Friday, April 07, 2006

Numbers of Child Psychiatrists Low

CNN recently reported on what it calls a severe lack of child psychiatrists in America. The article, for which Dr. Gregory Fitz of Brown Medical School was interviewed, explains that every state suffers a shortage of child psychiatrists (based upon need projections by the U.S. Bureau of Health Professions). Wyoming, for example, has only two child psychiatrists.

The low numbers of child psychiatrists has been attributed to the training and work requirements associated with the field. For one, the training for child psychiatry is longer than that for general psychiatry. Furthermore, some practitioners lament the increased time needed to counsel both patients and their parents. Child psychiatrists are not compensated for the additional time associated with the field.

The decrease in the numbers of child psychiatrists raises interesting questions. Student bioethicists at Brown have, for some time, debated the practices of child psychiatrists (including the use of antidepressant medications in children). In a number of situations, students have concluded that psychiatry in general (and child psychiatry specifically) ought to reevaluate its practices. Therefore, it may appear almost positive that the numbers of child psychiatrists have decreased.

This viewpoing is probably both simplistic and dangerous. Indeed, the lack of child psychiatrists ought to be perceived as a problem even for those who question the behavior of some psychiatrists. For one, we should note the recognized importance of child psychiatrists in particular circumstances, including child abuse and trauma.

Furthermore, our recent dearth in child psychiatrists should raise general concerns regarding the number of juvenile and adolescent-specific clinicians in our country. If, for practitioners, juveline practice is more expensive than adult practice, and if training for juveline practice is more extensive than it is for adult practice, then we ought to consider providing incentives for studying juvenile practice. Might there be particular government incentives for entering into pediatric medicine to offset the added training and work associated with counseling both a patient and his or her family members?

What's more, this may be a fruitful time for individuals who protest the practices of child psychiatrists to propose alternatives to drug therapies for children. The lack in child psychiatrists means that many children receive no counseling, diagnosis, or treatment. If alternatives to drug practices are indeed beneficial for children (and if empirical support exists backing these claims), then we ought to see serious proposals for the inclusion of alternatives to drug therapy in insurance programs, government medical programs, etc.

Our current lack in child psychiatrists may be a dangerous thing, even if psychiatry suffers from its own lapses in standards of practice. It may signify a more general problem regarding pediatric care. During this dearth in the numbers of psychiatrists, it would be beneficial for both children and their families to have available at their disposal alternative treatment options. If these treatment options display standards of practice that are more empirically supported and objectively applied than are the standards of practice of pscyhiatry, then we will have transformed a period of deficiency into one of progress.


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