Jump to content




Photo
- - - - -

Is There a Shortage of Doctors?


  • Please log in to reply
7 replies to this topic

#1 Akathesia Sux

Akathesia Sux

    Member

  • Member
  • Pip
  • 79 posts

Posted 01 August 2006 - 02:37 PM

Often I have noticed that when I see my doc, I am lucky if I am given 15 minutes. Even on initial visits, the time alloted is not sufficient for a thorough evaluation, imo. I have heard more than one person gripe about being in the hospital and the doctor interviewing you while you are half asleep or whatever, and only giving you 2 or 3 minutes. This just doesn't cut it as far as I am concerned.

So, I guess my question is: is there a shortage of pdocs?
DX - Bi-Polar 1, Acute Anxiety, PTSD, OCD
Current meds - Zoloft 200mg, Trileptal 1200mg, Seroquel 75mg (titrating up), Klonopin 1mg
Past meds - Paxil, Prozac, Buspar, Valproic Acid, Lithium, Geodon

And, yes, I know that my name is misspelled.


#2 AirMarshall

AirMarshall

    Jumping the CB Shark

  • Member
  • Pip
  • 6686 posts

Posted 01 August 2006 - 03:57 PM

I ended up reading up on the subject earlier in the year. I can't give you a complete answer, but some points.

- There is definitey a shortage of pediatric psychiatrists. I ran into this statement repeatedly.

- There is a mal-distribution of psychiatrists. Outside of major cities it can be difficult to get onto a patient list, or in rural areas, require driving one or more hours for service.

- I saw statements that there is at least a mild shortage. Since there is no national quota or goal for psychiatrists and no way to quantify how many patients are underserved, this is quite subjective.

There is not a push from med students applying for psych residencies. One likely reason is that psychiatry is one of the lowest paid specialties, and the insurance system has aggressively worked to keep costs down by limiting doctor payments and limiting patient visits.

Additionally over the last 30 years, a major shift occured (again driven by insurance) taking pdocs out of the talk therapy role and relegating them primarily to evaluation and med management. Paralleling this was the growth of PhD psychologists who have assumed much of the research and high level treatment roles. There are presently about 35,000 pdoc and about 35,000 PhD tdocs. 30 years ago there were only a few thousand Tdocs. Decreasing patient contact has probably served as a disincentive to interested doctors.

I'm not sure what your experience is. 15 minutes for a medication monitoring appointment is pretty much industry standard. It is common to allocate 1 hour for initial evaluation. After that you would need to check with individual insurance policies for authorized treatments and guidelines. Nowadays most insurances require the Pdoc to submit an initial dx and proposed treatment plan. Then they return an authorization stating how many visits of what types and lengths are authorized during a set period. If your insurance didn't send you a copy, your Pdoc should be able to give you a copy.

a.m.

**My work is done.  Swimming for the nearest shore.**


#3 Panz

Panz

    The mad witch of Darby

  • Member
  • Pip
  • 937 posts

Posted 01 August 2006 - 09:13 PM

I understand that I live in I-Dee-Ho, but I live on the border of Washington, with two universities with in 8 miles of each other. There is not a single Psychiatrist with in 50 miles, the best we have is licensed pshychologists and trauma counselers. We don't even have a psych unit in any of the nearby hospitals. I'd say that there is a shortage or that they only want to live in major metropolitan areas.

It really ticks me off
Panz and her pack of rascals, ner' do wells and dreamers

My DX-of-the-month: complete nutter
MEDS : Changing a lot right now, don't know what i'll end up with yet. Abilify 10mg, Klonopin, 1mg 2xdaily, Neurontin ~ Lots and changing and a bunch more medical ones that I don't want to write down
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The only thing better than being with the one you love, is being with the one you love dipped in dark chocolate =D
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"And the day came when the risk to remain tight in a bud
was more painful than the risk it took to blossom."

~ Anais Nin ~



[link=http://secretsistersbookofshadows.blogspot.com/" target="_blank]My new blog[/link]

#4 Loon-A-TiK

Loon-A-TiK

    Is there no way out of the mind? - Sylvia Plath

  • Member
  • Pip
  • 4902 posts

Posted 02 August 2006 - 01:12 PM

i live in a moderate-sized city.
there are about 5 pdocs in our city that are not private/tied to an HMO. so those are docs you can jump in to see (after a 20 year waiting list time) and either pay with cash or your own insurance if you have it. the other docs, as i said, are tied to HMOs, or county agencies (my current treatment team is a non-profit tied to the county).

i'd say that we have a shortage of pdocs. when you need one, like you haven't been seeing one but then have a psych emergency and know you need one right then (ahhem, like me several years ago), you can't get in, and it ends up with a hospitalization that could have been avoided (2nd hospitalization- they gave me geodon=BAD). yes, i got to see pdocs alright, and they gave me that shit!

so-

i used to live in a smaller midwest state, further west. there were only a few pdocs, attached or unattached, in that whole place. i got one who didn't speak english, and when i asked him what my husband and i could do to improve our marriage, he suggested watching porn. ????

so-

.... loon
DX-BP1 w/psychotic symptoms, PTSD, ADD (Inattentive), and body dysmorphic disorder
Daily RX- WB 300mg, Lamictal 400mg, Abilify 20mg, Adderall XR 30mg, Inderal 10mgx2, Nuvaring
a multi-vitamin, hair/skin/nails vitamin, super 50-b complex vitamin, flax oil

prn- Zyprexa 10-20mg for emergencies

In memory of my dad, BP1 suicide. I love you and miss you!

EX RX- Seroquel, Risperdal, Geodon (master of all that is evil), Zyprexa (the good stuff), Zyprexa Zydis, Trazadon, Depakote, Lithium, Serzone, Paxil, Effexor, Lexapro, Haldol, Strattera, Topamax, Symmetrel, other old school ACs, and more I can't remember now

"Can a selfish egocentric jealous and unimaginative female write a damn thing worthwhile?" - Sylvia Plath

If you don't have something nice to say, then don't say it at all.

#5 AirMarshall

AirMarshall

    Jumping the CB Shark

  • Member
  • Pip
  • 6686 posts

Posted 02 August 2006 - 01:38 PM

L.A.T...

- Your personal reaction to a medication has nothing to do with pdoc availability. That could have happened working outpatient too.

- Asking a pdoc for casual marriage counseling is really not appropriate, and a waste of your valuable time with him. Your question was broad and vague, so a broad and vague answer isn't unexpected. The phone book is full of marriage counselors who are more experienced and cheaper than a pdoc.

- I've had to wait a month for one, and 6 weeks for initial appointments with allergists. I had to wait about 10 weeks for my first pdoc appointment. My GP did a reasonable job with the basics. If I had qotten worse I really could have seen him again and I'm sure he would have done something to help me. And of course I could have gone to the ER if I was in extremis.

I think we are still better off in the US than our friends in the UK. Seems like their system is aimed to limit pdoc visits to the bare minimum necessary for dx, (if a GP can't handle it first) and initial meds, then kick you back to GP, except for occasional med checks with Pdoc. And it seems that initial appointments with pdocs take between 6 and 9 months to get.

a.m.

**My work is done.  Swimming for the nearest shore.**


#6 AirMarshall

AirMarshall

    Jumping the CB Shark

  • Member
  • Pip
  • 6686 posts

Posted 02 August 2006 - 04:07 PM

After a PhD psychologist the next level down would be an MS psychologist.

a.m.

**My work is done.  Swimming for the nearest shore.**


#7 Libby

Libby

    ~!~

  • Member
  • Pip
  • 1605 posts

Posted 02 August 2006 - 06:50 PM

John Doe, LMSW-ACP, LPC, LMFT:

This one is Licencsed Master's level Social Worker, Advanced Clinical Practitioner, Licensed Profesional Counselor, Licensed Marriage and Family Therapist.

MS, MA could be anything. Heck, I have an MA, and with few more classes and internship, I could have an LPC.

I would say to go with an LMSW, not an MA, LPC.

Edited by Libby, 02 August 2006 - 06:52 PM.

I'm not offended by all the dumb blonde jokes
because I know I'm not dumb...
and I also know that I'm not blonde.
~Dolly Parton



dx: severe, refractory double depression. GAD. OCD, paranoia, occasional psychosis.
Depersonalization and anxiety out the wazoo, no matter which meds I take.

current rx: Cymbalta 90mg as of 11/12, Trazodone 400mg as of 4/6/07. Clonazepam .5mg PRN.

Recent Titration: Seroquel 100mg>200mg>now 300mg>back to 200mg as of 11/10,
up to 300mg as of 11/29; up to 400 mg Seroquel as of 1/19/07.
Tapering down on Seroquel and adding Trazodone as of 3/26/07, much to my chagrin.
Now down to zero SQ, up to 400mg Traz. Can't sleep, but my girth is getting smaller.

And now: Stopped Traz. Added Navane. tripped off into some dissociation/psychosis shit. Off Navane. Back on 1,000mg Seroquel. Welcome to my nightmare.


previous rx: Tofranil, Desyrel, Pamelor, Prozac, Paxil, Zoloft, Wellbutrin,
Neurontin, Luvox, Serzone, Remeron, Effexor, Lexapro. Navane, Ativan, Inderal, Lithium.

#8 AirMarshall

AirMarshall

    Jumping the CB Shark

  • Member
  • Pip
  • 6686 posts

Posted 02 August 2006 - 07:12 PM

I was trying to indicate someone with a Masters degree in psychology.

One certainly needs to fully evaluate the credentials of anyone as there can be vast differences in education.

It is not possible to directly compare the person in Libby's example.

I deliberately did not list any licensing acryonyms since truly, they can indicate substantial education, and unfortunately they can mean NOTHING, since standards vary so much by state.


I might point out that in another thread discussing Social Workers, I did a survey of 5 major universities crossing the country and found that only 2 programs required an individual to have TWO (2) formal psychology course including both the bachelors and masters curriculum in order to recieve a Masters of Social Work. The remaining programs required only ONE (1) psychology course, i.e. PSYCH 101. This hardly presents a rigorous grounding in even basic psychology, let alone allowing them to present themselves as highly qualified psychologists. Schools curriculums surveyed: USC, UC Orange County, U. of Maryland, Texas State, U. of Illinios.

Social Workers certainly have a strong interest in people, and much practical experience. As "Counselors" the fill a valuable role in helping people cope with life, but there is a significant difference between them and someone who has a formal training in psychology through the masters level who is able to diagnose and understands the complexity of the actual illness.

BTW, my therapist is a Licensed Clinical Social Worker.

a.m.

Edited by AirMarshall, 02 August 2006 - 07:17 PM.

**My work is done.  Swimming for the nearest shore.**






The content of individual posts on this site are the sole work of their authors and do not necessarily reflect the opinions and/or policies of the Administrators, Moderators, or other Members of the Crazyboards community. Health related topics should not be used for the purpose of diagnosis or substituted for medical advice. It is your responsibility to research the accuracy, completeness, and usefulness of all opinions, services, and other information found on the site, and to consult with your professional health care provider as to whether the information can benefit you.