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Professional practice patterns of U.S. psychiatrists
M Olfson1, H A Pincus, T H Dial
1Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032.
The American Journal of Psychiatry
|January 1, 1994
Summary
Most psychiatrists do not exclusively practice in private offices; many work in multiple settings, influencing patient care and treatment diversity. This study classifies psychiatric practice based on work environments.
Area of Science:
- Psychiatry
- Health Services Research
Background:
- Understanding the diverse practice settings of psychiatrists is crucial for analyzing healthcare delivery.
- Previous classifications may not fully capture the complexity of modern psychiatric work environments.
Purpose of the Study:
- To develop and validate a classification system for psychiatric practice based on primary and secondary work settings.
- To analyze how different practice settings influence the types of patients treated and services provided by psychiatrists.
Main Methods:
- Utilized data from the 1988-1989 American Psychiatric Association (APA) Professional Activities Survey.
- Characterized seven distinct practice groups based on primary and secondary work locations.
- Analyzed data from 16,135 psychiatrists, excluding those in administrative or academic roles.
Main Results:
- Identified key practice groups, with the largest being private psychiatric/general hospital psychiatrists (19.6%) and those in private office practice with secondary non-hospital settings (18.9%).
- Demonstrated significant variation among practice groups in the proportion of outpatients receiving assessments, therapy, and medication management.
- Observed differences in the mean number of patients treated monthly for affective disorders, schizophrenia, anxiety disorders, and other conditions across practice groups.
Conclusions:
- Approximately 90% of clinical psychiatrists engage in practice settings beyond exclusive office-based private practice.
- Around half of all outpatients receive medication management from their treating psychiatrist.
- Psychiatric work setting is a significant determinant of patient population and service provision, with most psychiatrists serving diverse patient groups across multiple settings.