Non-physician Health Professionals Research Articles

Supply dynamics of the mental health workforce: implications for health policy.

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.

Population-based registries using multidisciplinary reporters: A method for the study of pediatric neurologic disorders

Few registries are available for evaluating population differences for rare, newly, or ill-defined pediatric neurologic disorders. The purpose of this article is to present standard methodologies for establishing a population-based registry and evaluating the completeness of a registry's case ascertainment. The Texas Rett Syndrome Registry (TRSR) is used as a model. The combination of health care and education resources has identified approx. 89–100% of the Rett syndrome cases in Texas. Cases reported by non-physician sources, although older on average (10.7 vs 7.7 years of age), did not differ by other demographic characteristics from those reported by physicians. Non-physician health and education professionals participated with the TRSR at a significantly higher rate than physicians, 89 and 37% ( p < 0.05), respectively. Capture-recapture techniques, both two-sample and log-linear modeling, were used to quantitatively evaluate case ascertainment. Standardized national and international population-based registries could be the basis of an initiative to identify the etiology and perhaps preventive measures for pediatric neurologic disorders.

Career satisfaction among psychiatrists in Texas.

We examined present and anticipated future levels of career satisfaction among psychiatrists in the greater Houston area. We gathered data by means of an anonymous questionnaire. The strongest univariate correlations between background variables and current and anticipated future levels of career satisfaction were found with age, years in practice, and source of professional income. Major threats to the quality of psychiatric practice were identified as changes in third-party reimbursement/managed care, competition from nonphysician mental health practitioners, and the national economy. Psychiatrists least satisfied with their current careers and most pessimistic about the future were found to be older with more years' experience and deriving their professional income chiefly from private practice. Much of their dissatisfaction appeared to relate to changes in third-party reimbursement/managed care and increasing competition from nonphysician mental health professionals.

Medical Students' Attitudes:

Although education in the care of the elderly is widely recommended for all medical students, the specifics of this aspect of pressional education are widely variable and their effects unclear. This study evaluated the effects of a short-term interdisciplinary clinical rotation in geriatrics on medical student attitudes toward elderly patients, as well as attitudes toward non-physician health professionals. We also evaluated whether assignment to long-term care facilities as geriatrics clinical sites had a deleterious effect on attitudes of medical students taking this rotation. Our analysis demonstrated no measurable beneficial effects of the week-long geriatrics rotation on medical student attitudes toward elderly patients. The brief rotation did improve student attitudes toward the importance of non-physician health professionals in patient care; at the end of the course the students had more positive attitudes toward social workers, psychologists, and occupational therapists. Assignment to long-term c...

Collaboration in the preparation of the generalist physician

Collaborative efforts among health care professionals and institutions at all levels will be essential to the increased production of generalist physicians. There have been many successful collaborations in education and patient care among certifying boards, faculty, physicians in practice, specialists, generalists, and non-physician health professionals, as well as among the three generalist specialties. Recommended strategies to encourage collaboration in the preparation of generalist physicians include: creation of an institutional collaborative curriculum committee; design of a longitudinal curriculum on collaboration for physicians-in-training and other health professionals; implementation of collaborative patient care in ambulatory care teaching clinics; development of integrated systems of care that link inpatient, outpatient, and community-based health services; and education of physicians-in-training in these and other collaborative and co-practice models of patient care.

The future of disease prevention

The success of curative medical strategies calls attention to a lack in the completeness of health care: disease prevention. Bringing prevention appropriately into health care requires five types of effort: 1) broadening the view of health beyond the medical model to include the environment, social services, and personal health habits; 2) improving the science of prevention; 3) institutionalizing preventive services by relating them to all the participants, from the professionals to the government to the payers to the public; 4) encouraging non-physician health professionals to assume their suitable, possibly majority, share of providing preventive services; and 5) emphasizing preventive services notwithstanding an unevenness of access to them.

Who Should Perform the AIMS Examination?

Psychiatrists and nonphysician mental health professionals working in community mental health centers have difficulty establishing the scope of their expertise, defining the limits of their roles, delegating responsibility, and sharing professional liability. The clinical, political, and administrative aspects of these tensions are examined in the context of arguments for and against physicians' delegating to nonphysician mental health professionals the task of screening CMHC patients for tardive dyskinesia using the Abnormal Involuntary Movement Scale. In 43 percent of mental health centers in Massachusetts surveyed by the authors, nonphysicians perform tardive dyskinesia screening. The authors suggest that the benefits of involving nonphysicians in tardive dyskinesia screening in the CMHC setting outweight the disadvantages.

Nonphysician Psychotherapist- Physician Pharmacotherapist: A New Model for Concurrent Treatment

In the last century the mental health field has vacillated between a biologic versus a psychologic model of the mind. Only in the last two decades have proponents of both views calmly discussed their virtues and limitations. As a result, clinicians have begun to promulgate the concept of an integrated, concurrent psychotherapy and pharmacotherapy. While this debate has raged in the psychiatric field there has been a parallel proliferation of nonphysician mental health professionals. Most of these mental health clinicians come from training programs steeped in the traditions of a psychodynamically based treatment that occurs within the interpersonal context. Today more and more of these clinicians compete for the increasing population of those seeking relief. The result of these two movements has been the introduction of a unique form of treatment in which a patient sees two therapists. In this triangular treatment, the pharmacotherapist prescribes medications and the psychotherapist provides the interpersonal therapy. In order for all practitioners to participate in this form of triadic treatment they must appraise themselves of not only the historical debates preceding this therapeutic concordance but of the transference and countertransference potentials. Some patients can have idealizing, magical, and nurturing transferences toward either therapist in the triangular relationship. Other patients can be narcissitically wounded, with a negative devaluing response toward either therapist. Paralleling the patient's transference distortions are the therapists' countertransference reactions. These can run from the omnipotent identification with the patient's idealization to the devalued, distancing response toward oneself or the patient. If these distortions are not checked they can intrude on the treatment, acting out the patient's internal split self-object representations and ultimately sabotaging treatment. Successful attention to transference and countertransference phenomena can lead to an enhanced treatment in which the biologic and psychologic treatments have a synergistic effect. Only then will we be capable of fully evaluating and researching the positive and negative effects of combined psychotherapy and pharmacotherapy with two different therapists. The outgrowth of this research will be improved patient care by enhancing our capacity to identify those patients and therapists who are good candidates for this triangular treatment relationship.

Psychiatric expertise in clinical decision making for psychiatric inpatients.

Hospital boards and medical staffs are faced with difficult decisions about whether nonphysician mental health professionals should be given admitting privileges to psychiatric hospitals or treatment units. The authors describe the special medical expertise of the psychiatrist and define 11 indicators, such as a patient's need for new psychotropic medication or the presence of symptoms requiring medical or laboratory procedures, that can be used to determine whether psychiatric expertise is needed. The indicators were applied to a group of ten patients who constituted all admissions to a treatment unit in a private, nonprofit psychiatric hospital in a one-month period. At least half of the indicators were relevant to all the patients studied, suggesting the need for management by a psychiatrist.

Attitudes of medical students and physician faculty members toward nonphysician health professionals.

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Consequences of an Oversupply of Specialists

DURING the past 15 years, there has been a large increase in the number of active physicians in the United States. Between 1965 and 1980, a 55.8% increase occurred, which represented a change in physician density from 140 to 195 per 100,000 population. 1 Large increases also occurred among nonphysician health professionals. In the years ahead, further large increases in the number of health professionals in the United States may be expected, as medical students and postgraduate trainees enter practice. A number of factors are likely to increase the demand for physicians' services during the next few decades, such as the growth and aging of the population and improvements in health technology and changes in the ways medical care is organized and financed, among others. However, a consensus is emerging that by the year 2000, the supply of physicians will be in substantial excess of requirements in the United States. The

The JCAH and psychiatry: current issues and implications for practice.

The Joint Commission on Accreditation of Hospitals recently revised its Accreditation Manual for Hospitals (AMH), used to assess the quality of care at health institutions. The authors briefly examine the history of accreditation of hospital-based psychiatric services. They then provide background on factors that influenced the revision of AMH standards such as third-party pressure for cost containment and consumer demands for high-quality health care. The authors also explore such issues as clinical privileges for nonphysician health professionals and the interdependence of the medical staff and the hospital administration in monitoring quality of care.

Guidelines for Psychiatric Evaluation of Social Security Disability Claimants

Back to table of contents Previous article Next article ArticleNo AccessGuidelines for Psychiatric Evaluation of Social Security Disability ClaimantsPublished Online:1 Apr 2006https://doi.org/10.1176/ps.34.11.1044AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractThe Social Security Disability insurance (SSDI) program, which pays benefits to those too disabled to continue working, has been under serious scrutiny during the past year by Congress, the executive branch, the media, and concerned organizations such as the American Psychiatric Association. APA has fostered changes in the program that are nowpending in Congress and in the Social Security Administration-changes that will work to the benefit of individuals with severe mental impairments.Concern about the program has arisen from the changed adjudicative climate within which it operates-stressing terminations and denials over continuances and allowances-and the all-too-hurried manner in which disability adjudication has taken place in the past year. Current interpretation of the law and regulations further exacerbates the problems.These issues are being addressed by APA through legislation and regulations, but there are also other concerns. Of special importance is the adequacy of the medical records provided to disability determination officers for the adjudication of claims for the mentally impaired. Simply stated, improved psychiatric case records provided by psychiatrists, other physicians, and nonphysician mental health professionals can help ensure that proper disability determination decisions can be made.This document can help. By using the information it presents, clinicians can prepare medical information and histories for their mentally impaired patients that will help assure that such patients do not risk inappropriate denial ofSSDI benefits.The nature of the SSDI program dictates the need for certain case-building information that might not appear to be part of a usual medical record. Its requisites for detail are substantially dsfferent from and more demanding than those imposed by third-party insurers.The goal of tbis document is to assure that clinicians are providing the best medical evidence to the Social Security Administration about their patients, and that they are able to act as advocates for their patients by being informed not only about the medical implications of disability, but also about the disability determination process. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited bySocial Security Disability and the Mentally Ill: Changes in the Adjudication Process and Treating Source Information RequirementsPsychiatric Annals, Vol. 32, No. 5 Volume 34Issue 11 November 1983Pages 1044-1051 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1983

Psychiatry and the fiscal third party.

Third-party payment has profound effects on such areas of psychiatry as confidentiality; diagnosis; the therapeutic relationship; psychiatry's identification with the rest of medicine and the role of nonphysician mental health professionals; psychiatric education; and the availability, type, location, and quality control of treatment. As third-party payment becomes increasingly frequent, psychiatrists will have to come to terms with its good and bad effects in hospitals and community mental health centers as well as in private practice.

Factors to Consider in Choosing a Health Profession

STUDENTS AND THOSE WHO counsel them need to consider several factors in selecting a particular career from among the health professions. The health-sciences professions, from jobs requiring little training at the entry level to those that require extensive training, are undergoing a rapid and exciting period of change. Many of them are involved in self-assessment, recertification, relicensure, licensure, and expanded roles that are going to have considerable impact in most health delivery areas. Factors contributing to this ferment include the following: (1) the increasing competition for entry into some training programs and later into the professions themselves; (2) the desire of professional organizations to maintain and improve standards; (3) the increasing state and federal government involvement in health delivery systems; (4) the expanded roles of many nonphysician health professionals; and (5) the growth of the team concept of health care delivery.