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Am J Psychiatry 1995; 152:1416-1426
Copyright © 1995 by American Psychiatric Association
Decline of U.S. medical student career choice of psychiatry and what to do about it
FS Sierles and MA Taylor
Department of Psychiatry and Behavioral Sciences, Finch University of Health Sciences, Chicago Medical School, IL 60064, USA.
OBJECTIVE: In 1994, only 3.2% of U.S. medical school graduates chose
psychiatry, the lowest proportion since 1929. Success in recruiting such
graduates is necessary to maintain adequate numbers of psychiatrists. The
authors' goal was to gain an understanding of the determinants of specialty
selection to ensure adequate recruitment. METHOD: They reviewed all
recruitment-related English-language publications since 1959: 173 papers,
17 reports, and 10 books. RESULTS: They found that recruitment has been
cyclical, with success from 1940 to 1969 and from 1985 to 1988, decline
from 1970 to 1984 and from 1989 to 1994, and a possible small upswing in
1995. The 1940-1969 success began with 1) public recognition of a dramatic
shortage of psychiatrists to serve in the military and treat casualties and
2) the fervor of the community mental health movement, which promised to
prevent mental illness; massive resources were provided for psychiatry
during this period. The declines were associated with 1) the failure of the
community mental health movement to fulfill its promise, 2) psychiatry's
becoming more biologically oriented and medically conventional, and 3) the
effects of managed care and increased competition for patients. The
psychiatry departments that have high recruitment rates are in
public-supported schools, particularly in the South, or give considerable
priority and resources for medical student psychiatric education.
CONCLUSIONS: A study of the psychiatric workforce is needed to ascertain
whether there is a surplus or a shortage of psychiatrists. Regardless, to
ensure adequate recruitment, medical institutions and departments of
psychiatry must commit resources for student education in psychiatry.
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