Earning the Commute: Psychiatry and the Debates at Your Patients’ Workplaces
Exploring the intersection of psychiatry and work.
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Psychiatry has promise. According to US Bureau of Labor statistics, although physician employment in general is forecasted to grow 3%,1 employment of aides and technicians supporting psychiatrists is forecasted to grow 9% from 2022 to 2032.2
And medical students have responded. Between 2016 and 2021, sports medicine (+27.2%) and psychiatry (+26.3%) saw the most growth in the numbers of first-year Accreditation Council for Graduate Medical Education residents and fellows.3
The causes are multifactorial and prominently include lifestyle choices—in particular the ability to control one’s own calendar. As this interaction between medical students and graduates and the profession of psychiatry has evolved, there has also been a steady increase in an interest in telepsychiatry. This allows patients who do not have immediate access to mental health services (eg, those who live in rural communities) to receive care from trained psychiatric clinicians.
More than 150 million individuals live in federally designated mental health professional shortage areas,4 and although telemedicine has reverted to a slim segment of overall care—5%—the proportion of mental health services provided via telemedicine has stayed high at 40%.5
Some patients prefer telemedicine. Many patients would rather not commute to a psychiatrist’s office, so these and other patients may intentionally look for virtual psychiatric treatment. In an article recently published in The American Journal of Managed Care, investigators found that “the most common reason for using telehealth was recommendation or requirement by a clinician (73.6%). Respondents with depression were more likely to use telehealth than those without depression.”6
Because of the interest in telepsychiatry, the modern and upcoming psychiatric workplace mirrors that of the professional workplace across many other fields.
Those who want professionals to physically be present in a shared office are increasingly making a challenging request. In the recent debates in the United States about whether employees in the corporate world must return to the office, the employees have answered: “No! Leadership has to earn the commute.”
In terms of the delivery of mental health services in general, many psychiatrists and other mental health clinicians have switched to teletherapy, which has had an unintended consequence on commercial real estate in that a lot of offices previously rented by clinicians have gone empty.
In November 2023, a US News & World Report noted that “despite several million new jobs being added to the US economy during the pandemic recovery, offices have lost several hundred million square feet of occupied space.”7 Businesses in many industries are feeling the pinch to have a return on their investment in offices.
Providing mental health care via telepsychiatry has many interesting differences and raises questions:
- How do you react to patients who are late?
- What do you say to patients who are driving during their sessions?
- What about maintaining and getting eye contact with the patient (or lack thereof)?
- When is it recommended or required for the clinician to be in the same room with a patient to do a proper assessment (eg, in cases of suspected substance abuse)?
It is enchanting to do telepsychiatry. It pays well, it can help clinicians with their licensing around the country, and it allows clinicians to have a very reasonable balance between life at work and life outside work.
If these kinds of questions about the nature of work, how trends impact professionals, and, more generally, how work and psychiatry are evolving and influencing each other are of interest to you, we want to help you earn the commute.
We hope you will join us at the upcoming international Academy of Organizational and Occupational Psychiatry (AOOP) annual conference. Our focus will be on The US Surgeon General’s Framework for Workplace Mental Health & Well-Being (Figure).8
Figure. The US Surgeon General's 5 Essentials for Workplace Mental Health and Well-Being8
The AOOP annual conference will be held in Chicago, Illinois, in person at the University Club of Chicago on Saturday, March 23. For more information, visit the AOOP website at aoop.org.
Dr Morrison is a clinical assistant professor of psychiatry at Rosalind Franklin University’s Chicago Medical School, and past president of AOOP. Dr Cohen is president of AOOP and an associate clinical professor of psychiatry at Weill Cornell Medicine in New York, New York. Dr Idowu is chairman and director of residency training in the Department of Psychiatry & Behavioral Sciences at Richmond University Medical Center in Staten Island, New York.
References
1. Physicians and surgeons. US Bureau of Labor Statistics. Updated September 6, 2023. Accessed January 19, 2024. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm
2. Psychiatric technicians and aides. US Bureau of Labor Statistics. Updated September 6, 2023. Accessed January 19, 2024. https://www.bls.gov/ooh/healthcare/psychiatric-technicians-and-aides.htm?view_full
3. 2022 Physician Specialty Data Report executive summary. Association of American Medical Colleges. Accessed January 19, 2024. https://www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary
4. HPSA find. Health Resources & Services Administration. Accessed January 19, 2024. https://data.hrsa.gov/tools/shortage-area/hpsa-find
5. Lo J, Rae M, Amin K, et al. Telehealth has played an outsized role meeting mental health needs during the COVID-19 pandemic. KFF. March 15, 2022. Accessed January 19, 2024. https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-during-the-covid-19-pandemic/
6. Raj M, Iott B. Characterizing telehealth use in the US: analysis of the 2022 Health Information National Trends Survey. Am J Manag Care. 2024;30(1).
7. Fydenkevez G. The commercial real estate outlook for 2024: tight credit, work-from-home trends, energy-hungry data centers and more color the horizon for commercial real estate as we enter 2024. US News & World Report. November 30, 2023, Accessed January 20, 2024. https://money.usnews.com/investing/articles/the-commercial-real-estate-outlook
8. The US Surgeon General’s Framework for Workplace Mental Health & Well-Being. The Office of the US Surgeon General. 2022. Accessed January 20, 2024. https://www.hhs.gov/surgeongeneral/priorities/workplace-well-being/index.html
