APA-IPS: Integrative care is an answer to psychiatrist shortage

NEW YORK – Integrative care, a system in which specialists collaborate with primary care physicians, might go part of the way toward solving the persistent and growing shortage of psychiatrists in the United States, according to an expert speaking at the American Psychiatric Association’s Institute on Psychiatric Services.

“The question to ask is whether we have a workforce shortage or just a misdistribution of resources,” said Dr. Lori E. Raney, medical director, Axis Health System, Durango, Colo. She suggested in a symposium devoted to the psychiatrist shortage that there is evidence, including randomized trials, that support the efficacy of integrative or collaborative care models for many specialties, not just psychiatry.

In psychiatry, integrative care encourages primary care physicians to deliver at least the first steps of care in patients presenting with psychiatric symptoms. Although the specifics of the collaboration might differ according to the integrative care model, psychiatrists are available to guide primary care physicians at any time in regard to diagnosis or initial treatment but assume full control of management only on the more challenging cases, such as those with severe disease or those who are not responding to standard therapies.

The goal is to avoid automatic referrals, which is a common practice for many primary care physicians, even when confronted with mild to moderate complaints of depression or anxiety, Dr. Raney said. As editor of a recently published book called “Integrated Care: Working at the Interface of Primary Care and Behavioral Health” (Arlington, Va.: American Psychiatric Association Publishing, 2015), she is among the leading experts in the concept of integrative care as it relates to psychiatry. Importantly, integrative care in psychiatry has the potential to lead to better outcomes. One reason is that patients are more likely to be treated. According to Dr. Raney, only about 50% of patients referred to a psychiatrist actually make an appointment.

The success of an integrative or collaborative care model is derived from measurement-based outcomes. This means that the primary care physicians and the psychiatrist collaborate on bringing patients to specific treatment goals based on an objective assessment tool. If, for example, symptoms of depression are not reduced to an agreed-upon target within a specific period of time, the psychiatrist and the primary care physician work together to adjust therapy. The psychiatrist becomes directly involved only in the treatment of those who are not improving.

Recounting her own experience, Dr. Raney said guiding primary care physicians toward next-step treatment adjustments requires relatively little time, particularly when compared with one-on-one patient encounters for patients who have been referred.

Reimbursement for the psychiatrist consultations in an integrative care model can be achieved in many ways, but Dr. Raney suggested that this approach is attractive to payers. She said integrative care is compatible with the growing emphasis on outcomes-based, rather than fee for service–based, reimbursement. In the integrative care services she described, the measurement- and evidence-based management conforms with key approaches to optimal management.

Calling integrative care a potentially new gold standard in the efficient delivery of mental health services, Dr. Raney emphasized that this approach “allows us to be accountable to payers,” even as it addresses the psychiatrist shortage.

This shortage is only getting worse, according to an update provided by Dr. Michael A. Flaum of the department of psychiatry, University of Iowa, Iowa City. Speaking in the same symposium in which Dr. Raney proposed integrative care as a solution, Dr. Flaum said there are about 45,000 active and licensed psychiatrists, not including residents, in the United States. This is about half of the estimated need. Moreover, more than half of practicing psychiatrists are older than 55 years of age versus about 40% for physicians overall.

As the number of physicians entering psychiatry has been flat for about 25 years, the ratio of psychiatrists to other specialists has been diminishing, reported Dr. Flaum, citing data from numerous sources. In Iowa, which has one of the worst shortages of psychiatrists of any state in the United States, “we are rethinking the concept of what the workforce is” in psychiatric care. While he reviewed numerous strategies to address the growing unmet need for psychiatric care, he stated, “meaningful integration” of psychiatry with primary care services “may give us the biggest bang for our buck.” He also said such strategies, including delivery of psychiatric care by nonphysicians, such as nurse practitioners and physician assistants, are actively being pursued in his state.

Dr. Raney reported no relevant financial relationships.

NEW YORK – Integrative care, a system in which specialists collaborate with primary care physicians, might go part of the way toward solving the persistent and growing shortage of psychiatrists in the United States, according to an expert speaking at the American Psychiatric Association’s Institute on Psychiatric Services.

“The question to ask is whether we have a workforce shortage or just a misdistribution of resources,” said Dr. Lori E. Raney, medical director, Axis Health System, Durango, Colo. She suggested in a symposium devoted to the psychiatrist shortage that there is evidence, including randomized trials, that support the efficacy of integrative or collaborative care models for many specialties, not just psychiatry.

In psychiatry, integrative care encourages primary care physicians to deliver at least the first steps of care in patients presenting with psychiatric symptoms. Although the specifics of the collaboration might differ according to the integrative care model, psychiatrists are available to guide primary care physicians at any time in regard to diagnosis or initial treatment but assume full control of management only on the more challenging cases, such as those with severe disease or those who are not responding to standard therapies.

The goal is to avoid automatic referrals, which is a common practice for many primary care physicians, even when confronted with mild to moderate complaints of depression or anxiety, Dr. Raney said. As editor of a recently published book called “Integrated Care: Working at the Interface of Primary Care and Behavioral Health” (Arlington, Va.: American Psychiatric Association Publishing, 2015), she is among the leading experts in the concept of integrative care as it relates to psychiatry. Importantly, integrative care in psychiatry has the potential to lead to better outcomes. One reason is that patients are more likely to be treated. According to Dr. Raney, only about 50% of patients referred to a psychiatrist actually make an appointment.

The success of an integrative or collaborative care model is derived from measurement-based outcomes. This means that the primary care physicians and the psychiatrist collaborate on bringing patients to specific treatment goals based on an objective assessment tool. If, for example, symptoms of depression are not reduced to an agreed-upon target within a specific period of time, the psychiatrist and the primary care physician work together to adjust therapy. The psychiatrist becomes directly involved only in the treatment of those who are not improving.

Recounting her own experience, Dr. Raney said guiding primary care physicians toward next-step treatment adjustments requires relatively little time, particularly when compared with one-on-one patient encounters for patients who have been referred.

Reimbursement for the psychiatrist consultations in an integrative care model can be achieved in many ways, but Dr. Raney suggested that this approach is attractive to payers. She said integrative care is compatible with the growing emphasis on outcomes-based, rather than fee for service–based, reimbursement. In the integrative care services she described, the measurement- and evidence-based management conforms with key approaches to optimal management.

Calling integrative care a potentially new gold standard in the efficient delivery of mental health services, Dr. Raney emphasized that this approach “allows us to be accountable to payers,” even as it addresses the psychiatrist shortage.

This shortage is only getting worse, according to an update provided by Dr. Michael A. Flaum of the department of psychiatry, University of Iowa, Iowa City. Speaking in the same symposium in which Dr. Raney proposed integrative care as a solution, Dr. Flaum said there are about 45,000 active and licensed psychiatrists, not including residents, in the United States. This is about half of the estimated need. Moreover, more than half of practicing psychiatrists are older than 55 years of age versus about 40% for physicians overall.

As the number of physicians entering psychiatry has been flat for about 25 years, the ratio of psychiatrists to other specialists has been diminishing, reported Dr. Flaum, citing data from numerous sources. In Iowa, which has one of the worst shortages of psychiatrists of any state in the United States, “we are rethinking the concept of what the workforce is” in psychiatric care. While he reviewed numerous strategies to address the growing unmet need for psychiatric care, he stated, “meaningful integration” of psychiatry with primary care services “may give us the biggest bang for our buck.” He also said such strategies, including delivery of psychiatric care by nonphysicians, such as nurse practitioners and physician assistants, are actively being pursued in his state.

Dr. Raney reported no relevant financial relationships.

NEW YORK – Integrative care, a system in which specialists collaborate with primary care physicians, might go part of the way toward solving the persistent and growing shortage of psychiatrists in the United States, according to an expert speaking at the American Psychiatric Association’s Institute on Psychiatric Services.

“The question to ask is whether we have a workforce shortage or just a misdistribution of resources,” said Dr. Lori E. Raney, medical director, Axis Health System, Durango, Colo. She suggested in a symposium devoted to the psychiatrist shortage that there is evidence, including randomized trials, that support the efficacy of integrative or collaborative care models for many specialties, not just psychiatry.

In psychiatry, integrative care encourages primary care physicians to deliver at least the first steps of care in patients presenting with psychiatric symptoms. Although the specifics of the collaboration might differ according to the integrative care model, psychiatrists are available to guide primary care physicians at any time in regard to diagnosis or initial treatment but assume full control of management only on the more challenging cases, such as those with severe disease or those who are not responding to standard therapies.

The goal is to avoid automatic referrals, which is a common practice for many primary care physicians, even when confronted with mild to moderate complaints of depression or anxiety, Dr. Raney said. As editor of a recently published book called “Integrated Care: Working at the Interface of Primary Care and Behavioral Health” (Arlington, Va.: American Psychiatric Association Publishing, 2015), she is among the leading experts in the concept of integrative care as it relates to psychiatry. Importantly, integrative care in psychiatry has the potential to lead to better outcomes. One reason is that patients are more likely to be treated. According to Dr. Raney, only about 50% of patients referred to a psychiatrist actually make an appointment.

The success of an integrative or collaborative care model is derived from measurement-based outcomes. This means that the primary care physicians and the psychiatrist collaborate on bringing patients to specific treatment goals based on an objective assessment tool. If, for example, symptoms of depression are not reduced to an agreed-upon target within a specific period of time, the psychiatrist and the primary care physician work together to adjust therapy. The psychiatrist becomes directly involved only in the treatment of those who are not improving.

Recounting her own experience, Dr. Raney said guiding primary care physicians toward next-step treatment adjustments requires relatively little time, particularly when compared with one-on-one patient encounters for patients who have been referred.

Reimbursement for the psychiatrist consultations in an integrative care model can be achieved in many ways, but Dr. Raney suggested that this approach is attractive to payers. She said integrative care is compatible with the growing emphasis on outcomes-based, rather than fee for service–based, reimbursement. In the integrative care services she described, the measurement- and evidence-based management conforms with key approaches to optimal management.

Calling integrative care a potentially new gold standard in the efficient delivery of mental health services, Dr. Raney emphasized that this approach “allows us to be accountable to payers,” even as it addresses the psychiatrist shortage.

This shortage is only getting worse, according to an update provided by Dr. Michael A. Flaum of the department of psychiatry, University of Iowa, Iowa City. Speaking in the same symposium in which Dr. Raney proposed integrative care as a solution, Dr. Flaum said there are about 45,000 active and licensed psychiatrists, not including residents, in the United States. This is about half of the estimated need. Moreover, more than half of practicing psychiatrists are older than 55 years of age versus about 40% for physicians overall.

As the number of physicians entering psychiatry has been flat for about 25 years, the ratio of psychiatrists to other specialists has been diminishing, reported Dr. Flaum, citing data from numerous sources. In Iowa, which has one of the worst shortages of psychiatrists of any state in the United States, “we are rethinking the concept of what the workforce is” in psychiatric care. While he reviewed numerous strategies to address the growing unmet need for psychiatric care, he stated, “meaningful integration” of psychiatry with primary care services “may give us the biggest bang for our buck.” He also said such strategies, including delivery of psychiatric care by nonphysicians, such as nurse practitioners and physician assistants, are actively being pursued in his state.

Dr. Raney reported no relevant financial relationships.