Collaboration between psychiatrists and primary care doctors, which is
becoming increasingly popular in the United States (see Barriers Slow, But
Don't Halt March of Collaborative Care), is also gaining ground throughout
"It works well in the Canadian system, playing on its strengths and
weaknesses," Randall White, M.D., a clinical assistant professor of
psychiatry at St. Paul's Hospital in Vancouver, told Psychiatric
News. "We have too few psychiatrists, so this approach allows us to
use our time effectively by supporting primary care providers."
In Quebec, for example, the government is trying to reorganize the health
care system so that less-ill psychiatric patients will be cared for by family
doctors, not by psychiatrists, Joel Paris, M.D., a professor of psychiatry at
McGill University in Montreal, said during an interview. This means that
psychiatrists will see only the sickest patients, either at the family
doctors' offices or at the hospital where they work. (Most psychiatrists in
Quebec work in hospitals, not in private practice.) "So that's how
things have evolved here," he said. "This is pretty typical of
In Vancouver, White and Rainer Borkenhagen, M.D., a family physician, set
up a collaborative-care program whereby psychiatrists would help family
physicians provide better mental health care to their patients. They named the
program Urbandoc. Today, not just White, but two other psychiatrists at St.
Paul's and two psychiatrists at Vancouver General Hospital are participating
in the program.
The family physicians and psychiatrists involved in Urbandoc can
communicate with each other through a secure Web site. "We accept any
referrals the family practitioners send," White said. "I have
diagnosed mood disorders, anxiety disorders, addictions, personality
disorders, and somatoform disorders." Still another valuable aspect of
the program, White explained, is that the public health insurance system in
British Columbia has set up special mechanisms to reimburse the family
physicians and psychiatrists who participate in the program.
"So I think partnering in Canada is going to increase," Paris
anticipates. "Patients will be treated by family doctors unless there is
a reason not to." ▪