National Psychiatrist and Child Psychiatrist Shortage

In my previous life some two decades ago as a young Turk clinical teaching and supervising faculty of psychiatric and child psychiatric residents and fellows in training at Duke Medical Center, I became interested in “manpower” (the vernacular then) or more properly speaking practitioner distribution and training issues of psychiatrists. This was in the so called Golden Age of mental health practice, even though the service delivery system in all disciplines, had serious issues, I and many many others could see the troublesome issue of maldistribution of mental health care professionals that was emerging three decades ago and worsening¬† year by year. Basically what was evolving was a situation in which desirable places to live, urban areas with urban amenities such as the symphonies, ballet and performing arts companies, university centers, and above all many colleagues around for support and lively continuing education meetings of regional psychology, social work and psychiatry societies, kept graduates of advanced training programs in the regions in which they trained. So over time, it evolved that areas like Boston/Cambridge MA, Raleigh-Durham-Chapel Hill NC (the Triangle Area), Ann Arbor MI, Dartmouth, New York City especially Manhattan, Stony Brooke, Long Island, Houston, Los Angeles, San Francisco, Seattle, Eugene OR, San Diego, Davis CA, Charleston SC, Atlanta GA, Birmingham AL, Albuquerque, Tucson AZ, and many other urban areas became the landing places where psychiatrists trained and often stayed to practice, in the university medical center cities. A good friend and colleague, now passed on Bruce Neeley MD of Duke and Emery, used to give lectures to residents nearing the penultimate stages of their training careers and were a year away from the decision of where to settle to practice. By then the 1980’s the trend had become set in concrete, only a minority of graduating psychiatrists left the training centers and set up practice in under-served areas.

Bruce Neeley and I separately in turn would give almost off the records seminars to the ‘senior residents,’ telling them in so many words, almost like the famous newspaper editor of the 1800’s, “Go West Young Psychiatrist,” In North Carolina we first meant go literally to western North Carolina which I knew very well because of my wife’s origin from Cherokee NC. But we also meant “get out of the urban centers, there are too many of us here already.”

WNC then and sadly still is vastly under-served by psychiatry with a chronic shortage that is almost criminal. I can count on the fingers of one hand the number of child psychiatrists in practice west of Asheville and that is a lot of territory. I used to tell senior residents to “Get out of the RTP [Research Triangle Park, another term used to denote the entire Raleigh-Durham-Chapel Hill area since each of those cities incredibly are only 8 to 15 miles from each other!

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We Didn’t Make It A Week Without Another Shooting

This past week I had hoped that the week would pass without another widely publicized shooting in this country. I wanted emotionally a respite from shootings of youth by police, enraged spousal murders or murders suicides between estranged couples of shootings of or by police. Well my naive wishes were crushed this past week and weekend when we had two separate unrelated shootings of police. I watched the first funeral of the one policeman who was actually killed, with full dress uniforms, police from many surrounding areas and states and the bagpipes and police solidarity with more than sadness. It was sadness for the whole country and a wish stronger than ever that the media talking heads, 24 hours new shows, would show more respect, report on the story and stop repeating it for days on end. I thought of the bereaved family and friends who would have to turn off their televisions, and other means of influx of media to keep from being traumatized over and over again by the flagrantly disrespectful, invasive repetitiousness of the reports covering the same ground and footage over and over again, until it would start to lose it impact and true meaning and lessen our ability to stop and ponder seriously what is going overall again.

I was reminded of an article I had curated just a month ago by Robert Gebelhoff published July 6, 2015 in the Washington Post entitled “Study: Why some mass killing and school shootings seem to be contagious.” This study, from Arizona State University in Tempe, AZ, was published in the largely not so well know online scientific journal,¬† “PLOS One,” which is a referreed journal with ethical review of articles submitted, It found that there may be a “period of contagion,” after school shootings and mass shootings that “lasts an average of 13 days.” The authors had constructed a mathematical model to measure and to some extend try to inject some predictability into this troublesome social phenomenon. It found for instance, that “for every three mass killings, an average of more more happens….” and “for every four or five school shootings-including those with no fatalities=another shooting takes place.”

It noted as a social precedent of sorts that studies have shown that “suicide can spread through social groups, with news [emphasis mine] of death provoking others to end their lives. The phenomenon is especially common among adolescents–and in the age of social media, widely publicized suicides can spread the effect much further than the rumor mill at a high school.”

Sherry Tower one of Arizona State University (ASU) professors and the study’s author stated: “It occurred to us that mass killings and school shootings that attract attention the national news media can potentially do the same things, but at a larger scale.”

The study further found that, “On average, mass killings involving firearms happen every two weeks in the United States….and school shootings happen once every months.”

I feel and fear that another factor is in play and not being considered enough in the hallways of thought and self observation of the profession of journalism, except in the always derided “Ivory Towers”, the schools of journalism where studies thought and studies such as this from ASU came with its sobering comment for consideration. The working media seems more driven by the old race for ratings, and by a philosophy that substitute almost Leninist repetitiousness for news reporting. A “breaking news story” on the news channels seems to have an hourly rebirth and presented at the top of each hour as if it were brand new and we the viewers are subjected to the same tragedy message all over again unfiltered and with little commentary or food for thought. Just the raw events over and over again. Mindless repetition, if I may coin a somewhat strong and critical phrase has its own destructive powers. It numbs us to the tragedy of such events and may even extend its power to making us more fatalistic and accepting of this relatively new and dangerous phenomenon of the quick and ready and impulsive use of firearms, mostly to give vent to idiosyncratic issues of the shooter, and lull us into a sense that there is not much we can do about all this or to prevent it. Repetition also when it is practiced constantly, our best current example being North Korea, “The Hermit State,” where the ‘truth’ has been distorted to social insanity on an almost unimaginable scale, that the nation’s population thinks it seems that what they hear in their own controlled media is the truth and the norm.

More thought and self examination needs to be given by the working media of its use of “mindless repetition,” which appears to be excessive, largely unneeded, and which may have more subtle destructive effect than we realize.