Managed Care and the Role and Training of Psychiatrists

Prologue: While the entire physician workforce is experiencing profound changes brought about by the growth of managed care, psychiatry faces some unique challenges. Psychiatrists' roles in managed care settings often have been restricted to those of “consultant, pharmacotherapist, and inpatient case manager,” in part because of efforts to contain costs. The authors of this paper advocate a broader view that considers psy-chiatrists' contribution to the overall health care system: “[P]sychiatry augments efforts to reduce lengths-of-stay and uncompensated care, permits treatment of difficult behavioral management cases, and collaborates with the complex, costly cases of combined physical and mental illness.” The growth of managed care also has important implications for psychiatrist training and academic psychiatry departments. The authors believe that managed care organizations and academic psychiatry departments have common interests: Both have a stake and an essential role to play in demonstrating cost-effectiveness and quality of care, and both have a stake in the development of relevant and effective educational programs. The authors emphasize the importance for psychiatrists of collaboration, in both clinical practice and training, with other disciplines, especially primary care. At the time this paper was prepared, Roger Meyer, a physician, was vice-president for medical affairs, Walter Bloedorn Professor of Administrative Medicine, and professor of psychiatry at The George Washington University (GWU) Medical Center in Washington, D.C. He is now a senior scholar at the Association of Academic Health Centers. Meyer received his medical degree from Harvard. Stuart Sotsky, also a physician, directs the Division of Ambulatory Care of the Department of Psychiatry and Behavioral Sciences at GWU Medical Center. He received his medical degree and a master s degree in public health from The Johns Hopkins University in Baltimore, Maryland. Abstract: While each sector of medical practice and academic medicine confronts the reality of a changing economic environment driven by managed care, psychiatry faces some of the most difficult challenges in defining the future roles and training of psychiatrists. In this paper we describe the challenges and opportunities for psychiatry in this new era, as well as some of the unique problems facing academic psychiatry departments as they seek to fund their academic mission.