Growth and Distribution of Child Psychiatrists in the United States: 2007–2016

Abstract

BACKGROUND: Historically, there has been a shortage of child psychiatrists in the United States, undermining access to care. This study updated trends in the growth and distribution of child psychiatrists over the past decade. METHODS: Data from the Area Health Resource Files were used to compare the number of child psychiatrists per 100 000 children ages 0 to 19 between 2007 and 2016 by state and county. We also examined sociodemographic characteristics associated with the density of child psychiatrists at the county level over this period using negative binomial multivariable models. RESULTS: From 2007 to 2016, the number of child psychiatrists in the United States increased from 6590 to 7991, a 21.3% gain. The number of child psychiatrists per 100 000 children also grew from 8.01 to 9.75, connoting a 21.7% increase. County-and state-level growth varied widely, with 6 states observing a decline in the ratio of child psychiatrists (ID, IN, KS, ND, SC, and SD) and 6 states increasing by .50% (AK, AR, NH, NV, OK, and RI). Seventy percent of counties had no child psychiatrists in both 2007 and 2016. Child psychiatrists were significantly more likely to practice in high-income counties (P , .001), counties with higher levels of postsecondary education (P , .001), and metropolitan counties compared with those adjacent to metropolitan regions (P , .05). CONCLUSIONS: Despite the increased ratio of child psychiatrists per 100 000 children in the United States over the past decade, there remains a dearth of child psychiatrists, particularly in parts of the United States with lower levels of income and education.

Treatment of mental illness in American adolescents varies widely within and across areas

“…The variation shown in Table 2 raises the question of what is driving these area-level variations? A hypothesis raised in the literature is that shortages of qualified mental health professionals are an important determinant of treatment (16,17). Shortages may leave primary care physicians providing mental health care, even though many pediatricians report that they are uncomfortable in this role (18).…”

Meeting the Demand for Pediatric Mental Health Care

“…This leads to the question: how many child psychiatrists do we need? The American Academy of Child and Adolescent Psychiatry estimates that 47 child psychiatrists per 100 000 children would be sufficient, which is quadruple the rate found by McBain et al 1,7 The recently published Health Resources and Services Administration (HRSA) "Behavioral Health Workforce Projections, 2016-2030" made the unsubstantiated determination that at most, the demand for child psychiatric services in 2016 exceeded the supply by 20%. 8 Assuming that the child psychiatrist shortage is closer to what American Academy of Child and Adolescent Psychiatry estimates, the current rate of increase will not meet the need for child psychiatric services over the next decade.…”

“…Wait times for new appointments can be many months, and families may be required to travel long distances. In the article "The Growth and Distribution of Child Psychiatrists in the United States: 2007-2016" in this issue of Pediatrics, McBain et al 1 evaluate whether we have made any progress in expanding the child psychiatry workforce, both in number and distribution. They found that from 2007 to 2016, the number of child psychiatrists increased by 21%, and the number of children in the United States declined slightly.…”

State Insurance Mandates and the Workforce for Children With Autism

“…More than 70% have no child psychiatrists. 11 Additionally, a majority of mental health treatment facilities do not provide behavioral health care services for children with ASD. 12 However, there is a paucity of information regarding whether insurance mandates have impacted workforce availability.…”

“…13 We evaluated the effect of state insurance mandates on workforce supply of three types of health care providers that commonly provide services to children with ASD (BCBAs, child psychiatrists, and pediatricians) over a 15-year period (2003-2017) during which 44 states introduced mandates. We anticipated mandates would be associated with a modest increase in BCBAs 14 but unrelated to supply of child psychiatrists and pediatricians because these latter roles are often overwhelmed by existing patient volume 11,15 and children with ASD likely represent a small percentage of their patient population.…”