The Associated Press reported last week that this country is suffering from a major shortage of child psychiatrists. Here's the article. Case loads for child psychiatrists are astronomical -- about 750 disturbed children is an "average" caseload.

To illustrate this, think about the numbers. If a doctor has 750 patients that he/she needs to see on a regular basis (every 4-6 weeks is a common interval). That doctor works 8-hour days, seeing patients in 30 minute session. Said doctor would need 46.8 workdays to see all 750 patients one time. There are only 30 workdays in a 6-week period -- see the problem!!!!! This doesn't take into account the patients who need more than 30 minute sessions or the patients who need to be seen more frequently. It also doesn't take into account any professional education the doctor needs, hospitalization consults, etc. Talk about job security.

This crisis has been brewing for a while. And the two major reasons for the shortage that are cited are:

1. It takes two additional years of training it takes to become a child psychiatrist.
2. The reimbursement rate for insurance doesn't take into account the extra time these professionals have to take interviewing the parent in addition to seeing the child.

The shortage continues to grow. The U.S. Bureau of Health Professions projects there will be about 8,300 child psychiatrists in 2020, only two-thirds of the estimated 12,600 needed. The states with the biggest shortages include Wyoming, Idaho, Nevada, Alabama, Mississippi, Arkansas, Oklahoma, Indiana and West Virginia.

So, in light of this shortage, the vast majority of the children in this country who are prescribed psychotropic meds for a variety of mental/emotional/behavioral disorders, are prescribed those meds by the family doctor or pediatrician. This can be problematic because these doctors often know very little about these types of medications, whereas a psychiatrist will likely have more up-to-date information on medication options to consider based on his/her training. Because psychiatry/neurology is a rapidly advancing field, finding a doctor specifically trained in this field to treat your child is highly recommended.

This shortage negatively impacts children and families across the U.S. Often, according to the National Alliance on Mental Illness, parents unable to find or afford private psychiatric care are told the only way to get needed treatment is to relinquish custody of their child to the state. I know from working with adoptive parents that this is often the unsavory choice they are left with to get their child the help he/she needs. Relinquishing custody of the child not only is a devastating emotional move, but in many states is met with the state filing abandonment charges against the parents. It is a horrific catch-22 for these struggling families.

Some places are trying to ease the psychiatrist shortage crisis by practicing tele-psychiatry, where physicians in under served (often rural) areas can access urban or university-based psychiatrists. Another concept is to provide psychiatry students and others studying to work in mental health professions with loan forgiveness, as is now done with for some nursing students and future teachers.


Photo is of Dr. Stephen Malloy, a doctor in the 1940s practicing medicine in Caswell County, NC. Here's the link.