Earn Your Commute: The Intersection of Psychiatry and Work

shutterstock_374127247

Psychiatry is growing. According to the US Bureau of Labor statistics, even though physician employment in general is expected to grow 3%,¹ employment of technicians and aides supporting psychiatrists is expected to grow 9% from 2022 to 2032.² And medical students have responded. Between 2016 and 2021, sports medicine (+27.2%) and psychiatry (+26.3%) saw the most growth in first-year Accreditation Council for Graduate Medical Education fellows and residents.³

The causes are multifactorial and prominently include lifestyle choices—in particular the ability to control one’s own calendar. As this interaction between medical students, graduates, and the profession of psychiatry has evolved, there has also been a steady increase in an interest in telepsychiatry. This allows patients who do not have immediate access to mental health services (eg, those who live in rural communities) to receive care from trained psychiatric clinicians.

More than 150 million individuals live in federally designated mental health professional shortage areas,⁴ and although telemedicine has reverted to a slim segment of overall care—5%—the proportion of mental health services provided via telemedicine has stayed high at 40%.⁵

Some patients prefer telemedicine. Many patients would rather not commute to a psychiatrist’s office, so these and other patients may intentionally look for virtual psychiatric treatment.

In an article recently published in The American Journal of Managed Care, the investigators found that, “The most common reason for using telehealth was recommendation or requirement by a clinician (73.6%). Respondents with depression were more likely to use telehealth than those without depression.”⁶ The outcome is a push and a pull to doing more of the work of psychiatry over the internet.

Because of the interest in telepsychiatry, the evolution of the psychiatric workplace mirrors that of the workplace across many other professions. Those who want the workforce to be physically present in a shared office are increasingly facing resistance. In the United States, when employees in the corporate world are directed to the office, they are answering: “No! Leadership has to earn the commute.”

In terms of the delivery of mental health services in general, many psychiatrists and other mental health clinicians have switched to teletherapy, which, along with the increased number of employees working remotely has had an unintended but significant consequence on commercial real estate: empty offices.

In November 2023, the US News & World report noted that, “Despite several million new jobs being added to the US economy during the pandemic recovery, offices have lost several hundred million square feet of occupied space.”⁷ Businesses in many industries are feeling the pinch to have a return on their investment in offices.

Providing mental health care via Zoom has many interesting differences and raises some concerning questions:

• How do you react to patients who are late?
• What do you say to patients who are driving during their sessions?
• What about eye contact with the patient (or lack thereof)?
• When is it recommended or required for the clinician to be in the same room with a patient to do a proper assessment (eg, in cases of suspected substance abuse)?

Despite the concerns, it is enchanting to do telepsychiatry. It pays well, it can help clinicians with their licensing around the country, and it allows clinicians to have a very reasonable balance between life at work and life outside of work.

If these kinds of questions about the nature of work, how trends impact professionals, and, more generally, how work and psychiatry are evolving and influencing each other are of interest to you, we want to earn your commute. We hope you will join us at the upcoming International Academy of Organizational and Occupational Psychiatry (AOOP) annual conference. Our focus will be The US Surgeon General’s Framework for Workplace Mental Health & Well-Being (Figure).⁸

Figure. The US Surgeon General’s 5 Essentials for Workplace Mental Health and Well-Being⁸

The AOOP annual conference will be held in Chicago, Illinois, in person at the University Club of Chicagoon Saturday, March 23. For more information, visit the AOOP website at aoop.org.

Dr Morrison is a clinical assistant professor of psychiatry at Rosalind Franklin University’s Chicago Medical School, and past president of AOOP. Dr Cohen is president of AOOP and an associate clinical professor of psychiatry at Weill Cornell Medicine in New York, New York. Dr Idowu is chairman and director of residency training in the Department of Psychiatry & Behavioral Sciences at Richmond University Medical Center in Staten Island, New York.

References

1. Physicians and surgeons. US Bureau of Labor Statistics. Updated September 6, 2023. Accessed January 19, 2024. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

2. Psychiatric technicians and aides. US Bureau of Labor Statistics. Updated September 6, 2023. Accessed January 19, 2024. https://www.bls.gov/ooh/healthcare/psychiatric-technicians-and-aides.htm?view_full

3. 2022 Physician Specialty Data Report executive summary. Association of American Medical Colleges. Accessed January 19, 2024. https://www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary

4. HPSA Find. Health Resources & Services Administration. Accessed January 19, 2024. https://data.hrsa.gov/tools/shortage-area/hpsa-find

5. Lo J, Rae M, Amin K, et al. Telehealth has played an outsized role meeting mental health needs during the COVD-19 pandemic. KFF. March 15, 2022. Accessed January 19, 2024. https://www.kff.org/coronavirus-covid-19/issue-brief/telehealth-has-played-an-outsized-role-meeting-mental-health-needs-during-the-covid-19-pandemic/

6. Raj M, Iott B. Characterizing telehealth use in the US: analysis of the 2022 Health Information National Trends Survey. Am J Manag Care. 2024;30(1).

7. Fydenkevez G. The commercial real estate outlook for 2024: tight credit, work-from-home trends, energy-hungry data centers and more color the horizon for commercial real estate as we enter 2024. US News & World Report. November 30, 2023, Accessed January 20, 2024. https://money.usnews.com/investing/articles/the-commercial-real-estate-outlook

8. The US Surgeon General’s Framework for Workplace Mental Health & Well-Being. The Office of the US Surgeon General. 2022. Accessed January 20, 2024. https://www.hhs.gov/surgeongeneral/priorities/workplace-well-being/index.html