"I always viewed this as the real psychiatry": provider perspectives on community psychiatry as a career of first choice.

The US needs engaged and skilled psychiatrists to support the recovery of people with severe mental illnesses and we are currently facing a shortage. This paper examines what attracts providers to community psychiatry and what sustains them in their work. Focus groups and interviews were used to elicit the perspectives of prescribing clinicians in three community mental health clinics in the US. Community psychiatry has inherent challenges, including facing high-risk decisions, encountering intense affects, and occasionally witnessing bad outcomes. Psychiatrists are motivated and sustained in this work by (1) cultivating relationships with patients and colleagues, (2) focusing on the mission of promoting recovery, and (3) engaging with clinical practice as intellectually stimulating work. Administrators support the engagement and morale of psychiatrists by creating workflows that allow psychiatrists to meaningfully apply their expertise to support patients' recovery. These findings hold implications for recruiting and retaining a new generation of physicians.