Pathways to a Career in Military Psychiatry.

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Psychiatric healthcare has been an essential aspect of the military medical mission over the past century. From very limited psychiatric services available during World War I to the development of multiple psychiatric graduate medical education training programs within the military healthcare system after World War II, psychiatry within the military has markedly evolved. With the onset of Operation Enduring Freedom in 2001 and Operation Iraqi Freedom in 2003, the USA embarked on the longest continuous conflict in its history, producing thousands of personnel suffering from combat-related psychiatric disorders and placing additional psychological stress on their spouses and children requiring the services of skilled psychiatric physicians both wearing the military uniform and serving as civilian healthcare providers in a military treatment facility. This paper will present an overview of the history of military psychiatric graduate medical education, current avenues of access to serve as a military psychiatrist either in uniform or as a civilian, and the opportunities and experiences one may expect working in the military healthcare system. Psychiatry GraduateMedical Education training has significantly evolved from the first known four Department of Defense psychiatric residents (two Army and two Navy) in 1909 who trained for 2 years at Saint Elizabeth Hospital in Washington, DC. However, very few psychiatrists were sponsored for training over the next several decades despite the evident need for psychiatric services in World War I when the total number of psychiatrists in the Army increased from 50 at the beginning of the war to nearly 700 when the Armistice was signed in 1918 [1]. Attrition from themilitary psychiatry ranks post-World War I significantly reduced the inventory to less than 100 in 1940, necessitating another quick infusion of psychiatric physicians into the Armed Forces to include the establishment of a standardized 12-week neuropsychiatry course for non-psychiatric clinicians which produced 1300 graduates to augment the pool of neuropsychiatric services available for service members [2, 3]. In 1946, Congress passed the National Mental Health Act which provided funds for a number of mental health initiatives including the training of mental health professionals, and over the course of the next decade, eight military psychiatry residency programs opened and received certification from the Accreditation Council for Graduate Medical Education [4]. Since the 1950s, there has been significant change in the total number and location of military psychiatry training programs to include a significant restructuring during the 1990s in unison with the large drawdown of troops after Operation Desert Storm. Six Military Psychiatry Graduate Medical Education training programs are currently in operation. The demand for behavioral health services post-9/11 for both service members and their families greatly increased in the setting of continuous combat operations and quickly exceeded existing resources. This increase in clinical demand necessitated increasing the numbers of psychiatrists within military treatment facilities and thus expanded opportunities for entry intomilitary psychiatry besides the traditional path of completing a military graduate medical education training program. A career in military psychiatry can now be achieved through several different pathways as discussed below.