Training directors are a special breed of psychiatrists who, at best, are scholarly educators, astute clinicians, warm mentors, meticulous businessmen, and smooth politicians. The past decade only raised the bar of expectation as increased pressures came to bear on training programs, including the explosion of biologic psychiatry, managed care defining ourselves and our trainees as providers, and our supporting institutions refocusing sharply on the fiscal bottom line. The identity of psychiatry has been sorely challenged and undeniably redefined by reimbursers who see us as diagnosticians, dispensers of medication, team leadersand too costly. Managed care, in its effort to save money (for itself), began to refuse any inpatient care except for crises, began to approve psychotherapy provided primarily by other mental health professions, and took final aim by refusing to reimburse services provided by psychiatry trainees. Chain hospital psychiatry began to flourish, and the private sector became extremely competitive with rampant illegal action, including bribery for referrals. Timberlawn, a private, closely owned Dallas hospital for over 75 years, with many nationally recognized leaders in psychiatry and an abiding commitment to education, could not withstand the challenge. Many units, senior psychiatrists, and staff were downsized. Enormous efforts to restructure debt
The Titanic: A View From the Bridge
Abstract
Training directors are a special breed of psychiatrists who, at best, are scholarly educators, astute clinicians, warm mentors, meticulous businessmen, and smooth politicians. The past decade only raised the bar of expectation as increased pressures came to bear on training programs, including the explosion of biologic psychiatry, managed care defining ourselves and our trainees as providers, and our supporting institutions refocusing sharply on the fiscal bottom line. The identity of psychiatry has been sorely challenged and undeniably redefined by reimbursers who see us as diagnosticians, dispensers of medication, team leadersand too costly. Managed care, in its effort to save money (for itself), began to refuse any inpatient care except for crises, began to approve psychotherapy provided primarily by other mental health professions, and took final aim by refusing to reimburse services provided by psychiatry trainees. Chain hospital psychiatry began to flourish, and the private sector became extremely competitive with rampant illegal action, including bribery for referrals. Timberlawn, a private, closely owned Dallas hospital for over 75 years, with many nationally recognized leaders in psychiatry and an abiding commitment to education, could not withstand the challenge. Many units, senior psychiatrists, and staff were downsized. Enormous efforts to restructure debtPreview Only. This article cannot be rented because we do not currently have permission from the publisher.
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The Titanic: A View From the Bridge
Blotcky, Mark J.
Follow Academic Psychiatry
, Volume 23 (3): 160
American Psychiatric Publishing, Inc (Journal) – Sep 1, 1999
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