Remove Barriers to Recruitment of Psychiatrists

I was just sitting here thinking about how Iowa mental health services leaders could continue the constructive brainstorming about how to improve access to high-quality psychiatric treatment in Iowa. And recent articles in a leading Iowa newspaper which I used to deliver door-to-door when I was a boy serves to highlight the vigorous debate. I compared an editorial and a letter-to-the-editor from Iowa Psychiatric Society President-Elect Dr. Joyce Vista-Wayne, which are covered in the tweets below:

The shortage of psychiatrists is not just an Iowa phenomenon and its history goes back many decades.

"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."--George W. Henry, MD, 1929

“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.”–George W. Henry, MD, 1929

 

This is not just about psychologist-prescribing and we’d all prefer not to frame this issue as psychiatrists merely protecting their turf. As many leaders know, the psychologist-prescribing issue will continue to be proposed by those who genuinely want to improve access to mental health care in Iowa. This is really about making psychiatric treatment available to more Iowans. Working towards that goal means promoting all of the interventions that Dr. Vista-Wayne outlines in her letter, and more.

I think we also need to work on eliminating another potential barrier to recruitment of psychiatrists to the state of Iowa, and that’s Maintenance of Licensure (MOL). The MOL process would tie obtaining and renewal of medical licensure to participating in the controversial Maintenance of Certification (MOC). These days I regularly reply to messages forwarded to me from psychiatrists alarmed about the dumbing down of psychiatrists by MOC.

Dr. Vista-Wayne is an effective leader, obviously aware of the need to address the issue of a shortage of psychiatrists on several fronts, which is why she supported my resolution to support the principle of lifelong learning and oppose MOL in April of 2013 at the Iowa Medical Society House of Delegates meeting. This resolution was adopted unanimously.

Since then the Iowa Medical Society (IMS) has moved from the House of Delegates format to a new process to set policy which engages all IMS members. I’ve introduced a new resolution (which, under the new model, will be called a Policy Request Statement). It has been officially submitted by IMS and in early August of this year, IMS will send out the Policy Request Statement to the entire membership.

My Policy Request Statement will be an adaptation of the resolution opposing MOC recently adopted by the South Carolina Medical Association. This resolution specifically opposes mandatory maintenance of certification for licensure, hospital privileges and reimbursement from third party payers.

Leaders accepted my draft and discussion about it will begin prior to the next scheduled Policy Forum meeting in September this year.

The Policy Request Statement will then be returned to the entire membership for feedback prior to the meeting.

The IMS staff will conduct additional research which might include review of existing AMA as well as IMS policy, regulations in other states, and other data. As many of us know, the AMA had on its schedule of resolutions to discuss at its annual meeting this week Resolution 316 Moratorium on Maintenance of Certification.

All comments and research will be forwarded to the Policy Forum Staff about a week prior to the meeting. Any of the IMS members, including the author of the Policy Request Statement, is eligible to testify about the issue. Other experts could also be asked to participate.

Following discussion the Policy Request Statement could be approved, rejected, or tabled pending review by a specially appointed committee. That decision could be as soon as September 18, 2014.

Resolutions opposing MOC and/or MOL have been adopted in Iowa, Ohio, California, Florida, Alabama, Texas, Oklahoma, New York, New Jersey, Michigan, Wisconsin, and North Carolina. The number of signatures is over 16,000 as of this moment on a petition to the American Board of Internal Medicine to recall recent changes to MOC making participation even more frequent and more costly than it already is. You can bet there are a lot of signatures from psychiatrists on it.

Removing barriers to recruiting psychiatrists is critically important for helping people access mental health care, not just in Iowa, but everywhere. Taking the load of MOC off our shoulders would be a great place to start.

 

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Comments

  1. I started in 1982, specialist since 1991 in child and adolescent psychiatry and pediatrics. I’m working currently in general psychiatry and CAP in Sweden. I have been the head of the university hospital psychiatry in Uppsala for several years. I am well paid, and I easily get jobs in Sweden. I have lived in the U.S. I would love to get a chance to work in the U.S. But no way!! The U.S. shortage is not that bad!!

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  2. What a nonsensical debate that completely lacks historical context.

    First – lets cut psychiatric services to the bone and restrict access to psychiatrists.

    Now let’s pretend we really want one small piece of what psychiatrists provide – the prescription of medications. Of course without psychiatric training it is basically the uninformed prescription of medications.

    The barriers to recruiting psychiatrists are immense because they basically include the federal government, most state governments and of course the managed care industry. We are at the point where we might as well throw the APA into the mix (American Psychiatric Association that is) based on their push for collaborative care and the dumbing down of the psychiatric profession.

    The ultimate test of MOC will be what happens when there aren’t any psychiatrists around any more. Just a number of people pretending to be psychiatrists.

    My guess is the ABPN and the ABMS will be a lot poorer at that point, but it will be way too late to rethink their strategy.

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