Coping with the crisis in psychiatric training
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1Sheppard Pratt Health Plan, Lutherville, MD 21093, USA.
Abstract:
No article on the future of psychiatry seems complete without mention of a sea change or a paradigm shift. The demands for cost containment and accountability have fueled a shift away from retrospective fee-for-service, solo practice to prospectively reimbursed care through giant health systems (Schreter 1993). These systems substitute less expensive, less well-trained and often less-experienced clinicians for psychiatrists whenever possible. Managed care gatekeeping utilizes psychiatrists mainly for medication management. Psychotherapy, a signature product of our profession, is being demedicalized. What will be the roles for psychiatrists in the emerging health care delivery system?
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