The perilously small supply of psychiatrists

From: POLITICO Future Pulse - Monday Oct 24,2022 06:01 pm
The ideas and innovators shaping health care
Oct 24, 2022 View in browser
 
Future Pulse

By Grace Scullion , Carmen Paun , Ben Leonard and Ruth Reader

WORKFORCE

DORCHESTER - APRIL 05: Dominique Entzminger, a physician assistant of family medicine, wears a stethoscope during an examination at the Codman Square Health Center April 5, 2006 in Dorchester, Massachusetts. State lawmakers approved a health care reform bill March 4 that would make Massachusetts the first state in the nation to require all its citizens have some form of health insurance. Governor Mitt Romney is scheduled to sign the bill next week. (Photo by Joe Raedle/Getty Images)

HHS projects the supply of new psychiatrists isn't keeping pace with the demand. | Getty Images

A shortage of psychiatrists and addiction counselors could stymie the Biden administration’s plan to expand mental health care.

The Department of Health and Human Services moved to expand Certified Community Behavioral Health Clinics to all 50 states last week. The enhanced clinics offer coordinated mental and physical health services and substance use treatment, all reimbursed by Medicaid.

They need psychiatrists for adults and children, social workers, nurses and counselors to provide those services, a median of 43 workers per clinic, according to data collected from demonstration clinics in ten states.

An agency study suggests it’ll be tough to find psychiatrists and addiction counselors who specialize in treating adults.

By 2030, HHS projects:

  • A 20 percent decrease in psychiatrists for adult patients against a 3 percent increase in demand for their services
  • A 3 percent increase in addiction counselors amid a 15 percent increase in demand

97

The percentage of mental health care providers surveyed by the National Council for Mental Wellbeing last year that said it was difficult to recruit and retain employees

Only one in three psychiatrists accepts Medicaid, according to data from the National Ambulatory Medical Care Survey.

A bipartisan bill in Congress could help. 

Debbie Stabenow (D-Mich.) and Steve Daines (R-Mont.), the chair and ranking member of the Senate Finance Committee’s Health Care Subcommittee, released draft legislation that includes provisions to expand a bonus program to attract practitioners to rural areas, increase the number of Medicare-sponsored residencies and require Medicare to develop guidance to help states grow the mental health care workforce.

Stabenow, who led the charge for Certified Community Behavioral Health Clinics with Sen. Roy Blunt (R-Mo.), said she hopes to see movement on her workforce legislation in the lame-duck session after next month’s election.

 

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IN SPACE - JULY 17: (EDITORIAL USE ONLY) In this handout photo provided by the European Space Agency (ESA) on July 17, 2014, German ESA astronaut Alexander Gerst took this image of the Earth reflecting light from the sun whilst aboard the International Space Station (ISS). Gerst returned to earth on November 10, 2014 after spending six months on the International Space Station completing an extensive scientific programme, known as the 'Blue Dot' mission (after astronomer Carl Sagan's description of Earth, as seen on a photograph taken by the Voyager probe from six billion kilometres away). (Photo by Alexander Gerst / ESA via Getty Images)

This is where we explore the ideas and innovators shaping health care.

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THE LAB

Cadets at West Point are pictured. | Getty

The Army is researching concussions using high tech mouthguards. | Getty

High-tech mouthguards could help detect when soldiers have head injuries, Department of Defense officials believe.

The Pentagon gave Minnesota-based Prevent Biometrics more than $4 million, supplemented by outside funding, to study the devices on 2,500 soldiers between 2018 and 2021.

The mouthguards measure the force of head impacts, allowing commanders to yank soldiers from training if they take significant blows.

The study’s main findings:

  • The vast majority of head hits in training were mild. 
  • Significant impacts happened about 0.3 percent of the time. 
  • Serious blows came “infrequently and unpredictiably,” including during athletics and hand-to-hand combat drills. 

Cmdr. Christopher Steele, director of the Army’s medical research, and Richard Shoge, chief of military health systems research, told Future Pulse the results showed the Army could use the mouthguards to flag when a soldier might be at risk in the same way a driver uses a car’s check-engine light.

But they said more research is needed to determine when impacts cause injury and assess the effect of multiple head hits over time.

Rugby and football players have also used Prevent Biometrics’ mouthguards.

 

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INNOVATORS

“Digital infrastructure really is the beginning of going to the next frontier in health.”

– David Agus of the Lawrence J. Ellison Institute for Transformative Medicine

Imagine a cloud-based digital infrastructure that would remind adults when they’re due for their next inoculations, not just for Covid-19, but for everything.

Some Americans would be wary, while others would embrace it as common sense.

The Global Health Security Consortium — a partnership among the Lawrence J. Ellison Institute for Transformative Medicine, the Tony Blair Institute for Global Change and the University of Oxford — launched a campaign this month to design such a system for the world.

BERLIN, GERMANY - JUNE 10: German Health Minister Jens Spahn holds up a smartphone with the CovPass Covid vaccination digital certificate on a smartphone through Germany's Corona Warn app on June 10, 2021 in Berlin, Germany. CovPass will provide those who have been fully vaccinated against Covid-19 international certification. Countries across the EU have been working on a common platform for digital vaccination certification in particular to promote international summer travel and tourism. (Photo by Sean Gallup/Getty Images)

Covid vaccine passports could be repurposed to remind people they're due for all sorts of inoculations. | Getty Images

Pandemic innovations: David Agus, the Ellison Institute’s CEO, points to digital Covid certificates, green passes and Covid passports that permitted the vaccinated to travel and visit public venues as examples of technology that can be repurposed to keep the world up to date.

“The technology has gotten to the place, the pandemic has changed many of the norms of how we deal with data and we have the vaccines, so it really is the time to move this forward,” he told Future Pulse.

The institute’s tech focus is not surprising: Its namesake is Lawrence J. Ellison who founded software giant Oracle.

Selling points: A reminder system might avert some of the 10 million deaths a year attributable to diseases with existing or forthcoming adult vaccines and preventive therapies.

Data collection and monitoring would make it easier to target vaccines and preventive treatments for tuberculosis, dengue, human papillomavirus, HIV or even high cholesterol where they’re needed most, according to the consortium.

And the system could be anonymized by giving each person a unique identifier that doesn’t give away their identity, Agus said.

 

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