Consultation-Liaison Psychiatrists Are Rare Birds

Sena alerted me to yet another on line article about the physician burnout crisis in America. The author focused on the usual contributors including the electronic medical record (EMR) and the difficulties with workflows that interfere with patient care and physician satisfaction. The article also mentioned the effect of burnout leading to worsening access to physicians by reducing supply as doctors retire or leave the workforce early because of the systems pressures. As a part of that, psychiatrists are becoming rare birds.

In short, there was nothing new under the sun. This is definitely a both/and rather than either/or problem although I still see a tendency to pit most of the blame on physicians using the often-cited driven personality with a heavy focus on work and achievement, throwing the work/life balance way out of whack.

But there are also systems problems including the managed care and regulatory pressures that contribute heavily to burnout.

This both/and view reminds me of my role as a Consultation-Liaison Psychiatrist. The ability to examine both body and mind causes of disease rather than either physical or mental drivers alone is one of the main skills of C-L Psychiatrists.

There are plenty of articles about the shortage of psychiatrists in general. However, I could not find any on line articles about the shortage of C-L Psychiatrists. We’re rare birds, indeed.

This is important because we, as C-L Psychiatrists, are expected to fill the need for psychiatric expertise in primary care via arrangements such as collaborative care—which many decry as a form of glorified curbside consult in which a single consultant reviews a large number of primary care cases with a care manager who acts as a coordinator between the primary care clinician and the consulting psychiatrist.

In most of the cases, the psychiatrist doesn’t actually interview or assess the patients but provides what is hoped to be practical advice on management of psychiatric contributors to physical illness management challenges. One essential feature of collaborative care is that the effort is population based in order to improve the health of the largest number of patients possible who suffer with comorbid medical and psychiatric illness. It’s one way of managing the C-L Psychiatrist shortage. However, there have to be other ways to serve our patients as the manpower dwindles.

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”–Henry, G.W., SOME MODERN ASPECTS OF PSYCHIATRY IN GENERAL HOSPITAL PRACTICE. Am J Psychiatry, 1929. 86(3): p. 481-499.

There are many pros and cons about the current conception of collaborative care and I’m not an expert. I’m a retiring C-L Psychiatrist who has been chasing all over the general hospital for a long time, sort of like a Road Runner.

Road Runner in Tucson, AZ

That reminds me of the Academy of Consultation-Liaison Psychiatry (ACLP) because I still remember one annual meeting in Tucson, Arizona 12 years ago in which I managed to get a quick snapshot of a Road Runner.

By the way, I got a pretty grainy shot of a small dark brown or black bird with a white streak along the wing, with mostly a yellow head but with a black crown and an orange eye patch. Maybe it’s a rare bird–at least rare in my limited experience. Can any of you help me identify it?

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