Thursday, October 8, 2009

Psychiatry Availability Tucson

I have noticed that it is very hard to schedule a psychiatric evaluation appointment in Tucson these days. I have had the repeated experience of trying to find a psychiatrist who can see a patient from Cottonwood after discharge to continue treatment and what I run into is that most of the psychiatrists here are either not taking new patients or have no appointment availability for several months. I don't know exactly how many psychiatrists we have here but I note there are 37 in the phone book not counting the University of Arizona or community mental health centers. If my math is right that makes about one psychiatrist for approximately every 27,000 people.

Now not everyone with mental health difficulties needs to see a psychiatrist but there a number of people who do and we are under served here in Tucson. This is not just a local problem but one that is experienced in many parts of the country. It is even worse for child and adolescent psychiatrist availability. Another problem is that many psychiatrists are no longer taking insurance payments due to low rates of reimbursement. Medicare is the worst and as I have mentioned before Medicare rates are not enough to support a psychiatric practice so a number of psychiatrists are not taking patients covered under Medicare.

The situation is likely to get worse as psychiatric residency training programs are having a hard time filling their spots. One reason is that for many medical students the debt burden upon completing school is enormous. This was not the case when I went to medical school. The costs were reasonable enough that with my wife working we did not have to take out any student loans. That could not happen now. The costs of medical school are way too high for that. For many newly graduated medical students it is not feasible to go into the lowest paying specialty of psychiatry. High paying specialties are those that have many procedures as reimbursement is very high for procedures but very low for cognitive services or time spent with patients. Some people may attribute the low rate of students going into psychiatry as "greedy doctors" but for many it simply would not be possible to repay their student loans in a medical specialty like psychiatry which has such low reimbursement rates.

I am not whining. I love psychiatry, am glad that I chose it, and probably would not be happy doing anything else. But I did not have any debt upon completion of medical school and I wonder if I would be able to make the same choice today that I did back in 1983.

Thought for the day

Lack of available psychiatrists is likely to be a problem for a long time.

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