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The Shortage of Child Psychiatrists

Buying the coolest new toys, being creative and keeping the inner child alive are part of the daily routine for child psychiatrists.

But this profession has the greatest staffing shortage of any medical specialty. Parents are waiting months for appointments for their children.

"Figures for children needing care are, sadly, about the same as adults -- around 20 percent," says Dr. Pippa Moss. She is a child and adolescent psychiatrist.

"Mental health, as a whole, requires a higher proportion of the health-care dollars to have equitable funding. The proportion of mental health dollars available to pay for children's treatment, taking into account the percentage of children in the population, is also too small," says Moss.

"When one considers that the average child patient's care requires about two to three times the amount of resources and time as the average adult patient's care, the relative shortage of resources becomes even more obvious!"

Moss adds that job prospects are pretty rosy for the foreseeable future.

So why is there such a shortage?

The problem is at least three-fold, says Dr. Thomas Anders. He is a professor of psychiatry and behavioral sciences at the UC Davis M.I.N.D. Institute in California.

"Firstly, there is a long period of training, and that comes with a debt burden to the students," says Anders.

After four years of medical school, students undergo five or six more years of training. During that time, they make a modest income -- but they must also begin to repay their debts.

Also, reimbursement rates from insurance companies are the same for child psychiatrists as for their adult counterparts. But treating a child often takes much longer than treating an adult, since the psychiatrist often has to talk with the family, school or other caregivers. That means child psychiatrists make less money compared to other doctors with the same amount of training.

"The second reason is that there are so few child psychiatrists in the country that very few are in teaching. So, some students in medical schools will make it through school without even meeting a child psychologist. There is an under-representation of role models," says Anders.

Plus, psychiatry has a bit of a bad reputation among medical professionals.

"Some doctors consider psychiatry to be a 'soft science,' and see us as counselors rather than doctors," says Anders. "Some students may be discouraged to enter the psychiatry field by our colleagues."

Moss agrees that the field has an image problem.

"I suspect that medical students get very negative messages about psychiatry as a whole. There is a lot of stigma and fear about mental illness and behavioral disturbance, and this rubs off on those who care for these patients," she says.

"Even the portrayal of psychiatrists in the movies and on TV tends to be far from complimentary, and not at all realistic," she adds.

"Rates of pay have not been as high as for other medical specialties, though this is being addressed. If more medical students knew about child psychiatry, as it is practiced outside the medical schools, they would be interested."

For those who are willing to face the challenges, the career can be very rewarding.

"The rewards have to do with constantly being stimulated and constantly learning. Work is always challenging and not boring," says Dr. Roslyn Seligman. She is an associate professor of child and adolescent psychiatry at the University of Cincinnati College of Medicine.

"Helping people, especially young people, is very gratifying. Seeing the sparkle in patients' eyes or seeing patients make it in life is very rewarding."

Psychologists and social workers offer therapy, but they can't write prescriptions. General psychiatrists may treat some children or adolescents, but they don't specialize in children's issues. Pediatricians can write prescriptions for kids, but they're not mental health specialists.

Child psychiatrists are experts on how psychiatric drugs work in children. That means they're better equipped to deal with complex problems.

"There are currently job opportunities across all aspects of child psychiatry, but especially in the subspecialty areas, such as eating disorders in children and in community child psychiatry -- rurally based," says Moss.

"If you are a high-energy person who loves living on the edge, you could enter forensic child psychiatry!"

Anders spends much of his time convincing students that child psychiatry is a good career. He says it allows you to live a relatively decent lifestyle compared to surgeons, who must work nights and weekends.

Child psychiatrists work intensely, but not in the same way. They have more time to spend with their families and pursue their own interests.

"No day is the same. Every child, family and challenge is different. Every adult has a little child inside, and this is a wonderful opportunity to keep that child alive," says Anders.

"As part of my daily work evaluating children, I get to get down on the floor and play with kids. I go to toy shops and buy new toys, and I keep up with all the latest toys and games. It keeps me young."


American Academy of Child and Adolescent Psychiatry
A wealth of information, all provided as a public service

American Psychiatric Association
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