Residents, report prepared for the Michigan Department of Mental Health by the Mental Health Research Institute, University of Michigan, Ann Arbor, July 1978. 10) G. D. Cottfredson and S. E. Dyer, “Health Service Providers in Psychology, American Psychotegist Vol. 33, April 1978, pp. 314-338. 1 1) J. M. Richards and G. D. Gottfredson, “Geographic Distribution of U.S. Psychologists: A Human Ecological Analysis,” American Psychologist, Vol. 33, January 1978, pp. 1-9. 12) R. Enos, “Undergraduate Social Work Manpower and Job Opportunities: A Regional Study,” Journal of Education for Social Work, Vol. 14, Fall 1978, pp. 34-41. 13) National Association of Social Workers, Final Project Report: Worker Involvement in Mental Health Services DeD.C., 1978. 14) M. Wittman, “Social Work Manpower for the Health Services: Problems and Prospects,” American Journal of Public Health, Vol. 64, April 1974, pp. 370-375. 15) S. Coleman, Physician Distribution and Rural Access to Medical Services, Rand Corporation, Santa Monica, California, April 1976. Study
sign,
of Social
Washington,
16) button reau
P. Gingras,
of Nursing of
editor, Analysis Personnel and
and Planning for Improved Services: Nauonal Conferences,
DistriBu-
Manpower, Health Resources Administration, BeNovember 1976. 17) Bureau of Health Manpower, Health Resources Administration, Report on Development of Criteria for Designation of Health Manpower Shortage Areas, mimeographed, Hyattsville, Maryland, 1977. 18) “Health Manpower Shortage Areas: Criteria for Designation,” Federal Register, Vol. 43, January 10, 1978, pp. 1586-1596. 19) Health Resources Administration, GMENAC StaffPapers, Vol. 4: Social and Psychological Characteristics in Medical Specialty and Geographic Decisions, Hyattsville, Maryland, 1978. 20) H. W. Zaretsky, Graduate Medical Education in California: A Position Paper, mimeographed, California Office of Statewide Health Planning and Development, Sacramento, December 1978. 21) S. N. Collier, “Influencing the Distribution of Physicians: Manpower Policy Strategies,” Issues in Higher Education, No. 13, Southern Regional Education Board, Atlanta, 1978.
thesda,
Health
Maryland,
A State Perspective on Psychiatric Manpower Development B
TIMOTHY
MORITZ,
Director Ohio Department of Mental and Mental Retardation Columbus, Ohio
M.D. Health
When the shortage of qualified psychiatrists and other physicians in Ohio’s mental institutions reached the critical point in 1975, a number of measures were implemented to upgrade medical manpower. Salaries were increased, and the leadership ofthe medical and psychiatric community was enlisted to help encourage phystcians to enter public service. In addition, clinical training programs were thifted from the traditional freestanding state-hospital-based prograims to programs operated by medical colleges. The author reports that the state has made steady progress in reducing psychiatt’ic manpower shortages, but he notes that new trends, such as the diminishing interest of American medical students in psychiatry, threaten to erode the gains. There has been psychiatrists erations. However,
U
and
Moritz’s
address
Mental Retardation Street, Columbus,
a shortage in Ohio’s between
of well-qualified physicians mental institutions for gen1970 and 1975 the medical
at
Department
the
is Suite
Ohio
43215.
Ohio
of Mental
1182, State Office Tower,
Health 30 East
and Broad
manpower deteriorated even more rapidly, with a 43per-cent loss of civil service medical staff other than residents in training. This loss was partially offset by part-time consultants working under personal service contracts. Nevertheless, the net loss of medical manpower was 29 per cent. The quality of medical manpower was as serious a concern as the quantity. In early 1975 the Department of Mental Health and Mental Retardation employed only 16 full-time, board-certified psychiatrists to openate 30 mental institutions with more than 17,000 inpatients and residents and to fulfill state responsibility for supervision of community mental health, mental netardation, and drug abuse services for 1 1 million people. There were 22 state mental institutions with no board-certified psychiatrists on their staffs. Deficiencies in other medical specialties were equally severe. Three-fourths of all full-time physicians in the department were foreign-born graduates of foreign medical colleges. Between 1970 and 1975 only four of 29 institutions had been able to recruit and retain a full-time psychiatrist who graduated from an American medical college. Only five of the 29 institutions had full-time physicians who had graduated from an American medical college within the past 14 years. Eighty-eight of 94 psychiatric residents in training were foreign-bonn graduates of foreign medical colleges. Only one of the full-time U.S. medical college gradu-
VOLUME
30 NUMBER
11 NOVEMBER
1979
775
ates in the department was under age 40, and 35 pen cent of all full-time physicians were older than 60. Two institutions had no physician under age 65. Forty-one physicians practicing in the department had no Ohio license. Thus the department for years had been almost totally unable to recruit graduates of U.S. medical colleges. It was surviving almost entirely with foreign graduates and U.S. graduates recruited many years ago. As the new department director, in early 1975 I testified before the Ohio state legislature on the shortage of medical manpower in our public institutions. I declared the situation an emergency, suggesting that we take down the signs that call the facilities hospitals if there were not prompt improvements. The legislature approved the department’s request for large salary increases and a more flexible merit-system pay scale to attract more and better qualified psychiatrists and other physicians.
REVERSING
THE
DOWNWARD
TREND
However, we realized that competitive remuneration was only the first step in efforts to upgrade our medical and psychiatric capability. We actively involved the leadership of the Ohio Psychiatric Association and the chairmen of the psychiatric departments of Ohio’s seven medical colleges in the development of strategies to improve Ohio’s mental health system in general, and its medical and psychiatric manpower in particular. Active liaison with these groups provided the opportunity to discuss problems and opportunities in the public mental health system with their members at various meetings and educational conferences. With leadership support, we attempted to encourage their members, especially the younger generation, to meet the challenge of the public sector and to meet their professional nesponsibilities to our most needy patients. We tried to convey a sense of excitement in being change agents and stressed the opportunity for rapid professional growth and development. Another major effort was directed at psychiatric training programs. We decided to phase out over three years the department’s freestanding state-hospitalbased programs. Instead we provided funds to the medical colleges to expand their programs in both total number and public service clinical rotations in state hospital and community mental health settings. Although there was some initial hesitance from the univensities, there has been steadily increasing support for this approach. At the same time the department was upgrading its full-time medical staff, it increased its use of part-time physicians and psychiatrists from the private sector. The new university affiliations were particularly important in this effort. Joint efforts with the medical schools have resulted in the recruitment of some outstanding psychiatrists who work full-time in our department’s programs and have high-level faculty appointments. University faculties have also been a major source of part-time consultants for clinical work, program con-
776
HOSPITAL
& COMMUNITY
PSYCHIATRY
sultation, and for work in inservice training. Of course, the specific efforts directed at medical manpower have been supplemented by efforts to improve facilities, other professional and paraprofessional manpower, and the public image of our programs. Ohio’s major programmatic thrust during this period has been the systematic development of community mental health and retardation services. As a result, the population in the state institutions dropped from more than 17,71 1 in January 1975 to 1 1,351 in June 1979. Thus merely maintaining state institution manpower would progressively improve staff-patient ratios and the quality of care.
IMPROVEMENTS
IN
STAFFING
The results of these efforts to date have been encouraging, although there is still considerable room for improvement. Clearly the deterioration of medical capability in Ohio’s mental institutions has been reversed. While the institutional population has decreased by 30 pen cent between 1975 and 1979, the total full-timeequivalent medical staff has increased by 3 pen cent. These two developments have resulted in a 32-pen-cent improvement in the physician-to-patient ratio. Equally important have been the qualitative improvements. The department now employs 434 physicians, of whom 189 are psychiatrists, 148 are other medical specialists, and 97 are general physicians. Of the total, 191 are full time and 243 are part time. Of the psychiatrists, 1 16 are full time and 73 are part time. They account for 31 pen cent of the 613 psychiatrists registered with the Ohio State Medical Board in 1975, the last year for which figures are available. The number of full-time board-certified psychiatrists has increased by 88 per cent, from 16 in 1975 to 30 in 1979. These psychiatrists are supplemented by 33 parttime board-certified psychiatrists. There are another 11 full-time and 89 pant-time physicians who are boardcertified in other medical specialties employed by the department. However, there are still no board-certifled psychiatrists in any of the mental retardation institutions and in seven mental hospitals. Although 53 per cent of the department’s total medical staff are now U.S. medical college graduates, only 39 pen cent of its psychiatrists are. Change in the composition of staff has also been substantial. Sixty-eight per cent of the total medical staff has been hired since 1975. Now only 7 pen cent are over age 65, and 25 per cent are under age 40. One-fourth have university faculty appointments. All psychiatrists have full Ohio medical licenses. Sixty per cent of department psychiatrists are members of the American Psychiatric Association. We now have 175 psychiatric residents in training in ten approved programs in Ohio. Of these, 72 per cent are U.S. medical graduates. There have been significant increases in the amount of time residents in universitybased programs spend in state hospital and community mental health programs. Only five residents remain in
the last year of an old state hospital program phased out. However, we have not yet felt the impact of the new affiliated programs that are phased in at different rates at different locations.
NEW
being major being
THREATS
Unfortunately, Ohio’s efforts to increase universitysponsored training of psychiatrists in the public mental health system is being threatened by the recent decline of interest among American medical students in specializing in psychiatry, which has been described by Pardes and others (1-3). Only 41 per cent of the firstpostgraduate-year positions and 71 per cent of the second-postgraduate-year positions were filled this year. Ohio has made major efforts to increase its medical manpower in recent years by opening four new medical colleges. But if efforts to motivate medical students to enter psychiatry are not more successful, our efforts to train and encourage psychiatric residents to enter state hospitals and community mental health programs may fall far short of developing the manpower necessary to operate the public system at a reasonable level of quality. This problem demands national attention, as well as systematic efforts at the undergraduate medical school level in Ohio. Programs should be carefully reviewed to see if they contain the following elements, as set forth by Langsley: a well-rounded faculty, a psychodynamic orientation, a greaten commitment to medical student education than to resident training, varied teaching methods, enthusiastic student response, and systematic evaluation that produces changes in subsequent years (4). Ohio was already committed to reducing its heavy dependence on foreign medical college graduates, so it did not initially feel threatened by the enactment of the Health Professions Educational Assistance Act of 1976, which limited the number of FMGs who could enter the United States. We had expected to offset this cutback of personnel by our increased production of physicians at the new medical colleges and our systematic training of psychiatrists in public facilities. However, if the national trend of decreased interest in psychiatry among U.S. medical students is not reversed and the flow of foreign medical graduates remains limited, we could again face a deteriorating ability to provide adequate psychiatric services in state mental institutions and community mental health programs. In addition, maximum salaries for the department’s medical and psychiatric staff have not been increased since July 1975 and are gradually becoming noncompetitive again, especially when compared to salanies in the private sector. These new impediments to the supply of psychiatrists are occurring at a time when the department needs another 70 physicians, mostly psychiatrists, to meet Joint Commission on Accreditation of Hospitals standards in all of its facilities, and when enormous unmet needs exist in the community mental health sys-
tem. We currently lack reliable information about psychiatric manpower needs in Ohio’s community system. However, there is a general consensus that serious shortages exist and are a threat to existing programs as well as to the new programs being planned to meet the unmet needs of special populations, especially the chronically mentally ill. Psychiatric manpower shortages could result in the diminished effectiveness of these programs and a decreased role for psychiatry in the control and operation of the public mental health system. Similar concerns have recently been expressed by Fink (5) and Winslow (6). The department has recently developed a computerbased simulation technique to estimate manpower and facility needs in the planned community mental health system as it develops oven time. The program is based on models of services and organization developed at the grass-roots level with the department’s technical assistance. It is hoped that it will result in more valid estimates of future psychiatric manpower needs that can be incorporated into planning for medical and psychiatnic education programs at the regional, state, and national levels (7). Thus after four years of steady progress that brought us in reach of our goals, we are in danger of having another trend reversal that could threaten the quality of cane and the leadership of psychiatry in the public mental health system. We plan to redouble our efforts, in cooperation with the medical colleges and organized medicine and psychiatry, to motivate medical students to enter psychiatry and to train psychiatrists in university-sponsored programs in state hospitals and community mental health programs. We also plan to adequately compensate psychiatrists for public service, to motivate them to accept public service responsibility, to provide flexible and professionally stimulating assignments to psychiatrists in public mental health programs, and to develop more reliable estimates of future psychiatric manpower needs.#{149} REFERENCES 1) H.
dent
Pardes,
“Why
Students Are Not Entering Psychiatry,” ResiVol. 25, April 1979, pp. 54-58. Association of Chairmen of Departments of Psychiain Psychiatric Manpower: Toward a NatiOnal PsychiatPolicy, American Psychiatric Association, Washington,
and StaffPhysician,
2) American The Crisis 7* Manpower D.C., 1977. 3) Report to the President From the President’s Commission on Mental Health, Vol. 1, Washington, D.C., 1978. 4) D. G. Langsley, A. M. Freedman, M. Haas, at al., “Medical Student Education in Psychiatry,” American Journal of Psychiatry, Vol. 134, supplement to March 1977, pp. 15-20. 5) P. J. Fink and S. P. Weinstein, “Whatever Happened to Psychiatry? The Deprofessionalization of Community Mental Health Canten,” American Journal ofPsychiatry, Vol. 136, April 1979, pp. 406409. 6) W. W. Winslow, “The Changing Role of Psychiatrists in Comtry,
Mental Health Centers,” American Journal of Psychiatry, Vol. 136, January 1979, pp. 24-27. 7) T. Moritz, F. Goldberg, and D. Chesser, “A Creative Systems Approach to Mental Health Manpower Development,” paper presented at the annual meeting of the American Psychiatric Association, May 12-18, 1979, Chicago. munity
VOLUME
30 NUMBER
11 NOVEMBER
1979
777
sign,
of Social
Washington,
16) button reau
P. Gingras,
of Nursing of
editor, Analysis Personnel and
and Planning for Improved Services: Nauonal Conferences,
DistriBu-
Manpower, Health Resources Administration, BeNovember 1976. 17) Bureau of Health Manpower, Health Resources Administration, Report on Development of Criteria for Designation of Health Manpower Shortage Areas, mimeographed, Hyattsville, Maryland, 1977. 18) “Health Manpower Shortage Areas: Criteria for Designation,” Federal Register, Vol. 43, January 10, 1978, pp. 1586-1596. 19) Health Resources Administration, GMENAC StaffPapers, Vol. 4: Social and Psychological Characteristics in Medical Specialty and Geographic Decisions, Hyattsville, Maryland, 1978. 20) H. W. Zaretsky, Graduate Medical Education in California: A Position Paper, mimeographed, California Office of Statewide Health Planning and Development, Sacramento, December 1978. 21) S. N. Collier, “Influencing the Distribution of Physicians: Manpower Policy Strategies,” Issues in Higher Education, No. 13, Southern Regional Education Board, Atlanta, 1978.
thesda,
Health
Maryland,
A State Perspective on Psychiatric Manpower Development B
TIMOTHY
MORITZ,
Director Ohio Department of Mental and Mental Retardation Columbus, Ohio
M.D. Health
When the shortage of qualified psychiatrists and other physicians in Ohio’s mental institutions reached the critical point in 1975, a number of measures were implemented to upgrade medical manpower. Salaries were increased, and the leadership ofthe medical and psychiatric community was enlisted to help encourage phystcians to enter public service. In addition, clinical training programs were thifted from the traditional freestanding state-hospital-based prograims to programs operated by medical colleges. The author reports that the state has made steady progress in reducing psychiatt’ic manpower shortages, but he notes that new trends, such as the diminishing interest of American medical students in psychiatry, threaten to erode the gains. There has been psychiatrists erations. However,
U
and
Moritz’s
address
Mental Retardation Street, Columbus,
a shortage in Ohio’s between
of well-qualified physicians mental institutions for gen1970 and 1975 the medical
at
Department
the
is Suite
Ohio
43215.
Ohio
of Mental
1182, State Office Tower,
Health 30 East
and Broad
manpower deteriorated even more rapidly, with a 43per-cent loss of civil service medical staff other than residents in training. This loss was partially offset by part-time consultants working under personal service contracts. Nevertheless, the net loss of medical manpower was 29 per cent. The quality of medical manpower was as serious a concern as the quantity. In early 1975 the Department of Mental Health and Mental Retardation employed only 16 full-time, board-certified psychiatrists to openate 30 mental institutions with more than 17,000 inpatients and residents and to fulfill state responsibility for supervision of community mental health, mental netardation, and drug abuse services for 1 1 million people. There were 22 state mental institutions with no board-certified psychiatrists on their staffs. Deficiencies in other medical specialties were equally severe. Three-fourths of all full-time physicians in the department were foreign-born graduates of foreign medical colleges. Between 1970 and 1975 only four of 29 institutions had been able to recruit and retain a full-time psychiatrist who graduated from an American medical college. Only five of the 29 institutions had full-time physicians who had graduated from an American medical college within the past 14 years. Eighty-eight of 94 psychiatric residents in training were foreign-bonn graduates of foreign medical colleges. Only one of the full-time U.S. medical college gradu-
VOLUME
30 NUMBER
11 NOVEMBER
1979
775
ates in the department was under age 40, and 35 pen cent of all full-time physicians were older than 60. Two institutions had no physician under age 65. Forty-one physicians practicing in the department had no Ohio license. Thus the department for years had been almost totally unable to recruit graduates of U.S. medical colleges. It was surviving almost entirely with foreign graduates and U.S. graduates recruited many years ago. As the new department director, in early 1975 I testified before the Ohio state legislature on the shortage of medical manpower in our public institutions. I declared the situation an emergency, suggesting that we take down the signs that call the facilities hospitals if there were not prompt improvements. The legislature approved the department’s request for large salary increases and a more flexible merit-system pay scale to attract more and better qualified psychiatrists and other physicians.
REVERSING
THE
DOWNWARD
TREND
However, we realized that competitive remuneration was only the first step in efforts to upgrade our medical and psychiatric capability. We actively involved the leadership of the Ohio Psychiatric Association and the chairmen of the psychiatric departments of Ohio’s seven medical colleges in the development of strategies to improve Ohio’s mental health system in general, and its medical and psychiatric manpower in particular. Active liaison with these groups provided the opportunity to discuss problems and opportunities in the public mental health system with their members at various meetings and educational conferences. With leadership support, we attempted to encourage their members, especially the younger generation, to meet the challenge of the public sector and to meet their professional nesponsibilities to our most needy patients. We tried to convey a sense of excitement in being change agents and stressed the opportunity for rapid professional growth and development. Another major effort was directed at psychiatric training programs. We decided to phase out over three years the department’s freestanding state-hospitalbased programs. Instead we provided funds to the medical colleges to expand their programs in both total number and public service clinical rotations in state hospital and community mental health settings. Although there was some initial hesitance from the univensities, there has been steadily increasing support for this approach. At the same time the department was upgrading its full-time medical staff, it increased its use of part-time physicians and psychiatrists from the private sector. The new university affiliations were particularly important in this effort. Joint efforts with the medical schools have resulted in the recruitment of some outstanding psychiatrists who work full-time in our department’s programs and have high-level faculty appointments. University faculties have also been a major source of part-time consultants for clinical work, program con-
776
HOSPITAL
& COMMUNITY
PSYCHIATRY
sultation, and for work in inservice training. Of course, the specific efforts directed at medical manpower have been supplemented by efforts to improve facilities, other professional and paraprofessional manpower, and the public image of our programs. Ohio’s major programmatic thrust during this period has been the systematic development of community mental health and retardation services. As a result, the population in the state institutions dropped from more than 17,71 1 in January 1975 to 1 1,351 in June 1979. Thus merely maintaining state institution manpower would progressively improve staff-patient ratios and the quality of care.
IMPROVEMENTS
IN
STAFFING
The results of these efforts to date have been encouraging, although there is still considerable room for improvement. Clearly the deterioration of medical capability in Ohio’s mental institutions has been reversed. While the institutional population has decreased by 30 pen cent between 1975 and 1979, the total full-timeequivalent medical staff has increased by 3 pen cent. These two developments have resulted in a 32-pen-cent improvement in the physician-to-patient ratio. Equally important have been the qualitative improvements. The department now employs 434 physicians, of whom 189 are psychiatrists, 148 are other medical specialists, and 97 are general physicians. Of the total, 191 are full time and 243 are part time. Of the psychiatrists, 1 16 are full time and 73 are part time. They account for 31 pen cent of the 613 psychiatrists registered with the Ohio State Medical Board in 1975, the last year for which figures are available. The number of full-time board-certified psychiatrists has increased by 88 per cent, from 16 in 1975 to 30 in 1979. These psychiatrists are supplemented by 33 parttime board-certified psychiatrists. There are another 11 full-time and 89 pant-time physicians who are boardcertified in other medical specialties employed by the department. However, there are still no board-certifled psychiatrists in any of the mental retardation institutions and in seven mental hospitals. Although 53 per cent of the department’s total medical staff are now U.S. medical college graduates, only 39 pen cent of its psychiatrists are. Change in the composition of staff has also been substantial. Sixty-eight per cent of the total medical staff has been hired since 1975. Now only 7 pen cent are over age 65, and 25 per cent are under age 40. One-fourth have university faculty appointments. All psychiatrists have full Ohio medical licenses. Sixty per cent of department psychiatrists are members of the American Psychiatric Association. We now have 175 psychiatric residents in training in ten approved programs in Ohio. Of these, 72 per cent are U.S. medical graduates. There have been significant increases in the amount of time residents in universitybased programs spend in state hospital and community mental health programs. Only five residents remain in
the last year of an old state hospital program phased out. However, we have not yet felt the impact of the new affiliated programs that are phased in at different rates at different locations.
NEW
being major being
THREATS
Unfortunately, Ohio’s efforts to increase universitysponsored training of psychiatrists in the public mental health system is being threatened by the recent decline of interest among American medical students in specializing in psychiatry, which has been described by Pardes and others (1-3). Only 41 per cent of the firstpostgraduate-year positions and 71 per cent of the second-postgraduate-year positions were filled this year. Ohio has made major efforts to increase its medical manpower in recent years by opening four new medical colleges. But if efforts to motivate medical students to enter psychiatry are not more successful, our efforts to train and encourage psychiatric residents to enter state hospitals and community mental health programs may fall far short of developing the manpower necessary to operate the public system at a reasonable level of quality. This problem demands national attention, as well as systematic efforts at the undergraduate medical school level in Ohio. Programs should be carefully reviewed to see if they contain the following elements, as set forth by Langsley: a well-rounded faculty, a psychodynamic orientation, a greaten commitment to medical student education than to resident training, varied teaching methods, enthusiastic student response, and systematic evaluation that produces changes in subsequent years (4). Ohio was already committed to reducing its heavy dependence on foreign medical college graduates, so it did not initially feel threatened by the enactment of the Health Professions Educational Assistance Act of 1976, which limited the number of FMGs who could enter the United States. We had expected to offset this cutback of personnel by our increased production of physicians at the new medical colleges and our systematic training of psychiatrists in public facilities. However, if the national trend of decreased interest in psychiatry among U.S. medical students is not reversed and the flow of foreign medical graduates remains limited, we could again face a deteriorating ability to provide adequate psychiatric services in state mental institutions and community mental health programs. In addition, maximum salaries for the department’s medical and psychiatric staff have not been increased since July 1975 and are gradually becoming noncompetitive again, especially when compared to salanies in the private sector. These new impediments to the supply of psychiatrists are occurring at a time when the department needs another 70 physicians, mostly psychiatrists, to meet Joint Commission on Accreditation of Hospitals standards in all of its facilities, and when enormous unmet needs exist in the community mental health sys-
tem. We currently lack reliable information about psychiatric manpower needs in Ohio’s community system. However, there is a general consensus that serious shortages exist and are a threat to existing programs as well as to the new programs being planned to meet the unmet needs of special populations, especially the chronically mentally ill. Psychiatric manpower shortages could result in the diminished effectiveness of these programs and a decreased role for psychiatry in the control and operation of the public mental health system. Similar concerns have recently been expressed by Fink (5) and Winslow (6). The department has recently developed a computerbased simulation technique to estimate manpower and facility needs in the planned community mental health system as it develops oven time. The program is based on models of services and organization developed at the grass-roots level with the department’s technical assistance. It is hoped that it will result in more valid estimates of future psychiatric manpower needs that can be incorporated into planning for medical and psychiatnic education programs at the regional, state, and national levels (7). Thus after four years of steady progress that brought us in reach of our goals, we are in danger of having another trend reversal that could threaten the quality of cane and the leadership of psychiatry in the public mental health system. We plan to redouble our efforts, in cooperation with the medical colleges and organized medicine and psychiatry, to motivate medical students to enter psychiatry and to train psychiatrists in university-sponsored programs in state hospitals and community mental health programs. We also plan to adequately compensate psychiatrists for public service, to motivate them to accept public service responsibility, to provide flexible and professionally stimulating assignments to psychiatrists in public mental health programs, and to develop more reliable estimates of future psychiatric manpower needs.#{149} REFERENCES 1) H.
dent
Pardes,
“Why
Students Are Not Entering Psychiatry,” ResiVol. 25, April 1979, pp. 54-58. Association of Chairmen of Departments of Psychiain Psychiatric Manpower: Toward a NatiOnal PsychiatPolicy, American Psychiatric Association, Washington,
and StaffPhysician,
2) American The Crisis 7* Manpower D.C., 1977. 3) Report to the President From the President’s Commission on Mental Health, Vol. 1, Washington, D.C., 1978. 4) D. G. Langsley, A. M. Freedman, M. Haas, at al., “Medical Student Education in Psychiatry,” American Journal of Psychiatry, Vol. 134, supplement to March 1977, pp. 15-20. 5) P. J. Fink and S. P. Weinstein, “Whatever Happened to Psychiatry? The Deprofessionalization of Community Mental Health Canten,” American Journal ofPsychiatry, Vol. 136, April 1979, pp. 406409. 6) W. W. Winslow, “The Changing Role of Psychiatrists in Comtry,
Mental Health Centers,” American Journal of Psychiatry, Vol. 136, January 1979, pp. 24-27. 7) T. Moritz, F. Goldberg, and D. Chesser, “A Creative Systems Approach to Mental Health Manpower Development,” paper presented at the annual meeting of the American Psychiatric Association, May 12-18, 1979, Chicago. munity
VOLUME
30 NUMBER
11 NOVEMBER
1979
777
