Now Let's Talk About This...

A recent NY Times article speaks out about something that has been plaguing me for some time now: the lack of psychotherapy treatment given by the majority of psychiatrists these days.

The culprit: healthcare reimbursement cuts.

Despite the fact that research more than supports the notion that psychotherapy is a far more effective treatment for some forms of depression, anxiety disorders, and other mental illnesses than are medications (in some patients), healthcare administrations still expect that psychiatrists successfully treat their patients with medication alone. However, the question remains as to whether this is even possible. There is a remarkable lack of controversy in the field as to whether medication alone is ever as effective as medication + psychotherapy. No one would ever suggest that an HIV patient trade in his drug cocktail for a single-medication treatment regimen simply in for the sake of reducing costs. We know from experience that this would not work -- so why then do we continue to expose our at-risk patients with depression, bipolar disorder, schizophrenia, and more to treatments that do not fully target the problem at hand? Can we wonder then why suicide rates are continuing to increase despite advancements in the pharmacology of mental disease?

I realize how angry the above paragraph reads, and while I do not want to represent myself as another raging, protesting student, I do think that these issues are somewhat of a medical prescription for disaster.

Furthermore, it concerns me to read how few psychiatrists have been able (read: motivated) to continue offering quality psychotherapy services despite reimbursement cuts. Psychiatrists have been known to enter the field out of passion and love for mental health (as surely the financial incentives have been notoriously few and far between), yet, at some point, I suppose passion fails and pragmatics take over. Thus, quality mental health services in the vast majority of the States continue to become harder and harder to find. 

Budget cuts have hit all areas of medicine. Everyone seems to be complaining about it. At a recent mixer/dinner with some Neurology residents, I heard ad nauseum of one young doctor's frustrations that an MRI, which used to reimburse $1,000, now only rakes in a measly $500. Nevertheless, I continue to stand by the somewhat snarks reply that I offered to her: "I believe you might still be able to find groceries on that reduced, yet still indulgent, income."

And now that I have successfully worked myself into an entirely unnecessary Sunday-evening frenzy, I wonder how I will compensate for such reimbursement cuts during my own career. Surely, the answer to this question is simple: grab another diet coke and stop thinking so hard until your homework has been done.