When Dr. David Diaz told his grandma he was going to become a psychiatrist, she wasn’t very impressed.
“She told me, ‘Why are you doing that? What don’t you do something worthwhile?’” he said.
Diaz, assistant professor of clinical psychiatry at the Indiana University School of Medicine, has proven for decades that the profession is worthwhile by helping mentally ill patients both in private practice and working at the medical school for the last seven years.
But he said his grandma’s attitude toward the profession isn’t uncommon, and it’s a reason fewer medical students are going into it.
A medical field that was once both lucrative and esteemed, Diaz said psychiatry has become an occupation considered by many as unskilled and irrelevant compared to other fields such as surgery or cardiology.
Dr. Alan Schmetzer, professor emeritus at Indiana University School of Medicine, said when he got into psychiatry in the 1960s, the profession was booming in the wake of the development of the first psychiatric drugs ever created.
“The 60s were a time when people were thinking in more psychological terms,” he said. “It was probably a little more attractive at the time to get into the field. Now, it doesn’t seem as exciting as it used to be to think in those terms.”
The lack of students going into psychiatry has led to one of the worst shortages the profession ever seen in the U.S.
According to data from the U.S. Department of Health and Human Services, 55 percent of U.S. counties don’t have a practicing psychiatrist, and 3,900 geographical areas across the country have been designated mental-health shortage areas.
To meet the need, the U.S. needs 2,800 more psychiatrists.
The shrinking pool of doctors practicing psychiatry means patients with severe mental illnesses often wait months to see one. The wait is only going to get longer, too, as millions of Americans get insurance for the first time through the recently opened healthcare exchange, and start seeking mental-health treatment.
Robert McClurg, a clinical psychologist and the clinical director of the Kokomo Family Psychiatric Center, said the stigma attached to the profession does contribute to students not going into it, but the biggest reason is money.
Psychiatrists have to complete just as much medical training as surgeons, cardiologists or any other kind of physician. But once they begin practicing, they make one of the lowest salaries in the medical industry.
With many medical students owing well over $200,000 in loans once they graduate, the field isn’t lucrative enough to make it worthwhile for most.
“If you’re smart enough to be a physician and spend all that money and all that time, you’re going to pick a residency that makes you happy and makes you money,” McClurg said. “Anymore, you really have to have a passion for psychiatry. Otherwise you’d pick the job that paid you $100,000 more a year.”
IU professor Diaz said he got into the profession because he wanted to help people – whether they could afford it or not – but the painfully low reimbursement rate from Medicaid made it impossible to keep the lights on while he ran his private practice for 18 years.
“I didn’t go into this to only take care of VIP patients,” he said. “But a psychiatrist couldn’t survive these days just taking Medicaid patients.”
Psychiatric Center director McClurg said not only are Medicaid payouts some of the lowest across the medical field, it’s a fight sometimes to even get paid at all.
“The hoops that they make you jump through to get reimbursed by quadrupling your paperwork, it gets to the point where it’s just too much,” he said.
Getting reimbursed at a rate that’s a fraction of what they charge, many psychiatrists have stopped dealing with insurance companies altogether.
Instead, they require patients to pay out-of-pocket and let them take up the claim with their insurance. Those who can’t pay themselves are just out of luck.
For many students, the low reimbursement rate, huge student debt and headache of dealing with insurance companies make the profession unattractive.
IU professor Schmetzer said the only way to make psychiatry appealing again is to make it more financially feasible.
First, states need to institute loan forgiveness programs to lessen the debt burden once students graduate, he said.
The federal government already has began to institute a loan forgiveness program for primary care providers working in medical, dental, and mental and behavioral health fields. Awardees receive up to $50,000 in exchange for two years of service if they practice in a “health professional shortage area.”
Second, the federal government needs to require higher reimbursement rates from Medicaid and private insurance companies, Schmetzer said.
But even if more students decided to get into psychiatry in Indiana, he said, there wouldn’t be many places for them to go.
Indiana University School of Medicine is the only college in the state that offers psychiatry residency programs. The program used to have 12 residency slots, but cuts in federal funding have sliced that number to just six in the last decade.
Schmetzer said the federal government has capped the number of psychiatric residency positions at 1997 levels by making drastic cuts to funding. He said that funding must be restored so colleges and universities across the country can start turning out more psychiatrists.
But until state and federal governments start taking steps to help increase the number of psychiatrists nationwide, people with mental illnesses will continue to wait months for treatment.
And delayed treatment is seriously bad news for those who need it, IU professor Diaz said.
“There are patients who, if they don’t receive the right treatment, end up as just another suicide statistic,” he said.