Sierles F S, Taylor M A
Department of Psychiatry and Behavioral Sciences, Finch University of Health Sciences, Chicago Medical School, IL 60064, USA.
Am J Psychiatry. 1995 Oct;152(10):1416-26. doi: 10.1176/ajp.152.10.1416.
In 1994, only 3.2% of U.S. medical school graduates chose psychiatry, the lowest proportion since 1929. Success in recruiting such graduates is necessary to maintain adequate numbers of psychiatrists. The authors' goal was to gain an understanding of the determinants of specialty selection to ensure adequate recruitment.
They reviewed all recruitment-related English-language publications since 1959: 173 papers, 17 reports, and 10 books.
They found that recruitment has been cyclical, with success from 1940 to 1969 and from 1985 to 1988, decline from 1970 to 1984 and from 1989 to 1994, and a possible small upswing in 1995. The 1940-1969 success began with 1) public recognition of a dramatic shortage of psychiatrists to serve in the military and treat casualties and 2) the fervor of the community mental health movement, which promised to prevent mental illness; massive resources were provided for psychiatry during this period. The declines were associated with 1) the failure of the community mental health movement to fulfill its promise, 2) psychiatry's becoming more biologically oriented and medically conventional, and 3) the effects of managed care and increased competition for patients. The psychiatry departments that have high recruitment rates are in public-supported schools, particularly in the South, or give considerable priority and resources for medical student psychiatric education.
A study of the psychiatric workforce is needed to ascertain whether there is a surplus or a shortage of psychiatrists. Regardless, to ensure adequate recruitment, medical institutions and departments of psychiatry must commit resources for student education in psychiatry.
1994年，只有3.2%的美国医学院毕业生选择精神病学专业，这是自1929年以来的最低比例。招募此类毕业生的成功对于维持足够数量的精神科医生至关重要。作者的目标是了解专业选择的决定因素，以确保充足的招募人数。
他们回顾了自1959年以来所有与招募相关的英文出版物：173篇论文、17份报告和10本书籍。
他们发现招募情况呈周期性变化，1940年至1969年以及1985年至1988年取得成功，1970年至1984年以及1989年至1994年出现下降，1995年可能有小幅上升。1940年至1969年的成功始于：1）公众认识到军队中服务及治疗伤员的精神科医生严重短缺；2）社区心理健康运动的热情，该运动承诺预防精神疾病；在此期间为精神病学提供了大量资源。下降与以下因素有关：1）社区心理健康运动未能兑现承诺；2）精神病学变得更加以生物学为导向且在医学上趋于传统；3）管理式医疗的影响以及对患者的竞争加剧。招募率高的精神病学系位于公立支持的学校，特别是在南方，或者给予医学生精神病学教育相当的优先地位和资源。
需要对精神科劳动力进行研究，以确定精神科医生是过剩还是短缺。无论如何，为确保充足的招募，医疗机构和精神病学系必须投入资源用于学生的精神病学教育。
