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April 18, 2014

In Our Opinion: Psych shortage will require creative solutions

The Daily Star

---- — Where have all the psychiatrists gone? 

This is the question facing, not only Bassett Healthcare, which announced earlier this month it would be closing its 10-bed inpatient psychiatric unit, but the nation as a whole. 

The Wall Street Journal reported in January that the country is on the precipice of crisis regarding the supply of psychiatrists. Between 2005 and 2010, while the U.S. population grew 4.7 percent, the number of practicing psychiatrists dropped from 38,578 to 38,289. At around the same time,  the Centers for Disease Control estimated that about 25 percent of U.S. adults have a mental illness. According to census figures, which put the U.S. adult population at about 234 million in 2010, that would mean there is one psychiatrist for every 1,500 mentally ill adults. 

And the problem is poised to get even worse, if such a thing can be imagined. The Journal reported that more than half the psychiatrists still practicing in 2010 were at least 55 years old. 

In 2011, some saw a change afoot to help reverse this trend. Dr. Tom Insel, director of the National Institute of Mental Health, wrote that innovations in neuroscience were helping to attract medical school students to psychiatry. 

But the shortages, here and elsewhere, continue. 

“It has been impossible to recruit psychiatrists and advanced practice clinicians who wish to participate in inpatient psychiatric care,” Bassett President and Chief Executive Officer Dr. William Streck wrote in a media release when announcing the closure. “This problem is not unique to Bassett. ... it is clear that the recruitment challenges to appropriately staff the unit are too big to overcome.” 

Many have been critical of Bassett because of a perception that more could have been done to keep the unit open. Indeed, it is tough to imagine that staff could not be found at any price. But perhaps the price would simply be too high for Bassett to pay. And, more significantly, there may be larger issues at play here. 

Attracting medical professionals to this region has not always been easy, regardless of their specialty. Bassett spokeswoman Karen Huxtable described rural inpatient psychiatry as “a complex, intense and challenging profession” — in other words, one that not too many people are interested in taking on. 

So what are we to do? Some regions have added slots to their residency programs, or recruited med school graduates by offering loans tied to a commitment to practice in that region. But even those ideas will do little to help our immediate problem. 

The need for psychiatric care in our region is not going away. If anything, the Affordable Care Act may make the need increase as more people get insurance and seek care. 

We urge the leadership of Bassett to partner with other stakeholders in the mental health community to seek creative solutions to this troubling problem.