Mind the Gap: The Ongoing Psychiatrist Shortage

Five years after its start, the National Center for Health Workforce Analysis found that the COVID-19 pandemic’s impact on mental health continues. As of November 2024, about 59 million Americans, or nearly a quarter of the population, had a mental illness — yet 46% received no treatment.  The shortage of healthcare professionals, including psychiatrists, is affecting patients’ ability to find care and placing a greater burden on healthcare professionals who provide mental health care

The Demand for Mental Health Treatment

The demand for mental health services is huge. “One in five Americans met the criteria for a mental health condition before COVID. Almost one in two experienced anxiety or depression during the pandemic, and post-pandemic, one in three identify as having a mental health condition,” Justin Kei, MD, the outpatient medical director for Behavioral Health at Hackensack University Medical Center Neuroscience Institute in Hackensack, New Jersey, told Medscape Medical News. “COVID really accelerated the incidence of mental health conditions for a lot of people.”

At the same time, many people are more willing to seek treatment for mental health issues than they have been in the past. “Society has made strides in destigmatizing care, but it’s still really hard for people to get connected with psychiatrists,” said Cara Angelotta, MD, vice chair for Education in the Department of Psychiatry and Behavioral Sciences at Northwestern University in Evanston, Illinois. “A lot of psychiatrists don’t accept insurance, and there are problems with parity — they aren’t reimbursed very well. There’s a huge unmet need for psychiatric services, especially among vulnerable populations.”

This shortage is likely to worsen as more psychiatrists “age out” and retire; the average age of psychiatrists is 55. And psychiatrists’ income (in 2024, an average of $323,000) lags behind many other specialties, which may make the field less appealing to medical students.

The numbers look bleak. “According to the US Health Resources and Services Administration, while the supply of adult psychiatrists is expected to decrease 20% by 2030 given the number of psychiatrists entering, leaving, and changing work hours (from full-time to part-time or vice versa), the demand for their services is expected to increase by 3%, leaving a shortage of over 12,000 fully trained psychiatrists,” said Howard Y. Liu, MD, MBA, chair of the University of Nebraska Medical Center Department of Psychiatry, Omaha, Nebraska, and chair of the Council of Communications at the American Psychiatric Association (APA).

The shortage of specialists is not unique to psychiatrists, pointed out Liu. “There is an overall dearth of physicians in the US, not just in psychiatry,” he added. “That being said, population growth, an aging workforce, physician burnout, lower rates of reimbursement, and the burden of paperwork all contribute to the psychiatrist shortage.”

More Psychiatrists Are Entering the Field

While the current situation is sobering, there is good news. “We can’t be sure exactly how many med students will choose psychiatry this year; however, recent data indicate that there is a growing interest in the field,” said Liu. “Last year, a total of 1823 US medical school graduates matched into psychiatry residency programs, marking the 13th consecutive year that psychiatry’s match numbers have increased.”

Psychiatric residency is also more popular now than ever, added Liu. The number of residency programs has increased from 178 in 2003 to 379 in 2013 to 2143 in 2023. “Many hospital systems have been investing in opening psychiatry residencies. When a new residency opens in a system that has not had residents, Medicare dollars are available to fund positions,” he said. “Many states have also been funding residency positions to help address local shortages of physicians in general and psychiatrists in particular.”

Yet, there is a need for more psychiatric residencies and more fellowships. “There’s huge interest in psychiatry, but there aren’t enough training slots,” said Angelotta, who is also the residency program director for the Psychiatry Program at Northwestern. “There aren’t enough slots for applicants who want to do general or adult psychiatry. Training psychiatrists is expensive, and more funding is needed for additional spots.” She noted that even with the interest in psychiatry, some fellowships in areas like child and adolescent psychiatry, addiction psychiatry, and geriatric psychiatry remain unfilled.

Other Ways to Address the Psych Shortage

Adding more psychiatrists to the field will help provide more patients with needed care. Other strategies, such as encouraging those in the field to continue practicing instead of retiring, can also help. However, physicians must be prepared to cope with the demands of an emotionally challenging field. “We have a lot of responsibilities to our patients,” said Kei. “And we feel a lot of responsibility for our patients…self-care becomes really important.” He encourages psychiatrists of all ages to develop self-care strategies, including exercise, staying connected with friends and family, and tapping relationships with colleagues for validation and social support.

Changing the way mental health care is delivered can also help address patients’ needs. “We need to move away from the one-to-one model — to be creative and be team-based,” said Kei. “Having people in private practice is important, but [it] won’t help these numbers.” From a care delivery perspective, supporting primary care doctors with psychiatric support can help meet patients’ needs, as can offering telemedicine options. “Collaborative Care Models can help primary care doctors,” added Kei. “The team-based approach is helpful and gets people better quicker.”

The APA also supports the team-based Collaborative Care Model. “The Collaborative Care Model is a workforce multiplier and leverages the expertise of a psychiatrist and expands access to care, particularly in underserved areas. The model integrates behavioral health within the primary care setting and features a primary care physician (PCP), a psychiatric consultant, and a care manager working together to provide care for a population of patients,” said Liu. In this approach, psychiatrists provide caseload consultation to a care manager, who coordinates with patients and a PCP. The model has more than 100 randomized controlled studies demonstrating its efficacy and is covered by Medicare, most private insurers, and many states’ Medicaid programs.

While the numbers are concerning, the psychiatrists that Medscape Medical News spoke with said medical students continue to choose psychiatry — because they’re fascinated by the human brain, want meaningful, longer-term relationships with patients, and understand the importance of behavioral health. Providing more opportunities for these students to become psychiatrists and maximizing the reach of all psychiatrists can help address the current shortage and help ensure that more patients receive the mental health care they need.

Kelly K. James is a freelancer, content manager, and author of  The Book That (Almost) Got Me Fired: How I (Barely) Survived a Year in Corporate America. She covers health/wellness, business/career, and psychology topics from her home in the Chicago suburbs.