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Is There a Shortage of Doctors?

8 posts in this topic

Posted

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?

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Posted

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.

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Posted

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

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Posted

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

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Posted

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.

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Posted

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

a.m.

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Posted (edited)

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

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Posted (edited)

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

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