Ken Duckworth, MD: The Modern Psychiatric Care Team
October 19, 2019
The field of psychiatry is shrinking in experts. Data show the average psychiatrist age is on the rise, and overall psychiatry specialist rates are on the fall. Care networks must become creative in their personnel makeup to adapt to this reality.
In an interview with MD Magazine®, Ken Duckworth, MD, medical director of the National Alliance on Mental Illness, explained how other members of the psychiatric care team are now being used, and what the true role of a physician has become in the space.
MD Mag: What does an optimized utilization of psychiatrists look like in a country with limited personnel?
Duckworth: So, several answers to that question. Wehave to incent more people to go intopsychiatry or go into addictionology. We need to think more creatively about loanforgiveness—encouraging people to enterthe field because we've had a seat changein new society. People are willing totalk about mental health, people arehappy to see mental health practitioners, but we have not transformed the supplyof them.
The most efficient thing to dowould be to add psychiatrists and have them see peoplefor medications. The problem with that ispsychiatrists are interested in thewhole person and want to do more thingsthan that—they want to be the captains of thetreatment team. They want to oversee allthe care, they want to deliverpsychotherapy.
They've gone togreat trouble to become a psychiatrist, and they don't want to be minimized interms of their role. There arepharmacologic experts of course, who onlydo that, and they're happy to do that. ButI think clinical nurse specialistsrepresent another great resourceunderutilized in the field overall, andalso in great demand—a lot of trainingand a lot of skills.
And I think thatin figuring out where to start, I encouragepeople to start with an independentlylicensed practitioner—not to start withthe rarest thing, which is a child andadolescent psychiatrist who's takingpatients, but to start with a more commonthing, which is get an interview, get amental health assessment by anindependently licensed practitioner.
Theyoffer a perspective on your diagnosisand a treatment plan which may notinclude a psychiatrist. I would start there, instead of trying to start up the narrowestpart of the pyramid. I would start closerto the base of the pyramid, because itmay be that psychotherapy and field work isall you need to do.
MD Mag: Do physicians now play more hands-off, leadership roles in care?
Duckworth:’ Master and Commander’ is how I would think about it, because the primary care doctor is still responsible for the PA’s work in most states. And I think nurses have different licensing authority in different states, but in some states, they're under someone.
Some states are completely independent, but I think that the doc as the master of the treatment plan and the master consultant to people who are more able to do the legwork, is a useful role for physicians.
But that doesn't mean that primary care doc's should only be doing physical exams. It doesn't mean the psychiatrist should only be prescribing med. So these models like McPAP—these ways that you have consultative services from psychiatry, child psychiatry to the primary care service which we have in Massachusetts—is a way to deploy the inadequate number of practitioners more creatively.
Copyright® ConsultantLive 2019 Intellisphere, LLC. All Rights Reserved.