Pilot Program Aims to Combat Shortage of Child and Adolescent Psychiatrists

Deborah Brauser

June 04, 2010

June 4, 2010 (New Orleans, Louisiana) — A new pilot project from the American Academy of Child and Adolescent Psychiatry is addressing the serious shortage of child and adolescent psychiatrists (CAPs) head-on, according to a study presented here at the American Psychiatric Association (APA) 2010 Annual Meeting.

The Post-Pediatric Portal Project (PPPP), which allows pediatricians to cut down the additional crossover training needed from 4 to 3 years, is currently running with 5 pilot programs that include 10 residents.

"I'd like to get the word out there is now a shorter, abbreviated training pathway for pediatricians to become [CAPs] — and it's not as daunting as it was previously," presenter Robert Ellis, MD, second-year PPPP fellow at Creighton University in Omaha, Nebraska, told Medscape Psychiatry.

Serious Shortage

Dr. Robert Ellis

According to Dr. Ellis, there are currently fewer than 7000 CAPs practicing in the United States, yet there is a need for almost 30,000.

In fact, editor-in-chief of the Journal of the American Medical Association Catherine DeAngelis, MD, MPH, professor of pediatrics at Johns Hopkins University School of Medicine in Baltimore, Maryland, recently called this shortage "seriously severe."

"A bright point is that there are currently 60,000 practicing pediatricians, which represent a large potential pool of physicians who could be trained as [CAPs]. These are people who are already committed to the well-being of the young," said Dr. Ellis.

However, making the switch from pediatrician to CAP has traditionally been a long journey that consisted of 4 years of additional training, including a general psychiatry residency and a CAP fellowship.

"The traditional training pathway is substantially longer than the 3-year fellowships typically required for other pediatric subspecialties and can discourage pediatricians from pursuing this career path," said Dr. Ellis. "It also doesn't acknowledge the pediatrician's existing skills in caring for the complex physical and emotional needs of young patients."

Because of the scarcity of CAPS, the PPPP was created in 2007 to give pediatricians a new way to get the training needed over a shortened, 3-year period.

Program "Up and Running"

Currently, the Accreditation Council for Graduate Medical Education has approved 5 pilot programs in Nebraska, Ohio, Pennsylvania, Maine, and Rhode Island.

For this study, a survey was distributed to all current PPPP fellows by email regarding their academic and practice experience, nd their decision to pursue psychiatric training. Of these, 9 returned completed surveys.

"We thought it would be interesting to see who else was doing this training, why they were doing it, and how they found out about it," said Dr. Ellis.

When asked, most fellows replied that they spent between 0% and 25% of their clinical time caring for children and adolescents with emotional and behavioral problems before fellowship training.

Four also replied that they were comfortable evaluating and managing attention-deficit/hyperactivity disorder (ADHD) before fellowship training, 3 were comfortable with depression, and only 1 was comfortable with anxiety. In addition, only 1 was somewhat comfortable with bipolar and psychosis.

"We had the expectation that people who would be attracted to this program would be used to dealing with these issues, but it came out that actually most people didn't spend a great deal of time taking care of kids with psychiatric problems," said Dr. Ellis. "That only 4 were comfortable managing [ADHD] was shocking to me because 10% of kids have this condition and by and large it's managed by pediatricians. I'm not sure what to make of that."

Some of the strengths that the fellows described bringing with them from their pediatric practice included medical expertise, experience and comfort in interacting with patients and families, understanding of family dynamics, and understanding normal growth and development.

More Openings Available

Although 5 of the fellows learned about the PPPP by word of mouth, 4 learned of it from a single 2007 announcement in the American Academy of Pediatrics newspaper.

"That almost half of the current fellows found out about the program from 1 small newspaper listing in 2007 is interesting, and there hasn't been much about it since. So if we ran another article, we could potentially double our participants!" said Dr. Ellis.

He noted that although the pilot project has been successful so far, "performance of residents on in-training and board certification exams and integration into practice settings remains to be assessed."

"However, we're hopeful that this alternate pathway will help alleviate the CAP workforce shortage," he added. "Expansion of the program and strategies to actively recruit pediatricians into this training are logical next steps."

Dr. Ellis noted that there are currently several PPPP slots open.

Most Underserved Medical Subspecialty

"This is an important and innovative program which is part of a larger strategy to help us address the shortage in [CAPs]," APA board of trustees member David Fassler, MD, a CAP in Burlington, Vermont, and clinical professor of psychiatry at the University of Vermont, told Medscape Psychiatry.

"This field is the most underserved medical subspecialty there is," added Dr. Fassler, who was not involved with the study. "This shortage is particularly severe in more rural and impoverished areas."

"So it's exciting to see that this program has actually been implemented, that a number of programs have agreed to initiate it, and that there are a number of pediatricians who are now training and will become [CAPs] through this innovative pathway," he said.

Dr. Fassler noted that other components of the overall strategy to increase CAPS have included increased funding for all child mental health training programs, increased resources for loan repayment, and enhanced collaborations.

"That's an area where I think these trainees may be able to play a particularly important role," he explained. "Since they already have a background in pediatrics, they are natural candidates to help us bridge that gap and to help us raise the level of awareness about mental health problems in pediatric practice, to help educate their colleagues, and to help us with consultation and telepsychiatry. I hope and expect that these trainees will play an important role in the future integration of child psychiatry and pediatrics."

"I think we need to do everything we can to support these programs, particularly in the early years. I'm sure there are still details that need to be resolved, but I think it's an important addition and glad to see that this is actually up and running," concluded Dr. Fassler.

Dr. Ellis and Dr. Fassler have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2010 Annual Meeting: Poster Abstract NR2-60. Presented May 24, 2010.

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