Talk Is Cheap

Survey data from APA’s Practice Research Network (PRN) confirms what you already know: you can earn more money providing medication management than you can providing psychotherapy.

Joyce West, Ph.D., director of the PRN, told Psychiatric News that a large national random sample of 1,189 psychiatrists in the PRN’s 2002 National Survey of Psychiatric Practice showed that psychiatrists earn approximately 57 percent more if they provide three medication-management visits instead of one psychotherapy visit.

The finding underscores the role of reimbursement as a barrier in the provision of psychosocial services for patients with schizophrenia.

In the public sector, West said, the problem is particularly acute. “The overall fee structure in the Medicaid program is considered to be a major barrier for clinicians interested in serving this population, particularly since most psychiatrists’ patients are treated in solo or group practice office settings in which physicians must cover their overhead costs,” she said.

The average undiscounted fee that psychiatrists charged for 45 to 50 minutes of individual psychotherapy (CPT code 90807) was $128.43, and the average discounted fee was $79.40. However, Medicaid rates are significantly lower. For example, physicians in California treating patients enrolled in Medi-Cal, which is California’s Medicaid program, are reimbursed only $49.22.