Education Support at the Heart of New Year Working Group
‘We really have to consider the educational background of interdisciplinary teams’—Interdisciplinary Education Subcommittee chair Liliya Gershengoren, MD
The 2023 ACLP Annual Meeting in Austin, with its theme Integrating Care and Evidence Across the Lifespan, is set to have a pre-conference course attracting allied professionals from interdisciplinary teams who are calling for C-L Psychiatry training resources.
At this early planning stage, the Academy’s educational organizers have also been charged with investigating curriculum resources specifically for allied professionals, the majority of whom are nurse practitioners, to enhance their knowledge of C-L Psychiatry.
The Interdisciplinary Education Subcommittee will help to lead a working group that includes members of the ACLP Board, the Education Committee, and input from our allied professionals in the new year to work on these educational resources.
The moves are a first step towards any decision by the Academy to consider providing a membership category, beyond the existing associate membership, for allied professionals from nursing, psychology, social work, and other professions with whom ACLP C-L psychiatrists are already working in interdisciplinary teams.
While stating that she will “focus on continuing to expand our membership of those who provide excellent integrated care,” new president Maryland Pao, MD, FACLP, has referred to any membership expansion decisions as a staged process. ACLP will engage in in-depth consultations with our current membership and past ACLP leaders, so no decision is expected in the near term.
At CLP 2022 in Atlanta, the Academy’s Interdisciplinary Education Subcommittee presented an evidence-based package to promote a lively debate on the subject against a background of a severe shortage of C-L psychiatrists as well as requests from allied professionals for C-L Psychiatry educational resources to enhance their knowledge and specific C-L skillsets.
One speaker, Board director Paul Desan, MD, PhD, FACLP, asserted: “Consult Psychiatry is already inter-disciplinary…The future is now…You can see how important these disciplines have become in our field—where we are right now…We need to step up to the plate.”
Speakers examined the credentials of allied professionals in multiple fields and traced decisions on membership expansion among other membership organizations, showing reasons given for acceptance as well as rejection of membership expansion proposals.
Reasons put forward among American Academy of Child and Adolescent Psychiatry (AACAP) members for acceptance in 2018 were:
Reasons against were:
The AACAP ultimately rejected accepting non-physicians as full-members.
Reasons put forward among American Association for Geriatric Psychiatry (AAGP) members for acceptance in 2019 were:
Reasons against were:
The AAGP decided in favor of accepting non-physicians as full-members.
Dr. Desan referred to a decision to accept allied professionals as ‘interdisciplinary members’ by the American Academy of Hospice and Palliative Medicine (AAHPM) which, financially, improved the organization’s reserves from USD 1.4 million in 2013 to an annual budget of USD 9 million today—and which enabled it to produce a significantly increased supply of educational resources for its own and allied members, staffed by a support team comprising 30 FTE. Today, 86% of the AAHPM members are physicians; 3,000 attended its annual conference pre-COVID-19.
The results of an institutional survey by the Interdisciplinary Education Subcommittee demonstrated the need for C-L Psychiatry practice resources. 56% of respondents expected to hire consult practitioners in the year ahead—and, of all hirings, 57% would likely be for non-physicians, including nurse practitioners, social workers, and psychologists. The survey also analysed numbers of non-physician personnel on inpatient C-L Psychiatry teams among respondents:
An analysis of C-L Psychiatry staffing in the US also shows the extent of allied professionals currently in post. 42% of hospital psychiatric consultation services report using nurse practitioners and/or physician assistants and 35% report using social workers:
Faced with a shortage of C-L psychiatric providers, the survey also showed there is also a growing trend among hospitals to appoint addiction consultation specialists not necessarily trained in C-L Psychiatry. Dr. Desan also observed that an expanding range of commercial companies have emerged to date providing telepsychiatry services by consultants, also not necessarily trained in C-L Psychiatry.
Research reports quoted by speakers at the workshop showed that one in five adults in the US experiences mental illness in a given one-year period. Only 41% of those will receive mental health care. The projected supply of psychiatric professionals is 250,000 workers short of demand by 2025. Collaborative care models will need to be implemented.
In addition to Dr. Desan, workshop presenters who provided the detailed analyses for debate on extended membership were:
Subcommittee chair Liliya Gershengoren, MD: “We really have to consider the educational background of interdisciplinary teams” ; and vice-chair Michael Maksimowski, MD: “It is important to understand potential roles, responsibilities, and gaps in knowledge of different team members.”
Subcommittee members Kristin Beizai, MD, FACLP (left): “The crux of the problem is the shortage of mental health providers”; and Lisa Giles, MD: “The American Academy of Child and Adolescent Psychiatry decided against non-physician membership in 2018. The American Academy of Geriatric Psychiatry decided in favor in 2019.”
Much of any future debate on extended membership is thought likely to center on what is being dubbed the ‘guild or field’ question—is the Academy a guild for C-L psychiatrists, or is the Academy for the development of C-L Psychiatry in a wider context. Or could they be mutual bedfellows?
Background to the workshop was in ACLP News, September.