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In their survey of psychotherapy practice by office-based psychiatrists, published in the August 2008 issue of the Archives, Mojtabai and Olfson report a significant decline in the provision of psychotherapy by psychiatrists (from 44.4% to 28.9%) over the 10-year period of 1996 to 2005.1 They interpret this change as reflecting an ongoing shift away from integrated care (psychiatrists providing both psychotherapy and pharmacotherapy) that is largely driven by financial disincentives to the provision of psychotherapy. For example, they point out that psychiatrists are reimbursed 41% less for a 45-minute psychotherapy session than for three 15-minute sessions of medication management. They also point out that the decline in the provision of psychotherapy is accompanied by an increase in the prescription of medications.
Further, they comment that there may be a “shifting culture” in residency training taking place, as “the newer cohorts of psychiatric trainees may be less motivated to use psychotherapy in their practices.”1 (p969)
We wonder if there is any empirical support for this interpretation, particularly as their study pertained to psychiatrists in practice rather than trainees. Moreover, we recently conducted a national survey of Canadian residents' perspectives on psychotherapy training,2 whose findings are in stark contrast to the view of psychiatry trainees that Mojtabai and Olfson espouse. In our study, most graduating residents (84%) anticipated practicing psychotherapy and viewed it as an important component to their work and identities as psychiatrists. Are the therapeutic preferences of emerging Canadian psychiatrists that different from their American counterparts? Or, are we witnessing diverging practice trends between countries, perhaps at least partially driven by disparate reimbursement schemes?
In a letter to the editor published 10 years ago in the Archives, Clemens and Gabbard argued that if psychiatrists abdicate their unique position to integrate biological and psychological facets of treatment, “they will leave a void for countless people suffering from mental illness that no one else can fill.”3 (p183)
Considering the perspectives of Canadian residents we surveyed, such a void thankfully does not appear on the horizon. Our findings suggest that there may be cause for optimism about the fate of psychotherapy within psychiatric practice. However, longitudinal or follow-up studies are required to develop a clearer sense of the factors that enable or discourage psychiatrists from providing psychotherapy.
Correspondence: Dr Ogrodniczuk, Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada (ogrodnic@interchange.ubc.ca).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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