Academic Psychiatry 28:56-59, March 2004
© 2004 Academic Psychiatry
Workforce Information on Addiction Psychiatry Graduates
Joyce A. Tinsley, M.D.
Dr. Tinsley is Director of Psychiatric Residency Training and Associate Professor of Psychiatry at the University of Connecticut, Farmington, Connecticut. Address correspondence to Dr. Tinsley, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030-1935, tinsley{at}psychiatry.uchc.edu (E-mail).
ABSTRACT
Objective: The aim of this paper is to report workforce information about graduates from accredited training programs in addiction psychiatry. Methods: As of June 30, 2002 there were 44 ACGME-accredited addiction psychiatry programs. The author asked the directors of these programs to complete a workforce survey about their graduates. Results: Seventy-three percent of program directors responded, providing information about 186 addiction psychiatrists. Forty-one percent of the graduates were employed in academic settings. Sixty-four percent of graduates employed in clinical settings dealt primarily with substance abuse patients. A majority of respondents described graduates as satisfied with compensation packages. Conclusion: Addiction psychiatry offers opportunities in a variety of settings that allow new graduates to utilize their subspecialty training.
The American Board of Psychiatry and Neurology (ABPN) established the subspecialty of addiction psychiatry in 1993 by offering a certificate of added qualifications. In order to sit for the board examination that leads to certification, the ABPN requires the candidate to complete a 1-year fellowship in an accredited program. At the end of June 30, 2002, the Accreditation Council for Graduate Medical Education (ACGME) listed 44 accredited addiction psychiatry programs.
There are limited data on the physician workforce in addiction psychiatry. Yet, it is likely that residents contemplating subspecialty training will want information about the positions graduates occupy, the ease in finding suitable employment, and the potential for a reasonable compensation package. The author surveyed training directors of accredited addiction psychiatry programs to better understand the place that new graduates occupy in the psychiatric workforce.
One useful resource on residents in psychiatry (who will make up the future workforce) is the APA Resident Census (1), conducted by the American Psychiatric Association (APA) in collaboration with the American Medical Association (AMA). The 2000–2001 Resident Census provides data on residents from 482 ACGME-accredited general and subspecialty programs. Of the residents reported, 11.5% were enrolled in child and adolescent psychiatry, 1.6% in geriatrics, 0.9% in addictions, 0.8% in forensics, 0.5% in consultation/liaison, 0.3% in research. International medical graduates accounted for 42.9% of general psychiatry residents, 68.9% of geriatric residents, 58% of addiction residents, 48.1% of consultation-liaison residents, 43.4% child and adolescent residents; and 25.5% of forensic residents. A nearly equal number of men and women were enrolled in general psychiatric training programs.
The AMA physician workforce information provides data on the psychiatric subspecialties on their website (2). The 1999 survey data on programs reported a total of 39 accredited addiction programs, with 46 residents in training, 30.9% of whom were female; 27 accredited forensic programs, with 44 residents in training, 37.7% of whom were female; and 55 accredited geriatric programs, with 98 residents in training, 37.2% of whom were female. The AMA report on graduate’s employment yielded little useful information because of the small number of graduate respondents.
METHOD
A list of ACGME-accredited residencies in addiction psychiatry was obtained for the year ending June 30, 2002. At that time, the ACGME reported that 44 programs were currently accredited or approved for accreditation effective at a future date. The author asked the directors of these programs to answer questions about the workforce status of their recent graduates by completing a survey. The survey was modified from the AMA questions on physician workforce (3). Training directors completed surveys at the 2001 annual meeting of the American Academy of Addiction Psychiatry or by e-mail. A follow-up e-mail survey was sent to each program that failed to respond to the first request.
RESULTS
Seventy-three percent (32 of 44) of the ACGME-accredited addiction psychiatry program directors responded to the survey. Of the 32 that responded, three directed programs were too newly accredited to have produced a graduate, but had fellows currently in training. Two of the programs listed as accredited by ACGME had closed. A director of one of the programs volunteered the additional information that the closure was due to financial reasons. Directors from the remaining 27 addiction programs provided the data reported presented here.
Respondents were from all six regions of the United States. Twenty-five of the 50 states in the United States have accredited training programs in addiction psychiatry (Table 1). Regional differences in responses to questions were minimal. However, the number of programs and graduates found in each region vary. The majority of programs are located in the Mid-Atlantic States. The response rate from these programs was very good, with 11of 13 programs responding to the survey. This region includes New York, a state that trained 40% of the graduates described here.
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TABLE 1. Numbers of Accredited Programs in Each State, Respondents, and Graduates of Responding Programs Listed by Regions
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Table 2 presents survey questions, along with the number (and percentage of total residents) reported in each category. Program directors were asked one additional question about whether or not graduates were pleased with their compensation packages. The program director was given the option of leaving this question blank. Seventeen of the 27 program directors chose to answer the question about some or all of their graduates. A total of 84 residents graduated from these 17 programs. Program directors reported that 73 of the 84 residents were satisfied with their compensation packages. There is information pertaining to this question on 45% of the graduates reported in the survey, and of these, a majority was satisfied with salary and benefits.
The number of female graduates is slightly greater than one-third of all graduates, which is more than reported in the 1999 AMA Physician Workforce Survey. Very few new graduates had difficulty finding suitable employment. A majority of graduates were employed in settings that included clinical responsibilities, and most were employed in urban settings.
DISCUSSION
Respondents were aware of only a few employment problems for new graduates. It is not known whether the unemployment situations were planned or unplanned. The graduates were employed in a variety of positions, including 41% in academic positions that were mostly in university-affiliated settings. Fifteen percent of residents from respondent programs were employed in research positions. The relatively high number employed in research may raise the question of a response bias. Nonetheless, research opportunities are clearly available in addictions.
Some of the graduates with academic positions were also reported to have clinical jobs. When all graduates were considered, 49% of the total were employed in clinical addiction positions, and 28% of all graduates were in general practice. However, when only those graduates in clinical practice were considered, 64% were employed in addiction psychiatry settings, and 36% were in general practice.
There are limitations of this study. The response rate of 73% does not capture all programs or all graduates. In addition, the information about the graduates comes from the program directors rather than directly from the graduates. If it were feasible to survey the graduates, it is likely that the response rate would be further compromised.
A few respondents pointed to an ambiguity in the survey, as to whether or not they were to include current residents. Although the survey was not meant to include current residents, some program directors asked for verification about this or added a separate category for the number of current residents in the program. In order to minimize potential error, each survey was checked as to the whether the number of residents reported matched the employment information that was given.
Another possible limitation is that 40% of graduates in this report are from one state. Even though New York is home to more training programs than any other state, the high response rate of programs in the Mid-Atlantic region may have resulted in a response bias that favors graduates from New York programs.
CONCLUSIONS
This report raises some concerns about addiction psychiatry training programs. While the number of ACGME-accredited addiction training programs increased from 39 in 1999 to 44 in 2002, two programs reported recent closure. The finances of training proved too onerous for at least one of the programs. In addition, the scarcity of training sites in some areas of the country raises questions about the uniform availability of addiction specialists. Women trainees are underrepresented in addiction psychiatry when compared to the numbers in general psychiatry. Shortages in addiction psychiatry expertise may be especially problematic in states without addiction training sites, in both Western states and rural areas. The number of women trainees in addiction psychiatry also appears slightly below the numbers of women in forensic and geriatric subspecialties.
On the positive side, results of this survey indicate that graduates of accredited addiction psychiatry programs have career opportunities in which they utilize their subspecialty skills. Respondents reported that 15% of new graduates were employed in research. The variety of opportunities for graduates, the ease with which they found suitable employment, and the number of graduates practicing their subspecialty.
REFERENCES
- American Psychiatric Association:2000–2001 APA Resident Census: Office of Graduate and Undergraduate Education. Washington, DC, APA, 2001
- http://www.ama-assn.org/cgi-bin/frieda/freida.cgi (accessed Aug. 16, 2001)
- http://www.ama-assn.org (accessed Aug. 16, 2001)
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