Psychiatry in medical practice. Implications for the education of primary care physicians in the era of managed care: Part 1.

In an effort to control the costs of mental health care, many medical care systems have emphasized the management of psychiatric illness by primary care physicians and curtailed specialty mental health referrals. While this trend mandates that primary care physicians have expertise in the diagnosis and treatment of psychiatric disorders, evidence indicates that not only are psychiatric disorders underrecognized in primary care settings, but also that treatment is often inadequate and accompanied by less than optimal outcomes. In Part 1 of this 2-part series, representative studies of the epidemiology of psychiatric disorders in primary care are reviewed in addition to data that has documented low rates of recognition and suboptimal management of psychiatric illness. In Part 2, to be published in the January-February 1997 issue of Psychosomatics, a core psychiatric curriculum for primary care physicians will be presented that emphasizes the use of competency-based training modules. Strategies for the development and implementation of these educational training modules will also be discussed.