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01-04-2015 | Original Paper

“I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice

Authors: Elizabeth Carpenter-Song, William C. Torrey

Published in: Community Mental Health Journal | Issue 3/2015

Abstract

The US needs engaged and skilled psychiatrists to support the recovery of people with severe mental illnesses and we are currently facing a shortage. This paper examines what attracts providers to community psychiatry and what sustains them in their work. Focus groups and interviews were used to elicit the perspectives of prescribing clinicians in three community mental health clinics in the US. Community psychiatry has inherent challenges, including facing high-risk decisions, encountering intense affects, and occasionally witnessing bad outcomes. Psychiatrists are motivated and sustained in this work by (1) cultivating relationships with patients and colleagues, (2) focusing on the mission of promoting recovery, and (3) engaging with clinical practice as intellectually stimulating work. Administrators support the engagement and morale of psychiatrists by creating workflows that allow psychiatrists to meaningfully apply their expertise to support patients’ recovery. These findings hold implications for recruiting and retaining a new generation of physicians.

Given the large number of prescribing clinicians at this site, we conducted two separate focus groups at this site.

Alimo-Metcalfe, B., Alban-Metcalfe, J., Bradley, M., Mariathasan, J., & Samele, C. (2008). The impact of engaging leadership on performance, attitudes toward work and wellbeing at work: A longitudinal study. Journal of Health Organization and Management, 22(6), 586–598.

Bovier, P. A., & Perneger, T. V. (2003). Predictors of work satisfaction among physicians. The European Journal of Public Health, 13(4), 299–305.CrossRef

Brotherton, S. E., & Etzel, S. I. (2013). Graduate medical education, 2012–2013. JAMA, 310(21), 2328–2346.CrossRefPubMed

Brotherton, S. E., Rockey, P. H., & Etzel, S. I. (2005). US graduate medical education, 2004–2005. JAMA, the Journal of the American Medical Association, 294(9), 1075–1082.CrossRef

Campos-Outcalt, D., Senf, J., Watkins, A. J., & Bastacky, S. (1995). The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: A review and quality assessment of the literature. Academic Medicine, 70(7), 611–619.CrossRefPubMed

Deegan, P., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.CrossRefPubMed

DeMello, J. P., & Deshpande, S. P. (2011). Career satisfaction of psychiatrists. Psychiatric Services, 62(9), 1013–1018.CrossRefPubMed

Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.CrossRefPubMedCentralPubMed

Feldman, S., Bachman, J., Cuffel, B., Friesen, B., & McCabe, J. (2003). Advanced practice psychiatric nurses as a treatment resource: Survey and analysis. Administration and Policy in Mental Health, 30(6), 470–494.CrossRef

Fischer, J., Kumar, S., & Hatcher, S. (2007). What makes psychiatry such a stressful profession? A qualitative study. Australasian Psychiatry, 15(5), 417–421.CrossRefPubMed

Garfinkel, P. E., Bagby, R. M., Schuller, D. R., Dickens, S. E., & Schulte, F. S. (2005). Predictors of professional and personal satisfaction with a career in psychiatry. Canadian Journal of Psychiatry, 50(6), 333–341.

Good, B. J. (1994). Medicine, rationality, and experience: An anthropological perspective. New York: Cambridge University Press.

Kleinman, A. (2006). What really matters: Living a moral life amidst uncertainty and danger. New York: Oxford University Press.

Kleinman, A. (2012). Rebalancing academic psychiatry: Why it needs to happen–and soon. The British Journal of Psychiatry, 201(6), 421–422.CrossRefPubMed

Krueger, R. A. (1994). Focus groups: A practical guide for applied research (2nd ed.). Thousand Oaks, CA: Sage Publications.

Lambert, T. W., Davidson, J. M., Evans, J., & Goldacre, M. J. (2003). Doctors’ reasons for rejecting initial choices of specialties as long-term careers. Medical Education, 37(4), 312–318.CrossRefPubMed

Landon, B. E., Reschovsky, J. D., Pham, H. H., & Blumenthal, D. (2006). Leaving medicine: The consequences of physician dissatisfaction. Medical Care, 44(3), 234–242.CrossRefPubMed

Lasalvia, A., Bonetto, C., Bertani, et al. (2009). Influence of perceived organisational factors on job burnout: Survey of community mental health staff. The British Journal of Psychiatry, 195(6), 537–544.CrossRefPubMed

Muxworthy, H., & Bowllan, N. (2011). Barriers to practice and impact on care: An analysis of the psychiatric mental health nurse practitioner role. Journal of the New York State Nurses Association, 42(1&2), 8–14.

Pollack, D. A., & Cutler, D. L. (1992). Psychiatry in community mental health centers: Everyone can win. Community Mental Health Journal, 28(3), 259–267.CrossRefPubMed

National Resident Matching Program. (2013). Results and Data: 2013 Main Residency Match ^®. Washington, DC: National Resident Matching Program.

Ranz, J., Stueve, A., & McQuistion, H. L. (2001). The role of the psychiatrist: Job satisfaction of medical directors and staff psychiatrists. Community Mental Health Journal, 37(6), 525–539.CrossRefPubMed

Staten, R., Hamera, E., Hanrahan, N., Hillyer, D., Limandri, B., Phoenix, B., et al. (2005). Advanced practice psychiatric nurses: 2005 legislative update. Journal of the American Psychiatric Nurses Association, 11(6), 371–380.CrossRef

Thomas, K., Ellis, A., Konrad, T., Holzer, C., & Morrissey, J. (2009). County-level estimates of mental health professional shortage in the united states. Psychiatric Services, 60(10), 1323–1328.CrossRefPubMed

Torrey, W. C., & Drake, R. E. (2010). Practicing shared decision making in the outpatient psychiatric care of adults with severe mental illnesses: Redesigning care for the future. Community Mental Health Journal, 46(5), 433–440.CrossRefPubMed

Torrey, W. C., Green, R. L., & Drake, R. E. (2005). Psychiatrists and psychiatric rehabilitation. Journal of Psychiatric Practice, 11(3), 155–160.CrossRefPubMed

Torrey, W. C., & Wyzik, P. (2000). Recovery vision as a service improvement guide for community mental health center providers. Community Mental Health Journal, 36(2), 209–216.CrossRefPubMed

Title: “I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice
Authors: Elizabeth Carpenter-Song
William C. Torrey
Publication date: 01-04-2015
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 3/2015
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-014-9752-5

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“I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice

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