If you are thinking about accessing mental healthcare services, you will likely encounter serious challenges–especially if you live in a rural area. Despite recent healthcare reforms, mental health care services are “inadequate or nonexistent to large segments of American society.” While the number of primary care providers grew between 2003-2013, researchers found that when adjusted for population size, the average number of psychiatrists decreased by almost 10 percent. Researchers note that the decline is occurring in the midst of increasing demand for mental health services.
As the map below from the US Department of Labor’s Bureau of Labor Statistics shows, the nation’s psychiatric workforce is unevenly distributed throughout the country. The number of psychiatrists per capita ranges from 18,000 per 100,000 people in Massachusetts to just five psychiatrists per 100,000 people in Idaho. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that more than half of U.S. counties–all rural–“have no practicing psychiatrists, psychologists, or social workers” at all. (To see how your county ranks, check the County Health Rankings and search for the number of mental health professionals practicing in your area).
Data from the National Resident Matching Program (NRMP) gives some indication of what our future health care workforce will look like–and it does not bode well for people who need mental health care. In 2015, NRMP celebrated the increased number of residency positions offered in primary care specialties like family medicine (3,195 positions), internal medicine (6,770 positions) and pediatrics (2,668 positions). In contrast, residency programs in psychiatry offered 1,374 positions in 2014, and only 695 registrants — just over half — reported that psychiatry was their top choice. In the end, 272 psychiatry residency spots went unfilled.
These numbers don’t surprise researchers, who have shown that “the discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades.” In 2014, a multi-country survey of final year medical students found that only 4.5 percent of definitely considered psychiatry as a career.
Students’ negative perceptions may be attributable to psychiatry’s image problem. As Dr. Jeffrey Lieberman argues in Shrinks: The Untold Story of Psychiatry, “today the single greatest hindrance to treatment is not any gap in scientific knowledge or shortcoming in medical capability but the social stigma. This stigma, unfortunately, has been been sustained by the legacy of psychiatry’s historic failures and its enduring reputation — no longer justified — as the unwanted stepchild of medicine.”
Researchers have also found that stigma towards mental illness itself has influenced medical student attitudes towards psychiatry and can dissuade them from pursuing psychiatry as a career. Negative attitudes may intensify once they start clinical training and come into contact with mentally ill patients, which they may perceive as stressful, dangerous, and emotionally draining.
Earning potential may also deter medical students from pursuing a career in psychiatry. The annual mean wage for a psychiatrist in the United States is $182,700, but as the New York Times reported in 2011, “psychiatrists rarely earn enough to compensate for their additional training. “most would have been better off financially choosing other medical specialties.” Almost 80 percent of medical school graduates face at least $100,000 of debt when they start their careers. Understandably, few would want to sign up for a medical specialty that won’t enable them to pay it back.