Summary: What remedies are currently being proposed to meet the rising demand and diminishing supply for Psychiatrists? The shortage of Psychiatrists has reached a critical point. What options are available to try to attain the volatile balance between supply and demand?
Psychiatrists are in short supply due to such factors as: profitability for the profession including reimbursement from Medicare/Medicaid, high burnout rate, and medical schools not highlighting the rewards which can be obtained. This is coupled with the increased demand caused from such factors as: increased awareness of mental health, more diagnoses and treatments available, and the desire for more individuals to seek treatment. So what remedies are available to bring supply and demand into alignment?
Primary Care as a Bandaid
Currently, a bandaid is being applied to help alleviate the effects of the shortage of Psychiatrists. Primary Care Physicians are providing assistance by treating or attempting to treat patients with mental illnesses. In theory, this makes sense. However, most Primary Care Physicians lack the specific training required to properly diagnose and treat mental illnesses. Psychiatric clerkships are not a popular choice in medical school and therefore behavioral health is not generally part of the clinical rotation. Treatments generally consist of both psychotropic medications as well as Psychoanalysis. Primary care Physicians generally lack the expertise in the Psychoanalysis. Additionally, Primary Care Physicians generally do not have the time to dedicate to the much needed follow-up of mental health patients. Primary Care Physicians are helping to fill in the gaps created from the shortage of Psychiatrists but shouldn’t be considered a long-term option.
Remedies
Some of the remedies which are currently being entertained include:
- Telemedicine – the ability to provide counseling remotely through the use of technology such as teleconferencing. One of the
How do we meet the rising demand for psychiatrists?
issues surrounding this option is how telemedicine should be reimbursed.
- Medical schools could provide training to require Psychiatry in the clinical rotations and spotlight the discipline to promote its profitability and rewards. The inclusion of follow-up with these patients could create relationships which can also help to promote the rewards aspect.
- Increase the number of Psychiatric Extenders such as Nurse Practitioners and Physicians’ Assistants. This will help lighten the caseload of Psychiatrists and possibly reduce the rate of burnout.
- Provide training to current Primary Care Physicians specific to mental health. This will provide more effective diagnosis and treatment to those Primary Care Physicians who are treating mental health patients.
- Use Psychologists and grant them prescriptive authority. Some states have started to grant prescriptive authority. These professionals already have the training in Psychoanalysis so this might be an excellent solution.
In summary, there are many contributing factors to the shortage of Psychiatrists. These include such things as the economy; Medicare/Medicaid/Insurance reimbursement and cutbacks; increased access to insurance due the Affordable Care Act; mental health issues becoming more prevalent; the aging population which increases the number of mental health patients and decreases the number of Psychiatrists due to retirement; the lack of focus in medical school;, the shift in paradigm from Psychoanalysis to prescribing medications; and the underuse of both Physician Extenders and Psychologists.
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