Psychiatric Workforce Research Articles

Trends in Psychiatrist-Led Care for Medicare Part B Enrollees

The rising incidence of mental illness in the US underscores the need for timely access to psychiatric care, especially for vulnerable populations such as older adults and individuals with mental and physical disabilities who receive Medicare. To assess changes in the number and proportion of active psychiatrists providing professional services to traditional Medicare Part B enrollees from 2014 to 2022. This repeated cross-sectional study of Medicare Part B enrollees used publicly available data (for January 1, 2014, through December 31, 2022) from the Centers for Medicare & Medicaid Services and the Kaiser Family Foundation. Data from all traditional Medicare Part B enrollees in all 50 states and the District of Columbia were analyzed. Primary outcomes included changes in (1) the proportion of active psychiatrists billing traditional Medicare and (2) the number of psychiatrists providing care relative to the number of Medicare Part B enrollees nationally, regionally, and by state. The study population comprised 291 748 472 Medicare Part B enrollee-years (33 042 936 in 2014: 5 800 903 [17.6%] eligible due to disability alone and 27 242 030 [82.4%] eligible due to age). From 2014 to 2022, the number of Medicare Part B enrollees decreased by 3 497 942 enrollee-years (10.6%), while the number of psychiatrists submitting more than 10 claims to Medicare Part B decreased by 3772 (16.8%). The nationwide proportion of professionally active psychiatrists submitting claims to Medicare Part B for professional services during this period declined from 22 409 of 50 416 (44.4%) in 2014 to 18 637 of 56 492 (33.0%) in 2022 (P < .001 on univariable regression). From 2014 to 2022, state-level changes in Medicare Part B-serving psychiatrists per enrollee ranged from a 31.7% increase in Alabama (from 36.5 to 48.1 psychiatrists per 100 000 enrollees) to a 67.8% decrease in Wyoming (from 42.9 to 13.8 psychiatrists per 100 000 enrollees). Every state and district assessed saw a decrease in the percentage of active psychiatrists who billed Medicare Part B for professional services over the study period. In this study of Medicare Part B acceptance among active US psychiatrists, declining acceptance of Medicare Part B for professional services among psychiatrists was observed nationally and across all states. During a time of psychiatrist workforce growth, the number of psychiatrists accepting traditional Medicare decreased, indicating potential challenges in providing equitable access to psychiatric care.

Difficult to Treat Depression: Focus on Approach, Algorithms, and Access.

The pandemic refocused interest on the burden of depression across the lifespan; the increased efforts to prevent and treat depression are now a priority of health care systems, insurers, patient advocates, digital therapeutic engineers, telemedicine platforms, and community health agencies. However, the challenges of treating depression to remission in adult patients who do not respond to first, second, or third levels of oral pharmacotherapy remain. The increased prevalence of these conditions is at odds with the shrinking psychiatric workforce. Since addressing difficult to treat depression is situated in a rapidly evolving treatment landscape, The University of Arizona College of Medicine-Tucson Department of Psychiatry organized and hosted the Southwest Forum on Difficult to Treat Depression: Focus on Approach, Algorithms, and Access in July 2024. The Forum convened 11 internationally renowned experts in the science and treatment of depression, in particular difficult to treat depression, for a day of teaching and discussion. Based on their expertise, participants were asked to address one of the following three themes: (1) Novel Mechanism Approaches for Difficult to Treat Depression, (2) What Do I Do Next? Evidence-Informed Algorithms to Get Patients Better Faster, and (3) Access: Providing Comprehensive Depression Care Across the Spectrum of Clinical Severity.

Psychiatric Care, Training and Research in Aotearoa New Zealand

Abstract Objective: Aotearoa New Zealand, a commonwealth country, is situated in the South Pacific Ocean, in the southwestern most part of Polynesia. The country comprises two main islands – the North and South Islands – with total population of 5 million. Within this context, the authors describe mental health (including indigenous Māori perspective), psychiatrist training, mental healthcare system, and recent research in New Zealand. This review is intended to familiarize the readers of the Taiwanese Journal of Psychiatry with the current status of psychiatric practice in New Zealand. Methods: The authors of this review collected and reviewed relevant literature on psychiatric care, education, training, and research in New Zealand. In addition, official government publications, such as reports from the Stats New Zealand and Ministry of Health, were examined to gather relevant data. Results: After providing a brief overview of New Zealand’s geography and history, the authors describe two major ethnic groups, New Zealanders of European descents, and the Māori, who are descendants of Polynesian settlers. Then, the prevalence of psychiatric diseases, trainings for the psychiatrist workforce, the Royal Australian and New Zealand College of Psychiatrists, the New Zealand Mental Health Act, and recent psychiatric research are highlighted. Conclusion: New Zealand, with dominant European and Māori cultural groups and an emerging Asian population, has a growing, diverse population. Its universal healthcare system, restructured in 2022 under Te Whatu Ora (Health New Zealand) is aimed at enhancing efficiency and equity but faces challenges like Māori underrepresentation in the psychiatry workforce and rising demands from the growing Asian community. While mental health issues have gained government attention, future advancements are needed to improve psychiatrist recruitment and retention, enhance equitable service delivery, strengthen mental health laws, and increase psychiatry funding.

I am the psychiatric patient and the psychiatric patient is me: Retelling a lived experience narrative of professional sexual misconduct.

WHAT IS KNOWN ON THE SUBJECT?: Professional sexual misconduct is the name given to the phenomenon of healthcare providers crossing sexual boundaries with their patients. It is comprised of a range of behaviors from comments to unwanted touching and even rape. The exact incidence is unknown, but estimates have been made. These abuses are thought to be underreported. The applicable reporting processes are problematic. Trauma-informed care presupposes knowledge of various types of trauma, and this is one type. Traua-informed care places emphasis on healthcare systems and healthcare providers' avoidance of retraumatizing patients who disclose any type of trauma, including sexual violence. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper adds one narrative experience of a sexual assault perpetrated by the writer's colleague psychiatrist. It can be viewed as a cautionary tale about horizontal violence against nurses. This narrative discusses how one traumatic event can mushroom into chronic traumatic sequelae when disclosure re-traumatizes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increased knowledge of this type of sexual violence may help those who have suffered it. As psychiatry is among the healthcare fields who regularly screen patients for trauma, it is imperative that the psychiatric workforce gain familiarity with trauma-informed responses to avoid re-traumatizing patients who disclose sexual violence.

Addressing the Health Needs of LGBTQ Persons in Medical Curricula: A Review of Educational Programs.

Given the vulnerability of and the importance of caring for the specific health care needs of the growing lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, the authors attempted to identify all educational interventions in psychiatric settings with quantitative outcomes targeting medical students, residents, and physicians in postgraduate settings. To gain insight from other disciplines that have published research in this area, a second objective was to review studies in teaching in those other disciplines. The authors sought to describe the methods of selected studies. The authors searched the published English-language literature indexed in PubMed, EMBASE, and PsycINFO using key terms for health care education concerning LGBTQ populations. The authors described and critically appraised studies with quantitative outcomes designed to enhance knowledge, skills, and attitudes in treating the LGBTQ community. Of the 15 trials identified, 10 included medical students, 4 included internal medicine residents or medical school faculty, and 1 included oncologists. We did not find any randomized controlled trials or controlled nonrandomized trials of curricula dedicated to teaching learners in psychiatry. All of the studies included a presurvey, followed by an educational intervention and then a postsurvey assessment. The educational interventions, outcome measures, and quality of studies varied widely. Four studies enrolled self-identified members of the LGBTQ community as trainers and facilitators of the educational interventions. The lack of high-quality controlled studies indicates the need to develop evidence-based curricula to support the education of the psychiatric workforce to provide for the special needs of LGBTQ persons.

Navigating merits and limits on the current perspectives and ethical challenges in the utilization of artificial intelligence in psychiatry – An exploratory mixed methods study

BackgroundThe integration of Artificial Intelligence (AI) in psychiatry presents opportunities for enhancing patient care but raises significant ethical concerns and challenges in clinical application. Addressing these challenges necessitates an informed and ethically aware psychiatric workforce capable of integrating AI into practice responsibly. MethodsA mixed-methods study was conducted to assess the outcomes of the “CONNECT with AI” - (Collaborative Opportunity to Navigate and Negotiate Ethical Challenges and Trials with Artificial Intelligence) workshop, aimed at exploring AI's ethical implications and applications in psychiatry. This workshop featured presentations, discussions, and scenario analyses focusing on AI's role in mental health care. Pre- and post-workshop questionnaires and focus group discussions evaluated participants' perspectives, and ethical understanding regarding AI in psychiatry. ResultsParticipants exhibited a cautious optimism towards AI, recognizing its potential to augment mental health care while expressing concerns over ethical usage, patient-doctor relationships, and AI's practical application in patient care. The workshop significantly improved participants' ethical understanding, highlighting a substantial knowledge gap and the need for further education in AI among psychiatrists. ConclusionThe study underscores the necessity of continuous education and ethical guideline development for psychiatrists in the era of AI, emphasizing collaborative efforts in AI system design to ensure they meet clinical needs ethically and effectively. Future initiatives should aim to broaden psychiatrists' exposure to AI, fostering a deeper understanding and integration of AI technologies in psychiatric practice.

The changing psychiatry workforce in Australia: Still lacking in rural and remote regions.

There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.

Videos for Psychiatric Education: Could Deidentification Technology Make it Possible to Use Video Recordings of Patients for Psychiatric Education?

The field of psychiatry has been limited in its use of patient videos for educational purposes because essential facial information must be obscured to protect patient privacy, confidentiality, and dignity. This article calls attention to emerging technologies for deidentification of patients in video recordings while still preserving facial expression. Fully anonymized videos could be used to augment the education of psychiatric residents and for continuing education of the psychiatric workforce. This article suggests projects that deidentification technology could make possible; it also outlines some complex problems that would need to be addressed before the field could use this potentially transformative technology.

Project ECHO in Psychiatric Workforce Development: the Example of a Perinatal Mental Health ECHO.

Perinatal mental health and substance use disorders (PMHSUD) often go unrecognized and untreated. This study examined the use of the Project ECHO model to teach obstetric, primary care, and mental health clinicians about screening, diagnosis, and treatment of PMHSUD. Participants in 3years of the University of Washington's Moms' Access Project (MAP) ECHO program (2019-2022) completed pre- and post-program surveys. Nine participants in year 1 completed qualitative interviews. Dedoose was used for qualitative analysis of interviews. Of 136 participants, 62.5% (15/24) completed both pre- and post-surveys in year 1, 56% (28/50) in year 2, and 32.2% (20/62) in year 3. Most respondents agreed or strongly agreed that they were glad to have participated (96.8%; 60/62) and that they had used information learned in the program in treating a patient (95.1%; 58/61). In all years, respondents endorsed increased confidence regarding learning objectives of the program. Qualitative interviews following year 1 yielded themes of hierarchy of competence, motivation versus results of participation, connection, and politics of change: position and practice type. Findings supported the feasibility, acceptability, and self-reported effectiveness of the ECHO model for workforce development in PMHSUD.

Why Does the US Overly Rely on International Medical Graduates in Its Geriatric Psychiatric Workforce?

International medical graduates (IMGs) tend to choose careers in geriatric psychiatry likely because high-quality training and robust mentorship opportunities from other IMGs are available. Geriatric psychiatry offers stable career prospects and opportunities to express humanitarian impulses by working closely with elders. IMGs currently constitute almost a quarter of the psychiatry workforce and approximately 53% of the geriatric psychiatry work force in the United States. However, the number of IMGs entering psychiatry residencies-and, subsequently, geriatric psychiatry fellowships-has recently declined. Overreliance on IMGs in the US geriatric psychiatric workforce means these shortages will further burden an already-limited geriatric mental health care workforce and further compromise US health system capacity to meet its elders' needs.

Pan-Canadian study of psychiatric care (PCPC): protocol for a mixed-methods study

IntroductionThe Canadian population has poor and inequitable access to psychiatric care despite a steady per-capita supply of psychiatrists in most provinces. There is some quantitative evidence that practice style and...

Reflecting on a Big Year for Mental Health

Reflecting on a Big Year for Mental Health

It’s 10 O’clock: Do You Know Where Your State Legislature Is?

It’s 10 O’clock: Do You Know Where Your State Legislature Is?

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Cleveland’s Safety Net Hospital Builds 112-Bed Psychiatric Facility

Back to table of contents Previous article Next article ProfessionalFull AccessCleveland’s Safety Net Hospital Builds 112-Bed Psychiatric FacilityMark MoranMark MoranSearch for more papers by this authorPublished Online:9 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.35AbstractThe new hospital and an enlarged training program mark the largest expansion of behavioral health services in northeast Ohio in 30 years.MetroHealth Hospital in Ohio, founded in 1837, is the safety net hospital for Cleveland and Cuyahoga County, serving more than 300,000 patients, two-thirds of whom are uninsured or covered by Medicare or Medicaid. Last October, the hospital opened the MetroHealth Behavioral Health Hospital to replace the 20-bed psychiatric unit in the old hospital. The Cleveland MetroHealth Behavioral Health Hospital opened last October and will eventually have 112 inpatient beds, cutting the region’s inpatient deficit by more than 50%.Cleveland MetroHealth HospitalThe psychiatry residency training program at MetroHealth received approval from the Accreditation Council for Graduate Medical a (ACGME) to add three new training slots per year, which will increase the total number of residents from 20 to 32. Like the state-funded expansion of the training program at the University of Iowa (see “Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations”), the developments at MetroHealth are evidence that states and municipalities are responding to the shortage of mental health professionals and the need to invest in expanding the psychiatric workforce. Last November, the Cuyahoga County Council approved the use of $5 million from its Opioid Mitigation Fund to construct the $42 million hospital. The council’s $124 million fund is derived from settlements with opioid manufacturers. According to the U.S. District Attorney’s Office for Northeastern Ohio, the county saw a 1,000% increase in opioid deaths between 2007 and 2016. There were 653 overdose deaths in the county in 2022, according to the County Medical Examiner’s Office. Cheryl Wills, M.D., director of child and adolescent psychiatry at MetroHealth, said the new hospital and the expansion of the training program are the result, in part, of a 2018 needs assessment conducted by the hospital’s strategic team. Taking into account existing resources in the region, the assessment showed that Cuyahoga County was short 200 inpatient psychiatric beds. The new hospital is expanding incrementally—40 adult beds became available when the hospital opened in October. Separate 20-bed units for adolescents, patients with substance use disorders, and geriatric patients are expected to open this year.Cleveland MetroHealth Hospital“MetroHealth has a rich history of serving all people, regardless of ability to pay,” said Wills, who is also APA’s Area 4 trustee. “But we were consistently referring people out for mental health treatment because we had only 20 beds. By expanding with the new hospital to 112 beds, we are addressing 50% of the deficit, a huge step.” Raman Marwaha, M.D., the residency training director at MetroHealth, said the developments there mark the largest expansion of behavioral health services in northeast Ohio in 30 years. “When I joined MetroHealth eight years ago, I had a waiting list of 18 months,” said Marwaha, who is president of the APA Caucus of International Medical Graduates. He said the new hospital is moving incrementally toward reaching the total of 112 beds—40 adult beds became available when the hospital opened last October, and at press time a psychiatric-medical unit and a four-bed psychiatric intensive care unit were expected to open. “The plan is in the next six months to open more beds—a 20-bed adolescent unit, a 20-bed addiction unit, and a 20-bed geriatric unit.” Marwaha said that residents in the expanded program, which will be located at the new hospital, will have training rotations in schools, integrated group practices, and the county correctional facility. Attracting residents and, importantly, faculty to help supervise residents is critical. Wills did some detective work and discovered an Ohio state loan repayment program for which physicians who work at MetroHealth would qualify—a lesson, Wills said, for other institutions and localities. “It’s important to think creatively and strategically and to learn about existing available resources,” she said. “When I started at MetroHealth in March last year, one of my concerns was recruitment of the best faculty possible. I felt we had to have something to offer people, to make it attractive to work here. We are hoping to attract psychiatrists invested in working with underserved and safety net populations who will be involved for the long haul.” ■Ohio Physician Loan Repayment ProgramThe Cuyahoga County Medical Examiner’s Report on opioid deathsCuyahoga County Opioid Mitigation FundHeroin Epidemic, U.S. Attorney’s Heroin and Opioid Task Force ISSUES NewArchived

Addressing Psychiatric Workforce Shortages: The Role of Advanced Practice Psychiatric Nurses and Physician Assistants.

Back to table of contents Previous article Next article Controversies in Psychiatric ServicesNo AccessAddressing Psychiatric Workforce Shortages: The Role of Advanced Practice Psychiatric Nurses and Physician AssistantsRachel M. Talley, M.D.Rachel M. TalleySearch for more papers by this author, M.D.Published Online:7 Feb 2023https://doi.org/10.1176/appi.ps.20220599AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Metrics KeywordsNursing/psychiatricEconomicsstaffingPDF download History Published online 7 February 2023

Using social network analysis approach in developing rural psychiatrist workforce

This study examines how rural and remote junior doctors career decisions are influenced by highly connected principles within a discipline. Social network analysis was completed with data collected, by structured interview, with five psychiatry trainees and three early career psychiatrists in a rural location rated MM3 using the Modified Monash Model. UNICET software was used to determine the interactions between individual networks to look for overlap and common influencers. A single central, highly connected, psychiatrist was found at the core of the entire social network. This connector was instrumental in recruitment and retention in rural psychiatry workforce. Improving the understanding of human capital can encourage innovative solutions in developing sustainable strategies for recruiting and retaining rural psychiatry workforces.

Congress Passes Spending Bill With Several APA Priorities

Back to table of contents Previous article Next article Government & LegalFull AccessCongress Passes Spending Bill With Several APA PrioritiesKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:20 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.43AbstractThe $1.7 trillion omnibus package includes many provisions for which APA heavily advocated, including new investments in the psychiatric workforce, collaborative care, and mental health parity.dkfieldingIn December, Congress passed the Consolidated Appropriations Act of 2023 (HR 2617), a massive spending bill that will keep the U.S. government funded through September.The package, which President Joe Biden signed on December 29, includes numerous APA priorities for which it has advocated heavily. They include APA initiatives focused on encouraging implementation of the evidence-based Collaborative Care Model (CoCM), enforcing mental health parity, and bolstering the psychiatric workforce.“These accomplishments as well as many others in the legislation are a great victory for psychiatry and the patients we serve and could not have been achieved without the active engagement of APA members and the dedication of APA staff,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A.Some of the APA priorities in the package include the following:Collaborative care: The package includes grants and technical assistance to implement the CoCM in primary care settings for the prevention of mental and substance use disorders (SUD) and early intervention for treatment.Mental health parity: Grants for state insurance agencies were included in the package to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and ensure that insurers are complying with the federal parity law. The spending package also eliminates the parity opt-out for non-federal governmental health plans.Workforce: The package made significant investments in the medical workforce with the creation of 200 new graduate medical education (GME) residency slots, half of which are designated specifically for psychiatry or psychiatric subspecialties.Telehealth: The package extends the current Medicare telehealth flexibilities instituted due to the ongoing public health emergency. It delays the implementation of the in-person requirement for telehealth services for mental health until December 31, 2024.APA’s members and staff have initiated many of these provisions and actively advocated for them. In May 2022, in her role at the time as incoming APA President, Rebecca Brendel, M.D., J.D., provided expert testimony to the Subcommittee on Health of the House Committee on Energy and Commerce. She spoke about numerous bills that would bolster the nation’s mental health system, explaining that many insurers are not in compliance with MHPAEA and that Congressional action is needed. She also emphasized the importance of integrating mental and physical health care to enhance access and the need of primary care offices for support so they can implement the CoCM (“Incoming APA President Testifies Before House Subcommittee”).In addition, APA members and staff engaged congressional offices and deployed a strong grassroots push to encourage congressional action addressing the psychiatry workforce shortage, resulting in the 100 new GME slots reserved for psychiatry. Congress has increased the number of GME slots only twice over the last 25 years.Other APA-supported provisions within the spending package include investments in health equity. The package increased the authorizations and funding for programs to improve maternal health and for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Minority Fellowship Program, a program in which APA participates.Additionally, the package increases funding for critical mental health and SUD programs under SAMHSA; the Centers for Disease Control and Prevention; and the National Institutes of Health, including the National Institute on Minority Health and Health Disparities.In a statement applauding the package’s passage, APA also emphasized the need for continued work. Congress did not entirely eliminate a cut in Medicare payments for physicians imposed by the Centers for Medicare and Medicaid Services. The cut, which went into effect January 1, was originally slated to be 4.5%, but Congress adjusted it down to 2%. “This runs counter to the need to improve access to care for patients, and we urge Congress to revisit this continuing challenge as soon as possible in the new year,” APA’s statement reads.“Improving mental health care is critically important for families across the country,” said Sen. Ron Wyden (D-Ore.). “I was proud to fight for measures that will bring more mental health providers into the workforce and boost access through innovations like telehealth. There’s still more work to do, but the accomplishments in this legislation are a promising start for Americans that need mental health care.” ■APA Statement on Mental Health Provisions in Federal End-of-Year Spending Package ISSUES NewArchived

The methodology to estimate the demand and supply of national psychiatric services in Taiwan from 2005 to 2030.

The transformation from institutionalization to community-based mental healthcare may increase the difficulty of psychiatric workforce estimation and change the role of psychiatrists in hospitals and private clinics. This study aimed to estimate the growth and forecast psychiatric services in hospitals and private clinics in Taiwan from 2005 to 2030. We first examined the correlation between the number of psychiatrists and several indicators of psychiatric services. The forecast of the national demand for psychiatrists was based on projected outpatient psychiatrist visits from historical data. We also estimated the supply of psychiatrists by the number of psychiatrists practicing in hospitals or private clinics from Taiwan's Medical Affairs System and examined the supply and demand of the psychiatrist workforce through 2030. Outpatient visit was the most relevant indicator of psychiatric services to psychiatrist workforce. Growth rates in private clinics were higher than the hospital counterparts within the following decade (172.3 % vs. 37.7 %) and in the following decade (42.3 % vs. 13.3 %). The hospital-clinic disparity in the growth of psychiatric services also reflects the shortage of psychiatrists in private clinics but not in hospitals through 2030. The supply of 1158 psychiatrists in hospitals would nearly equal the clinical-based demand of 1156 psychiatrists in 2030. By contrast, the supply of 514 psychiatrists in private clinics would be lower than the clinical-based demand of 636 psychiatrists in 2030. The hospital-clinic disparity in the growth of psychiatric services reflects the transformation from hospital-based to community-based mental healthcare in Taiwan.