Psychiatr News January 19, 2007
Volume 42, Number 2, page 4
© 2007 American Psychiatric Association
Model Program Shows Rewards Of Addiction-Medicine Career
Mark Moran
Medical students typically see the drunk person through the emergency
department's revolving door. The same person appears again and again and
leaves without receiving any real treatment.
The Annenberg Foundation is
funding a unique initiative aimed at developing educational models for
attracting physicians to addiction medicine and addiction psychiatry.
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Stuart Gitlow, M.D.: "We are trying to intervene early when
students are open to the idea of treating patients with addictive
disease."
Photo courtesy of Stuart Gitlow
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The foundation has given $12.5 million in perpetuity to support the
Annenberg Physician Training Program in Addictive Disease. The agreement is
between Annenberg and the Mt. Sinai School of Medicine in response to a
proposal written by addiction psychiatrist Stuart Gitlow, M.D., M.P.H.,
M.B.A., who chairs the training program and is an assistant clinical professor
of psychiatry at Mt. Sinai.
Last year the endowment piloted a program to place nine first- and
second-year medical students in abstinence-based rehabilitation programs
around the country for between four and eight weeks, with the goal of allowing
students to experience addiction treatment from the patient's perspective.
"The students interact with the patients, and the patients know they
are students," Gitlow explained, "but we have seen that within a
few days the students fit into the program. Our hypothesis is that through
this experience the students will learn what they share with the patients.
They will observe patients coming into the program in bad shape and leaving in
good shape and the rapport that develops between themselves and patients in
the treatment milieu."
Gitlow added that a key to the Annenberg program is the ability to track
participating students over time to determine what interventions succeed in
attracting students to specializing in addiction medicine and addiction
psychiatry. "This will take a long time, but we have the funding to do
that," he said.
He said students last year came from the University of Florida School of
Medicine, Indiana University School of Medicine, Case Western Reserve
University School of Medicine, Philadelphia College of Osteopathic Medicine,
and Northeastern Ohio Universities College of Medicine. The students were sent
to programs in Texas, Florida, Michigan, Pennsylvania, and Utah.
The Annenberg program provides students with a stipend, expenses at the
treatment program, and travel and accommodation expenses.
The program is accepting applicants for the year beginning summer 2007.
Students can e-mail the program for information at
annenbergprogram{at}aol.com;
the deadline for applying is March 1.
"We see this as our first operational year and are planning for 20
participants," Gitlow said.
He added that a unique aspect of the endowment is that while it is housed
at Mt. Sinai, the grant can be moved to another institution as determined by
the training program's advisory committee. "The program doesn't have any
physical space at Mt. Sinai, so this is unlike any other large-scale project
with which I'm familiar," he said. "We do almost all our work
cooperatively with other institutions in an online setting."
Gail Levin, Ph.D., executive director of the Annenberg Foundation, told
Psychiatric News that the endowment is part of the foundation's
commitment to improving public health. "We wanted to respond to the need
identified by several medical societies to increase the number of trained
physicians in addictive disease," she said.
In an article in the summer 2000 American Journal on Addictions,
addiction psychiatrist Marc Galanter, M.D., of New York University School of
Medicine, and colleagues surveyed the 38 PGY-5 (and 5-6) addiction psychiatry
residency programs accredited by the Accreditation Council for Graduate
Medical Education as of July 1999.
They found that in the 1998-99 academic year, the 36 programs that
responded to the survey had offered 84 positions for entering addiction
fellows, but were able to fill just 61 of them.
"As of 1998, there were 1,776 addiction psychiatrists certified by
the ABPN," Galanter and colleagues said. "These diplomates
received their training and clinical experience prior to the institution of
the [PGY-5, 5-6] residency requirement, although some had already completed
accredited fellowships. Clearly, as these diplomates retire, a greater number
of residents will have to enter training programs to meet the needs of
tertiary care centers and treat the general population as well, given the high
prevalence of substance-use disorders."
Gitlow said the traditional format for training in addictive disease, in
which students shadow a physician in a hospital setting, has not been
successful in attracting interest to the field.
"We tend to get exposed early on to the process in an inpatient
hospital setting," he said. "Consequently, students tend to see
the revolving door of the emergency department, where the drunk comes in again
and again not receiving any real treatment. What they learn is that drunks
don't get better. Students are not exposed to addiction-rehab programs or any
of the longer-term interventions that are most useful to these patients.
"If you look at what happens to medical students' attitudes about
addiction, they get worse as they progress through training," he added.
"Through the Annenberg endowment, we are trying to intervene early when
students are open to the idea of treating patients with addictive
disease."
Gitlow said a result of the dearth of physicians entering fellowship
programs in addiction psychiatry is what he called "an enormous
scope-of-practice problem" in the field.
"Most patients are initially seen by a nonphysician who does the
diagnosis," he said. "We have a highly prevalent disease that is
diagnosed by nonphysicians and treated by nonphysicians, and not always
particularly well."
"Residencies in Addiction Psychiatry 1999 to 2000, A Decade of
Progress" is posted at
<http://taylorandfrancis.metapress.com/index/WY816D9EUNU3VUP6.pdf>.
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