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Physicians at the Medicine/Psychiatric Interface

What Do Internist/Psychiatrists Do?

Received November 27, 2000; revised March 3, 2001; accepted April 6, 2001. From the Departments of Psychiatry and Emergency Medicine, Forbes Regional Hospital, University of Pittsburgh Medical School, Pittsburgh, PA; the Department of Primary Care Psychiatry, Montefiore Medical Center; and the Albert Einstein College of Medicine, Bronx, NY. Address correspondence to Dr. Stiebel, 221 Penn Avenue, Suite 1100, Pittsburgh, Pennsylvania 15221.

Studies have convincingly demonstrated that some 50% of patients in primary care settings have both medical and psychiatric diagnoses requiring dual treatment. The concept of primary care psychiatry has emerged in recent years as one way to address this problem. In 1979 the first combined medicine-psychiatry residency was formed. There are now over 20 such programs, but there is little information on how these doubly trained physicians actually practice. In 1997, the authors surveyed the 268 physicians with board certification in both internal medicine and psychiatry that were listed with the American Board of Medical Specialties. Only 15% practiced any type of medicine at all; the rest were involved only in the practice of psychiatry. Although 75% identified themselves only as psychiatrists and worked predominantly in psychiatry, 95% reported using both their medical and psychiatric training in their professional work. They reported that the dual training made them better physicians, improved their professional credibility, and enhanced their diagnostic skills. Several significant barriers were discovered that directly affect the ability of physicians to practice in two fields. Findings, study limitations, and potential implications for the field and its patients are discussed.

Key Words: Delivery of Care • Health Services • Primary Care

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