As the nation faces what has been characterized as a primary care shortage, due at least in part to the implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and the resulting increase of newly insured individuals, some states have acted to offset the provider shortfall. Kentucky, a state which has been reported as lagging behind the primary care physician-to-citizen ratio, is among those states taking at least a creative approach to the looming shortage. While at least one of these practices, which involved stepping up the responsibilities and authority of nurse practitioners, has been widely reported as following the trend of many other states that are working to quell the primary care shortage, another path has been drawn to target other types of underserved patients.
Physician Shortage Nationwide
According to data reported by the Association for American Medical Colleges (AAMC) and the Health Resources and Service Administration (HRSA), the nation overall and especially certain rural areas are beginning to face a severe shortage of health care providers. In sum, the HRSA report highlights the following: (1) almost 20 percent of Americans live in areas that have an insufficient number of primary care physicians and (2) 16 percent of Americans live in areas with insufficient numbers of dentists. Perhaps what is most shocking is the final result that was highlighted in that study that indicated 30 percent of Americans reside in areas where there is a shortage of mental health providers. The AAMC predicts that by 2020 there will shortage of 45,000 primary care physicians and an equal number of needed but non-existent specialists.
While some reports indicate that these predictions were incorrect or have at least failed to come to fruition as of yet, local sources in Kentucky outlined its provider shortage in no uncertain terms. In particular, this report included data offered by the Kentucky Rural Medical Educators Conference, which asserted that “Kentucky had a 1,287:1 primary care physician-to-citizen ratio, 557 short of the national average.” Additionally, the HRSA data lists Kentucky as among the states with the lowest per capita number of psychologists and mental health counselors.
Targeting Mental Health
While Kentucky has recently passed a law empowering nurse practitioners to prescribe medication, presumably to fill the shortage of primary care providers, it also has adopted a measure to target the shortage of mental health providers. Specifically, through the passage of a new law, Kentucky recently became the sixth state to allow pastoral counselors to become licensed as mental health counselors. According to a local source, the state joined Arkansas, Maine, New Hampshire, North Carolina, and Tennessee to provide this licensing option for pastoral counselors. It appears in doing so, the state officials hoped that this option would encourage increased numbers of pastoral counselors to become mental health counselors and fill the void of mental health care professionals in the state.
As it has been noted in nationwide data, the demand for mental health care professionals, like primary care providers, is expected to grow as more individuals take advantage of coverage options under the ACA. In terms of mental health, the combination of the ACA mental health benefits and the Mental Health Parity and Addiction Equity Act is also projected to increase numbers of potential new patients in this field, creating more demand for providers. Critics of the law have asserted the importance of maintaining differentiation between mental health providers and pastoral counselors, who may be swayed by spiritual factors and are generally thought to be not in the same category as non-pastoral counselors, as reasons for blocking its passage previously. Yet the report also noted that pastoral counselors often serve clients outside of churches and treat patients of different faiths and denominations. Additionally, the training requirements for pastoral counselors are often more stringent than those requirements for certain types of mental health counselors.