 |
 |
|
|
With a substantial proportion of psychiatrists and mental health experts insisting that too few psychiatrists are being trained to meet the treatment needs of the U.S. population, the APA Board of Trustees voted in November to explore the possibility of sponsoring a "major workforce conference" to study the issue in depth.
Despite the contention of many government health officials and medical experts--as well as some psychiatrists--that the supply of practicing psychiatrists and the number being trained are adequate, Board members pointed out that considerable anecdotal and statistical evidence points to a growing shortage and increasingly difficult access to care. This is true particularly in areas such as child and adolescent psychiatry, substance abuse treatment, and geriatric psychiatry.
Introduced at the Board meeting by Assembly Speaker Dale Walker, M.D., and former APA president John McIntyre, M.D., the proposal, which passed unanimously, states that "because of the unmet treatment needs of patients and the critical problems faced by psychiatric training programs, the Board of Trustees asks the president and speaker to appoint a work group to consider actions to address these issues, including the possibility of a major workforce conference."
The Board's action followed a discussion of the impending closing of Georgetown University's child psychiatry training program, though as James Scully, M.D., pointed out, this does not signal a crisis since no other similar shutdowns appear imminent. Scully is a deputy medical director of APA and head of its Office of Education.
McIntyre told Psychiatric News that a primary focus of the proposed conference would be to "explore issues relevant to various aspects of the workforce debate and to see if a consensus can be reached" about whether the size of the psychiatric workforce is sufficient to ensure access and quality care for patients or requires APA to develop strategies that will lead to growth in the number of psychiatrists being trained.
The in-depth exploration of workforce issues he envisions for this conference would also require participants to examine "underlying assumptions about the role of psychiatrists in various health care delivery systems," McIntyre said. Some of the experts who claim that an oversupply of psychiatrists exists work from the assumption that psychiatrists will spend more and more of their time prescribing and managing psychoactive drugs and less conducting psychotherapy. A very different conclusion arises, however, if psychiatrists can "assert their crucial treatment role in multidisciplinary systems," a role that goes far beyond serving as medication managers, he suggested.
One of the areas likely to be on the agenda of such a conference is the future of one of the psychiatric subspecialties whose practitioners recently became eligible to receive a certificate of "added qualification" from the American Board of Psychiatry and Neurology.
During his presentation to the Trustees, Scully pointed out that there is considerable doubt about whether the number of accredited fellowships in addiction psychiatry is sufficient to meet the criterion set by the Accreditation Council for Graduate Medical Education (ACGME) for a subspecialty to maintain its added-qualification eligibility. As of early November there were nine accredited fellowships in addiction psychiatry, but the field has to have 25 such programs in place by 1998 to meet the ACGME's standards.
Several additional fellowship programs are at some stage of the accreditation process, so the total may soon increase, said Patricia Ordorica, M.D., chair of the APA Council on Addiction Psychiatry. She noted that there are more than 25 addiction training programs and that the council and its Committee on Training and Education have been working with training directors to help them achieve ACGME approval. Some have been reluctant to navigate the accreditation process because of its complexity, Ordorica said, while others did not think they could free up the resources to meet the accreditation group's program requirements.
"We don't know the consequences of not having the required number of fellowships in place" by the deadline, Scully said in an interview with Psychiatric News. One possibility is that the ACGME will rescind the accreditation eligibility for addiction psychiatry. While that is a serious concern for the field, "there is no guarantee that that will be the outcome," he emphasized, because the accrediting body has never taken such a step. In 1990 and 1991 APA "made a very strong case for approval [of added qualification for addiction psychiatry] based on the public need and the existence of a knowledge and skills base among practitioners," Scully said. "Recent research continues to point to a serious need for psychiatrists skilled in treating addictions, especially when comorbid disorders are present. These are complicated cases that require the specialized care only psychiatrists can give."
"The current economics of funding graduate education, and not the absence of a demonstrated need for specialists," is the primary obstacle to the development of additional addiction psychiatry fellowships, Scully added.
The discussion on training and workforce issues was part of the somewhat unusual format the Board used at its November meeting in Washington, D.C. Instead of debating and voting on a roster of proposals and action items, the Trustees brainstormed on the six major issues that APA President Harold Eist, M.D., has set as the focus of his term in office--ethics and confidentiality, legislation and litigation, managed care, the American Medical Association, strategic alliances and public education, and education and research.
At the beginning of the meeting the Trustees were also introduced to APA's next medical director, Steven Mirin, M.D. Mirin, chief executive officer and psychiatrist in chief of McLean Hospital in Massachusetts, will replace Melvin Sabshin, M.D., who is retiring next year after 23 years as APA medical director.
(Psychiatric News, December 6, 1996)