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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Given the large number of prescribing clinicians at this site, we conducted two separate focus groups at this site.
References
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.
Brotherton, S. E., & Etzel, S. I. (2013). Graduate medical education, 2012–2013. JAMA, 310(21), 2328–2346.
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.
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.
Deegan, P., & Drake, R. E. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.
DeMello, J. P., & Deshpande, S. P. (2011). Career satisfaction of psychiatrists. Psychiatric Services, 62(9), 1013–1018.
Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.
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.
Fischer, J., Kumar, S., & Hatcher, S. (2007). What makes psychiatry such a stressful profession? A qualitative study. Australasian Psychiatry, 15(5), 417–421.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Torrey, W. C., Green, R. L., & Drake, R. E. (2005). Psychiatrists and psychiatric rehabilitation. Journal of Psychiatric Practice, 11(3), 155–160.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carpenter-Song, E., Torrey, W.C. “I Always Viewed this as the Real Psychiatry”: Provider Perspectives on Community Psychiatry as a Career of First Choice. Community Ment Health J 51, 258–266 (2015). https://doi.org/10.1007/s10597-014-9752-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-014-9752-5