Advocating for Telepsychiatry in Psychiatric Training

The APA Telepsychiatry Blog has frequently highlighted ways in which those practicing telepsychiatry have attempted to tame the "Wild West" of telepsychiatry practice and to integrate it into mainstream psychiatry. In July and September 2016, we raised important issues regarding psychiatrists' training in telepsychiatry. In May 2016, we discussed West Virginia's movement to institute telemedicine policy.

My recent experience as co-chair of the Telepsychiatry Committee of the American Academy of Child and Adolescent Psychiatry (AACAP) has further helped me to identify the challenges inherent in advancing the practice of telepsychiatry. In an attempt to address the financial considerations of practicing telepsychiatry, AACAP recently published a policy recommending that each state pass legislation mandating that financial reimbursement for telepsychiatry services to achieve parity with services delivered in person.

This policy was readily adopted by AACAP, which prompted the Committee to also draft a policy recommending that residency training programs include telepsychiatry in core rotations. This policy, too, obtained ready support from several other relevant AACAP committees.

However, when these policies were presented to external stakeholders in academia, AACAP ran into roadblocks to acceptance and adoption. For instance, training directors were hesitant to include telepsychiatry in the curriculum. They expressed concerns about the "top down" and iterative processes needed among the Accreditation Council for Graduate Medical Education (ACGME), the American Association of Directors of Psychiatric Residency Training (AADPRT), and AACAP to implement new, required rotations.

Thus, it appears that developing and implementing new education and training requirements for telepsychiatry can be onerous and time consuming, especially if programs do not have faculty who possess expertise–or are otherwise involved in–telepsychiatry. As an alternative, telepsychiatry rotations could be developed and integrated into curricula as electives. But, these electives still need faculty to lead the course, and the hesitation by faculty to do so serves as its own barrier to increasing telepsychiatry training and practice across the United States.

The disparity between acceptance and adoption of telepsychiatry between the two sectors, commercial and academic, is very telling. The difference between the seemingly lightning speed by which the commercial sector has adopted and continues to leverage telepsychiatry and the slower pace by which academia has come to appreciate and practice telepsychiatry is concerning. How can the field of psychiatry facilitate the process of preparing early career psychiatrists for new opportunities to improve the quality of psychiatric care for under-served populations, while also developing new practice opportunities, via telepsychiatry? Some answers may lie in the work of Shore1, Godleski2, and Hilty3, who have proposed curricula for training and competencies in telepsychiatry.

Do you have thoughts on how or whether the APA should advocate for national residency training programs in telepsychiatry? E-mail us: practicemanagement@psych.org.

About the Author

Kathleen Myers MD, MPH, MS, FAACAP, FATA
Member, APA Committee on Telepsychiatry
Department of Psychiatry and Behavioral Sciences, University of Washington
Director, Telepsychiatry Service, Seattle Children's Hospital
Co-Chair, Telepsychiatry Committee, American Academy of Child and Adolescent Psychiatry

References

  1. Shore JH, Thurman MT, Fujinami L, Brooks E, Nagamoto H, A Resident, Rural Telepsychiatry Service: Training and Improving Care for Rural Populations. Academic Psychiatry 2011; 35(4): 252-255.
  2. Godleski L. A Comprehensive National Telemental Health Training Program. Academic Psychiatry 2012; 36(5): 408-410.
  3. Hilty DM, Crawford A, Teshima J, et al. A framework for telepsychiatric training and e-health: Competency-based education, evaluation and implications. International Review of Psychiatry 2015; 27(6): 569-592.

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