Psychiatrists Shun Country for Urban Opportunities

Article excerpt

MARY TOOK HER son to a psychiatrist 25 years ago, when this town had just one, a doctor so busy he had only minutes to spare.

Now, Mary's son is in a state mental institution, and he may never leave. She still agonizes over the possibility that he might have received better treatment and maintained his independence if she'd had a choice of doctors.

"If I had insurance or if I lived some place else, things might be different," Mary said recently, asking that her real name not be used. "But you're stuck with what the community has got."

Mary's son, now 42, is schizophrenic and manic depressive. When he was 16 and beginning to have problems, Mary faced the same painful scarcity of psychiatrists that many rural Americans still face.

More than nine of every 10 U.S. psychiatrists live in metropolitan areas, the federal government estimated in 1986. Most medical schools are in big cities. They tend to attract urban students, who become urban doctors.

"If someone is used to large X-ray machines and magnetic resonance scanners, they might find it hard to adjust to a place where a black bag, a stethoscope and some pills are all you've got," said James Ciarlo, a psychology professor at the University of Denver who is studying the problem.

In Illinois, which has 1,118 psychiatrists, only 27 practice south of Interstate 70, which separates the bottom fourth of the state from the top three-fourths, the Illinois Psychiatric Society says. Nine of the 27 practice at the state's Choate Mental Health Center in Anna, where Mary's son is a patient.

That's about one psychiatrist for every 32,322 people in Southern Illinois. The ratio in Cook County, including Chicago, is one per 6,844 people.

Until about a year ago, Carbondale only had one psychiatrist for its 20,000 people, a population that doubles when Southern Illinois University is in session.

Today, the city has four psychiatrists, including one who divides his time among a private practice, two Carbondale clinics, a clinic in Mount Vernon and another in Du Quoin. …