Talk Therapy Loses Popularity with Psychiatrists
The utilization of psychotherapy by psychiatrists is losing popularity according to a recent study published in the Archives of General Psychiatry. According to the study, psychotherapy is involved in less than 30% of cases where patients visit with psychiatrists. Conversely, in 1996 psychotherapy was utilized in approximately 47% of patient encounters with psychiatrists. Authors of the study, Ramin Mojtabai, M.D., Ph.D., M.P.H., of Johns Hopkins University, and Mark Olfson, M.D., M.P.H., of Columbia University in New York, commenting wrote, “these trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalization of psychiatric practice.” The following is an excerpt of an article from Medpage Today that reviews the study:
In an interview, Dr. Mojtabai said financial incentives are probably driving the change.
He said that under typical reimbursement rates, a psychiatrist who conducts one 45-minute psychotherapy session will receive 40% less than if he or she saw three patients for 15-minute medication management visits.
Many insurance plans also cap the number of reimbursable psychotherapy sessions, whereas they pay indefinitely for maintenance drug treatment, he said.
Dr. Mojtabai said findings in the study, which used data from more than 14,000 office visits collected in the government’s regular National Ambulatory Medical Care Survey, support the idea that finances are an issue.
Multivariate regression analysis revealed an odds ratio of 2.10 (95% CI 1.59 to 2.78) that a patient receiving psychotherapy would pay out of pocket for the session.
In addition, certain types of practices, particularly HMOs, appeared to favor medication over psychotherapy.
The multivariate analysis found an odds ratio of 0.20 for psychotherapy in an HMO-based practice (95% CI 0.09 to 0.44), relative to a freestanding solo practice. Freestanding group practices had an odds ratio of 0.41 (95% CI 0.27 to 0.61).
However, Dr. Mojtabai cautioned that the study did not evaluate outcomes, and hence could not conclude that patients were worse off for the shift toward drug therapy.