Psychiatrist supply not meeting demand; complex cases should be given priority

The shortage of psychiatrists is worsening throughout the nation, leading many patients to travel long distances to reach the nearest one, and this problem is not likely to go away any time soon. Citing a study by the Association of American Medical Colleges, the Associated Press (AP) reported that 59 percent of psychiatrists are 55 or over, making psychiatry the fourth oldest out of 41 medical specialties. This indicates that the bulk of the nation’s psychiatrists may be retiring or reducing their workloads soon.

The growing number of physicians is not benefiting the practice of psychiatry, either. Statistics from the American Medical Association showed that while the total of number of physicians increased by 45 percent between 1995 and 2013, the number of adult and child psychiatrists only rose by 12 percent. Taken into account with a population increase of 37 percent in the same time frame and increased eligibility for mental health coverage under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the number of psychiatrists is not meeting the rising need, and patients are having trouble finding psychiatrists near them who are accepting new patients.

President of the American Psychiatric Association Dr. Renee Binder told the AP that perceptions of inadequate pay, with averages of $182,700 annually, which is slightly below the mean for general practitioners and 28 percent below the wages of surgeons, keep some medical students from choosing psychiatry as a specialty. Additionally, some psychiatrists have switched to cash-only practices out of frustration with what they believe is inadequate reimbursement from the government and private insurance plans, the AP reported. Binder also reported that paperwork requirements with both private insurance and Medicare are burdensome and interfere with the ability to meet with patients.

To address the shortage of psychiatrists, mental health experts suggest expanding the use of psychiatric telemedicine to allow more patients in expanded regions to gain care. South Carolina, North Carolina, and Michigan have already implemented extensive telepsychiatry programs. Collaborative care, under which mental health specialists provide consultation to other health care providers, and other efforts to increase primary care physicians’ mental health training, can also aid in funneling the more complex cases to psychiatrists through referrals.

“We’re going to have to do business differently, and in my view that’s not a bad thing,” Dr. Michael Flaum of the University of Iowa told the AP. “The way it is now, people with the right insurance who happen to knock on the right door at the right time will get seen. They may not be the ones most in need.”