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| Adapted from drawing of Dr. M.A. Farmer (see Supplement 2) |
My theme lately has been about how other people tend to characterize the identity of psychiatrists. The argument is that psychiatrists have some kind of "identity crisis". This argument is invariably advanced by antipsychiatrists who distort psychiatric training and attitudes. There are other interests who also want to distort the core identity of psychiatrists. Health bureaucrats both in the government and in managed care systems would like to say that our role is to ration and undertreat people consistent with their goals of corporate profits or diverting tax revenues to their favorite cause. They use the euphemism "managing resources" when psychiatrists frequently start out in these organizations with no resources. The legal profession including legislators has forced a law enforcement role on us in the form of duty to warn - even though this is clearly a job for trained law enforcement officers. The most depressing identity arguments are made by people who should know better like the recent NEJM editorial. This editorial used an argument by a journalist author who was clearly not familiar with how psychiatrists are trained or their skill set.. These numerous intrusions on the psychiatrist identity are presented as though they have something to do with the profession and they do not.
To make this diagram I read through the first two documents on the reference list below. In order to make the diagram, only the broad intent of the detailed training criteria are included. I could use a much smaller font and more detail, but the concept of a quick read of the basic elements would be lost.
The diagram could be much more complex since every psychiatrist (like everyone else) has a unique conscious state. In the case of a psychiatrist, there is an interaction between professional identity and general identity and personality.
I am posting this for the purpose of educating nonpsychiatrists and for further collaboration with psychiatrists. Please feel free to send me training requirements for psychiatrists that are unique to your institution or country and I will include them here. From my read of the top two references, there appears to be broad agreement at least across the Atlantic. Also feel free to refer to this page when people inside or outside of the field mischaracterize what psychiatrists do or suggest that we are having an identity crisis.
I have been in the field over 35 years and my professional identity was firmly established in medical school and residency. I have made the same intergenerational observations about my colleagues who range in ages from 30 to 85.
George Dawson, MD, DFAPA
ACGME – the current real training and skillset https://www.acgme.org/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf?ver=2015-11-06-120520-753
RCP - A Competency Based Curriculum for Specialist Core
Training in Psychiatry https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/core_psychiatry_curriculum_may_2019.pdf?sfvrsn=f8594b3e_2
Royal
College of Physicians and Surgeons of Canada Specialty Training Requirements in
Psychiatry
http://www.royalcollege.ca/rcsite/ibd-search-e?N=10000033+10000034+4294967084Supplementary 1:
This is the original Visio drawing that I made based on the references.
Supplementary 2:
I was surprised and very pleased to receive a photo of a graphic that will replace mine. It was done by Dr. Melissa A. Farmer and I think it is better than my original because it was designed to show the relationship among the variables. A higher resolution graphic will be posted at some point and my thanks to Dr. Farmer!
