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Child Psychiatry Faces Workforce Shortage: Page 2 of 6

Child Psychiatry Faces Workforce Shortage: Page 2 of 6

The first one relates to the need for changes in the training of child and adolescent psychiatrists. The current track is a five-year program: three years of adult psychiatry followed by two years of child psychiatry.

"What happens as a result of that kind of training track is that a number of people who initially express their interest in child psychiatry really get ground down before they finish," said Anders, also a professor of psychiatry at the University of California, Davis, Medical Center. As many as 50% of students who are initially interested in child psychiatry lose that interest by the time they complete their adult training. Beginning this year, AACAP's goal is to increase recruitment into residency programs by 10% a year for the next decade. The training takes too long, and residents accrue too much debt, Anders said. As a point of contrast, pediatric residents do not take three years of internal medicine before they begin their pediatric training. They're trained primarily with children from the beginning, he said, adding that AACAP would like to see students trained in more integrated programs that offer experiences with children beginning on day one. Instead of doing a PG-1 year in internal medicine and adult neurology, students interested in child psychiatry would do a PG-1 in pediatrics and child neurology. They would have early exposure to children that would stay with them during their five years of training.

And although it's a long shot, Anders said, it would be nice to reduce the total amount of time it takes to get board certification as a child psychiatrist.

The second thread, he continued, relates to getting more appropriate reimbursements for child psychiatrists, which would help make the profession more attractive. Most insurers reimburse the services of child psychiatrists in about the same way as they do adult services.

A 50-minute session may work for an adult patient, but it is insufficient for doing an evaluation on a child. "You've got to see the family, you've got to talk to the teachers, you've got to see the kid in action in several different settings," he said. Consequently, child psychiatrists need to advocate for better reimbursement for the services they provide, including the ancillary services that are necessary to evaluate the child and provide treatment.

Urban Versus Rural

Few child psychiatrists can afford to live off the reimbursement rates that managed care companies are providing, so many of them are choosing to provide services only to patients who can pay out-of-pocket, Anders said. Consequently, rural populations, which tend to be poorer, get underserved, as do inner-city populations.

People in child psychiatry are not very interested in living in rural areas, Glenn J. Kashurba, M.D., told PT. "Generally speaking, child psychiatrists don't get out of the city."

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