Abstract
We read with great interest the article by MacKinnon et al. entitled “Defining, Locating, and Characterizing Psychiatrists who Primarily Treat Children and Adolescents and their Practices in Ontario: A Cross-Sectional Study.” 1 The study addresses an important and timely workforce issue in child and adolescent mental health care and offers a novel data-driven approach to identifying psychiatrists who primarily treat younger patients. However, we believe two methodological issues deserve further consideration.
Firstly, although the study's data-driven approach is innovative, the operational definition of a “child-focused psychiatrist” remains insufficiently validated. The ≥50% pediatric-encounter threshold may be useful for classification, but the authors do not demonstrate criterion validity against an external standard such as clinician self-identification, direct chart review, or independent subspecialty practice confirmation. Sensitivity analyses at 30%, 50%, and 70% assess robustness, but they do not establish that the selected cutoff accurately captures true child-and-adolescent psychiatric practice. Because the study's workforce estimates and policy inferences depend heavily on this threshold, some misclassification is likely, especially for psychiatrists with mixed caseloads or consultation-heavy practices. A validation step would have strengthened confidence in the reported supply estimates and regional comparisons.2,3
A further limitation is the study's reliance on encounter counts as a proxy for clinical practice composition. Encounter volume does not necessarily reflect clinical intensity, case complexity, consultation role, or indirect care work. Physicians may manage fewer but substantially more complex pediatric cases, or provide consultation-heavy care that is poorly represented by simple visit counts. Prior work has shown that workload assessment should account for both face-to-face and non-face-to-face care, because visit counts alone may underrepresent total clinician burden. Accordingly, the encounter-based approach used here may not fully capture the true scope of practice and could introduce measurement bias into the classification of psychiatrists. 4
In conclusion, while this study provides important insights into the child and adolescent psychiatry workforce in Ontario, further validation of the proposed child-focused psychiatrist definition and consideration of clinical workload beyond encounter counts would further enhance the robustness of its findings and policy implications.
Footnotes
Authors’ Contributions
Conceptualization: Noor Un Nisa; writing—original draft preparation: Noor Un Nisa and Syeda Ukasha Mati; writing—review and editing: Noor Un Nisa and Syeda Ukasha Mati; all authors have reviewed the final version of the manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Declaration of Generative AI in Scientific Writing
The authors report no AI usage to facilitate this manuscript, however, we used Grammarly for the language clarity and flow of the manuscript and ChatGPT to recheck the suitability of the references. The authors take responsibility for this usage in the manuscript.
