The number of primary care physicians in Rhode Island is not enough to meet national standards for adequate access to care and is 40 percent less than previously estimated, according to a new comprehensive health care survey initiative from the Rhode Island Department of Health.
There are 803 primary care physicians but 602.7 total full-time equivalents in calendar year 2014, as reported in the RIDOH 2015 Statewide Health Inventory released in mid-November.
That number has essentially one primary care full-time equivalent for every 1,718.1 Rhode Islanders.
While the report assesses the number of primary care physicians and found modest levels of integration between primary care and behavioral health clinics, it did not address the numbers of behavioral health clinicians in the state.
“That would be good to know,” observed Peter M. Oppenheimer, Ph.D., president and Legislative Committee chair of the Rhode Island
Psychological Association. He is also chair of the state Board of Psychology and the Rhode Island Primary Care Physicians Corporation Behavioral Health Network, which links behavioral health care and primary care providers to facilitate referrals and coordination of care.
There were 871 people with an active psychologist license from RIDOH in December.
Is that enough in a state where surveys indicate more residents report poor mental health days than the national average?
“From what I hear from my peers who are running practices, I hear we are all extremely busy with a lot of people with high need, and it’s a struggle to serve them in part because the intermediate resources are not there,” Oppenheimer said.
In 2014 the General Assembly passed the Rhode Island Access to Medical Technology and Innovation Act that required RIDOH to establish and maintain an inventory of health care facilities and services.
The statewide inventory will help guide the development of policies to meet the health needs of Rhode Islanders. Surveys were sent to health care facilities and practices throughout the state, including licensed behavioral health clinics, psychiatrists and psychologists. The overall response rate exceeded 92 percent for nearly all surveys.
The rate of mental health treatment for Rhode Island adults is higher than the national rate, according to federal data. But the new statewide inventory found that nearly one third of the state’s residents put off medical care because of cost and almost half of them became sicker before receiving care.
Both psychologists and psychiatrists reported having only 5 percent of their patient profile on Medicaid. Psychiatrists reported having more self-paying patients who were not on insurance (43 percent) than psychologists (17 percent).
Two-thirds of primary care practices were accepting new adult patients and only 45 percent were taking new pediatric patients in 2014. Only 45 percent of practices accepted new adult Medicaid patients and 39 percent accepted new pediatric Medicaid patients.
In comparison, about 86 percent of psychology practices indicated they accepted new patients. But only 56 percent said they accepted new Medicaid patients.
The statewide inventory also showed differences between primary care and behavioral health practices in the use of electronic medical records (EMR). While 85 percent of primary care outpatient practices used EMRs, 59 percent of behavioral health clinics and 55 percent of community outpatient specialty clinics did. About 75 percent of behavioral health clinics, 89 percent of psychology practices and 100 percent of psychiatry practices reported they did not use the same EMR as primary care providers.
Nearly 60 percent of behavioral health clinics reported they used EMR/EHR information software while 18.2 percent didn’t use any information software.
Nearly 28 percent of psychology practices reported they used EMR/EHR while 53 percent said they didn’t use any information software.
The report found the average number of patients seen in 2014 by psychiatrists was 1,151. For psychologists, the average number was 559.
“That, I think, is high. I can’t imagine I’m seeing 550 people in a year,” Oppenheimer said. “There are different kinds of practices, but I probably average 100, 200 different people over the course of the year.”
Oppenheimer suggested that psychologists working in integrated care settings primarily doing screenings may be more likely to see higher numbers of patients.
High numbers of patients would also be seen by the Rhode Island Department of Corrections, the single largest provider of mental health treatment in the state. Between 15 and 20 percent of corrections facilities inmates have a serious mental illness, and up to 80 percent of the incarcerated population are substance abusers, the statewide inventory reported.
Twelve licensed RIDOC mental health clinicians had 1,043 encounters with inmate patients each month in 2014. Nine psychiatrists split about 414 patient encounters per month, according to department spokeswoman Susan Lamkins.
By Janine Weisman