Content uploaded by Jim Phillip Demello
Author content
All content in this area was uploaded by Jim Phillip Demello on Nov 18, 2015
Content may be subject to copyright.
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9 11001133
There is compelling evidence
indicating that the number of
psychiatrists in the United
States is far short of the current need,
especially in rural and poorer com-
munities (1,2). Preliminary estimates
place the shortage at around 45,000
psychiatrists, and all signs indicate
that the situation will get worse in the
future (3). This shortage is happen-
ing at a time when the demand for
psychiatric services is increasing sig-
nificantly because of factors such as
population growth, greater evidence
for the treatability of mental illness,
more efficacious medications, and
social acceptability of mental illness
conditions (4). A larger number of re-
turning war veterans and deteriorat-
ing economic conditions may also
further increase the need for psychi-
atric services.
Unfortunately, the supply of psy-
chiatrists has not kept up with the de-
mand because of factors such as un-
derfunding of psychiatric services by
the government, reductions in hours
worked by aging psychiatrists, and a
general reluctance of incoming med-
ical students to choose psychiatry as
their area of specialization (4,5). Un-
like other physicians, psychiatrists
face some unique problems. Psychia-
trists as a group are more vulnerable
to vicarious trauma, compassion fa-
tigue, and job burnout and have the
highest rate of suicidal tendencies
among male physicians (6–8). These
issues can have a major impact not
only on service delivery and quality of
care but also on turnover rates among
psychiatrists.
Experts have suggested various op-
tions as possible remedies for the
shortage of psychiatrists, such as get-
ting primary care physicians to absorb
excess patients, training a greater
number of advanced practitioner
nurses and physician assistants, hiring
locum tenens, and providing mental
health care via the Internet. But each
option has limitations associated with
its cost, quality of service, or effec-
tiveness in treating patients (3,5,9). If
implemented, these measures collec-
tively could alleviate some of the
shortage of psychiatrists, but in the
long run it will be very difficult to
bridge the gap in services without at-
tracting more medical students to
psychiatry and motivating the current
crop of psychiatrists to see more pa-
tients and delay retirement.
Past research suggests that physi-
cians’ career satisfaction has a critical
impact on the medical profession
(10–17). Physicians who are satisfied
with their careers are more likely to
provide better health care and have
patients who are more satisfied
(18,19). Moreover, dissatisfaction
among physicians of a particular spe-
cialization can lead to declining num-
bers of medical graduates in that spe-
cialty (20,21), increase in rates of
medical errors related to job stress
(22), unionization (23), strikes (24),
and even exodus from the medical
profession (25). Toward this end it is
Career Satisfaction of Psychiatrists
JJiimm PP.. DDeeMMeelllloo,, DD..BB..AA..
SSaattiisshh PP.. DDeesshhppaannddee,, PPhh..DD..
Dr. DeMello is affiliated with the Department of Finance and Commercial Law, and Dr.
Deshpande is with the Department of Management, Western Michigan University, 1903
West Michigan Ave., Kalamazoo, MI 49008-5429 (e-mail: james.demello@wmich.edu).
Objective: According to recent estimates, there is a shortage of around
45,000 psychiatrists in the United States. It will be very difficult to ad-
dress this problem without attracting more medical students to psychia-
try and motivating the current crop of psychiatrists to see more patients
and delay retirement. In this study the authors sought to identify factors
that have a significant impact on the career satisfaction of psychiatrists.
Methods: Data were gathered from 314 psychiatrists who participated in
the 2008 Health Tracking Physician Survey conducted by the Center for
Studying Health System Change. Independent variables were grouped
as practice-related factors, compensation-related factors, patient-related
factors, and demographic characteristics of psychiatrists. Career satis-
faction of psychiatrists was the outcome measure of this study. Results:
Threat of malpractice and the need to consider in treatment decisions
out-of-pocket cost to patients had a significant negative impact on career
satisfaction. Adequate time with a patient had a significant positive im-
pact on career satisfaction. None of the compensation-related factors
was significant. Psychiatrists who worked in practices that accepted new
Medicare patients reported significantly higher levels of career dissatis-
faction, whereas those who worked in practices that accepted new Med-
icaid patients reported significantly higher levels of career satisfaction.
Older psychiatrists were more satisfied than younger psychiatrists, and
white, non-Hispanic psychiatrists were more satisfied than African-
American or Hispanic psychiatrists. Conclusions: The results of this study
highlight the need for policy makers and health care administrators to
develop specific strategies to increase career satisfaction, which in re-
turn may help alleviate the shortage of psychiatrists. (Psychiatric Ser-
vices 62:1013–1018, 2011)
imperative that politicians, health
policy makers, and medical school di-
rectors have a good understanding of
the factors influencing the overall ca-
reer satisfaction of psychiatrists. The
purpose of this study was to analyze
the responses given by a nationwide
sample of practicing psychiatrists so
as to understand what it is that makes
them “tick” and to identify areas
needing reform, increased funding,
efficiency, or political attention.
Methods
Sample
The data for this study were from a
sample of psychiatrists who partici-
pated in the 2008 Health Tracking
Physician Survey (HTPS) conducted
by the Center for Studying Health
System Change (HSC) and spon-
sored by the Robert Wood Johnson
Foundation. The HTPS replaces the
Community Tracking Study (CTS)
series (1996–97, 1998–99, 2000–01,
and 2004–05). Although the CTS
used a community-based design and
collected data via telephone inter-
views, the HTPS is based on a survey
of a nationally representative sample
of physicians. Substantial changes in
the wordings and administration of
the survey make it impractical to
compare the results of the HTPS
and CTS.
The HSC used a comprehensive
process to identify participants for the
HTPS. The HSC first obtained a list
of 735,378 physicians from the Amer-
ican Medical Association. The center
then used stratification procedures to
identify 10,250 physicians to survey.
These physicians were then surveyed
between February 2008 and October
2008. At the completion of the survey,
HSC was left with a nationally repre-
sentative sample of 4,720 physicians
who completed surveys. The HTPS
does not include the following: resi-
dents, fellows, federal employees,
foreign medical school graduates who
are temporarily licensed to practice in
the United States, and specialists
whose primary focus is not direct pa-
tient care. We obtained HTPS public-
use data and survey documentation
from the Web site of the Inter-Uni-
versity Consortium for Political and
Social Research in Ann Arbor, Michi-
gan (www.icpsr.umich.edu/icpsrweb/
HMCA/studies/27202).
Our study was limited to 314 physi-
cians who identified their primary
specialty as psychiatry, addiction
medicine, or pediatric psychiatry in
the survey. The 24-page survey con-
sisted of various sections, including
survey eligibility, satisfaction with
medicine, practice characteristics, pa-
tient characteristics, quality and coor-
dination of care, acceptance of new
patients by the practice, medical mal-
practice, and personal background.
Detailed information on specific
questions on the 2008 HTP and the
variables used in this study is avail-
able at www.icpsr.umich.edu/icpsr
web/HMCA/studies/27202.
Dependent variable
Overall career satisfaction in medi-
cine was the dependent variable of
our study. This was measured on a 5-
point Likert scale that ranged from 1,
very dissatisfied, to 5, very satisfied.
Independent variables
Independent variables used in this
study were grouped in four categories.
They are practice-related factors,
compensation-related factors, patient-
related factors, and demographic
characteristics of psychiatrists. These
variables are listed in Table 1.
Practice-related factors. Threat of
malpractice, adequate time with pa-
tients, ability to provide high-quality
care, number of physicians at prac-
tice, and patients’ out-of-pocket costs
were the practice-related factors used
in our study. The five items used to
measure threat of malpractice includ-
ed the following: physicians were
concerned that they would be in-
volved in a malpractice case some-
time in the next ten years, they felt
pressure in their day-to-day practice
by threat of malpractice litigation,
they ordered tests or consultations to
avoid appearance of malpractice, they
asked for a consultation to reduce risk
of being sued, and they relied less on
clinical judgment and more on tech-
nology to make a diagnosis because of
threat of malpractice lawsuit. Ade-
quate time with patients, ability to
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9
11001144
TTaabbllee 11
Description and scoring of independent variables among 314 psychiatrists
Variable M SD
Practice-related factor
Threat of malpracticea3.12 .99
Adequate time with patientsa3.79 1.36
Ability to provide high-quality carea2.04 .37
Number of physicians at practiceb16.98 32.03
Consider out-of-pocket cost to patientc3.54 .93
Compensation-related factor
Incomed2.77 1.41
Financial incentivee2.06 .63
Patient-related factor
Accept new Medicare patientsr2.43 1.29
Accept new Medicaid patientsf2.11 1.28
Accept new privately insured patientsf2.73 1.05
Hard-to-understand patientsg1.01 .09
Self-referred patientsh2.27 .59
Demographic characteristic of psychiatrists
Agei4.54 1.89
Male (%) 70 46
Race or ethnicityj2.24 .80
aPossible scores range from 1 to 5, with higher scores indicating strong agreement.
bRange 1–101; practices with more than 101 psychiatrists were capped at 101.
cPossible scores range from 1 to 5, with high score indicating always.
dPossible scores range from1 to 6, with higher scores indicating higher category of income.
ePossible scores range from1 to 3, with high scores indicating incentive to expand services.
fPossible scores range from 1 to 4, with high scores indicating acceptance of all new patients.
gPossible scores range from 1 to 2, with high scores indicating more than 25%.
hPossible scores range from 1 to 3, with high scores indicate seldom or never.
iPossible scores range from1 to 8, with high scores indicating later date-of-birth category.
jPossible scores range from 1 to 5, with 1 indicating Hispanic; 2, white; 3, black; 4, Asian or Pacif-
ic Islander; and 5, other or mixed race.
provide high-quality care to patients,
and number of physicians at practice
were measured using a single item for
each variable. Out-of-pocket cost to
patient was measured using three
items that examined whether the psy-
chiatrist considered a patient’s out-of-
pocket cost in prescribing generic
versus brand name drugs, what tests
to recommend, and inpatient care.
Compensation-related factors. Com-
pensation-related factors used in this
study consisted of income of physi-
cians and financial incentives to ex-
pand services. Income of physicians
consisted of net income from practice
after expenses but before taxes. Both
categorical variables were measured
using a single item.
Patient-related factors. Some pa-
tient-related factors included in this
study examined the extent to which
the practice was accepting new
Medicare patients, new Medicaid pa-
tients, and new patients through pri-
vate or commercial insurance plans,
including managed care and health
maintenance organizations. In addi-
tion, we examined whether psychia-
trists found patients hard to under-
stand and the extent to which patients
were self-referred. Each variable was
measured using a single item.
Demographic characteristics. Age,
gender, and race and ethnicity of psy-
chiatrists were the demographic vari-
ables examined in this study.
Analysis
SPSS, version 17.0, was used in this
study to perform statistical analysis on
the data. We first calculated Cron-
bach’s alpha of the two construct vari-
ables used in our study (threat of mal-
practice and cost to patient). Next,
characteristics of the sample were ex-
amined by performing a frequency
distribution of age, gender, race, and
income of the study participants. Fi-
nally, multiple regression analysis was
used to examine the beta values of
each independent variable and the R-
squared value of our model.
Results
Cronbach’s alpha values for threat of
malpractice and cost to patient were
.86 and .68, respectively.
Table 2 indicates that 39% of the
psychiatrists were “very satisfied”
with their career in medicine. Half
the psychiatrists in our sample were
born before 1956. Sixty-eight percent
of the participants were men, and
74% were white, non-Hispanic. Thir-
ty-two percent of the respondents re-
ported a net income from practice of
between $100,001 and $150,000.
Regression results are presented in
Table 3. Practice-related factors were
the most significant variables in our
model of career satisfaction. Threat
of malpractice and having to consider
out-of-pocket cost to patients had a
significant negative impact on career
satisfaction. On the other hand, ade-
quate time with a patient had a sig-
nificant positive impact on career sat-
isfaction of psychiatrists. None of the
compensation-related factors had a
significant positive impact on career
satisfaction. Among the patient-relat-
ed factors, psychiatrists who worked
in practices that accepted new
Medicare patients reported signifi-
cantly higher levels of career dissatis-
faction, whereas those who worked in
practices that accepted new Medic-
aid patients reported significant
higher levels of career satisfaction.
Among the demographic characteris-
tics, older psychiatrists reported
higher levels of career satisfaction.
Race and ethnicity of psychiatrists
also had an impact on career satisfac-
tion. Hispanic (3.43±1.43) and Af-
rican-American (3.81±1.05) psychia-
trists reported lower levels of career
satisfaction than white, non-Hispanic
psychiatrists (4.10±1.08).
Discussion
Major studies examining career satis-
faction of various physicians in the
past have used the CTS, a communi-
ty-based survey conducted over the
telephone since 1996. Because the
CTS had various well-documented
limitations (26), it was replaced by the
HTPS in 2008, the secondary data
used in our study. This 2008 nation-
wide survey addressed many contem-
porary physician care policy issues
not addressed by the CTS, such as
threat of malpractice lawsuits, and
also formed a baseline for subsequent
HTPS surveys to be conducted at a
regular interval in the future.
In our study 33% of the psychia-
trists were born in or before 1950.
Thus it is very likely that this cohort
group will trim their practice hours or
even retire in the coming decade. This
is of concern because recent articles
on the state of the psychiatry profes-
sion have highlighted the acute short-
age of psychiatrists and the difficulty
in obtaining mental health services in
the United States (3,4,9). A recent
study that used the CTS found that
two out of three primary care physi-
cians reported that they could not ob-
tain mental health services for some of
their patients (27). The current short-
age of nearly 45,000 psychiatrists is
likely to get worse when the psychia-
trists born before 1950 start retiring or
cutting down their services.
The shortage of psychiatrists is
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9 11001155
TTaabbllee 22
Characteristics of 314 psychiatrists
who participated in the 2008 Health
Tracking Physician Survey
Factor N %
Career satisfactiona
Very dissatisfied 12 4
Somewhat dissatisfied 32 10
Neither satisfied nor
dissatisfied 15 5
Somewhat satisfied 131 42
Very satisfied 121 39
Not ascertained 3 1
Birth year
1940 or earlier 29 9
1941–1945 32 10
1946–1950 43 14
1951–1955 53 17
1956–1960 60 19
1961–1965 53 17
1966–1970 32 10
1971 or later 12 4
Gender
Men 213 68
Women 101 32
Race
Hispanic 21 7
White, non-Hispanic 232 74
Black or African American 16 5
Asian or Pacific Islander 37 12
Other or more than one race 2 1
Not ascertained or refused
to answer 6 2
Income
<$100,000 58 18
$100,001 to $150,000 102 32
$150,001 to $200,000 79 25
$200,001 to $250,000 33 11
$250,001 to $300,000 21 7
>$300,000 21 7
aAs measured on a 5-point Likert scale that
ranged from 1, very dissatisfied, to 5, very
satisfied.
likely to get worse at a time when the
need for certain specialties such as
geriatric psychiatrists is likely to go
up (5). We cannot expect more med-
ical students to choose to specialize
in psychiatry because the average
salary of psychiatrists is considerably
less than some of the other medical
specialties. In addition, many med-
ical schools have cut down on train-
ing programs for potential psychia-
trists because of cuts in federal fund-
ing (5). Some experts have suggested
that primary care physicians pick up
the slack (9). But primary care physi-
cians are also in short supply and
have to deal with a large variety of ill-
nesses (3). Other suggestions include
increasing the number of advanced
practice psychiatric nurses and physi-
cian assistants (3). In addition, doc-
tors of psychology can also be author-
ized to write prescriptions (9). Some
even suggest the use of telemedicine,
so that psychiatrists can treat their
patients over the Internet (9). Steps
also need to be taken to ensure that
adequate coverage of mental health
professionals exists in areas of great-
est shortage such as rural areas and
the public sector (1).
Among the practice-related factors,
both threat of malpractice lawsuits
and having to consider out-of-pocket
cost to patients had a significant neg-
ative impact on career satisfaction.
Each year, nearly 5% of psychiatrists
face a lawsuit. Long-term conse-
quences of malpractice cases include
an increase in insurance premiums
and limited opportunities for employ-
ment (28). In addition, all settlements
may be noted in the National Practi-
tioner Database. A longitudinal study
(1997–2002) based on the National
Health Interview Survey uncovered
some important disparities in the
state of mental health care in the
United States. The study reported
that a large proportion of adults with
significant psychological distress
could not afford mental health care.
In addition, large increases in costs
for mental health care and medica-
tion over the years have resulted in a
significant increase in the number of
patients foregoing such services (29).
Unfortunately, this development has
resulted in out-of-pocket costs dictat-
ing optimal treatment to patients re-
ceiving mental care. Thus it is not sur-
prising that cost of out-of-pocket
treatment had a significant negative
impact on career satisfaction of psy-
chiatrists.
On the other hand, adequate time
spent with patients had a significant
positive impact on career satisfaction.
In a recent survey of psychiatrists by
Epocrates, a manufacturer of mobile
drug-reference tools, 27% of the re-
spondents indicated that over the past
five years, the length of patient visits
had decreased (30). Unlike other
medical specialties, patients in psy-
chiatry share intimate details about
their lives. It is critical for psychia-
trists to ensure that they have enough
time with their patients to develop a
rapport with them, ensure their trust,
and build a lasting relationship (5).
Thus psychiatrists who perceived that
they spent adequate time with their
patients experienced higher levels of
career satisfaction.
Unlike other factors, none of the
compensation-related factors (in-
come level and financial incentives)
had a significant impact on the career
satisfaction of psychiatrists. A study of
career satisfaction of psychiatrists and
surgeons in Canada reported that
compared with surgeons, psychia-
trists report a higher level of satisfac-
tion with the process of determining
pay rates (31). In addition, previous
studies have shown that a balance be-
tween personal and professional life is
very important to psychiatrists (31).
Among the patient-related factors,
psychiatrists who worked in practices
accepting new Medicare patients re-
ported significantly less career satis-
faction than those who worked in
practices that did not. Most of the
people under Medicare coverage are
65 years old or older. Medicare also
covers people with disabilities who
qualify for Social Security. For most
mental health services, Medicare has
high copayments or coinsurance and
has been criticized by physicians for
low reimbursement rates and too
much paperwork (32,33). On the oth-
er hand, psychiatrists who worked in
practices that admitted new Medic-
aid patients reported significantly
higher levels of career satisfaction
than those who worked in practices
that did not. Medicaid is an entitle-
ment program provided jointly by the
federal and state governments, where
the federal government sets the
framework for the program and the
states decide the eligibility require-
ments and payment rates. Medicaid
provides benefits for low-income
families and is a major source of
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9
11001166
TTaabbllee 33
Predictors of career satisfaction among psychiatrists who participated in the
2008 Health Tracking Physician Survey (N=235)a
Factor βSE p
Practice-related factor
Threat of malpractice –.290 .068 <.001
Adequate time with patients .224 .053 .001
Ability to provide high-quality care –.007 .198 .918
Number of physicians at practice –.052 .002 .383
Consider out-of-pocket cost to patients –.131 .070 .027
Compensation-related factor
Income .093 .046 .121
Financial incentive .055 .103 .355
Patient-related factor
Accept new Medicare patients –.232 .071 .006
Accept new Medicaid patients .275 .070 .001
Accept new privately insured patients –.048 .069 .463
Hard-to-understand patients –.063 .683 .274
Self-referred patients –.044 .108 .456
Demographic characteristic of psychiatrist
Age –.154 .035 .011
Gender .076 .143 .205
Race or ethnicity .200 .079 .001
aF=7.22, df=15 and 219, p<.001; R2=.331. Sample size reflects missing values deleted by regres-
sion analysis.
funding for public mental health sys-
tems. Most of the Medicaid programs
have nominal or no copayments.
It is important to note that since
2008, when the data used in this study
were collected, there have been ma-
jor assaults on Medicaid funding at
the state and federal levels. In addi-
tion, the 2010 Patient Protection and
Affordable Care Act will allow an ad-
ditional ten million Americans with
income up to 133% of the poverty
level to become eligible for mental
health coverage through Medicaid.
That may make Medicaid one of the
largest items in many state budgets.
States already facing budget shortfalls
will be forced to make cuts in other
services to meet this obligation. A
number of states have filed lawsuits to
nullify the Patient Protection and Af-
fordable Care Act. The act also ex-
tended a 5% increase in Medicare
payment rates for outpatient psy-
chotherapy until the end of 2010. All
these changes that have occurred
since 2008 may have an impact on the
results of our study.
Age had a significant impact on the
career satisfaction of psychiatrists—
that is, older psychiatrists tended to
be more satisfied than younger psy-
chiatrists. Previous research has
shown a direct relationship between
career satisfaction and outcomes
such as better health care service,
more satisfied patients (18,19), and
exodus from the medical profession
(25). Our data do not allow us to de-
termine specifically what might keep
older psychiatrists from practicing
longer or lead to earlier retirement.
Previous research suggests that com-
pared with younger cohorts of psy-
chiatrists, older cohorts of psychia-
trists report less burden from their
patients (34). In addition, older co-
horts of psychiatrists were less likely
than younger cohorts to perform re-
search, teach, do hospital rounds, or
hold university appointments. This
decrease in job demands may explain
the higher levels of satisfaction
among older psychiatrists.
Our results also indicate that race
and ethnicity had a significant impact
on career satisfaction. Hispanic and
African-American psychiatrists re-
ported lower levels of career satisfac-
tion than white, non-Hispanic psychi-
atrists. Previous research on under-
represented minority faculty in med-
ical schools found that because un-
derrepresented minority faculty had a
higher debt load than peers in nonmi-
nority groups, underrepresented mi-
nority faculty were more likely to
have more clinical responsibilities, to
have less research time, and to moon-
light to supplement their income
(35). It is possible that similar issues
may have had an impact on career
satisfaction of minority psychiatrists
who were not faculty in medical
schools. Hispanic and African-Ameri-
can psychiatrists accounted for only
12% of our sample. Previous research
has indicated that African-American
and Hispanic patients prefer to seek
treatment from physicians of their
own race (36). In addition, minority
physicians are more likely to locate
their practice in underrepresented
areas (37).
Steps need to be taken to encour-
age more African-American and His-
panic medical students to become
psychiatrists. One example of such a
program is the Program for Minority
Research Training in Psychiatry fund-
ed by the National Institute of Mental
Health. Another useful program is
the Substance Abuse and Mental
Health Services Administration’s Mi-
nority Fellowship Program, which
provides grants to encourage and fa-
cilitate the doctoral and postdoctoral
development of psychiatrists from
ethnic and racial minority groups.
However, in terms of decision to re-
tire, one major factor that is not dealt
with in the study is the financial aspi-
rations and overall financial situation
for the physician. It is very likely that
many psychiatrists of retirement age
continue to work because they cannot
afford to retire.
This study has various limitations.
The secondary data used in this study
were self-reported. As with secondary
data sets, the variables used in the
study were identified and developed
by the primary researchers and not by
the authors of this study. Thus vari-
ables of interest, such as support at
workplace, organizational culture,
and types of rewards, could not be in-
cluded in this study. The HSC in its
public use data included physicians
who identified their primary specialty
as psychiatry, addiction medicine, or
pediatric psychiatry under the gener-
al heading of psychiatrists. The data
set does not allow us to differentiate
them into the three categories. Fu-
ture research can address these is-
sues. Despite these limitations, this
study has important implications for
health care policy makers, health care
educators, and future psychiatrists.
Conclusions
Spending adequate time with pa-
tients and working in practices that
admit new Medicaid patients had a
positive impact on career satisfaction
of psychiatrists. At the same time,
threats of malpractice lawsuits, prac-
tices that admit Medicare patients
and patients with considerable out-
of-pocket medical expenses can have
a negative impact on career satisfac-
tion. Both younger and underrepre-
sented minority psychiatrists were
less satisfied with their careers. Clear-
ly, policy makers and health care ad-
ministrators need to develop specific
strategies to work on these issues to
increase career satisfaction. That may
in return help alleviate the shortage
of psychiatrists.
Acknowledgments and disclosures
The authors report no competing interests.
References
1. Thomas KC, Ellis AR, Konrad TR, et al:
County-level estimates of mental health
professional shortage in the United States.
Psychiatric Services 60:1323–1328, 2009
2. Table 28: Total US Medical School Enroll-
ment by Race and Ethnicity Within Sex,
2003–2008: FACTS: Data. Association of
American Medical Colleges, Washington,
DC. Available at www.aamc.org/data/facts/
enrollmentgraduate/85972/enrollmentgrad
uate_table28-enrllbyraceeth0308.html
3. Carlat D: 45,000 more psychiatrists, any-
one? Psychiatric Times, Aug 3, 2010, pp
1–4
4. Goldman W: Is there a shortage of psychi-
atrists? Psychiatric Services 52:1587–1589,
2001
5. Gallegos A: Psychiatry facing challenges,
shortage of doctors, finances plague indus-
try—including Madison Center. South-
BendTribune, Apr 19, 2010
6. Amos J: Stress and the psychiatrist. Psychi-
atric Times, June 1, 2006, pp 1–5
7. Kumar S: Burnout in psychiatrists. World
Psychiatry 6:186–189, 2007
8. Boscarino JA, Adams RE, Figley CR: Sec-
ondary trauma issues for psychiatrists. Psy-
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9 11001177
chiatric Times, Nov 11, 2010, pp 1–6
9. A “Perfect Storm” for Mental Health:
Shortage of Psychiatrists, Underfunding
Challenges Nation. Davenport, Iowa,
Genesis Health System, June 11, 2010.
Available at www.genesishealth.com/news/
2010/a-perfect-storm-for-mental-health.aspx
10. Ahmadiyeh N, Cho NL, Kellogg KC, et al:
Career satisfaction of women in surgery:
perceptions, factors, and strategies. Jour-
nal of the American College of Surgeons
210:23–28, 2010
11. Leigh JP, Tancredi DJ, Kravitz RL: Physi-
cian career satisfaction within specialties.
BMC Health Services Research 9:166–
177, 2009
12. Cydulka RK, Korte R: Career satisfaction
in emergency medicine: the ABEM longi-
tudinal study of emergency physicians. An-
nals of Emergency Medicine 51:714–722,
2008
13. Clem KJ, Promes SB, Glickman SW, et al:
Factors enhancing career satisfaction
among female emergency physicians. An-
nals of Emergency Medicine 51:723–728,
2008
14. Duffy RD, Richard GV: Physician job sat-
isfaction across six major specialties. Jour-
nal of Vocational Behavior 68:548–559,
2006
15. Gendreau M: Career satisfaction in emer-
gency medicine and burnout: all is not
well. Annals of Emergency Medicine 52:
577, 2008
16. German RH: Career and lifestyle satisfac-
tion among surgeons. Journal of the Amer-
ican College of Surgeons 209:795, 2009
17. Kuhn G, Goldberg R, Compton S: Toler-
ance for uncertainty, burnout, and satisfac-
tion with the career of emergency medi-
cine. Annals of Emergency Medicine
54:106–113, 2009
18. DeVoe J, Fryer GE, Hargraves JL, et al:
Does career dissatisfaction affect the abili-
ty of family physicians to deliver high-qual-
ity patient care? Journal of Family Practice
51:223–228, 2002
19. Hass JS, Cook EF, Puopolo RL, et al: Is the
professional satisfaction of general in-
ternists associated with patient satisfac-
tion? Journal of General Internal Medicine
15:122–128, 2000
20. Pugno PA, Schmittling GT, McGaha AL, et
al: Entry of US medical school graduates
into family medicine residencies: 2005–06
and 3-year summary. Family Medicine
38:626–636, 2006
21. Lambert TW, Davidson JM, Evans J, et al:
Doctors’ reasons for rejecting initial choic-
es of specialties as long-term careers. Med-
ical Education 37:312–318, 2003
22. Fahrenkopf AM, Sectish TL, Burger LK,
et al: Rates of medication errors among de-
pressed and burnt out residents: prospec-
tive cohort study. British Medical Journal
336:488–491, 2008
23. Burke RJ: Stress, satisfaction and militancy
among Canadian physicians: a longitudinal
investigation. Social Science Medicine
43:517–524. 1996
24. Kravitz RL, Shapiro MF, Linn LS, et al:
Risk factors associated with participation
in the Ontario, Canada doctors’ strike.
American Journal of Public Health 79:
1227–1233, 1989
25. Landon BE, Reschovsky JD, Pham HH, et
al: Leaving medicine—the consequences
of physician dissatisfaction. Medical Care
44:234–242, 2006
26. Center for Studying Health System
Change: Health Tracking Physician Sur-
vey, 2008 [United States] [Computer file].
ICPSR27202-v1. Ann Arbor, Mich, Inter-
university Consortium for Political and So-
cial Research, Feb 16, 2010. doi:10.3886/
ICPSR27202
27. Cunningham PJ: Beyond parity: primary
care physicians’ perspectives on access to
mental health care. Health Affairs 28:490–
501, 2009
28. Daly R: Psychiatrist helps colleagues re-
duce malpractice-suit pain. Psychiatric
News, July 20, 2007, p 17
29. Mojtabai R: Trends in contacts with men-
tal health professionals and cost barriers to
mental health care among adults with sig-
nificant psychological distress in the Unit-
ed States: 1997–2002. American Journal of
Public Health 95:2009–2014, 2005
30. 4 of 5 psychiatrists would choose same
specialty again. Psychiatric News, Sept 3,
2010, p 7
31. Lepnurm R, Dobson R, Backman A, et al:
Factors explaining career satisfaction
among psychiatrists and surgeons in Cana-
da. Canadian Journal of Psychiatry 51:243–
255, 2006
32. Connolly J: Doctors are opting out of
Medicare. New York Times, April 1, 2009.
Available at www.nytimes.com/2009/04/
02/business/retirementspecial/02health.
html
33. Barlas S: Psychiatrists and Medicare: un-
appetizing developments for 2011. Wash-
ington Post, Jan 13, 2011
34. Garfinkel P, Bagby M, Schuller DR, et al:
Gender differences in the practice charac-
teristics and career satisfaction of psychia-
trists in Ontario. Academic Psychiatry
28:310–320, 2004
35. Palepu A, Carr PL, Friedman RH: Spe-
cialty choices, compensation, and career
satisfaction of underrepresented minority
faculty in academic medicine. Academic
Medicine 25:157–160, 2000
36. Reede JY: A recurring theme: the need for
minority physicians. Health Affairs 22(4):
91–93, 2003
37. Saha S, Taggart SH, Komaromy M, et al:
Do patients choose physicians of their own
race? Health Affairs 19(4):76–83, 2000
PSYCHIATRIC SERVICES ops.psychiatryonline.org oSeptember 2011 Vol. 62 No. 9
11001188
