PROFESSIONAL PRACTICE PATTERNS OF US PSYCHIATRISTS

Objective: The authors develop a classification of psychiatric practic e 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 wit h private secondary work settings, private psychiatric/general hospita l psychiatrists, private office practice psychiatrists, private office practice psychiatrists with secondary private psychiatric/general hos pital work settings, private office practice psychiatrists with second ary settings other than private hospitals, and psychiatrists in privat e 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 pr ivate psychiatric/general hospital psychiatrists (19.6%), private offi ce practice psychiatrists with secondary settings other than private h ospitals (18.9%), and private office practice psychiatrists with secon dary private psychiatric/general hospital work settings (17.4%), follo wed by public psychiatrists with private secondary work settings (14.5 %), private office practice psychiatrists (11.7%), public Psychiatrist s (11.4%), and psychiatrists in private organized outpatient settings (6.6%). During a typical week, the practice groups varied in the avera ge proportion of their outpatients who received assessments, therapy a nd medication, therapy and no medication, and medication management. T he 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 psychiatr ists is engaged exclusively in office-based private practice, and appr oximately 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 psych iatrists serve a broad range of patients and provide a variety of trea tments.