The United States is suffering from a growing shortage of psychiatrists and other mental health providers. It is particularly dire in rural regions.
1 in 5 US adults and kids have a mental health or substance abuse issue according to a report published in the Journal of the American Medical Association.
According to a New American Economy report, 60% of US counties have no practicing psychiatrists to evaluate mental health issues and prescribe and manage medications and other treatments. Many of those counties, if not all, are in rural areas.
There are an estimated 612 psychiatrists per 100,000 people in parts of New York State but less than 1 per 100,000 in Idaho.
While the number of new psychiatrists emerging from residency programs has increased somewhat recently, we may be short by 6,090 to 15,600 psychiatrists by 2025, says a National Council for Behavioral Health report.
A number of factors fuel the shortage, including a greater awareness of mental health problems that has spurred people to seek treatment.
Also, mental health providers frequently are reimbursed less than physical health providers.
And many of these doctors are retiring. More than 60% of practicing psychiatrists are over the age of 55, one of the highest proportions among all specialties, AAMC 2015 data indicate.
Anna Ratzliff, MD, PhD at the University of Washington School of Medicine mentions another possible cause. “Stigma and misunderstanding of mental illness have led to insufficient attention to this issue,” she believes. “I don’t think we’d ever say to someone, ‘I‘m sorry, but only one in 10 people with cancer will be able to see a cancer specialist.‘ I don’t think people would tolerate that.”
Some institutions are adding residency slots to help increase the numbers of psychiatrists, notes Carlyle Chan, MD, AAMC senior consultant in graduate medical education. “Part of the problem is that Medicare stipends for residency positions were frozen in 1997,” he explains. “So some hospitals have taken on the added training costs themselves.”
Mentoring also is part of efforts by institutions. The Behavioral Health Education Center of Nebraska, is an interprofessional workforce group embedded at UNMC, to increase the number of Nebraska’s rural mental health providers. For example, rural high school and college students have video conferenced with psychiatry residents three times a month, discussing everything from MCAT preparation to work-life balance.
Telepsychiatry, including videoconferencing for patient evaluation, medication management, and therapy is one effective way to deliver more care to remote areas, says James Shore, MD, an associate professor of psychiatry at the University of Colorado School of Medicine who has expertise in telemedicine.
Increasing the supply and training new psychiatrists, including adding residency training slots, will help. Addressing reimbursement challenges will also help. Finding other ways to increase access to psychiatric care in underserved areas will also be required.