What professional skills should general psychiatrists possess these days, especially since managed care is in effect limiting the services they provide at the same time that neuroscience is expanding their knowledge base and leading to new treatments? APA’s Committee on Workforce Issues conducted a survey of some 3,000 psychiatrists to find out.

Some of the survey results were reported at APA’s annual meeting in Chicago in May at a workshop titled "The Psychiatric Scope of Practice and Its Implications." The speakers included APA President Allan Tasman, M.D.; workshop chair Nyapati Rao, M.D., of Brookdale Hospital in Brooklyn, N.Y.; and Mary Kay Smith, M.D., of the Medical College of Ohio in Toledo and a former APA member-in-training trustee. Rao is chair of APA’s Committee on Workforce Issues, and Smith is a member.

A questionnaire was sent to 2,600 nonresident and nonstudent APA members (from whom the committee got a 55 percent response) and to 385 chairs of psychiatry departments or residency training directors (from whom the committee got an 80 percent response). The questionnaire consisted of 76 knowledge and skill items, and respondents were asked to rate on a four-point scale how important they felt each item to be in the repertoire of a general psychiatrist.

Some of the lowest-ranked items, Tasman said, included the following: being able to conduct electroconvulsive therapy, being able to do couples therapy, being able to do hyponosis, being able to interpret brain-imaging studies, being able to handle pain management, and being able to do formal psychoanalysis.

Tasman found the low rating regarding pain management "an interesting result" since a subspecialty in pain management is now being offered with board certification in psychiatry. And even though he himself is a psychoanalyst, he agreed with the 99 percent of respondents who indicated that formal psychoanalysis is not one of the tools that a general psychiatrist needs to use.

Some surprises also came out of the survey, Tasman continued. For example, respondents thought it important for a general psychiatrist to be able to do psychodynamic therapy despite all the publicity about newer therapies such as cognitive therapy. What Tasman found particularly noteworthy was that whereas 80 percent of the respondents said that conducting individual psychodynamic psychotherapy is important for a general psychiatrist, only 50 percent thought a general psychiatrist needs to understand psychoanalytic theory to be able to do so.

How international medical graduates (IMGs) answered survey questions compared with graduates of American medical schools is of special interest to Rao, who is an IMG. The IMGs tended to think it is important for a general psychiatrist to be able to practice some primary care medicine and child psychiatry, as well as general psychiatry. American graduates disagreed. This discrepancy really isn’t surprising, Rao said, since the 30 percent of psychiatrists in the United States today who are IMGs often work in large cities or in underserved rural areas where they must provide primary care and child psychiatry, as well as general psychiatry.

Another interesting difference, Smith pointed out, is that the respondents who were under 40 years old ranked administrative skills as more important for a general psychiatrist than had those who were over 40. The reason, she said, is that many early career psychiatrists are joining the staffs of managed care companies rather than going into private practices.

Now that the committee has the survey findings, the members are going to try to interpret what they mean, Tasman said.