Talk therapy has dominated the psychiatric profession since the days of Sigmund Freud. Because of changes in how much insurers will pay, most of the nations 48,000 psychiatrists are forced to prescribe medications instead, usually after only a brief consultation with the patient.
Historically, psychiatrists often saw patients ten or more times before arriving at a diagnosis. But things have changed ― now they must make a decision in the first 45-minute visit. Without a diagnosis, they cannot get paid. Their patients are referred to a less costly therapist to explore their personal crises. Psychologists and social workers ― who unlike psychiatrists do not attend medical school ― can often afford to charge less which has driven down the price of talk therapy. There is no evidence that psychiatrists provide higher quality talk therapy than psychologists or social workers.
MORE PATIENTS, QUICKER THROUGHPUT
Psychiatrists used to treat 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now they may treat 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. The goal used to be to help their patients become happier, now it is just to keep them functional. A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.
SUMMARY
The switch from talk therapy to medications has swept through psychiatric practices and hospitals. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills. Unfortunately, recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago. Of course, there are thousands of psychiatrists who still offer talk therapy to all their patients, but they care mostly for the worried wealthy who pay in cash.
Source: “Talk Doesn’t Pay So Psychiatrists Turn Instead to Drug Therapy” by Gardiner Harris, The New York Times, March 5, 2011.