Just call me the newsboy today! JPG FW: Short on Shrinks Psychologists and Psychiatrists Debate Possible Remedies By Laurie Barclay, MD WebMD Medical News Reviewed by Dr. Jacqueline Brooks March 29, 2001 -- Worrisome statistics from the state of Illinois are pointing to a shortage of psychiatrists, a trend that is reflected nationwide. But as the debate rages over whether or not to grant prescribing privileges to psychologists, experts tell WebMD there are other strategies to help ensure adequate access to mental health professionals. Illinois has 57 counties with no psychiatrists and 17 counties with only one psychiatrist. While shortages in mental health care have been defined as less than one psychiatrist for every 30,000 people, there is one area in Illinois with only one psychiatrist serving 203,000 people. "In farm and rural areas of Illinois, patients might have to drive between 50 and 100 miles to the nearest psychiatrist's office," Nancy Molitor, PhD, president of the Illinois Psychological Association, tells WebMD. "Even then, there's no guarantee that their insurance plan would cover that psychiatrist or that he or she would have any openings." Nationwide, there are 444 counties with no psychiatrist but with at least one clinical psychologist, according to Marlin Hoover, PhD, president-elect of the Illinois Psychological Association. "We have many people who don't receive medications, and others who do, but [get them] from physician's assistants and nurse practitioners who may not have much training in mental health. Psychologists are ideally positioned to be given the training necessary to prescribe drugs safely," says Hoover, who claims that psychologists receive seven years of mental health training after college, more than any other professional. "It would be a terrible, misguided error for any legislature in this country to allow psychologists to have prescribing privileges," Michelle Riba, MD, MS, associate chair for education and academic affairs in psychiatry at the University of Michigan in Ann Arbor, tells WebMD. "Quality of care for patients and our medical ethics dictate that only those who have ... a medical degree and clinical residency training should be allowed to prescribe medications." Riba claims there are adequate numbers of psychiatrists, primary care physicians, and specialists in this country to provide quality care to patients, and suggests that any remaining shortage could be solved by innovative programs, such as telemedicine, to provide care in rural communities and in other underserved areas. "These programs would make it possible for all patients to receive the care they need without resorting to lowering our country's standards of healthcare," says Riba, vice president-elect of the American Psychiatric Association. The psychiatric profession in California has been working hard to increase services to underserved populations, both through telepsychiatry services and by recruiting psychiatrists to rural areas, explains Maria T. Lymberis, MD, a clinical professor of psychiatry at the UCLA School of Medicine. But the main problem restricting access to mental health care is lack of funding, according to a November 2000 report by the Little Hoover Commission about the state of mental health care in California's public sector. "If you do not treat, you save money!" Lymberis says about the report. "Psychologists do not necessarily charge less, they do not go to the underserved areas, and they will not solve the problem of the underserved." There has been a steady decline in medical school graduates entering psychiatry over the past decade, down to 482 in 1999 from 664 in 1990. "Psychiatry has been a very stigmatized field, both for psychiatrists and patients," Lymberis says. "We are still fighting for nondiscrimination in the coverage of psychiatric conditions." "With managed care organizations refusing to authorize needed services and paying less than cost in many cases, medical students who are looking for satisfying specialties have shied away from psychiatry," agrees Paul S. Appelbaum, MD, professor and chair of psychiatry at the University of Massachusetts Medical School in Worcester, and president-elect of the American Psychiatric Association. Medicare cuts of $115 billion over five years beginning in 1998 have decreased funding for resident education, leading to fewer residency positions and an even greater decline in the number of specialists, such as psychiatrists.
