AACAP to Step Up Search For More Child Psychiatrists
The American Academy of Child and Adolescent Psychiatry (AACAP) issued a bold call to action at its annual meeting in San Francisco in October to increase the number of child and adolescent psychiatrists by 10 percent annually for 10 years beginning in 2004.
The call to action was taken to reverse the shortage of child and adolescent psychiatrists in the United States. There are about 6,300 of these specialists to care for the 15 million children and adolescents who need their services, according to the strategic plan, “A Call to Action: Children Need Our Help.”
Marilyn Benoit, M.D.: “We must examine our residency training programs to understand how we can attract more bright young medical students into the profession.”
The strategic plan focuses on three initiatives to promote interest in the subspecialty. They involve creating an attractive image of child psychiatry, developing flexible training programs, and supporting strategies to increase child psychiatrists’ reimbursement rates and funding for residents and training programs.
Lois Flaherty, M.D., chair of the APA Council on Children, Adolescents, and Their Families, commented in an interview with Psychiatric News, “The plan represents an impressive commitment of resources by AACAP and a multipronged approach to recruitment that can be implemented simultaneously.”
Inadequate recruitment into child and adolescent psychiatry has persisted for several years, said Flaherty. “Despite numerous conferences and discussions, not much has changed in terms of actual initiatives with the exception of the triple-board program [Original article: see story below], which exists only in a few medical centers and is not contributing much to the pool there.”
She continued, “I think the two most important initiatives in the strategic plan are supporting legislation to allow loan forgiveness for medical students, sponsored by Rep. Patrick Kennedy [D-R.I.], and developing flexible pathways to training in child and adolescent psychiatry, such as the four-year concentration [in that field] that would allow pediatricians direct entry.”
The first initiative calls for AACAP to increase its communication to medical students and general psychiatry residents, expand mentoring opportunities, and develop a public relations campaign to counter negative images of the profession.
The Steering Committee on Work Force Issues, which developed the strategic plan, has held focus groups with minority medical students and general psychiatry residents to determine barriers to recruitment, according to co-chair Tom Anders, M.D. Many minority medical students reported that they became interested in the subspecialty through mentors or other child and adolescent psychiatrists they met during their psychiatry rotation, according to a summary of their group meeting.
They also reported, however, that the dearth of child and adolescent psychiatry faculty at medical schools creates a vacuum in which stigmatizing stereotypes about the profession flourish.
Delayed Gratification an Issue
The steering committee reported in the strategic plan that 75 percent of general psychiatry residents who plan to train in child and adolescent psychiatry don’t follow through.
The vast majority of child psychiatry programs require two years of training after the completion of general psychiatry training, which usually runs three to four years, said Anders.
“General psychiatry residents headed for child psychiatry training may consider this sequence too long and expensive. They may become more interested in other adult subspecialties, including geriatrics and forensics,” said Anders.
The minority medical student focus group reported that their peers are less likely to enter child psychiatry training because they have to wait so long to work with children, which is less gratifying than if they were to have contact with them early on.
Alternatives Proposed
The AACAP plan proposes several alternatives to the traditional training program that may appeal to a broad range of medical students and physicians, said Anders. These include the following:
• A four-year program focused on child and adolescent psychiatry without adult psychiatry training. This option may appeal to family practitioners and pediatricians who want to be eligible only for the child psychiatry board exam.
• A four- or five-year program integrating child and adult psychiatry training that would expose residents to child training sooner and would result in eligibility for adult and child psychiatry board certification.
• A six-year program also integrating child and adult psychiatry with an additional year for research in child psychiatry to prepare residents for academic careers.
James Leckman, M.D., chair of the AACAP Task Force on Training and Education, is developing the curricula for the integrated child and adolescent psychiatry training programs. The first year is an internship in pediatrics and neurology focusing on children and developmental issues, Leckman said at the AACAP meeting.
“The second year is designed to teach residents basic skills derived from the latest science such as using practice parameters, neuroimaging techniques with children, and conducting clinical trials,” said Leckman.
Child and adult psychiatry training would be integrated into the third and fourth years. The fifth year would involve specialized electives with children, adults or families, Leckman noted.
He is seeking medical schools to pilot the proposed curricula to determine their effectiveness and residents’ career satisfaction, according to Anders.
Funding Initiative Crucial
The third initiative in the plan calls for advocacy strategies to increase the reimbursement rates for child psychiatry treatment and for legislation to ease the financial burden on child psychiatry trainees and training programs, said Anders.
Retaining child psychiatrists is as important as recruitment and is linked to adequate reimbursement rates, said Gregory Fritz, co-chair of the Steering Committee on Work Force Issues, in an interview. “We lose more child psychiatrists to adult psychiatry because [adult psychiatrists] are paid the same amount of money for diagnostic evaluations that are less complex and time intensive” than ones for children.
“Our members in Massachusetts worked with Magellan this past year to obtain significant increases in child psychiatry evaluation rates. We are urging our members in their regional organizations to use the Massachusetts experience as a model to achieve similar adequate reimbursement rates throughout the country,” said Anders.
AACAP’s strategic plan, “Call to Action: Children Need Our Help,” is posted on the Web at www.aacap.org with a link to the document. ▪
