Many health professionals realize that there is a shortage of psychiatrists as well as other behavioral health providers. The shortage in mental health services includes nurse practitioners (NPs), physician assistants (PAs) and advanced practice registered nurses (APRNs).
This trend is particularly troubling due to the fact that demand for mental health and substance use treatment services is only increasing across the United States. However, there are a few ways to alleviate this problem. Below are three proposed ways to remedy the problem with a lack of behavioral health providers.
[1] Expanded the number of NPs, PAs, and APRNs:
The idea here is to extend the reach of behavioral health treatments, mainly by creating more mental health professionals. One of the more direct solutions to the shortage problem is to allocate more responsibility and leadership to what are traditionally known as midlevel providers. The National Council for Behavioral Health has advocated that physician assistants with psychiatric training are one of the more scalable solutions for the shortage problem.
According to the National Council, the length of training for physician assistants “is the shortest of the psychiatric prescribers, they represent one of the most cost-effective solutions to the shortage of psychiatric workforce.” By just adding more advanced practice PAs, patient wait times to see a behavioral health practitioner should dramatically drop.
The addition of more nurse practitioners and advanced practice registered nurses would only further decrease patient wait times. However, this potential source of help for psychiatric practices does have some significant hurdles to overcome. The regulation of where and what mid-level providers can perform varies state by state.
For example, nurse practitioners do not possess full practice authority in all 50 states. Often, they must partner with psychiatrists and work under them. At the time of publication, a total of 21 states and the District of Columbia grant NPs full practice authority. This granted authority allows these behavioral health providers to diagnose, treat, order diagnostic tests and prescribe to patients without any physician oversight.
In other states, these same NPs can only work (collaborate) in behavioral health facilities under the direction of a supervising psychiatrist. Yet, other states restrict an NP’s ability to prescribe medications that are deemed too dangerous.
However, new federal regulations are making it easier for specially trained NPs and PAs to prescribe powerful drugs like Buprenorphine, which is used to treat opioid addiction, moderate acute pain and moderate chronic pain. In addition, the Veterans Administration recently extended full practice authority to nurse practitioners in all VA hospitals, regardless of the facility’s location.
[2] Expand Telehealth and Telepsychiatry Services:
The rapid advancements in internet and communication technology have allowed for the implementation of distance medicine. The Mayo Clinic defines telehealth “using digital information and communication technologies, such as computers and mobile devices, to manage your health and well-being.
Telehealth, also called e-health or m-health (mobile health), includes a variety of healthcare services.” As the Millennials and X generation of Americans age, they will increasingly expect the on-demand, digital services that they have experienced in other areas of their life.
The use of telepsychiatry can fill this desire for quick and seamless access to behavioral health treatments. Currently, telepsychiatry services are ready to expand across the nation, but regulations and reimbursements restrict the use of this service. Currently, telepsychiatry services are ready to expand across the nation, but regulations and reimbursements restrict the use of this service.
For example, it is a challenge for mental health providers to deliver treatments across state lines. In order to do this, the health professional must be licensed in all of the states where the digital delivery of treatment is occurring. This is a substantial barrier for many behavioral health practitioners. As is often the case with new technologies, our regulatory systems, practices and laws usually lag behind.
At an efficiency level, telepsychiatry could quickly reach underserved areas in the United States and alleviate areas with shortages of behavioral health professionals. This means that insurance providers would have to update their policies on telepsychiatry, especially as the technology continues to mature and infrastructure to support it expands.
Traditional behavioral health practices would be able to capitalize on the efficiency and scalability of telepsychiatry. This expansion of digital treatments could quickly and inexpensively help with the shortage of behavioral health practitioners. Especially for patients who reside in remote or hard to access locations.
[3] Increase Behavioral Health Reimbursement Rates:
The funding levels and overall reimbursement rates from insurance providers is a major barrier for expanding the number of behavioral health options. Often, psychiatry and other behavioral health services are reimbursed at a lower rate, versus what a primary care physician (PCP) are paid.
This variance in rates is even evident in the evaluation and management codes, with PCPs often receiving a higher reimbursement rate for services rendered. In addition, insurance providers will only pay an NP or PA 85 percent of what a psychiatrist is reimbursed for the same procedure. This economic reality places downward pressure on the supply of mental health practices.
One way to decrease the shortage of behavioral health professionals is to incentivize the career choice. The economic laws of supply and demand have a powerful impact on careers and workforces. Currently, the average age of a psychiatrist in the United States is about 55 years old. Higher reimbursement rates for psychiatric treatments would grow the amount young people who wish to pursue a career as a behavioral health professional.
These three solutions are not conclusive, but they are a step in the right direction.
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For additional reading on the shortage of behavioral health providers:
The Psychiatric Shortage and Behavioral Health
VA Grants Full Practice Authority to Advance Practice Registered Nurses
Midlevel practitioners help workforce shortage in Psychiatry
Telehealth: When technology meets health care
Fixing the psychiatrist shortage requires multifaceted solution
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