About the Work: This anonymous submission is presented as a question-and-answer editorial wherein the author, a medical student interested in psychiatry, speculates whether the recent rise in psychiatry residency applicants is positive or negative. The opinions presented in this piece do not reflect the official stance of the Latino Medical Student Association.
Q: What is your response to the growing number of medical students pursuing psychiatry?
I always feel enthusiastic to learn of fellow students interested in psychiatry. Over time, I noticed themes in psychiatry’s appeal to students: amazing work-life balance, less competitive than the “ROAD” specialties (radiology, ophthalmology, anesthesiology, and dermatology), and one of the easiest paths to practice privately. So, I try to taper my enthusiasm, especially considering the vast need for community psychiatrists. Work-life balance, the chance to work remotely, and the ability to go to private practice with less overhead than other specialties are compelling reasons and something that medical students should consider when choosing a career. However, if the field becomes saturated with applicants who are highly qualified but are not excited about psychiatry itself, we may have large numbers of people switching to private psychiatry, leaving an even greater gap of care between the socioeconomically disadvantaged population and the wealthy.
Q: The number of residency spots has consistently risen over the past decade in response to increased demand for psychiatrists. How do you see this impacting medical students interested in psychiatry?
I believe the rise in the popularity of psychiatry residency has caused an increase in the competitiveness of the field. The American Psychiatric Association reports that the number of residency spots for psychiatry has increased by 10% in the last 5 years alone, with a jump from 1,038 spots in 2016 to 1,746 in 2023.1 This increase reflects not only a higher demand for psychiatrists but a higher volume of psychiatry applicants, implying more competition for coveted residency spots.
This change may also present barriers for applicants of lower socioeconomic backgrounds or who lack connections in psychiatry. In 2019, it was reported that the average senior allopathic student applied to over 50 psychiatry programs.2 Applicants must pay per program that they apply to; this becomes a considerable fee when one must apply to such a high number of programs to increase their chances of being accepted. This statistic was also taken before the United States Medical Licensing Examination (USMLE) Step 1 switched to pass/fail rather than a score. This increases the need to pursue more research opportunities, volunteer work, and extracurriculars to stand out amongst other applicants. Access to such opportunities requires knowledge of an “unspoken curriculum” within medicine, connections with researchers in the field, and the ability to spend limited free time during medical school working for free.
Q: How do we meet the need for accessible, affordable, high-quality psychiatric care?
Increasing the number of psychiatrists is an obvious way to fill the need for more mental health providers. However, if large numbers of these physicians choose to practice privately, we will continue to have shortages for populations historically struggling to receive care. A recent study published in JAMA surveyed 11,521 physicians comprising 584 psychiatrists, 4,400 primary care physicians, and 6,537 other specialists, finding that psychiatrists were the least likely to accept new patients with Medicaid.3 There was a decline in the likelihood that a psychiatrist would accept Medicaid from 47.9% in 2010 to 35.4% in 2015.3 The National Council for Mental Wellbeing sought to identify causes for psychiatrist shortages and one of the most significant findings was that 40% of psychiatrists are operating under a cash-only practice; this makes psychiatry the field with the second highest number of physicians in private practice, second only to dermatology.4
There is no simple answer to this complicated issue, but we can start by identifying why students are drawn to apply. A survey of 81 medical students found that 72% of respondents noted that “available job position” was an important factor in choosing psychiatry, and another 69% chose “lifestyle,” making these the two most common responses.5 Psychiatry requires unique emotional skills compared to other disciplines of medicine. It is crucial to find psychiatry applicants who understand and fit the job. As we advance in the context of psychiatry’s newfound popularity among medical students, it’s more important than ever for students to understand the need to bring quality psychiatric care to historically disadvantaged patients and the emotional demand for compassion and empathy.
References:
1. Moran M. Psychiatry match numbers increase for 12th consecutive year. Psychiatric News. 2023;58(05). doi:10.1176/appi.pn.2023.05.5.043
2. Balon R, Morreale MK, Coverdale J, et al. Medical Students Who Do Not Match to Psychiatry: What Should They Do, and What Should We Do? Academic Psychiatry. 44(5):519-522. doi:10.1007/s40596-020-01295-w
3. Wen H, Wilk AS, Druss BG, Cummings JR. Medicaid acceptance by psychiatrists before and after Medicaid expansion. JAMA Psychiatry. 2019;76(9):981. doi:10.1001/jamapsychiatry.2019.0958
4. The Psychiatric Shortage Causes and Solutions [Internet]. National Council for Behavioral Health; 2017 Available from: https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Sh ortage_National-Council-.pdf
5. AlOsaimi, F. M. S., AlShehri, H. M., AlHasson, W. I., Agha, S., & Omair, A. (2019). Why psychiatry as a career: Effect of factors on medical students’ motivation. Journal of Family Medicine and Primary Care, 8(2), 648.
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