Oversaturation in psychiatry impending?

[hopefulscribe2]

Hello there,

I was wondering what your thoughts are on the expansion of psychiatry residency programs recently. There has been a 27% increase in number of psychiatry residency spots in the past 5 years. For the 2023 cycle, there are now 2047 spots compared to 1400 just a few years prior. This seems to me incredibly high considering that family medicine only has 5000 spots but primary care visits are much more frequent than psychiatry visits. I am just wondering if the expansion will lead psychiatry to become like emergency medicine in the next decades

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[WisNeuro]

Decades is a long time. But, at least in the short-term, if you are a psychiatrist who takes insurance, you don't have much to worry about in most markets. Even the cash pay ones are doing just fine at the moment. Also, aren't y'all a little top heavy when it comes to age? So, won't there be a raft of retirements in the next decade anyway?

 

[annoyedpsychiatrist]

this question is asked so many times. Google how many psychiatrists are projected to retire in the next 10 years along with average age of a psychiatrist and psychiatrist shortages by state

 

[PsyDr]

Satiani, A., et al. (2018). "Projected Workforce of Psychiatrists in the United States: A Population Analysis." Psychiatr Serv 69(6): 710-713.

 

[Stagg737]

This seems to me incredibly high considering that family medicine only has 5000 spots but primary care visits are much more frequent than psychiatry visits.

Where did you get this idea? We see most outpatients every 3 months or sooner. How many FM docs do you know seeing the majority of their patients that frequently?

 

[clausewitz2]

Where did you get this idea? We see most outpatients every 3 months or sooner. How many FM docs do you know seeing the majority of their patients that frequently?

I see most of my patients monthly. some I see every couple of weeks. A few I see weekly. If your PCP is seeing you this often on an ongoing basis something is seriously wrong.

 

[Sushirolls]

Psychiatry won't ever become Emergency Medicine.

There will be ample time for people to steer clear before that, and more medical specialties will become EM before Psych. When that happens the number of specialties in that situation will be a warning bell that most of medicine will simply be avoided.

Psychiatry will always have the pressure relief value of moving away from 30min 'med checks' with +/- therapy, and transitioning to hour long therapy with +/- meds. I.e. Going from needing 400+ patients, to 100 patients.

Psychiatry will likely be the specialty that gets to turn off the lights in the American Healthcare system once things atrophy - assuming no meaningful changes between now and then.

 

[Nudexta]

Psych is far from saturation. I wish it gets saturated so that we get some relief. Most patients cannot find a psychiatrist soon enough and have to wait at least 2-3 months.

 

[Celexa]

Can we pin a topic or something? This gets asked so dang often and always indicates the poster has no familiarity with the current state of the field.

I agree with Sushi. Psychiatry will be the last specialty standing due to the private practice off ramp.

We don't have enough psychiatrists to see all the patients who are trying to see us--and if we ever catch up to that there's at least as many who don't realize we can help them to be tapped.

 

[Stagg737]

Psych is far from saturation. I wish it gets saturated so that we get some relief. Most patients cannot find a psychiatrist soon enough and have to wait at least 2-3 months.

Increase that to 6+ months in some areas and even years for some subspecialists...

 

[randomdoc1]

although I would argue if you suck, it is possible to not have enough business unless you work in a hospital system. There are some private psychiatrists locally that are terrible and their turnover is high--always starving for patients. That is them on a part time PP schedule and they still use regular employment to supplement their income. A bad product if bad enough will hurt for business.

 

[dl2dp2]

This is not a concern:
1. expansion is related to new programs/locations with fewer training programs. These locations have a dire need, and insurance-driven services are woefully supply-bottlenecked.
2. for cash practice, upper-end programs don't have any substantial expansion.

One thing though I think will become more of a problem is if you go to a new program or a "less reputable" program, it used to be that it's easy to set up a cash PP and/or transition from facilities job to cash PP. I think this will be harder in the future. A different way to say this is that everyone will have a job at max insurance coverage rates, but good jobs that pay a lot more will be somewhat harder to get.

 

[whopper]

Every year I see fear of this and discussion and I never see it happening. If anything mental health problems will IMHO get worse with further global warming, a globalized world that hasn't gotten it's legal act together in making sure globalization is done in orderly and rational manner, America's possible (and hopefully avoided but I think it's going to happen) further fracturing apart.

If the future were bright and sunny, fusion was invented and utilized in an orderly and beneficent manner (I think whoever invents it is as much likely to get killed as be honored), and the world's problems were otherwise solved, yes then I'd think there'd be an oversaturation in the future.

For all of you Star Trek optimist fans out there who believe the bright and utopian future of Star Trek will happen, just remember it took another world war, over 60 million dead and massive environmental and nuclear devastation before humanity got their act together.

 

[comp1]

I think it's fine for this to be asked over and over. It allows us to consistently provide more and more and more new evidence that there is nothing resembling oversaturation. Then these people asking go on to be hiring managers and see how we continue to have horrifically few mental health providers of all types.

 

[Sushirolls]

*I moved from one metro where things were saturated. I also cut out UHC, which was 18% of the market, and not actively taking medicare. Those 2 variable had an impact, too. The nuances of an ARNP mill saturated the outpatient independent market. Several large health system Big Box shops, seldom referred out even when they back out months for internal referrals. My rate of growth was nominal.

Now, in my new location I'm cresting over the attrition of original location patients, and now booking out 3-4 weeks. Growth is on par with usual reports that people have here. I don't take UHC in this location either, and rarely see it.

I reference this, to say, there are weird pockets, where saturation exists, so be aware.

 

[tr]

How are we even worried about this when the singularity is now upon us?

(I, for one, welcome our new robot overlords.)

 

[PikminOC]

*I moved from one metro where things were saturated. I also cut out UHC, which was 18% of the market, and not actively taking medicare. Those 2 variable had an impact, too. The nuances of an ARNP mill saturated the outpatient independent market. Several large health system Big Box shops, seldom referred out even when they back out months for internal referrals. My rate of growth was nominal.

Now, in my new location I'm cresting over the attrition of original location patients, and now booking out 3-4 weeks. Growth is on par with usual reports that people have here. I don't take UHC in this location either, and rarely see it.

I reference this, to say, there are weird pockets, where saturation exists, so be aware.

I'm glad you mentioned this, the nurses are proliferating very fast. They can churn out tons of them with no limits.
And as the hospital groups merge and get bigger and more monopolistic, yes they keep all referrals in house, with one MD name for many midlevels.

 

[docksan]

We aren't hitting a saturation any time soon. There's a world of difference between APPs and physicians in psychiatry.

 

[Kissmyabjj]

Almost impossible to find a psychiatrist accepting insurance in the Indianapolis area. The majority of patients I see have a psych NP.

 

[WisNeuro]

Almost impossible to find a psychiatrist accepting insurance in the Indianapolis area. The majority of patients I see have a psych NP.

Fairly similar in my patient population. The Medicare crowd doesn't tend to want to pay out of pocket, or wait 6+ months for an appointment, so it's definitely been increasingly NPs managing psych meds in my older folks. Aside from the ones that are just managed by their PCPs.

 

[docksan]

I'm going to end up on a ward myself if I see another mid level eval that says "patient is bipolar because they have far decreased sleep increased impulsivity and high energy" and the patient is on 30 different meds.

 

[calvinhobbes]

I'm going to end up on a ward myself if I see another mid level eval that says "patient is bipolar because they have far decreased sleep increased impulsivity and high energy" and the patient is on 30 different meds.

Lol annnnnnnd this is why we will always have high paying jobs cleaning up their messes 😂

 

[MedMan80]

I'm going to end up on a ward myself if I see another mid level eval that says "patient is bipolar because they have far decreased sleep increased impulsivity and high energy" and the patient is on 30 different meds.

But how else can we deal with the Adderall come downs apart from xanax?

 

[vanfanal]

Every year I see fear of this and discussion and I never see it happening. If anything mental health problems will IMHO get worse with further global warming, a globalized world that hasn't gotten it's legal act together in making sure globalization is done in orderly and rational manner, America's possible (and hopefully avoided but I think it's going to happen) further fracturing apart.

If the future were bright and sunny, fusion was invented and utilized in an orderly and beneficent manner (I think whoever invents it is as much likely to get killed as be honored), and the world's problems were otherwise solved, yes then I'd think there'd be an oversaturation in the future.

For all of you Star Trek optimist fans out there who believe the bright and utopian future of Star Trek will happen, just remember it took another world war, over 60 million dead and massive environmental and nuclear devastation before humanity got their act together.

And the arrival of the Vulcans 🖖🏽😅

 

[allantois]

The problems we treat are largely chronic so we are blessed in a way that there is no cure to human suffering

 

[Monocles]

Satiani, A., et al. (2018). "Projected Workforce of Psychiatrists in the United States: A Population Analysis." Psychiatr Serv 69(6): 710-713.

As a statistics nerd IMO this is the most interesting and perhaps overlooked comment in this whole thread.

The article is here.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201700344#F1

And in comparing the 2018 projections with AAMC's 2021 data, the psychiatrist shortage is much worse than anticipated (probably covid led to many more psychiatrists retiring than before) and the % of 55+ is much higher.

Active Physicians by Age and Specialty, 2021

The number and percentage of active physicians by age group for each of the 48 specialty categories featured in the Physician Specialty Data Report.

www.aamc.org

 

[ksharp33]

As a statistics nerd IMO this is the most interesting and perhaps overlooked comment in this whole thread.

The article is here.

https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201700344#F1

And in comparing the 2018 projections with AAMC's 2021 data, the psychiatrist shortage is much worse than anticipated (probably covid led to many more psychiatrists retiring than before) and the % of 55+ is much higher.

Active Physicians by Age and Specialty, 2021

The number and percentage of active physicians by age group for each of the 48 specialty categories featured in the Physician Specialty Data Report.

www.aamc.org

looking at that link you posted:

• Between 2016 and 2021, sports medicine (+27.2%) and psychiatry (+26.3%) saw the most growth in the numbers of first-year ACGME residents and fellows. Preventive medicine (-39.4%) and pediatric anesthesiology (-16.0%) saw the biggest decreases. (Refer to Table 2.6.)

Are there too many psychiatry programs opening? That was one of the factors in decreased popularity of EM.

 

[jbomba]

looking at that link you posted:

• Between 2016 and 2021, sports medicine (+27.2%) and psychiatry (+26.3%) saw the most growth in the numbers of first-year ACGME residents and fellows. Preventive medicine (-39.4%) and pediatric anesthesiology (-16.0%) saw the biggest decreases. (Refer to Table 2.6.)

Are there too many psychiatry programs opening? That was one of the factors in decreased popularity of EM.

Just look at the data on projected shortage through 2050

 

[ksharp33]

Just look at the data on projected shortage through 2050

Right. They give a huge range, including a potential for a surplus of psychiatrists.

"By 2050, the workforce of psychiatrists will range from a shortage of 17,705 psychiatrists to a surplus of 3,428."

 

[heartsink]

Right. They give a huge range, including a potential for a surplus of psychiatrists.

"By 2050, the workforce of psychiatrists will range from a shortage of 17,705 psychiatrists to a surplus of 3,428."

To put that into context, currently there is a projected surplus of EM physicians of over 7800 by 2030. Obviously EM is feeling the oversaturation now, but relative to EM, Psychiatry will

- Only reach half that level
- In 30 years
- In the worst case scenario
- And still have the option for PP

Add to all of that the increasing awareness of the lay public that seeing a psychiatrist is preferable to seeing a midlevel, and the increasing number and severity of national and global woes that are by and large worsening the mental wellbeing of most people across this country, suggesting a steady if not increasing demand for mental healthcare resources over that time. So likely the field is going to be more than fine for the majority of us in this thread planning on spending most of our time practicing in that window.

 

[Merovinge]

To put that into context, currently there is a projected surplus of EM physicians of over 7800 by 2030. Obviously EM is feeling the oversaturation now, but relative to EM, Psychiatry will

- Only reach half that level
- In 30 years
- In the worst case scenario
- And still have the option for PP

Add to all of that the increasing awareness of the lay public that seeing a psychiatrist is preferable to seeing a midlevel, and the increasing number and severity of national and global woes that are by and large worsening the mental wellbeing of most people across this country, suggesting a steady if not increasing demand for mental healthcare resources over that time. So likely the field is going to be more than fine for the majority of us in this thread planning on spending most of our time practicing in that window.

This is not even accounting for the meteoric worsening of adolescent mental health in the present day (e.g. depression rates alone doubling over the past 15 years) and how this will impact adult mental health down the pipeline.

 

[dl2dp2]

The *demand* side of the equation is likely to throw the estimates out of whack a bit.

In terms of specialty demand, things like EM and rad onc actually have decreasing demands. Mental health service demand is most certainly going up.

That being said, I think the average/below average job will be more competitive and the jobs themselves will be less rewarding. On the high-end side, I don't see any program size expansion in the top 10-20 programs, and academic departments continue to try to shuffle people away from private practice. PP (especially cash PP) will continue to be in demand if you have the right resume and do the right things with business development.

 

[Mad Jack]

looking at that link you posted:

• Between 2016 and 2021, sports medicine (+27.2%) and psychiatry (+26.3%) saw the most growth in the numbers of first-year ACGME residents and fellows. Preventive medicine (-39.4%) and pediatric anesthesiology (-16.0%) saw the biggest decreases. (Refer to Table 2.6.)

Are there too many psychiatry programs opening? That was one of the factors in decreased popularity of EM.

Who has the least need for hospitals and employment versus the most? EM vs psych is really apples to oranges

 

[Sartre79]

There has been a lot more competition from Psychiatric ARNPs, some even opening up their own practice in the medium-sized metro I currently live in. The public really doesn't know the difference, or so it seems. I worry about saturation from that standpoint.

 

[dozitgetchahi]

I see most of my patients monthly. some I see every couple of weeks. A few I see weekly. If your PCP is seeing you this often on an ongoing basis something is seriously wrong.

You’d be surprised how many PCPs can’t be bothered to see even the sickest patients more often than every 3-6 months at best.

 

[dozitgetchahi]

I'm going to end up on a ward myself if I see another mid level eval that says "patient is bipolar because they have far decreased sleep increased impulsivity and high energy" and the patient is on 30 different meds.

And they have fibro too. Send to rheumatology.

 

[Yale Medicine]

There has been a lot more competition from Psychiatric ARNPs, some even opening up their own practice in the medium-sized metro I currently live in. The public really doesn't know the difference, or so it seems. I worry about saturation from that standpoint.

Most patients I've encountered who saw NPs were well aware that they were not MDs and seemed more relieved seeing an MD. Sure, there was some selection bias but the general public has some clue.

 

[comp1]

Most patients I know are desperately glad to see anyone in mental health...

 

[whopper]

I don't think an oversaturation is anything worth worrying about for decades. Even if the needle of people wanting to go into psychiatry doubled every year for the next 5 years, these people won't get into the practice circulation for over 4 years. Even then we'd still have a shortage.

Edit-I say this true story once in awhile. I'm now 50 years old. I was on this forum while a resident. As a medstudent some idiot IM attending told me within a few years all mental illness would be 100% curable and there'd be no need for psychiatry. What a bunch of bul$hit. IMHO seems to me that IM attending needed an antipsychotic or a big cutting down of his ego at the knees.