Health care reform and postgraduate psychiatric education: Challenges and solutions

Psychiatric educators must prepare to teach in an era in which funding for education is more difficult to obtain, all forms of treatment are shorter, patients are discharged from the hospital while they are still acutely ill, the burden of paperwork and other administrative tasks is greater, psychiatrists provide less psychotherapy, and residents are no longer able to play a primary role in the treatment of patients covered by third-party payment schemes. A surcharge on a national insurance plan could make up for funding deficits, but this is not likely to occur in the near future. A more realistic model involves billing for services of faculty who integrate direct participation in patient care with teaching and better definitions of the role that residents can play in modern patient care. Overage from clinical activities driven by faculty may provide sufficient funding for resident services that provide an opportunity for longitudinal patient experiences. Strategies for political action and for better collaborations with primary care faculty are discussed.