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Psychiatry: A Silent Shortage That Just Keeps Getting Worse

Merritt Hawkins Team | January 20, 2018

psychiatry a silent shortage

By Mark Smith

I recently read about a Kaiser Family Foundation analysis I found particularly disturbing.

The analysis examines the need for mental health services by state and shows the percentage of need being met and not being met.

The following is a link to a chart with some revealing state-by-state numbers.

As the numbers indicate, some states are doing very well, or at least fairly well. Rhode Island is meeting 100% of its mental health service needs, North Dakota 83% and Colorado 76%. Others are not doing nearly as well. South Dakota is only meeting about 15% of its need, Wisconsin 21% and Montana 25%. Overall, the Kaiser Family Foundation projects that about 50% of mental health service needs throughout the U.S. are not being met.

Some states, such as Wisconsin, Texas and Alaska, have put educational payment and/or direct financial payments in place to psychiatrists willing to practice in underserved areas. Others, such Illinois, New Mexico and Louisiana, have passed laws allowing psychologists to prescribe pharmacological drugs. Primary care physicians and mental health nurse practitioners and physician assistants also are providing mental health services where psychiatrists are not accessible, and more tele-psychiatry services are coming online.

The bottom line, however, is that more psychiatrists need to be trained. According to a physician demographic study Merritt Hawkins recently completed on behalf of the North Texas Regional Extension Center (NTREC), 185 counties in Texas (out of 254) with a combined population of 3.3 million people have no psychiatrist. That is a service population roughly equal to or greater than the populations of 21 states. Many other states have similar stark needs. In Illinois, 50 counties have no inpatient psychiatric services in their hospitals.

Traditionally, mental health care has been deemphasized in our procedural oriented health care system. For this and other reasons, psychiatry remains a “silent shortages” that now is reaching epidemic proportions. The fact that 60% of psychiatrists are 55 years old or older (compared to about 43% of all physicians) does not bode well for the future.

Since Congress shows no sign of lifting the 1997 cap on residency program funding, action will have to be taken at the state level. I would be interested in any efforts readers know of regarding how the shortage of psychiatrists is being addressed and what effects the shortage is having on patient care in your area.


Mark Smith is president of Merritt Hawkins, the nation’s leading physician search firm and a company of AMN Healthcare (NYSE: AHS). He can be reached at


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