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Facing the Dilemma of Too Few Psychiatrists

It’s been called the “silent shortage.” There are simply far too few psychiatrists and way too many Americans suffering from mental health issues.  Drug and alcohol addiction, domestic violence, and suicidal adolescents are only the tip of the iceberg. Lack of timely and appropriate access to psychiatrists leaves others to struggle with life-draining episodes of depression and anxiety.

According to the American Medical Association, the total number of physicians in the U.S. increased by 45% from 1995 to 2013, but the number of psychiatrists rose by only 12%, while the U.S. population increased by 37%. Making matters worse, many of today’s practicing psychiatrists are nearing retirement age.

According to a recent study by the Association of American Colleges, 59% of psychiatrists are 55 years of age or older, one of the oldest groups of doctors practicing in 41 specialties.  Plus, fewer medical school graduates are choosing psychiatric residencies, because psychiatry doesn’t offer them the same prestige or income as other specialties.  It’s almost as if the field of psychiatry has divorced itself from the rest of medicine.

Primary care physicians are trying to fill the void. One study showed that 70% to 80% of all antidepressants are prescribed by primary care physicians–family physicians, internists, and even pediatricians. Despite their best efforts, however, primary care physicians are not psychiatrists; they have fairly limited training in the diagnosis and treatment of mental disorders.

Meanwhile, American adults and adolescents alike appear to be increasingly vulnerable to mental health problems.  “For youths between the ages of 10 and 24 years, suicide was the third leading cause of death behind only unintentional injuries and homicide,” says Cynthia Fontanella, Ph.D., Department of Psychiatry, Ohio State University (JAMA  Pediatrics, May 2015). Dr. Fontanella found that 66,595 youth had committed suicide from 1996 to 2010, with rural suicide rates nearly double the rate for urban areas for both males and females.

Addressing the shortage of psychiatrists has been a long-standing dilemma. Mental health experts agree that getting more medical students to choose psychiatry over other specialties is pretty much a losing battle. Although some students will still want to be psychiatrists, the number will not be enough to make up for the deficit.  That leaves two alternatives: 1) psychiatric telemedicine or telepsychiatry, and 2) collaborative patient care.

Telepsychiatry enables psychiatrists to serve more patients in more places, including adolescents and the elderly, individuals with limited mobility, emergency room patients, and even individuals who have been locked away in city and county jails. Also among the beneficiaries are people who live in rural, physically remote communities.

A perceived negative of telepsychiatry is the inability to interact at a more personal level, but experienced telepsychiatrists say this has not proven to be a significant barrier to establishing an appropriate doctor-patient relationship. In fact, tech savvy teenagers may be more comfortable seeing a psychiatrist on a video screen than in-person.

Collaborative patient care, based on an expanded role for non-psychiatrists, is the other alternative. This strategy includes making better use of qualified clinical psychologists who would be given limited authority to prescribe psychiatric medications. Also, primary care physicians, if given more solid training in mental health, would be able to care for the easier-to-handle cases while referring the more complex cases to a psychiatrist.