Posts Tagged ‘ACA’

Toward the New World Order

March 11th, 2013

If the federal health reform initiative proceeds apace, before long almost all Americans will have health insurance. But there are nowhere near enough physicians to care for all of us—especially as the population ages.

Many approaches make sense to enhance the quality and efficiency of our care system—including algorithms, more effective use of extenders, electronic decision support, and patient education. Another feature to come is more selective use of specialists—including psychiatrists.

When care is paid for by a third party, we cannot afford to have many patients cared for primarily by a specialist. The model to come will have specialists create algorithms and protocols for primary care providers (PCPs). Specialists will be available for brief electronic or phone consultations and, less commonly, for one-on-one direct consultation with patients. A psychiatrist will see a patient and refer the patient back to a PCP, with backup as needed. Sometimes we may see the patient for a few visits to ensure stability.

There will always be a small cadre of chronically ill patients who require ongoing care from specialists—brittle diabetics, unstable cardiac patients, and in psychiatry, people who suffer from schizophrenia or bipolar disorder, for example. People who pay out of pocket can call their own tune. But for most Americans, care will have to be more rationalized. I regularly point out to medical students and residents that this will soon change the way we practice and the lives we lead.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

When Passion Trumps Practicality

November 19th, 2012

My department at Penn State reaches out regularly to medical students who may be interested in careers in psychiatry: movie nights, mentorship, electives, and much more. A few days ago we held an open question-and-answer lunch, in which three faculty members and a senior resident fielded questions from a couple of dozen students from all four years. We munched on take-out Chinese food and chatted.

One student asked about careers in psychiatry, unmet needs, and subspecialties. He was reasonably trying to sort out his options. I knew that if I told him what had been the facts over my 40 years in practice, and what the world looks like today, he would make his calculations and decision for his practice over the coming 40 years. But the world of U.S. healthcare is anything but static. The changes coming over the next few years will be huge.

I am certain that psychiatry—and our subspecialties even more—will remain short of manpower. But who can say what tomorrow’s psychiatrists will do, what their hours will be, how long they will spend with patients, or what they might earn? I would say the same for the choice of specialty, whether surgery, medicine, pediatrics, or any other. Science and technology will bring major new developments, and the healthcare delivery infrastructure is undergoing a sea change.

What I am sure of is that there will be patients. People will be scared, in pain, confused, and uncertain. They will require ministrations, explanations, treatments, and comfort. The safest course for young doctors looking forward is to follow their passion, to chart their paths by what they most want to do—independent of practical, economic, and lifestyle factors. The joy in medical practice will remain forever—if they can follow their own hearts.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

And Now: Healthcare Reform

November 7th, 2012

Last summer the U.S. Supreme Court upheld the Affordable Care Act (ACA). Yesterday’s re-election of President Barack Obama virtually guarantees that ACA will be implemented. The process will be long, complex, with countless moving parts. Many of its features require interpretation, further enabling policies from the HHS Secretary, individual state actions, and a myriad of detailed steps. But the continuing escalation of healthcare costs is unsustainable—especially when we are not buying improved care for our citizens. And we can now see a path forward.

Within a few years, almost all who reside within our borders will be eligible for medical care. Mental and behavioral diagnoses will be covered. With the increased focus on efficiencies, behavior will become paramount: enhancing patients’ understanding of their conditions and care, securing their buy-in to treatments, prompting them (often electronically) to take medicine, come to appointments, and more. Recognizing and effectively treating depression, for example, will improve outcomes and save costs in treating diabetes, heart disease, and many other chronic illnesses. I sincerely hope the chronically mentally ill will begin to receive the medical care that has often been denied them—with safe integration of brain treatments and those for other body organs.

Doctors will experience a sea change. The premium for surgery and invasive procedures will give way to preventive and long-term management foci. Information technology will play a growing role in every aspect of health care. Teams of professionals will be integral in the new order.

It will take a long while to “get it right.” The journey will require patience and efforts at every level. But I am convinced we will get to a better place.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry