Professional practice patterns of U.S. psychiatrists

OBJECTIVE: The authors develop a classification of psychiatric practice based on primary and secondary work settings. METHOD: Data from the 1988-1989 APA Professional Activities Survey were used to characterize seven practice groups: public psychiatrists, public psychiatrists with private secondary work settings, private psychiatric/general hospital psychiatrists, private office practice psychiatrists, private office practice psychiatrists with secondary private psychiatric/general hospital work settings, private office practice psychiatrists with secondary settings other than private hospitals, and psychiatrists in private organized outpatient settings. Psychiatrists primarily in government administrative agencies, medical schools, or nursing homes were among those excluded. Usable data were available from 16,135 psychiatrists (82.8% of the target respondents). RESULTS: The largest groups were private psychiatric/general hospital psychiatrists (19.6%), private office practice psychiatrists with secondary settings other than private hospitals (18.9%), and private office practice psychiatrists with secondary private psychiatric/general hospital work settings (17.4%), followed by public psychiatrists with private secondary work settings (14.5%), private office practice psychiatrists (11.7%), public psychiatrists (11.4%), and psychiatrists in private organized outpatient settings (6.6%). During a typical week, the practice groups varied in the average proportion of their outpatients who received assessments, therapy and medication, therapy and no medication, and medication management. The groups also varied in the mean number of patients they treated each month with affective disorders, schizophrenia, anxiety disorders, and other disorders. CONCLUSIONS: Only about one in 10 clinical psychiatrists is engaged exclusively in office-based private practice, and approximately half of the outpatients treated by the average psychiatrist receive medication. Work setting appears to exert a powerful influence over whom psychiatrists treat and what services they provide. Because a majority of psychiatrists work in more than one setting, most psychiatrists serve a broad range of patients and provide a variety of treatments.