July 21, 2017
By Joe Stumpe
|Dr. Matthew Macaluso, residency program director|
With the demand for psychiatrists at an all-time high, the role of KU School of Medicine-Wichita in producing them has never been more important.
It takes only a few numbers to make that importance clear. Of the 37 psychiatrists who are under 65 and practicing outside the Kansas City corridor, 29 (or 78 percent) completed their residency at KUSM-Wichita. In Sedgwick County, KUSM-Wichita has trained 90 percent of the psychiatrists under 65.
"I would say there would be almost no psychiatrists in Sedgwick County if it weren't for our program," said Dr. Matthew Macaluso, associate professor and director of residency education at KUSM-Wichita's department of psychiatry and behavioral sciences.
Of course, numbers aren't the most important part of the story. Psychiatry, like other branches of medicine, is focused on helping people.
"You can make a difference in people's lives," Macaluso said. "People often don't get the mental health treatment they need. Many of our patients don't even realize they have a mental health issue."
"I just like to help people, and a lot of times it seems like all they want is to be listened to, which in health care often doesn't happen as well as it should," added Dr. Alisha Coulson, who finished her residency at KUSM-Wichita in 2015 and now practices at the Salina Regional Health Center. "I do a lot of listening in my job."
The World Health Organization reports that one in every four persons will suffer a mental illness that could require treatment at some point in their lives. And there are - sorry for yet another number - some 2.9 million Kansans. That leads Macaluso to conclude that Kansas, especially outside the Kansas City corridor, is "woefully underserved" in that regard.
Kansas isn't alone, by the way. Nationally, growth in the number of psychiatrists has lagged behind that of other types of physicians and the population as a whole, and a 2010 survey found that nearly 60 percent of psychiatrists were 55 or older. In 2014, Mental Health America, a national community-based non-profit, performed a national study that used 15 measures to rank states' prevalence of mental illness and access to care. Kansas had an overall ranking of 21 out of 50 states. In other words, 20 states had a lower prevalence of mental illness and greater access to care.
KUSM-Wichita's department of psychiatry and behavioral sciences employs nine full-time psychiatry faculty and 15 volunteer faculty at present. Residents train at the school's outpatient clinic, Via Christi Health, the Robert J. Dole VA Medical Center and COMCARE, the community mental health center. The department also operates a faculty psychiatric clinic at the medical school campus.
KUSM-Wichita has room for 20 psychiatry residents at a time, and the four-year program is always maxed out. The program had about 1,300 applicants last year. Not surprisingly, those that are accepted are grateful for the opportunity.
Coulson applied to the KUSM-Wichita program and stayed in Kansas to practice because she wanted to be close to her hometown of Larned. She said growing up near the Larned State Hospital - the state's largest psychiatric facility - naturally influenced her choice of career. "I worked there for a summer as an undergrad and had relatives who worked there."
Coulson added that pay for psychiatrists in rural areas can be higher because there is such a shortage of them. On the downside, she and her colleagues must deal with a scarcity of resources. For instance, there are no geriatric or adolescent psychiatrists in Salina, meaning those patients are usually referred to Wichita. Because the state-run Central Kansas Mental Health Center has a patient overload, she said, "We often get their patients admitted here. They're very, very busy and so are we at the hospital."
Dr. Susan Carr is one of the faculty psychiatrists specializing in geriatrics. She leads a geriatric inpatient service at Via Christi Hospital. She is an associate clinical professor at KUSM-Wichita, where she completed her medical studies and residency.
"Via Christi has been very good in letting us keep this geriatrics unit," Carr said. "We treat a lot of patients that we wouldn't be able to otherwise."
For Carr, one of the most satisfying aspects of her job is working with other members of a patient's medical team.
"I like the combination of having an idea of what to do with their psychiatric ailment and also being able to help with their medical illness. A lot of patients just need some medication changes."
Another graduate of the KUSM-Wichita residency program, Dr. Shean McKnight, is medical director at Horizons Mental Health Center in Hutchinson. In addition to administrative duties, he sees a full patient load, makes morning rounds at Hutchinson Regional Medical Center's 15-bed psychiatric unit and then sees outpatients at the clinic in the afternoon.
McKnight first became interested in psychiatry while attending nursing school in Oklahoma. He ended up working as a psychiatric nurse for several years, then entered medical school in his 30s. He started realizing the demand for psychiatrists when a fellow student posted his resume online and received phone calls from recruiters every 15 minutes. McKnight gets similar calls and emails every day.
The Affordable Care Act helped fuel the growth of psychiatry with its requirement that health care plans cover mental and substance-abuse disorders - also known as mental health parity. There's also been a change in public sentiment. "I think as the stigma continues to go down about mental health, people are more aware and willing to come in and seek treatment," McKnight said.
Like Coulson, McKnight mentioned that demand has made psychiatry a well-paying specialty and also noted that it's considered one of the "lifestyle" specialties, with practitioners able to keep normal hours. A recent American Medical Association publication showed psychiatrists to have lower burnout rates than other specialties.
"I love forming the relationship with people and being able to sit down and talk to them, get to know them and their families and learn about what's going on in their lives," he said.
To serve as many patients as possible, McKnight has recently ramped up use of televideo to see patients remotely from such locations as Anthony and Kingman.
"It's really increased patient access," he said. "We're able to see more patients because we're not spending all that time on the road driving, and I don't think it has limited the quality of care."
Another initiative that could increase access to psychiatric care in Kansas was a bill approved by Legislature broadening the Medical Student and Resident Loan Act to include psychiatry.
Macaluso, who's also director of clinical trial research for the KUSM-Wichita's department of psychiatry and behavioral sciences, said psychiatry is enjoying an exciting phase of innovation thanks to developments in brain imaging and medication. KUSM-Wichita has played a role in that, too, thanks to a 30-year history of conducting clinical trials of new drugs used in psychiatry. One member of the faculty, Dr. Sheldon Preskorn, has tested about 90 percent of the pharmaceuticals used in psychiatry that are currently on the market.
"Advances in neuroscience are going to change the way we diagnose and treat mental illness," Macaluso said.
And psychiatrists from KUSM-Wichita's residency program will be in the forefront of that care.
Macaluso added, "The residency program is the main pipeline for bringing psychiatrist to the state, particularly rural areas."KU School of Medicine-Wichita