I can't speak for other specialties with any real knowledge, but in the case of child psychiatry there are several obstacles to increasing the numbers. First there is the basic length of training - it is a 5-6 training period after medical school; equivalent to a general surgery training (after which you get paid a child psychiatry salary, not a general surgeons...). Secondly there are stigma issues. When a medical student announces an intention to enter psychiatry, there are often a chorus of "real doctors" saying "Why do you want to waste your training with psychiatry?" Then to decide to enter child psychiatry specifically means spending an extra year or two in training, plus having the temprament to work in child psych, which is very rewarding (at least in my point of view), but also very challenging. As one of my friends pointed out, at least in geriatric psychiatry, the families are glad to have you help, even if you can't change the outcome.

There are also concerns about training programs having enough people to do research and training of residents (since working in academic medicine means taking another financial hit). Finally, given the degree to which child psychiatry is in shortage, we will likely never meet the projected demand, especially when there are constant pressures to choose something else.

Ultimately, what I intended to convey is that there are so many factors working against increasing the supply of child psychiatrists that I don't think we will see the numbers needed to relieve the issue of having a shortage, not that having more docs would not solve the problem. I appreciate your observation that most people are not motivated by simple financial gains. I think this is generally true, although I admit I know some people that seem to be all about the dollar.

In response to deduction's comments, I think the issue of how a practice is run does make a big difference. Most larger clinics have a variety of business people making decisions about how to keep the coffers flowing, without regard to clinical utility. This is part of the problem, in my opinion, with the inefficient system of insurance companies each having their own set of rules and reimbursements. I'd be all for having a private practice again if I knew that the kids and the community were still getting served somehow. We need about 4 more child psychiatrists here to reach that goal. Do you know anybody willing to relocate?

In response to billstein's experience, the clinic I work at was having a terrible problem with no-shows (upwards of 30%) and wanted to double book. I stood firm on this one, since the appointments were already jammed too close together to do my best work, and instead I got them to invest the time to call people the day before their appointments. This has improved the no-show rate significantly. I think any practice that has a big no-show rate needs to first look at why patients are not showing up and try to address this. Otherwise the problem perpetuates itself in the form of patients feeling that the scheduled time is more of a suggestion than an appointment, so they don't show up, so the no-show rate stays high. I was in a good position since (a) I was the only child psychiatrist left on staff, and (b) I had "real world" experience in getting patients to show up, since in private practice, no-show means no pay, which means no practice. My private practice had a no-show rate of under 10%, usually due to weather or other unavoidable issues.