Thursday, March 27, 2014

Dr. Fischbach and the Pittsburgh Post-Gazette on the State of Psychiatry

I received a link to this excellent post by Marnin E. Fischbach commenting on two articles in the Pittsburgh Post Gazette on the shortage of psychiatrists, why people have difficulty finding a psychiatrist, and his broad overview of the importance of psychiatry.  From other sources I have learned that Dr. Fischbach has over 40 years experience as a psychiatrist.  It is good to find another psychiatrist who has confidence in their colleagues.  Even though most of my colleagues would agree, that is often not the public opinion stated by many psychiatrists.  Conflict of interest issues do not apply since it appears that Dr. Fischbach is not selling a book or trying to come across like somebody who can correct the deficiencies in his colleagues.

His subtitle is critical:

"If more people knew what psychiatrists really do, there would be more of them and better health care for everyone".

In his elaboration he discusses inaccurate portrayals in the media, the lack of "whiz bang technology" like some other specialties and how the general stigma of mental illness also attaches itself to psychiatrists.  His discussion of the value of psychiatrists has 5 significant points.  Those points include being "willing and able" to deal with the mental forces that affect the human condition, having the broadest understanding of all of the factors that affect those forces, diagnosing and treating borderland conditions because our work requires close attention and listening, being first and foremost physicians, and providing treatment that results in patients getting better.  None of these points should come as any surprise.  It is only in the context of media bias against psychiatry that they do.  

At the end of his essay he states: "I have much faith in our psychiatric profession and great respect for its practitioners."  That is a good note to end on.  The other theme in the essay was addressing the compensation of psychiatrists.  That was critical because it speaks to the shortage of psychiatrists and the two previous articles.  It also explains why psychiatrists refuse to accept insurance, but his article does not explain the underlying reason.  Most people do not understand that as far as most insurers go, psychiatry is "carved out" from all other medical specialities.  In terms of managed care organizations that means services that are either not covered or that are covered by a much different payment mechanism that other medical services.  It was actually part of the federal reimbursement scheme until new rules allowed the submission of standard medical billing codes.  It makes sense that if managed care companies expect you to accept minimal or in some cases trivial reimbursement that you would refuse to contract with them and accept patients who subscribe to that plan.  It is clear cut rationing of psychiatric services by insurance companies and the government.

The other area in Dr. Fischbach's essay that is impacted by similar rationing mechanisms is the collaborative care model.  As I have pointed out, this is an extension of rationing by both the managed care cartel and the government that will only result in psychiatry being further marginalized.  

Psychiatry is a vital and effective medical specialty.  The biases against psychiatry that he mentions and the biases noted in the original article are significant and in my opinion are a larger factor in reducing the number of psychiatrists than the compensation issue.  That is why those biases are addressed right here on this blog.  

I congratulate Dr. Fischbach on pointing out and elaborating these biases in his essay and and share his positive regard for our colleagues.  I encourage a read of his well written essay and a look at the links to the two articles that he is responding to.  Never forget that access to psychiatrists is restricted by both the government and the managed care cartel and one of the reasons they can do that is the longstanding stigma against mental illness.

George Dawson, MD, DFAPA

Marnin E. Fischbach.  The Importance of Psychiatry.  Pittsburgh Post-Gazette.  March 22, 2014.

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