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Expect Disruption as Healthcare Leaders Decide Our Field’s Priorities
Our field is on the cusp of change. We are steadily moving under the leadership of big companies like health plans and health systems. We do not know what will change, but our field’s priorities will surely be challenged. For example, healthcare leaders might decide to push cost-effectiveness and evidence-based solutions as our top goals. Such a definitive shift in priorities could disrupt our existing equilibrium.
The needs of our field will not always be in sync with those of the healthcare industry. We need behavioral leaders to promote our field’s interests above all else. It is worth reflecting on the qualities needed in our leaders in this coming era.
The Right Clinical Executives in This Era of Healthcare Consolidation
Our field has medical and psychosocial roots. These origins generate a diverse array of clinicians and interventions. As our field’s autonomy declines and we come under the medical leadership of large healthcare companies, how will our differences be handled?
Medical leadership is strong, but not exclusive in our field. Psychiatrists are our medical leaders, and yet they are not always the presumed clinical leaders. Many function as consulting medication specialists. Roughly half reject insurance payments to work outside the healthcare system for private pay. At the same time, we have a strong tradition of non-MD clinicians embracing every type of leadership role.
Clinicians in our field understand these distinct educational and career paths. However, our norms diverge from healthcare’s norms in important ways. We value medical and psychosocial solutions, and many of us view them as equally valuable traditions and models. Medical leaders in healthcare do not necessarily share that view, and an unspoken medical bias could drive us in a strictly medical direction.
Some psychiatrists might agree. For example, a medically dominant approach might view psychotherapy as a medical procedure (e.g., physical therapy, speech therapy) rather than as a unique psychosocial procedure. Medical leaders might expect to dictate preferred therapies. Physicians might expect psychiatrists to lead our field as we fit into the overall healthcare (i.e., medical) enterprise.
This last suggestion might be valid for other reasons. Having more psychiatrists in leadership roles is probably a good thing for our field. We will increasingly need psychiatrists to help medical colleagues and healthcare executives understand the richness of our biopsychosocial model. We could be at a disadvantage if more psychiatrists do not assume leadership roles.
While psychiatrists are broadly trained, most have restricted their practices to medication management. This need not change, but a vanguard of psychiatrists is essential for promoting the full range of our services. A simple point needs stressing. We should not minimize the power of one physician speaking to another about our multi-dimensional field. This may be as important as the message itself.
The Right Business Leaders in This Era of Healthcare Consolidation
The other leadership domain is business, and our executives will be tested immediately on funding and financial performance. Our field may be chronically underfunded, but healthcare CFOs will likely assume our field’s funding level is sufficient. Cost-effectiveness is likely to be their recommended priority for our businesses. Forewarned is forearmed. The best strategy is a united front.
As healthcare companies take control of behavioral programs and services, our business and clinical leaders should collaborate and be alert to:
- The devaluing of some existing psychosocial services; and
- An overall focus on cost-effective people and tools.
New owners rarely adhere to old norms, and they tend to trust their methods for solving problems. What problems will our field hand off to new leadership? We will be presenting healthcare with a critical problem we failed to solve—abysmally poor care access rates. The approach taken by healthcare leaders may be a harbinger for how they will manage other issues.
An Imaginary Report from 2043
Let us now change the narrative. The remainder of this article is an exercise in imagination. Instead of prosaic discussion, it describes an imaginary future. Why imagine the future? It is another way to call attention to how our field might be impacted by the growing dominance of the healthcare industry. It is simply a provocative, rhetorical device.
Let us imagine the future. Imagine a time when our care access problems have been resolved. The following points are make-believe. They are from an imaginary speech on the state of our field in 2043:
- In the early decades of the 21st century, the care access crisis was seen as not having easy access to a therapist or psychiatrist. Leaders then shifted focus.
- We now have richly staffed behavioral teams in many healthcare settings offering a range of services. Each care team includes a large number of highly trained, unlicensed counselors who provide evidence-based interventions. Supplemental support is also available in the form of digital therapeutics. We no longer have a provider shortage.
- Licensed clinicians care for people with serious mental illnesses and other diagnosable disorders using medically approved psychotherapies. General psychotherapy is no longer provided for everyday distress. Instead, brief interventions are routinely available, usually in primary care, from unlicensed behavioral specialists who help with less severe behavioral issues.
If this is not the state of affairs hoped for in 2043, it is not too late to debate the issues and present healthcare leaders with a different vision for our field.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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