Specialists in geriatric and child and adolescent psychiatry say the workforce shortages in California highlighted by a recent report by the Center for Health Professions at the University of California at San Francisco are reflective of a national problem.

Lois Flaherty, M.D., chair of APA’s Council on Children, Adolescents, and Their Families, said the shortfall in child psychiatrists nationally has been a continuing theme dating back almost to the beginning of child psychiatry as a specialty. The American Academy of Child and Adolescent Psychiatry has a statement on the subject taking the federal government and organized medicine to task for a rigid adherence to the notion that there are too many specialists.

"The need and voice of child and adolescent psychiatry have been buried under the sweeping forces of the federal mandates and national medical organizations’ consensus on the oversupply of specialists," the AACAP statement says. "They have failed to recognize the continuing critical shortage of child and adolescent psychiatrists. There is a danger of becoming marginalized when the profession cannot provide needed services and contribute to society. The serious undersupply of practitioners has resulted in children receiving inadequate care from mental health professionals who lack the necessary training."

Flaherty said that APA and AACAP have been pursuing strategies to rectify the shortage, including changes in the structure of subspecialty training—such as "integrated" psychiatry programs that would allow residents to begin their subspecialty training earlier while still residents in general psychiatry. "There are some programs around the country, and we would like to see this more widespread," she said.

APA has initiated a program to fund general psychiatry residents interested in child psychiatry to attend APA’s annual meeting for two years in a row, with a leading practitioner in child psychiatry as a mentor. "One of the expectations is that the resident will give a presentation in the second year," Flaherty told Psychiatric News.

Geriatric psychiatrists, too, said that the report’s predictions of shortage are not surprising and not confined to California. "It is important that this task force report is calling attention to the manpower shortage in geriatric psychiatry," said Kenneth Sakauye, M.D., chair of APA’s Council on Aging. "It may be a crisis now, but it is going to be even worse 10 years from now."

Sakauye said 40 percent of residency slots in geriatric psychiatry have gone unfilled. "There aren’t enough trainees in the pipeline, so we won’t even be able to keep up with those who are retiring," he told Psychiatric News.

Sakauye said there is a perception among early career psychiatrists that the restrictions on reimbursement for care of the elderly are so great that "you can’t make a living."

That perception is not far from the truth. "Medicare brags about disallowing 40 percent of nursing home bills," he said. The government makes "it almost impossible for private practitioners to get reimbursed for the work that they do."