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Psychiatry and medicine in the US: interpreting trends in medical specialty choice.

An integrated model of change in knowledge, highlighting the role of technologic and organizational paradigms and the activities of professional and extra-professional groups, is used to clarify the historical development of psychiatry and to account for current specialty choice trends. American psychiatry and medicine stem from disparate scientific/philosophical roots. A review of events leading to the establishment of psychiatry as a medical specialty indicates that the merger of psychiatry and neurology may have stemmed as much from professional competition as from technological or paradigmatic convergence. Recent perceived declines in the choice of psychiatry as a medical specialty are examined in light of this sociology of knowledge perspective. Declining choice of psychiatry as a specialty reflects both underlying paradigmatic conflicts with medicine as well as declining federal support for psychiatric training. Solutions proposed for the perceived problem within psychiatry are designed to solidify ties with medicine, increase political power and prestige, and retain federal support.