Implications of Rising Residency Numbers

An area of psychiatry undergoing significant changes is in the practice of clinical psychiatry and the financial implications of these changes on practitioners and career choice.

Today the majority of physicians graduating from residency enter some form of group practice. In psychiatry, however, graduating residents are most likely to enter exclusive outpatient practices. In many settings patients requiring hospital care are treated by psychiatric hospitalists. In outpatient settings most patients are treated by psychiatrists engaged in medication management. They refer patients in need of psychotherapy to social workers or psychologists. Limiting a practice to medication management in which one can see many patients increases the practitioner’s income. This in turn has a positive impact on one’s lifestyle. While psychiatrists may not earn as much as some other types of medical specialists, they can have parallel, well-ordered clinical practices and lifestyles.

We know that today lifestyle issues are significant variables in career selection. While the new clinical practice patterns and their resultant economic impact may enhance recruitment into psychiatry, they may also have some negative implications. The focus on medication management may lessen the discipline’s commitment to the biopsychosocial model of understanding and treating our patients. Forty years ago Mel Sabshin, M.D., who served as APA medical director for more than 20 years, was concerned about biologic reductionism adversely impacting patient care and the intellectual foundation of our discipline. The impact of financial considerations may lead to a financial reductionism that may have adverse consequences on patient care and our discipline’s vitality.

We can accomplish more in caring for our patients today than at any other time in my 50 years of practice. This enhanced ability must become and be the basis for an enhanced recruitment.

Sidney Weissman, M.D.

Chicago, Ill. ■