In his third year of pediatric residency, Ryan Murphy, MD, found himself referring child after child to psychiatrists who had no openings. Waitlists stretched for months.
“Feeling the frustration of wanting to help but not having the expertise really reinforced that this was the path I wanted to follow,” he says.
That path led him to the University of Tennessee Health Sciences’ Post-Pediatric Portal Program, one of only five such programs in the country. Under program director Allison Ford, MD, Dr. Murphy is completing a fellowship that will make him board-eligible as both a general adult psychiatrist and a child and adolescent psychiatrist, a dual capability rare anywhere and urgently needed in Tennessee and elsewhere.
A Fellowship Crafted for the Shortage
The numbers are bleak, Dr. Ford states. According to the American Academy of Child and Adolescent Psychiatry’s latest data, Tennessee has only 131 child and adolescent psychiatrists serving 1.5 million children under 18, and 82% of Tennessee counties have none at all.
“We aren’t catching up,” Dr. Ford says. “In 10 years, only 27% of the need will be addressed, even in an optimistic scenario. You have to make a dent somewhere.”
The portal fellowship is designed specifically for pediatricians who have completed residency and want to specialize in psychiatry. Fellows spend 18 months in general psychiatry and 18 months in child and adolescent psychiatry, earning two board certifications with a clinical background in primary care.
Alicia Barnes, DO, MPH, chief of Pediatric Psychiatry at Le Bonheur Children’s Hospital, director of the Division of Child and Adolescent Psychiatry at UT Health Sciences, and the Urban Child Institute Endowed Chair of Excellence in Child and Adolescent Psychiatry, sees the portal as one of the most targeted responses available for that shortage.
“Pediatricians know from their experience what the need is for children’s mental health,” she says. “That leads them to pursue this extra training.”
What Sets Memphis Apart
The university’s program trains fellows alongside four peer institutions nationally, yet what often separates UT Health Sciences is depth of community integration, Dr. Ford says. Fellows rotate through Le Bonheur, St. Jude Children’s Research Hospital and community psychiatry sites, gaining real-world exposure that purely academic programs don’t offer.
Community-rooted training appears to aid where graduates land, Dr. Ford adds. Data from portal programs nationally shows most graduates go on to practice community psychiatry, serving patients on Medicaid and state-funded insurance in underserved areas. UT Health Sciences’ program has graduated two fellows with a 100% board pass rate, and Dr. Murphy plans to stay in Tennessee, hoping to grow a practice where he provides care for patients as both pediatrician and child psychiatrist.
“I can already see ways I hope to integrate both roles into a more comprehensive care home for patients and families,” he says.
Sustaining the Investment
That kind of outcome is key to state and local stakeholders, leaders and teams, including Dr. Barnes, who has made overall workforce development a centerpiece of her leadership. “My goal is to find ways to sustain this workforce in our community,” she says. “Because if we don’t have the ability to care for their children, we’re not able to recruit the best.”
The program launched with seed funding tied to the 2021 national declaration of a child mental health state of emergency, including support from Le Bonheur, the Tennessee Child and Adolescent Psychiatry Education and Support initiative, and other partners. Today, Dr. Ford and her colleagues piece together support from Le Bonheur, St. Jude, Youth Villages and others, while continuing to build a broader base of sustained community investment for program expansion.
Two other programs nationally have already closed, Dr. Ford says, not for lack of applicants but for lack of funding. UT Health Sciences’ program has never struggled to fill its spots. The challenge is keeping it running.
“We’ve shown proof of concept,” Dr. Ford emphasizes. “We have graduates, a 100% board pass rate and fellows who want to stay in Tennessee. The issue is continuing to engage our stakeholders when budgets are tenuous.”
Yet the way forward is straightforward. “We grasp for zebras,” she says, borrowing a phrase physicians use when they reach for complex solutions while simpler ones are right in front of them. Tennessee needs more child psychiatrists, and the portal fellowship is one of the most direct ways to train them for its communities.