For the past year, Dr. Peter Levine has been the executive medical director of Behavioral Health Services at Methodist Medical Center of Illinois and also serves as interim chair of the Department of Psychiatry and Behavioral Medicine at the University of Illinois College of Medicine at Peoria. With all of this on his plate, however, he remains passionate about his first love—private practice psychiatry. “During my last five years in Houston, my private practice represented the smallest percentage of my professional day. However, it was the part of my day that I felt most relaxed and effective. It would always remind me of why I went into psychiatry and how emotionally satisfying and rewarding it could be. Because this is important to me, I do plan to fit an office practice into my week.”
Levine’s experience has prepared him superbly for his new challenges. He’s studied and worked at such impressive institutions as Tulane University in New Orleans, King’s College in London, Mt. Sinai Medical School in New York, New York Hospital-Cornell Medical Center, and Dartmouth Medical School.
In addition to teaching, running a private psychiatry practice, and consulting, Levine has authored articles for publications such as American Journal of Psychiatry, Behavioral Medicine, and Journal of Podiatric Medical Education.
Levine and his wife, Jan, have two children.
Tell us about your background, schools attended, family, etc.
I grew up in Silver Spring, Md. My father was chief economist for the National Science Foundation, and my mother was a homemaker. After attending high school in East Lansing, Mich., I attended Tulane University in New Orleans on a swimming scholarship and spent my junior year abroad at King’s College in London. I returned to New Orleans to attend Tulane Medical School. During the summer between my first and second year of medical school, I worked with a Tulane psychiatrist who ran a large methadone clinic for heroin addicts, and during the summer between my second and third year, I worked in the Department of Adolescent Psychiatry at Mt. Sinai Medical School in New York. I had great mentors, and these very positive experiences secured my ongoing interest in psychiatry and desire to pursue it as a career.
I completed my psychiatry residency at New York Hospital-Cornell Medical Center, where I was chief resident my final year. I then completed a fellowship in consultation liaison psychiatry at Dartmouth Medical School. This subspecialty deals with the psychiatric/psychological complications of medically ill patients. After this fellowship, I moved to Houston to head the consultation liaison service at the University of Texas Medical School, as well as the university’s chronic pain service. Additionally, I was the chief psychiatric consultant to M.D. Anderson Cancer Center. Eventually, I went into private practice and had a multi-disciplinary team in my office including other psychiatrists, psychologists, and social workers.
I’ve always been involved in the administrative and business aspects of medicine and was for many years the psychiatric medical director of the primary hospital where I admitted patients. When managed care began to penetrate the Houston market in the early 1990s, I was introduced to a managed behavioral health care company looking for a medical director who could help them become a leader in developing a managed care product that was a “win/win/win” for the patient, the physician, and the company. I did this on a part-time basis for 10 years while continuing my private practice. The company covered 12 million lives nationally, but eventually it was acquired by a larger company that had a different philosophy, which made me realize it was time for a change. During my last five years in Houston, I also returned to the University of Texas Medical School to direct the consultation liaison service and was very involved in teaching family practice and neurology residents psychiatry that would be relevant to their future careers.
A couple of years ago, my wife, Jan, who’s a health care consultant, and I began to feel it would be nice to raise our two young sons, Oscar and Max, in a smaller city than Houston.
As a relative newcomer to Peoria, what are your impressions of the area?
Jan and I were pleasantly surprised when we visited Peoria for the first time. I found an outstanding hospital system led by bright, energetic individuals who had a definite vision for growth and excellence in the field of psychiatry, community leaders working together to help in the treatment and recovery of mentally ill individuals, and a medical school eager for help in pursuing their needs in psychiatry.
We love the friendliness of the people in this community and are pleased with our quality of life here. We’re excited about the future of Peoria and the many civic initiatives that are underway. In an effort to integrate myself into the community, I’ve been involved with the Peoria zoo expansion effort. I’ve always felt that zoos are an important component of worldwide animal conservation and bring joy and educational opportunities to children and adults alike.
Explain exactly what psychiatrists do and how they can help their patients.
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. A properly trained psychiatrist can provide a comprehensive evaluation from a psychiatric point of view, a medical differential evaluation (sorting through all the diagnostic possibilities), treatment planning, and multiple therapeutic and health enhancing interventions.
The term “mental disorder” unfortunately implies a distinction between “mental” and “physical” disorders. At this time, we know there’s much “physical” in “mental” disorders and much “mental” in “physical” disorders. Briefly, a mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern associated with present distress (a painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. Whatever the original cause, a mental disorder must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the person.
A psychiatrist also sees conditions or problems that may be the focus of clinical attention and aren’t considered mental disorders. Some examples include phase-of-life problems, relationship problems, academic or occupational problems, identity problems, bereavement, adult antisocial behaviors, and problems related to abuse and neglect.
Depression is the most common mental health problem and is what leads the largest number of patients to see a psychiatrist. It can range from mild to severe and may be associated with suicidal thoughts. Treatment for this may be medication, talk therapy, or a combination of both, and can be very successful.
How has psychiatry changed since you began in the 1970s? What changes is the field currently undergoing?
I’ve seen a number of major changes over the past 30 years. New medications and economic factors have fueled many of these changes. During my residency, patients would have lengthy stays in the hospital. It wasn’t uncommon for troubled adolescents to spend up to two years in the hospital being treated and in school in what was termed a “therapeutic community.” A substance abuse admission would automatically trigger a 30-day stay in a program. Today, the long lengths of stay continue in only a very few places where people pay for it out-of-pocket. Insurance began limiting stays in the late 1970s, and managed care began penetrating the market in the late 1980s. Managed care dramatically altered the style of practice for many psychiatrists. Hospital stays are markedly curtailed, and often psychiatrists are only authorized to provide medication management for outpatient work. Many psychiatrists of the older generation have felt their careers to be less professionally rewarding due to these changes. For the new generation of psychiatrists, managed care and economic pressures are all they know.
The art and science of psychopharmacology has undergone many changes since the 1970s. There have been major changes in antidepressant medication, antipsychotic medication, and mood stabilizers. While there have been no radical cures or breakthroughs, there continues to be substantial refinement and elaboration.
Despite advances, however, American psychiatry is in crisis today. The American Psychiatric Association supports access to universal health care and fights for patients. Its vision statement states, “Every American with significant psychiatric symptoms should have access to expert evaluation leading to accurate and comprehensive diagnosis which results in an individualized treatment plan that is delivered at the right time and place, in the right amount and with appropriate support, such as adequate housing, rehabilitation and case management when needed. Care should be based on continuous healing relationships and engagement with whole persons rather than a narrow symptom-based, symptom-focused perspective. Timely access to care and continuity of care remain today the cornerstones for quality.”
While this is the appropriate vision for psychiatry, it continues to have problems as a profession and is falling far short of its ideals. In a recent address to the psychiatric membership, the new president of the American Psychiatric Association, Steven Sharfstein, outlined the current problems and challenges of the profession. Briefly, some of his important message: “The problem is not our policy position. It is our profession lacks credibility and leverage. As a profession, we have neglected the uninsured, the poor, the needy and the seriously and persistently mentally ill.” Further, Dr. Sharfstein stated that psychiatrists must recommit themselves to advocating for our patients. “Individuals with mental illness are stigmatized, mistreated and ignored. Psychiatrists must strongly advocate for better care in battles with insurers and discussions with policy makers. The unconscionable cuts in federal Medicaid passed recently by Congress will hurt our patients first and foremost. Medicaid is the safety net for the seriously and persistently mentally ill. They will be neglected during this period of fiscal retrenchment unless funding is restored. Our advocacy must extend beyond the doctor-patient relationship to broader issues of the public health. Thousands of youths are incarcerated unnecessarily each night because community mental health services are not available. This must be psychiatry’s concern. Adults with mental illness are shot and killed by police who have little or no training to deal with them. This too must be psychiatry’s concern.”
I feel it’s important to hear these problems and concerns for they’re the very challenges faced by our community. Many state facilities have closed due to financial problems and, at times, inefficiency. More often than not, community mental health centers haven’t been able to adequately deal with the volume of patients needing help. There’s a shortage of psychiatrists—especially child and adolescent psychiatrists—in this setting. Homelessness is a major problem throughout the country, and mental illness is a major issue for many of the homeless.
What does your position as executive medical director involve?
Methodist has included the Behavioral Health Services in its new service line model, which moves decision making to service line management, gives the medical staff ready access to decision makers, and allows physicians more influence over those decisions. The service line is jointly led by an executive medical director and an administrative director, who lead an operational group capable of following through on and implementing requested change. These two roles are interdependent and work together to make the major decisions regarding strategy, budget, capital requests, and operations. I was very fortunate in Methodist’s choice of Dean Steiner as administrative director. Dean’s background as a mental health clinician and his 17 years at Methodist has allowed for a great partnership as he’s very knowledgeable and well respected throughout the hospital and community.
What are the pros and cons of being an active psychiatrist versus an administrator?
From the start of my career I was worried I might lose interest or burn out early if I focused only on a single aspect in my career. I’ve sought to diversify through clinical teaching, supervision, administration, and clinical activities. I’ve found each of these challenging and rewarding.
What prompted you to go into teaching? Is that something you intend to continue?
During medical school and residency, my mentors and role models were all teachers. Some excelled in classrooms and others in clinical teaching. From my first year as a psychiatry resident at New York Hospital, we always had bright, inquisitive Cornell medical students assigned to us. It prompted me to read, find answers, and stay up to date to meet their challenging questions. I enjoy seeing—with medical students and psychiatry, family practice, and neurology residents—medically ill patients who have psychological or psychiatric problems. We work on interviewing techniques, diagnosis, treatment, and management. When I came here, I set up a consult service we could use to teach the medical students, as well as the family practice and neurology residents.
How are you helping Methodist adjust and expand its mental health offerings following the changes Peoria has seen in the mental health landscape?
Zeller Mental Health Center closed in 2002, and soon thereafter, there were other closures of psychiatric units. Methodist was the only area hospital to keep psychiatric unit beds open, and we’ve made a commitment to remain open and expand our services.
My first order of business was to recruit additional psychiatrists. We were fortunate to recruit two new adult psychiatrists and three child psychiatrists to complement the existing team of four adult psychiatrists and one child psychiatrist. Along with community psychiatrists who admit and treat patients at Methodist, we’re working on meeting the challenges of those in need of hospitalization. Meanwhile, we’re growing our outpatient practices.
We’re collaborating with community agencies to help meet their needs. One of our child psychiatrists works as a consultant with a multi-disciplinary team at the Easter Seals Autistic Spectrum Disorder Early Diagnosis and Treatment Center. We also provide psychiatric services for Children’s Home and Guardian Angel Home. We’re developing a telepsychiatry program since there’s a vast shortage of psychiatrists, especially child and adolescent psychiatrists, in the central Illinois region. Telepsychiatry is the delivery of psychiatric services at a distance using telecommunication and information technologies. We’re collaborating with Tazwood Community Mental Health Center and North Central Behavioral Health Systems in a pilot program. If we’re successful, we’ll work with Peoria Next to develop a pilot project in Peoria using Internet2 technology.
I feel internal growth, creativity, and collaboration will help distinguish the Department of Psychiatry at Methodist.
Can you bring us up to date on the collaborations you’re forming with the University of Illinois College of Medicine at Peoria? With the network of community mental health providers?
Since Methodist has become the community leader in psychiatry, I felt there was an opportunity for our department and the Department of Psychiatry at UICOMP to forge a collaboration that would benefit both. I’ve been appointed clinical professor and interim chair of the Department of Psychiatry and Behavioral Health at UICOMP, and the department is now located at Methodist. We established the Illinois Center for Mental Health, a partnership between these two departments. As interim chair, I’ve been involved in working on the business plan that includes looking for growth opportunities for the department, as well as expanding clinical teaching for residents in family practice, neurology, and pediatrics.
Early on, I had the opportunity to meet State Representative David Leitch and attend one of his weekly meetings of community mental health leaders. I was impressed with his knowledge of and passion for the plight of the seriously and persistently mentally ill. He’s spearheaded this group to better facilitate recovery of the mentally ill in the Peoria community. I’ve become a member of this group and have been meeting with them for more than a year. We’re working to make this group a formal “think tank” to capitalize on our collective strengths. We hope to use this as a springboard for community education and model delivery systems for the state.
This excellent example of community collaboration includes the following members: Rep. David Leitch; Linda Daley, legislative aide to Rep. Leitch; Mike Boyle, CEO of the Human Service Center; Arun Pinto, M.D., executive medical director of the Human Services Center; Mike Polson, CEO of the Tazwood Community Health Center; Jack Schlicksup, manager of Information and Performance Improvement at the Tazwood Community Mental Health; Arlene Happach, CEO of Children’s Home; Jane Weede, vice president of Children’s Home; Dean Steiner, administrative director of Methodist Medical Center; Keith Stone, president of the National Alliance for the Mentally Ill (NAMI) Tri-County; Carolyn Jakopin, treasurer of NAMI Tri-County and president-elect of NAMI, Illinois; Frank Mayfield, past president of NAMI Tri-County; Ruth Mayfield, board member of NAMI Tri-County; and me.
Organizations such as NAMI are at the forefront of providing support for individuals and education for the community. Peoria is very fortunate to have a NAMI chapter known for its outstanding leadership and programs.
Is there, or will there be, a shortage of mental health professionals in the future?
Currently, there are shortages of psychiatrists throughout the U.S. This is especially true for the subspecialty of child and adolescent psychiatry. There’s a shortage of graduating medical students picking psychiatry as a specialty. Also, there’s a problem of distribution, as psychiatrists mainly cluster in the urban centers. In a 2005 survey, 74 out of 101 counties in Illinois designated shortages of psychiatrists, and 14 have no full-time psychiatrist. Currently, there are 7,000 child and adolescent psychiatrists in the U.S. It’s projected that by 2020, 12,624 child and adolescent psychiatrists will be needed, but there will be only 8,312—approximately one-third fewer than needed.
What advice would you give people to help them navigate their busy lives?
“Good” and “bad” stress can lead to sleeplessness, anxiety, and depression. If these problems become severe enough to interfere with day-to-day functioning, then certainly professional help should be sought. However, I’m a big advocate of routine exercise as a stress reliever. If one is physically able, exercise should be incorporated as part of the daily routine. Exercise has been shown to be helpful in the treatment of anxiety and depression.
People often forget the importance of leisure time in general. We all need this leisure time to unwind, relax, and refuel ourselves for the challenges of our workday. To ensure quality leisure time, one must actually plan for and work at it. While this concept may seem paradoxical, this simple solution will help us achieve more balanced and rewarding lives. IBI
