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Prescribing psychiatric medications, on the other hand, is something that few people other than psychiatrists have been trained in and feel comfortable doing (although many primary care physicians do it out of necessity). A psychiatrist who is willing to see patients briefly can see up to four times as many patients as a professional who works on the 50 minute patient hour.

With psychiatric practices and clinics now experiencing painfully long waiting lists, the psychiatrist as therapist increasingly looks like a luxury nobody can afford.

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Contrary to some public opinion, it actually does take quite a bit of skill to be a good “psychopharmacologist” — the term that is now often applied to psychiatrists who focus mainly on medication treatment.

In 15 minutes, however, there is barely enough time to go over side effects, dose and medication changes, and informed consent, let alone engage in discussions about what may really be going on in a patient’s life and how a multitude of other possible interventions (improving sleep, exercise, nutrition, relationships) might be useful.

In its place is now the infamous 15-minute “med check” which focuses on symptoms, medications, and side effects.

Psychotherapy may still occur, but generally when it happens it is provided by someone else like a psychologist, social worker, or mental health counselor who often is not affiliated with the psychiatrist.

The end result is a mental health care system that is overloaded, uncoordinated, and over-focused on pharmacological solutions.While we're not saying you should quit the gym (please don't), we study, researchers followed about 1,000 adults (ages 50 and older) for 21 years.At the end of the study, 85 percent of the runners were still kicking it, while only 66 percent of the non-runners were alive. Sure, your gym workout might only take an hour, but getting to and from the gym takes another 30 minutes.In the old days, people made fun of those rigid 50 minute appointments psychiatrists had with patients that focused mainly on psychotherapy.In today’s world, however, an appointment that long for all but new patients has become a dinosaur of the past at many clinics.We are also experimenting with technology that might make communication between providers quicker and more efficient.On a larger scale, the possible replacement of the current fee-for-service model of care (in which providers get paid only when they have face-to-face time with a patient) with systems such as accountable care organizations, which pay a set amount for a population and leave the clinicians to figure out how to provide care best, hold promise, yet certainly have their own set of [email protected] by David Rettew, MD David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.Follow him at @Pedi Psych and like Pedi Psych on Facebook. Have you heard if therapy and counseling are also going this route?This shift occurred as insurance companies began to exert more and more control over medical care.Reimbursements dropped more sharply for psychotherapy relative to other types of services.

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