychiatrist who prescribed it. However, Dr. Carlat says in most practices, that is not the case. Psychiatrists who still want to specialize in talk therapy can opt out of insurance or agree to make less money. Dr. Carlat says with those options he doesn't see talk therapy in his field ever coming back.