Career Choices: Consultation-liaison psychiatry
Dr. Stanciu: What challenges and surprises did you encounter when you first began to practice in this setting?
Dr. Ganpat: I think the largest challenge that I have encountered is the lack of resources. Substance abuse is a major problem here, especially opioids, and there are limited community resources for these patients, so they wind up in the hospital.
Dr. Stanciu: What are the disadvantages of C-L compared with other branches of psychiatry?
Dr. Ganpat: There isn’t much continuity of care with C-L psychiatry over the long run, but you do get to see patients improve during the duration of their hospitalization, which is very rewarding.
Dr. Stanciu: What is the typical reimbursement model for a C-L psychiatrist, and have you run into difficulties with insurance providers in this setting?
Dr. Ganpat: The reimbursement model varies from one system to the next. The common model is to bill just as any other hospital service would, based on the time or level of complexity. Obviously, the more consults you have, the more billing is generated. Most insurance carriers recognize this and so I haven’t had much of an issue with reimbursement, although some unexpected problems may arise.
Dr. Stanciu: What advice do you have for early career psychiatrists and trainees who are contemplating a C-L career?
Dr. Ganpat: If you enjoy working in the hospital and interfacing with other specialties, then consider C-L psychiatry. It is challenging but intellectually stimulating. Make sure you request a C-L rotation during your training, because the Accreditation Council for Graduate Medical Education requires it during a psychiatric residency.
Dr. Stanciu: What is the future outlook of C-L?
Dr. Ganpat: There is a shortage of C-L psychiatrists because >50% of practicing psychiatrists are in private practice in an outpatient setting. Because access to psychiatric care outside of a hospital setting is an issue, and much care is being driven to hospitals, there will be an increasing need for C-L psychiatrists.
