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National Trends in Psychotherapy by Office-Based Psychiatrists
Ramin Mojtabai, MD, PhD, MPH;
Mark Olfson, MD, MPH
Arch Gen Psychiatry. 2008;65(8):962-970.
Context In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years.
Objective To examine recent national trends in the provision of psychotherapy by office-based psychiatrists.
Design Data from the 1996 through 2005 cross-sectional National Ambulatory Medical Care Survey were analyzed to examine trends in psychotherapy provision within nationally representative samples of visits to office-based psychiatrists. Multivariate analyses examined the time trend, adjusting for patient, visit, and setting characteristics. Practice-level analyses examined time trends in the percentage of psychiatrists who provided psychotherapy to all, some, or none of their patients during a typical week.
Setting Office-based psychiatry practices in the United States.
Participants Patients with psychiatric diagnoses visiting outpatient psychiatrists.
Main Outcome Measure Provision of psychotherapy in visits longer than 30 minutes.
Results Psychotherapy was provided in 5597 of 14 108 visits (34.0% [weighted]) sampled during a 10-year period. The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often.
Conclusions There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy—changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.
Author Affiliations: Departments of Psychiatry, Beth Israel Medical Center (Dr Mojtabai), and College of Physicians and Surgeons, Columbia University (Dr Olfson); and the New York State Psychiatric Institute (Dr Olfson), New York. Dr Mojtabai is now with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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