MUSC-led study finds adult psychiatry shortage likely to get worse as need grows

A study led by the Medical University of South Carolina shows just how serious the shortage of psychiatrists for adults may become. It found that from 2024 to 2037, the supply may decrease by about 12% while the demand may rise a stunning 43%.

That raises important questions, said lead researcher Jason Silvestre, M.D. “There's this huge need. What can we be doing as a community of allied health professionals? Where can we increase the residency training pipeline?”

The study’s findings

The study, done in collaboration with the University of Pennsylvania’s Perelman School of Medicine, analyzed data from the federal government’s Health Workforce Simulation Model. The model estimates the supply of and demand for health care workers by profession, location and year.

It found:

-In 2024, non-metro areas had less access to adult psychiatrists than more populated areas.
-That disparity was likely to get worse by 2037.
-The Midwest and South are way behind the Northeast in terms of supply and demand. “Workforce adequacy,” meaning what percentage of the need is filled, was 57% in the Midwest and 60% in the South. In contrast, the Northeast has more than enough psychiatrists who treat adults – 101% adequacy.
-By 2037, things are projected to get worse everywhere. The Midwest would be down to 36%, the South to 35% and the Northeast 63%.

The study also broke down the statistics by state. It found that in 2024, the states with the biggest imbalance between supply and demand were North Dakota, New Mexico and Oklahoma. By 2037, the top three would shift to Idaho, Nevada and Alaska.

In South Carolina, where the study was based, the adequacy of the workforce of psychiatrists who treat adults was 77% in 2024 but projected to drop to 64% by 2037. In other words, things are expected to get worse.

What the researchers suggest needs to be done

To address the projected deficiencies, the researchers suggested several strategies:

-Increasing the number of psychiatry residency training positions. It’s a competitive field with more qualified applicants than residency openings.
-Making it more attractive for psychiatrists to work in states that need them. That could be through incentives like expanding student loan forgiveness programs and creating visa work programs.
-Finding ways to get mental health services to patients in areas that don’t have enough psychiatrists with the help of technology and advanced practice providers such as nurse practitioners and physician assistants.
-Passing laws to let psychiatrists offer telehealth in states where they don’t have a physical presence.
-Encouraging psychiatrists to be part of public insurance networks. Right now, lower reimbursement rates from Medicare and state Medicaid programs may be causing some psychiatrists to opt out.
-Easing administrative burdens.

Silvestre, a former management consultant who has looked at the workforce adequacy of other professions as well, said this one stands out. “One of the hallmark findings of our study was that relative to the 25 different specialties that we looked at, psychiatry was ranked dead last by a pretty big margin. That highlights the number of psychiatrists that are retiring and the increase in prevalence of mental health burden in the U.S. population.”

Easing that burden will be crucial, Silvestre said. “Timely access to psychiatry care is paramount to improving mental health outcomes.”

What MUSC is doing

Edward Kantor, M.D., vice chair for education & training and residency director for the MUSC Department of Psychiatry and Behavioral Sciences, wasn’t surprised by the study’s findings. “There's a psychiatrist shortage across many subspecialties,” he said.

Hospitals and academic medical centers with residency programs are trying to address it. “There are a lot of new programs starting. We've gone from maybe 195 to well over 300 across the country in the last eight years. So there are more training programs overall, and more established programs like ours are trying to increase our positions,” Kantor said.

MUSC is already in the top 10 nationally when it comes to the number of psychiatry residency slots available, with 14 first-year positions. “We tend to have a national draw because the department is pretty big in psychiatry research and well known. I think we’re between No. 7 and 1 in the country for research funded departments of psychiatry.”

And Kantor said new subspecialties within psychiatry at MUSC are helping to expand future psychiatrists’ options. “So we have women's reproductive psychiatry now, which is a major area that never existed even five years ago. We're one of the few places in the country with a reproductive fellowship after residency. Brain stimulation – we’re world leaders in neuromodulation, sometimes called interventional psychiatry, defining the field really. Our group is working in areas not yet available anywhere else.”

Another appealing factor in his field, according to Kantor: Psychiatry is on the cusp of a major change. “We had a big change in the ‘90s. We used to be separate from medicine – we didn't really do much medical care – mostly psychotherapy. Then shifted to more medically-based psychiatry. Now we're moving into procedures, like TMS, which were historically limited in psychiatry. Newer techniques are safer and seem to be even more effective for a number of serious illnesses, like mood and substance use disorders.”

He hopes the momentum from that change will draw more people to the field. In the meantime, Kantor encouraged medical schools to make sure they expose students to enough psychiatry, so they’ll consider it as a profession. “If you’ve never seen it, why would you choose it?”

People who do choose psychiatry tend to be happy in their profession, according to the website Career Explorer. But Silvestre said there’s no question that this study points out a problem that must be tackled from many angles.

“If you don't address this, I think you're going to have a lot of unmet need and perhaps some devastating consequences to a population that is experiencing more and more mental health burden. So, I think it's a tale of caution as well.”