U.S. Shrink Supply May Be Shrinking

The number of practicing psychiatrists in the U.S. has stalled over the last decade, in contrast to an upward trend among many other specialties, researchers found.

Co-author Harold Pincus, MD, of Columbia University and New York-Presbyterian Hospital, told MedPage Today that more medical school students were going into psychiatry in the 60s and 70s, but there’s been a “generational shift and this proportion has declined. Thus, psychiatrists are not being replaced at a sufficient rate.”
He offered two potential reasons for this shift: “First, psychiatrists are one of the lowest compensated specialties,” he said. “Secondly, there are a greater number of other professionals providing behavioral health services, such as mid-level providers and counselors.”
Bishop and colleagues looked at data from 2003 to 2013 from the Area Health Resources Files, a county-level database maintained by HRSA.
In addition to the overall totals, they saw a 10.2% decline in the median number of psychiatrists per 100,000 residents in hospital referral regions — compared with a 15.8% per capita increase for neurologists, and stable per capita proportions for primary care doctors and all practicing physicians.
In further analyses, they also found that both the percentage of high school graduates and the median household income was significantly and positively associated with the per capita number of psychiatrists in 2013.

The researchers suggested that the decline in psychiatrists might explain “why people report poor access to mental healthcare and why a large portion of psychiatrists are able to sustain practices without accepting insurance.”
“There is nothing being done to increase the number of psychiatrists right now,” Pincus told MedPage Today. He suggested that “compensating them more appropriately” might increase interest. However, even if this stimulated interest, it would take a long time to see an increase due to the length of psychiatrist training, he said.
Petros Levounis, MD, chair of psychiatry at Rutgers Medical School, who wasn’t involved in the study, noted that there have been policy efforts to increase reimbursement for mental health services, such as the Mental Health and Substance Use Disorder Act of 2008 — but its implementation “has been slow,” he said.
“Reimbursements are very low,” Levounis added. “Thus, many psychiatrists don’t accept insurance, such as those in the greater New York area.”
From his perspective as a medical school instructor, Levounis said that medical students “are initially interested in mental health and addiction. However, as their education progresses, their interest drops significantly.”

Psychiatrists may not be inspiring students enough; or, medical and surgical specialists could be perpetuating the impression that mental illnesses are less important than physical illnesses, Levounis said.
He emphasized that the lack of psychiatrists is problematic not just for population mental health, but for its overall health.
“We now realize that the root causes for many physical conditions are linked to mental health disorders,” Levounis said. “For example, lung cancer and COPD are linked heavily to smoking cessation, which is under the realm of psychiatry.”
Pincus suggested that giving psychiatrists a supervisory role to guide other behavioral health professionals, while diminishing their own face time with patients, may be the best path to managing population mental health. But Levounis disagrees: he believes such a move will online increase the need for psychiatrists.
On the other hand, telemedicine may be able to pick up the slack, although it’s “early to tell the success of their outcomes,” Levounis said.
The researchers concluded that “policy makers, payers, and the medical community simultaneously must develop strategies to enhance recruitment into psychiatry and rapidly develop and effectively disseminate new care models to use the psychiatric workforce more efficiently in the near term.”


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