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Am J Psychiatry 1994; 151:89-95
Copyright © 1994 by American Psychiatric Association
Professional practice patterns of U.S. psychiatrists
M Olfson, HA Pincus and TH Dial
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032.
OBJECTIVE: The authors develop a classification of psychiatric practice
based on primary and secondary work settings. METHOD: Data from the
1988-1989 APA Professional Activities Survey were used to characterize
seven practice groups: public psychiatrists, public psychiatrists with
private secondary work settings, private psychiatric/general hospital
psychiatrists, private office practice psychiatrists, private office
practice psychiatrists with secondary private psychiatric/general hospital
work settings, private office practice psychiatrists with secondary
settings other than private hospitals, and psychiatrists in private
organized outpatient settings. Psychiatrists primarily in government
administrative agencies, medical schools, or nursing homes were among those
excluded. Usable data were available from 16,135 psychiatrists (82.8% of
the target respondents). RESULTS: The largest groups were private
psychiatric/general hospital psychiatrists (19.6%), private office practice
psychiatrists with secondary settings other than private hospitals (18.9%),
and private office practice psychiatrists with secondary private
psychiatric/general hospital work settings (17.4%), followed by public
psychiatrists with private secondary work settings (14.5%), private office
practice psychiatrists (11.7%), public psychiatrists (11.4%), and
psychiatrists in private organized outpatient settings (6.6%). During a
typical week, the practice groups varied in the average proportion of their
outpatients who received assessments, therapy and medication, therapy and
no medication, and medication management. The groups also varied in the
mean number of patients they treated each month with affective disorders,
schizophrenia, anxiety disorders, and other disorders. CONCLUSIONS: Only
about one in 10 clinical psychiatrists is engaged exclusively in
office-based private practice, and approximately half of the outpatients
treated by the average psychiatrist receive medication. Work setting
appears to exert a powerful influence over whom psychiatrists treat and
what services they provide. Because a majority of psychiatrists work in
more than one setting, most psychiatrists serve a broad range of patients
and provide a variety of treatments.
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