Countries Trade Residents As Health Care Goes Global

“We are now at the beginning of a new academic discipline—global health.”

So declared Stan Kutcher, M.D., head of international psychiatry at Dalhousie University in Halifax, Nova Scotia, at the annual meeting of the Canadian Psychiatric Association in Vancouver, British Columbia, in September.

“Global mental health will be a career option for young psychiatrists in 10 years,” Kutcher predicted. And in anticipation of that development, he and his colleagues have launched a program to give psychiatry residents in Canada, Mexico, and the United States some experience in working in each other's countries.

It all started, he explained, when he was attending an international meeting and learned that funding for such an endeavor was available from Canada, the United States, and Mexico under the North American Free Trade Agreement. So he quickly contacted American psychiatric colleagues (at Harvard University and Tufts University) and Mexican psychiatric colleagues (at the National Institute of Psychiatry and the National Institute of Neurology and Neurosurgery) to ask them whether they would like to participate. All answered yes.

The program that he and these colleagues ultimately designed and got funded, he explained, is called IMPACT. A total of six residents at a time participate in the three-month program. Two psychiatry residents from each of the three countries come together to receive a month's worth of psychiatry training in Canada, the United States, and Mexico.

Twenty-eight psychiatry residents from the three countries have participated in the program so far, he said, and most have found it a valuable experience. Selene Etches, M.D., one of the Dalhousie University psychiatry residents who took part in IMPACT, was on hand at the meeting to provide some details about her experience.

During her stint in Mexico, she reported, she learned that mental health care was provided only at mental hospitals. She would see people waiting outside the hospital each day to receive care. She observed electroconvulsive therapy (ECT) being given without anesthesia because the psychiatrist providing it believed that it was more effective this way.

During her sojourn in the United States, she said, she observed how psychiatrists often had to spend up to two hours to get health insurance company approval before they could admit psychiatric patients to the hospital. She also reported that she was exposed to patients without health insurance.

She also commented on some aspects of mental health care in Mexico that she liked—say, that all hospital units have only one floor, so that patients have access to the out of doors. And she likewise mentioned some of what she liked about mental health care in the United States. For example, “The resources are unbelievable, much better than we have [in Canada].”

Moreover, she talked about the program changing her. She said that it made her realize that there are only finite mental health care resources in the world, and that the best way that she could serve the public in Canada, or in any other country, is to concentrate on what she does best—complex diagnostics and medication treatment, not psychotherapy.

On the whole, “I think the program has made me a much better psychiatrist,” she attested.

To which Kutcher added, “Every resident who goes through the program takes something very personal from it. I have seen differences in how they think and how they work because of the experiences they have had.”

Kutcher said they plan to make the curriculum available, for free, to all psychiatry residency training programs in North America. Although the program is targeted toward residents in Canada, the United States, and Mexico, it could also be adapted for use with residents in other countries, he believes.

Not surprisingly, launching IMPACT entailed some challenges, Kutcher admitted. For example, it was difficult getting psychiatry residents from one country certified to conduct psychiatry in the other two countries. He thought that when the residents were in Canada, the Canadian funders would pay the residents' room and board, in-country travel, and other incidentals, and that when the residents were in the United States or Mexico, the American or Mexican funders would do likewise—sort of a reciprocity agreement. However, the funders balked at this idea. Altogether, he said, dealing with funding agencies in three different countries was a“ nightmare.”

Also, participating in IMPACT has presented challenges for psychiatry residents as well, he admitted. For example, the Canadian and American residents had to take courses in Spanish while in Mexico, and the Mexican residents had to take courses in English while in Canada and the United States. Some of the Mexican residents had trouble adapting to the Canadian climate. “One had to borrow my ski jacket even in summer!” Kutcher noted. And once residents had signed onto a three-month stint in the program, they had to live together as well as work together for that period.

“Sure, it was tough,” Kutcher admitted, “but international health care teams have to do something similar to get the job done.” ▪