Letters to the Editor
To the Editor:
New medical schools, increasing class sizes, and the recently passed Affordable Care Act provide stimuli for us as educators to reexamine the distribution of physicians by specialty as we guide our students toward an understanding of the needs of our patients and society. Psychiatry needs more practitioners, as evidenced by the approximately 3,400 counties in the United States currently designated as mental health care professional shortage areas.1 Also, in 2012, 616 U.S. medical school graduates matched into psychiatry residency programs, representing 3.9% of graduating U.S. medical students,2 a stagnant percentage over the last 10 years. The expansion of mental health parity in the Affordable Care Act and the inclusion of millions of more Americans in the insurance pool raise the immediacy of the issue.
I propose three avenues to increase student interest in psychiatry. First, we must identify students with an interest in psychiatry from the time they begin medical school (or even sooner). This initial interest is the best early predictor of who ends up in the field.3 Psychiatry departments need to nurture that interest and thus invest in the future. Avenues include the use of faculty mentors and student interest groups, along with involvement in case conferences, faculty research projects, professional online groups, and access to complementary psychiatry journals.
The second consideration is addressing the ongoing stigma and misperceptions regarding psychiatry and the mentally ill. All medical schools need plans to combat these issues embedded in the curriculum, such as using psychiatrists as mentors in introduction to clinical medicine and professionalism courses. Additionally, the biologic underpinnings of mental illness and the success rates of psychiatric treatment compared with those of other medical specialties need to be part of basic science education.
Finally, the optimal structure for the psychiatric rotation must be determined—perhaps the stand-alone clerkship is not the best approach. In the May 2012 issue of Academic Medicine, Hirsh et al4 noted that medical students who had longitudinal, integrated educational experiences in each of the major clinical disciplines “demonstrated richer perspectives on the course of illness, more insight into social determinants of illness and recovery, and increased commitment to patients” compared with students in traditional training. Innovative approaches such as this one could be key to giving students exposure to the benefits of psychiatric treatment while demonstrating to them the value of this field of medicine.
It is an imperative and a responsibility for medical education leaders to find a way to increase the workforce of psychiatrists and other mental health professionals to meet the increasing need for psychiatric services. I hope that the approaches I have proposed will stimulate medical educators to review the design of their curricula and their interactions with students.
Kathleen A. Crapanzano, MD
Assistant clinical professor, Department of Psychiatry, Louisiana State University (LSU) Health Sciences Center School of Medicine, New Orleans, New Orleans, Louisiana, and program director, LSU-OLOL(Our Lady of the Lake) Psychiatry Residency Program, Baton Rouge, Louisiana; firstname.lastname@example.org.
3. Gowans MC, Wright BJ, Brenneis FR, Scott IM. Which students will choose a career in psychiatry? Can J Psychiatry. 2011;56:605–613
4. Hirsh D, Gaufberg E, Ogur B, et al. Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: A way forward for medical education. Acad Med. 2012;87:643–650