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Objective: The authors explored practice characteristics, activities, and career satisfaction of male and female psychiatrists. Method: A questionnaire was mailed to all practicing psychiatrists in Ontario, Canada, to which 52% responded. Results: More women specialized in child, women's mental health and geriatrics than did men, while men specialized more in forensics and psychosomatics. Women saw fewer patients for pharmacotherapy than did men. Women spent more time in session with their patients than did the men. Women were less involved in research, less likely to hold pharmaceutical funding, and less likely to have published within the last 5 years than men. Women described their careers as less successful than men but felt less regret in choosing psychiatry as a career. Conclusions: Men and women practicing psychiatry in Canada show similar differences to that reported in the U.S., although women report more satisfaction with their careers than men in Canada, a finding not reported in the U.S.

Background: Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years.Methods: A total of 29 psychiatrists, all of whom had participated in a study during their residency 21 to 24 years earlier, completed a self-report questionnaire. The first set of questions addressed the type and characteristics of their professional practice; the second set assessed aspects of their nonprofessional practice; and the third set assessed aspects of their nonprofessional, personal lifestyles. The personality traits of neuroticism and extraversion were assessed during the residency years and were used as predictors. Composite measures of self-perceived external success and personal satisfaction were computed. Regression models were constructed to determine the best predictors of these composite measures.Results: Neuroticism proved to be a significant predictor of external success but not of personal satisfaction, with higher scores predicting a lower rating of perceived external success. There were 2 practice characteristics--involvement with research and practising from an orientation other than psychoanalytic--that predicted perception of success. One personal lifestyle characteristic--the perception that one's nonprofessional life sustained professional life--also predicted perception of success. The best predictor of personal satisfaction was overall satisfaction with nonprofessional aspects of life.Conclusions: Personality, nonprofessional social support, and engaging in research are associated with greater perceived success and personal satisfaction with a career in psychiatry. [ABSTRACT FROM AUTHOR]

The field of psychiatry is experiencing great excitement at this time, much as it was 100 years ago. Current excitement is rooted in the greatly strengthened therapeutics, new models for understanding, and an exponential increase in knowledge of brain function as well as in the opportunity to revise health care delivery. While public expectations of professionals have generally fallen, the role of the healer, which is at the heart of psychiatric practice, has remained high in public regard. Psychiatry has also had to develop new relationships with an active consumer movement. Consumers now appropriately expect to be part of the planning, governance, and evaluation of care. Patients are questioning the research agenda and demand a role in determining the conduct of investigations. This active consumer movement is playing an important role in destigmatizing mental illnesses. Newer, nonmoralistic theories about mental illness and the profession's emphasis on the public trust have also played an important role. The increasing closeness of psychiatry to the rest of medicine has had a greatly beneficial impact, not only on stigma but also on diagnosis and treatment. Care must be taken, however, to see that diagnosis does not become a means to avoiding understanding of people. A welcome recent change has been the reunion between psychiatry and the addictions. This reunion has been facilitated by the development of multifactorial models of care in the mental health field and harm-reduction strategies in the addictions. This bodes well for more integrated treatment in the coming years. The strong psychiatric treatments that are now available and those on the horizon also auger well for an exciting period in our field. The excitement is enhanced by recognizing the multiple approaches to care that have been demonstrated to be effective and the need for great investment in research in this country and by developing new partnerships between the profession and public. [ABSTRACT FROM AUTHOR]

Objective: To identify important trends and themes that will affect psychiatric training and practice., Method: Selective literature review and reflections by the authors., Results: Three principal themes are elucidated relating to empiricism and integration, accountability and collaboration, and training and the public trust., Conclusions: There must be debate and action on these and other themes to maintain the relevance of psychiatry to its changing context.

A variety of sociocultural, familial and individual features associated with the eating disorders were examined in subjects with full syndrome (FS) and partial syndrome (PS) eating disorders and in normal high school students. The EAT-26 was administered to 995 high school students. This was followed by individual interviews with those who scored in the symptomatic range. Fifty-one students with PS eating disorders, 57 students without eating disorders (normal controls) and 30 hospital patients with FS, anorexia nervosa or bulimia nervosa were compared on subscales of the Eating Disorder Inventory, the Diagnostic Survey for Eating Disorders and the Beck Depression Inventory. The three groups displayed statistically significant differences on dimensions of EDI subscales Ineffectiveness and Interoceptive Awareness and also with respect to depression, history of being overweight and past history of emotional problems, as well as having mothers with medical illnesses. On these characteristics, the FS subjects displayed higher levels than the PS subjects, who in turn were higher than the NC subjects. The PS subjects displayed elevations on Body Dissatisfaction (EDI subscale), past medical illnesses, and mother's over-concern with eating and weight. These data support a continuum model of the eating disorders, but a continuum of multiple associated features rather than of dieting.

A survey among psychiatric residents about their satisfaction with and concerns about their training in psychopharmacology was conducted. One hundred and seventy responders (61%) from ten post-graduate psychiatric programs in Canada completed the questionnaire. The questionnaire assessed the residents' satisfaction with the training they had received over the previous six months as well as over their entire residency period. The questionnaire inquired specifically about the quantity and quality of supervision in the use of different medications for different therapeutic purposes. It also looked at the quality of supervision of drug therapies within hospital services, inpatient, outpatient, consultation and emergency services. Residents also were asked about coverage of specific topics and ranked different methods of learning. The survey uncovered a number of deficiencies mostly related to the teaching of basic psychopharmacology, integration of psychopharmacological and psychosocial issues and the lack of teaching of clinical appraisal of recent advances. Factors that may have contributed to the development of such deficiencies as well as specific recommendations are discussed.

The two following papers describe some of the benefits and problems involved in integrating clinical and investigative work. It is stressed that there are a number of advantages to such integration. Researchers especially benefit from the proximity to patients and clinicians. Education can be significantly enhanced when researchers and clinicians are in one setting and this can benefit residents, medical students and non-medical health personnel. There are a number of problems to such clinical research in psychiatry. These are discussed especially as they relate to senior faculty and their resistances to research. The shortage of clinician scientists in teaching positions means that most residents are not involved with such people as mentors early in their training and do not consider this as a career option after their residency training. Reductionistic thinking on the part of some researchers and when researchers are not first-rate clinicians both contribute to residents not becoming involved in clinical investigation. Funding policies as well as chairmen's hiring policies also play a role here.

The Clinical Investigation Unit has served as a natural focus for clinical research; as such it has a number of advantages and specific problems. On such units a variety of themes may occur. Some of these have the potential to interfere with the integration of clinical and research work. These include the theme that the research itself is therapy, or that research will find all the answers. Both may result in problems for the functioning of the ward. Most problematic of all is the theme that research is harmful and exploitative. Optimally, the unit develops an attitude that the research is compatible with excellent patient care. Problems of patients, staff, ethical issues, admissions policies and problems of the clinician-scientists are reviewed with recommendations on how to minimize difficulties.