Ten years ago, when J. Chase Findley, MD, was in medical school, psychiatry was not considered a smart move for an up-and-coming physician.
“I was discouraged from choosing psychiatry as a career,” said Dr. Findley, now a psychiatrist and director of medical student education at McGovern Medical School at UTHealth in Houston. “I was told that it wasn’t scientific enough, that I could make more money in a different specialty, and so I felt discouragement from my peers.”
That ongoing discouragement is just one reason why psychiatrists are in really short supply statewide today.
In 2017, Texas was short more than 1,000 psychiatrists to meet demand, according to a model used by the Texas Department of State Health Services (DSHS). That same year, 171 Texas counties (out of 254) had no psychiatrist, according to DSHS data. (See “Texas Counties Without a Psychiatrist,” page 42.)
Based on what Dr. Findley sees in today’s medical students and residents, attitudes about going into psychiatry seem to be changing.
“Not only have mental health issues been stigmatized in the past, but I do believe that psychiatrists have been stigmatized in the past,” he said. “But with the increased attention and awareness of the importance of mental health, I think the stigma of choosing psychiatry as a career is decreasing among students also.”
That notion is backed by data compiled by the National Resident Matching Program (NRMP) as well as statewide data from the Texas Medical Association. For instance, in 1994 the share of psychiatry residency positions filled by graduating U.S. medical students hit a low of 43 percent; that was after a high point of 69 percent in 1986. However, there’s been an unmistakable upward trend in the past few years:
- The number of psychiatry residency positions has grown every year since 2008.
- The share of psychiatry residency positions filled by graduating U.S. medical students hit 63 percent in 2018.
- The 1,556 entry-level training positions offered in 2018 was the highest on record.
- In Texas, psychiatry residency programs offered 95 entry-level training positions in 2017 and 93 in 2018. Those are the largest numbers recorded since TMA began compiling this information in 1996.
- The number of entry-level training positions has increased 41 percent for psychiatry in Texas over the past 10 years, and in 2018, every one of the 93 positions filled on the first day of the match.
- In an April TMA survey, Texas medical schools cited psychiatry most frequently as the specialty that was most difficult to find a position for this year.
Why the rebound?
There is a lively discussion among psychiatrists about why their specialty has become so popular, Dr. Findley says.
Improved compensation is probably one of the biggest factors. Psychiatry has long been one of the lowest-paying specialties, but that appears to be changing. In 2018, psychiatrists reported among the largest gains in compensation, followed by plastic surgeons and physiatrists, according to Medscape’s Psychiatrist Compensation Report. Just as important, about two-thirds of psychiatrists felt they were fairly compensated, similar to specialties that reported much higher compensation.
“It’s very much a buyer’s market for psychiatry residency graduates,” Dr. Findley said. “The challenge is trying to find which good opportunity works for them.”
Psychiatry also has benefited from recent changes to the Medical College Admission Test that allow a more diverse group of students to enter medical school, Dr. Findley says. In the past, the test was geared toward students with a science background, but now it gives more weight to older students and those with a nonscience background. That latter group is more likely to choose psychiatry as a career, he says.
Additionally, there’s been a steady effort nationwide to fund and improve psychiatric services and to dispel myths about the people who need them, Dr. Findley says.
While attitudes are improving, the stigma is still out there, says Kim Grayson, MD, a second-year psychiatry resident at the UTHealth Harris County Psychiatric Center in Houston. Fortunately for her, it did not come from fellow physicians.
“Both my family and friends who weren’t in the medical field were like, ‘Why wouldn’t you become a real doctor?’” she said.
Anastasia Ruiz, MD, a second-year psychiatry resident at Texas Tech Health Sciences Center in Lubbock, says she also experienced that attitude among older family members when she announced her specialty choice. But they were pleased when Dr. Ruiz told them psychiatrists tend to have better work-life balance than other physicians.
“When I explained to my family, ‘I’m getting paid like any other physician, and I’ve got a great schedule,’ they said, ‘That’s really good,’” she said.
Despite all this good news, Texas’ shortage of psychiatrists is still expected to get worse in coming years. DSHS projects today’s 1,067 deficit of psychiatrists will grow to 1,208 by 2030.
But the influx of fresh blood into psychiatry reflected in the match data is badly needed. According to Merritt Hawkins, a physician staffing company, 60 percent of psychiatrists are 55 or older, compared with about 43 percent of physicians as a whole.
Dr. Ruiz says seeing other young psychiatrists helping people through tough, life-long problems makes her glad she went into this specialty.
“We get to hear from the [patients] about their life stories and the circumstances that led them to their path in life,” she said. “We have a special opportunity to assist them, and that is a really humbling and rewarding experience.”
Texas Counties Without a Psychiatrist (in red)
(171 out of 254 counties)
Tex Med. 2018;114(11):40-43
November 2018 Texas Medicine Contents
Texas Medicine Main Page