Attracting Child Psychiatrists to a Televideo Consultation Service: The TeleLink Experience

Abstract

Objective. Identify aspects of psychiatry work that are rewarding, as well as those that are challenging, from the perspective of psychiatrists and residents participating in televideo consultation services. Method. A web-based survey was distributed to psychiatrists within the Division of Child Psychiatry at the University of Toronto. Also, semistructured interviews were conducted with six child psychiatrists providing services to a telepsychiatry program. Finally, a focus group interview was held with four psychiatry residents. Results. Child psychiatrists are very comfortable conducting assessments via televideo. Factors identified as being important in the decision to participate in telepsychiatry include assisting underserved communities, supportive administrative staff, enhanced rural provider capacity, financial incentives, and convenience. The study's qualitative phase identified four themes in the decision to participate in telepsychiatry: (1) organizational, (2) shared values, (3) innovation, and (4) the consultation model. Conclusion. The success of televideo consultation programs in attracting child psychiatrists to provide consultation services to underresourced communities makes an important contribution to psychiatric workforce shortages. Understanding what aspects of telepsychiatry are most appreciated by consulting psychiatrists and residents offers useful strategies to telepsychiatry administrators and medical school educators seeking to attract, train, and retain psychiatry practitioners.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…20,38,46 Like patients, clinicians also report improved attitudes toward telepsychiatry after trying it, suggesting that increased exposure for clinicians may be important to alleviate their concerns about rapport. 35,[47][48][49][50] Where organization level barriers have been eliminated, the most frequent barrier…”

“…79 Collaborating with local clinicians provides knowledge of local resources and culture, 9,78 provides connection to the community, 33,34,77 and may mitigate feelings of loss of control that local clinicians may feel from remote expert consultations. 20,50,[80][81][82] Connection with local clinicians also enhances feedback on the effectiveness of recommendations (the lack of which has been of concern to remote telepsychiatrists). 50 In addition, the investment of community stakeholders and the support of telepsychiatry champions have been cited as key to telepsychiatry program success and sustainability.…”

“…20,50,[80][81][82] Connection with local clinicians also enhances feedback on the effectiveness of recommendations (the lack of which has been of concern to remote telepsychiatrists). 50 In addition, the investment of community stakeholders and the support of telepsychiatry champions have been cited as key to telepsychiatry program success and sustainability. 48 PATIENT PRIVACY, SECURITY, BOUNDARIES, AND SAFETY Clinicians and patients have concerns about protecting patient privacy when using telepsychiatry.…”

“…59 Those who received training were likely to use telepsychiatry more often, 38 and clinicians reported increased positive attitudes toward telemedicine after using it, 35 suggesting that education and training in telepsychiatry is an important strategy to increase use. [47][48][49][50] A leading expert has even recommended that training become a mandated requirement for telepsychiatry clinicians. 47 Telehealth competencies have been developed in recent years, which align targeted clinical outcomes with teaching and supervisory methods, evaluation, and feedback.…”

“…47 Growing numbers of psychiatrists are signing for telepsychiatry positions. 17 Although little has yet to be published about their reasons for doing so, citied factors include desire to bring care to support resource scarce areas, 50 flexibility/ control over schedules, ability to diversify practice, desire to work part-time, and the opportunity to work from home. 17,47 As a growing number of clinicians accept telepsychiatry practice, there will be new challenges to adapt to, including risk of social and professional isolation, difficulty separating work from home, and possibly a more sedentary lifestyle.…”