Wun Jung Kim, M.D., M.P.H. and Dorothy Stubbe, M.D.

Can child and adolescent psychiatry become a leading medical specialty with the highest remuneration and the most prestige? Maybe someday, although the two should not necessarily be correlated. The modern American culture, especially in medical schools, has fostered the perception of “the higher remuneration, the more prestige of a specialty.” Scientific breakthroughs and diagnostic/therapeutic efficacy also influence the image and prestige of a specialty. Historically, child and adolescent psychiatry has competed with primary care specialties in the annual income survey of all medical specialties.

However, a series of surveys of physicians completing a residency or fellowship training program in New York and in California in 2000 and 2001, indicated that child and adolescent psychiatry has stepped into the right direction in terms of job opportunity and financial remuneration. The Center for Health Work Force Studies at the State University of New York in Albany sent a survey instrument to all graduating residents and fellows annually in New York State since 1998 and in California since 2000. The Center recently published another survey of 2001 graduates and also a summary data combining 2000 and 2001 graduates for each state. Because of marked discrepancies of the data between the 2000 and the 2001 graduates in New York State but not in California, this report will highlight the findings of the 2000 New York graduates (http://chws.albany.edu/reports/042001/nyexit2001.pdf) and the summary findings of the 2000 and 2001 California graduates (http://chws.albany.edu/reports/042002/caexit2002.pdf).

  1. The survey was responded to by 2120 (40 percent, including 29 child and adolescent psychiatry residents) of 5248 graduating physicians in California in 2000 and 2001, and by 2866 (65 percent, including 26 child and adolescent psychiatry residents) of 4422 graduating physicians in New York in 2000. These residents come from 27 specialties and subspecialties in California and 28 of those in New York.
  2. Median starting income of child and adolescent psychiatrists was ranked 13th, $32,500 higher than that of adult psychiatrists in California but the discrepancy was not that high in New York State.
  3. Child and adolescent psychiatry ranked the first in the mean number of job offers per resident in California (6.32) and the second in New York (6.45), next to dermatology.
  4. Child and adolescent psychiatry was ranked the best by its graduating residents in terms of their assessment of both regional and national job market in California and within the first five in New York State, much higher than general psychiatry.
  5. None of the graduating child and adolescent psychiatry residents had to change plans due to limited practice opportunities in both California and New York, the lowest among all specialties.
  6. The average number of hours of clinical work in a week was 41.6 in child and adolescent psychiatry, ranked the 25th out of 28 specialties which ranged from 52 in anestheology to 28th, 35.8 in dermatology (28th).
  7. In several other measurements, child and adolescent psychiatry came out very favorably in terms of job flexibility, diverse options of practice, and work environment, etc.

Finally, in a recent survey of mean physician salaries, Physician Search reported the average salary in psychiatry was almost $175,000, significantly higher than the primary care specialties of Family Practice ($147,516), Pediatrics (149,754), or Internal Medicine (160,318).

This is encouraging news to young physicians who are interested in child and adolescent psychiatry but may not be confident about the job prospects. Child and adolescent psychiatry mentors need to actively disseminate the encouraging news to medical students and general psychiatry residents in addition to preaching how stimulating and rewarding a specialty practice in child and adolescent psychiatry is in terms of cutting edge development in neuroscience, developmental science and providing crucial mental health care and health care/policy advocacy for our country’s youngest and most vulnerable citizens (Task Force on Workforce Needs/AACAP, 2001). If only there were more support by the government and medical schools for child and adolescent psychiatry training! We would then be able to recruit significantly more talented young physicians into child and adolescent psychiatry. Regardless, there is ample evidence that child and adolescent psychiatry is moving forward into becoming a leading medical specialty.


References
Center for Health Workforce Studies at SUNY, Albany (2001); Residency training outcomes by specialty in 2000 for New York State, http://chws.albany.edu/reports/042001/nyexit2001.pdf

Center for Health Workforce Studies at SUNY, Albany (2002); California residency training outcomes in 2001, http://chws.albany.edu/reports/042002/caexit2002.pdf

Dr. Kim is Visiting Professor of Psychiatry at University of Pittsburgh, a member of AACAP Steering Committee on Work Force issues and Work Group on Training and Education.

Dr. Stubbe is Director of Child and Adolescent Psychiatry Residency at the Yale University Child Study Center and a co-chair of AACAP Work Group on Training and Educatio a member of AACAP Steering Committee on Work Force issues.