Telemedicine Offers Solution to Psychiatrist Shortage
The District of Columbia is the latest to join the Interstate Medical Licensure Compact, a move expected to address the nation’s shortage of psychiatrists and other medical professionals.
State governments, led by their medical boards, began working together in 2017 to form the Interstate Medical Licensure Compact, an agreement establishing an expedited way for experienced physicians to practice beyond their state borders. The compact became effective in 2017 once seven states adopted it. A state, district, or territory can join by enacting a law doing so. The compact now includes 26 members.
Telemedicine can increase access to mental health diagnosis and treatment for adults and children in places with shortages of psychiatrists, especially rural areas, says Peter Yellowlees, M.D., of the University of California, Davis and past president of the American Telemedicine Association.
“We currently have 25,000 to 50,000 licensed psychiatrists in the country and need about 5,000 to 10,000 more,” said Yellowlees. “There is a particular shortage of psychiatrists not just in rural areas but in all regions of the country when it comes to adolescent and geriatric psychiatric care.”
Seventy percent of practicing psychiatrists in the United States are age 50 or older. A majority of psychiatrists are in cash-only practices and work independently of health care teams. Many don’t accept Medicaid patients or treat people with severe mental illness, the National Council for Behavioral Health (NCBH) reported in a 2017 paper, The Psychiatric Shortage: Causes and Solutions.
Burnout is a common problem, the report states. Psychiatrists complain of insufficient time with patients to do proper assessments, regulatory restrictions on information sharing, and increased time spent on entering required data into patients’ electronic medical records. Another problem is patients not showing up for appointments scheduled months in advance.
Although there is better access to mental health counselors, generally those who are not physicians cannot write prescriptions. Yellowlees says it is critical to have specialists for the geriatric population.
“One of the biggest problems is overmedication of patients in nursing homes,” said Yellowlees. “Many are being treated by doctors who have little training in psychiatry and drugs and may be more inclined to write prescriptions to sedate patients who are exhibiting behavioral problems.”
In adolescent and pediatric care, there is a severe shortage in all but six states, NCBH reports: Connecticut, Maine, Massachusetts, Rhode Island, New York, and Vermont.
Telepsychiatry’s Track Record
The concept of remote psychiatric treatment is not new. Yellowlees says he has used it in California on thousands of patients since 1991. The American Psychiatric Association (APA) issued a statement approving of telepsychiatry in 2018:
“Telemedicine in psychiatry, using video conferencing, is a validated and effective practice of medicine that increases access to care,” the statement read in part. “The American Psychiatric Association supports the use of telemedicine as a legitimate component of a mental health delivery system to the extent that its use is for the benefit of the patient, protects patient autonomy, confidentiality, and privacy; and when used consistent with APA policies on medical ethics and applicable governing law.”
National Council Medical Director Institute,The Psychiatric Shortage: Causes and Solutions, The National Council for Behavioral Health, March 28, 2017: https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf