Child Psychiatrist Shortage

In his letter in the August 17 issue, Dr. Robert Fintzy raised skepticism on workforce recommendations cited in an article in the April 20 issue on the great need for child psychiatrists. He described his personal experiences of diminishing access to child patients as a reason for early retirement, primarily due to managed care constraints.

I agree with Dr. Fintzy that managed care made the traditional psychodynamic and psychoanalytic mode of child and adolescent psychiatric practice almost impossible unless the family can afford private pay. We are sometimes surprised to hear that our psychoanalyst teachers now prescribe psychotropic drugs to children, the very teachers who used to question the motivation/countertransference issues when a resident proposed an option of medication—“Why do you want to poison a child?”

Child and adolescent psychiatrists have had to adapt to changes in society’s culture, scientific database, and reimbursement system. We all envied colleagues who could afford early retirement without having to undergo the painful transformation caused by the managed care trends of the last several years. However, the message that there are no families who can afford access to child and adolescent psychiatrists is not correct. On the contrary, in a survey of almost 3,000 graduating residents and fellows of all specialties in New York state in 2000, child and adolescent psychiatry ranked first and second, respectively, in terms of job flexibility and the number of job offers per resident (6.5). The mean starting salary of $129,900 ranked 15th of 28 specialties and ranked second in the rate of increase in the past two years. (This information can be found in “Residency Training Outcome by Specialty in 2000 for New York State” posted at http://chws.albany.edu.)

I’m perplexed by the increasing number of child and adolescent psychiatry private practices that are paid out of pocket. It seems that there is some ethical dilemma since our specialty is not like plastic surgery. There have been numerous studies over the years to point to the unequivocal need for more child and adolescent psychiatrists. Child and adolescent psychiatry practice has been transforming like any other medical specialty in recent years but still is as exciting and rewarding a field as ever.

We need more vigorous and well-trained child and adolescent psychiatrists like Dr. Fintzy. We would like to recall Dr. Fintzy from his early retirement to share the burden of caring for so many needy children and adolescents in our nation.

Dr. Kim was cochair of the Task Force on Work Force Needs of the American Academy of Child and Adolescent Psychiatry from 1999 to 2001.