Recent estimates show that fewer than 40% of Americans who suffer from mental illness—or about 11 million people—get the psychiatric care they need, and access to psychiatrists has been identified as part of the problem. In an issue of Psychiatric Services, J. Wesley Boyd, MD, PhD, and colleagues published a study that examined the availability of psychiatrists for outpatient appointments in three U.S. cities: Boston, Houston, and Chicago. The study team posed as patients searching for a psychiatrist in private practice and attempted to get an appointment with 360 outpatient psychiatrists based in these cities. All were listed in the database of a major private insurer, and the investigators made a maximum of two attempts to schedule an appointment.
Investigators were able to reach psychiatrists about one-third of the time after one round of calls; approximately 36% of unanswered calls made in the first round were returned. In addition, 16% of the phone numbers in the insurer’s database were simply incorrect. “After two calling rounds, we were able to secure appointments with psychiatrists just 26% of the time,” says Dr. Boyd. “These findings were similar even when we were willing to pay out-of-pocket. Many failures to make appointments occurred because of a complete inability to reach a psychiatrist, often because the phone number provided was incorrect or they simply never called us back.” About 20% of psychiatrists were not accepting any new patients, and the patient’s intended form of payment or reimbursement was not accepted in 5% of cases. Another 5% of psychiatric offices required more information before booking appointments.
Results of the study suggest that having insurance is not enough to guarantee that patients can access the mental healthcare they need. This is a critical issue for patients who are profoundly depressed or anxious because it can be challenging for them just to begin to make calls for an initial appointment with a psychiatrist. “Much of the problem can be attributed to the fact that there appears to be a shortage of available psychiatrists,” Dr. Boyd says. “In addition, psychiatrists are generally reimbursed less than other types of physicians, which in turn can lead medical students to select other more lucrative career paths.” There are also managed care roadblocks to overcome, such as requiring providers to get permission and seek pre-authorization before they can care for patients.
“The healthcare system needs to change because expanding insurance coverage alone may do little to improve access to psychiatrists,” says Dr. Boyd. “Efforts are needed to improve reimbursement for psychiatric services—and to reduce the stigma associated with mental illness—so that more medical students choose to enter psychiatry.”
Malowney M, Keltz S, Fischer F, Boyd JW. Availability of outpatient care from psychiatrists: a simulated-patient study in three U.S. cities. Psychiatr Serv. 2014 Oct 15 [Epub ahead of print]. Available at: http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201400051.
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