Psychiatry Needs to Reclaim What Makes It Distinct
The author warns that psychiatry is losing ground to other mental health professionals, nurses without psychotherapy training, and AI tools. He argues the field has become too impersonal and should return to more in-person care and move away from brief medication checks. The piece calls on psychiatrists to focus on their unique skills and gather evidence to defend the profession.
The essay is framed as an open letter by David Rettew, M.D., who says he values psychiatry while warning that its survival is threatened. He identifies psychologists without medical training, nurses without psychotherapy training, and corporate-backed AI as competitors.
He argues that psychiatric practice has become more uniform, restricted, and impersonal, while research resources are directed elsewhere and professional organizations focus on external attacks. His remedies include more face-to-face care, ending brief medication checks, accepting insurance such as Medicaid, and producing rigorous studies of practical outcomes.
If psychiatry shifts toward the changes described, patients—especially those with lower incomes or Medicaid—could gain more access to sustained, relationship-based care, while those who rely on telemedicine may face reduced convenience. The field’s push for outcome evidence may influence how insurers and the public compare psychiatrists with other providers or AI tools. Greater emphasis on in-person visits and insurance participation may affect wait times and practice viability, though the actual impact would depend on implementation and local workforce capacity.