Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for May 3rd, 2012

How Many Patients Should Residents See? The Confusion Of Medical Training

Posted by Dr. Vollmer on May 3, 2012

When I was in training, I had six or seven outpatients, three clinical supervisors, along with the responsibility of doing inpatient psychiatry work. In this pre-Prozac era, there were not very many “outpatient clinics” since there was very little that we could do for patients on an outpatient basis, other than psychotherapy. Today’s resident spends his time in a series of clinics in which he prescribes medication to patients in a medical model which resembles a primary care visit. In programs that I am familiar with, the requirement to do long-term psychotherapy work is usually one or two cases a year, during his last two years of training. Once again, I must ask myself if I am resistant to change or if this change is harmful to our future generation of psychiatrists. The training programs are focused on the brain and not the mind. Hence, the medical student drawn to psychiatry is a different student than in my day when the common thread in going into psychiatry was the passion to mine the mind. The sadness I feel about this cannot be overstated. I am not saying that every psychiatrist trained today does not appreciate the depth of meaning which is learned from deep listening. However, I am saying that the priorities have shifted such that a “clinic” model of psychiatry is overtaking the long-term psychotherapy model of psychiatry. This shift causes most psychiatry residents to feel most comfortable with a prescription pad and less comfortable with formulating psychodynamic understandings of how a patient’s mind has come to give that patient deep suffering. I am left to hope the pendulum will swing back to prioritizing intense listening. This skill is what so many patients need to heal. Have I said this loudly or too many times? I don’t think that is possible. This series of posts will continue until training programs turn back the clock, just a little, in order to bring back psychotherapy training. Change is good, sometimes. This change was too far.

Posted in Child Psychiatry, personal growth, Professional Development, Psychiatry in Transition, Psychotherapy | 5 Comments »

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