Psychiatry at a crossroad: our role in primary care

OBJECTIVE: The shortage of primary care physicians is seen as an urgent health systems priority and is supported by a national consensus. Psychiatry is at a crossroad and must reevaluate the profession's role in primary care. This article supports the position that psychiatrists need to be able to medically evaluate and to provide basic primary medical care for seriously mentally ill patients who do not have adequate access to general health care. Many of the seriously mentally ill are difficult to treat when they contact a medical care provider. Because of their psychiatric symptoms, they often are unlikely to receive adequate medical care. Psychiatrists frequently are the only physicians with whom they have consistent contact. METHOD: This article contains a proposal for a new initiative to broaden the role of public psychiatrists to include a primary care role. In addition, new opportunities for dual or triple board certification are reviewed. RESULTS: A new curricular model for primary care training in general psychiatry programs is outlined. The new curriculum would include training for diagnostic and primary care skills to prepare psychiatrists to provide basic primary medical services for the chronically mentally ill. CONCLUSIONS: The new curricular proposal would create an elective psychiatry primary care track. This is possible within current accreditation requirements. Psychiatric residents could receive primary care training throughout their residency.