ARLINGTON, Va. (March 27, 2012)—The number of U.S. medical students choosing psychiatry as a specialty has been declining for the past six years, according to a report from the National Resident Matching Program. The American Psychiatric Association expressed concern that this trend is occurring as the nation faces a shortage of psychiatrists. The association encourages medical schools to provide more information and training to medical school seniors to teach them that psychiatry can be a profitable and rewarding career path.<\/p>\n “In 2010 there was a slight increase in the number of seniors choosing psychiatry, but overall the trend has been downward,” said John Oldham, M.D., president of the APA. “We need to reach out to medical students in more effective ways than simply exposing them to a four-week clerkship on an inpatient unit, with no follow-up of the patients they have cared for. Establishing and maintaining ongoing relationships with patients is one of the key factors that makes psychiatry such a fulfilling career.” Dr. Oldham said that students need to know what it is like to get to know their patients and follow their progress over time to know how rewarding the profession can be.<\/p>\n
So far reasons for the decline in students selecting psychiatry are not well known, but James H. Scully, Jr., M.D., the APA’s Medical Director and CEO, speculated that there could be several reasons. “This is a very exciting time for psychiatry,” he said, “when we have more scientific developments in the field than ever before, but this means that the field is evolving in ways in which the outcome is unknown. It’s a great time for young doctors to have an impact on what the future of psychiatry will look like.”<\/p>\n
Some experts have suggested that there should be more than one track to an education in psychiatry. Advances in science are leading some future psychiatrists in the direction of clinical neuroscience, whereas others would like to focus mainly on psychotherapy. Another issue that most medical students face is a large burden of student loan debt upon graduation, which puts pressure on medical students to choose more lucrative careers than psychiatry, such as surgery.<\/p>\n
There are currently about 50,000 psychiatrists in the U.S., a number that is already inadequate to serve all the patients who need help, especially those in rural areas of the country. In fact, according to the National Institute of Mental Health, there are more than 3,500 Health Professional Shortage Areas for Mental Health, mostly in non-metropolitan areas. In addition, about half of currently practicing psychiatrists are over the age of 55 and many will soon start retiring…<\/sup><\/div>\n<\/blockquote>\n
![](\"http:\/\/1boringoldman.com\/images\/residency-2.gif\")
<\/p>\n
I couldn’t confirm much of a falling specialty choice rate from the National Resident Matching Program figures, but I wouldn’t doubt the finding [it’s mighty flat]. I doubt this letter is going to do a lot [Duh!]. But looking over the numbers was like a trip back in time for me. I started my life in psychiatry running a psychiatric emergency room, but within a short time, I was directing a Residency Training Program. I used to jokingly call it trafficking in human flesh<\/em>, because what seemed to matter the most was filling the program so we had ample residents to cover the various hospitals where the residents were placed [and paid]. I started in 1978, which, as you can see, was a down time for people choosing psychiatry. I can’t claim any credit for the upward trend during the decade that I did that job, but I did notice that it got a little easier each year.<\/p>\nThe real measure was the number of US Seniors. That’s not a racist comment, it actually means that a program with US Seniors was chosen<\/em>. Some of the best residents I had were Foreign Medical Graduates who chose psychiatry, but many of the FMG applicants were people who were primarily interested in staying in the US and not so passionate about the specialty. At least that’s the way it was then. And I had something extra on my side that helped – Atlanta Georgia was a definite designation city<\/em> in the 1980s. I left in 1987-88, and didn’t much look back so I was unaware of that big dip after I left and had to be reminded that it was the time of the coming of Managed Care which was devastating to psychiatric practice. This graph compares psychiatry to several other specialties [% available positions so the dip looks smaller]:<\/p>\n![](\"http:\/\/1boringoldman.com\/images\/residency-1.gif\")
<\/div>\n
As you can see, the lower paying, non-procedural general specialties took the biggest hit, particularly psychiatry because the number of available positions also shrank during that time as many hospitals [a major source of funding] closed their doors.<\/p>\n
Managed Care originally slashed reimbursement to psychiatry to eliminate long term psychotherapies and were successful in that endeavor. However, the current situation is that reimbursement usually only covers short medication visits ["the med check"]. So part of the cry for treatment reform gets tangled up in economics – anything other than "med checks" is self-pay and so one can predict the numbers choosing psychiatry will fall further. The current figure is that 80% of psychoactive drugs are currently being prescribed by Primary Care Physicians, and that figure has been rising.<\/p>\n
One of the tragedies of the current situation is that the psychiatrists being paid by the pharmaceutical companies on their speaker’s bureaus [Propublica] are speaking TO groups of primary care physicians whose prescribing habits are apparent to me every time I work in one of the clinics in this underserved area – abysmal, arbitrary. The problem of overuse of medications is bigger than meets the eye. All forces promote it, and leave little alternative in any system running primarily on third party coverage. Painfully, it comes down to money no matter which direction you turn. I’m as against overmedication as much as anyone, but the solution will not be at all simple. It’s an Augean Stables with thirty plus years of manure. There’s a lot of cleaning out to do, but it also will require putting a system in place that is incentivized to deliver proper care, that can attract and train the kinds of people who will deliver it, and that has a non-volatile source to fund it.
Oh Hercules, where art thou?<\/font><\/strong><\/div>\n![](\"http:\/\/1boringoldman.com\/images\/augean.jpg\")
<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
Fewer Medical School Seniors Electing Psychiatry as a Specialty According to the American Psychiatric Association APA News Release ARLINGTON, Va. (March 27, 2012)—The number of U.S. medical students choosing psychiatry as a specialty has been declining for the past six years, according to a report from the National Resident Matching Program. The American Psychiatric Association […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-21784","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21784","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=21784"}],"version-history":[{"count":10,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21784\/revisions"}],"predecessor-version":[{"id":21794,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21784\/revisions\/21794"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=21784"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=21784"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=21784"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}