There are a number of problems for subspecialties in psychiatry. Once recognized, a specialty must attract trainees to its programs. Both specialties of geriatrics and addictions have had disappointments in filling programs, especially with qualified U.S. medical graduates. The training of international medical graduates on J-1 Visas presents a problem in determining the physician workforce in the United States. Additionally, the rate at which certified specialists will recertify once their temporary certificates expire is unclear. In a 2003 article, Juul and Scheiber (
+7) reported that 2,595 certificates have been awarded in geriatric psychiatry; however, only 63% of those eligible to recertify have done so.
The potential for competition between specialties was clear when consultation-liaison (C/L) made a bid for subspecialty status. Recently, ABMS approved the ABPN recommendation to recognize C/L as a subspecialty under its new name "psychosomatic medicine," but there was considerable debate in the field prior to approval. There were concerns that the scope of C/L was too broad, that it overlapped with geriatrics, and that consultations are part of the "bread and butter" of general psychiatry. Some educators in approved subspecialties feared competition for applicants with the addition of another subspecialty. Nevertheless, the argument in favor of a psychiatric subspecialty specifically devoted to the complex care of the medically ill was accepted, with compromise on the name of the new subspecialty.
Two of the educational challenges for subspecialists are: 1) acquainting general program directors and other educators with subspecialty training programs and 2) sharing ideas about how to teach medical students and residents about these topic areas. This issue of Academic Psychiatry aims to provide information and stimulate thought by presenting papers on a variety of subspecialty training and content areas. Each subspecialty is exciting enough to stand alone. Perhaps putting them together in a single issue is a statement about how closely linked one subspecialty is to another in contributing to this expanding and attractive field of medicine, with its many facets of practice and research and education.