http://www.philly.com/mld/inquirer/n...nt/8174960.htm


Posted on Sat, Mar. 13, 2004





A dire need for more child psychiatrists

By Stacey Burling

Inquirer Staff Writer


Jennifer Leong, who will officially graduate as a child psychiatrist in June, knows finding a job will be no problem. But which one should she take?

Leong is finishing her training at Thomas Jefferson University at a time when the shortage of child psychiatrists, a perennial problem, seems to be getting worse. Demand is increasing as parents grow more accepting of mental-health diagnoses for children such as depression and bipolar disorder, schools identify more troubled children, and the use of medications for children's emotional problems becomes more common.

Already, Leong, 35, of Philadelphia, has interviews with two academic medical centers. Four community mental-health centers have contacted her. At least three times a week, recruiters tempt her with jobs outside Philadelphia.

On the other side of the equation are parents who wait up to two months for appointments, while their children's behavior may worsen, exacerbating problems at school and home. Mental-health centers and hospitals are struggling to recruit - and afford - the child psychiatrists they need to write prescriptions for their youngest patients.

"The demand is growing exponentially," said Lawrence Stewart, president of the permanent-placement division of CompHealth Group Inc., a Salt Lake City-based recruiting firm. "Our business in child and adolescent psychiatry is up about 40 percent in the last year." Salaries are up 20 percent, ranging from $150,000 to more than $250,000 a year.

In modern mental-health care, most therapy is done by psychologists and social workers, who can't write prescriptions. General psychiatrists often are willing to treat teenagers, and pediatricians will write prescriptions for some children, but experts say child psychiatrists, the experts on how psychiatric drugs work in children, are preferable, particularly for complex problems.

The American Academy of Child and Adolescent Psychiatry has made increasing the ranks of child psychiatrists its top priority. There are now about 6,500 child psychiatrists in the country. The U.S. Bureau of Health Professions estimates that there will be 8,312 by 2020, far fewer than the 12,600 expected to be necessary just to maintain current levels of service. Currently, 717 doctors are in two-year child and adolescent psychiatry training programs, up 5 percent from last year.

Surveys of graduating residents and primary-care doctors show increasing demand for child and adolescent psychiatrists, said Edward S. Salsberg, a State University of New York at Albany professor who will soon direct the Association of American Medical Colleges' Center for Workforce Studies. From 2000 through 2002, newly minted child psychiatrists were the specialists most in demand in California, he said.

"There are a number of indications that would lead me to believe that there's reason for concern that there may be a shortage of child and adolescent psychiatrists," he said.

Like other medical specialists, child psychiatrists are poorly distributed, with the greatest shortage in rural areas. An analysis of American Medical Association data by Wun Jung Kim, at Medical College of Ohio, found that there are 1.32 child and adolescent psychiatrists for every 100,000 children in West Virginia and 17.53 in Massachusetts. There are 7.86 in New Jersey and 9.31 in Pennsylvania.

Even in Philadelphia, a physician mecca, child mental-health experts say there is a shortage. Some fear it is worsening as doctors, beset by high malpractice premiums, leave the state.

During the 1990s, the number of child and adolescent psychiatrists in training was flat or decreasing, and a growing proportion of residents were foreign medical graduates. Recently, there's been an uptick in interest among American medical-school graduates.

Thomas Anders, a child psychiatrist at the University of California, Davis, who is active in the American Academy of Child and Adolescent Psychiatry's effort to raise the number of child psychiatrists, said many medical students barely considered the field because they never met a child psychiatrist during their training.

In addition, child and adolescent psychiatrists train a year or two longer than general psychiatrists - nine to 10 years of medical training after college - but, until recently, were paid about the same.

Anders and other child psychiatrists say it takes more time to work with children than adults, and that insurance companies don't pay them adequately for that. It takes longer to evaluate a child, they said, and a child psychiatrist must get to know the whole family.

Leong said that while that appeals to her, many of her fellow medical students don't want to work with "parents who frustrate them or parents who mistreat their children."

For parents, the shortage means long waits and few choices. Some say the situation is worst for families dependent on private insurance, but others contend it's at least as bad in the public sector. Parents wealthy enough to pay cash - the going rate is $150 to $200 an hour - may have shorter waits.

Tamika Iseley's 10-year-old son, who has attention deficit hyperactivity disorder, wound up in the city's emergency facility for children with mental-health problems on Feb. 3. The first outpatient appointment she could schedule for him was on April 28, and he still would not have seen a psychiatrist. In the meantime, her son's behavior got worse. Iseley said he's been suspended so often that she lost her job. The Kensington woman was surprised at how difficult it was to get help for her son. (The mental-health center moved up her son's appointment by nearly two months after it was contacted by The Inquirer. He saw a psychiatrist last week and is now hospitalized for further evaluation, Iseley said.)

Gail Edelsohn, director of child and adolescent psychiatry at Thomas Jefferson University Hospital, said children can slip further off their proper developmental track when treatment is delayed. Without help, they are at "risk of increasing clinical severity and possibly even dangerousness." They could be more prone to risk taking and impulsive behavior. Their emotional problems can cause turmoil in their families and schools.

The shortage means a wait of six weeks to see Randall Gurak, a child psychiatrist in private practice in Cherry Hill. Managed-care companies are having enough trouble finding child psychiatrists that they're willing to hire him on a case-by-case basis, paying what he charges his cash customers.

Allene Lyons, a clinical social worker who is regional director of the Philadelphia Advocate Program, said her agency has been looking for a child psychiatrist for well over a year. "There are no child psychiatrists, and the ones who are working are so overworked, they really are at a premium," she said.

She said her agency is offering a competitive rate, and money is not the issue. It tried advertising in newspapers, on the Internet, and in professional publications. The agency also tried word of mouth. It even went through the Yellow Pages. All for naught. "We've totally run out of ideas," Lyons said.

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I think the more parents don't bother to raise and spend time with their kids these issues will arrise more and more.

Militant feminism combined with more and more daily pressure on families must take main burden of this problem, not to forget the divorce rates and all kids growing up without a father figure.

my pal from sgu is a fellow in child psych at JHH. there is a ross grad too.

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My guess is that child psychiatry is pretty stressful but it sure is needed. The pay isn't as good as some other fields but it can be an 8-5 job I would guess. How are psychiatrists seen these days? Many of my friends in the past complained of being treated as second class citizens by their fellow MD's. az skeptic

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well, the problems of families are immense and in many communities fathers are kept from their children by zealous courts. On the other hand, many women suffer from the economic pressures when men walk out...we should be spending more money on researching and preventing divorce...one of the biggest problems in our society. az skeptic

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Still skeptical after all these years.
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Zealous courts run by judges with obvious agendas and irresponsible fathers acting like ****** are really putting family values down in our communities.

I also think the typical elementary schools should be acting more closely with parents than what is presently done. This all boils down to money issues and an attitude change in regard to what parents should be willing to spend their moneys on.

I am personally in big favour of school vouchers if this would create this bonding with families. There is typically a much stronger sense of willingness to get involved once, people pay for it from their own pockets, even though a school voucher is not directly from "own pockets".

Politicians are to blame here. The Democrats from overprotecting teachers unions so no solid reforms can be launched, but just as much the republicans for fronting this issue in a millitant way instead of solving it in a bipartisan way.

Unfortunately, this is the tragic way of American politics where most politicians don't posess the decency and dignity of people like Joe Liebermann or Laura Bush. More politicians need to act like caretakers instead of pamperers for various illuminaties.

I personally dont think that divorce rates and male role models are the only thing responsible for the increasing child/adolescent psych probs. I think it also has alot to do with govt enforced limits on parenting. I rber when I was a kid child abuse became an huge issue. From then on the govt starting taking a huge interest in the way ppl parent. Huge advertising campaigns were put up tellin kids it was okay to call the cops on your parents if they hit you. There is a big difference between an occassional spanking and abuse. There are different types of kids out there. Some kids just listen and others need to be forced. Inately some are just rebellous. Those types of children, I believe, need an occassional "shaking up" per say. But bcuz of the all the abuse campaigns kids started calling the cops on their parents for everything and anything. This caused alot of parents to rethink their parenting strategies.

I have been to different countries where spankings, paddling, beating is still allowed within the school system and at home. These places seem to have less probs with kids.

Please dont think I am saying parents should go out and beat the hell out of their kids..this is certainly not what we need! However, I am saying that I think we as Americans, def need to rethink where we let the govt intervene and where not!

Just my two cents!!

Geeta

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