As a medical student, Eric Achtyes really didn’t know what field he should specialize in. But after a six-week rotation in psychiatric medicine, he knew.
“In that period, I got to experience an inpatient unit and see some patients in a partial hospitalization program. I got to see outpatients and spend a week at an addictions hospital. I remember going to all of those different areas and thinking, ‘Wow, I could really do this someday,'” the 48-year-old says. “I would say psychiatry found me, not the other way around. I was just blown away by the opportunity to help people in that way.”
Now, as the chair of the Department of Psychiatry at the Western Michigan University Homer Stryker M.D. School of Medicine (WMed), Achtyes hopes to help other aspiring doctors find their way into the field at a time when they are sorely needed. Psychiatrists are an essential part of the mental-health workforce. Unlike psychologists, psychiatrists are medical doctors, which means they have expertise in both mental and physical health and the intersection between the two. Psychiatrists also are licensed to prescribe psychotropic drugs, which most other mental-health professionals cannot do.
There already is a nationwide shortage of psychiatrists, the result of growing demand amid shrinking numbers of doctors as Baby Boomers retire, and that shortage is expected to grow. The American Association of Medical Colleges estimates that in just a few years the U.S. will be short between 14,000 and 31,000 psychiatrists.
“We’re not going to train our way out of that,” Achtyes says. “We have to think about creative, creative approaches. We want people to be able to get treatment for mental health conditions in the same way that they do for physical health conditions.”
What is your biggest challenge in this role?
It is workforce and competing with other markets to attract talent. Coming out of the pandemic, the entire health care system is strained. A lot of focus was on the medical system, and people were really tired after the pandemic. We saw a number of people take early retirement and decide that it was time to end their work. It’s going to be really hard for us to replace those people and to compete with other markets that are trying to recruit the same talent that we are.
Also, any time you have a large traumatic event, whether it’s a pandemic, a war or a natural disaster, there’s the event and then following that event is a much longer mental health shadow. Those in mental health care are going to be continuing to help people who developed depression, anxiety disorders or addictions during the pandemic for years after much of the rest of society has gotten back to whatever the new normal looks like. The mental health workforce is going to continue to be challenged for months and years to come.
Is there a solution for that?
We have to develop new strategies because only a tiny fraction of people with mental health conditions in the United States ever see a psychiatrist. There just aren’t enough psychiatrists in the pipeline so that everybody who needs to can see a psychiatrist.
We need new models of care, and some of that is team-based care. Much of the time, a primary-care doctor can treat anxiety and depression for patients in their practice. But if they’ve tried a couple different medications or counseling and things aren’t getting better for that individual, they could refer them to psychiatry, but there’s limited access because we don’t have enough psychiatrists, or they can work through a collaborative-care relationship. The collaborative-care model is incredibly important for providing access and to leverage expertise and get it to more people.
A few years ago, WMed started the Kalamazoo Collaborative Care project, where the expertise of a single psychiatrist is leveraged to affect patients within primary-care practices. One of our psychiatrists will meet with members of treatment teams from primary-care practices and review cases and say, “OK, you’ve tried these two medications and you’ve tried this therapy, the next step in care that I would recommend is to try this option.” Then the primary-care doctor can implement those. Many people are understandably more comfortable staying with their primary-care doctor, who they’ve known for years and have a relationship with, to try to address some of those symptoms.
With just an afternoon every other week of psychiatric expertise, the doctors can spread that expertise to hundreds and even thousands of patients within a practice.
Research shows that there are more students applying for psychiatric medical programs than before. So why aren’t there more psychiatrists coming through the pipeline?
We need more residency slots. Many residency slots are funded through the Centers for Medicare and Medicaid Services (CMS), and when a hospital develops a residency program, it gets one shot to say how many residents it will have in each specialty. If the community grows or the need grows, the hospital can’t go back and get more CMS-funded residencies. Our program at WMed, which has been around for a long time, only has four CMS-funded slots per year. The only way that we can increase that allocation is if a hospital that doesn’t have a residency training program opens one and they establish a new residency cap for that hospital.
We do have some opportunities coming up here. The Bronson Behavioral Health Hospital, opening in Battle Creek, will have the opportunity to set a new cap, which we could do in collaboration with them. The same is true for the new NeuroPsychiatric Hospital (a new 64-bed facility under construction in Texas Township). If they choose to establish a residency training program, they can apply for CMS funding to support those residency slots.
There are endless debates about how CMS funding works. We’ve built new medical schools to graduate more doctors, but we need to expand the residency slots to accommodate those students that are graduating. And we need Congress to act to do that. Is there really a strong rationale that only brand-new hospitals should be able to grow their residency programs? If there’s an established program that’s already teaching and training, adding a couple more residency slots to that program makes a lot more sense, but we have to have the political will to do that.
— Interview by Marie Lee, edited for length and clarity
This story is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in Southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 12 regional organizations dedicated to strengthening local journalism. For more information, visit swmichjournalism.com.