Projected Workforce of Psychiatrists in the United States: A Population Analysis.

OBJECTIVE: This analysis quantified and assessed the projected workforce of psychiatrists in the United States through 2050 on the basis of population data. METHODS: With use of data from the Association of American Medical Colleges (2000-2015), American Board of Psychiatry and Neurology (2000-2015), and U.S. Census Bureau (2000-2050), the psychiatrist workforce was projected through 2050. Two established psychiatrist-to-population ratios were used to determine the estimated demand for psychiatrists and potential shortages. RESULTS: The psychiatrist workforce will contract through 2024 to a projected low of 38,821, which is equal to a shortage of between 14,280 and 31,091 psychiatrists, depending on the psychiatrist-to-population ratio used. A slow expansion will begin in 2025. By 2050, the workforce of psychiatrists will range from a shortage of 17,705 psychiatrists to a surplus of 3,428. CONCLUSIONS: Because of steady population growth and the retirement of more than half the current workforce, the psychiatrist workforce will continue to contract through 2024 if no interventions are implemented, leading to a significant shortage of psychiatrists. Despite an expected workforce expansion beginning in 2025, it is unclear whether the shortage will completely resolve by 2050. Future research should focus on developing strategies to address this quantified shortage in an effort to curb the worsening shortage through 2024 and over the coming decades.

Principles of antipsychotic prescribing for policy makers, circa 2008. Translating knowledge to promote individualized treatment.

Findings from 2 pivotal government-funded studies of comparative antipsychotic effectiveness undermine assumptions about the marked superiority of the more expensive second-generation "atypical" medications in comparison to the less expensive first-generation "typical" drugs. Because this assumption was the basis for the almost universal recommendation that these newer antipsychotics be used preferentially resulting in a 10-fold increase in state governmental expenditures on this class of medications over the past decade, a reassessment of policy is called for. To address the issue, the Medical Directors Council of the National Association of State Mental Health Program Directors critically reviewed findings of these studies in the context of other data and considered policy implications in the light of the obligations of state government to make available best possible and individually optimized treatment that is cost-effective. The Medical Directors Council unanimously adopted a set of recommendations to promote appropriate access, efficient utilization, and best practice use. We present our policy statement, in which we provide a succinct background, articulate general principles, and describe a set of 4 broad recommendations. We then summarize our understanding of the current state of knowledge about comparative antipsychotic effectiveness, best antipsychotic practice, and considerations for state policy that represent the basis of our position statement.

Mortality and medical comorbidity among patients with serious mental illness.

OBJECTIVES: This study examined mortality and medical comorbidity among patients with serious mental illness in Ohio. METHODS: Data for 20,018 patients admitted to an Ohio public mental health hospital between 1998 and 2002 were matched against state death records, and 608 deaths were identified. Leading causes of death and medical comorbidities, years of potential life lost (YPLL), and standardized mortality ratios were calculated for this population. RESULTS: Heart disease (126 persons, or 21 percent) and suicides (108 persons, or 18 percent) were the leading causes of death. The mean+/-SD number of YPLL was 32.0+/-12.6 years. The highest cause-specific mean YPLL was for suicides (41.7+/-10.3 years). Deaths from unnatural causes had higher mean YPLL than deaths from any other causes. Cause-specific mean YPLL were higher for women than for men, except for homicides, pneumonia and influenza, and heart disease. The aggregated standardized mortality ratio from all causes of death was 3.2, corresponding to 417 excess deaths (p<.001). Obesity (144 persons, or 24 percent) and hypertension (136 persons, or 22 percent) were the most prevalent medical comorbidities. CONCLUSIONS: This study demonstrated excess mortality among patients in Ohio with serious mental illness. Results highlight the need to integrate delivery of currently fragmented mental and physical health services and to target interventions that improve quality-of-life outcomes for this population.

The Professor of Public Psychiatry Model in Ohio: the impact on training, program innovation, and the quality of mental health care.

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.

A quality improvement process for implementing the Texas algorithm for schizophrenia in Ohio.

Medication algorithms developed in Texas are being implemented in a number of states in the United States and internationally. This report describes a quality improvement process adapted from the Texas Medication Algorithm Project that was used to implement the Texas algorithm for schizophrenia in Ohio. A total of 38 physicians were surveyed about their perceptions of barriers to implementation of the guidelines. The physicians generally thought that the schizophrenia algorithm was good, current, and applicable. Although they did not perceive barriers to its implementation, they did not seem to alter their practices to a great extent in response to the algorithm. The results of the study may guide other states in their implementation of algorithms.