There was already urgency for more mental health providers before the pandemic struck. Today, in the face of rapidly rising rates of opioid addiction, depression and suicides, we're approaching critical mass as the demand for behavioral specialists is greater than ever. So, now what?
Increasing Demand Leaving Mental Health Professionals in Short Supply
According to the Steinberg Institute in California, the situation is so dire now that two-thirds of all primary care providers in the U.S. say they have trouble finding mental health specialists to refer their patients to. Two-thirds.
To put that in context, consider what would happen if:
Two out of three patients with heart disease couldn't find a cardiologist?
Two out of three cancer patients couldn't find an oncologist?
Two out of three children couldn't see a pediatrician?
In fact, there are provider shortages across the entire healthcare spectrum. To illustrate, data released in April 2021 by the Health Resources & Services Administration (HRSA) identifies shortfalls in the following areas:
|Provider shortage||*- People affected|
|Primary Care||15,303||83 million|
|Mental Health||6,471||124 million|
*-Indicates people living in regions designated by the HRSA as "Health Professional Shortage Areas" - more than
6,000 areas in the U.S. in which the population-to-provider ratio for mental healthcare is at least 30,000-to-1.
As it applies to mental health, the supply-and-demand issue becomes even more pronounced when you consider that:
20% of all Americans (adults and children) have mental health or substance abuse conditions, according to a 2017 report by the Kaiser Family Foundation
40% of patients seen by PCPs have active psychiatric problems, according to the Steinberg Institute
42%: Increase in patients going to emergency departments for psychiatric services, according to a three-year study by the National Council for Behavioral Health
44.8% of people with any mental illness reported receiving treatment in 2019, according to the National Institutes of Mental Health (NIMH)
65.5% of people with serious mental illness reported receiving treatment in 2019, according to the NIMH. (34.5% didn't.)
As harsh and revealing as these numbers may be, they all pre-date the even greater demands brought on by the pandemic. They also don't fully convey the extent of the pre-pandemic provider shortage, nor what it means for those in desperate need of mental health services.
To better understand the extent and complexity of the situation, consider these five challenges facing the behavioral health industry today:
1. Spotty National dispersal of Mental Health Providers
Or think about this: There are about 612 psychiatrists per 100,000 people in parts of New York State (a 1-to-163 ratio) yet there are fewer than one per 100,000 in Idaho.
At last count, there were 45,580 psychiatrists in the U.S., which translates to about nine psychiatrists per 100,000 Americans. In order to provide true quality care, however, that ratio should be 15 per 100,000, according to Merritt Hawkins, a physician search firm.
Among the states with the highest number of psychiatrists are California, New York, Texas, Florida and Pennsylvania. Even in those states, however, there aren't enough providers to meet demands. For example, California has the most psychiatrists of any state in the nation with almost 6,000, yet 2016-17 rankings by the Kaiser Family Foundation identify California as the state with the largest number of residents (1.47 million) who said they felt their need for mental health treatment or counseling had not been met in the past year.
Regardless of state, rural areas are at an obvious geographic disadvantage when it comes to accessibility to mental health services. But if one good thing has come of the pandemic - especially for mental health providers and patients - it's the emergence of remote therapy and treatment through telehealth and telepsychiatry, both in rural and urban areas. Within months of the outbreak, providers and patients alike were adapting to technology that facilitates treatment for those in the most densely and sparsely populated areas in the nation.
2. Career Choice: Obstacles & Opportunities
There are reasons why people don't pursue career paths to become social workers:
Long and irregular hours
Potential threat to personal safety
Proneness to compassion fatigue
High educational requirements
So, what's the attraction to such a job? For one thing, opportunity, and that includes the opportunity to help others. With more than 700,000 social workers currently in the U.S., the U.S. Bureau of Labor Statistics projects a need for more than 800,000 by 2029.
The question is, will supply be able to meet this growing demand? Although social workers earn an average of about $56,000 a year, they're generally overworked and underpaid. The prospects are similar for those considering careers in psychology or psychiatry - demanding professions but with no lack of opportunity.
3. Reward of Success Takes Time
In an age of instant gratification, those in the mental health profession stand as outliers. Regardless of specialty - counselors, therapists, psychologists or psychiatrist - work as a behavioral health professional is a process that requires patience and a commitment to the long haul.
It's not like a doctor setting a broken femur with the confidence that the patient will be up and walking in two months' time. Nor does it come with the satisfaction of a cardiologist performing a successful triple bypass surgery in three hours' time.
Mental health is different. Successes are realized over time, but quick-fix solutions are rare.
“While other medical specialties such as cardiology and orthopedic surgery offer healthcare providers center-based care where patient illnesses can be treated with medical procedures or tangible intervention care, mental health coverage often requires long-term management without a defined ‘cure’ that is often not profitable,” says a Merritt Hawkins report.
Despite a growing awareness and appreciation for the value of mental health care, many students considering healthcare careers simply do not view mental health and physical health careers with the same regard.
4: The retirement drain: mass Exodus Is Coming
It's come to this: The American Psychological Association is calculating workforce projections for 2030 based on whether psychologists retire two years earlier than expected - or two years later. Either way, it expects the 2030 demand for 101,120 psychologists will be met.
Not so for social workers, which PubMed expects to fall 195,000 short of demand in 2030. Why? In part because of the massive number of anticipated retirements.
And what of those in the psychiatry profession? According to the Association of American Medical Colleges, 60% of all practicing psychiatrists are over the age of 55. As such, it's easy to imagine the dearth of psychiatrists that's likely to create as this generation of providers approach retirement.
5: Overcoming the Funding Cap of 1997
The Balanced Budget Act of 1997 slammed the door on Medicare funds previously earmarked for medical residency programs. These funding limits delayed - or perhaps squashed - the career pursuits of many mental health residents. The results were predictably detrimental to the pipeline of mental health specialists.
The act's limitations effectively prohibit existing teaching hospitals from receiving Medicare-support for any new medical residency positions. As medical school enrollment continues to grow, the Medicare cap on graduate medical education has made it difficult for medical resident training to keep pace.
Recent legislative efforts are now seeking to increase funding for medical residency positions, including:
Consolidated Appropriations Act of 2021: Signed by President Trump in December 2020, this bipartisan bill creates 1,000 new Medicare-funded graduate medical education residency positions. The funds will be distributed over a five-year period to qualifying hospitals that submit applications.
American Rescue Plan: Signed by President Biden in March 2021, the law sets aside about $4 billion to fund myriad mental healthcare initiatives, including funds for behavioral health workforce education and training.
Resident Physician Shortage Reduction Act: If enacted, this pending legislation would authorize 14,000 new Medicare-supported medical residency positions over seven years (from 2023-2029, with 2,000 allotted per year).
None of these acts create educational support exclusively for those pursuing degrees in mental health though it's expected a percentage will go toward those specialties. These may be small steps, but they're welcome (if not long overdue) steps in the right direction.
With Greater Demand Comes Better Solutions For Your Practice
Much of the demand for mental health specialists can be directly attributed to improved perceptions and promotion of what was once a greatly stigmatized profession. Stigmas still exist today, but to a lesser degree.
Positive media attention has generated greater acceptance of mental health care, greater awareness of its benefits, and a greater willingness on the part of people to seek treatment. And incremental help appears to be on the way, thought whether it will be enough to close the gap remains to be seen.
An increased reliance on physician assistants is already helping to ease the shortage of psychiatrists. There was a 63% increase in PAs in psychiatric care between 2015 and 2019, from 1,033 to 1,685.
And again, the rising use of telehealth in mental health practices is already creating huge inroads into remote and underserved rural regions of the country. Technology has proved pivotal in streamlining the transition to telehealth solutions.
InSync Healthcare Solutions provides exactly the kind of superior EHR software to facilitate that transition or upgrade.
Through a HIPAA compliant partnership with Zoom, we offer a telehealth platform with features that enhance patient care, including remote access from anywhere with internet access, appointment requests through a patient portal, video calls, and much more. All on our fully integrated, HIPAA compliant medical records system.
Schedule time for a quick discovery call with an InSync Healthcare Solutions representative if you're interested in learning more about how telemedicine can strengthen your practice's patient care.
Association of American Medical Colleges:
Health Resources & Services Administration:
U.S. Bureau of Labor Statistics:
117th Congress of the United States:
American Society of Addiction Medicine:
Adaptive Medical Partners:
National Commission on Certification of Physician Assistants: