Title: Should Mental Health Be a Primary-Care Doctor’s Job? | The New Yorker
Headings: Should Mental Health Be a Primary-Care Doctor’s Job?
Should Mental Health Be a Primary-Care Doctor’s Job?
Video From The New Yorker

Content: Fewer medical students are going into psychiatry, partly because psychiatrists, like primary-care doctors, earn among the lowest salaries of all physicians. Those who do choose psychiatry often don’t accept insurance, including Medicare and Medicaid, requiring patients to pay out of pocket. Affordable psychiatric treatment is especially limited for children and in rural states. Wyoming, for example, which has one of the highest suicide rates in the nation, had, according to one count from a few years ago, a mere twenty-seven psychiatrists—just over five per hundred thousand residents. Massachusetts, by comparison, had around over two thousand psychiatrists, or around thirty-two per hundred thousand residents. But even in Boston, where I practice, primary-care doctors are treating more mental illness. Some patients don’t have adequate insurance to obtain specialized mental-health care, despite legislative efforts, including the Affordable Care Act, to create parity between mental-health coverage and coverage for other medical conditions. Some people want psychiatric care without having to see a psychiatrist. Having finally confided a long-held secret of compulsive hand-washing or bulimia to me, some patients would rather not share it all over again with someone else. And some wish to avoid having, as one of my patients put it, “a psychiatric rap sheet”—a record that an insurance company, employer, or nosy family member might discover.