A Belated Memorial: Bye Bye to Cedars Psychiatry Training Program
Posted by Dr. Vollmer on September 18, 2013
I am reminded today of a major closure of an adult psychiatric residency and a child psychiatry fellowship in my town. Although this closure happened over a year ago, the ripples are still important. Less psychiatrists will be trained in the United States, and patients in Los Angeles will have fewer mental health resources to access. The sadness around this closure is enormous, both for the faculty, the graduates, and what, were at the time, current trainees. The reason for this closure is confusing, at least to me, but I can assume, there were large financial concerns, anticipating the change in reimbursement from Medicare, which funds a good percentage of Graduate Medical Education (GME). Once again, I surmise that the death of this program suggests that psychiatry is losing it’s place in medicine. I should add that Cedars-Sinai has maintained a Consultation-Liaison service and an Addiction Medicine service, but these are run by trained physicians, and so Cedars-Sinai is no longer giving birth to new and well-trained psychiatrists.
I wonder to myself why I did not blog about this major Los Angeles mental health event last year, and with wild speculation, I think it was just too painful. I know too many faculty members who lost their class, and I know too many patients who have difficult choices about how to continue their care. I also worry that this closure speaks to my broader concern that medicine is so focused on outcome measures, that psychiatry, with few good outcome measures, will deteriorate to a specialty that medical students will not see as desirable, and patients will not feel the freedom to access.
What does it mean that a major Los Angeles medical center closed their psychiatry department, with the exception, as mentioned of consultation-liaison and addiction? I think it means that specialties with machines, good metrics, will flourish, whereas specialties that want to sit with patients through their struggles will flounder. I know that there will always be room for people who want to comfort the mentally and physically ill, but my concern is that these professionals need to be well trained in body, mind and soul. Their training needs to be accessible and it needs to be able to ultimately pay off their massive debts. Should Medicare change their funding of GME, then it is possible that other psychiatric training programs will also close their doors. Psychiatry, simply put, does not pay for itself. It requires government assistance to keep these training programs alive.
The withdrawal of this assistance, might seem like a reasonable choice, given the expense of health care, but, on the other hand, does the apparent rise in these gun massacres, have anything to do with the diminishing psychiatric resources? If there were a connection, would this justify having the government supplement more psychiatric residencies and child psychiatry fellowships? Would more psychiatrists diminish the excessive use of medical resources to evaluate and treat psychosomatic disorders? I think so, but I have no data to back me up. The longitudinal studies needed to get this data are enormous. Should we, as a society, have to wait, or should we use our intuition? If your husband, or wife, or mother, was killed by Aaron Alexis, maybe the argument would feel stronger? Sure, maybe he would never have sought treatment and the same tragedy would have happened, but every time there is a reduction of services, we have to think about the unintended consequences.