A July 2020 Health Tracking Poll from the Kaiser Family Foundation (KFF) found that four in 10 adults reported symptoms of anxiety or depressive disorder, up from one in 10 from January to June 2019. The increase in these symptoms is leading to an increased demand for behavioral health care. A 2021 American Psychological Association (APA) survey reported a spike in referrals for services from 37 percent in 2020 to 62 percent in 2021; 68 percent of psychologists also have wait lists.
Jennifer M. Doran, Ph.D is president of the Connecticut Psychological Association (CPA) and an assistant professor at Yale School of Medicine. She pointed out that Connecticut has the biggest shortage of providers in New England and is also ranked in the top 10 states with the most residents living in a MH Health Professional Shortage Area (HPSA).
She reported that 52 percent of the population resides in a designated shortage area, the highest within New England. According to Doran, Connecticut would need a more than 50 percent increase in the behavioral health workforce to meet the needs of children, families, and underserved individuals.
However, Doran said psychologists are not necessarily leaving the profession, but rather are changing their professional roles. “Psychologists have many options. They can work in a bigger system, the VA, hospital, or a consulting role,” she said.
Private practices are opting out of insurance panels as reimbursement has become “astronomically worse,” Doran added. “[Psychologists] are not getting paid enough to offset operating costs.”
Doran noted that Connecticut needs a larger workforce and has to strive to improve the economics of the profession. She said that to become a psychologist requires a significant financial investment. Furthermore, behavioral health care providers need to be paid appropriately. “There is a cost to income discrepancy,” she said.
Doran was part of a team that conducted a national survey that found an increased gap between the time and cost to get into the profession and income. “The average debt is $150,000 for doctoral level and starting salaries are around $60,000,” she said. “The profession is becoming less viable. There is a need for state-funded resources and investment.”
John F. Todaro, Ph.D, a clinical associate professor at Brown University’s department of psychiatry and human behavior, cited the high cost of graduate education and five-year commitment to become a psychologist as potential barriers to enticing newcomers to the profession.
He suggested that more efforts should be made to promote the field as the demand for psychological services, particularly in the wake of the pandemic, outweighs the number of available providers.
Todaro also serves as director at Providence Behavioral Health Associates.
He said loan forgiveness and more scholarships to fund graduate school might reduce barriers to enter in the field. He added that some states are considering accelerating the licensure process and allowing pre-doctoral hours to count toward licensure, steps that could help boost entry into the profession.
Reimbursement issues continue to push providers to opt out of insurance panels, which limits access to care for patients. “Reimbursement rates are largely flat or not going down,” Todaro said. “They are not keeping up with the inflation of operating costs.”
Additionally, some psychologists find the application process to participate in insurance panels not worth the trouble. While psychologists are not being obstructed from joining insurance panels in Rhode Island, they are experiencing longer wait times to become credentialed, according to Todaro. “Previous wait times ranged between 30 and 45 days; nowadays that timeframe is 60 to 90 days.”
Todaro said, “The significant demand for mental health services is so much more than we can meet with our current workforce of psychologists.”
He noted that telehealth has created flexibility and has had a positive influence on keeping providers in the profession. “More services can be conducted virtually and paid for at the same rate as in-person services,” he said. However, certain populations who need in-person services, continue to experience long delays and limited access.
Augustus E. Jordan, Ph.D, retired executive director, health and counseling services, Middlebury College, noted that colleges, in some way, are a predictor of what will happen in the general population. During the last 15 years, the number of students requiring services has dramatically increased.
He sees an “existential anxiety crisis” as demand surges, a trend that now cuts across populations and the country. “There is more depression and anxiety,” he said. “There is more reaching out, more awareness of our own struggles.”
While Middlebury College offers mental health services on campus, the surge in numbers prompted the school to refer some students out to the community. However, therapists already had full patient caseloads so it was “hit or miss” to place a student with a community-based psychologist.
Jordan finds that messages on professional listservs are the best indicator of the psychologist shortage. He belongs to two listservs that pertain to different types of providers. “Every other day, someone on the list seeks another provider to take on a client. Five years ago, this did not happen. Now it happens all the time,” he said.
Anecdotally, he is seeing more therapists seeking to manage their practices more carefully, setting limits on what they are willing to do, and pulling back from taking every client. Some want to be more flexible and/or work part time.
Jes Leonard, Ph.D, training director at Life Stance Health in Londonderry, New Hampshire, said retiring psychologists tend to disrupt the supply chain. “We have an ethical obligation to find ongoing care. Last year, the email chain was rampant with requests. Psychologists were closing their practices and looking to find a practitioner to take on clients,” she said. “Psychologists are having difficulty figuring out how to manage their current caseload, without taking on new clients.”
Leonard, past president of the New Hampshire Psychological Association (NHPA), said for psychology students, COVID-19 has negatively affected training hours and rotations. “The pipeline has been somewhat restricted due to the pandemic,” she said.
At the beginning of the pandemic, students in practicum were sent home, so face-to-face training might have been cut short and placements may not have happened. Leonard said, “Licensing boards have to take these factors into consideration.”
Leonard is playing an active role in helping to revamp programs for early career psychologists. “We know the young trainee experience has been so different. We want them to feel supported,” she said. “We want to support and help them become leaders.”