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What does American psychiatry in the 1990’s look like?
The 1996 National Survey of Psychiatric Practice (NSPP) depicts a diverse profession whose practitioners work in a range of practice settings and earn income from a variety of sources.
The survey was conducted by APA’s Practice Research Network, codirected by APA Deputy Medical Directors Harold A. Pincus, M.D., and Deborah Zarin, M.D.
Differences in practice characteristics and patient caseloads were examined across various psychiatrists’ characteristics, including age and gender.
Zarin, who is also codirector of the Office of Research, said the survey will provide a rich source of data for tracking the way psychiatrists are adapting to changes in American health care.
"As psychiatry moves into the next century, findings from the NSPP will form a baseline for monitoring changes and trends in the delivery and financing of mental health services," she told Psychiatric News.
The survey consisted of a 23-item questionnaire mailed to 1,481 psychiatrists randomly selected from a sample of 28,076 APA members currently practicing psychiatry.
A total of 1,076 surveys were returned; 970 were considered valid for analysis, with a response rate of 71 percent.
Notable among the findings are the differences observed across three age cohorts: 39 years and younger, 40 to 54 years, and 55 years and older. For purposes of analysis, these age cohorts serve as a proxy for early, mid, and late stages in a psychiatrists’ professional career.
Psychiatrists in all three age groups reported treating the majority of their patients in outpatient settings, but late career psychiatrists treated the greatest percentage (78 percent). Respondents 39 years old and younger reported treating 25 percent of their patients in inpatient settings, compared with only 17 percent for respondents 55 and older.
Overall, respondents spent the greatest percentage of direct patient care time in a solo office practice (40 percent). Further analysis showed, however, that late and mid-career psychiatrists spent a greater percentage of their time in solo office practice, while early career psychiatrists spent a greater percentage of time in clinics and outpatient facilities and in general hospitals.
Mood disorder (36 percent) was the most common primary diagnosis among patients seen in the respondents’ last typical work week, followed by anxiety disorders (14 percent), schizophrenia and other psychotic disorders (13 percent), and disorders usually first diagnosed in infancy, childhood, or adolescence (10 percent), the survey found.
Alcohol use disorders and other substance abuse disorders accounted for 6 percent and 4 percent of primary diagnoses, respectively, of patients in respondents’ last typical workweek.
Public sources of payment or uncompensated care made up 42 percent of all sources of payment for psychiatrists’ services. The primary payment mechanism for psychiatrists’ patient care services was fee for service, accounting for 53 percent of psychiatrists’ income from direct patient care.
Nonmanaged public and private insurance were the most frequent types of health plans for patients (41 percent). Twenty-nine percent of patients used some form of managed care health plan.
Other findings from the survey included the following:
Further details from the survey can be found in the October Psychiatric Services and the American Journal of Psychiatry.