Magazine article Clinical Psychiatry News

Solutions for Psychiatry: New Report Calls for Better Training, Delivery Models

Magazine article Clinical Psychiatry News

Solutions for Psychiatry: New Report Calls for Better Training, Delivery Models

Article excerpt

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More work needs to be done to address the shortage of psychiatrists, including improvements in training and models of health care delivery, according to a new report from the National Council for Behavioral Health's Medical Director Institute.

In framing the problem, Joseph Parks, MD, a psychiatrist who serves as medical director of the National Council, said during a recent teleconference to introduce the report that "55% of the counties in the United States have no psychiatrist in them" and "77% of the counties report a severe shortage." He noted that the number of psychiatrists available declined by 10% between 2003 and 2013 and that the average age of practicing psychiatrists is in the mid-50s. In other medical specialties, the average age is in the mid-40s, he said.

"This has resulted in people having long wait times and being unable to get psychiatric services," Dr. Parks said. Those factors are leading patients to pursue psychiatric care in alternative places, such as in primary care physician practices and emergency departments.

In emergency departments, the average wait for dispositions for some psychiatric patients can reach 23 hours, the report says. And more people are going to EDs for care.

"There has been a 42% increase in patients going to the emergency rooms for psychiatric services in the past 3 years," Dr. Parks said. "But most of them aren't staffed with psychiatrists. So people end up stuck in the emergency rooms for hours two to three times as long as they spend for general medical conditions."

The report looks at causes, and makes actionable recommendations for payers and providers. It also makes recommendations about the infrastructure needed to train future psychiatrists.

A key part of the problem is the increased demand, which is partly attributable to the expansion of health care coverage through the Affordable Care Act's Medicaid expansion provisions as well as the normalization of views on behavioral health.

"People want psychiatric services," said Dr. Parks, who has practiced medicine and worked as a policy maker in Missouri. "They know treatment works. It's less stigmatized than it used to be, so people are more willing to accept and seek treatment."

Among the trends cited by the report is a shortage of new psychiatrists coming out of medical schools.

"There are problems with not enough training capacity," he said. "We've had increases in federal support for increased training capacity for ob.gyns. and primary care, but we've not had that same increase and support, and there are [fewer] supports for training of psychiatrists and fewer slots."

Burnout is another problem facing psychiatrists.

"Psychiatrists who are practicing are in many cases forced to do it at lower than usual reimbursements [and] are having short visits," Dr. Parks said. "They are rushed.... They don't get the same supports that other physicians get. They don't get the same ancillary staff to assist them in caring for the patients."

Elaborating on the issues surrounding reimbursement, Dr. Parks noted that 40% of psychiatrists work on a cash-only basis, and 75% of behavioral health organizations lose money on fees collected for psychiatric services.

An ongoing workforce concern, especially in light of changes to the H-lB program, is that 50% of new trainees are foreign medical graduates.

"Luckily, there is a broad range of solutions, and there is something for all the major players to do here," Dr. Parks said, noting that the report highlights many of these solutions. …

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