ATLANTA ― A new American Psychiatric Association study confirms what patients with mental illness in the Washington, DC, area already know ― that it is almost impossible to get a new patient appointment with a psychiatrist for needed care.

The research shows that the majority of network psychiatrists in the three largest carriers in the DC Health Link Health Insurance Exchange Network were either not reachable or were not able to schedule a new patient visit.

The study was released here at the American Psychiatric Association (APA) 2016 Annual Meeting.

Unreachable

In response to frequent complaints that patients cannot find a psychiatrist in their network, the APA worked with the APA Foundation to conduct a study of the three largest health insurance plans in the Washington, DC, health insurance exchange to determine whether the psychiatrists publicly listed in the network directories were available to see patients.

Among the key findings, presented by Joyce West, PhD, of the APA and the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, were the following:

Only 14% of the psychiatrists listed in the network directories were available to schedule new outpatient appointments; 86% of the psychiatrists listed were either unreachable or were not taking new patients.

Nearly a quarter (23%) of the telephone numbers listed for network psychiatrists were nonworking numbers.

Nearly half (49%) of the psychiatrists were no longer at the number listed.

Callers often had to call several times to get a response.

Only 7% of listed psychiatrists were able to schedule a new appointment within 2 weeks; 3% were able to do so within 15 to 28 days; and 4% had wait times longer than 4 weeks.

The average wait time for a new appointment was nearly 3 weeks (19.1 days).

"This study shows us that many people are not able to access needed care, and people are paying for mental health care they cannot access," APA CEO and Medical Director Saul Levin, MD, said in a statement.

"The Affordable Care Act is intended to expand access to mental health and substance use disorder care, yet networks are shrinking, both because psychiatrists are dropping out of the networks, citing unreasonable administrative burden and low payment rates as reasons, and because plans are 'narrowing their networks' while providing robust directories of providers to attract purchasers to the plan," Dr Levin added.

No Surprise

None of the panelists discussing the study here were surprised by the study's findings.

Panelist Steven S. Sharfstein, MD, president and CEO of Sheppard Pratt Health System in Maryland, said he "often gets calls from patients in Baltimore saying they've called every provider on the list and can't reach anyone. The fact is, there just aren't enough psychiatrists. It's a supply and demand problem."

Panelist Steven Epstein, MD, professor and chair of the Department of Psychiatry of the Georgetown University School of Medicine and chief of service of the Department of Psychiatry of MedStar Georgetown University Hospital, said, "The data we have completely support what this study found.

"We get 30 calls a day from someone looking for a psychiatrist, so that's 150 calls a week, and we can accommodate about 10% of them. And the reason we say yes is almost invariably because the person is being treated currently by someone within Georgetown or MedStar Health, and if we don't say yes, we're not doing integrated care, or I'm going to get a phone call 2 days later saying, 'You're not seeing our patients.' But if a random person calls and says, 'I moved recently to the area,' they aren't going to get in," Dr Epstein added.

In an interview with Medscape Medical News, incoming APA President Maria A. Oquendo, MD, of the New York State Psychiatric Institute and New York–Presbyterian/Columbia University Medical Center, made the point that "about 20% to 25% of the population suffer mental illness, and on average, in the United States, we have 13 psychiatrists per 100,000 population, and in some places even fewer. In Idaho, there are only 6 per 100,000. So there simply aren't enough physicians in general but also psychiatrists in particular in the United States. So we really need to partner with physician extenders."

Panelist Irvin "Sam" Muszynski, JD, of the APA's Office of Healthcare Systems and Financing, said a large part of the problem is that insurance plans do not keep their list of network providers up to date, "and that has to change." Regulators "need to get involved and clean this up, because it's akin to fraud."

American Psychiatric Association (APA) 2016 Annual Meeting: Forum, presented May 16, 2016.