The future of psychiatry: psychiatrists of the future.

OBJECTIVE: The authors' goal was to examine the changing demographic trends in psychiatry manpower. These changes have important implications for the practice of the profession in the future. METHOD: Each year, the APA Office of Membership, in collaboration with the American Association of Directors of Psychiatric Residency Training, conducts a census of all residents in psychiatry. A survey instrument is sent to the director of residency training in each U.S. program accredited by the Accreditation Council for Graduate Medical Education. Using data from this survey and from the American Medical Association, the authors conducted a study of the changes in the number of psychiatric residents over the last decade, particularly the increases in the number and percentage of women in medicine and psychiatry. RESULTS: They found that the number of psychiatric residents has grown from 4,674 in academic year 1978-1979 to 5,829 in 1987-1988, an increase of 25%. The percentage of women has increased from 32% of all psychiatric residents in 1978-1979 to 41% in 1987-1988. The largest proportions of female physicians and psychiatrists were found in the age groups younger than 35. CONCLUSIONS: Previously documented gender differences that affect practice patterns and career opportunities may very well change as a function of the increasing representation of women in the profession of psychiatry, and these changes need to be taken into account in planning for future patient care and research needs.

Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940.

Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.