Shirah Vollmer MD

The Musings of Dr. Vollmer

Child Psychiatry Shortage: Impact?

Posted by Dr. Vollmer on June 28, 2016

“There are only about 8,500 child psychiatrists in America, not nearly enough for the estimated 15 million kids who need one, the American Academy of Child and Adolescent Psychiatry says. On the local level, the shortfall becomes more pronounced. No individual state meets the AACAP’s standard of 47 child psychiatrists for every 100,000 children 17 or younger — or one for every 2,127 kids. In Wyoming, there is one child psychiatrist for 22,960 children, and in Texas the ratio is one per 12,122. Only Washington D.C., enjoys what the group calls “sufficient supply,” with one child psychiatrist for every 1,797 children.”

 

The mantra that there are not enough child psychiatrists in the US, as stated above, comes from the American Academy of Child and Adolescent Psychiatry. A group that I respect and often attend their professional meetings. Yet, I question this assertion. Child Psychiatrists, by and large, prescribe medication, and as such, they help some children, while, at the same time, they, as a profession, are guilty of over-prescribing medication to children who could benefit more from behavioral and/or psychological interventions. So, it is not clear to me that the problem is physician supply, but rather I see the problem as the need to re-define the job of the child psychiatrist. If the child psychiatrist were in charge of systems of care for children, we would not need more child psychiatrists, but rather we would need to change the training of child psychiatrists to include leadership skills to improve the health and welfare of children and their families. If we do not train child psychiatrists to take the aerial view of the profession, and we continue to train them to take a piecemeal view of children, then training more child psychiatrists will not help. We need to learn how to be thought leaders, and as such, we need to learn how to execute our ideas into a major overhaul of mental health for children which includes wellness centers, home visits, and family interventions. Medication can be a piece of this, but, it is only one of many pieces. This is the message that we need to get out to policy makers. Incentivizing child psychiatry by loan repayment programs or higher salaries are not the answer. The field needs to change its focus. There, I have said it again.

 

 

2 Responses to “Child Psychiatry Shortage: Impact?”

  1. Shelly said

    Bravo! I think child psychiatrists being in charge of systems of care, with teams made up of psychologists, therapists, social workers and others to actually give the care would be an excellent idea and this could have very far-reaching implications. That would mean that you wouldn’t necessary feel the loss of so many child psychiatrists or the lack of specialization in this field so deeply when young residents choose to specialize in other fields. Your wellness centers are another great idea, family interventions too. You’re right, your field does need to change.

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