Building A Road to Happiness: Recruitment to Psychiatry

I saw a couple of great pieces in the April 20, 2012 issue of Psychiatric News. One of them was by the current President of the American Psychiatric Association (APA), Dr. John M. Oldham, M.D [1]. The title of his editorial is “The Road to Happiness?”. This made me wonder about how  roads to happiness are built. He noted the drop in recruitment of U.S. medical school graduates into psychiatry this year, also reported in another article in the same issue. A total of 616 graduates entered psychiatry residency programs this year, compared to 640 last year and 670 in 2010 [2]. Before going on, I think it’s important to highlight the under-emphasized statistics also published in the same issue indicating the numbers of U.S. medical school seniors matching into psychiatry is still “well above” those at the beginning of the last decade.

Dr. Oldham recounted what a psychotherapy committee member who is also a psychiatry resident told him about what medical students learn about “the road to happiness” regarding the selection of medical specialties to pursue after graduation. The four specialties are anesthesiology, dermatology, ophthalmology, or radiology. The selling points for them are “plenty of business, a good income, controllable hours, and minimal night call.”

I suppose one definition of a “good” income would be that which allows new grads to pay off their student loan debt, although even President Obama and the First Lady didn’t get theirs paid off until just 8 years ago. Regarding “controllable hours”, isn’t there something called duty hours restrictions these days? And how about “minimal night call”? There is such a thing as life after residency, and I get rousted out of bed in the middle of the night with calls from the ER about admissions to our Medical-Psychiatry Unit. However, emergency surgeries don’t happen on an 8 to 5 schedule either, and somebody has to keep the patients alive on the operating table (I’m just saying). And how about the “plenty of business” factor? I regularly get postcards from recruiters about how I can be “busy from day one” in dynamic, hugely successful psychiatry practices all over the country, including Iowa.

Boy, am I glad we cleared that up. Kidding aside, some of the reasons why medical students seem to shy away from psychiatry are understandable:

  • Stigma about mental illness. This is an ongoing issue which speaks to the need for continuing efforts to educate the public and our colleagues about the real, not just the perceived risk as magnified by the press, from persons who suffer from psychiatric illness.
  • Negative media coverage of debates about the effectiveness of psychiatric treatment, how our profession defines itself, the strength of our voice in shaping medical school curricula and health care policy, and what our role should be in medicine and in society. The press is going to cover these issues, negative or not, and that won’t change. Our job is to conduct respectful and collaborative debates with patients, each other, and policy makers both in private and in public.
  • Difficulties in fostering a positive impression of psychiatry in medical student clerkships as they’re traditionally designed, often as short 4 week rotations on busy inpatient psychiatric wards where the insurer-driven turn-around time from admission to discharge  is typically about 9 days or less, which can highlight the trouble students can have establishing a longitudinal relationship with patients. It makes me hopeful about changing the culture of medical school education, which is being done in longitudinal integrated clerkships programs similar to what I posted about in Teaching An Old Dog New Tricks: Longitudinal Integrated Clerkship in Medical School « The Practical Psychosomaticist: James Amos, M.D. Another impression medical educators have is that general hospital consultation psychiatry services may be a better experience for medical students than the traditional inpatient rotation [3]. I’m biased for that idea, of course, but it makes sense for many learners. When you consider that the majority of them will be pursuing careers in non-psychiatric specialties, they learn about persons with both medical and psychiatric disorders while on the consultation service . This gives them the best view of the population of patients they’re most likely to see. Many medical students have told me this. And this further persuades me that sometimes we may not fully appreciate the other value-added feature of the psychiatry rotation, best expressed by Dr. George W. Henry, M.D. in 1929 [4]:

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”

Other traits that tend to propel a medical student into psychiatry are positive experiences in psychiatric treatment and in a clerkship experience that is long enough to show the kind of change patients can have in treatment.

Another factor is a charismatic mentor. Good enough mentoring is a big issue all by itself, which I could only sketch in past posts;

Finding the Way North: Defining Mentorship « The Practical Psychosomaticist: James Amos, M.D.

The Geezer as Mentor « The Practical Psychosomaticist: James Amos, M.D.

Dr. Roger Kathol, A Mentor at the Frontier of Medicine and Psychiatry « The Practical Psychosomaticist: James Amos, M.D.

Did I mention that my statue will soon be completed in the main lobby, as soon as the PlayDoh embargo is lifted?

1. Oldham, J. M., M.D. (2012). The Road to Happiness? Psychiatric News. 47.

2. Moran, M. (2012). Fewer U.S. Grads Matching In Psychiatry. Psychiatric News. 47. Several psychiatric leaders say the medical student clerkship experience is inadequate to convey to young people what is attractive and interesting about psychiatry.

3. Moran, M. (2012). What’s Deterring Med Students From Psychiatry Careers? Psychiatric News. 47. Essays by students seeking entry into medical school typically emphasize a desire to have long-lasting relationships with patients, a fact that ought to make psychiatry an attactive career option.

4. Henry, G. W. (1929). “SOME MODERN ASPECTS OF PSYCHIATRY IN GENERAL HOSPITAL PRACTICE.” Am J Psychiatry 86(3): 481-499.

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Comments

  1. Kathryn Lyons-Keyt says:

    Did you ever read Dr. RIchard P. Bentall’s excellent article proposing happiness be included as a psychiatric disorder in a future edition of the DSM? Even though the article is now 20 years old, it’s a phenomenal disquisition about the pathologies of happiness and its disquieting effects on human beings. His research is meticulous.

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    • Hi Kathryn,

      I have not yet had the pleasure of reading Dr. Bentall’s article but I certainly intend to because of your comment and because of the Aphelis summary of it, the link to which is http://aphelis.net/richard-bentall-proposal-classify-happiness-psychiatric-disorder-1992/. I suppose it would be going too far to suggest that his proposal is nothing more than ironical humor, though I suspect an element of that might be embedded in the context of a serious challenge to the current model of psychiatric illness classification systems. I wonder if the DSM-5 committees are aware of him.

      Thank you so much for this reference!

      Best wishes,

      Jim Amos, MD

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