Medical Students Are Losing Interest in Psychiatry

Textbook with glassesThere is already a shortage of psychiatrists in the United States, and now it appears that even fewer medical school seniors are choosing psychiatry as a specialty, according to a news release from the American Psychiatric Association. Statistics that point to this declining interest in psychiatry are found in a report from the National Resident Matching Program, according to the news release.

The American Psychiatric Association is uncertain as to the exact reasoning for the smaller number of students choosing psychiatry, but they might be choosing other specialties that offer more profit, or they may be more interested in careers in clinical neuroscience and psychotherapy and don’t see the rewards associated with psychiatry. Experts within the association suggest that more emphasis should be put on the profits and rewards that psychiatry can bring.

According to a blog on the National Institute of Mental Health website, there are more aging psychiatrists and a small number of medical school students choosing psychiatry, leading to a shortage in psychiatrists. The blog mentions that the duties of psychiatrists appear to be shifting from incorporating psychotherapy to only prescribing medication. The author, Thomas Insel, the director of the National Institute of Mental Health, stated that it appears psychiatry is moving more toward cognitive neuroscience instead of psychoanalysis. Many students appear to have an interest in both fields, and it seems like the two specialties could be blending somewhat.

Carole Lieberman, a media psychiatrist and author of several books, such as Coping With Terrorism: Dreams Interrupted, said in an email that the role of psychiatrists has changed and not necessarily for the better, which is leading to a shortage.

“The reason why fewer med students are choosing psychiatry these days is because insurance companies and government reimbursement have turned psychiatrists into pill-pushers instead of psychotherapists,” Lieberman said. “Nowadays, many psychiatrists only see patients for ‘med visits’ of 15 to 30 minutes once a month or less. This is what I call ‘in and out burger psychiatry’—an assembly line. Patients get caught in the cross-hairs of this malpractice.”

She said that she doesn’t follow this new routine that many psychiatrists are sucked into. “Personally, I refuse to be reduced to a pill-pusher,” Lieberman said. “If someone wants to be my patient, they have to come once a week for 45-minute sessions of psychotherapy, and if they need medication I also prescribe it for them.”

She said the way many psychiatrists are working now is ineffective in actually helping people with mental health issues. “If a patient needs medication, they absolutely also need psychotherapy to get at the root of their problem,” Lieberman said. “When psychiatrists only prescribe meds, patients end up committing suicide or homicide or getting into other problems. Psychiatrists are not fulfilled as pill-pushers because the most interesting part of treatment is getting a deep understanding of each patient’s psychodynamics, and helping the patient to get insight into his behavior.”

She said even though psychiatrists now tend to be more focused on prescribing medication, a decline in this profession is still bad news. “A decline in psychiatrists, at a time when the world is in chaos, makes for a very dangerous combination, indeed,” Lieberman said. “Today’s stressors—the economy, terrorism, breakdown of the family, and so on, are causing more people to have psychiatric problems.”

“Every day we read about average people being pushed over the brink of sanity and doing desperate or crazy things, such as random acts of violence,” she added. “If there were more psychiatrists to go around, more people would be helped before they destroyed their lives or the lives of others.” The shortage of psychiatrists can put more pressure on other mental health professionals, who are not necessarily trained to handle certain issues. “Other mental health professionals, who are not as intensively trained as psychiatrists, are now being called upon to treat patients beyond their scope of expertise,” Lieberman said. “This puts stress on the mental health professionals and leaves many patients confused and insufficiently treated.”

“The concept of having allied mental health professionals do psychotherapy, and only paying psychiatrists to push pills, does not work,” Lieberman said. “There is not enough dialogue between them to make for cohesive and successful treatment. I see the results of this every day—mostly in my role as a psychiatric expert witness—testifying in cases of malpractice and wrongful death.”

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  • lizzy

    lizzy

    April 13th, 2012 at 4:05 PM

    Oh no! This is something that I really hate to hear.
    My dad was a psychiatrist and he got so much pleasure from getting to know his patients and helping to see so many of them through their darkest periods of their lives and helping them find some light and enjoyment again.
    It would make me very sad if this was a dying science because it was work that my father was so proud of.

  • Vaughn

    Vaughn

    April 13th, 2012 at 6:29 PM

    maybe they see the whole insurance pyramid as a big sham and they would rather go into a field where payments are a known quantity instead of mental health claims which are more likely to be denied

  • Warner

    Warner

    April 14th, 2012 at 5:30 AM

    I can see how those who are very much drawn into psychiatry in the hopes of genuinely helping others could be turned against the field because there has developed the perception that this is a part of the medical field that clearly only stands to support the pharmaceutical industry. I know that medications are needed sometimes, but there are others when all it takes is some good conversation and talk therapy to get someone back to the point of feeling normal. But when your patients are hounding you for the meds, it must be hard to deny that sometimes.

  • carrington

    carrington

    April 14th, 2012 at 4:40 PM

    If the perception remains that this is a field solely made up of pill pushers and doctors who only wish to profit by getting into bed with big pharma, then I am not surprised that more and more medical students are failing to see that appeal. I hope that the trend to do this though does not continue, because the field of psychiatry deserves to be so much bigger and better than that. This is about helping patients when they are at their very lowest, and contrary to what some other practitioners of medicine believe this is a specialty that saves thousands of lives each year, even without drugs.

  • Cameron

    Cameron

    April 15th, 2012 at 6:15 AM

    If students are engaged and made to love the field then they will turn to that and want to share its benefits with others.
    Have the professors and instructors looked to themselves in the medical schools and thought that maybe the teaching styles or the information being provided or not could in reality be what is driving more med students out of the field?
    If the students are not given information that excites them and makes them want to become a part of something, then they won’t.
    They have to be given a reason to believe that they can fight the system that has been created and that they can make a difference.

  • Artie

    Artie

    April 16th, 2012 at 5:02 AM

    If I went to school and did all of this work, then I want to be so much more than an expert witness in a criminal case day after day. That would not necessarily be my dream after so much medical school!

  • Gabs

    Gabs

    April 16th, 2012 at 4:10 PM

    The last time I saw my own therapist I was kind of surprised while waiting (I got there early) how quickly the other patients shuffled in and out. It was like they were called back, given their new prescription, paid their co pay and were gone. My therapy is a little more intensive than that so I don’t know if they were seeing a different doctotr from the one I see or what.

  • GIBBS

    GIBBS

    April 16th, 2012 at 9:39 PM

    We cannot force students to choose psychiatry.But what we can doin make them aware Nd make the profession purer,getting rid of the pill-pushing as you have described.Also,the reason for choosing speciality could be collected and the we can analyze this disinterest better.

  • George T

    George T

    January 20th, 2013 at 9:53 PM

    Declining recruitment into psychiatry is an interesting topic, but if you ask a medical student that dropped out of psychiatry this is basically what they say.

    Psychiatry is about 200 years old, and was formally founded as medical profession in 1884. Neurology took off about 100 years later with newer ideas as technology began to develop.

    Psychiatry study’s and diagnoses subjective observations of the patients mind. In recent years (last 50), psychiatry developed 2 competing international diagnostic manuals which combine symptoms into ‘Mental Disorders’ (the ICD and DSM).

    Neurology Study’s the brain, and makes diagnoses based on physical findings with various diagnostic technologies. In recent years (last 50), neurology has developed (among many other things) MRIs scans, PET scans, QEEG tests, and a number of blood tests for genetic conditions. Neurology is nearing cures for several illnesses, one of which is Huntington’s.

    When students try to go into a medical specialty, and choose psychiatry, they find there are an awful lot of treatments and yet not a single diagnostic test. They also find that it’s not known how any of these treatments work (ECT, drugs, psychosurgery, psychotherapy), and the cause of mental illness remains unknown. Depending on the teacher, a student is taught either that psychiatric illness is psychological, or bio-psychological. These views are not scientifically compatible. They are not fully compatible with neurology either.

    This makes it more difficult to sell psychiatry to students who understand science plays the role in medicine of developing an understanding of a disease so that diagnostic tests and treatments can be produced. Without that, the treatments basically just do *something* to the patient to get a subjective effect (to be subjectively observed), and this translates in psychiatry to disrupting or damaging the brain.

    I think in an era of rapid technological development, and the increasingly apparent view that mental illness is probably produced solely by malfunctions of information processing in the brain, it basically pushes psychiatry into a scientific corner. It’s becoming increasingly clear the subjective symptoms psychiatry diagnoses and treats are probably produced at random from a physical brain malfunction, and probably don’t have any clinical or scientific utility. Worse yet, no treatments in psychiatry address the cause of illness (not even psychotherapy), and there is no real evidence of preexisting ‘chemical imbalances’.

    Psychotherapy may still have a use outside of medicine, but prescribing drugs that disrupt brain activity (and feedback mechanisms which produce drug dependence with time) never will, and represents a self evident scientific dead-end. No amount of tinkering with existing drugs in psychopharmacology will ever make them adequate.

    What i heard from students was that “psychiatry is a scientific dead-end, it will be gone in 25 years probably”.

  • Rich

    Rich

    April 4th, 2014 at 7:09 PM

    I’m a board-certified psychiatrist and I regret that decision every day. We are not respected by our colleagues (unless they need us), we see the most difficult patients and no matter how much we work to try to help them, their insurance pays very little. Psychiatry should dye. It’s a trap for medical students who could have a much better career removing gallbladders. Why fight a society that seem to have concluded that mental illness is equally treated by pastoral services.

  • hunterjuly

    hunterjuly

    June 29th, 2015 at 6:58 AM

    Yes the churches do way more for the mentally ill. All Psychiatry did was exploit them. I will be so glad when they kick Psychiatry out of the Medical field.

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