Caitlin Gardiner never planned to pursue a career in psychiatry. But when she began doing rotations in medical school, she instantly felt drawn to the field and to the deeper level of understanding it encouraged her to form with patients.

“Even just doing the rotations, you get more time with your patients,” she said. “Psychiatry is one of those fields that lets you hear a patient’s story and build a relationship with them.”

Gardiner’s decision to study psychiatry is unusual compared to prevailing trends in mental health, in both central New York and the United States as a whole. For years, the nation has struggled with a growing shortage of mental health professionals, particularly psychiatrists.

Many patients have been forced to wait months for an appointment or admit themselves into emergency or inpatient care for immediate medical attention. Others have no choice but to go without psychiatric treatment.

The national shortage of psychiatrists is a culmination of multiple factors, said Viral Goradia, an assistant psychiatry professor at Upstate Medical University. Many practicing psychiatrists are approaching retirement, with one in four U.S. psychiatrists currently over the age of 65, according to a New American Economy report. Goradia said it is difficult to recruit enough medical students to replace retiring psychiatrists because other medical fields are more attractive to students.

Psychiatry is considered more emotionally-taxing than other medical fields because of its emphasis on doctor-patient interaction, Goradia said. Mental health issues tend to be more difficult to diagnose than physical health problems, and many students dislike psychiatry’s trial-and-error testing style, he said.

Only about 4% of medical residents choose to go into psychiatry, according the New American Economy’s report.

“Psychiatry has always been the ugly stepchild of medicine,” said Marla Byrnes, the president of the Syracuse chapter of the National Alliance on Mental Illness. “It’s easier and more financially-rewarding to go into other fields of medicine.”

Sen. Chuck Schumer, D-N.Y., has introduced legislation in Congress that would create new residency positions for mental health doctors in cities across central New York. Called the “Resident Physician Shortage Reduction Act,” this legislation aims to boost the number of medical students who choose to study psychiatry.

Goradia said the proposed act doesn’t go far enough. To increase the number of psychiatrists across the nation, the U.S. needs to introduce incentives such as loan repayment or higher income to psychiatry students, he said. Improved recruitment strategies will help close the gap between the high number of retiring psychiatrists and the low number of incoming psychiatric medical students.

While the legislation goes through Congress, the shortage of psychiatrists has severe consequences, Byrnes said. It often takes several drug trials for patients to find the best-fitting medication — but with fewer psychiatrists available, patients often need to switch to a new psychiatrist after only a few appointments, which can delay effective treatment, she said.

“It’s a very delicate balance of the relationship and the person feeling like they’re being listened to and that their psychiatrist knows them and cares about them,” Byrnes said. “You can’t do that if you keep changing out the players all the time.”

Many individuals have also become reliant on hospital admittance to receive more immediate psychiatric treatment, and Syracuse offers few non-emergency mental health programs, Gardiner said.

The city lacks services such as partial hospitalization or day treatment programs, where patients live at home but spend the majority of their time at a treatment center, Gardiner said. In other cities, psychiatrists and other mental health professionals reach out to individuals at their homes or homeless shelters through community treatment programs, she said.

The declining number of psychiatrists and other clinicians in the Syracuse area has made these programs impossible to sustain in recent years, she said.

“Syracuse is really in a desperate state in terms of mental health care and psychiatry,” Gardiner said.

Though many medical students view psychiatry as unappealing, Gardiner sees her career path as more important than ever before, she said. Now a chief resident in Upstate Medical University’s psychiatry department, she hopes to contribute to a reversal of the national shortage of mental health professionals.

“It’s a very rewarding field,” she said. “I feel lucky to be able to do it.”

Published on September 25, 2019 at 11:40 pm

Contact Gillian: gifollet@syr.edu