Shirah Vollmer MD

The Musings of Dr. Vollmer

Is Psychiatry Popular Amongst Medical Students?

Posted by Dr. Vollmer on December 17, 2014

 

 

“Consider these numbers. While 37.6% of practicing physicians are age 55 or older, in psychiatry nearly 55% are in this age range, ranking as the second oldest group of physicians, surpassed only by preventive medicine. Part of this aging cohort effect is the low rate of medical school graduates choosing psychiatry. Only 4% of US medical school seniors (n = 698) applied for one of the 1097 post-graduate year one training positions in psychiatry2. As Dr. Roberts noted, it is troubling that the area of medicine addressing the leading source of medical disability is also facing a shortage of new talent. Indeed, over the past decade the number of psychiatry training programs has fallen (from 186 to 181) and the number of graduates has dropped from 1,142 in 2000 to 985 in 2008. In spite of the national shortage of psychiatrists, especially child psychiatrists, 16 residency training programs did not fill with either U.S. or foreign medical graduates in 20113.”

http://www.nimh.nih.gov/about/director/2011/psychiatry-where-are-we-going.shtml

So, Shelly is right! Fewer medical students are going into psychiatry, creating a shortage of psychiatrists in this country. And yet, on the Westside of Los Angeles, there is no shortage. In addition to declining numbers, psychiatrists clump together in affluent areas, so they are not evenly distributed throughout the country. My  “club” is smaller and older than it used to be for reasons that make me speculate about the changing nature of psychiatry. Seeing quick-fixes, not only does not hit the deeper issues of mental health, it also does not satisfy the deep craving, in many prospective psychiatrists, to drill down into the mental apparatus, curious about motivation, feelings, and thoughts.

Who are these four percent of medical students opting for a career as a psychiatrist? Do they, like the joke implies, hate blood? Or, are they the “humanities type,” who only went to medical school to please a parent, and once there, wanted to revert back to their primary interest in literature, which psychiatry most resembles. Or, are they are neuroscientists of the future, studying nematodes as a window into the human brain? Or, do they see a “lifestyle choice,” as a physician who by and large has little on-call duties? Or, maybe they have had their own psychic trauma, pushing them towards helping others, and maybe helping themselves at the same time? I wonder. I talk to prospective psychiatry residents on a weekly basis, as they tour around the country looking for their next step, their residency. I see the “best and the brightest,” meaning that the students I chat with have impressive accomplishments and strong verbal skills. They all seem like a wonderful addition to my field, but my field needs to utilize their intelligence to its maximal good for patient care, not minimize the need for intelligence, and propose superficial treatments for deep problems.

7 Responses to “Is Psychiatry Popular Amongst Medical Students?”

  1. Shelly said

    Shirah, getting a touch away from the subject of this blog, if you look close enough at anyone’s interior, doesn’t everyone “have deep problems?” Doesn’t everyone think that what they are experiencing is the worst, the hardest, the most troubling? How can psychiatrists discern people who are really ill and those who are troubled (isn’t everyone, at some level)? Perhaps this is why your students aren’t choosing psychiatry? Because helping troubled people isn’t considered necessarily “medicine,” whereas treating physical ills is?

    • Looking at the interior, the emotional interior, that is, does yield some interesting understandings of the level of maturity and narcissism in different people, and at different times in their lives. To go to the “why me” place, or the “I have it the worst” place typically signals a deep wound, but it does not necessarily correspond to external trauma. There are ways of separating out levels of mental functioning through psychiatric assessment. This is an art, and not a science, and as such, only some people are drawn into this line of work.
      On another note, primary care also is a relatively unpopular field, as the popular fields are very specialized and very technical, so I am not sure the old adage that people want to be “real doctors” is why students shy away from psychiatry. Medicine has a lot of cool “toys” these days, which many technically oriented students are drawn to. As my doctor told me when she referred me to get a technical test, “he is good at videogames, so I am sure he will be good for this.” The “toys” in psychiatry, are limited, at least for now. Thanks.

      • Eleanor said

        “Emotional interior”….what an easy understandable term for the layperson to “get” the idea of deeper layers of functioning. The thought of the psychodynamic approaches in psychiatry and psychology gradually disappearing is so very very sad to me. To define our human condition superficially is an insult to our deeply important complexity and “humanness”. I quite literally cannot imagine my life without the ability to think as I do now. Those who stay in the field for the few patients who want the deeper approaches are to be commended.

        • Thanks, Eleanor. Although fewere psychiatrists are entering psychoanalytic training, there are many non-MDs involved, so psychodynamic psychotherapy will continue. The landscape of professionals are changing, and like you, that makes me sad.

          • Eleanor said

            Shirah are the majority of these non-physicians practicing the psychodynamic approach to therapy members of and/or approved (licensed?) by the ApsA? Just wondering .

            • Eleanor said

              Sorry one other question…is a self/training analysis a usual or expected training requirement of non physicians? Thanks

            • Hi Eleanor..that is a complicated question. Analytic institutes come in many varieties, some are affiliated with the American Psychoanalytic (ApsA), some affiliated with the international Psychoanalytic Association (IPA), and some not affiliated with either organization, but they still call themselves psychoanalytic institutes. Further, all of these institutes have “full” programs which means four years of classes, three control cases with supervision and a piece of writing to demonstrate mastery of the material. The institutes also have smaller programs which are 1-2 years and do not require the rigor of the “full” program. Those who go to the “full” program are required to have their own analysis, but again the requirements are variable and there is little accountability with regards to this. Many people represent themselves as psychoanalysts and so the lay public has little way of knowing their training or their institution that they are affiliated with. To make matters more complicated the people that go into psychoanalytic training may be doctoral level or masters level or doctoral level, but not in a field of mental health. Thanks.

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