Michelle Conroy

The American Association for Geriatric Psychiatry’s Scholars Program: A Model Program for Recruitment into Psychiatric Subspecialties

The number of psychiatrists and other mental health professionals in the USA is insufficient to meet the needs of a population where nearly one in five adults experience some form of mental illness [1]. A paucity of general psychiatrists exists in much of the country, with an even greater lack of psychiatrists trained in Accreditation Council on Graduate Medical Education (ACGME)-approved psychiatry subspecialties: geriatric psychiatry, child and adolescent psychiatry, addiction psychiatry, forensic psychiatry, and psychosomatic medicine [2]. A large majority of outpatient mental health care for these specialized populations is provided by non-psychiatric physicians [3] and general psychiatrists without subspecialty training [4, 5]. The case of geriatric psychiatry is particularly dire. The 2012 Institute of Medicine (IOM) report “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” projects that the growth of elderly individuals in the US population will outpace the geriatric psychiatry workforce capacity [6]. In support of the IOM study, the American Psychiatric Association predicts that the ratio of geriatric psychiatrist per older Americans will fall from “one for every 23,000 older Americans” to “one geriatric psychiatrist for every 27,000 individuals 65 and older by 2030” [7]. Studies on recruitment into psychiatry indicate that a variety of medical student, institution, and specialty-specific factors contribute to a student’s decision to enter the field [8]. In recent years, recruitment into psychiatry has trended slightly upward [9], while recruitment into psychiatric subspecialties has remained stable or trended downward [10, 11]. Clinical exposure [12–14], quality of teaching [13, 14] and mentorship in a subspecialty [15] all positively influence trainees’ interests in that field. The amount of clinical and didactic time devoted to a particular psychiatric subspecialty varies among psychiatry residency programs, and the quality of this training depends on the availability of subspecialty-trained faculty and clinical services. For example, the ACGME requires only a 1-month fulltime equivalent experience in geriatric psychiatry [16]. Each general psychiatry residency program is tasked with fulfilling this 1-month requirement based on availability of local resources. Training programs without subspecialty-trained faculty may lack adequate subspecialty mentorship and appropriate clinical sites for trainees to see geriatric psychiatry patients under supervision. In order to meet the subspecialty workforce imperative in psychiatry, a shift in recruitment strategy toward thinking “outside the residency box” is needed. National professional organizations are one way to introduce trainees to opportunities for training, careers, and mentorship in a psychiatric subspecialty. The American Association for Geriatric Psychiatry (AAGP) has had success in harnessing the enthusiasm, dedication, and generosity of its members to help build a “pipeline” of trainees interested in careers in geriatric psychiatry. In this paper, we describe the development, implementation, and preliminary outcomes of the AAGP’s Scholars Program. We present this program as a mentorship-based program model designed to foster trainee interest in and recruitment into a psychiatric subspecialty. * Kirsten M. Wilkins kirsten.wilkins@yale.edu

Cocaine Abuse in the Elderly

(medically or psychiatrically) and specific NPS of depression (p1⁄40.0084), anxiety (p1⁄40.0096), and apathy (p1⁄40.0094) were significantly related to psychiatric hospitalization. Hospitalized patients also had more NPI categories present than those who were not hospitalized (3.7 2.0 vs. 2.8 1.7, p1⁄40.0414). Further results are pending and will be presented during the poster session. Conclusions: Among older adults with dementia presenting for emergency services, 22% present with NPS, and most of them are already taking psychotropic medications at the time of presentation. Not surprisingly, those patients presenting to the psychiatric emergency setting had more NPS present. Very few patients required physical restraint or seclusion, while a small but noteworthy number of patients received antipsychotics or benzodiazepines. Hospitalization was fairly common and relationships were found between the total number of NPI categories present and specific NPI categories. NPS are important and previously unrecognized clinical factors that may influence the care that older patients receive in emergency settings.