Research Training in Psychiatry Residency Strategies for Reform (2003) / Chapter Skim
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5 Personal Factors
5 Personal Factors
Pages 133-166
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From page 133... ...
Included is a discussion of issues faced by foreign medical graduates who matriculate into psychiatric residency programs in the United States. The chapter ends with conclusions and recommendations.
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Alternatively, one may have extraordinary curiosity and skill that lead to a productive research career despite the absence of direct support and encouragement in the context of formal medical training. This was the case with Eric Mantle]
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Sieries and Taylor (1995) reviewed literature on medical students' interest in psychiatry and found that, as of the late 1 9SOs, those favoring psychiatry tended to have relatively Tow science scores compared with their peers who were interested in other medical specialties.
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MCAT = Medical College Admission Test; USMLE = U.S. Medical Licensing Examination; N/A = not available.
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(Kassebaum et al., 1995~. These data fall well short of full confirmation that high standardized test scores on either the MCAT or USMLE correlate with successfuT patient-oriented research careers, but they do support the concern expressed by some in psychiatry that the discipline is currently not attracting the brightest medical students (Hymen, 2002b; Meyer, 20021.
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Therefore, medical students' exposure to psychiatrists frequently does not include exposure to psychiatrists doing exciting research that addresses intellectually challenging, interesting, and clinically relevant issues. The media frequently depict mental health professionals in general and psychiatrists in particular as inept or eccentric, rather than bright, well-trained medical professionals who are addressing extremely important health care issues (British Broadcasting Company, 20021.
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From page 139... ...
Since New York State supplements Medicare graduate medical education fun(ls with state fiends, other regions where state support is not available will likely compensate residents at even lower levels. The shortest core residency training period accredited by the Accreditation Council for Graduate Medical Education (ACGME)
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He found a direct and significant correlation between specialty income and relative demand for a given specialty among medical students.30 Figure 5-1 summarizes this finding graphically. What is apparent Rom this graph and from the evidence presented 30Relative demand for a given specialty is defined as the ratio of the number of graduating medical students selecting a specialty as their first choice, divided by the total number of national slots available in that specialty.
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Based on 1992 National Residency Matching data for 14,030 U.S. medical graduates.
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, the mean salary was $61,000 (Singleton et al., 20031. 2 Although this survey did not isolate clinical or other psychologists engaged in part-time research, nor does it permit full adjustments for years of professional experience, the data support the hypothesis that psychologists engaged predominantly in research, at least in their early professional years, earn lower base salaries than their clinician counterparts.
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, and thus their salanes are likely lower in part because of TABLE 5-3 Selected Data Tom the American Psychiatric Association's 1998 National Survey of Psychiatric Practice Full-Time Employed Psychiatrists (n - 628a) Males Females Nonresearcher Annual Salary Researcher Annual Salary $143,000 $1 1 1,000 $1 14,000 $121,000 Nonresearcher Hours Workedb 52 44 Researcher Hours Workedb 56 51 Nonresearcher-Implicit Waged $55/hour $50/hour Researcher-Implicit Wanes ~ ~ .
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Nevertheless, the data suggest that psychiatrist-researchers earn less and work longer hours than psychiatrist-clinicians (see Table 5-31. Nonsalary Benefits of a Research Career Given the combination of high educational debt, low training stipends, and relatively low salaries for psychiatrists and psychiatristresearchers, it is no surprise that financial issues may well dissuade some from the latter career.
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It's like falling in love and getting to the top of a mountain all in one" (Rosenberg, 2002:3681. Given the brain's importance in governing human physiology and thought, it is not an overstatement to say that research in the treatment and prevention of mental illness addresses some of the most complex and intriguing topics faced by contemporary patient-oriented researchers.
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Broad Network of Colleagues Research careers foster the development of a broad network of colleagues both within and outside the discipline of psychiatry, many of whom are likely to add new dimensions and perspectives to the work of academic psychiatrists. Multidisciplinary efforts have become essential to scientific programs across the brain and behavioral sciences (IOM, 20001.
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The prospect of competing for soft money on a regular basis, in addition to publishing or perishing, is a daunting one and clearly represents a key Lamer to many considering a research career. Nevertheless, there is considerable evidence to suggest that when they apply, M.D.'s are as successful as Ph.D.'s at obtaining federal research funds.
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and Ph.D. degree holders who apply for federal grants, as well as by their comparative involvement in the formal grant application evaluation process.
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Finally, there are local and national seminars and workshops that offer pragmatic information about the overall grant application process. For example, there is an annual 1.5day NIMH Workshop on Child and Adolescent Research that is focused on providing participants with research career information, including study design, statistics, and "grantsmanship" issues (NIMH, 2002a)
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The table shows that psychiatry attracts a relatively high number of women, international medical graduates (l:MGs) , and underrepresented racial and ethnic minorities as compared with most other specialties of medicine.
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50.9 N/A 25.4 Populations 6.1 (9) International medical graduates are all physicians who received their undergraduate medical education in a non-U.S.
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physicians declaring research as their primary activity, 197~2000. SOURCE: Pasko and Seidman (2002)
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Similarly, Leibeniuh and colleagues (1993) conducted a survey of 1,923 full-time psychiatry department faculty members who had received their medical degree from 1956 to 1985, and found that for the years 1976 to 1985, nearly three-quarters of male psychiatrists in academic settings had conducted research, compared with about half of female psychiatrists.
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(2001a) found that female psychiatrists work fewer hours than other female physicians, with age-adjusted mean hours worked being 38.5 and 43.9, respectively.
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who entered psychiatry as PGY1 residents. International medical graduates are those who attended a non-U.S.
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medical graduates for basic skills; once these requirements have been met, however, outstanding residents should be given full opportunities to engage in research training and to contribute to psychiatric research, as many foreign IMGs have made important contributions in the past (Baron et al., 19991. Akin to allowing IMGs to serve in geographic areas with a need for health professionals, Congress should consider designating specific areas of research training and patient-oriented research activities as federally underserved disciplines, thereby permitting individuals who have `demonstrated the necessary aptitude and ambition to train as patient-oriente`d researchers.
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Data indicate that African Americans, Hispanics, and Native Americans are underrepresented as fulI-time faculty in health science, natural science, and social science departments (National Advisory Mental Health Council's Workgroup on Racial/Ethnic Diversity in Research Training and Health Disparities Research, 2001~. Data from 2001 indicate that fewer than 5 percent of full-time meclical faculty with an M.D.
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Additionally, the National Institutes of Health (NTH) funds minority supplement grants to encourage senior investigators to mentor minority trainees in the context of their ongoing work (National Advisory Mental Health Council's Workgroup on Racial/Ethnic Diversity in Research Training and Health Disparities Research, 2001~.
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Accordingly, one obvious recommendation the committee makes is as follows: Recommendation 5.1. The National Institute of Mental Health and other funding agencies should seek mechanisms to offer increased financial incentives, such as loan repayment, to trainees who commit to research training and research involvement beyond core psychiatry residency.
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. A complementary strategy to loan repayment is for funding agencies to supplement research training stipends as they are well below the income levels one could expect from direct entry into clinical practice.
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Foundations, philanthropists, and other third-party supporters also represent important potential sources of funding for financial incentives to trainees committed to patient-oriented research careers. In the case of residents, whose time is limited by the demands of clinical training, department funds might be used to increase residency compensation by creating "research moonlighting" opportunities, a practice currently in place at Columbia University (personal communication, R
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The above recommendation is made to encourage recruitment strategies that emphasize the growing scientific evidence base underlying the practice of modern psychiatry (Charney et al., 2001; Goiciman, 2002~. As obvious as this recommendation may appear, the committee nevertheless believes such promotion strategies are logically and plainly tied to recruiting students and residents to research careers.
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Departments of psychiatry, supported by the National Institute of Mental Health and other psychiatric organizations, should provide leadership in recruiting and retaining more women for psychiatry research careers. Such efforts should include: Increasing part-time training and job sharing opportunities.
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for training foreign IMGs may come from the Epidemic Intelligence Service, which offers classroom- and field-based training to 60 to 80 health professionals, including ~ to 10 foreign trainees, each year (Centers for Disease Control and Prevention, 2002; White et al., 2001~. Similar programs that increase international cooperation in the area of mental health research might enhance not only psychiatric research efforts in the United States, but also mental health efforts internationally.
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Inform more minority psychiatrists about research training and other funding opportunities. Data indicate that racial and ethnic minorities apply in relatively low numbers for NIMH funds (National Advisory Mental Health Council's Workgroup on Racial/Ethnic Diversity in Research Training and Health Disparities Research, 2001~.
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