Shortage of child psychiatrists? Still a shortage but much better and not the way it used to be in Buffalo, says doctor who played key role in creating a child psychiatry residency program here
By Chris Motola
Q: What are some of the differences between child and adult psychiatry?
A: We oftentimes think of child psychiatry as lifespan psychiatry. Child psychiatrists do three or four years of mostly adult psychiatry and then do two years of childhood and adolescent psychiatry. So you have to complete your training in general psychiatry as well. Both see many of the same kinds of problems, for example, depression, anxiety, suicidal behaviors, and eating disorders but child and adolescent psychiatrists more often evaluate and treat ADHD, autism, school and learning problems and typically work with the families closely.
Q: What’s unique about the child psychiatry training?
A: Well, when you finish your general psychiatry training, you could technically see children. In many communities, due to lack of specialists, they’ll look to general psychiatrists to provide treatments to kids in their area. I think what child psychiatrists are bringing to the table is a developmental perspective on patients. It used to be most child psychiatrists also saw adults. More recently there’s been more of a specialization along the lines of pediatrics and internal medicine. Most pediatricians will see kids up until they’re 21. I’d say that’s now mostly true of child psychiatrists as well. And even though general psychiatrists are capable of seeing kids, many don’t feel like they’ve had all the training they need to do it and they typically don’t see any youth under 18.
Q: Is that common in the Buffalo region? Do adult psychiatrists see children?
A: In the Buffalo area there are only a handful of general psychiatrists who will see older adolescents. Out in the rural areas, many of the kids are being seen by general psychiatrists though.
Q: I understand you had a lot to do with helping Buffalo develop a better number of child psychiatry specialists.
A: I’ve been at the University at Buffalo for 30-some-odd years. Throughout that time, I’ve been involved in child psychiatry training. I was the residency training director for about 25 years. In the last few years, I’ve had a different role. I still am involved with training medical students, just not as much as I used to be. But one of the things I feel very good about is that I was a key person in starting the child psychiatry residency program here in Buffalo. When I came to Buffalo, there were three other child psychiatrists. Within a year, one of them left the field. The only real solution is to have a residency program in your city. Syracuse did not have a program for many years and had similar problems to us, but Rochester has had a residency program for 50 years and had 40 or 50 child psychiatrists to our three. In 1991, we put together a residency program here in Buffalo and it’s been flourishing since then.
Q: How many are there today?
A: We have 40 child psychiatrists in the Buffalo area today. So when I think about my career, that’s one of the things I feel very good about.
Q: What were some of the challenges in getting that program up and running?
A: I think the challenges are largely having leadership at the top that thinks it’s important and also putting in the legwork to put the pieces together for funding and training. Like any residency program, there are many requirements for accreditation. Those include experience in inpatient and outpatient settings. You have to put all those pieces together. You have to recruit enough faculty. And that gets trickier as funding for teaching has lessened over the years.
Q: How has the increase in autism diagnoses affected child psychiatry? And for that matter, is autism actually on the rise?
A: That’s a very big topic. Autism is a bread-and-butter clinical problem for child psychiatrists. What brings a lot of kids in to see us has to deal with oppositional-defiant behaviors or physical aggression that many children with autism struggle with. That gets them in the door, then we try to figure out what’s driving the behavior, whether it’s autism, depression, ADHD, etc. With respect to autism, autism was first described in 1943. For many years after that, it was thought to be a pretty rare condition. Over the years, as people have studied it more, we’ve come to appreciate that there’s a range of difficulties and deficits that runs from very mild to severe. What was originally described back in the 1940s would today be considered on the severe end of the spectrum. In the DSM-5, which came out in 2013, they changed the name of the disorder to autism spectrum disorder to capture this range of difficulties. At the most extreme end, you have kids who have no eye contact, no language and repetitive motor behaviors that almost everyone would recognize. But now we’ve come to appreciate that many more kids have more subtle difficulties in processing emotional and social cues. And those kids are also considered to have autism spectrum disorder. As that happened, the numbers of cases have increased and prevalence of autism went from 4-5:10,000 in the 1970s to the most current figures of 1:59. And that’s mostly because we’ve become better at looking for and appreciating the subtleties and including these milder cases.
Q: So there hasn’t been a rise, overall, in autism then?
A: There’s still some question as to whether there’s been an absolute increase in the prevalence of autism. A lot of people think there has been, but it’s been very difficult to establish for sure. And we have not identified a reason for an increase although there has been much speculation about that. Many people have looked high and low for factors that could have caused an increase. Nothing’s really been identified. It’s possible in 10 or 20 years, we may identify something in the environment that has produced a real increase, but by and large we know most of the increase is due to better recognition and broader criteria.
Name: David L. Kaye, M.D.
Position: Professor of psychiatry and vice-chairman of academic affairs, Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo and a physician with UBMD Psychiatry
Education: Medical degree from University of Vermont (1977); residency in psychiatry, University of Wisconsin (1980); residency, child and adolescent psychiatry, University of Wisconsin (1982)
Affiliations: Erie County Medical Center
Organizations: American Psychiatric Association; American College of Psychiatrists; American Academy of Child and Adolescent Psychiatry
Family: Two daughters
Hobbies: Playing music