US Psychiatrist Shortage Causing Months-Long Wait Times

Megan Brooks

May 24, 2023

Securing an appointment with a mental health professional in the United States continues to be a challenge, with wait times for an in-person appointment north of 2 months and over 1 month for a telepsychiatry visit, a new study shows.

"Long wait times for mental healthcare were a huge problem even before the pandemic, but especially during the pandemic," study investigator Erin McDaid, BS, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, told Medscape Medical News.

"It's not like you have a cold or a virus and maybe you wait a little bit and it goes away. Mental health problems can completely impact your life; you can't do anything, you can't go to work, you can't build relationships, you can't take care of your kids. It's a really big issue," McDaid said.

The study was presented at the American Psychiatric Association (APA) 2023 Annual Meeting.

Few Psychiatrists Taking New Patients

To find out just how big an issue wait times are, the researchers examined general psychiatry outpatient availability during the COVID-19 pandemic in five states ― New York, California, North Dakota, Virginia, and Wyoming.

Altogether, 948 psychiatrists were sampled. Simulated adult patients made 864 calls seeking an initial psychiatric evaluation for general mental health care. The calls were made late in the pandemic, between May and July 2022.

Only 18.5% of psychiatrists were available to see new patients. The median wait time was 67 days for in-person appointments and 43 days for telepsychiatry appointments (P < .001).

More than half of psychiatrists who were contacted said they were not taking new patients, which was the most common reason given for unavailability.

"This is happening at the worst time when we are seeing mental health issues spike," McDaid told Medscape Medical News.

Telepsychiatry Helpful but No Panacea

The fact that wait times were a bit shorter for telepsychiatry is encouraging, McDaid said.

Telepsychiatry is a potential solution to provider shortages and geographic barriers, but it does not resolve the concerning shortage of psychiatric outpatient care, she noted.

"Psychiatrists adapted very well to telepsychiatry during COVID," Saul Levin, MD, MPA, chief executive officer and medical director of the APA, noted during a preconference briefing with reporters.

"Before COVID, we always thought that the psychiatrist had to be with the patient in the room," said Levin. But now we see that either "sitting inside the room with your psychiatrist or mental health specialist or [being there virtually] has the same effect. The patient is concentrating and working out their problems with you. I think that's one of the positives — if anything coming out of COVID is positive."

In an interview with Medscape Medical News, Robert Trestman, MD, chair of the APA Council on Healthcare Systems and Financing, said telepsychiatry "will help, but there is not one simple solution that will fix the problem" regarding access to mental health care.

One promising approach is the collaborative care model, which enlists primary care physicians to provide mental health care in consultation with psychiatry and case management, Trestman said.

"There's no question that there aren't enough providers. There aren't enough primary care doctors, and there certainly aren't enough psychiatrists," Trestman noted.

Encouragingly, however, the past few years have seen a steady increase in medical students choosing psychiatry.

"Psychiatry is now being thought of as a branch of neuroscience. We are understanding so much more about the field and about the brain. So that's intriguing and intellectually challenging to many," Trestman said.

He also noted that the pandemic has helped to "breakdown stigma. More people acknowledge and talk about mental health, and when an area is destigmatized, it's so much easier for people to consider."

Jack Resneck, Jr, MD, president of the American Medical Association (AMA), who also spoke with Medscape about this issue, acknowledged that there is a "severe workforce shortage in healthcare right now."

"I'm a physician and the president of the AMA, and it took me way too long to be able to find a primary care physician for myself," he said.

"I also am a physician who refers patients to rheumatology and endocrinology, psychiatry, and other areas of medicine, and it is, in many geographic areas both rural and urban, a huge struggle right now," said Resneck.

The study had no specific funding. McDaid, Levin and Trestman have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2023 Annual Meeting: Poster P11-007. Presented May 23, 2023.

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