Guest Blog: Thoughts About the Psychiatrist Shortage
*This piece is edited from an original article published in the Summer 2021 Queens County Psychiatric Society newsletter.
As part of PRMS’ ongoing efforts to support the behavioral healthcare community and promote the organizations that work towards this mission, we are pleased to feature Dr. Richard Young, Editor of the Queens County Psychiatric Society Newsletter and a psychiatrist at the Queens Hospital Center, as a guest blogger. Dr. Young shares his thoughts on the shortage of psychiatrists and offers a few solutions to decrease workloads, and in turn, burnout.
I never paid much attention to it, but recently the issue of psychiatrist shortage hit close to home when we started losing staff due to retirement and personal reasons. I have always known that this is a common problem in the public sector, but losing multiple people around the same time has been incredibly anxiety-provoking. Reasons for the shortage cited in a report by the National Council for Mental Well Being include aging of the current workforce, low reimbursement rates, burnout, burdensome documentation requirements, and restrictive regulations limiting information sharing for coordination of care. They proposed solutions, recommendations, and a call to action to expand the supply of psychiatrists (and other providers). They focus on five areas - workforce development, improved efficiency of service delivery, reducing burdensome regulations and confidentiality restrictions, broader implementation of innovative models, and improving reimbursement for psychiatric services.
I am particularly interested in workforce development. Besides expanding residency training programs, I believe that a potential solution is to shorten the training to three years or promote fourth-year psychiatry residents to junior attending psychiatrists. These residents can focus their last year of training in a particular area (outpatient, inpatient, etc.), working with enhanced salary or bonus. Doing this would benefit both the resident, who will gain more confidence in themselves, and the institution, which will get much-needed staffing. Another possible solution is to create a position for unmatched pre-residency medical graduates, perhaps as psychiatry apprentices. With this available, the apprentices would have the chance to enhance their clinical experience and boost their residency application credentials while providing necessary help to psychiatrists. In the outpatient setting, they can aid by providing documentation on the electronic record, administering scales, writing letters, filling out forms, obtaining prior authorizations, and following up on missed appointments.
Psychiatric nurse practitioners (NPs) are filling the gaps left by the lack of psychiatrists. However, there is also a low supply of experienced NPs. To attract NPs with less experience, multiple places around the country and in New York state have started NP residency or fellowship programs, recruiting new graduates for a one-year paid training program that includes supervised clinical experience and didactics. These businesses also add another year of employment as a regular staff member.
In summary, the psychiatrist shortage in the public sector is a pressing issue. With an increased demand for psychiatric services due to the pandemic, we need to start thinking outside the box to alleviate the situation. I am hopeful that the stakeholders who can make a difference will consider this a priority.
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