Danielle Goerke has heard the well-meaning joke many times. At least you have job security!
Goerke is ready with her standard response.
“I would take one-tenth of the job security to have more resources for my patients,” she said. “Even if we trained 10 times more people, we’d still be at a deficit. That’s not a fun feeling.”
Goerke is “painfully aware” of how unusual she is. She came to the University of Minnesota after medical school to do a residency in adult psychiatry, then completed a fellowship in children and adolescent psychiatry in 2013. She’s now an assistant professor of psychiatry specializing in children and teens.
As I reported last Sunday, there are only about 8,300 practicing child psychiatrists in the United States, out of a total of about 41,000 psychiatrists. Many of them are moving toward retirement, while just 5 percent of new medical school students choose psychiatry.
That leaves a growing number of youngsters, particularly in rural areas, vulnerable to falling through the cracks. Rates of depression rise substantially from age 13 to 18, according to the National Institute of Mental Health. Without quick and proper interventions, mental illnesses can follow a child right into adulthood.
While child psychiatric ranks won’t be increasing tenfold soon, as Goerke dreams, Minnesota has reason to be optimistic. Aside from model collaborations and mental health training built early into medical school classwork, leaders are taking a rather un-Minnesotan approach:
They’re proudly selling psychiatry as a fulfilling, long-term and lucrative profession.
“Some medical students think psychiatry would be too emotionally taxing,” said Rabindra Tambyraja, the U’s vice chairman for clinical affairs.
He works with children and families facing a spectrum of disorders including psychoses, depression, severe anxiety and autism.
“They wonder, ‘How could you bear to hear those kinds of sad stories day after day?’ Being a psychiatrist is emotionally very intense work,” he said, “but we hear those stories so that we can respond. This really is a rewarding field to be in.”
Psychiatrist Katharine Nelson agreed. “Many students have a certain vision of what their lives as a doctor will be, with a white coat and a stethoscope around their neck, listening to their patient’s heart,” said Nelson, the U’s vice chairwoman for education in psychiatry. “Sometimes, a mental shift must happen from ‘I’m never going to perform a physical examination on a patient again?’ ”
It doesn’t help that the mental health field still carries a stigma, added Nelson, even for professionals. While she knew she wanted to be a psychiatrist since high school, “it’s not always easy to tell your family you’re choosing psychiatry over a field like pediatrics. A parent will ask, ‘Why would you want to do that?’ ”
For lots of reasons.
Quality time with one’s patients, for starters. While other doctors are lucky to get 15 minutes, psychiatrists have regular, nearly hourlong sessions with theirs. “Psychiatry offers a way of developing close relationships with patients,” said Dr. Renee Binder, president of the American Psychiatric Association. In addition, the field is becoming more collaborative, she noted, with mental health practitioners sharing office space with pediatricians, obstetricians and other disciplines.
The work is varied. Recent graduate Goerke, who directs the school’s Child and Adolescent Psychiatry Fellowship program, said she’ll never get bored. “There are so many facets of psychiatry,” she said. “I’m board-trained to work with adults. I could work with pregnant moms with postpartum depression. It appealed to me to have some wiggle room.”
The hours are generally reasonable, and the years in practice are among the longest in medicine, Binder added.
And, not for nothing, compensation is improving.
“My grads are coming out with very lucrative offers,” Goerke said.
To get the word out, U faculty members are moving into the classrooms of first- and second-year students to tell them what it’s really like to be a psychiatrist — an effort to demystify the field and combat the stigma related to working with people living with mental illness.
During their medical school clinical rotations in the third and fourth year of training, students are required to do a six-week rotation in psychiatry, “where they are embedded right in the care team on the front lines,” Nelson said. These rotations occur at the U, as well as at one of the affiliated programs at the Minneapolis VA, Regions, Hennepin County Medical Center or Anoka-Metropolitan Regional Treatment Center.
Nobody had to sell Benjamin Otopalik on psychiatry. His mother, Julie Gerndt, is a psychiatrist in Mankato. He grew up talking about psychiatry with her, and still does.
“She was helpful in exposing me early on to the field,” said Otopalik, a U psychiatry resident.
Otopalik considered family medicine and surgery. “But psychiatry is one of the only specialties where you get to spend special quality time with your patient,” he said. “You’re taught to be sensitive to people who perceive the world differently.”
He’s candid that his patients, adults and children, “can be really sick.” But he, like his medical school mentors and mother, remains optimistic about the future of mental health outreach for children.
“What’s different about psychiatric care is that we’re starting to look more holistically at what helps people achieve mental wellness,” he said. “Historically, society looked to psychiatry for the pill. Now children’s mental health care is interdisciplinary. You get to work with psychologists, school social workers, case managers, occupational therapists, physical therapists and nurses.
“It’s a team of people trying to help the child and the family.”