My profession has been “outed” by the New York Times’ articleTalk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy, by Gardiner Harris and I am breathing a sigh of relief. It’s about time the public knew the repugnant truth.

Harris describes how psychiatrists no longer perform talk therapy because of changes in how much insurance companies will pay. So they now prescribe and adjust medications leaving the personal crisis of patients “unexplored and unresolved” and relegate talk therapy to a lower priced therapist such as a social worker or a psychologist. The article centers around Dr. Donald Levin, a psychiatrist who has relinquished his professional protocols in order to accommodate the insurance industry. Levin can no longer remember his patients’ names and by his own admission, “trains himself not to get too interested in their problems. He does not want to get sidetracked trying to be a semi-therapist.”

According to the article, recent studies suggest that talk therapy is as good as or even better than drugs in the treatment of depression but less than half of the patients receive talk therapy. Levin earns $150 for three 15-minute medication visits as compared with $90 for a 45-minute talk therapy session. Levin, like many physicians had his wife, a former therapist, take over the role of his business manager and her comments were all too familiar and sad. Harris writes “Ms. Levin firmly asks for a co-payment which can be as much as $50. She schedules follow-up appointments without asking for preferred times or dates because she does not want to spend precious minutes as patients search their calendars.” Ms. Levin states “This is about volume and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we’re here two hours longer every day. And we just can’t do that.”

Levin states his office is like a bus station; that the “quality of care he offers was poorer than when he was younger; and how he makes a diagnosis within a 45-minute visit because he “plays the game” in order to get paid. Although Dr. Levin’s specialty is psychiatry, the phenomenon that he described applies to ALL specialties, including obstetrics. The doctor-patient relationship is dead and nothing short of a miracle will resurrect it back to life. In my next post, I’m going to share some personal experiences and make an announcement. Until then, remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.