Jun 11, 2019
Norris, MD, interview with Robert
McCarron, DO, at the American Psychiatric Association meeting
Dr. McCarron is vice chair of education and integrated care at
University of California, Irvine, department of psychiatry. He is
also trained as an internist.
Shortage of psychiatrists, other mental health
- About 70% of all psychiatrists are over the age of 50 years and
looking toward retirement.
- This also pertains to other mental health providers, such as
Implications of shortage
- People with severe mental illnesses (SMIs) are not getting the
care they need. On average, they die 10-15 years younger than
people who do not have SMIs. Patients with SMIs have a higher risk
of death from illnesses such as heart disease, hypertension, and
osteoarthritis because they are not getting preventive/primary
- Patients with chronic pain issues are not getting care.
- In California, physician assistants provide care to many
patients, but they get only 2 weeks of instruction in
- About 80% of all antidepressants are prescribed by
nonpsychiatrists. About 60% of all mental health care is delivered
in the United States by clinicians who do not specialize in mental
health. This care is delivered in primary care settings. About
40%-45% of patients seen in primary care offices are treated for
behavioral health issues, such as depression, anxiety, or substance
- Suicides are up more than 20% over the last decade. On average,
25 veterans die by suicide each day.
Training primary care colleagues in
- Primary care physicians have a core baseline in biomedical
sciences. Giving them a booster in behavioral health is a way to
address the shortage.
Train New Trainers Primary Care Psychiatry Fellowship was
launched at University of California, Davis, and the University of
California, Irvine. It has 125 fellows throughout the country, and
the hope is to double that number.
- The program lasts 1 year, including two intensive
- It teaches fellows how to conduct motivational interviewing;
short, targeted, and brief psychotherapies that are effective and
- The Fellowship includes Web-based presentations two to three
times per month.
- It also includes small group mentorship meetings in which
fellows discuss patients and learn how to navigate complex
- A combined residency program might be another way to address
the need for more training in psychiatry.
Price S. Front line: Using primary care to prevent suicide.
2018 Nov 1;114(11):16-21.
Santiani A et al. Projected workforce of psychiatrists in the
United States: A population analysis.
Psychiatr Serv. 2018 Jun;69(6):710-3.
Huff C. Shrinking the psychiatrist shortage. Manag Care. 2018
Wilkins KM et al. Integration of primary care and psychiatry: a
new paradigm for medical student clerkships. J Gen
Intern Med. 2018 Jan;33(1):120-4.
McGough PM et al. Integrating behavioral health into primary
Health Manag. 2016;19(2):81-7.
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