General Psychiatry Resident Perceptions of Geriatric Psychiatry: A Qualitative Study.

Abstract

Objective: As the population of older adults with mental health needs grows, there is an increasing demand for geriatric psychiatrists, but the workforce is shrinking. This study investigated psychiatric residents' perceptions of geriatric psychiatry to understand why fewer psychiatrists choose to specialize in geriatric care and ways to counteract this trend.

Methods: We conducted two focus groups with first- and second-year general psychiatry residents at the University of New Mexico to understand perceived challenges and benefits of geriatric psychiatry as a profession. We analyzed transcripts using an exploratory qualitative, thematic, team-based approach.

Results: Analysis revealed primary themes of perceived challenges, perceived benefits, and learning goals. Within perceived challenges included sub-themes "subspecialty-related" (lack of personal value or meaning, it is too demanding, and too complex), "patient-related" (lack of knowledge, low confidence, futility, lack of connection, and moral injury), and "system-related" (low resources, stigma, and discrimination). Likewise, perceived benefits had sub-themes "subspecialty-related" (impactful, engaging, and meaningful), "patient-related" (rewarding), and "system-related" (needed). Finally, residents discussed learning goals they wanted (e.g., managing complex pharmacology and medical comorbidity; late-life developmental theory, legal concerns, and ethics) and did not want (e.g., redundancy in MoCA teaching).

Conclusions: Without urgent attention, the patient-provider mismatch in psychiatric care for older adults will continue to grow. Residents' negative and positive attitudes provide insights into barriers and opportunities to address the shrinking number of geriatric psychiatry fellows.