Developing Our Workforce and Advancing Collaborative Care

The number of medical students who elect psychiatry as their career choice is disappointingly low in the United States, averaging 4% of each year’s graduating class since [year]. Quality, not quantity, matters more, one might say. Well, unfortunately, there is no evidence that “the brightest and the best” are going into psychiatry. If anything, there are multiple forces working against the perpetuation of our psychiatry workforce (1). That said, there has been an upturn in interest in psychiatry, culminating in 923 U.S. medical students going into psychiatry residencies this year, up from 850 in 2016, a cumulative 52% increase over the past 16 years.

This is encouraging and in line with the enthusiasm within our field regarding the current momentum in neurobiological understandings of mental disorders, as well as with the perceived professional satisfaction and quality of life among practicing psychiatrists. This increase in the “production” of psychiatrists is, however, not keeping up with the rate of population growth, the retirement of psychiatrists, and the compelling and unmet needs for care. Data from the 2017 report by the Medical Director Institute of the National Council for Behavioral Health (2) attest to both the workforce deficit and the overwhelming need for mental health clinicians. The shortage of psychiatrists is estimated to be 6.4% and is anticipated to become more drastic, with a 12% workforce deficit (approximately 6,000 psychiatrists) projected by 2025. Thus, while the pipeline efforts of increases in the number of medical students into psychiatry are encouraging, this present shortage and predicted shortage are daunting. It is unlikely—given sustained retirements, burnout, workplace challenges (funding, etc.)—that we will be able to remedy this deficit solely by increasing our physician pipeline.

We need to alter this situation, and we need to address “guild issues” that diminish our clinical effectiveness as well as our ability to advocate effectively on behalf of our patients. We need to recognize that simply producing more child psychiatrists, adult psychiatrists, consultation liaison psychiatrists, addiction specialists, and forensic psychiatrists will not make a meaningful difference in the lack of mental health clinicians. In tandem with judicious growth of the number of general and specialist psychiatrists, we need to embrace our many other clinician colleagues—psychologists, nurses, social workers, counselors, rehabilitation counselors, and peer support specialists. We also need to embrace models of care that maximize integrative deployment of our collective mental health teams. We need to embrace telepsychiatry (as well as emergent mobile health and related technological interfaces) as a key approach to extend our therapeutic effectiveness, especially in our efforts to address the mental health needs of rural populations. The extent to which we can develop our services in tandem with other medical services will further advance our reach, our perceived value among our peers, and our ability to reduce the stigma that keeps people in need from seeking care.