Mental Health

Most office-based psychiatrists are providing medication rather than psychotherapy to their patients

The use of psychotherapy has declined markedly among U.S. office-based psychiatrists, reveals a new study. For instance, the percentage of visits to psychiatrists that included psychotherapy dropped from 44.4 percent during 1996-1997 to 28.9 percent in 2004-2005. Similarly, the number of psychiatrists who provided psychotherapy to all of their patients fell by nearly half from 19.1 percent to 10.8 percent during that time. The researchers attribute the decline in psychotherapy to a drop in the number of psychiatrists specializing in psychotherapy and a corresponding rise in those specializing in drug therapy. They note that these changes were likely sparked by reimbursement policies favoring brief medication management visits over psychotherapy and the introduction of new psychotropic medications with fewer adverse effects in recent years.

These developments continue the shift toward the medicalization of psychiatric practice. The magnitude of financial disincentives for providing psychotherapy was highlighted by a Practice Research Network study documenting that third-party reimbursement for one 45- to 50-minute outpatient psychotherapy session is 41 percent less than reimbursement for three 15-minute medication management visits.

Consistent with these findings, the current study found that psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed care visits, prescribed medications in fewer of their visits than psychiatrists who provided psychotherapy less often, and prescribed medications for only slightly more than half of their patients. A growing group of psychiatrists, in recent years, appeared not to deliver formal psychotherapy to patients. The study was supported in part by the Agency for Healthcare Research and Quality (HS16097). More details are in "National trends in psychotherapy by office-based psychiatrists," by Ramin Mojtabai, M.D., Ph.D., M.P.H., and Mark Olfson, M.D., M.P.H., in the August 2008 Archives of General Psychiatry 65(8), pp. 962-970.

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