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Sunday, January 27, 2013

Shortage of Child Psychiatrists

Apparently in response to Newtown,  the media are reporting on the shortage of child psychiatrists.  Unfortunately, some of the resulting stories refer to autism as a "mental illness."

From The Des Moines Register (via USA Today):
More Iowa children are being diagnosed with mental illness than in past decades, especially autism and attention deficit/hyperactivity disorder. The increase in children needing mental health care and an inadequate system to help them are among an array of challenges facing this generation of Iowa's kids.
"There really isn't a children's mental health system," said Dr. Jennifer McWilliams, a child psychiatrist at the University of Iowa. "So much needs to be improved — I don't even know where to begin."
From The Bangor Daily News:
For at least 30 years, experts have been sounding the alarm about the shortage of child psychiatrists across the country. In 1980, the Graduate Medical Education National Advisory Committee said so many children and teens were projected to need help that the U.S. would require 8,000 to 10,000 child and adolescent psychiatrists by 1990. In 1990,the Council on Graduate Medical Education said the country would need 30,000 by the year 2000.
Neither goal was met.
In 1999, the surgeon general said only about 20 percent of mentally ill children received mental health services and only a fraction of that 20 percent got that help from a child psychiatrist. Today, according to the American Medical Association, there are about 7,600 practicing child and adolescent psychiatrists in the county, less than experts said the U.S. would need 23 years ago.
Urban areas typically have the easiest time finding and keeping psychiatrists. Rural areas struggle the most.
And Maine is very rural.
“I see a huge need,” said Sandra Fritsch, a child psychiatrist and president of the Maine Council of Child Adolescent Psychiatry.
She created a map to show the number of child psychiatrists in each county in Maine. In 2011, Cumberland County had the most at 22. Androscoggin County had four.
Oxford, Franklin and three other counties had none.
The New Haven Register quotes  Gregory Fritz, director of child and adolescent psychiatry at the Brown University School of Medicine and academic director for Bradley Hospital in Providence, R.I..  Fritz identifies three reasons for the shortage:

It takes a minimum of five years in medical school to become certified in both adult and child psychiatry and can be longer, similar to some higher-paying specialties. More years in school mean higher student loans.
“The medical students to my eye now pay a little more attention to income … and the reason is their debt is much higher,” Fritz said. He said child psychiatrists earn about the same as general practitioners. So, many students who want to work with children go into pediatrics instead.
Insurance reimbursements are given for the service, not the time spent on evaluations or medication sessions. “The problem is it takes longer to do it for a child,” because parents and teachers must be consulted. “Fundamentally, the payment per hour is less,” Fritz said.
Finally, “there is still significant stigma about mental illness and psychiatric patients, and that stigma also applies to those who treat those stigmatized patients,” Fritz said.
Not surprisingly, the insurance companies screw up:
 The Register called several doctors’ offices listed on Aetna’s website as “Psychiatry, child and adolescent.” Of those who responded, all said they treat adolescents only, despite being listed as treating children as well.
“I will see about age 15 and my partner will see a little bit younger; he’ll see 14,” said Dr. Douglas Berv of Hamden. “I’m not trained or certified with children and that’s where you’re running into a problem.”
He said of the rosters of providers issued by insurance companies, “Their lists are never correct.”
Another on Aetna’s “child and adolescent” list, Dr. Robert Ostroff, head of adult psychiatry at the Yale Psychiatric Hospital, said he does not treat children and has heard of the problems in finding doctors who do.
“It’s been very hard to get my insured patients’ children seen by child psychiatrists,” he said. “I have people who can’t afford to pay out of pocket. … It’s a real problem.