It's almost impossible to find a good psychiatrist. While demand for mental health care has skyrocketed in the United States, the number of graduating psychiatrists has not kept up. There is not only a critical shortage of psychiatrists, but there is an even greater deficit of high-quality psychiatrists.
A good psychiatrist can generally be described as an M.D. who excelled in medical school and residency and perhaps received additional fellowship training in the field.
But more importantly, a good psychiatrist possesses a unique set of qualities, including wisdom, insight, empathy and social intelligence, paired with the analytical ability and up-to-date grasp of psychopharmacology required to piece together medication strategies for complex and difficult-to-characterize symptoms.
A good psychiatrist is also likeable, with excellent people skills. He or she forms strong, intimate, and therapeutic relationships with patients while observing appropriate boundaries.
Ultimately, a good psychiatrist has both a deep understanding of humanity and an extraordinary ability to relate to all types of people. And as stereotypes of awkward psychiatrists attest to, these last two qualities may not be as highly correlated as one would hope.
One of the biggest reasons that medical schools are not churning out a greater number of psychiatrists is because psychiatry is considered low-status in the medical world and is therefore less competitive. Only four percent of medical students choose to specialize in psychiatry, making it one of the least popular medical specialties.
Psychiatry also has the reputation of being a lower-paying speciality with some of the most difficult patients who seem beyond help. But this is simply mis-branding. Psychiatry can actually be one of the highest paying specialities that affords a high quality of life including a flexible schedule and stimulating work that produces results. Although psychiatric patients are seen as hard to work with, the combination of targeted talk therapy and judiciously-used medications is quite effective, and there is abundant scientific evidence to back that up.
Over years of practicing in the outpatient setting, I have seen the vast majority of the patients in my private practice get better and lead more functional, fulfilling lives. I feel great purpose in what I do, as I am reminded on a daily basis that my work is meaningful and important, and I am paid well for it.
I am also constantly reminded that most patients have had bad experiences with psychiatrists. One of my patients, an adolescent boy, had gained over 50 pounds after being put on an antipsychotic medication as a result of being misdiagnosed with Bipolar Disorder. He was devastated by the weight gain, became severely depressed, and experienced no improvement in the symptoms of anger and impulsivity that had led him to treatment in the first place. He came to me because he had lost trust in his previous psychiatrist and was much worse off than before he had started treatment. After taking the time to taper him off his medications and choosing others with a better risk-benefit profile, as well as connecting with him about his emotional experience and setting treatment goals together, I observed this patient stabilize and display a willingness to take greater responsibility for the course of his life.
Another one of my patients, a successful woman who struggled with severe anxiety, explained with frustration that she had been in therapy for years but that it never felt like more than a sounding board for her worries and her symptoms never improved. This experience might lead many patients to believe that psychiatry is itself ineffective. But after working with this patient in a manner that balanced trust and safety with a more challenging approach, I saw significant improvement in her anxiety and overall well-being within just months.
I also frequently see patients who feel neglected or maligned by psychiatry because many doctors have turned them away due to the severity and acuity of their symptoms. It seems that these psychiatrists feel ill-equipped to manage the most difficult patients and moreover, may not feel passionate enough about their work to take on the challenge. Unfortunately, this leaves the patients with the most severe mental illness with the least options in terms of finding a good provider.
My patients with severe mental illness often make as much progress as my "worried-well' patients. I believe that my work is effective because I have the skills and training to adapt to patients' evolving needs in a fluid process that entails mindfulness, emotional intelligence, extensive medical knowledge, and a self-awareness about the biases that I may bring to each clinical interaction. This sort of comprehensive and nuanced approach to treatment is essential, and psychiatrists with inadequate training may lack the competence or motivation to provide it.
Until more talented doctors go into psychiatry, patients will continue to find it extremely difficult to find a good psychiatrist, and stories about patients receiving substandard psychiatric care will overshadow stories about good treatment.
This crisis can only be resolved with a rebranding of psychiatry as a specialty. Medical students need to know that if they are talented and ambitious, they can make a great living as a psychiatrist, work with patients from a diverse set of backgrounds, and enjoy much better quality of life than doctors in other specialties. Even more importantly, they can form meaningful, influential, and long-term relationships with patients while witnessing their profound personal growth.
But in the meantime, things remain difficult for most people with mental illness. Where do they begin to find the psychiatrist who will best fit their needs?
My suggestion to patients is to educate themselves appropriately about their illness and its treatment but remain open to receiving expert guidance. Since patients may be confronted with varied opinions between different providers, they will have to become savvy mental health consumers who are capable of discerning between good and bad advice. I would also urge patients to truly value their mental health, even if it means paying out of pocket rather than going through insurance, which more talented psychiatrists often eschew. But most importantly, I would tell them to be tireless in their quest for good care and keep shopping for the best psychiatrist they can find.