Psychiatrists Talking Less, Prescribing More Due To Insurance Policies

The time patients spend in talk therapy with psychiatrists fell by 15 percent between 1996 and 2005, shows an examination of office-based psychiatrists published in this month's edition of The Archives of General Psychiatry. The percentage of psychiatrists who used talk therapy with all of their patients also fell eight percent during this time, while more than one-fourth of psychiatry offices didn't provide any talk therapy at all in the typical week.

For anyone who watched television or picked up a magazine during this time, the reason for this decline may seem obvious. A variety of medications for depression and anxiety have not only made the news for their mood-stabilizing abilities but also infiltrated airwaves and pages in a flurry of marketing. Good old-fashioned psychotherapy, meanwhile, has seen little in the way of advertising.

However research shows the drop is tied to changes in insurance company reimbursement policies prompted by the introduction of a variety of newer, more effective psychiatric medications. Recent research has shown that psychiatrists now receive less money for a 45-minute psychotherapy session than for three 15-minute medication evaluations.

Although the findings suggest that psychiatrists are being pulled into medicating by money, researchers note that a number of factors may account for the drop in talk therapy. Patients now possess a greater awareness of medications available for them, increasing demand for medication. Meanwhile, doctors have a wider variety of options to treat patients via medication and may therefore be more willing to prescribe it. Patients may also be turning to less expensive mental health professionals such as social workers and licensed clinical professional counselors to provide talk therapy while psychiatrists are more likely to be seen for cases where medication is most applicable.

ABSTRACT: National trends in psychotherapy by office-based psychiatrists.