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The Big Chill

The Transition From Residency to Managed Care Nightmare

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Abstract

Even though concerns about managed care are a source of extraordinary distress among psychiatrists today, many residents are not being provided with adequate preparation and training to deal with those concerns. When young psychiatrists leave their training programs and enter practice, they are experiencing profound demoralization. Much of their dysphoria appears to be a result of the impact of specific aspects of the managed care system on the preexisting psychological characteristics of psychiatrists. Preventive strategies to minimize this impact are discussed.

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References

  1. Sharfstein SS: Managed mental health care, in American Psychiatric Press Review of Psychiatry, vol 11, edited by Tasman A, Riba M. Washington, DC, American Psychiatric Press, 1992, pp 570–584

    Google Scholar 

  2. Rubin W: Psychiatrists resent interference with patient care. Clinical Psychiatry News 1991; 19(5):1, 7–10

    CAS  Google Scholar 

  3. Vaillant GE, Sobowale NC, McArthur C: Some psychologic vulnerabilities of physicians. N Engl J Med 1972;287:372–375

    Article  CAS  PubMed  Google Scholar 

  4. Gabbard GO. The role of compulsiveness in the normal physician. JAMA 1985; 254:2926–2929

    Article  CAS  PubMed  Google Scholar 

  5. Gabbard GO, Menninger RW: The psychology of the physician, in Medical Marriages, edited by Gabbard GO, Menninger RW. Washington, DC, American Psychiatric Press, 1988, pp 23–38

    Google Scholar 

  6. DeLeon PH, VandenBos GR, Bulatao EQ: Managed mental health care: a history of the federal policy initiative. Professional Psychology: Research and Practice 1991; 22:15–25

    Google Scholar 

  7. Bibring E: The mechanism of depression, in Affective Disorders: Psychoanalytic Contribution to Their Study, edited by Greenacre P. New York, International Universities Press, 1953, pp 13–48

    Google Scholar 

  8. Gabbard GO, Takahashi T, Davidson J, et al: A psy-chodynamic perspective on the clinical impact of insurance review. Am J Psychiatry 1991; 148:318–323

    CAS  PubMed  Google Scholar 

  9. Talmon M: Single Session Therapy: Maximizing the Effect of the First (and Often the Only) Therapeutic Encounter. San Francisco, Jossey-Bass, 1990

    Google Scholar 

  10. Simon RI: The psychiatrist as fiduciary: avoiding the double agent role. Psychiatric Annals 1987; 17:622–626

    Google Scholar 

  11. Sabin JE: The therapeutic alliance in managed care mental health practice. Journal of Psychotherapy Practice and Research 1992; 1:29–36

    CAS  PubMed  Google Scholar 

  12. Book HE: Is empathy cost efficient? Am J Psychother 1991;45:21–30

    CAS  PubMed  Google Scholar 

  13. Ginzberg E: The destabilization of health care. N Engl J Med 1986; 315:757–761

    Article  CAS  PubMed  Google Scholar 

  14. Winkenwerder W, Ball JR: Transformation of American health care: the role of the medical profession. N Engl J Med 1988; 318:317–319

    Article  CAS  PubMed  Google Scholar 

  15. Chemtob CM, Hamada RS, Bauer G, et al: Patients’ suicides: frequency and impact on psychiatrists. Am J Psychiatry 1988; 145:224–228

    CAS  PubMed  Google Scholar 

  16. Hatfield AB, Lefley HP (eds): Families of the Mentally Ill: Coping and Adaptation. New York, Guilford, 1987

    Google Scholar 

  17. Isaac RJ, Armat VC: Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill. New York, Free Press, 1990

    Google Scholar 

  18. Bashook PG, Weissman SH: Career plans of new psychiatrists. Presented at the Annual Meeting of the American Psychiatric Association, May 9–14, 1987. CME Syllabus and Proceedings Summary. Washington, DC, American Psychiatric Association, 1987, p 228

    Google Scholar 

  19. Westermeyer J: Problems with managed psychiatric care without a psychiatrist-manager. Hosp Community Psychiatry 1991; 42:1221–1224

    CAS  PubMed  Google Scholar 

Download references

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Gabbard, G.O. The Big Chill. Acad Psychiatry 16, 119–126 (1992). https://doi.org/10.1007/BF03341380

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  • DOI: https://doi.org/10.1007/BF03341380

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