Since 2018, the US Department of Health and Human Services has been projecting that the supply of psychiatrists will not be enough to meet mental health needs.
Over the last two decades, changing workplace culture, the introduction of technologies like social media, and the Covid-19 pandemic have taken a massive toll on our collective mental health. By 2036, the US will be short 42,130 psychiatrists, according to research from the federal National Center for Health Workforce.
“Whenever there is uncertainty in society or polarization, worsening economic situations, more natural disasters, dislocations, all of those things will contribute to an increase in psychiatric illness,” Robert Trestman, chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing, told Healthcare Brew.
Pipeline problems
Psychiatry has not traditionally been a top choice for medical students, partly because of the low pay and high burnout, according to the Health Resources and Services Administration (HRSA). In 2024, the National Resident Matching Program reported that psychiatry received 3,246 of the 66,816 residency applications across the country. Internal medicine received 15,451 applications by comparison.
The amount of residency matches has been increasing in the last few years, though. In 2024, there were about 1,823 available spots for psychiatry residents, according to a white paper by healthcare staffing company Medicus, a 5% increase from last year at 1,746. But the distribution of these to-be psychiatrists is uneven: As of December 2023, HRSA estimates that 169 million people in the US live in “health professional shortage areas” where there is an unmet need for health professionals in the geography, facilities, or populations.
Plus, working psychiatrists skew older: some 70% are over age 50, according the US Chamber of Commerce “What we see on the ground is there is a real and significant concern about retirement for some of the current practicing psychiatrists,” Adrian Jacques Ambrose, chief clinical integration officer for the psychiatry department at Columbia University Medical Center, told Healthcare Brew.
The Centers for Medicare and Medicaid Services (CMS) has made efforts to add new Medicare-funded residency slots in underserved communities—in the first round, which went into effect July 2023, 20 of the 200 slots were allocated for psychiatry. Professional organizations like the American Medical Association and the American Psychiatric Association are pushing for additional legislative approaches to address shortages by increasing resources for training programs and providing more visas for internationally trained medical students and doctors.
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“We cannot magically expand the number of slots unless they’re paid for and there are enough teachers,” Trestman said. “Psychiatry is an investment. Psychiatry at this point does not make anything like neurosurgery. So actually, it costs healthcare systems money to provide expanded psychiatric care.”
Stop-gap solutions and beyond
Ambrose and Trestman agree that telemedicine and collaborative care models are two possible solutions for expanding access to psychiatric services.
Ambrose said telemedicine allows psychiatrists to extend services to underserved rural communities so patients don’t have to drive hours to a treatment center. Psych urgent care can also be offered as a telehealth service.
Another way to stretch a hospital’s psychiatry resources is to coordinate care with other departments. One model developed initially at the University of Washington, for example, utilizes a diverse network of care providers and brings in psychiatrists to consult on complex issues like medication management or symptom monitoring.
Importantly, it’s also a model CMS will fund, Trestman said. One study in AJMC found that these collaborative care models did not increase overall healthcare costs. Another study in the Journal of General Internal Medicine said that the models could even “result in lower costs through decreased utilization of emergency department and inpatient hospital services.”
Working with psychologists, therapists, social workers, nurse practitioners, community health workers, and peer recovery specialists to manage care at different levels can reduce overall burden on psychiatrists, Trestman said.
But the degree to which hospitals can use these care providers varies by state. For instance, in some states like New York, psychologists have limited prescribing abilities.
“The problem has been that our nation, frankly, sees healthcare as a commodity, not a human right. So there isn’t the underlying organizational structure to make it coherent,” Trestman said. “It’s not like there’s a national licensing standard, so there are many impediments to the consistency that we see, and what you’re seeing is a consequence of the system’s design.”