There's a Serious and Growing Psychiatrist Shortage in the U.S.

Public health research continues to connect mental health with other comorbidities, signifying a need to better understand mental and behavioral health.

One in five adults are likely to experience a mental health disorder during their lifetime, and the widespread presence of these disorders is even greater in populations with chronic conditions such as diabetes, asthma, or cardiovascular disease (2). 

Additionally, continual efforts are being made to de-stigmatize mental health which encourages more of the population to seek help for their mental health conditions. In light of these continual mental health needs, the question narrows down to -- is the US still facing a shortage of psychiatrists?

The top 20 most requested health professionals in 2015, according to a survey conducted by Merritt Hawkins, a leading physician search and consulting firm

The top 20 most requested health professionals in 2015, according to a survey conducted by Merritt Hawkins, a leading physician search and consulting firm

According to a study conducted by the Association of American Medical Colleges- 59 percent of psychiatrist are 55 or older, implicating that more that half of the psychiatrist population may soon be retiring or decreasing their working hours (1).

Aside from an aging psychiatrist population - statistics help us tell us a deeper story. According to the American Medical Association, the number of adult and child psychiatrists rose by only 12 percent from 1994 to 2013, from 43,640 to 49,079. During that span, the U.S. population increased by about 37 percent; meanwhile, millions more Americans have become eligible for mental health coverage under the Affordable Care Act (1). So, although the number of licensed psychiatrists is steadily increasing - the sheer volume of mental health need is surpassing the status quo.  

The shortage of psychiatrists can be answered two-fold: 

1. Pay & Paperwork

Among the medical student population, there is a perception that choosing psychiatry as a specialty means inadequate pay. Although federal data shows comparable annual wages of $182,700 for psychiatrists - the burden of student loans and a slow economy may sway medical students to choose a different specialty (1).

Similarly, reimbursement from government and private insurance, in addition to the burden of paperwork requirements imposed by Medicaid and some private insurance companies make it difficult for psychiatrists to do what they are trained to do -- consult with their patients and use their expertise to improve their patients’ lives (3).

2. Geography

The distribution of psychiatrists across the U.S. is uneven. It is no surprise that states like New York, Connecticut and Massachusetts have more than 15 psychiatrists per 100,000 people while states like Texas, Indiana, and Idaho have fewer than six (1). 

Solutions:

Do things differently: Telepsychiatry

Telepsychiatry  (i.e., delivering psychiatric assessment and care through videoconferencing) enables psychiatrists to serve more patients in a wide variety of regions. The provider can stay in their preferred location and, with HIPAA compliant videoconferencing, can start seeing patients with limited mobility or in rural communities (3). As long as they are licensed to practice in the appropriate state(s)- the provider can even take on a moonlighting position to boost their income and pay off those student loans more quickly! 

Leading psychiatric organizations believe the benefits of telepsychiatry far outweigh any negatives -- because some type of psychiatric care is better than none. Technology is continually transforming health care- and telepsychiatry is one of them.  

Different approach: Patient-Centered Medical Home and Mental Health Services

Another known strategy in health care, which is not mutually exclusive to telepsychiatry, is a form of collaborate care, or Patient-Centered Medical Home (PCMH) provider (2).

A PCMH provider is a team-based approach to delivering primary care services that are accessible, comprehensive, and patient-centered as determined by patient self-reporting (2). This continues the ongoing efforts to ensure primary-care physicians and facilities are trained and equipped with mental health - so that they can conduct straightforward assessments and make proper referrals.

This approach becomes easier when a telepsychiatry network is integrated into the facility - by making mental health specialists accessible through a web-based platform.


Although there are some roadblocks for current and future psychiatrists to treat the needs of the growing mental health population – having an innovative and smart approach can decrease that burden and continue to make a lasting impact in the populations overall health needs.

REFERENCES

1.  Crary, David. There's A Serious Shortage Of Psychiatrists In The U.S. As public awareness of mental illness increases, the shortage of psychiatrists worsens. Sept 8, 2015. http://www.huffingtonpost.com/entry/theres-a-serious-shortage-of-psychiatrists-in-the-us_55eef13ce4b093be51bc128f

2. Jones, Audrey L. et al. Usual Primary Care Provider Charateristics of Patient-Centered Medical Home and Mental Health Service Use. Journal of General Internal Medicine. June 2015.

3.  Kim, Wun Jung, Child and Adolescent Psychiatry Workforce: A Critical Shortage and National Challenge. Academic Psychiatry. Jan 2014.