Maldistribution and Shortage of Psychiatrists and Child Psychiatrists

This is a reprise of a recent post on my other site “Pen and Psychiatrist.” I apologize to the the reader if you have already read this topic at the other site which deals in more cultural and social issues. But after I posted that entry not too long ago, I realized it more properly belonged on this site, since it deals with one aspect of the mental health reform puzzle in this country.

In my previous life some two decades ago as a young Turk clinical teaching and supervising faculty of psychiatric and child psychiatric residents and fellows in training at Duke Medical Center, I became interested in “manpower” (the vernacular then) or more properly speaking practitioner distribution and training issues of psychiatrists. This was in the so called Golden Age of mental health practice, even though the service delivery system in all disciplines, had serious issues, I and many many others could see the troublesome issue of maldistribution of mental health care professionals that was emerging three decades ago and worsening  year by year. Basically what was evolving was a situation in which desirable places to live, urban areas with urban amenities such as the symphonies, ballet and performing arts companies, university centers, and above all many colleagues around for support and lively continuing education meetings of regional psychology, social work and psychiatry societies, kept graduates of advanced training programs in the regions in which they trained. So over time, it evolved that areas like Boston/Cambridge MA, Raleigh-Durham-Chapel Hill NC (the Triangle Area), Ann Arbor MI, Dartmouth, New York City especially Manhattan, Stony Brooke, Long Island, Houston, Los Angeles, San Francisco, Seattle, Eugene OR, San Diego, Davis CA, Charleston SC, Atlanta GA, Birmingham AL, Albuquerque, Tucson AZ, and many other urban areas became the landing places where psychiatrists trained and often stayed to practice, in the university medical center cities. A good friend and colleague, now passed on Bruce Neeley MD of Duke and Emery, used to give lectures to residents nearing the penultimate stages of their training careers and were a year away from the decision of where to settle to practice. By then the 1980’s the trend had become set in concrete, only a minority of graduating psychiatrists left the training centers and set up practice in under-served areas.

Bruce Neeley and I separately in turn would give almost off the records seminars to the ‘senior residents,’ telling them in so many words, almost like the famous newspaper editor of the 1800’s, “Go West Young Psychiatrist,” In North Carolina we first meant go literally to western North Carolina which I knew very well because of my wife’s origin from Cherokee NC. But we also meant “get out of the urban centers, there are too many of us here already.”

WNC then and sadly still is vastly under-served by psychiatry with a chronic shortage that is almost criminal. I can count on the fingers of one hand the number of child psychiatrists in practice west of Asheville and that is a lot of territory. I used to tell senior residents to “Get out of the RTP [Research Triangle Park, another term used to denote the entire Raleigh-Durham-Chapel Hill area since each of those cities incredibly are only 8 to 15 miles from each other!

Continue reading “Maldistribution and Shortage of Psychiatrists and Child Psychiatrists”

The Continuing Serious Shortage of Child Psychiatrists

I first have to make my disclosure statement: I am a child psychiatrist, in addition to being and adult, and geriatric psychiatrist. I trained and was board certified in all three subspecialties but I am a child psychiatrist and that will necessarily makes its way into this post and I wish the reader to know that up front.

The Arab news agency Al-Jazeera had a very recent article that caught my week several days ago. It was entitled: “Shortage of child psychiatrists plagues the US.” It appeared June 25, 2015. It was very fair and well done and I appreciated the factual, accurate and in depth reporting that went into it. But as an American and a child psychiatrist, it stung a little. One of our 30 year old problems that we have unconscionably neglected and is a big part of our present self inflicted, national “mental health crisis” is catching the attention of the foreign press more and more. This hurts. And part of why it hurts is that the venerable, sort of business-y conservative, Wall Street Journal has been reporting on the shortage of child psychiatrist now for well over a decade. If the reader will Google ‘child psychiatrist shortage Wall Street Journal’ you will get a few pages of listings of well done articles published in the past by the Wall Street Journal in past years.

Continue reading “The Continuing Serious Shortage of Child Psychiatrists”

Unintended Consequences of Mental Health Care Delivery Reform

A small town newspaper can often offer a startlingly accurate portrayal of policy governmental changes not noticed, or reported upon by the mega-media in many locales. One such North Carolina very small regional newspaper is the Laurinburg NC Exchange. This town is likely unknown to 99% of my readers unless you are from northeastern NC, an area to the east of Interstate 85 as it curves north from Durham “The City Of Medicine” toward the state border with Virginia. It has a proud heritage of being a center of Scot (not “Scottish”) culture with an annual festival with the wearing of clan tartans and kilts.

The Laurinburg NC Tartans
The Laurinburg NC Tartans

Just three weeks ago, one of its weekly lady columnists that all Southern papers worth their while seem to have to comment on the higher ordinations of life, Ms. Mary Katherine Murphy, published a most perceptive piece of analysis entitled, “State of Mental Health: Barriers Impede Treatment.” As this is what I blog about in large part, this piece caught the ever roving eye of one of now well trained roving Google searchbots, and snagged this piece for persual. Ms. Murphy may be from a small town area and culture but her piece is well worth reading for anyone interested in this 15-20 year crisis in the  social fabric of our country. I would most strongly recommend it if I had the power to do so, to policy wonks and governmental planners, scholars in research and “think tanks” of all political stripes in this country for thorough pondering. It is that good in its brief but very on target two pages.

Continue reading “Unintended Consequences of Mental Health Care Delivery Reform”