Psychiatrists Can't Get No (Job) Satisfaction

Fran Lowry

September 30, 2011

September 30, 2011 — Not being able to spend enough time with patients, fears of malpractice lawsuits, worries that their patients cannot afford out-of-pocket expenses associated with treatment, and having to deal with Medicare are some of the things that are negatively affecting the way psychiatrists feel about their careers, a new study shows.

The study, by Jim P. DeMello, DBA, and Satish P. Deshpande, PhD, from Western Michigan University in Kalamazoo, appears in the September issue of Psychiatric Services.

It highlights factors that need to be addressed to attract more medical students to psychiatry, Dr. Deshpande told Medscape Medical News.

There seems to be a shortage of about 45,000 psychiatrists in the US, and it became clear that it would be difficult to address this problem without attracting more medical students to study psychiatry, and perhaps motivate the current crop of psychiatrists to see more patients and possibly delay retirement.

"There seems to be a shortage of around 45,000 psychiatrists in the US, and it became clear that it would be difficult to address this problem without attracting more medical students to study psychiatry, and perhaps motivate the current crop of psychiatrists to see more patients and possibly delay retirement," he said.

Dr. Satish P. Deshpande

One third of the psychiatrists practicing today are 60 years or older and will be thinking about retiring soon, and some may have already started to trim their practices. In addition, most primary care physicians report they find it hard to obtain mental health services for their patients, Dr. Deshpande noted.

"We thought it would be interesting to see what the factors that impact career satisfaction of psychiatrists are."

To find out, the authors looked at data from 314 psychiatrists who participated in the 2008 Health Tracking Physician Survey conducted by the Center for Studying Health System Change.

Threat of Litigation a Major Worry

To their surprise, they discovered that the threat of malpractice lawsuits was a major factor in career dissatisfaction.

You don't hear of psychiatrists being sued as much as surgeons or primary care doctors, but even the risk of being sued creates a fear that is still in the back of their minds.

"This was surprising to us because you don't hear of psychiatrists being sued as much as surgeons or primary care doctors, but even the risk of being sued creates a fear that is still in the back of their minds," Dr. Deshpande said.

Another factor was the length of time psychiatrists were able to spend with their patients.

"In a profession like this, you need to spend time with your patients to build rapport, trust, and a lasting relationship. But the doctors in the survey reported they needed more time," he said.

Worries about how much the patient has to pay in out-of-pocket costs were another source of career dissatisfaction.

"This suggests that, perhaps because of insurance rules and things like that, psychiatrists may not be in a situation where they can provide their patients what they consider to be the best care. For instance, they may have to change medications based upon what the patient can pay. Out-of-pocket costs for the patient are dictating the optimal treatment, and that worries them," Dr. Deshpande said.

Too Much Red Tape

The study addresses an important issue that has long been of concern, Psychiatric Association President John Oldham, MD, told Medscape Medical News.

Dr. John Oldham

"This paper reinforces and supports that there is an inadequate psychiatry supply that isn't enough to meet the existing needs we now have," he said.

That need is going to grow as the population ages.

Dr. Oldham said one of the findings he found particularly notable was that psychiatrists cited a disincentive to work with Medicare.

He believes this is not because of a reluctance to work with elderly patients but, rather, because of the complexity and poor reimbursement associated with Medicare.

"There is a huge bureaucratic work load that goes with taking care of these patients, and an enormous amount of paperwork, as well as insufficient reimbursement for the time required to care for these patients," he said.

"And, from the current already inadequate amount of reimbursement, there will be another cut by 30% due to go into effect next year. It's already hard to persuade psychiatrists, as well as doctors in other specialties, to take care of Medicare patients. Further cuts may make doctors bail out of the Medicare program," said Dr. Oldham, who is also professor of psychiatry at Baylor College of Medicine and senior vice president and chief of staff at the Menninger Clinic in Houston, Texas.

Too Little Time

Dr. Oldham added he was also struck by the fact that job satisfaction increased when the physicians could spend more time with their patients.

"This is what psychiatrists really, uniquely, need to be able to do," he said.

However, the forces in the healthcare world today conspire to minimize the time psychiatrists get to spend with their patients, he noted.

Psychiatrists spend a lot of time fighting with very junior insurance reps, calling them and fighting to defend their need to continue to treat their patient. This takes a lot of time that isn't reimbursed. These are the kinds of things that erode satisfaction.

"Insurance companies will not reimburse treatment by psychiatrists to do the kind of comprehensive treatment that allows you to spend enough time with a patient, and that would be much more beneficial for them. They limit the number of sessions they will reimburse," Dr. Oldham said.

Such constraints even apply to hospitalized patients, where reimbursement will only cover 5 or 6 days in hospital, he said.

"As a result, psychiatrists spend a lot of time fighting with very junior insurance reps, calling them and fighting to defend their need to continue to treat their patient. This takes a lot of time that isn't reimbursed. These are the kinds of things that erode satisfaction."

Dr. Deshpande and Dr. Oldham have disclosed no relevant financial relationships.

Psychiatric Services. 2011;62:1013-1018. Abstract

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....