Last week, the American Psychiatric Association issued a press release highlighting an ongoing decline in the recruitment of medical students into the specialty—at a time when the numbers of practising psychiatric professionals in the USA is falling. Various reasons are proposed, including the short-term nature of placements [usually just 4 weeks]; the sheer breadth of an evolving specialty, which is drawing students towards newer areas such as clinical neuroscience; and concerns that psychiatry is not as lucrative as other specialties.Tom Brown, Assistant Registrar of Recruitment at the Royal College of Psychiatrists [RCPsych], UK, views psychiatry’s identity crisis as an international problem, and for profound reasons. He told The Lancet: “Common perceptions within the medical profession include the view that psychiatry is just not scientific enough, is too remote from the rest of medicine, is often viewed negatively by other medical professionals, and is a specialty too often characterised by difficult doctor–patient relationships and limited success rates of therapeutic interventions”.
So, what kind of therapy is psychiatry in need of? The RCPsych views the current problem crucial enough for a concerted campaign to promote the specialty, not just to medical students and doctors at foundation stage, but even to senior-school pupils studying psychology. While such initiatives may help raise the profile of psychiatry, perhaps there are more fundamental issues that need to change.
Psychiatrists, first and foremost, are clinicians. Evidence-based approaches should be at the core of the psychiatrist and non-clinical members of any mental health team. The evidence that psychiatric patients have poorer overall health than the general population should ensure that psychiatry is strongly connected to other medical specialties. But more fundamental still, it is time for the specialty to stop devaluing itself because of its chequered history of mental asylums and pseudo-science, and to realign itself as a key biomedical specialty at the heart of mental health.
“They go into psychiatry because…fill in the blank” and yet, they are NOT going into psychiatry.
The market seldom has a voice in the medical profession, but perhaps the market is speaking here. The kids don’t want to go into psychiatry. So FMGs will fill residency positions in the short term and there will be fewer MD-level providers of mental health services in the future. That’s not such a bad thing.
Rob
I reckon you saw this…
Pretty much no one with half a brain would go into psychiatry as of now. Let me tell potential candidates for a psychiatry residency this little opinion from working in 3 different community mental health clinics in the past year: the drive is to just keep patients coming in for any appointment, irregardless if there is any psychotherapy being done with any frequency of possible efficacy. I see patientS every week who just keep their med checks and demand, not ask mind you, for med changes to treat overt psychosocioeconomic issues and then bitch and moan in med follow ups that they have no improvement, and you as the doctor are lucky to read at best 1 or 2 therapy visits have occurred in the past 2 or more months time.
If this is the trend, and believe me it is fairly much what I have seen in private practice too since returning to it last year after a 2 year hiatus, then good luck defending that tolerance by patients WHEN you have a negative outcome that is at least questionably of risk for a suit.
Personally, and this is a very harsh comment coming next, I think we are witnessing covert eugenics at hand, albeit post partum by years, by just whittling away at the standards of care for mental health patients, and I firmly believe against the providers as well, until they either have no where of substantial impact to go, or just accept the false premise of “take a pill and don’t bother to call me in the morning” that psychiatry as a whole has adopted.
Adopted, indeed. No responsible clinician would conceive of such a disgusting premise!
Oh, and by the way, be prepared to be treated like a drug dealer in an office setting. 20% of my private practice is of people seeking ADD diagnoses over the age of 20, most with no prior history of such a diagnosis as a child/adolescent, and don’t even ask me what I deal with every day at either site for benzo seekers. ANd some are getting bold to even try to demand getting opiate scripts from a psychiatrist NOT practicing pain management.
And the APA bemoans why less people are interested in the profession. What planet do they have their monthly meetings, before they land on earth in late April for their yearly sojourn on the Northern Continent to act like Spock wannabes? Logic? Not for our species!
Perhaps the specter of being prescription machines is unappetizing for idealistic medical students who want to help people recover from illness. The best of them may realize that psychiatry is floundering right now, casting about for a replacement for the now-ridiculous “chemical imbalance” theory. Perhaps the intellectual poverty of biopsychiatry is becoming evident.