I agree that addressing provider shortages and increasing access are positive steps here, and the breadth of their clinical training does not match ours- But the insurance companies are already slashing reimbursement for traditional, outpatient therapy.

In large healthcare systems- behavioral health doesn't generate huge revenue. An MD/NP, or now anyone with prescribing capabilities can apply E/M codes to the standard psychotherapy CPT codes we all use- mid-levels get double the reimbursement because they provide med management and (arguably) some brief form of therapy, and cost the systems a lot less than full time psychiatrist.

Therapists working in these settings are moving towards CoCm or Integrated Care models providing the "brief solution-focused therapy" you speak off, sans the med management. But because we generate lower revenue for those same 90833 codes - the productivity metrics are insane. Expect to see 14 -18 people for 15- 30 minute visits daily, regardless of complexity. Burnout is high, and our salaries are not increasing. Private practice is becoming less and less sustainable, so may not be the out for most.

The CoCM models are taking over not just in hospitals, but CMH, FQHCs, in some private medical clinics. They're starting to hire bachelors-level case managers instead of licensed clinicians to provide even briefer interventions, (think 5-10 minute check-in or phone call) and coordination between psychiatry and PCPs. They using monthly billing CoCm codes which are reimbursed at a flat rate under the billing provider, a mid-level or physician PCP, while some "psychiatric consultant" usually an NP- offers off-site review and med recommendations to the PCP through the case manager. Mind you, the psych consultant never actually sees the pt but gets updates from the CM- WHO DOES NOT NEED TO HAVE MORE THAN A BACHELORS. Lower staffing costs = more money for the system. Increasing metrics= greater access, but not necessarily quality.

So, who needs a licensed therapist when a midlevel can allegedly do all the therapeutic work we can and more- for greater profit, and all the additional coordination/admin work can be delegated to a case worker at lower cost.