A shortage and maldistribution of psychiatrists is of critical concern within the behavioral health workforce. There is a growing shortage of total psychiatrists, as well as those with sub-specialized training in geriatric, child and adolescent, and addiction psychiatry. Recruitment and retention factors are a continuing concern in this field due to burnout, time needed for sub-specialization training, and lack of incentives to raise interest among medical students. Additionally, differential recruitment patterns and challenges may contribute to the maldistribution of providers across the country.
This project focused on the total supply and location of psychiatrists as well as three psychiatric subspecialities: child and adolescent psychiatrists, addiction psychiatrists, and geriatric psychiatrists. This study enumerated this workforce on the national, state, and county level as well as in rural areas. Researchers utilized American Medical Association Physician Masterfile data to develop reports of active physicians who identify as psychiatrists, child/adolescent psychiatrists, geriatric psychiatrists, or addiction psychiatrists per U.S. county.
After the passage of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act, behavioral health coverage has expanded to cover more U.S. citizens. However, access to behavioral health services remains an issue, owing in part to maldistribution of the workforce. The psychiatric workforce, in particular, is in the middle of a professional shortage, which is projected to worsen by 2025. Rural populations appear to be more affected by this shortage than metropolitan populations. This study sought to map the precise amount of psychiatrists, child and adolescent psychiatrists (CAPs), geriatric psychiatrists (GPs), and addiction psychiatrists (APs) per county, and to test whether the proportion of these providers varied significantly between urban and rural areas.
Data for this study were purchased from the American Medical Association Masterfile in May 2018. County population estimates were drawn from the U.S. Census bureau. Rural/metropolitan designations were taken from the Federal Office of Rural Health Policy. Supply estimates for total psychiatrists, CAPs, GPs, and APs were mapped across U.S. counties. Maps depict the ratio of providers per 100,000 population at the county level for the four psychiatrist types and two-sample t-tests were conducted to compare the proportions of these providers in rural and urban counties.
Approximately 41,133 psychiatrists were actively practicing in the U.S. within 1,397 counties (44.4% of all counties), 9,956 CAPs were actively practicing within 828 counties (26.3% of all counties), 1,265 GPs were actively practicing within 321 counties (10.2% of all counties), and 836 APs were actively practicing within 230 counties (7.3% of all counties). Psychiatrists of all categories were primarily located within the northeastern U.S. and within some counties along the west coast. The difference in the average supply of each type of psychiatrist per 100,000 metropolitan and rural county residents was statistically significant (p<0.01), suggesting that rural counties had a significantly lower proportion of psychiatrists per resident than metropolitan counties.
Studies suggest that psychiatrists are likely to practice in the state they completed their residency. To this end, the Health Resources and Services Administration has built several federal incentive programs to move psychiatric residents out into medically underserved and health professional shortage areas. Data from these programs could inform other potential policy interventions. Creating stronger partnerships among rural provider sites and medical programs could channel more psychiatric residents to rural areas, alleviating the country’s maldistribution of psychiatric providers. Telepsychiatry could also leverage existing psychiatric capacity in a way that addresses issues of geographic maldistribution, provided its infrastructure and regulations are established and favorable.