Shortage of psychiatrists strains Ottawa resources
Report finds both communities and hospitals affected as situation worsens
The wide and worsening shortage of psychiatrists in Ontario is affecting the Ottawa area, and the city needs around 25 more psychiatrists to make up the difference, says the president of the Ontario Psychiatric Association.
Dr. Mathieu Dufour, associate chief at The Royal, is one of the co-chairs with the Coalition of Ontario Psychiatrists, who released a report last week that said Ontario is facing a shortage of psychiatrists that is expected to worsen by 2030.
The report, plainly titled “Ontario needs psychiatrists,” found that Ontario has a shortage of about 200 psychiatrists. By 2030, that number is forecast to rise to 350.
That provincial shortage exists on a local level as well, said Dufour. “Just recently, we know that there’s between 20 and 25 psychiatrists missing in the whole region,” he said. That shortage is similar in scale to what other urban centres in the province are facing, but since Ottawa encompasses so many rural areas, other challenges arepresent.
“There might be a bigger shortage of psychiatrists in rural areas,” Dufour said. “That’s for sure. There’s more difficulty accessing psychiatric care in the region of Ottawa if you’re outside of Ottawa.”
The shortage in Ottawa and across the province touches different areas of psychiatry, but the report points out that there is an “acute shortage” of communitybased psychiatrists, which in turn adds to the workload of psychiatrists who work in hospitals and emergency departments.
“We certainly need more community-based psychiatrists in the region of Ottawa,” Dufour said. It is not, however, the case that we need community-based psychiatrists exclusively. “But we also need, I would say most hospitals — acute care hospitals and The Royal — we also suffer from that shortage.”
The report also singles out child and youth psychiatric services as an area in which this pinch in psychiatrists is particularly worrisome. The report found that Canada needs about 1,500 child and youth psychiatrists but that there are only about 500 active; in Ontario, there are fewer than 100 child psychiatrists, mostly in urban areas, leaving parts of the province “entirely unserved.”
Joanne Lowe, executive director of Ottawa’s Youth Services Bureau (YSB), sits at the intersection of those two concerns. She sees day in and day out how that shortage impacts young people. “We certainly see that for young people, the whole lack of mental health services in general plays itself out through the absence of child and youth psychiatrists, for sure,” Lowe said. “If there is a need for a psychiatrist, that’s when it becomes more challenging when you’re trying to find someone.”
A psychiatrist shortage is a problem that will continue to grow as psychiatrists age out of the system with little in the way of young replacements. Fifty-six per cent of the psychiatrists in Ontario are above the age of 55, the report notes; only 4.3 per cent of psychiatrists surveyed were below the age of 35. The report does not mince words on this point, saying that “the efforts made to recruit students to psychiatry are abysmal.”
Part of the problem, notes the report, is that every year psychia- try residencies — the specialized training positions in medical school that qualify one to practise psychiatry and other specialties — go unfilled despite excess demand for them. In 2018, for instance, 190 medical students ranked psychiatry as their preferred discipline, but of 184 residencies available, only 175 were filled.
“We need to ensure all psychiatry residency spots are filled,” reads the report. “The need for psychiatric services is too great, and the effects of psychiatric shortage are too severe, to fail here year after year.”
Though the report points out that in 2017 that the University of Ottawa left two residencies unfilled, Véronique Vallée, a spokeswoman for the university, confirmed that all residency spots were filled for the past five years.
Dufour said that making sure the local medical school fills all its vacancies is a start toward attracting more psychiatrists to Ottawa in the first place. “We try to retain them as much as we could,” he said. “We’ve also been trying to recruit out of the province, out of the country as well, to get some good candidates to provide mental health services.”
The supply of psychiatrists and the number being trained annually give shape to the resource management challenges that front-line services face. Lowe said she was hesitant to put a number on the shortage of psychiatrists that her organization, and the field of child and youth psychiatry in Ottawa sees; she jokes that if she could, she would hire 100 new staff and start there.
“I mean, let’s be really clear. Do we need more child and youth psychiatrists? Absolutely,” she said. “It’s an imperfect system. I’ll be the first person to say that.”
Efforts to increase the number of psychiatrists working in the province by incentivizing psychiatry in medical school have a built-in lag time for training, which means that in the short-term the field will continue to feel the pinch in Ottawa.
“As psychiatrists we have seen the increased demands,” Dufour says. “Psychiatrists have responded by actually increasing their hours and the number of patients they see. Over 10 years, psychiatrists have increased by 20 per cent (in terms of ) their hours and the number of patients they see.”
Lowe admits that more funding would be nice, but in the interim they will continue to work with partners to try to marshal what resources they do have to the right places. “The gap’s not just in the what we have, but how we use our existing resources,” she said, and then jokes: “If you could write me a blank cheque I’d be good with that.”
If you are experiencing a mental health crisis, you can call the 24/7 Mental Health Crisis Line at 613722-6914. If you’re a young person experiencing difficulties, you can call the Youth Services Bureau at 613-260-2360 or talk to someone online, between 4 p.m. and 10 p.m., at www.chat.ysb.ca.
The need for psychiatric services is too great, and the effects of psychiatric shortage are too severe, to fail here year after year.