Physicians at the medicine/psychiatric interface - What do internist/psychiatrists do?

Studies have convincingly demonstrated that some 50% of patients in primary care settings have both medical and psychiatric diagnoses requiring dual t reatment. The concept of primary care psychiatry has emerged in recent year s as one way to address this problem. In 1979 the first combined medicine-p sychiatry residency, was formed. There are now over 20 such programs, but t here is little information on how these doubly trained physicians actually practice. In 1997, the authors surveyed the 268 physicians with board certi fication in both internal medicine and psychiatry that were listed with the American Board of Medical Specialties. Only 15% practiced any type of medi cine at all; the rest were involved only in the practice of psychiatry. Alt hough 75% identified themselves only as psychiatrists and worked predominan tly in psychiatry, 95% reported using both their medical and psychiatric tr aining in their professional work. They reported that the dual training mad e them better physicians, improved their professional credibility, and enha nced their diagnostic skills. Several significant barriers were discovered that directly affect the ability of physicians to practice in two fields. F indings, study limitations, and potential implications for the field and it s patients are discussed.