Even as telemedicine is gradually catching on in this country, one particular area of medicine is being left behind: psychiatry. Thanks to a combination of regulations, industry resistance and traditional expectations, psychiatrists are having a challenging time incorporating telemedicine into what they do. The challenges they face are leading some to stand up and offer solutions.
Also known as tele-psychiatry, the practice of psychiatric telemedicine involves seeing patients remotely rather than in the office. Through a private online link, doctors and patients can communicate via live video and audio. The technological mechanics are no different than making a video call to a family member on Facebook or Skype.
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Treating Patients Where They Are
A MedPage Today article published on February 19 described lobbying efforts undertaken by a number of psychiatrists to get lawmaker attention in Washington. Apparently, the Capitol Hill briefing allowed psychiatrists to meet with members of Congress through an event sponsored by a number of psychiatric associations.
A commonly heard refrain on that day was that psychiatrists need to be able to treat patients where they are. It is an idea that permeates all of psychiatry – from private practice owners to employed psychiatrists and locum tenens providers.
Patients would always be able to visit doctors at their offices in a perfect world. Yet we all know that such a world doesn’t exist. Not only do circumstances sometimes make it difficult for patients to travel, there are times when traveling is actually dangerous.
One doctor discussed in the MedPage Today piece told the story of a patient forced to drive great distances to see him over many years of treatment. As a suicidal patient, there was always the danger that she would take her own life during her travels. Tele-psychiatry would have benefited her.
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Overcoming Licensing Barriers
Psychiatrists say that tele-psychiatry could be improved in several ways, including coming up with solutions to licensing barriers. Doctors must have licenses in whatever states they practice in, and that doesn’t change where telemedicine is concerned. A Florida doctor wishing to treat New York patients via telemedicine must be licensed in both states.
This would not be a problem if every state’s licensure requirements were identical. But they are not. States have different requirements for both licensing and continuing education. Trying to keep up with multiple states makes practicing psychiatry a nightmare. As such, tele-psychiatry is hindered to some degree.
One solution is to create a national license rather than leaving it to the states. However, that solution is unworkable at the current time. The Constitution does not allow federal lawmakers to set licensing standards for medical professionals. Such standards are the domain of the states.
Another solution is to encourage states to enter reciprocal compacts, similar to what has long existed for drivers’ licenses. All of the states in a given compact will honor the other’s licenses as long as minimum standards are met. Though not a perfect solution, it would certainly open the door to more tele-psychiatry.
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Psychiatry Practice is Changing
The recent lobbying events in Washington represent just one of the many signs indicating that psychiatry practice is changing. In fact, all of medicine is changing. The old system we have relied on for so long is showing its age and limits. It was good in its day, but a new day has dawned. Telemedicine is a big part of that new day.
It is clear that psychiatrists want more access to telemedicine. It is clear that they believe technology can improve both psychiatry jobs and the treatments patients receive. Now they have to convince lawmakers to loosen the reins.
