The question of “the physician surplus,” as well as that of the supply of future physicians, is increasingly under discussion by medical educators and administrators. As a significant corollary, one hears concomitant debates on interdisciplinary, interspecialty, intraspecialty, and town-gown competition for patients. Rapid developments in health care economics, cost effective payments, and DRG's provide an urgent setting for controversy. It is imperative that we consider the impact of this changing scene on the pool of psychoanalytic candidates and learn from the experience of others.
Studies have indicated that physicians and medical students who become involved in organized medical groups early in their careers are more likely to continue participating in such groups as they advance and settle into their professional identities.
Mindful of the need to involve medical students, who must make specialty choices ear Her in their careers, the AMA and the APA (American Psychiatric Association), for example, have developed membership categories for these younger future colleagues.
At a time when many of our institutes are having fewer suitable applicants and when our Association has discussed the possibility of accepting gifted individuals from disciplines other than psychiatry, it behooves us to look at the recruitment of medical students for psychiatric and psychoanalytic specialization. The standards for acceptance can and should remain high, but the opportunity for encouraging promising, interested individuals who are psychologically gifted at an early phase of their career should not be ignored.
It would be distinctly to our advantage to accept candidates while they are still in medical school. While the busy curriculum of medical schools does not readily permit attendance of medical students at courses outside of the medical center, active efforts at recruitment might well be concentrated in the first two years of medical education. Decisions about career choices often are fixed by the junior year. Analysts should therefore be teachers in those early years and an innovative approach to the education of potential analysts is called for.
At the very least the training process could be speeded up if personal training analyses could begin while the candidate is still in medical school. Specialty training and psychoanalytic training could then be concomitant. Perhaps it would be possible to coordinate a program in which analytic training would be credited as part of a residency in psychiatry. The psychiatric residency might be modified for candidates to include more of the basic science valuable for analysts, such as preparation in psychology, sociology, anthropology, and some of the humanities.
If we wait until psychiatric residents complete their residencies, we are limiting our opportunities in selection and education. Institutes should be active in providing their best teachers for suitable lectures or courses in psychoanalysis to medical students. Institutes could offer free consultation to medical students considering analytic training and a personal analysis. We need to make an effort to attract the best students before they are committed to other specialties by emphasizing what psychoanalysis has to offer.
If institutes can accept carefully selected medical students, track these candidates and later compare their experiences with those of other institutes, we may find that we can render a service to future colleagues as well as to institutes without any compromise of our standards.