Academic Psychiatry Department Names: Reflections on Research, Practice, and Education

Abstract

Objective

Medical schools’ departments reflect changes in health care and medical school organization. The authors reviewed psychiatry department name categories associated with school age, research, and primary care focus.

Methods

Department names were identified and categorized for US allopathic and osteopathic medical schools. A multinomial regression model analyzed the relationship between department name category and established year, adjusted for school type. Fisher’s exact tests analyzed the relationships between name category and research/primary care foci.

Results

Among 147 allopathic schools, 52% had departments with names limited to psychiatry, 42% had names with psychiatry plus other terminology, and 5% had no identified psychiatry department. In 34 osteopathic schools, 12% had psychiatry departments, 12% had departments named psychiatry plus other terminology, and 75% had no identified psychiatry department. Age of school was related to departmental name: for a 1-year increase in the school’s established year, the odds of having a department name other than psychiatry were 1.02 times the odds (p < 0.001) of having the name psychiatry. Newer schools were less likely to have departments with “psychiatry” in their name. Associations were found between department name and research and primary care rankings.

Conclusions

Variability in the names of psychiatry departments in medical schools may suggest changing views within and about academic psychiatry. The limited presence of formal psychiatry departments in newer schools raises questions about psychiatry’s impact on educational pathways, the future workforce, and participation in schools’ research mission and clinical enterprise.

Recent years have witnessed changes in naming conventions of departments in US medical schools, including for psychiatry. Many factors likely influence such trends. Changes can emphasize basic sciences in which specialties are rooted or acknowledge disciplines contributing to specialties or departmental missions. Examples include orthopedic surgery combining with rehabilitation medicine (e.g., Yale University) and ophthalmology integrating visual sciences (e.g., Vanderbilt University). Others invoke superordinate names (e.g., clinical sciences, basic sciences) or merge multiple surgical departments, reducing the total number of departments in a medical school. Florida State University has only five departments; Florida Atlantic University has only three.

Academic psychiatry similarly has been transforming. Various factors affect how psychiatry is represented and organized within medical schools. It is unclear whether traditional names reaffirm what they have previously represented (e.g., historical psychiatric values and cultures) or if new names reveal alternative clinical and research directions. It is not known how strongly specific factors may drive the naming process for departments. Historical trends and a constellation of forces (e.g., team science, collaborative care, economics) likely contribute to departments’ names, organization, and status.

Developments in psychiatry can be considered within broader changes throughout academic medicine. In 2006, the Association of American Medical Colleges (AAMC) called for a 30% increase in medical school enrollment over 10 years to address projected shortfalls of physicians to care for an increasing, diversifying population [1]. In 2002, there were 16,488 new matriculants to allopathic schools. The AAMC sought to expand medical education to 21,434 first year matriculants in 2015—a goal 98% achieved [2].

Shipman et al. [3] compared matriculants and graduates before the expansion (1999–2001) and 10 years later (2009–2011). Among the 124 schools existing prior to the expansion, growth patterns varied. Eleven new schools enrolled students by 2009–2011 with others developing. Existing and new schools increased enrollment 16.6%. Osteopathic medical schools contributed a significant amount to these expansions; the proportional growth of the osteopathic physician workforce was greater than that of the allopathic physician workforce [4]. This evolution has increased the physician workforce but the inclusion of psychiatry within this expansion is unclear.

We hypothesized that the age of a medical school (i.e., reflected by the year it was established) will have an effect on the name categorization of psychiatric departments and, further, that departments with expanded names beyond “psychiatry” will be more common than exclusively named “psychiatry” departments over time. Given increased attention to behavioral matters [5], we anticipated that “psychiatry and behavioral science” would be an increasingly common expanded name. Additionally, we hypothesized that schools’ research and primary care rankings would be associated with department name categorization.

Methods

The AAMC and American Association of Colleges of Osteopathic Medicine websites [6, 7] were reviewed to identify US accredited allopathic and osteopathic schools to create a comprehensive list. The list included 181 schools (147 allopathic, 34 osteopathic, data available upon request). We compiled department names from schools’ websites.

Three categories were created by reviewing the total list of names: psychiatry only, psychiatry plus, and other. “Psychiatry only” represented those singularly named “department of psychiatry.” Departments whose name included “psychiatry” along with other terms were labeled “psychiatry plus.” We were also interested in trends in the decision to forego naming psychiatric departments in light of some schools creating departments with superordinate names (e.g., clinical sciences) and correspondingly broad purviews. Such schools were grouped together as “other.” For some schools, psychiatry was not located on the website (for which the dataset listed “none”). For others, psychiatry was incorporated into departments or divisions of “clinical medicine/sciences/specialties,” “integrated medical sciences,” or “medical specialties.” These schools were treated as one category because psychiatry was not uniquely identified. Many of these schools had other departments that were independently named (e.g., pediatrics).

To understand potential factors associated with department names, we considered US News and World Report (USNWR) rankings because the public and medical community take interest in rankings and schools commonly aspire to higher rankings. Rankings are assigned based on rigorous methodology weighing diverse factors: quality assessment, research activity, total funding from the National Institutes of Health, primary care rate, and student selectivity among others [8]. Full accreditation is required to rank schools. Schools were included in the list but unranked if accreditation status was provisional, preliminary, or pre-accreditation. Schools would be categorized as unranked if providing insufficient data to calculate rankings. Research ranking was examined given medical schools’ importance to society in creating and disseminating new knowledge. Primary care ranking was investigated given the critical national need to reduce shortages of primary care physicians. Additionally, the primary care workforce serves an important role in addressing mental health needs [9, 10], which in turn necessitates strong psychiatric training.

Based on USNWR rankings of allopathic medical schools’ research funding in 2020 [11], a new variable was created to split the ranking roughly into three categories. The top 92 schools were ranked individually (including ties) and labeled “high research ranking.” The “mid research ranking” group included those ranked 93–120. The remaining 61 schools were unranked and were labeled “low/unranked research.” A similar variable was created for primary care ranking [12]. When ties occurred at a boundary of two categories, all schools with that ranking were included in the same rank category. Our institutional review board determined that this project did not meet the regulatory definition of human subjects’ research.

Department name categories (psychiatry only, psychiatry plus, other) were summarized with count (percentage) overall and by school type (i.e., allopathic vs. osteopathic). A multinomial logistic regression model was constructed with department name category as the outcome (reference group: psychiatry only), with department-established year as the predictor of interest, adjusted for school type. Fisher’s exact tests determined if there was an association between department name category and the research and primary care ranking categories. All p values are two-sided and evaluated at the 0.05 significance level. Analyses were conducted in R, version 3.6.1.

Results

Of 147 allopathic schools, 77 (52%) had “psychiatry only” departments (Table 1). Sixty-two “psychiatry plus” (42%) departments included heterogeneous terminology along with psychiatry. Eight (5%) were in the “other” category. Of 34 osteopathic schools, 4 had departments titled “psychiatry only” (12%). Four schools (12%) had “psychiatry plus” expansions, while the remaining 26 (76%) were in the “other” category.

Table 1.

Names of departments of psychiatry

Name	Count for allopathic schools	Count for osteopathic schools
Behavioral Medicine and Psychiatry	1	-
Neuropsychiatry and Behavioral Science	1	-
Psychiatric Medicine	-	1
Psychiatry	77 (52%)	4
Psychiatry and Behavioral Health	3	1
Psychiatry and Behavioral Medicine	5	-
Psychiatry and Behavioral Neurobiology	1	-
Psychiatry and Behavioral Neuroscience(s)	7	-
Psychiatry and Behavioral Science(s)	35 (24%)	1
Psychiatry and Biobehavioral Sciences	2	-
Psychiatry and Health Behavior	1	-
Psychiatry and Human Behavior	4	-
Psychiatry and Neurobehavioral Sciences	1	1
Psychiatry and Psychology	1	-
Integrated Within Broader Department/Division	5	12
None	3	14
Total	147	34

With a 1-year increase in established year, odds of being named “other” were 1.02 (95% CI (1.02, 1.02), p < 0.001) times the odds of being named “psychiatry only,” holding school type constant (Table 2). We found no statistically significant effect of the established year in being named “psychiatry only” compared with “psychiatry plus.” The odds of being named “other” were 37.77 (95% CI (37.06, 38.49), p < 0.001) times the odds of being named “psychiatry only” for osteopathic schools compared with allopathic schools, holding established year constant. Table 2 presents results regarding distribution of research and primary care rankings based upon name categories. Fisher’s exact test results for both variables were statistically significant (p < 0.001).

Table 2.

Psychiatry department characteristics by name category

	Department name category
	Psychiatry only	Psychiatry plus	Other
Overall, N (%)	81 (44.8)	66 (36.5)	34 (18.8)
Established year
Mean (SD)	1920.4 (67.4)	1920.2 (57.3)	1989.8 (35.6)
Median [range]	1943 [1765, 2018]	1913 [1819, 2014]	2007 [1892, 2017]
School type, N (%)
Allopathic	77 (95.1)	62 (93.9)	8 (23.5)
Osteopathic	4 (4.9)	4 (6.1)	26 (76.5)
Research funding rank category, N (%)
High ranking	35 (43.2)	29 (43.9)	0 (0.0)
Mid ranking	24 (29.6)	18 (27.3)	14 (41.2)
Low/unranked	22 (27.2)	19 (28.8)	20 (58.8)
Primary care rank category, N (%)
High ranking	35 (43.2)	26 (39.4)	0 (0.0)
Mid ranking	24 (29.6)	21 (31.8)	14 (41.2)
Low/unranked	22 (27.2)	19 (28.8)	20 (58.8)

Research and primary care categories (high, mid, and low/unranked) were created by splitting the rankings of each into three groups with roughly the same number of schools, as described in the “Methods” section

Discussion

While there is good news that there has been an expansion in the number of medical schools and trainees, the news may be less positive for psychiatry—there are relatively fewer new named departments of psychiatry. Clear support of our primary hypothesis, that established year and department name are associated, was not found in this analysis. While the pattern for the “other” category differed from “psychiatry only,” we did not see evidence of a difference between “psychiatry only” and “psychiatry plus.” The observed longitudinal trend was due principally to newer schools not creating distinct psychiatry departments. We do not know if those with “psychiatry plus” names were originally titled psychiatry and added complementary language or whether their present elaborated names were their original names when the departments were created.

Our second hypothesis, that inclusion of “behavioral science(s)” would be the most common expanded departmental name, was supported. While “behavioral science(s)” was the most common terminology, it was interesting to examine the terms expanding upon psychiatry. The name heterogeneity reflects complex issues involved in psychiatric and behavioral sciences and contributes to reflections on possible changes underway in research, practice, and education.

Our hypothesis regarding name categorization and research and primary care rankings was supported. As with our first hypothesis, this largely reflected different rankings for the newer schools without formally named psychiatric departments. The “other” category of schools was not in the top category for research or primary care and was overwhelmingly represented in the lowest category. Based on reviewing Table 2, the “psychiatry only” and “psychiatry plus” categories had similar profiles; their greatest representation was in the top category, with smaller percentages in the mid and bottom categories.

Our original intention had been to investigate departments that had expanded their name from “psychiatry only” to “psychiatry plus.” The question had been whether the conceptualization of psychiatry has broadened over time and whether a department’s name might reflect this shift. However, longitudinal data from the AAMC was inexact because department names had not been consistently collated prior to 2002. We created an alternative strategy to investigate the relationship between longevity of a department and its name because we could not confidently identify which departments had changed their names. The profiles were relatively similar for “psychiatry only” and “psychiatry plus” schools. It is possible the departments with expanded names are not fundamentally different from the more narrowly named ones; alternatively, it is possible our methodology failed to capture relevant differences.

Names communicate numerous notions [13]. Department names may relate to research trends in psychiatry. The NIH supports team science by funding multisite, interdisciplinary clinical research projects wherein investigators’ skills are considered more consequential to fulfilling objectives than are the disciplines in which they trained. Inclusive department names may position psychiatry to have broader reach or greater success when competing for big science initiatives and seeking to exert leadership in team science. By contrast, it seems challenging to imagine how a school without a psychiatry department would be actively engaged in creation and dissemination of new psychiatric knowledge.

Clinical practice may be captured by department names. Hospitals, insurance companies, and the Centers for Medicare and Medicaid Services have adopted the term behavioral health to encompass psychiatry, psychology, and other professions, reflecting interdisciplinary realities. Non-medical and non-doctoral mental health professions (e.g., professional counselors) are increasingly referred to with superordinate behavioral health terminology. These changes could obscure recognition of psychiatry and blur existing distinctions among professional groups.

A department’s name could be relevant to learners and their educational decisions. Medical school applicants may be encouraged to consider which schools align most closely with their career ambitions when they are foreseen. Future psychiatrists may find it advantageous to attend schools that identify psychiatry departments rather than schools that lack named academic psychiatry departments. Schools specifying psychiatric emphasis through named departments may offer richer learning and research opportunities, enhanced faculty expertise, and more extensive mentoring. These considerations are particularly critical considering the national shortages of psychiatrists specializing in child/adolescent [14], geriatrics [15], and from communities traditionally underrepresented in medicine [16].

Our review of department names was based on medical schools’ websites, which presumes names were correctly posted. This presumption might be flawed: inconsistencies could exist between departments’ official names and their websites’ terminology. Given variability among schools in terms of relationships with teaching hospitals, and their highly complex environments, there could be mischaracterizations (i.e., inconsistencies between teaching hospitals and medical schools). The study is limited to the present era: different patterns could emerge over time. Ideally data would have been available to identify which schools have changed their name and when they did so. Those interested in developing a deeper understanding could contact schools to gather this information. It is possible that newer schools do not have a department yet due to logistics, suggesting that trends in naming decisions could be tracked. Alternatively, it is possible that psychiatry might not be incorporated into a department name. The USNWR ranking methodology presents another limitation: only the top 92 schools were individually ranked, and remaining schools were less distinctly categorized.

We propose avenues for future research based upon these findings. Many schools have joined larger health systems in the creation of service lines. Academic departments’ involvement in service lines might relate to broader names. Faculty composition (e.g., percent of psychologists) might impact naming prerogatives. This project combined allopathic and osteopathic schools as both addressed the AAMC’s call to reduce the shortage of physicians. Nonetheless, naming patterns differed between the two types of schools. Further investigation might identify consequences of such differences. For example, allopathic schools tend to provide a richer research environment than osteopathic ones [4]. Finally, it would be interesting to investigate trends in psychiatry relative to other specialties to understand how broad such changes might be.

The National Academies of Sciences estimated that roughly 50% of mortality is linked to behavior/social factors and stress in patients’ and providers’ lives [17] and noted, “the importance of an institutional commitment to behavioral and social science instruction cannot be overemphasized” (p. x). Nonetheless, as the number of schools and physicians increases, the creation of designated psychiatry departments has been less robust. Given the importance of psychiatric and behavioral factors in health care, academic institutions’ commitment to educating physicians about these phenomena is demonstrated by sponsoring named psychiatry departments and incorporating closely related disciplines. Psychiatry must remain a key part of medical education and promote its name recognition as a discipline. Weakening of this proposition is a disservice to patients and their families as well as to the specialty. A name is more than a name.