Challenges and Perspectives to the Fall in Psychiatry Fellowship Applications

Assessing the Factors Affecting Recruitment to Child and Adolescent Psychiatry Fellowship Programs

OBJECTIVE

The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship.

METHOD

A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students.

RESULTS

A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it.

CONCLUSIONS

The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice, Program Choice, and Program Quality

OBJECTIVE

This study explored factors influencing a physician's choice to pursue geriatric psychiatry fellowship training from fellow and program director perspectives to improve recruitment into this critical need specialty.

METHODS

Questionnaires were sent to the 54 fellows and 79 fellowship program directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) available through the American Association for Geriatric Psychiatry (AAGP) listserv. A 5-point Likert scale (strongly disagree, disagree, neutral-undecided, somewhat agree, strongly agree) was used to score and rank these questionnaires.

RESULTS

Thirty-three program directors (42%) on the AAGP listserv and 24 (44%) of all ACGME accredited fellows responded. The clinical quality of the faculty (Fellows 92%, Program Directors 92%) and the fellowship's national reputation (Fellows 75%, Program Directors 88%) were most highly ranked by both. Fellows ranked proximity to family (79%) high (2nd) in their program choice, while ranking workload, salary, and visa issues as low.

CONCLUSION

This study emphasizes that family and cultural/ethnographic considerations, along with the core values of a training program, remain highly valued by trainees, and should inform structural changes to incentivize training, and enhance the inherent quality of fellowship programs.

The Development and Current Status of Subspecialty Training and Certification in Addiction Psychiatry

OBJECTIVE

This article describes the evolution of subspecialty training and certification in addiction psychiatry. The impact of the newer subspecialty in addiction medicine is also addressed.

METHODS

Information about programs and trainees was obtained from records of the Accreditation Council for Graduate Medical Education. Information about addiction psychiatry certification was obtained from the records of the American Board of Psychiatry and Neurology (ABPN). Information about the addiction medicine subspecialty was obtained from the American Board of Preventive Medicine.

RESULTS

In AY 2020-2021, there were 53 addiction psychiatry programs with 92 fellows, and the numbers of each have increased over the past 5 academic years. The total number of addiction psychiatry certificates awarded through 2020 was 2806. Three years after addiction medicine programs were first accredited, there were 83 programs with 149 fellows. Thus far, 3282 addiction medicine certificates have been awarded, 1275 (38.8%) of them to ABPN diplomates.

CONCLUSIONS

In the 30 years since addiction psychiatry received subspecialty recognition, the numbers of training programs and fellows have grown steadily and are continuing to increase. Recently, the numbers of training programs and fellows in the newer subspecialty of addiction medicine have grown rapidly with substantial psychiatry involvement in addiction medicine training and certification programs. Nonetheless, it is apparent that the need for specialists with expertise in substance use disorders will far exceed the supply for the foreseeable future.

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action

OBJECTIVE

The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce. In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations.

METHOD

This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported.

RESULTS

Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trends and the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030.

CONCLUSION

There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.

Gender and Racial Disparity Among US Forensic Psychiatry Fellows: Broken System by Default

Diversity enhances the performance of the healthcare system by providing better patient outcomes and reducing physician burnout. In this study, we explored the gender and racial trends in the recruitment of women and racial minorities into forensic psychiatry fellowship programs in the US. Retrospective data analysis was performed by utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from the year 2007 to 2021. Demographic data, including gender and race, were extracted for forensic psychiatry fellows. The number of female trainees increased significantly to become a majority, i.e., 58.8% of all forensic psychiatry trainees in 2020-2021 were female compared to 27.78% of women forensic psychiatry fellows in 2007-08. Between 2011-12 and 2020-2021, there was a relative increase in White (Non-Hispanic), Asian/Pacific Islander and Black (Non-Hispanic) forensic psychiatry fellows, by 54.75%, 114.4%, and 0.36% respectively. Despite the overall increase in the numbers of ethnic minorities in US psychiatry residency and fellowship programs, racial minorities remain significantly under-represented in forensic psychiatry fellowship programs. We need to revise policies to promote underrepresented minorities in medicine (URMM) in forensic psychiatry.

Development and Implementation of an Integrated Care Fellowship

INTRODUCTION

Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. To date, a formal clinical fellowship devoted to professional development for this role has not been described.

METHODS

The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics.

RESULTS

We successfully recruited three classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All five graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n=5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n=581), and the mean quality of the talk was 5.35 (n=582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows).

CONCLUSIONS

The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing Consultation-Liaison Psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.

Psychiatry Match Rates Increase After Exposure to a Medical Student Mentorship Program: A Multisite Retrospective Cohort Analysis

OBJECTIVE

Since 2002, the Klingenstein Third Generation Foundation (KTGF) has supported a network of medical student mentorship programs (MSMPs) across the USA with the explicit aim of enhancing interest in, and eventual recruitment into the field of child and adolescent psychiatry (CAP). The authors conducted a multisite, retrospective cohort analysis to examine the impact of the program on career selection, as reflected by graduation match rates into psychiatry or pediatrics.

METHODS

The authors collected graduating match information (2008-2019) from fourteen participating medical schools (Exposed) and thirteen non-participating schools (Control). Control schools were selected based on region, comparable student body and faculty size, national standing, and rank in NIH funding. Match rates into psychiatry and pediatrics were compared between Exposed and Control groups.

RESULTS

Exposed schools had significantly higher match rates into psychiatry as compared to unexposed schools (6.1% and 4.8%, respectively; OR [95%CI] = 1.29 [1.18, 1.40]; X2 = 32.036, p < 0.001). In contrast, during the same time period, exposed schools had significantly lower match rates into pediatrics than unexposed ones (11.6 and 10.5%, respectively; OR [95%CI] = 0.89 (0.83, 0.95); X2 = 12.127, p < 0.001). These findings persisted even after adjustment for secular trends in match rates.

CONCLUSIONS

Seventeen years after its inception, the KTGF medical student mentorship program network has had a positive impact on match rates into general psychiatry. Future studies will address whether these results translate to trainees' eventual selection of careers in CAP.

An Exploratory Survey of Career Choice, Training, and Practice Trends in Early Career Child and Adolescent Psychiatrists and Fellows

OBJECTIVE

A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends.

METHOD

A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors.

RESULTS

Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x = 85.7, SD 22.9) compared with females (x = 77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x = 79.9, SD 17.1) compared with providing psychotherapy (X = 63.3, SD 23.9).

CONCLUSIONS

The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.

Factors Affecting Psychiatry Resident Decision to Pursue Consultation-Liaison Psychiatry or Other Subspecialty Fellowship Training

BACKGROUND

There is a national shortage of psychiatrists with subspecialty fellowship training, and many fellowship positions are unfilled.

OBJECTIVE

We conducted a survey of US psychiatry residents to better understand the motivation to pursue fellowship training and to determine any specific factors that were particularly influential in choosing a fellowship in consultation-liaison (C-L) psychiatry.

METHODS

Online surveys were distributed electronically to US general psychiatry residents through the American Association of Directors of Psychiatric Residency Training list server.

RESULTS

A total of 219 questionnaires were completed. Interest in fellowship declined during residency training. Most important factors in consideration of fellowship training were lifestyle (89%), finances (69%), and academic opportunities (63%). Specific influential factors were residency experiences, attending staff as a role model, and medical school experiences. Most important discouraging factors were extra training time, financial concerns, and belief that fellowship training was not necessary. Only 30% of residents had outpatient C-L psychiatry experiences. Few residents belonged to any subspecialty organization or attended any subspecialty meeting. Residents interested in C-L psychiatry fellowships had lower expectation of increased salary than other residents. Outpatient practice settings were seen as preferable over inpatient settings by most residents.

CONCLUSIONS

Results of this survey suggest that enhancing consultation psychiatry exposure in medical school and residency with strong role models, outpatient C-L psychiatry experiences, facilitating subspecialty organization membership and meeting attendance, emphasizing academic opportunities of fellowship training, and improving remuneration for fellowship-trained psychiatrists might be important factors that could improve recruitment into C-L psychiatry and other psychiatric fellowships.

Variations in Application Instructions for Forensic Psychiatry Fellowships

OBJECTIVE

In this study, the authors examined the consistency and the transparency of application instructions for forensic psychiatry fellowships in the USA.

METHODS

The authors collected the names of US forensic psychiatry fellowships listed in the Directory of Forensic Psychiatry Fellowships maintained by the American Academy of Psychiatry and the Law. Using data from active fellowship websites, the authors extracted for each program: (1) timelines for applications and interviews, (2) whether an application form was supplied, and (3) the presence of specific application requirements (e.g., curriculum vitae, personal statement, letters of recommendation, residency training director evaluations, writing samples).

RESULTS

Among 45 fellowship websites, 31 (68.9%) did not provide specific dates or months when their application cycle opened, nor did they indicate whether they accepted applications on a rolling basis. Fourteen (31.1%) did not have an application form, and 8 (17.8%) did not list application requirements. Among 37 programs that listed specific requirements on their websites, 36 (97.3%) required a curriculum vitae or letters of recommendation, 35 (94.6%) required a personal statement and/or letter of interest, and 27 (73.0%) required writing samples and/or evaluation materials from residency program directors.

CONCLUSIONS

This study found considerable variations among online application instructions for US forensic psychiatry fellowships. Although many factors shape recruitment into forensic psychiatry fellowships, improving the consistency and the transparency of application instructions might decrease stress related to the application cycle and streamline recruitment into the field.