The Future of Medicine and Psychiatry
William Yates, M.D.
University of Oklahoma

     The year 2000 provides a time to look back as well as forward to the next decade, century and millennium. None of us can predict what the future holds, but its informative to consider the opinions of leaders in medicine and psychiatry. The December issue of Archives of Psychiatry included three commentaries on psychiatric practice in the new millennium. I thought the commentary by Steve Sharfstein was provocative and important for members of AMP (Sharfstein SS: In the year 2099...Archives of General Psychiatry 1999, 56:1151-1152.)

     Sharfstein proposes that in one hundred years, psychiatrists will be certified in 1 of 4 categories of practice: neuroscience, psychotherapy, social psychiatry and medical psychiatry.

     The neuroscience psychiatrist is described as a scientist with an MD degree and a PhD. These psychiatrists will be the "most highly specialized and, therefore, the most highly compensated ... psychiatrist/clinician-scientists." Neuroscience psychiatrists will be experts in genetics, brain imaging and neurochemistry.

     Psychotherapy psychiatrists will have an MD degree plus training in areas such as psychology, religion or the humanities. Sharfstein suggests psychotherapy psychiatrists will extend the scope of services to problems of "individuation and separation, grief and loss, insight and self-actualization". He is optimistic about the acceptance of psychotherapy by projecting that in 100 years more than 50% of the population will have benefited from psychotherapy.

     The social psychiatrist is described as the psychiatrist with an additional degree in sociology, criminology or law. Social psychiatrists will be involved in the practice of forensic psychiatry and the practice of psychiatry in the workplace and schools.

     Of most note to AMP members is the category of medical psychiatry. Dr. Sharfstein describes these clinicians by noting, "...the medical psychiatrist will most resemble the late 20th century psychiatrist through the subspecialties of geriatrics, adult, child and adolescent, and substance abuse". Sharfstein goes on to comment,"...the medical psychiatrist will be most closely affiliated with other medical colleagues with many having board certification in not only psychiatry, but also in other areas of medicine". This sounds like an endorsement for the AMP as a trend-setting organization, with our members being ahead of the curve for an important part of the future of psychiatry.

     I think Sharfstein is correct in predicting this important trend in psychiatry. He may have gone a little too far when he estimated that "This (medical psychiatry) will be a very popular area of specialization for physicians, with more than 20% of all American medical graduates practicing in medical psychiatry." Wow! Assuming that the number of graduating medical students each year remains stable at 15,000, this projection would mean 3,000 students each year choosing a medical psychiatry training track. His commentary suggests that the vast majority of psychiatrists in 100 years will resemble many of the current members of the AMP.

     All of Sharfstein’s categories for the psychiatrists of the future to include a specialty area of knowledge or skill in addition to the skills of today's general adult psychiatrist. I agree that specialty training in psychiatry is an important strategy for improving the status of psychiatry and improving the success for graduates of psychiatry residency training programs. Combined residency training in family practice or internal medicine provides one specialty choice for medical students with an interest in psychiatry.

     It's heartening to know that leaders outside of the AMP agree on an optimistic future for those working at the interface of medicine and psychiatry. If Sharfstein's predications are correct, then the need for combined residency programs will continue to grow through the next century. This growth will be promoted by what our organization does today to foster and promote combined training graduates and combined training residency programs.

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