Magazine article Clinical Psychiatry News

Why 10.8% Is Misleading

Magazine article Clinical Psychiatry News

Why 10.8% Is Misleading

Article excerpt

It's a number we see repeatedly in the popular press. In case you missed the reference, 10.8 is the percentage of sychiatrists who saw all of their patients for psychotherapy, according to a study published by Dr. Ramin Mojtabai and Dr. Mark Olfson in August 2008 (Arch. Gen. Psychiatry 2008;65:962-70). It represents a decrease from 10 years ago, and it is said to prove that psychiatry has come to be about nothing more than prescribing medicines.

I've been wondering about this statistic since I first saw it-does it really mean that psychiatrists don't do psychotherapy anymore? Is the number of psychiatrists who see all of their patients for psychotherapy even relevant to the question of whether psychiatrists practice psychotherapy? I wanted to understand this particular statistic-the press hurls it around to discount the work that we do-and I found that I couldn't understand the details of the original study in a way that made sense to me.

I decided to ask Dr. Mojtabai if he would explain the study to me, and we met for lunch. He is an animated and energetic man, and conversation came easily.

Using information Ramin gave me, with statistics from the Centers for Disease Control and Prevention's website, I now have a sense of how "10.8%" was derived.

The National Medical Ambulatory Care Survey queries randomly selected office-based physicians every year. The physicians, or their office staff, are asked to submit data for patient visits during a one-week period of the year. According to the NMACS website, each year 3,000 physicians submit information on approximately 30 patient visits. For 2007, the number of physicians who actually participated was about half this, or just over 1,500 and the patient visits were closer to an average of 25 per practice.

Specially trained interviewers visit the physicians prior to their participation in the survey in order to provide them with survey materials and instruct them on how to complete the forms. Data collection from the physician, rather than from the patient, provides an analytic base that expands information on ambulatory care collected through other NCHS surveys. Each physician is randomly assigned to a 1-week reporting period. During this period, data for a systematic random sample of visits are recorded by the physician or office staff on an encounter form provided for that purpose. Data are obtained on patients' symptoms, physicians' diagnoses, and medications ordered or provided.

If you'd like to see the forms that are used, you can download them at http://www.cdc.gov/nchs/ahcd/ahcd survey instruments.htm.

For this study, Dr. Mo-jtabai and Dr. Olfson took the data that had already The numb been gathered for psychiatrists. For each year, an average of 75.6 psychiatrists were surveyed, for a total of 756 psychiatrists for the years 1996-2005. All visits were not included, as the survey uses "a systematic random sample of visits," and it is not possible to know if psychiatrists submitted data sheets for every patient contact. The study included data from an average of 19 visits per psychiatrist. Data were collected by visit, so theoretically, a psychoanalyst who sees the same patient five times a week would be submitting the same data for a few patients, while a psychiatrist with a high volume practice would only have a fraction of his interactions included, and psychotherapy visits might be missed. …

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