The Long Wait: Shortage of Psychiatrists Affecting Patients
By Debra Wood,
Whether “boarding” in
the emergency department or waiting weeks or months for an appointment with a
psychiatrist, numerous behavioral health patients experience delays in care,
which can lead to poor outcomes.
Why is this happening—and
what can be done to address this mental health crisis?
“In 10 years, they will consider this the good old days,”
said Joe Parks, MD,
medical director of the National Council for Behavioral Health in Washington,
D.C. “This is as good as it gets.”
Parks expects access will become
even more challenging, as a wave of psychiatrists retire and patients recognize
mental health treatments work and have insurance coverage for those treatments.
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The prevalence of
mental health disorders
million people in the United States, or 18.3 percent of the population, suffer
from a mental illness, according to the National Institute of Mental Health.
Yet, less than half of these people have received mental health treatment.
Top diagnoses include anxiety,
depression and substance abuse, including among people in their 20s and 30s,
according to Parks. Additionally, people need treatment for more serious
conditions, such as schizophrenia and bipolar disease.
“Demand for psychiatry
is going through the roof, because stigma is down and coverage is up,” Parks
The federal Mental Health Parity and Addiction Equity Act of 2008 required large group commercial insurers, but not
self-insured companies, to provide coverage for mental health disorders on a
par with medical/surgical conditions. That expanded coverage, as did the
Affordable Care Act.
“Demand is up at the
same time supply is down,” Parks said.
The causes and effects of the psychiatrist shortage
The country is experiencing
a psychiatrist shortage, which is challenging for patients and providers, but bodes
well for those seeking new psychiatrist opportunities.
“The number of
psychiatrists per capita is down about 10 percent over the last 13 years,”
Parks said. “Whereas, the number of physicians overall is even.”In 2025, demand may outstrip supply by 6,090 to 15,600
, according to a 2017 National Council for Behavioral Health report
With demand up and
psychiatrists in short supply, the price of a psychiatry visit has gone up, and
more than 40 percent of psychiatrists operate cash-only practices. In a
metropolitan area, a psychiatrist can charge and get $300 for a 45-minute
therapy visit, yet on average insurers will only reimburse about $150, Parks
explained. Actuarial firms have not reset the rates for behavioral health
will still accept commercial insurance and be listed on the health plan’s panel
of providers, but will limit the percentage of patients. “The panels are
inadequate,” Parks noted.
A 2017 study by Milliman,
involving nearly 42 million Americans, found patients went out of network for
outpatient behavioral health services 3.0 to 5.8 times more often than for
Six out of 10 (60
percent) of the 37,725 practicing psychiatrists in 2015 were age 55 or older, according
to the Association of American Medical Colleges, which indicates many will be
retiring over the next few years.
About one-third of new
psychiatrists are graduates of foreign medical schools, so changes to
immigration laws could adversely affect that supply, Parks said.
“And the inside the
U.S. production pipeline is fixed, because there is no extra funding for
graduate medical education,” Parks said. “We produce more medical students than
we have first-year training slots available. There are people who have finished
medical school and cannot practice.” During the last three or four years, all
psychiatry residency slots have been filling, he said.
A multifaceted fix is needed
To solve the psychiatrist
shortage and patient access problem, Parks said better regulation of access for treatment of mental health disorders
is needed, along with better enforcement of the Mental Health Parity and
Addiction Equity Act, including reimbursement rate parity.
surveys could help determine areas with insufficient access. A study led by
Harvard researchers in 2014 used a secret shopper approach in Boston, Houston
and Chicago, calling psychiatrists’ offices seeking an appointment. After two
rounds of calling, only 26 percent of the callers were able to secure an
appointment, regardless of whether they had commercial insurance or Medicare or
companies need to take a look and see they are not getting the health coverage
they want for their employees,” Parks said. Then these companies need to advocate for change. After all, good mental
health coverage benefits employers, because untreated anxiety and depression increases
absenteeism and reduces productivity.
More psychiatry residency slots are needed, which means more federal or state funding for
graduate medical education.
Another solution could
involve integrated care. Patients
often seek care for anxiety and depression from primary care physicians, who
may be reluctant to treat these conditions if they do not have back up from a
psychiatrist. But these primary care physicians could bring a psychiatrist into
“I practice in a
primary care clinic, and I love it,” Parks said.
illness is a problem for everyone in health care. While there is not one single
solution, the experts agree: more needs to be done to get patients the help
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