Using telemedicine, senior psychiatrist provides top-notch care to veterans

Updated 2 years ago on October 17, 2022

When the COVID-19 pandemic struck, limiting patients to the relative safety of their homes, doctors rushed to implement telemedicine in order to continue providing care.

But Oklahoma psychiatrist Jenny L. Boyer, MD, PhD, is ahead of the curve. She has been practicing telepsychiatry for more than four years, and has been practicing telemedicine full-time for the Veterans Health Administration since 2018.

Dr. Boyer, 72, currently serves as chair of the AMA Senior Physician Section (AMA-SPS) Board of Governors and practices telemedicine as a staff psychiatrist in the West Texas Health System. Her opinion expressed here does not represent the VA.

After several years as deputy chief of behavioral medicine at East Oklahoma Health System, Dr. Boyer was looking for telemedicine as a career change and a way to get back into patient care.

"I was looking for places that actually have full-time telepsychiatry," she says. "And my children and grandchildren moved back to Norman, Oklahoma, so I moved back to Norman, Oklahoma, and that allowed me to live the lifestyle of the matriarch of the family."

She can build a Monday-Thursday work week out of 10-hour days caring for patients via telemedicine and has three days off to spend with family.

"I work in my socks," Dr. Boyer said in an interview before the AMA-SPS education sessions at the 2022 AMA Annual Meeting. In one day, Dr. Boyer can see veteran patients living in Abilene, Texas, or even Hobbs, New Mexico - nearly 500 miles from her office.

Supporting telemedicine is a critical component of the AMA's plan to rebuild America's physicians. You have taken care of the nation. It's time for the nation to take care of you. It's time to rebuild. And the AMA is ready for it.

Telemedicine is critical to the future of health care, so the AMA continues to lead the way in actively expanding telemedicine policies, research and resources to ensure physician practice sustainability and equitable payment.

The Significance of Telepsychiatry

After several years as an administrator in another VA health care system, Dr. Boyer was excited about the opportunity telemedicine gave her to fully utilize her diagnostic and clinical skills to improve patients' lives.

Although Dr. Boyer said she would personally practice if telepsychiatry were not available, given the shortage of psychiatrists in the country and in the VA system, it is very helpful to patients that Dr. Boyer is able to practice through this mode of care.

"Psychiatry is an area where disorders are diagnosable and treatable, and people do recover. And for me personally, it's that I'm seeing some pretty complicated patients, so it's kind of a challenge," she said.

"In many cases, I see patients who have gone to primary care, then to the pharmacist, then to the nurse practitioner and PA [physician assistant], and finally," she says, "they are referred to me for a primary psychiatric evaluation where I try to figure out the diagnosis.

"I see a lot of patients for psychotherapy and medicine, but patient problems have become more general medical - such as COPD, diabetes, cardiology, infections, neurology, chronic pain - than ever in the past."

Patients may have a psychiatric disorder such as bipolar disorder, major depression, schizophrenia, or post-traumatic stress disorder, but these disorders are also associated with general medical and substance use disorders.

"So," Dr. Boyer explained, "patients need a physician, not a less qualified professional, because they have at least three levels of diagnosis" related to their psychiatric, general medical and substance abuse disorders.

"Generalized anxiety is probably the most common psychiatric diagnosis that many people start later in life. It is different from other psychiatric conditions that begin in adolescence or childhood. Generalized anxiety and major depression secondary to general medical disorders are also common," she said. "For example, anxiety is secondary to uncontrolled diabetes or COPD. Insomnia is secondary to sleep apnea."

Dr. Boyer will work with patients on controlling type 2 diabetes and weight loss, as well as using a continuous positive airway pressure machine to treat sleep apnea.

"I use psychotherapy to overcome barriers to change," she added, and often ask patients to reduce their alcohol intake because alcohol can cause the very insomnia that patients often try to cope with through alcohol.

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