Addressing a Workforce Shortage: How Early Medical Education Can Shape Future Mental Health Care
The need for more medical students to pursue careers in psychiatry has become increasingly urgent as the demand for mental health services continues to outpace the available supply of professionals.
According to the U.S. Health Resources and Services Administration, the nation's psychiatry workforce—currently about 40,000—is projected to decrease by 27% by 2030, leaving the country with a shortage of up to 21,000 psychiatrists. This shortage is particularly critical in rural areas, where access to psychiatric care is often limited or nonexistent.
One of the key contributors to the shortage of psychiatrists is the underrepresentation of medical students choosing psychiatry as their specialty. While the stigma surrounding mental illness has diminished in recent years, misconceptions about psychiatry persist, discouraging some students from pursuing this crucial field.
Early, consistent exposure key
Janis Cutler, MD, director of the Medical Student Education in Psychiatry, is dedicated to changing this narrative. A professor of clinical psychiatry, Dr. Cutler leads a comprehensive curriculum that spans the four years of medical school at Columbia University's Vagelos College of Physicians & Surgeons (VP&S). Her signature course, "Psychiatric Medicine," provides first-year medical and dental students with a semester-long introduction to psychiatry.
Dr. Cutler emphasizes that engaging students in psychiatry early is critical to fostering a deeper understanding of psychiatric disorders, improving patient care through early identification and intervention, and encouraging more students to consider psychiatry as a career. This approach also enhances mental health literacy across all medical specialties.
'Early exposure to the many facets of psychiatry has been key to our program's success in attracting students to the field," says Dr. Cutler. "Recently, psychiatry has been the second-most popular specialty choice among our graduating medical students.'
Centering on the patient experience
Dr. Cutler's teaching approach centers on the patient experience. Her lectures incorporate recorded patient interviews, and small group discussions led by senior residents feature live patient interviews. A longstanding collaboration with NAMI (the National Alliance on Mental Illness) provides students with exposure to family members of individuals living with serious mental illness.
"Students cannot truly learn about psychiatry without seeing patients. The small group patient exposure, which involves our clinical services, is a massive effort but vital to helping students understand the real-world challenges faced by individuals with mental illness," says Dr. Cutler.
Suicide Prevention as a Core Component
One of the most critical areas in psychiatry education is teaching students how to assess and manage suicide risk. At Columbia, this education begins early, with Dr. Cutler integrating suicide prevention into the Psychiatric Medicine course. In one compelling session, "standardized patients," played by trained actors, simulate symptoms of depression, allowing students to practice screening for suicidal ideation.
"Students struggle at first with asking direct questions," Dr. Cutler notes. "They worry about being impolite or giving a patient a harmful idea. Asking the right questions is important in getting a patient to express suicidal thoughts."
These skills are further reinforced during students' major clinical year, where they assess suicidality in real-world settings like the Psychiatric Emergency Room. After the introductory course, students continue their psychiatric education through a five-week psychiatry clerkship. This immersive experience occurs in hospitals and clinics such as CUIMC/NYSPI, Bronx VA, Creedmoor Psychiatric Center, Gracie Square Hospital, Harlem Hospital, and Rockland Psychiatric Center. During this time, students take on the role of primary caregivers on an inpatient team, working directly with patients. This hands-on training strengthens both their medical knowledge and interpersonal skills, preparing them to handle complex cases—skills invaluable in any medical field.
A 'rare and special opportunity'
Julia Schluger, MD, a third-year resident in psychiatry at VP&S, credits her exposure to psychiatry as a Columbia medical student with solidifying her decision to become a psychiatrist—and to continue her education in the school's residency program.
Dr. Schluger says that one essential way Columbia prepares medical students for a career in psychiatry is by providing them with access to clinical spaces. "The school made it a priority for us to have clinical exposure early on," she says. Before going into our clinical year, we were already welcomed to NYPSI, the building, and the inpatient units. It is a rare and special opportunity to feel valued even as a first-year student."
During her psychiatry rotation, Dr. Schluger spent six weeks at 9GN NewYork Presbyterian-Milstein inpatient unit, which serves patients from the neighborhoods surrounding the medical center. She found immense value in collaborating with a multidisciplinary team—psychiatrists, nurses, social workers, rehabilitation therapists, and peer service workers who provided mentorship and support throughout her experience.
Most importantly, Dr. Schluger cherished her direct interactions with patients, finding fulfillment in helping them navigate their challenges. "The experience on the unit, connecting with patients, was more meaningful than anything else in medical school."