National health insurance and private psychiatry

From 1972-73 to 1988-89, the number of Canadian psychiatrists doubled. Most psychiatrists are in fee-for-service practice. The median earnings of psychiatrists are close to those of internists. There is lack of psychiatric services available, but not a lack of psychiatrists. The lack of services is due largely to the allocation of psychiatric resources. The maldistribution of psychiatrists is increasing as more settle in urban centres. The U.S. General Medical National Advisory Council recommends that psychiatry spend two thirds of clinical time treating severe illnesses such as psychoses. Before any changes are made to the structure of Canadian psychiatry, more data are needed on patterns of fee-for-service practice, the characteristics of patients, the course and outcome of private psychiatric care, and alternative patterns of practice in which psychiatrists are consultants to family physicians and non-medical therapists.