Gagandeep Singh, M. D.
Helping you put the pieces together
These specialties have many things in common, but also important differences.
Psychiatrists are medical doctors (MD’s or DO’s) who are licensed physicians. After attending an undergraduate college/university, they attend 4 years of medical school, and then complete an additional four years of specialty residency training in psychiatry. Psychiatrists who are child and adolescent specialists, such as myself, complete an additional 2 years of specialized training known as a fellowship. As physicians, psychiatrists can prescribe medications. Psychiatrists are also uniquely qualified to understand the complex interaction and overlap between “mind” and “body” problems as a result of their training. As residents and fellows, psychiatrists also receive broad training in psychotherapy.
Psychologists hold doctorate-level degrees (either PhD or PsyD) in mental health. Although rightly referred to as “Doctor”, a psychologist does not have a medical degree, and cannot prescribe medication in NJ and most other states. (Only psychologists who are licensed in Louisiana and New Mexico, and complete a special degree in psychopharmacology can prescribe medications. Psychologists are not able to prescribe medications in the other 48 states.)
As mentioned above, a child and adolescent psychiatrist has trained in a specialized two-year fellowship beyond the speciality training for general psychiatry. The nuances of working with children and adolescents are honed in this training, as well as effective approaches to address the challenges of establishing and maintaining a rapport with patients of this age. Children and adolescents are often mistaken to be "little adults", but their needs and issues are unique and depend on a variety of factors that are taken into account when working one on one in a therapeutic setting with the youngster.
A psychiatrist is often the best choice if you know you need medications, or want an opinion about medications. A psychiatrist may also be the best choice if you feel that a broad medical background is helpful in understanding how the mind works. Some people choose to see a psychiatrist for their medications, and a different practitioner for psychotherapy. While this is a often a reasonable approach, there are benefits to seeing just one person for both.
Although your primary care physician may be able to provide this service, you may find that in a purely medical setting you do not have the chance to explore your difficulties in much depth. The medical model often stresses intermittent follow up visits which focus more on a checklist of symptoms rather than the larger picture of overall well being. Research also shows that treatment of some issues, such as depression, works best when psychotherapy is used in addition to medication; this is something that most primary care doctors cannot provide. Finally, many people simply want the additional expertise that a psychiatrist can bring to bear on medication management, whether for efficiency, improved effectiveness, minimization of side effects, or safety.
The unfortunate reality of managed care, especially when it comes to mental health, is a stress towards "production" and "efficiency" in order for many physicians to maintain their practice. This often translates to check-list type appointments which briefly address medication issues, and are often cramped into 10-15 minute sessions in the interest of seeing the maximum number of patients each day. Insurance companies may also try to dictate the number of visits with a provider that they deem to be the "appropriate" number. Additionally, the insurance companies can limit which medications that they are willing to pay for, which may not be the best one for the patient but may be the cheapest option for them.
As a psychiatrist who enjoys getting to know my patients and being an integral partner in their treatment, this format and subsequent restrictions do not serve my purpose of being an invested and involved doctor. In recent decades, managed care has pushed many psychiatrists to focus primarily on medication management; others, such as myself, offer both psychotherapy and medication management. You may also find that you would have to wait up to several months before you can get an appointment with psychiatrists (especially for children and adolescents) on the "panels", as they are often overbooked to meet the fiscal demands of having a practice and getting through the necessary volume of patients in each day.
As a result, I am not participating in managed care programs at present. I urge you to contact your insurance company about out-of-network benefits and their respective reimbursement rates and procedures. While I do not participate on the panels, I would be happy to provide a receipt with the appropriate identifying information (my license number, address, etc.) and other details necessary which you could then forward to your insurance company for reimbursement. Please also note that this may be a privacy issue for some, as the insurance companies require a diagnosis code on said invoice/receipt. Often, the best way to maintain privacy is to involve as few people in the process as possible, and some people may therefore prefer to keep their insurance company completely "out of the loop".
If you are concerned about out of pocket costs and you wish to contact your insurance company and find a psychiatrist who participates in their network, please feel free to do so. If you would like, I would be happy to discuss with you any names you come across and provide feedback if I am familiar with the physician(s) in question. However, please keep in mind the time pressures and likely prolonged wait before an initial appointment that may result in this case.
Not necessarily. After a consultation I will discuss therapeutic approaches with you, and there may be non-medication interventions that are as effective as medication in a specific case. I often tell my patients that therapy is a "given" recommendation for most situations, while medication may or may not be. Each unique person's situation and history is taken into careful consideration when deciding on the best treatment course.
Yes. I work with many adults, as I enjoy working with patients of all ages and I have had, as mentioned above, extensive training in General Psychiatry. I feel that my training in child and family development improves my understanding and perspective with adult patients.
Any past evaluation or testing would be helpful, but not essential. Generally, recent labwork and prescriptions can provide valuable information. For children and adolescents, copies of the Individualized Education Plan (IEP), recent report cards, and any school notes are also useful in addition to the forms provided on my website.
The bottom line is really whether or not you feel the psychiatrist listens to you and is doing everything he/she can to help you. You should trust your instincts.
Asking yourself the following questions may be helpful:
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