This issue of Academic Psychiatry contains a section consisting of three papers on the topic of psychiatric education and primary care. Although this does not seem to be as "hot" an issue as it was 2 years ago, there have been and remain significant issues for academic psychiatrists to address.
Some 20-plus years ago, as family practice was still evolving as a medical specialty, but not yet fully flowered, efforts were made, primarily by consultation—liaison psychiatrists, to establish effective relationships and collaborations. These, on the whole, despite some isolated successes, were ineffective. Many have theorized about this but, in truth, little is known. Most Family Practice programs turned to psychologists and social workers to provide their required teaching and clinical consultation in their clinics. Consultation—liaison psychiatrists moved on to other collaborations, of which there was no dearth.
There, matters lay until 1993. Managed care, with its emphasis on primary care physicians as gatekeepers, and the Clinton administration's healthcare proposal, forced academic psychiatrists to look again at their previously missed opportunity. The Association for Academic Psychiatry devoted its 1998 annual meeting to "Psychiatry and Primary Care," and the American Association of Directors of Psychiatry Residency Training (AADPRT) formed a task force chaired by Dr. Nathan Smith, Vice Chair for Education and Training at the University of Alabama School of Medicine. Out of these efforts emerged the special section of this issue.
Dr. Smith approached the editors and proposed a special issue or series on "Psychiatry and Primary Care," based on the work of the AADPRT task force he chaired. We agreed. He screened the papers and forwarded to the editors the ones he felt worthy of review, and they were then peer-reviewed in our usual format. Much has changed in psychiatry since the unsuccessful efforts at collaboration with Family Practice 20 years ago. Our relationship to the rest of medicine has evolved; our comfort with a traditional medical model integrated with other models has grown; consultation—liaison psychiatry has made efforts to move into the outpatient setting; and our understanding of the biological bases of psychiatric illnesses and their treatments has exploded.
The three articles in this issue demonstrate that the frustrations of the past need not be permanent and provide us with models for overcoming them. It would not surprise us if, 10 years from now, a common model of clinical practice for psychiatrists involved sharing space in a primary care clinic.