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As a psychiatry resident in the early 1980s, Carol A. Bernstein, MD, remembers a teaching setting where young physicians worked long hours, male residents outnumbered female residents, and messages were delivered in the form of handwritten notes.
Today, the learning environment for psychiatry residents is vastly different. Duty-hour restrictions are routine, the gender gap has narrowed, and electronic communication in its many forms, is the norm. Medical advancements give residents a greater ability to treat patients and improve illnesses, said Dr. Bernstein, a clinical psychiatry professor and vice chair for education in psychiatry at New York University. However, residents also face a range of modern challenges, such as higher learning expectations, a more litigious culture, and a practice landscape increasingly reliant on ratings and patient satisfaction scores.
“This is a generation – whether you want to call it the Millennials or the iGen – [who have] been pushed to do more and more,” said Dr. Bernstein, a past president of the American Psychiatric Association. “Medical care has become very complicated, and it is very hard for trainees to get mastery of it.”
At the same time, the digital world that today’s residents are accustomed to has become a double-edged sword in medical education, said Donna M. Sudak, MD, outgoing president of the American Association of Directors of Psychiatric Residency Training. Technology has generated new ways of learning, such as online modules, but also created opportunities for distraction, she said.
“All of us, our learners as well as ourselves, need to figure out the best balance of using technology in order to facilitate learning,” Dr. Sudak said. “The pro is having the world at your fingertips and the ability to work with other people across the country. The con is the temptation to be attached to your screen, rather than truly listening to the person you’re in the room with – as a psychiatrist, that’s even more critical.”
The new faces of psychiatry
Interest in psychiatry has grown steadily over the years. In 2018, 2,739 medical school graduates ranked for a PGY-1 psychiatry residency, up from 1,806 ranked applicants in 2008, according to data from the National Residency Matching Program. Of the 2018 ranked applicants, 1,540 matched to a residency program. Data from the Association of American Medical Colleges (AAMC) show that 47% of psychiatry residency applicants in 2018 were women.
Millennial graduates are choosing psychiatry for a variety of reasons. For Nina Vasan, MD, MBA, the career path meant an opportunity to make a broader impact.
“Mental health is a defining social issue of our time, and in medical school I felt like if I committed my time and energy to improving mental health, I would maximize the impact I make on the world,” said Dr. Vasan, who finished residency at Stanford (Calif.) University in 2018. “I feel even stronger about that today. … I felt drawn to both the fundamental way in which we get to connect with our patients on an individual level and impact their lives, as well as the broader societal-level change that must happen in the coming years that I want to be a part of.”
A sense of social responsibility is a common trait of this generation’s psychiatrists, said Dr. Vasan, who has a private concierge practice in the Silicon Valley.
“We have a global sense of the world and recognize that our role as physicians gives us the unique platform to make an impact at this level,” she said.
Graduates also are attracted to psychiatry because of its focus on the physician-patient connection, particularly as patient time is eroded in other specialties, such as primary care, Dr. Sudak said.
“People who become physicians really want to have relationships with patients, and if you have to see eight people an hour, that’s a tough go,” she said. “Many people are attracted to the capacity to really learn about somebody’s story and make a difference in their life. Psychiatry offers that and then some.”
Working closely with patients to improve their quality of life was a primary motivator for Steven Chan, MD, MBA, who completed his psychiatry residency at the University of California, Davis, in 2016. He currently serves on the addiction treatment services team at the VA Palo Alto Health Care System.
“I additionally pursued a subspecialty in clinical informatics to apply today’s technologies to further improve people’s lives,” he said.
Dr. Chan said he is fortunate to practice in a work environment that is more collaborative with other health professionals than in the past.
“It’s wonderful,” he said. “There’s so much work to be done, and working with others has been rewarding to me. We’re already seeing more psychiatrists take on leadership roles in technology and health care administration, so we’re seeing collaborations with informatics, engineers, and service designers.”
A sea of challenges
Despite the advantages of practicing in modern times, psychiatrists today also face unique challenges, such as an upcoming shortages of physicians.
A 2017 report by the National Council for Behavioral Health estimates that, by 2025, demand might outpace supply by up to 15,600 psychiatrists. An aging population of psychiatrists is part of the problem. Sixty percent of practicing psychiatrists are older than 55, one of the highest volumes of older doctors of all specialties, according to AAMC data.
Physician numbers are improving, but a crisis point looms, especially as more states pass legislation that target the so-called dangerously mentally ill, said Annette L. Hanson, MD, a forensic psychiatrist who is assistant professor of psychiatry at the University of Maryland and at Johns Hopkins University, both in Baltimore.
“The trend seems to be that governments want to provide more involuntary or forced care, which means you’re going to need to have doctors available to provide that care,” Dr. Hanson said in an interview. “We don’t have enough doctors to meet the public policy demand.”
Compounding the problem is the fact that the majority of new psychiatrists pursue community private practices in urban areas, rather than practicing in state hospitals or rural areas, Dr. Hanson added. In addition, some states are passing laws that require state hospitals to admit incompetent criminal defendants within a certain time frame.
“That’s created significant problems where you’re moving someone from an overcrowded, understaffed jail to overcrowded, understaffed hospital,” she said.
The growing use of telepsychiatry might be one answer to the upcoming shortage. A June 2018 letter from the Centers for Medicare & Medicaid Services encouraged more states to use health technology efforts to address the opioid crisis, including through telemedicine and telepsychiatry. Meanwhile, several states have expanded their controlled substance laws to allow remote prescribing through telehealth for the treatment of psychiatric or substance use disorders.
However, licensing issues and reimbursement inconsistencies continue to act as barriers to the practice of telepsychiatry, according to the National Council report.
Some academic institutions are crafting new ways to use technology to meet the demand for mental health care. At Stanford, for example, Dr. Vasan started a lab called Brainstorm, the Stanford Laboratory for Brain Health Innovation and Entrepreneurship, which unites medicine, business, technology, and design to develop tech products for patients. She also chairs Stanford’s Mental Health Technology Hub, a consortium of more than 20 faculty labs addressing the role technology plays in improving mental health.
“We psychiatrists need partners to help increase access to mental health prevention, diagnosis, and treatment,” Dr. Vasan said. “Technology can be that partner.”
Improving diversity is an ongoing challenge for the field, said Dr. Sudak, also professor and vice chair for education in the department of psychiatry at Drexel University in Philadelphia. Of practicing psychiatrists, 42% declare as white, 8% as Asian, 4% as black, and 4% as Hispanic, according to the latest workforce data published by the AAMC. By comparison, 61% of the U.S. population is white, while 18% is Hispanic, 13% is black, and 6% is Asian, according to recent census statistics. By 2044, more than half of all Americans are projected to belong to a minority group.
“In general, we know that more diversity will enhance outcomes of care for our patients,” Dr. Sudak said. “When I talk about workforce, I think about that piece as a significant part of the equation. It’s not just about getting more slots, but it’s about filling those slots with a population of trainees that mirrors the population, rather than mirrors a very small subset.
Training changes
One of the biggest changes affecting residency training today is the decreased length of stay for inpatients, Dr. Hanson said. When she was a resident, the average length of stay was about 3 weeks, compared with 7-10 days now.
“The challenge is sorting out an underlying psychiatric condition from the effects of substances, which is really difficult with that short of a length of stay,” she said. “You lose a longitudinal perspective if you don’t have a chance to observe someone once they’ve been stabilized and the crisis has passed and they’re detoxified from the substances they were using prior to admission.”
The arrival of electronic medical records also has affected the trainee experience by taking time away from the doctor-patient relationship, Dr. Bernstein said. Other technology, such as algorithms used to avoid mistakes, have become both helpful and harmful.
“[Having the technology] is very good, but people have to learn how to think,” Dr. Bernstein said. “There’s a lot of medicine that’s an art, and in psychiatry even more so. You don’t have the blood tests or the imaging tests that other specialties have, and that is both our advantage and our disadvantage.”
In the future, technology will continue to have a central role in residency training, experts said. Already, independent study using technology has become the norm, Dr. Hanson said. When students are in a more structured environment, technology such as cell phones, can act as a distraction, she noted.
“I’ve decided to embrace it and use it,” she said. “My approach is to co-opt the cell phones. Periodically, during a talk, I may put up a website that has a pop quiz on it [in which] students use their cell phones to answer.”
Certainly, efforts to build diversity will be a continued focus for the specialty, said Dr. Sudak. In addition, residency might shift from less inpatient training to more subspecialty rotations for general psychiatry training, she said.
“We will need to teach residents to retain a focus on the patient as a person and use outcomes to help guide treatment,” she said.
Dr. Bernstein would like to see the pendulum swing back on such rigid duty hours, she said, with more emphasis placed on building residents’ confidence in managing complex cases and preparing trainees for overcoming adversity.
Dr. Vasan envisions more integration of psychiatry with neurology and the rest of medicine, more training in business elements, such as managing teams and a practice, as well as education on technological tools for psychiatrists.
From a broader perspective, Dr. Vasan hopes that the stigma around mental health will continue to improve and that society at large becomes more supportive of the work of psychiatrists.
“In some ways it seems like we have come far in openly discussing and understanding mental illness, as well as the fact that having these diseases does not need to hold anyone back from realizing their potential,” she said. “But not far enough. The public’s understanding of the scope of the problem and the urgency and value for addressing mental health has increased tremendously.
“Our colleagues in other fields of medicine, employers, politicians, educators ... they all value, seem to value psychiatry more, and I hope this continues to grow.”
As a psychiatry resident in the early 1980s, Carol A. Bernstein, MD, remembers a teaching setting where young physicians worked long hours, male residents outnumbered female residents, and messages were delivered in the form of handwritten notes.
Today, the learning environment for psychiatry residents is vastly different. Duty-hour restrictions are routine, the gender gap has narrowed, and electronic communication in its many forms, is the norm. Medical advancements give residents a greater ability to treat patients and improve illnesses, said Dr. Bernstein, a clinical psychiatry professor and vice chair for education in psychiatry at New York University. However, residents also face a range of modern challenges, such as higher learning expectations, a more litigious culture, and a practice landscape increasingly reliant on ratings and patient satisfaction scores.
“This is a generation – whether you want to call it the Millennials or the iGen – [who have] been pushed to do more and more,” said Dr. Bernstein, a past president of the American Psychiatric Association. “Medical care has become very complicated, and it is very hard for trainees to get mastery of it.”
At the same time, the digital world that today’s residents are accustomed to has become a double-edged sword in medical education, said Donna M. Sudak, MD, outgoing president of the American Association of Directors of Psychiatric Residency Training. Technology has generated new ways of learning, such as online modules, but also created opportunities for distraction, she said.
“All of us, our learners as well as ourselves, need to figure out the best balance of using technology in order to facilitate learning,” Dr. Sudak said. “The pro is having the world at your fingertips and the ability to work with other people across the country. The con is the temptation to be attached to your screen, rather than truly listening to the person you’re in the room with – as a psychiatrist, that’s even more critical.”
The new faces of psychiatry
Interest in psychiatry has grown steadily over the years. In 2018, 2,739 medical school graduates ranked for a PGY-1 psychiatry residency, up from 1,806 ranked applicants in 2008, according to data from the National Residency Matching Program. Of the 2018 ranked applicants, 1,540 matched to a residency program. Data from the Association of American Medical Colleges (AAMC) show that 47% of psychiatry residency applicants in 2018 were women.
Millennial graduates are choosing psychiatry for a variety of reasons. For Nina Vasan, MD, MBA, the career path meant an opportunity to make a broader impact.
“Mental health is a defining social issue of our time, and in medical school I felt like if I committed my time and energy to improving mental health, I would maximize the impact I make on the world,” said Dr. Vasan, who finished residency at Stanford (Calif.) University in 2018. “I feel even stronger about that today. … I felt drawn to both the fundamental way in which we get to connect with our patients on an individual level and impact their lives, as well as the broader societal-level change that must happen in the coming years that I want to be a part of.”
A sense of social responsibility is a common trait of this generation’s psychiatrists, said Dr. Vasan, who has a private concierge practice in the Silicon Valley.
“We have a global sense of the world and recognize that our role as physicians gives us the unique platform to make an impact at this level,” she said.
Graduates also are attracted to psychiatry because of its focus on the physician-patient connection, particularly as patient time is eroded in other specialties, such as primary care, Dr. Sudak said.
“People who become physicians really want to have relationships with patients, and if you have to see eight people an hour, that’s a tough go,” she said. “Many people are attracted to the capacity to really learn about somebody’s story and make a difference in their life. Psychiatry offers that and then some.”
Working closely with patients to improve their quality of life was a primary motivator for Steven Chan, MD, MBA, who completed his psychiatry residency at the University of California, Davis, in 2016. He currently serves on the addiction treatment services team at the VA Palo Alto Health Care System.
“I additionally pursued a subspecialty in clinical informatics to apply today’s technologies to further improve people’s lives,” he said.
Dr. Chan said he is fortunate to practice in a work environment that is more collaborative with other health professionals than in the past.
“It’s wonderful,” he said. “There’s so much work to be done, and working with others has been rewarding to me. We’re already seeing more psychiatrists take on leadership roles in technology and health care administration, so we’re seeing collaborations with informatics, engineers, and service designers.”
A sea of challenges
Despite the advantages of practicing in modern times, psychiatrists today also face unique challenges, such as an upcoming shortages of physicians.
A 2017 report by the National Council for Behavioral Health estimates that, by 2025, demand might outpace supply by up to 15,600 psychiatrists. An aging population of psychiatrists is part of the problem. Sixty percent of practicing psychiatrists are older than 55, one of the highest volumes of older doctors of all specialties, according to AAMC data.
Physician numbers are improving, but a crisis point looms, especially as more states pass legislation that target the so-called dangerously mentally ill, said Annette L. Hanson, MD, a forensic psychiatrist who is assistant professor of psychiatry at the University of Maryland and at Johns Hopkins University, both in Baltimore.
“The trend seems to be that governments want to provide more involuntary or forced care, which means you’re going to need to have doctors available to provide that care,” Dr. Hanson said in an interview. “We don’t have enough doctors to meet the public policy demand.”
Compounding the problem is the fact that the majority of new psychiatrists pursue community private practices in urban areas, rather than practicing in state hospitals or rural areas, Dr. Hanson added. In addition, some states are passing laws that require state hospitals to admit incompetent criminal defendants within a certain time frame.
“That’s created significant problems where you’re moving someone from an overcrowded, understaffed jail to overcrowded, understaffed hospital,” she said.
The growing use of telepsychiatry might be one answer to the upcoming shortage. A June 2018 letter from the Centers for Medicare & Medicaid Services encouraged more states to use health technology efforts to address the opioid crisis, including through telemedicine and telepsychiatry. Meanwhile, several states have expanded their controlled substance laws to allow remote prescribing through telehealth for the treatment of psychiatric or substance use disorders.
However, licensing issues and reimbursement inconsistencies continue to act as barriers to the practice of telepsychiatry, according to the National Council report.
Some academic institutions are crafting new ways to use technology to meet the demand for mental health care. At Stanford, for example, Dr. Vasan started a lab called Brainstorm, the Stanford Laboratory for Brain Health Innovation and Entrepreneurship, which unites medicine, business, technology, and design to develop tech products for patients. She also chairs Stanford’s Mental Health Technology Hub, a consortium of more than 20 faculty labs addressing the role technology plays in improving mental health.
“We psychiatrists need partners to help increase access to mental health prevention, diagnosis, and treatment,” Dr. Vasan said. “Technology can be that partner.”
Improving diversity is an ongoing challenge for the field, said Dr. Sudak, also professor and vice chair for education in the department of psychiatry at Drexel University in Philadelphia. Of practicing psychiatrists, 42% declare as white, 8% as Asian, 4% as black, and 4% as Hispanic, according to the latest workforce data published by the AAMC. By comparison, 61% of the U.S. population is white, while 18% is Hispanic, 13% is black, and 6% is Asian, according to recent census statistics. By 2044, more than half of all Americans are projected to belong to a minority group.
“In general, we know that more diversity will enhance outcomes of care for our patients,” Dr. Sudak said. “When I talk about workforce, I think about that piece as a significant part of the equation. It’s not just about getting more slots, but it’s about filling those slots with a population of trainees that mirrors the population, rather than mirrors a very small subset.
Training changes
One of the biggest changes affecting residency training today is the decreased length of stay for inpatients, Dr. Hanson said. When she was a resident, the average length of stay was about 3 weeks, compared with 7-10 days now.
“The challenge is sorting out an underlying psychiatric condition from the effects of substances, which is really difficult with that short of a length of stay,” she said. “You lose a longitudinal perspective if you don’t have a chance to observe someone once they’ve been stabilized and the crisis has passed and they’re detoxified from the substances they were using prior to admission.”
The arrival of electronic medical records also has affected the trainee experience by taking time away from the doctor-patient relationship, Dr. Bernstein said. Other technology, such as algorithms used to avoid mistakes, have become both helpful and harmful.
“[Having the technology] is very good, but people have to learn how to think,” Dr. Bernstein said. “There’s a lot of medicine that’s an art, and in psychiatry even more so. You don’t have the blood tests or the imaging tests that other specialties have, and that is both our advantage and our disadvantage.”
In the future, technology will continue to have a central role in residency training, experts said. Already, independent study using technology has become the norm, Dr. Hanson said. When students are in a more structured environment, technology such as cell phones, can act as a distraction, she noted.
“I’ve decided to embrace it and use it,” she said. “My approach is to co-opt the cell phones. Periodically, during a talk, I may put up a website that has a pop quiz on it [in which] students use their cell phones to answer.”
Certainly, efforts to build diversity will be a continued focus for the specialty, said Dr. Sudak. In addition, residency might shift from less inpatient training to more subspecialty rotations for general psychiatry training, she said.
“We will need to teach residents to retain a focus on the patient as a person and use outcomes to help guide treatment,” she said.
Dr. Bernstein would like to see the pendulum swing back on such rigid duty hours, she said, with more emphasis placed on building residents’ confidence in managing complex cases and preparing trainees for overcoming adversity.
Dr. Vasan envisions more integration of psychiatry with neurology and the rest of medicine, more training in business elements, such as managing teams and a practice, as well as education on technological tools for psychiatrists.
From a broader perspective, Dr. Vasan hopes that the stigma around mental health will continue to improve and that society at large becomes more supportive of the work of psychiatrists.
“In some ways it seems like we have come far in openly discussing and understanding mental illness, as well as the fact that having these diseases does not need to hold anyone back from realizing their potential,” she said. “But not far enough. The public’s understanding of the scope of the problem and the urgency and value for addressing mental health has increased tremendously.
“Our colleagues in other fields of medicine, employers, politicians, educators ... they all value, seem to value psychiatry more, and I hope this continues to grow.”
As a psychiatry resident in the early 1980s, Carol A. Bernstein, MD, remembers a teaching setting where young physicians worked long hours, male residents outnumbered female residents, and messages were delivered in the form of handwritten notes.
Today, the learning environment for psychiatry residents is vastly different. Duty-hour restrictions are routine, the gender gap has narrowed, and electronic communication in its many forms, is the norm. Medical advancements give residents a greater ability to treat patients and improve illnesses, said Dr. Bernstein, a clinical psychiatry professor and vice chair for education in psychiatry at New York University. However, residents also face a range of modern challenges, such as higher learning expectations, a more litigious culture, and a practice landscape increasingly reliant on ratings and patient satisfaction scores.
“This is a generation – whether you want to call it the Millennials or the iGen – [who have] been pushed to do more and more,” said Dr. Bernstein, a past president of the American Psychiatric Association. “Medical care has become very complicated, and it is very hard for trainees to get mastery of it.”
At the same time, the digital world that today’s residents are accustomed to has become a double-edged sword in medical education, said Donna M. Sudak, MD, outgoing president of the American Association of Directors of Psychiatric Residency Training. Technology has generated new ways of learning, such as online modules, but also created opportunities for distraction, she said.
“All of us, our learners as well as ourselves, need to figure out the best balance of using technology in order to facilitate learning,” Dr. Sudak said. “The pro is having the world at your fingertips and the ability to work with other people across the country. The con is the temptation to be attached to your screen, rather than truly listening to the person you’re in the room with – as a psychiatrist, that’s even more critical.”
The new faces of psychiatry
Interest in psychiatry has grown steadily over the years. In 2018, 2,739 medical school graduates ranked for a PGY-1 psychiatry residency, up from 1,806 ranked applicants in 2008, according to data from the National Residency Matching Program. Of the 2018 ranked applicants, 1,540 matched to a residency program. Data from the Association of American Medical Colleges (AAMC) show that 47% of psychiatry residency applicants in 2018 were women.
Millennial graduates are choosing psychiatry for a variety of reasons. For Nina Vasan, MD, MBA, the career path meant an opportunity to make a broader impact.
“Mental health is a defining social issue of our time, and in medical school I felt like if I committed my time and energy to improving mental health, I would maximize the impact I make on the world,” said Dr. Vasan, who finished residency at Stanford (Calif.) University in 2018. “I feel even stronger about that today. … I felt drawn to both the fundamental way in which we get to connect with our patients on an individual level and impact their lives, as well as the broader societal-level change that must happen in the coming years that I want to be a part of.”
A sense of social responsibility is a common trait of this generation’s psychiatrists, said Dr. Vasan, who has a private concierge practice in the Silicon Valley.
“We have a global sense of the world and recognize that our role as physicians gives us the unique platform to make an impact at this level,” she said.
Graduates also are attracted to psychiatry because of its focus on the physician-patient connection, particularly as patient time is eroded in other specialties, such as primary care, Dr. Sudak said.
“People who become physicians really want to have relationships with patients, and if you have to see eight people an hour, that’s a tough go,” she said. “Many people are attracted to the capacity to really learn about somebody’s story and make a difference in their life. Psychiatry offers that and then some.”
Working closely with patients to improve their quality of life was a primary motivator for Steven Chan, MD, MBA, who completed his psychiatry residency at the University of California, Davis, in 2016. He currently serves on the addiction treatment services team at the VA Palo Alto Health Care System.
“I additionally pursued a subspecialty in clinical informatics to apply today’s technologies to further improve people’s lives,” he said.
Dr. Chan said he is fortunate to practice in a work environment that is more collaborative with other health professionals than in the past.
“It’s wonderful,” he said. “There’s so much work to be done, and working with others has been rewarding to me. We’re already seeing more psychiatrists take on leadership roles in technology and health care administration, so we’re seeing collaborations with informatics, engineers, and service designers.”
A sea of challenges
Despite the advantages of practicing in modern times, psychiatrists today also face unique challenges, such as an upcoming shortages of physicians.
A 2017 report by the National Council for Behavioral Health estimates that, by 2025, demand might outpace supply by up to 15,600 psychiatrists. An aging population of psychiatrists is part of the problem. Sixty percent of practicing psychiatrists are older than 55, one of the highest volumes of older doctors of all specialties, according to AAMC data.
Physician numbers are improving, but a crisis point looms, especially as more states pass legislation that target the so-called dangerously mentally ill, said Annette L. Hanson, MD, a forensic psychiatrist who is assistant professor of psychiatry at the University of Maryland and at Johns Hopkins University, both in Baltimore.
“The trend seems to be that governments want to provide more involuntary or forced care, which means you’re going to need to have doctors available to provide that care,” Dr. Hanson said in an interview. “We don’t have enough doctors to meet the public policy demand.”
Compounding the problem is the fact that the majority of new psychiatrists pursue community private practices in urban areas, rather than practicing in state hospitals or rural areas, Dr. Hanson added. In addition, some states are passing laws that require state hospitals to admit incompetent criminal defendants within a certain time frame.
“That’s created significant problems where you’re moving someone from an overcrowded, understaffed jail to overcrowded, understaffed hospital,” she said.
The growing use of telepsychiatry might be one answer to the upcoming shortage. A June 2018 letter from the Centers for Medicare & Medicaid Services encouraged more states to use health technology efforts to address the opioid crisis, including through telemedicine and telepsychiatry. Meanwhile, several states have expanded their controlled substance laws to allow remote prescribing through telehealth for the treatment of psychiatric or substance use disorders.
However, licensing issues and reimbursement inconsistencies continue to act as barriers to the practice of telepsychiatry, according to the National Council report.
Some academic institutions are crafting new ways to use technology to meet the demand for mental health care. At Stanford, for example, Dr. Vasan started a lab called Brainstorm, the Stanford Laboratory for Brain Health Innovation and Entrepreneurship, which unites medicine, business, technology, and design to develop tech products for patients. She also chairs Stanford’s Mental Health Technology Hub, a consortium of more than 20 faculty labs addressing the role technology plays in improving mental health.
“We psychiatrists need partners to help increase access to mental health prevention, diagnosis, and treatment,” Dr. Vasan said. “Technology can be that partner.”
Improving diversity is an ongoing challenge for the field, said Dr. Sudak, also professor and vice chair for education in the department of psychiatry at Drexel University in Philadelphia. Of practicing psychiatrists, 42% declare as white, 8% as Asian, 4% as black, and 4% as Hispanic, according to the latest workforce data published by the AAMC. By comparison, 61% of the U.S. population is white, while 18% is Hispanic, 13% is black, and 6% is Asian, according to recent census statistics. By 2044, more than half of all Americans are projected to belong to a minority group.
“In general, we know that more diversity will enhance outcomes of care for our patients,” Dr. Sudak said. “When I talk about workforce, I think about that piece as a significant part of the equation. It’s not just about getting more slots, but it’s about filling those slots with a population of trainees that mirrors the population, rather than mirrors a very small subset.
Training changes
One of the biggest changes affecting residency training today is the decreased length of stay for inpatients, Dr. Hanson said. When she was a resident, the average length of stay was about 3 weeks, compared with 7-10 days now.
“The challenge is sorting out an underlying psychiatric condition from the effects of substances, which is really difficult with that short of a length of stay,” she said. “You lose a longitudinal perspective if you don’t have a chance to observe someone once they’ve been stabilized and the crisis has passed and they’re detoxified from the substances they were using prior to admission.”
The arrival of electronic medical records also has affected the trainee experience by taking time away from the doctor-patient relationship, Dr. Bernstein said. Other technology, such as algorithms used to avoid mistakes, have become both helpful and harmful.
“[Having the technology] is very good, but people have to learn how to think,” Dr. Bernstein said. “There’s a lot of medicine that’s an art, and in psychiatry even more so. You don’t have the blood tests or the imaging tests that other specialties have, and that is both our advantage and our disadvantage.”
In the future, technology will continue to have a central role in residency training, experts said. Already, independent study using technology has become the norm, Dr. Hanson said. When students are in a more structured environment, technology such as cell phones, can act as a distraction, she noted.
“I’ve decided to embrace it and use it,” she said. “My approach is to co-opt the cell phones. Periodically, during a talk, I may put up a website that has a pop quiz on it [in which] students use their cell phones to answer.”
Certainly, efforts to build diversity will be a continued focus for the specialty, said Dr. Sudak. In addition, residency might shift from less inpatient training to more subspecialty rotations for general psychiatry training, she said.
“We will need to teach residents to retain a focus on the patient as a person and use outcomes to help guide treatment,” she said.
Dr. Bernstein would like to see the pendulum swing back on such rigid duty hours, she said, with more emphasis placed on building residents’ confidence in managing complex cases and preparing trainees for overcoming adversity.
Dr. Vasan envisions more integration of psychiatry with neurology and the rest of medicine, more training in business elements, such as managing teams and a practice, as well as education on technological tools for psychiatrists.
From a broader perspective, Dr. Vasan hopes that the stigma around mental health will continue to improve and that society at large becomes more supportive of the work of psychiatrists.
“In some ways it seems like we have come far in openly discussing and understanding mental illness, as well as the fact that having these diseases does not need to hold anyone back from realizing their potential,” she said. “But not far enough. The public’s understanding of the scope of the problem and the urgency and value for addressing mental health has increased tremendously.
“Our colleagues in other fields of medicine, employers, politicians, educators ... they all value, seem to value psychiatry more, and I hope this continues to grow.”