Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to fix the psychiatrist shortage in the U.S.

Glenn Mark Losack, MD
Physician
June 27, 2022
Share
Tweet
Share

Mental health disorders are by far the largest cause of disability in the world. More money is spent on mental health than either diabetes or cardiovascular disease. About 45 million people in the U.S. have a mental illness. Almost every American will, at some point or another, face a mental health challenge. It may be related to depression, anxiety, suicidal thoughts, substance abuse or maybe something more circumstantial like grief over a loss or trouble adjusting to a life change.

Now imagine there wasn’t a psychiatrist or psychologist miles around. This is what life is like in rural America in 2022.

A majority of non-metropolitan counties do not have a psychiatrist.

In rural America, mental health issues are many times treated only when they become a full-blown crisis. Rural areas have a higher suicide rate than non-rural areas, a disparity that has been widening since 2001.

Common psychiatric disorders have a higher prevalence in impoverished, lower socioeconomic status (SES) areas. These patients also tend to receive less specialty care for mental health and instead rely on acute hospital care for medical and psychiatric needs.

Due to a growing elderly patient population aged over 65, there will be greater demand for psychiatrists. The paucity of psychiatrists has led to the rise in psychiatric nurses and PAs performing exactly the same work as board-certified psychiatrists.

Psychiatric services are essential in nursing homes because of the potentially aggressive behavior, psychosis, depression, dementia and other psychiatric symptoms these patients exhibit. Many nursing homes do not have on-site services of a geriatric psychiatric provider.

Veterans and prisoners face greater difficulties gaining access to adequate psychiatric care. Veterans can face difficulties traveling to receive care due to poor public transportation, disabling medical conditions, time constraints, and fear of the mental health stigma secondary to reduced privacy in rural settings.

Getting psychiatrists to work in prisons is a difficult task.

Prisons (mostly found in rural areas) have often been called the “largest psychiatric institution.” I have worked in the prison system for 30 years. The mentally ill are overrepresented in correctional settings, and so there are now more individuals with a serious mental illness in prisons and jails than there are in state mental hospitals.

Suicide, suicidal ideation and self-harm are more prevalent in prison populations than in the general population.

Working as a telepsychiatrist in rural areas of the U.S.

I have worked as a locum tenens since 1995. Locums exist because there simply aren’t enough psychiatrists in the nation. And very few are willing to work in rural areas/prisons etc. Since 2014, from my home in Manhattan, I have treated patients remotely in a very underserved rural community. I evaluate and treat patients with all types of mental illness the same way I would if I was directly in front of the patient. The technology is excellent, and I have a very well-trained nurse always present while the patient is in the office.

During the COVID and during the lockdown, I have had to call many patients to start them on medications and monitor their progress. This would be a major challenge for any specialist.

Therapists, drug and alcohol treatment, partial hospitalization and psych rehab programs are available in this rural clinic.

Both patient and provider acceptance of telepsychiatry is high when measured via surveys given out at the clinic. Many of the negative attitudes concerning telepsychiatry do not manifest themselves in practice indicating that a vital part of the patient-provider relationship in psychiatry can exist even over videoconferencing.

The barriers or obstacles of getting mental health services in rural America

Rural America is quite poor and uneducated. Many who need treatment do not get it until it’s too late. There are insurance snags, dwindling health care funding, hospital and facilities closing, high non-compliance, serious transportation difficulties, the “stigma” attached to having a psychiatric illness, substance abuse and above all, not enough mental health practitioners. In addition, MDs are reimbursed less for services provided to Medicaid and Medicare patients, which further decreases the number of psychiatric practitioners who will accept these patients.

Pitfalls of PCPs treating mental illness in rural USA

Most patients receiving treatment for psychiatric issues are treated solely by primary care providers.

PCPs are not trained in the usage of psychiatric medications. Many PCPs wait a long time — if at all — to refer a patient to a psychiatric physician. Because of the shortage of psychiatrists, these services may be the only option for psychiatric treatment. Studies have found that primary care providers routinely fail to recognize and diagnose psychiatric disorders. I have found that many PCPs prescribe a lot of benzodiazepines and stimulants to appease the patient and provide short-term alleviation of their symptomatology which simply puts a band-aid on a gaping wound. They use low doses of psychotropics that are never raised, modified or changed.

Why a shortage?

The reasons for a shortage of psychiatrists in the rural areas of the U.S. are numerous. Most psychiatrists prefer to practice in big cities or suburban areas. Psychiatry is not high on the list of graduating medical students seeking residency. Most psychiatrists don’t trust telepsychiatry, and unless face to face with a human being, it’s not adequate treatment.

Telepsychiatry

Telepsychiatry is a well-recognized and established method of providing mental health care and is in use in all areas of the United States and in many other countries worldwide. The American Psychiatric Association (APA) fully endorses video conferencing as an effective means of psychiatric health care delivery.

Studies have shown that telepsychiatry, in the form of live videoconferencing, is overall as efficacious as face-to-face psychiatry in every direct comparison assessing psychiatric disorders such as depressive disorder, substance abuse, bipolar disorder, psychotic disorder, and anxiety disorder.

The ability to reduce or eliminate the distance between patient and provider increases access to clinical care, minimizes costs and improves veterans’ quality of life. It’s effectively equivalent to those delivered face-to-face in a clinic, including levels of participant satisfaction with treatment and symptom improvement. Labs and pharmacies all benefit from telepsychiatry. Hospitals that outsource mental health services via telepsychiatry experience cost savings and better meet their specific patient population’s cultural and specialty needs.

Glenn Mark Losack is a psychiatrist and author of The Bonds We Share: Images of Humanity, 40 Years Around the Globe.

Image credit: Shutterstock.com

Prev

Physicians need to be trained as entrepreneurs and encouraged to innovate [PODCAST]

June 26, 2022 Kevin 0
…
Next

Get ready for a COVID culture shock

June 27, 2022 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Physicians need to be trained as entrepreneurs and encouraged to innovate [PODCAST]
Next Post >
Get ready for a COVID culture shock

More by Glenn Mark Losack, MD

  • Leprosy: a disease that turns hands into paws, feet into stumps, and eyes into darkness

    Glenn Mark Losack, MD
  • A physician’s photo essay from his travels around the globe

    Glenn Mark Losack, MD
  • San Pedro de Macoris: a physician’s photojournal

    Glenn Mark Losack, MD

Related Posts

  • We are on the brink of a crisis-level physician shortage in the United States

    Jamie Katuna
  • The health care system will cause its own physician shortage

    Advait Suvarnakar and Aashka Suvarnakar
  • How to tackle the physician shortage

    Sujan Gogu, DO and Aishwarya Sivaramakrishnan
  • The J-1 work exemption: a flawed solution to the physician shortage

    Gregory Tan
  • Patient autonomy in times of shortage

    Deepak Gupta, MD
  • Why the baby formula shortage happened

    Divya Srinivasan and Tejas Sekhar

More in Physician

  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • How to overcome telemedicine’s biggest obstacles

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Senators Press Moderna's CEO to Drop COVID Vaccine Price
  • Senators Press HHS Chief on Alzheimer's Drugs, Opioids at Budget Hearing
  • Despite Abortion Restrictions, Ob/Gyn Remains Competitive Residency
  • Cholera Outbreak Widens; What Beethoven's DNA Revealed; Grindr's Free HIV Tests

Meeting Coverage

  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How to fix the psychiatrist shortage in the U.S.
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...