It's definitely a two way road, but if you aren't changing meds and are only seeing the patient every 3-6 months, it's time to go back to the PCP even if they're on three different meds or an adjunctive antipsychotic or whatever weird barrier the PCP tries to throw up. Good systems will facilitate this, smooth it out and prohibit inappropriate barriers. It helps no one to have SMI patients out there without access because a PCP is scared of refilling stimulants. Of course this is a thread about resident education, so I guess what you can do is model discharging patients back to PCPs regularly even if that means having a full on supportive psychotherapy session with said PCP. I get that this is still very much an issue within academic centers, but it should not be. You gotta fix it in academia so there's some hope for private practices where the financial incentives are horribly perverse.