(2014). Psychodynamic Psychiatry, 42(3):479-495
Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader.
Graduating residents face an in which surveys show a steady and alarming decline in practice of by psychiatrists, along with a decline in job . High educational debts, practice structures, intrusive management, and reimbursement policies that devalue discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of unable to develop a critical mass of experience or a secure as a psychiatric psychotherapist.
Implementation of parity laws and the Affordable Care Act (ACA) will the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care.
The authors recommend 1) vigorous advocacy for better payment levels for and freedom from disruptive management; 2) aggressive against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the for providing
in their practice, and 4) post-graduate in through supervision/consultation, continuing education courses, computer instruction, and distance learning.