Addressing Texas’ psychiatrist shortage

Although the entire nation is experiencing a shortage of mental health practitioners, Texas ranks far below the national average in terms of the number of mental health professionals per 100,000 residents. In fact, second to California, Texas has the largest number of Mental Health Care Professional Shortage Areas (HPSAs) in the United States. Furthermore, amplifying the difficulty of finding a solution to the mental health care provider shortage, the state faces a unique challenge as a large percentage of Texans live in a rural area. Thus, many Texans may need to travel large distances to get access to the few mental health care providers available.

Plans for Texas A&M College of Medicine’s psychiatry residency program

One way to address the lack of providers is—of course—to train additional psychiatrists. To that end, the Texas Higher Education Coordinating Board awarded a $250,000 planning grant to the Texas A&M College of Medicine. The grant prioritized primary care and psychiatry programs, especially in a rural setting.

“With the help of the grant, we hope to develop a Bryan-College Station-based psychiatry residency program,” said Andrew Harper, MD, child and adolescent psychiatrist with the Texas A&M Outpatient Psychiatry Clinic, associate department head for clinical care and clinical professor at the Texas A&M College of Medicine. “This grant will help us on several fronts as we plan and finance the project.”

For example, the funds will help Harper and his team recruit top notch faculty, coordinate with community resources and potential partners and hire a consultant to make sure the Accreditation Council for Graduate Medical Education (ACGME) criteria are met.

After completing medical school, a psychiatry resident undergoes a residency that lasts four years before they can become an independent practicing psychiatrist. “In our program, we hope to have three to four residents per year,” Harper said. “Our goal is to have the program running by summer 2020, so we have a lot to do between now and then.”

One of the reasons behind the psychiatrist shortage

The grant is a part of the state’s effort to expand the graduate medical education programs in Texas. Within the last decade, the number of medical schools and spots within existing medical schools have expanded to attempt to solve Texas’ physician shortage. However, the available graduate medical education positions and residency program spots have not expanded at the same rate to match this growth.

Statistically, matriculating medical residents are more likely to practice within 100 miles of their residency program. With the increase in medical school attendance, Texas has graduated more students from medical school than ever before, but those graduates are not finding a residency position in the state. As a result, many move out of state to complete their medical training and stay within 100 miles of that site to practice.

“We are losing opportunities to give our Texas communities a chance to have a physician,” Harper said. “By offering more graduate medical education positions specifically in psychiatry, we hope to increase the number of psychiatrists in the areas of the Brazos Valley surrounding Bryan-College Station, where they are very much needed.”

Unique possibilities for collaboration

A comprehensive approach to health care involves both physical and mental care. As a result, one of the ACGME requirements for an accredited psychiatry residency program is a minimum of four months’ experience in a primary care setting.

Harper emphasized the importance of psychiatry residents getting an immersive training in primary care. “We know people with behavioral health problems often have shorter lifespans,” he said. “Similarly, some medical problems can first present in changes to mental status.” One example is hyperthyroidism, which, according to Harper, can make the patient experience symptoms similar to someone with an anxiety disorder.

Furthermore, some commonly prescribed medications within a psychiatry clinic cause side effects like hyperlipidemia and insulin-resistance. Therefore, psychiatry residents need to be knowledgeable about the overall health of patients to make the best judgement about what medications to prescribe.

“We are exploring potential partnerships with the Texas A&M Family Medicine Residency as well as other partners to get our psychiatry residents quality experiences within primary care and hospital settings,” Harper said. “We are lucky to have great resources through Texas A&M University, the Texas A&M University Health Science Center and the College of Medicine.”

Facing a similar requirement for cross-training, family medicine residents must be educated in the diagnosis and management of common mental illnesses. As of right now, family medicine residents at the Texas A&M Family Medicine Residency rotate within the behavioral health clinic at Texas A&M Health Family Care as well as in the Texas A&M Outpatient Psychiatry Clinic to meet this criterion.

“Because there is a shortage of behavioral health providers of all types and due to the stigma of psychiatric illness, a huge number of patients show up in their primary care provider’s office asking for help,” Harper said. “It is important the family medicine residents know how to treat them.”

Promising future

Although the shortage of health care practitioners in Texas will not be solved overnight, the Texas A&M College of Medicine is working to bring health care to the surrounding communities. With programs like the Texas A&M Telebehavioral Care Clinic, which brings mental health care to patients regardless of distance, and the Texas A&M Family Medicine Residency Program that consistently matriculates physicians dedicated to working in rural communities, Texas is closing the physician shortage one community at a time.

“We are extremely appreciative of the opportunity provided to us by the Texas Higher Education Coordinating Board,” Harper said. “It is thanks to them that we can start to plan our new psychiatry residency program, and as a result, improve the mental health of the Brazos Valley.”