Psychiatry Facing Severe Workforce Crisis

July 30, 2015

The physician recruiting firm Merritt Hawkins has its finger on the pulse of the medical profession like few other groups. As a head-hunting company that fills spots in group practices and hospitals, it knows what specialists are in demand, and why.

Its latest report on recruiting trends shows a weak pulse for one specialty: psychiatry. The number of searches for psychiatrists from April 2014 through March 2015 hit an all-time high in the company's 27-year history. Not only did psychiatry rank third on the list of recruiting assignments by specialty, with 230, but it came close to tying internal medicine, at 237, for second place. As usual, family medicine occupied the top spot, this time with 734 searches.

The shortage of psychiatrists will only get worse, said Travis Singleton, senior vice president of Merritt Hawkins. Forty-eight percent of these specialists are 60 years of age and older and are closing in on retirement. And although psychiatrists are aging out of the profession, the demand for services is spiking, according to Singleton. He cites a report from the Department of Health and Human Services showing that only 41% of adults with any kind of mental illness received mental health services in the past year.

"It's very scary," Singleton told Medscape Medical News. "We're desperately underserved."

The scarcity of psychiatrists has caught the government's attention, too. The Department of Health and Human Services has identified roughly 4000 health professional shortage areas for mental health. A county, a portion of a county, or a group of counties qualify for that designation if there are 30,000 or more people per psychiatrist.

Unfair Reimbursement Contributes to Shortage

A past president of the American Psychiatric Association and a current member of its board of trustees attributes the crisis to systemic problems in healthcare that hit his profession especially hard.

"When healthcare gets a cold, mental health gets pneumonia," said Jeffrey Lieberman, MD, chair of the psychiatry department at Columbia University College of Physicians and Surgeons in New York City, in an interview with Medscape Medical News.

One big problem is that as a cognitive specialty, similar to family medicine and internal medicine, psychiatry is reimbursed less than procedure-oriented specialties such as cardiology and urology, said Dr Lieberman. "That creates a disincentive for people to go into these fields."

Exacerbating that economic disincentive is that historically, insurers have paid less for psychiatric services than medical and surgical services. Recent laws have attempted to establish reimbursement parity for mental health, but they have not been fully implemented and enforced, said Dr Lieberman.

An insufficient number of slots in psychiatric residency programs also leaves the profession short-handed, he said, "They haven't had an increase since 1997."

Similar to others, the American Psychiatric Association's current president, Renee Binder, MD, characterizes the demand for psychiatric services as "tremendous." However, Dr Binder said there are "signs of hope of progress."

"In 2015, we saw a 13% increase in the number of medical students who chose a residency in psychiatry — the largest increase of any medical specialty," Dr Binder told Medscape Medical News.

Several new bills and laws, she added, create more incentives for medical students to enter this field. The Clay Hunt Act, signed into law in February, will help repay educational loans of psychiatrists who choose to practice in the Veterans Health Administration. And a bill introduced this spring called the Helping Families in Mental Health Crisis Act of 2015 would create a nationwide strategy to boost the psychiatric workforce.

"There are no instant fixes to meeting the demand for psychiatrists," said Dr Binder, "but with time we believe it can and will be resolved."


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