“I recall the last time there was a huge shortage of psychiatrists, it was right after World War II. The nation opened the doors for general practitioners to become psychiatrists. And quite a few took advantage of that opportunity. I foresee the same thing happening, but instead of general practitioners, this time it will be psychologists, nurse practitioners, and physician assistants. I am less concerned about the trade association issues and more concerned with the quality of patient care issues. My concern is that children, the elderly, the poor, and people of color will become the second-class patients that the ‘psychiatrist extenders’ will be slotted to treat.
“Of course, there is hope that modern science will develop scientific tests to accurately identify Alzheimer’s disease, and it will become easier to prevent and treat this major public health disorder. I am hoping the same will occur with some of the childhood neurodevelopmental disorders.”
–Carl C. Bell, M.D.
Dr. Antonio Y. Hardan
“Several strategies should be developed to motivate the general psychiatrist to go into child and geriatric psychiatry, such as loan-repayment programs, and increasing salaries. Additionally, we should make sure that general psychiatrists get more training in child and geriatric psychiatry.”
–Antonio Y. Hardan, M.D.
“This is a systemic problem that has been building over a period longer than 20 years and is now reaching critical proportions.
“Some of the components include:
• The number of medical school graduates hasn’t kept up with the increase in population.
• Though the proportion of graduates going into psychiatry hasn’t declined, all the cognitive specialties face stiff competition from better paying procedure specialties.
• Private practice is being challenged by the many opportunities offered to psychiatrists by institutions that do not focus on clinical care.
• The private practice of psychiatry is being compartmentalized by institutions and organizations that hire psychiatrists.
• Many who have had enough from harassment by insurers, bureaucrats, and insurance companies are retiring early.”
–Rodrigo A. Muñoz, M.D.
Dr. Rodrigo A. Muñoz
“Psychiatry needs to expand its use and innovation of collaborative team-based models of care that support front-line mental health and medical professionals treating these populations. Videoconferencing can be used to increase access to care for these patients, their providers, and care givers in traditional medical settings of hospitals and clinics as well as nontraditional settings such as schools, care facilities, homes, and offices.
“Additional technologies (for example, Web-based treatments and mobile applications) should be leveraged as ‘force multipliers’ to allow providers with child and geriatric expertise the greatest clinical reach in supporting these efforts. Attention and resources need to be directed at developing pilots that can inform the wider deployment of team-based models of care that preserve the quality of treatment while remaining economically sustainable within the current dynamic funding environment.
–James (Jay) H. Shore, M.D.