Ken Duckworth, MD: The Modern Psychiatric Care Team

The field of psychiatry is shrinking in experts. Data show the average psychiatrist age is on the rise, and overall psychiatry specialist rates are on the fall. Care networks must become creative in their personnel makeup to adapt to this reality.

In an interview with MD Magazine®, Ken Duckworth, MD, medical director of the National Alliance on Mental Illness, explained how other members of the psychiatric care team are now being used, and what the true role of a physician has become in the space.

MD Mag: What does an optimized utilization of psychiatrists look like in a country with limited personnel?

Duckworth: So, several answers to that question. We have to incent more people to go into psychiatry or go into addictionology. We need to think more creatively about loan forgiveness—encouraging people to enter the field because we've had a seat change in new society. People are willing to talk about mental health, people are happy to see mental health practitioners, but we have not transformed the supply of them.

The most efficient thing to do would be to add psychiatrists and have them see people for medications. The problem with that is psychiatrists are interested in the whole person and want to do more things than that—they want to be the captains of the treatment team. They want to oversee all the care, they want to deliver psychotherapy.

They've gone to great trouble to become a psychiatrist, and they don't want to be minimized in terms of their role. There are pharmacologic experts of course, who only do that, and they're happy to do that. But I think clinical nurse specialists represent another great resource underutilized in the field overall, and also in great demand—a lot of training and a lot of skills.

And I think that in figuring out where to start, I encourage people to start with an independently licensed practitioner—not to start with the rarest thing, which is a child and adolescent psychiatrist who's taking patients, but to start with a more common thing, which is get an interview, get a mental health assessment by an independently licensed practitioner.

They offer a perspective on your diagnosis and a treatment plan which may not include a psychiatrist. I would start there, instead of trying to start up the narrowest part of the pyramid. I would start closer to the base of the pyramid, because it may be that psychotherapy and field work is all you need to do.

MD Mag: Do physicians now play more hands-off, leadership roles in care?

Duckworth:’ Master and Commander’ is how I would think about it, because the primary care doctor is still responsible for the PA’s work in most states. And I think nurses have different licensing authority in different states, but in some states, they're under someone.

Some states are completely independent, but I think that the doc as the master of the treatment plan and the master consultant to people who are more able to do the legwork, is a useful role for physicians.

But that doesn't mean that primary care doc's should only be doing physical exams. It doesn't mean the psychiatrist should only be prescribing med. So these models like McPAP—these ways that you have consultative services from psychiatry, child psychiatry to the primary care service which we have in Massachusetts—is a way to deploy the inadequate number of practitioners more creatively.