Abstract
Objective
The increasing frequency and societal cost of psychiatric disability underscore the need for accuracy in evaluating patients who seek disability benefits. The authors investigated senior psychiatric residents’ experiences performing disability evaluations, their self-assessment of competence for this task, and whether they perceived a need for more training.
Methods
Seventy-nine third- and fourth-year psychiatric residents in Massachusetts and Rhode Island training programs were surveyed from May to June in 2008. Participants were asked about the frequency of requests and completion of disability evaluations, the practice patterns followed when performing evaluations, the identification of role and potential conflict of interest in doing evaluations, and their sense of preparedness and need for more training.
Results
Residents reported having limited experience performing disability evaluations and followed a variety of practice patterns when performing evaluations. They reported having a limited understanding of what constitutes psychiatric disability and a lack of confidence in their ability to perform evaluations accurately. A significant minority had identified patients as disabled despite believing otherwise. A majority of residents reported receiving no didactics on psychiatric disability and desired more training.
Conclusion
Residents may be unprepared to perform disability evaluations. Residency programs may need to provide additional training.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Social Security Administration: Annual Statistical Report on the Social Security Disability Insurance Program, 2007. August, 2008. Available at www.ssa.gov/policy/docs/statcomps/di_asr/2007
Social Security Administration: Annual Statistical Report on the Social Security Disability Insurance Program, 2000. September, 2001. Available at www.socialsecurity.gov/policy/docs/statcomps/di_asr/2000
Sederer LI, Clemems NA: Economic grand rounds: the business case for high-quality mental health care. Psychiatr Serv 2002; 53:143–145
Stewart WF, Ricci JA, Chee E, et al: Cost of lost productive work time among US workers with depression. JAMA 2003; 289:3135–3144
Greenberg PE, Kessler RC, Birnbaum HG, et al: The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 2003; 64:1465–1475
Gold LH, Metzner JL: Psychiatric employment evaluations and the Health Insurance Portability and Accountability Act. Am J Psychiatry 2006; 163:1878–1882
Anfang SA, Wall BW: Psychiatric fitness-for-duty evaluations. Psychiatr Clin North Am 2006; 29:675–693
Gold LH, Anfang SA, Druktenis AM, et al: AAPL practice guideline for the forensic evaluation of psychiatric disability. J Am Acad Psychiatry Law 2008; 36(suppl 4):S3–50
Schouten RA, Williams CD: Psychiatric assessment and management of chronic disability syndromes, in Psychiatric Care of the Medical Patient, 2nd ed. Edited by Stoudemire A, Fogel BS, Greenberg DB. New York, Oxford University Press, 2000, pp 253–264
Mischoulon D: An approach to the patient seeking psychiatric disability benefits. Acad Psychiatry 1999; 23:128–136
Lemmen C, Guyer ML, Neal E, et al: Disability evaluations: is there inter-evaluator reliability? American Academy of Psychiatry and the Law 2007 Annual Meeting. Miami Beach, Fla, October 19, 2007. Available at www.aapl.org/pdf/AAPL_Past_Meeting_2007.pdf
Arikan R, Saleh F, Marrero I, et al: Dual agency issue in the social security disability evaluation process. American Academy of Psychiatry and the Law 2004 Annual Meeting. Scottsdale, Arizona, October 22, 2004
Appelbaum PS, Gutheil TG: Clinical Handbook of Psychiatry and the Law, 4th ed. Baltimore, Lippincott, Williams & Wilkins, 2006
Social Security Administration: Part II: Evidentiary Requirements, Disability Evaluation Under Social Security. “The Blue Book”: SSA Publication Number 64-039, ICN 468600, June 2006, amended April 2007
Williams CD: Psychiatric disability assessments. Psychiatr Ann 2006; 36:774–783
Strasburger LH, Gutheil TG, Brodsky A: On wearing two hats: role conflict in serving as both psychotherapist and expert witness. Am J Psychiatry 1997; 154:448–456
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Christopher, P.P., Boland, R.J., Recupero, P.R. et al. Psychiatric Residents’ Experience Conducting Disability Evaluations. Acad Psychiatry 34, 211–215 (2010). https://doi.org/10.1176/appi.ap.34.3.211
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1176/appi.ap.34.3.211