Behavioral health provider shortage strains systems

Geisinger ramped up its telehealth behavioral services over the past year, reducing its backlog of patients from 18,000 to 3,000.

The Danville, Pennsylvania-based integrated health system has expanded employee recruitment efforts and hired an external telepsychiatry service to increase its behavioral health capacity and its reach, said Dawn Zieger, associate vice president of psychiatry and behavioral health. While psychiatrists, psychologists and social workers can now treat behavioral health patients in other states, demand still outstrips the supply, particularly in specialties like pediatric behavioral health, she said. 

“We have had more demand than ever for behavioral health services,” Zieger said. “We think we’ll have to continue working on our surge strategy as folks deal with the trauma from COVID and the erosion of social structures.”

Health systems across the country are grappling with an increase of behavioral health cases and a lack of providers.  

Half of the counties in the U.S. do not have a psychiatrist or an addiction medicine specialist, new data from George Washington University shows. The shortages have disproportionately affected low-income consumers, as nearly 1 of 4 behavioral health providers did not see any Medicaid beneficiaries in 2020, according to the analysis of workforce data from the healthcare analytics firm IQVIA, the Centers for Medicare and Medicaid Services and state licensure boards.

The lack of behavioral health providers has created care deserts throughout the country, forcing many patients into short-staffed and often ill-equipped hospital emergency rooms. Patients are typically staying in inpatient settings longer as outpatient facilities also struggle to find workers. Health systems have scrambled to fill short- and long-term staffing shortages exacerbated by the COVID-19 pandemic. 

Systems like Geisinger and Sanford Health look to treat more patients while expanding their pipeline of behavioral health workers by partnering with medical schools and reimbursing tuition for those entering the field. 

Geisinger, for instance, pays for students’ tuition if they specialize in family medicine, internal medicine, pediatrics or psychiatry and stay at the health system for a set period of time. It also has a two-year social work fellowship program that helps participants obtain their clinical license as well as a psychology internship that offers training in adult clinical and health psychology, pediatric integrated primary care and clinical neuropsychology.

Sanford Health, a Sioux Falls, South Dakota-based health system, has a behavioral health internship program and a master’s degree-track for social workers, said Dr. Jeremy Cauwels, chief physician at Sanford. 

“Ninety-one percent of the counties in North Dakota are designated as mental health shortage areas,” he said. “Our hope is that our supply continues to increase and improve so we can continue to reach out to folks who need us.”

Virtual behavioral healthcare and broader recruitment efforts have helped fill some of the access gaps. Still, the U.S. would need more than 7,700 additional behavioral health practitioners to meet current demand, according to estimates from the Health Resources and Services Administration. There’s a projected shortage of 14,000 psychologists by 2030, according to the agency.

The imbalance between supply and demand has put a significant burden on primary-care providers. In Texas, for instance, 70% of its counties wouldn’t have anyone providing behavioral healthcare if it wasn’t for primary-care providers, according to the George Washington University data. Even with primary-care providers, 23% of counties in Texas have no providers for serious mental illness conditions.

“We are not going to mint a brand new army of providers,” said Dr. Harry Greenspun, chief medical officer at the consultancy Guidehouse. “The capacity problem is not going to be solved with people, it is going to be solved with different modalities of care.” 

Project Extension for Community Health Outcomes, which uses video conferencing to train, advise and support primary-care providers, can bolster the current workforce, said Ryan McBain, a policy researcher at the RAND Corp. Researchers at the University of New Mexico launched Project ECHO in 2003 to educate providers to try to expand access, reduce referrals and boost their bottom lines. 

“Unlike regular models of telehealth—which allow providers to reach people in different areas, but doesn’t expand the reach of the behavioral health workforce—models like Project ECHO have a multiplier effect because they are empowering new people to provide services,” he said. 

Reimbursement for telehealth services and the relative low wages of mental health professionals are still barriers, health system executives said. 

“We’ve started to see some payers not pay the same rate—or at all—for telehealth as in-office visits,” Geisinger’s Zieger said. “While there is parity legislation, the reality is the payment doesn’t cover the cost of the services.”

Federal and state policymakers should enforce mental health parity laws, which require insurance coverage for mental health conditions to be no more restrictive than coverage for other medical conditions, experts said. 

States have only recently begun to pay for peer-support specialists and community health workers. Meanwhile, psychiatry, pediatrics and primary care rank among the lowest specialties in terms of annual compensation, according to Medscape’s 2022 physician compensation report. 

“We need more funding to attract the workforce into this field,” Zieger said.  



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