There is an estimated shortage of 45,000 psychiatrists in the United States. A new survey highlights the factors that contribute to career dissatisfaction among these specialists, and notes that, owing to these issues, the shortage may not be filled any time soon.

The study published in Psychiatric Services includes data from 314 psychiatrists who participated in the 2008 Health Tracking Physician Survey. The authors analyzed factors including compensation, practice environment and organization, patient characteristics, and physician demographics. According to the survey, a major cause of career dissatisfaction for psychiatrists was the threat of malpractice lawsuits. The length of time spent with each patient also impacted career satisfaction, with increased time spent with patients associated with increased satisfaction.

Additionally, worries about the out-of-pocket costs patients must pay for treatment negatively impacted career satisfaction. Older psychiatrists reported higher levels of satisfaction than younger psychiatrists, and white, non-Hispanic psychiatrists reported higher levels of satisfaction than African-American or Hispanic psychiatrists. Compensation-related factors did not significantly affect career satisfaction among the psychiatrists surveyed.

One-third of practicing psychiatrists are over 60 years of age and will be retiring soon. It is already difficult for patients to obtain timely psychiatric care, and the gap in available care providers is only going to get larger as the population continues to age.  Of all specialties, psychiatrists arguably need to spend the most time with patients to build rapport and long-lasting trust. But, now, psychiatrists are being forced into little more than medication management and a how-many-patients-can-we-see-in-one-day model of practice.

In order to recruit new medical graduates into the specialty of psychiatry and support practitioners, these issues affecting job satisfaction must be corrected. However, these issues cannot be corrected without an increased supply of psychiatrists, according to the authors. Delaying retirement and extending work hours might allow psychiatrists to see more patients, effectually closing the gap, but these are not likely long-term solutions.

The sample size of this study was small and, possibly, not representative of all psychiatrists in the United States. And, many factors other than those presented in the study affect career satisfaction: family responsibilities, personal stress, involvement in community activities, and workload. The authors contend that more research is needed to fully determine the factors that influence job satisfaction, and what actions can be taken to fix the shortcomings.

The bottom line of this study is that psychiatrists want to provide the best possible care to their patients. But, for reasons such as insurance and bureaucratic red tape, time constraints, and increasing costs and decreasing reimbursement, psychiatrists are not able to provide that care. Psychiatrists, like most other physicians, entered the practice of medicine to, at least in part, help people. Results like those presented in this analysis are frustrating to patients who still need timely, quality care, regardless of whether or not the doctor likes his job.

So, what does this mean for patients? For now, the care that patients receive will likely not change, but the future of mental health care is uncertain as experienced practitioners retire and younger physicians continue to be unhappy in their specialty.

References

Demello JP, & Deshpande SP (2011). Career satisfaction of psychiatrists. Psychiatric services (Washington, D.C.), 62 (9), 1013-8 PMID: 21885578

Fothergill A, Edwards D, & Burnard P (2004). Stress, burnout, coping and stress management in psychiatrists: findings from a systematic review. The International journal of social psychiatry, 50 (1), 54-65 PMID: 15143847

Lepnurm R, Dobson R, Backman A, & Keegan D (2006). Factors explaining career satisfaction among psychiatrists and surgeons in Canada. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 51 (4), 243-55 PMID: 16629349

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