Q. I am a solo psychiatrist with a parttime practice—about 10
hours a week. I use an answering service that patients can use to contact me
after hours. This arrangement is not cost-effective, and I am considering
alternatives. Since I see about only 40 patients and they're very stable,
would I be providing sufficient coverage if I directed patients to leave a
message on my office answering machine and I checked the machine
A. Such an arrangement would almost certainly not be considered
sufficient. Parttime practice does not mean part-time patients. Even stable
patients can have unanticipated emergencies, and the bottom line is that you
must either be available to meet your patients' needs or arrange for them to
have access to the care they might need in your absence.
Various guidelines about this issue are instructive. The following is taken
from Section 1-AA of APA's Opinions of the Ethics Committee on the
Principles of Medical Ethics With Annotations Especially Applicable to
Psychiatry (2001 Edition):
Question A: One of our members is concerned that psychiatrists in
his area do not routinely check in with their answering machines after hours,
leave no number where they may be reached, or leave a message for patients to
contact the local emergency room in case of emergency. Is this member's
concern about the ethics of these psychiatrists warranted?
Answer: Yes. Ethical psychiatrists are obliged to render competent
care to their patients. That competent care would include either being
available for emergencies at all times or making appropriate arrangements.
Certainly, a message telling patients to call an emergency room is not
adequate coverage. Even in rather stable practices, including analytic
practices with relatively stable patients, emergencies do arise. Care must be
taken that, if and when such emergencies do arise, the patient is not
abandoned (September 1993).
In addition, some state medical boards have developed positions about
coverage of a practice. For example, both the North Carolina and Colorado
boards maintain that patients must be able to secure necessary care at all
times whether or not the treating physician is available personally.
Psychiatrists should check with their state licensing bodies in order to
determine what is considered acceptable after-hours coverage in their state
and whether there are specific state-licensing rules, policies, or opinions
about this issue.
Q. I will be attending APA's 2005 annual meeting in Atlanta in May. Will
the Psychiatrists' Program have customer service staff at the meeting and will
Program staff be presenting at any risk management or insurance
A. Yes. The Psychiatrists' Program will be located at booth #1210 in
the Exhibit Hall in the Georgia World Congress Center. Risk managers and
insurance underwriting specialists will be present to provide individualized
insurance information and risk management advice for psychiatrists.
If you're a participant of the Psychiatrists' Program, be sure to visit our
booth and receive complimentary copies of our most requested materials as our
thanks for your participation. You'll receive a "For Participants
Only" package and a valuable customer resource guide.
Program staff will also present at the following sessions:
During the meeting, please be sure to check the conference schedule for any
lastminute changes to times or locations. More information appears on the
Program's Web site.
Q. I am a participant in the Psychiatrists' Program and recently
received a CD-ROM that included a risk management manual. Is this resource
also available online?
A. Yes. As a benefit of the Psychiatrists' Program, all participants
receive a CD-ROM copy of the newly released resource "Risk Management
Resource for Psychiatric Practice: A Comprehensive Manual for Psychiatrists
and Mental Health Professionals." This resource can also be found online
on the Program's Web site at<www.psychprogram.com>
in the "For Participants Only" section. Developed by the Program's
risk management department, this resource has been designed to be the most
extensive psychiatric risk management resource available. The 350-plus-page
manual includes discussion on topics such as the risk management process and
associated legal concepts, creation of the psychiatrist-patient relationship,
informed consent to treatment process, psychiatric records, and protecting and
This column is provided by PRMS, manager of the Psychiatrists'
Program, for the benefit of members. More information about the Program is
available by visiting its Web site at<www.psychprogram.com>;
calling (800) 245-3333, ext. 389; or sending an e-mail to