Report finds limited number of psychiatrists statewideNorth Carolinians dealing with anxiety, depression or other common mental disorders are having a more difficult time getting treatment because of the limited number of psychiatrists statewide, according to a recent report on psychiatrist supply.
For children, the report said, the situation is critical: Almost half of the counties statewide lack a child psychiatrist.
The report, "The Supply and Distribution of Psychiatrists in North Carolina: Pressing Issues in the Context of Mental Health Reform," is a collaborative effort among the department of psychiatry and behavioral sciences at the Duke University Medical Center; the N.C. Area Health Education Centers (AHEC) Program, based in the University of North Carolina at Chapel Hill's School of Medicine; and UNC's Cecil G. Sheps Center for Health Services Research.
"We undertook this report because we thought it was important and timely to look at psychiatrist supply in the context of mental health reform in the state," said Erin Fraher, co-author of the report and work force researcher at the Sheps Center. "Also, in the past three years, the increase in the supply of physicians has slowed below that of population growth and we were interested in exploring how the psychiatrist work force was doing in terms of supply and distribution throughout the state."
The report highlights four areas of concern for the future of mental health care statewide:
- North Carolina's population is growing faster than the state's supply of psychiatrists, setting the stage for an emerging shortage;
- The lack of psychiatrists in certain counties means that people may not have access to the mental health care services they need;
- The lack of child psychiatrists statewide has reached a critical stage; and
- In some counties, both psychiatrists and primary care providers are in shortage, creating a situation in which people with mental disorders might go undiagnosed or untreated.
"Unfortunately, we have a growing shortage of psychiatrists, and many people find that their health insurance provides poor coverage to see a mental health professional. Often, this means they turn to their primary care physicians who may not have the time or resources to adequately treat them," said Dr. Marvin Swartz, a psychiatrist at Duke University Medical Center.
North Carolina ranks 20th nationwide in terms of psychiatrist supply, with just over one psychiatrist for every 10,000 people, according to the 2004 Area Resource File (of the Bureau of Health Professions), from the U.S. Department of Health and Human Services Health Resources and Services Administration.
The supply of psychiatrists statewide has remained fairly constant during the 1995-2004 period, the authors said, although recent growth has slowed slightly. "North Carolina's relatively good supply is due, in part, to past investments in medical education and residency training programs in the state," the authors wrote.
The picture is not as promising when one examines the psychiatrist supply at the county level: In 2004, 17 counties had no practicing psychiatrist, and 43 counties had no child psychiatrist. Most psychiatrists work near one of the state's four mental hospitals or close to a major medical center.
In addition, between 1999 and 2004, the report said, five counties lost all of their psychiatrists and 48 counties experienced a decline in their supply relative to population growth; 12 counties had no psychiatrists in either 1999 or 2004.
"Taken together," the authors said, "these data mean that in the last five years nearly two-thirds of North Carolina's counties have experienced a decline in psychiatrist supply or have had no psychiatrists."
The researchers concluded, however, that state psychiatric residency training programs and their AHEC community psychiatry rotations provide a relatively high yield to adding to the state's psychiatric work force. "Given current shortages, it is important for psychiatry residencies to maintain or increase their number of graduates and for policy-makers to explore mechanisms to encourage these graduates to enter practice in North Carolina."
Other considerations listed in the report that might address these work force shortages include:
- Pursuing telemedicine and other psychiatric consultation models for primary-care providers and other clinicians that are financially sustainable.
- Developing new educational programs for other health professionals, such as nurse practitioners and physician assistants, with competencies in mental health care.
- Fostering mechanisms to reduce the isolation of psychiatrists in practice settings.
Katie Gaul, a research associate at the Sheps Center, also was a co-author on the report.
To view the report, visit www.shepscenter.unc.edu/hp
Note: Contact Fraher at (919) 966-5012 and Swartz at (919) 684-8676.
Sheps Center contact: Christine Shia, (919) 843-7661
Duke University Medical Center contact: Tracey Koepke, (919) 660-1301
UNC News Services contact: Lisa Katz, (919) 962-2093
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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