Child Psychiatrists In Short Supply
Declining Numbers, Growing Caseloads Increase Risks For Troubled Youths
Associated Press, April 9, 2006
NEW YORK -- In state after state, statistics and anecdotes lead to the same conclusion: The nation has a serious, long-term shortage of child psychiatrists that is taking a toll on young people, their parents and their doctors.
Wyoming is down to two child psychiatrists; another left last year. In Augusta, Ga., Dr. Sarah Sexton tells would-be new patients that she might be able to see them in July. Elsewhere, some doctors accept no new patients.
"There is no state where it is not a problem - none," said Dr. Gregory Fritz, director of child psychiatry at Brown Medical School in Providence, R.I. "We see it in the emergency ward every night, where problems have gotten out of hand over time due to lack of intervention, and progress to a point where a kid is suicidal or dangerous."
Worsening problem
The shortage has been noticed within the profession for years, but psychiatrists say the consequences are worsening as the stigma of mental health problems recedes and more families seek help for their children, including prescriptions for psychiatric drugs.
Demand for such drugs is intense, and the shortage of psychiatrists "forces kids to see other practitioners for medication management who might not have the training or experience to appropriately treat them," the National Conference of State Legislatures warned in a report last month.
The shortage is attributed to the extra two years of training required for child psychiatrists, on top of four years of medical school and three years of general psychiatry; and reimbursement that doesn't reflect the extra time a psychiatrist needs to interview parents, teachers and others familiar with a child's behavior.
"You always have to deal with a parent or caretaker. It doubles the interview time," Fritz said. "But the reimbursement rate is the same as if you're evaluating an adult."
The main organization representing the profession is the American Academy of Child and Adolescent Psychiatrists, which estimates the number of practitioners in the field at about 7,000. The U.S. Bureau of Health Professions projects that there will be about 8,300 child psychiatrists in 2020, two-thirds of the estimated 12,600 needed.
The Center for Mental Health Services estimates that at least 5 percent of American children and adolescents have acute mental health disorders.
A study commissioned by the AACAP in 2003 found there was, on average, one child psychiatrist for every 15,000 youths younger than age 18, in theory, producing a caseload of 750 seriously disturbed children per doctor. West Virginia had 1.3 child psychiatrists per 100,000 young people.
Because of the shortage, pediatricians, family doctors and child psychologists have been trying to fill the void, though their training is far less thorough. Several states are encouraging physicians in under-served rural areas to consult long distance with urban or university-based child psychiatrists.
"We have to use our expertise in as broad a way as possible, to help the physicians actually providing the care," said Dr. Steve Cuffe of the University of South Carolina.
Often, according to the National Alliance on Mental Illness, parents unable to find or afford private psychiatric care are told that the only way to get needed treatment is to relinquish custody of their children to the state.
'Human cost'
"The human cost is far too great," Theresa Brown, a Westbrook, Maine, mother said in U.S. Senate testimony, describing her long and unsuccessful struggle to obtain mental health services that would have enabled her to retain custody of her daughter.
Compounding the problem is the surging use of drugs for children with attention deficit disorder or other behavioral problems. One recent study estimated that 2.5 million children take such drugs every year. Fritz said most are prescribed by pediatricians and other non-psychiatrists.
"They're probably overused, and often without appropriate assessment and monitoring," he said of the drugs. "If there were more child psychiatrists, they wouldn't be used as casually as they are."
Several steps have been proposed to ease the shortage, though none is expected to produce swift changes. One approach is to shorten the five-year psychiatry program or enable students interested in child psychiatry to begin working with children sooner in their training.
Another step was taken recently when the House of Representatives approved an amendment that would make students preparing for work in youth mental health eligible for loan forgiveness. But the measure's Senate prospects are uncertain, and a broader bill addressing the psychiatrist shortage has languished in committee for two years.
"Everyone knows there's a shortage of nurses, of science teachers," said Michael Zamore, an aide to amendment sponsor Rep. Patrick J. Kennedy, a Rhode Island Democrat. "When it comes to mental health, it's hidden in the closet."
Source: Baltimore Sun