Newspaper article The Canadian Press

More Psychiatrists Not Answer to Boosting Patient Access to Care: Study

Newspaper article The Canadian Press

More Psychiatrists Not Answer to Boosting Patient Access to Care: Study

Article excerpt

Access to care goes beyond psychiatrist numbers


TORONTO - Despite a long-held belief that there are too few psychiatrists to care for patients in need, an Ontario study suggests it's the way the specialists practise -- not their number -- that contributes to difficulties accessing mental health services.

The 2009 study, published Tuesday in the journal Open Medicine, identified 1,379 full-time psychiatrists in Ontario, then examined where in the province they practised and the number of patients they treated and how often.

Geographically, practices are divided among 14 LHINs, or Local Health Integration Networks, across the province. Some regions, such as Toronto Central and Champlain (which includes Ottawa), have a far higher concentration of psychiatrists than more sparsely populated areas, such as North Simcoe Muskoka and Erie St. Clair.

"One would assume that in regions with more psychiatrists, patients would have better access to care, as well as more timely care after being hospitalized," said lead author Dr. Paul Kurdyak, an emergency-care psychiatrist at the Centre for Addiction and Mental Health in Toronto.

"Instead, we found that in such regions, the opposite was true. A substantial number of these psychiatrists saw fewer outpatients, while their colleagues in low-supply, non-urban areas had more patients and more new patients."

The study found a huge disparity in the per capita number of psychiatrists, on a region-by-region basis. In Toronto Central, for example, there were 63 psychiatrists per 100,000 residents, compared to an average of seven per 100,000 in low-supply LHINs.

"People assume this is an urban-rural issue, but that's not the case," Kurdyak said in an interview Monday, noting that Mississauga, a sprawling, highly populated city adjacent to Toronto, was among the areas with a low supply of the mental health physicians.

"What was more striking was the way that the outpatient practice patterns changed as psychiatrist supply increased," he said.

"What we found was that the number of patients seen per year reduced as the number of psychiatrists per capita increased, to the point where in Toronto, the average outpatient volume was 181 and for the low-supply LHINs it was 431."

In higher-supply regions, the doctors tended to see fewer patients more frequently and often for longer-duration appointments, while low-supply-area psychiatrists saw their patients much less frequently, the study found.

But even within Toronto, there was a variety of practice patterns.

While the majority of psychiatrists had patient loads similar to their counterparts in low-supply regions, 10 per cent of those practising full-time hours in Toronto saw fewer than 40 patients a year, while 40 per cent treated fewer than 100.

In Champlain, 28 per cent saw fewer than 100 patients annually, while that was the case for 24 per cent in the Southwest LHIN (includes London, Goderich and Owen Sound). That compares to just 10 per cent of psychiatrists in non-urban regions who had a patient roster under 100.

These patients were seen more frequently and for longer visits, suggesting that they may have been receiving long-term psychotherapy, researchers said. …

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