PsychResSurvey

Psychiatry

Article:
How Interested in Community/Public Psychiatry Are
Pennsylvania Psychiatry Residents?
How Do They Choose Employment and Sub-Specialties?

Click on heading to go directly to a section:
INTRODUCTION

KEY FINDINGS

SURVEY QUESTIONS

SURVEY FINDINGS

DISCUSSION

CONCLUSION

ACKNOWLEDGEMENTS

INTRODUCTION
Recruiting adequate numbers of competent psychiatrists to work in public and community settings
has been a concern for local and state governments and community behavioral health agencies for
many years. However, there has been little or no research about the number of psychiatry residents
who are interested in this subspecialty, how and when they became interested, and what would
constitute attractive post-residency employment to them.

To address such concerns, Philadelphia Connections and the Pennsylvania Psychiatric Leadership
Council (PPLC) developed a survey for psychiatry residents in psychiatry residency programs in
Pennsylvania. Data collection was completed in fall of 2008.

The Psychiatry Residents Seminar Survey consists of 53 questions in 9 main sections, plus two items
asking for residency year and geographic area. Surveys were distributed and collected at eight
psychiatry residency programs at the following locations across the state:
-           Einstein Medical Center
-           Lake Erie College of Osteopathic Medicine
-           Pennsylvania State University-Hershey
-           Temple University
-           Thomas Jefferson University
-           University of Pittsburgh
-           University of Pennsylvania
-           Drexel University

The total number of surveys distributed to all programs is not available, since a number of programs
copied and distributed surveys on their own. From a total of 262 reported psychiatry residents and
fellows in eight psychiatry residency programs, 162 completed surveys were collected, a return rate
of 61%. Most programs had return rates in the 60+% range. All four years of residency and fellows
were represented: PGY 1 through 3 were roughly 25% each of the total, about 17% were PGY 4,
and about 7% were fellows.

v Almost two-thirds of psychiatry residents in Pennsylvania are making decisions about a specialty
      prior to their third year in medical school.

v Sixty-five percent of respondents indicated they were very or moderately interested in
     working in community and public psychiatry.

v Experiences and mentors in a medical school clerkship were nearly as influential as experiences
     in a residency rotation in determining when interest in community psychiatrist first developed.

v The majority of residents expected that gross income in their first job post-residency would be less
     than $150,000, which is above the median psychiatrist salary for Pennsylvania.

v The items chosen as very important in deciding what job to seek after residency included facility
     safety, on call expectations, clinical versus administrative duties, availability of support staff, and
     opportunities for further education.

SURVEY QUESTIONS

Decision-Making About Specialty
A majority of psychiatry residents reported making a decision about choosing psychiatry as their
specialty before they completed medical school. The highest percentage (46%) of respondents
reported making the decision to become a psychiatrist in the 3^rd year of medical school. The second
highest percentage (20%) of residents made their decision prior to entering medical school. The third
highest percentage (16%) reported that they made their decision during “internship.”

Level of Interest in Community Psychiatry
A majority (65%) of respondents reported that they were “very interested” (29%) or had a
“moderate interest” (36%) in working in community and public psychiatry after completing their
residency, using this definition:

“Psychiatry practiced in any public/community agency/institutional behavioral health care
setting that delivers a range of services to all patients in the community, regardless of income.”

High and moderate interest combined stayed at 50% or above during every year of the residency.
Only 8% or respondents said that they had “no interest.”

At the same time, there appeared to be a definite trend toward decreased interest in the 3^rd and 4^th
years of residency:

Post-Graduate Year	Very Interested	Very Interested Plus Moderate Interest
1	37 %	77 %
2	32 %	71 %
3	14 %	50 %
4	19 %	54 %

Table 1: Interest in working in community psychiatry by year of residency.

Double the number of first and second year residents showed interest in community psychiatry as
opposed to those in their third or fourth year of residency. Left unanswered is whether those third
and fourth year residents always had a lower interest in community psychiatry or if those levels
decreased as time progressed.

Factors Influencing Interest in Community Psychiatry
Those who indicated a high or moderate interest in community psychiatry indicated that the following
had a “large influence” on their interest: experiences in residency rotation (30 percent), experience in
a medical school clerkship or rotation (26 percent), and a consumer/patient with whom she/he had
worked (21 percent).

It is notable that almost as many respondents reported that a medical school clerkship/rotation
was significant in developing an interest in community psychiatry as those identifying a residency rotation.

Gross Income Expected in First Job
Sixty-nine percent of respondents indicated that they expected gross income in their first post-residency
job would be under $150,000 and 45 percent expected it would be under $140,000. A survey in late
2008 of large community mental health centers in an urban Pennsylvania area revealed an average starting
salary of community psychiatrists between $145 – 155,000, dependent on board certification. One source
puts the median psychiatrist salary for Pennsylvania at $146,643 for non-profit organizations, typical
employers of community psychiatrists.

Factors Important in Post-Residency Employment
A list of 17 factors affecting the decision about what job to seek after completing residency was included
in the survey. The top five responses were:

• Safety of the facilities and area (49 percent)

• Few or no days of being on call (44 percent)

• How much time is clinical as opposed to administrative or other duties (42 percent)

• How much support staff help is available (41 percent)

• Opportunities for further training/education (40 percent)

Other issues identified as very important by more than 30 percent of the respondents were benefits that
cover a spouse/partner, number of hours over 40 expected per week, and litigation rates. It should be
noted that only 16 percent of respondents indicated that a starting base salary higher than most
psychiatrists just completing residency was “very important.”

In addition to the factors listed above, international residents identified having adequate vacation time
to visit their home countries (89 percent), job location in an underserved area for visa purposes
(42 percent), and being close to a community with familiar cultural/religious features (40 percent) were
“very important.”

Many administrators in community-based behavioral health settings are concerned about their ability to
attract and retain good psychiatrists. Several issues are raised:

Perceived lack of interest by psychiatrists in the subspecialty of public and community psychiatry

In developing a seminar curriculum for psychiatry residents concerning community psychiatry, one of the
authors (Molinaro) heard repeatedly that there was limited interest by residents in this subspecialty.
The standard rationale was that there was too little money or too many demands to attract the interest
of many residents. This belief seemed to be shared by a number of both psychiatry faculty and
provider administrators.

This survey suggests that there is in fact much interest by psychiatry residents: over 70% of PGY1
and PGY2 Pennsylvania residents completing the survey said that they were very or moderately interested.
Interest dropped in the third and fourth years of residency, but at least 50% continued to say that they were
very/moderately interested. If these same residents are going on to other subspecialties than community
psychiatry, there are likely to be other issues at play including real world working conditions at
community agencies.

The results of this survey suggest that administrators’ concerns about offering non-competitive salaries
do not accurately reflect what most residents expect to earn in their early post-residency employment,
although it is certainly possible that some agencies cannot offer salaries that reflect the average for the
state or for the Philadelphia area. If residents are ready to take jobs at salary levels offered by many
or most provider agencies in Pennsylvania, however, it seems unlikely that this is a crucial factor in their
decision about going into the subspecialty and would more probably lead to decisions to seek community
psychiatry positions in better paying areas, rather than abandoning the field.

Another frequently heard complaint is that providers can’t pay for the job conditions or benefits that
would attract good psychiatrists. The list of survey factors most important to residents in a job,
however, include a number of factors that are not necessarily a function of funding, such as on-call
hours, safety of facilities, types of patients, and opportunities for training in their areas of interest.

A survey completed by a majority of psychiatry residents in Pennsylvania demonstrated a substantial
level of interest in community and public psychiatry, and key factors in making anticipated job
decisions that did not center on salaries. Opportunities may exist to build on the data from this initial
survey to enhance the relationship between residents interested in community psychiatry and the providers
who wish to employ them.

b. Develop proposals and identify models for making psychiatry positions in the community/public
sector more attractive to psychiatrists and more likely to promote better consumer outcomes.

This survey had the invaluable help of Mary Diamond, Medical Director of OMHSAS at the time, members
of the PPLC who supported this effort and contributed to the content of the survey, and the Department of
Behavioral Health and Intellectual Disability Services (DBH/IDS) for its support through Philadelphia Connections,
and especially to DBH/IDS Medical Director Margaret Minehart.

Thanks also to the administrators and residents of the following institutions for their crucial participation: