The Future of the Psychiatrist

Abstract

Objective: The American Psychiatric Association (APA) issued a 2023 report on the future of psychiatry, focusing on how the organization should position itself in relation to coming developments over the next 10 years. Here, we follow up with a discussion of how the psychiatrist's role needs to evolve to adapt to the changes ahead.

Methods: We drew on senior experts and junior trainees within the APA's Council on Healthcare Systems and Financing, along with additional content experts, to choose areas of focus and discuss their interrelationships. Literature review focused on publications with implications of these areas for future training and practice.

Results: We are only ∼5% of the mental health work force, and we have unique strengths, including training providing us the ability to discern the varied factors contributing to distress, and direct and apply interventions across all available modalities. Psychiatrists make best use of our capabilities when we lead the process of comprehensively formulating patients' problems and generating a multi-faceted treatment approach. We have chosen six areas where we envision new developments impacting how psychiatrists will practice and residents should train: digital data and precision medicine, measurement-based care, artificial intelligence (AI), psychotherapy, integrated care, and care for the seriously mentally ill. We provide suggestions regarding next steps that will allow us to make the best use of our training and expand access to high quality diagnosis and care.

Conclusions and relevance to clinical practice: We will need to handle the most challenging cases: the most psychiatrically complex, medically complex, and treatment-resistant. We must preserve our skill, unique among physicians, in psychotherapeutic approaches, even as we manage psychiatric illness. We must also adapt and become more tech-savvy, as digital data, mobile and computer-based treatments, electronic medical records, and AI algorithms take on increasing prominence in our field.

FIGURE 1

According to a National Center for Health Workforce Analysis assessment of the 2021 behavioral health workforce, there were 980,511 mental health professionals in the U.S. Of these, 50,376, or just 5.1%, were psychiatrists (2).

FIGURE 2

The psychiatrist's role has undergone significant evolution over the last 150 years, as new developments in medicine, psychology, pharmacology, technology, workforce, and economics have shaped where we focus and how we practice. The figure depicts the themes that have dominated the role in each era, though the work of the psychiatrist has never been limited to each theme. Some psychiatrists today integrate psychotherapy with psychopharmacology, and many will continue to do so over the next 10 years, even as new elements of our role emerge.