Public Psychiatry

Abstract

Since public funds (primarily Medicaid and Medicare) provide the bulk of funding for psychiatric services in the United States, clinical services in psychiatry are more related to public psychiatry than most physicians realize. The majority of international medical graduate (IMG) physician training occurs in academic centers that are usually affiliated with state-funded hospitals or clinics. Depending on the region of the country in which the residency training occurs, the IMG physician is exposed to different systems of care in psychiatry. One of the few surveys done as a needs assessment for IMG physicians to prepare them for residency training showed that an overwhelming 51% felt that they needed more help in understanding the health care system in the United States, and 88% felt that they would benefit from a curriculum geared toward orienting them toward the health care system at the offset of their residency training. Nonetheless, most residency programs provide limited didactic or clinical training in community psychiatry or recovery. This becomes more important in the context of IMG physician training where they are already having difficulty negotiating a new health care system. Educating residents about to work with challenging patient populations, such as those with serious mental illness who are mostly being treated in community settings, can meet educational objectives beyond an understanding of the clinical population itself. For example, people with mental illness who are homeless typically present complex clinical problems, including substance use and prominent physical health issues, which are in turn compounded by the vicissitudes of severe poverty and social alienation. (PsycInfo Database Record (c) 2022 APA, all rights reserved)