Medical Director Institute The Psychiatric Shortage Causes and Solutions March 29, 2017 | Updated March 1, 2018 Table of Contents The Psychiatric Shortage: Causes and Solutions March 28, 2017 Introduction...............................................................................................................................................................1 National Council Medical Director Institute........................................................................................................1 Initial Charge of the Medical Director Institute..................................................................................................1 Expert Panel............................................................................................................................................................2 Terminology for Persons Receiving Services, Providers Delivering Services and Problems Addressed.....3 Summary.................................................................................................................................................................3 Executive Summary.................................................................................................................................................4 Environmental Scan...............................................................................................................................................4 Access to Psychiatric Services in Outpatient Psychiatric Programs, Hospital Emergency Departments and Inpatient Psychiatric Units..................................................................................................................................4 Workforce................................................................................................................................................................4 Training....................................................................................................................................................................5 Consequences of Lack of Access..........................................................................................................................5 Conclusions on Access and Environmental Scan...............................................................................................5 Solutions, Recommendations and a Call to Action............................................................................................6 3i D92053NCBH_E-Version.indd 3 3/29/18 12:45 PM Environmental Scan ................................................................................................................................................9 Access to Psychiatric Services ..............................................................................................................................9 Extended Wait Times for Psychiatry in Outpatient Clinical Settings ...............................................................9 Lack of Access in Emergency Departments .................................................................................................... 10 Access for Children and Families ...................................................................................................................... 11 Access for Referring Primary Care Clinicians .................................................................................................. 11 Lack of Access to Inpatient Psychiatric Beds .................................................................................................. 11 Summary ............................................................................................................................................................. 11 Workforce ............................................................................................................................................................... 12 Workforce Trends and Projections to Meet Demand .................................................................................... 12 Geographic Populations with Inadequate Access to Psychiatry ................................................................... 12 Populations Served by the Existing Workforce ............................................................................................... 12 Influences on the Psychiatric Workforce ......................................................................................................... 14 Burnout of Psychiatrists ..........................................................................................................................................14 Rates and Methods of Reimbursement for Psychiatric Services .........................................................................15 Documentation Requirements and Regulatory Restrictions................................................................................17 Gaps in Residency Training ............................................................................................................................... 17 Workforce of Other Providers .......................................................................................................................... 20 Consumer Experience ........................................................................................................................................ 20 Consequences of Problems Identified in the Environmental Scan .....................................................................20 Conclusions on Access and Environmental Scan ........................................................................................... 21 The Shortage of Psychiatrists Will Only Increase. .....................................................................................................21 Summary ............................................................................................................................................................. 24 Solutions ............................................................................................................................................................. 25 Overview of Solutions ........................................................................................................................................ 25 Expanding the Psychiatric Workforce .............................................................................................................. 25 Recruitment........................ ......................................................................................................................................25 Updating Psychiatry Residency Training ..................... .........................................................................................26 Expanding Workforce of Other Providers......... ....................................................................................................27 Increasing the Efficiency of the Delivery of Psychiatric Services .................................................................. 28 Telepsychiatry ...........................................................................................................................................................28 Open Access Scheduling...........................................................................................................................................28 Adequate Staff Support to Increase Psychiatrist Efficiency .................................................................................29 Improving Capacity to Share Information .............................................................................................................29 Reducing Excessive Documentation Requirements ..............................................................................................29 ii iii5 D92053NCBH_E-Version.indd 4 3/29/18 12:45 PM Table of Contents Expanding Innovative Models of Delivery of Psychiatric Care ...................................................................... 30 Collaborative Care Model for Integrating Primary Care and Behavioral Health ..............................................30 Reducing Stigma in the Primary Care Setting .......................................................................................................30 Early Intervention and Prevention ..........................................................................................................................30 Colocation of Primary Care and Psychiatry ..........................................................................................................31 Shift in Culture from the Mental Health Clinic to the Primary Care Setting ......................................................31 Measurement-based Care .......................................................................................................................................31 Use of Emerging Technologies ......................................................................................................................... 33 Reducing Psychiatrist Burnout and Optimizing Retention ............................................................................ 33 Finance and Reimbursement ............................................................................................................................ 33 Regulatory Barriers and Opportunities ........................................................................................................... 34 Mental Health Parity and Access ............................................................................................................................34