This Is One Reason It's So Hard To Find A Psychiatrist

Findings from a new study are striking -- and distressing.

The nation’s supply of psychiatrists is dwindling just as the demand for their services is growing, according to a new study out Wednesday.

The study, which appears in the July issue of the policy journal Health Affairs, uses government data to show how the number of psychiatrists changed between 2003 and 2013.

In 2003, there were 37,986 practicing psychiatrists in the U.S., according to the study. Ten years later, there were 37,899.

That's not much of a difference, obviously. But when the researchers adjusted for population growth, they found that the number of practicing psychiatrists per 100,000 residents in a typical community had declined from 8.2 to 7.4.

In other words, the relative number of psychiatrists had fallen by 10 percent.

The change is striking, because it has happened at a time when the relative number of physicians overall has been increasing. The change is also unsettling, because it’s happened in an era during which society has become more aware of mental health problems -- and expansions of insurance coverage have given more people a way to pay for services.

But the ability to pay for mental health care is not the same as the ability to get mental health care. Many psychiatrists do not take health insurance, because the reimbursements are low and because dealing with insurance companies can be so difficult.

This has limited access to mental health services, particularly for people who can’t afford to pay for treatment out of their own pockets. And now, according to this study, finding a psychiatrist is even harder than it was before.

Reversing this trend and boosting access to mental health care has been a focus of reform efforts for some time. Mental health parity legislation, including provisions of the Affordable Care Act, have gradually -- if fitfully -- forced insurers to pay for mental health treatment in the same way they pay for physical health treatment. The health care law also increased funding for training new psychiatrists.

But the study’s authors caution that making psychiatry more attractive and lucrative won’t be sufficient to address existing shortages. “Simply producing more psychiatrists is not going to fix the problem,” Harold Pincus, one of the co-authors, told The Huffington Post in an interview.

Pincus, who is vice chair and professor in the psychiatry department at Columbia University, says a major focus should be on reorganizing the delivery of mental health care — so that psychiatrists work more frequently in teams with psychologists, social workers and other professionals, with each member of the team focusing on his or her own skill set. (For example, psychologists could focus on therapy while psychiatrists could focus on managing medications.)

The good news is that this transition is already underway. Richard Frank, a health economist at Harvard Medical School and longtime researcher on mental health care, noted in an interview that the ranks of counselors and therapists are swelling, even as the number of psychiatrists is falling. In addition, primary care providers are increasingly handling some mental health care issues directly, rather than referring all patients to psychiatric specialists.

But there’s still more work to do, Frank cautioned. “We’ll never train enough enough psychiatrists to meet the demand. …It will help, but it will be a small bite at the problem.”