With great interest I read the article titled “NIMH Director Expresses Hope for Future in Psychiatry” in the April 4 issue. The article highlighted the difficulty in recruiting psychiatrists into research and cites three main factors for this problem: financial, lack of mentorship, and the “failure of current teaching curricula in connecting clinical psychiatry with relevant science.”
The problem is more pervasive. I believe that the core problem is that research in psychiatry is significantly underemphasized. This is the result of two misperceptions by psychiatrists: that we actually know enough about the disorders we treat already and that detailed knowledge about our target organ (the brain) is not necessary for practicing. The third problem is that the public believes that research on psychiatric disorders is a low priority compared with other illnesses. These perceptions conspire to decrease the public outcry for more research in psychiatry and decrease the desire of young psychiatrists to pursue this career.
An additional problem is the undue dependence on grant funding for the conduct of research. Junior research faculty have to work long hours juggling clinical, teaching, and administrative duties between grant deadlines, as well as enduring repeated dismay with every grant rejection. Of course, the pay is not great either. It is no surprise, then, that not too many bright psychiatrists flock to this grind.
Fundamental changes need to occur.
This goal cannot be met with the current dependence of research on NIMH funding. According to the article, the agency will target schizophrenia, depression, suicide, autism, bioterrorism, and HIV. This is a small fraction of psychiatric disorders. NIH funds approximately 20 percent of submitted grant proposals. Many of the nonfunded proposals are important studies. What is needed is a fundamental change that will allow all academic institutions to contribute significantly to research. This will require greater emphasis of research productivity for holding tenurable positions in academic departments and state-government efforts to facilitate the building of research infrastructures.
In addition, academic departments of psychiatry should have a primary mission of advancing knowledge both through research and teaching at the cutting edge of knowledge. Psychiatry residents should be required to complete and publish a research project as part of the requirement for graduation. This will assure firsthand knowledge of the actual mechanics of research, as well as an advanced knowledge in at least one area of psychiatry. I will go further and propose that psychiatric residencies should be five years with at least 18 months fully dedicated to research activities.
