Dr. Miller is harsh on the lack of psychiatric advances since completing training 25 years ago. I have been in academia throughout those years and I am thrilled by how much neuroscience we have discovered that is directly related to disorders of affect, thought, cognition, and behavior. The challenge continues to be in translating those discoveries into practical therapeutic interventions, which proves the point that psychiatry is the most challenging medical specialty, consistent with the brain (and its mind) being, by far, the most complex organ.
We cannot abdicate insurance reimbursement except for our well-to-do patients. Patients with severe and disabling mental disorders, who need our services the most, cannot afford to pay for care, and depend on Medicare and Medicaid, whose modest reimbursement would impoverish non-salaried psychiatrists. Because of the severe shortage of psychiatrists, who are the only specialists who can competently manage neurobiological disorders such as schizophrenia, bipolar disorder, and severe depression, I believe we should deploy our resources for those vulnerable patients and leave the worried well and walking wounded to other mental health professionals.
Henry A. Nasrallah, MD
Professor and Chairman
Department of Psychiatry
Saint Louis University School of Medicine
St. Louis, Missouri