supply and distribution of the behavioral health …...7/18/17 1 c. holly a. andrilla, eric h....

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C. Hol ly A . Andr i l la , Er ic H. Larson, Davis G. Patterson, L isa A . Garberson

Un ive rs i t y o f Wash ington WWAMI Ru ra l Hea l th Resea rch Cente r

SupplyandDistributionoftheBehavioralHealthWorkforceinRuralAmerica

AcknowledgementsandDisclaimer

ThisresearchwassupportedbytheFederalOfficeofRuralHealthPolicy(FORHP),HealthResourcesandServicesAdministration(HRSA),U.S.DepartmentofHealthandHumanServices(HHS)undercooperativeagreement#U1CRH03712. Theinformation,conclusionsandopinionsexpressedinthispresentationarethoseoftheauthorsandnoendorsementbyFORHP,HRSA,orHHSisintendedorshouldbeinferred.

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Methods

DataSources:

• NationalPlanandProviderEnumerationSystem(NPPES)NationalProviderIdentifier(NPI)data(downloadedOctober2015)

• U.S.DepartmentofAgricultureEconomicResearchService(ERS)UrbanInfluenceCodes(UIC),2013

• 2014Claritas U.S.populationdata

Methods- CountyClassificationCountiescategorizedusingtheirUICcode

Metro- UIC1,2

(Countieswithanurbancorewithapopulationofatleast50,000)

Non-Metro- UIC3-12

Micropolitan- UIC3,5,8

(Countieswith anurbancoreofatleast10,000, butlessthan50,000,population)

Non-Core- UIC4,6,7,9-12

(labeled"noncore"becausetheyarenotpartof"core-based"metroormicroareas.)

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BehavioralHealthProviders

•Psychiatrists•PsychiatricNursePractitioners•Psychologist•SocialWorkers

•Counselors

AlloftheseprovidertypesarerepresentedintheNPIdatainvaryingstatesofcompleteness

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MetropolitanvsNon-metroprovideravailability

MetroCounties

•27%lackapsychiatrist

•17.5/100,000population

•19%lackapsychologist

•33.2/100,000population

•42%lackapsych.NP

•2.2/100,000population

Non-MetroCounties

•65%lackapsychiatrist

•5.8/100,000

•47%lackapsychologist

•13.7/100,000population

•81%lackapsych.NP

•1.6/100,000population

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MetropolitanvsNon-metroprovideravailability

MetroCounties

•9%lackasocialworker

•66.4/100,000population

•6%lackacounselor

•118.1/100,000population

Non-MetroCounties

•27%lackasocialworker

•38.9/100,000

•18%lackacounselor

•86.7/100,000population

118.1

66.4

33.2

17.5

2.2

100.2

45.0

16.87.5

2.1

67.1

29.9

9.13.4 0.9

Counselors SocialWorkers Psychologists Psychiatrists Psych,NPs

Providersper100,000PopulationinU.S.CountiesbyUrbanInfluence

Category

Metropolitan Micropolitan Non-Core

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6% 9% 19%

27%

42%

6% 11%

19%

35%

60%

24%

35%

61%

80%

91%

Counselors SocialWorkers Psychologists Psychiatrists Psych,NPs

U.S.CountieswithoutMentalHealthProvidersbyUrbanInfluenceCategory

Metropolitan Micropolitan Non-Core

U.S.CensusDivisions

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DisparitiesbyCensusDivisionTherearelargedisparitiesintheratiosofproviderstopopulationbyCensusDivision

Morethana3-folddifferenceinthepsychiatrist andpsychologist providertopopulationratiobetweenhighestandlowestsuppliedcensusdivisions

Thedifferenceisconsistentoverallandinurbanandrurallocations

DisparitiesbyCensusDivision

Morethana5-folddifference inthesocialworkerandpsychiatricnursepractitionerprovidertopopulationratiobetweenhighestandlowestsuppliedcensusdivisions.

Thedifferenceisconsistentoverallandinrurallocations.

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PercentofU.S.CountiesWithoutaPsychiatristbyCensusDivision

CensusDivision Overall Metro Non-MetroNewEngland(67counties) 6% 3% 9%MiddleAtlantic (150counties) 9% 4% 19%EastNorthCentral (437counties) 42% 22% 55%WestNorthCentral (618counties) 69% 40% 77%SouthAtlantic (582counties) 42% 29% 58%EastSouth Central(364counties) 57% 40% 65%WestSouthCentral (469counties) 64% 36% 77%Mountain (281 counties) 61% 28% 71%Pacific (167 counties) 34% 9% 56%

PercentofU.S.CountiesWithoutaPsychologistbyCensusDivision

CensusDivision Overall Metro Non-MetroNewEngland(67counties) 1% 3% 0%

MiddleAtlantic (150counties) 5% 2% 9%EastNorthCentral (437counties) 22% 12% 29%WestNorthCentral (618counties) 56% 33% 62%SouthAtlantic (582counties) 27% 17% 38%EastSouth Central(364counties) 46% 34% 52%WestSouthCentral (469counties) 49% 26% 61%Mountain (281 counties) 40% 18% 46%Pacific (167 counties) 22% 5% 37%

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PercentofU.S.CountiesWithoutanyMentalHealthProviders* byCensusDivision

CensusDivision Overall Metro Non-Metro

NewEngland(67counties) 1% 3% 0%

MiddleAtlantic (150counties) 1% 0% 4%

EastNorthCentral (437counties) 3% 2% 4%

WestNorthCentral (618counties) 20% 3% 24%

SouthAtlantic (582counties) 5% 2% 8%

EastSouth Central(364counties) 7% 3% 8%

WestSouthCentral (469counties) 14% 7% 18%

Mountain (281 counties) 8% 2% 10%

Pacific (167 counties) 3% 1% 4%

*MentalHealthProvidersinclude:Psychiatrists,Psychologists,SocialWorkers,PsychiatricNursePractitioners,Counselors

StatelevelDataSheetsAvailableattheWWAMIRHRCwebsite:https://depts.washington.edu/fammed/rhrc/publications/the-supply-and-distribution-of-the-behavioral-health-workforce-in-america-a-state-level-analysis/

FullNationalReport(WWAMIRHRCDataBrief#160)isalsoavailableontheWWAMIRHRCwebsite.

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WashingtonStateLevelDataSheet

SummaryandImplications•Rural-urbandisparitiesinbehavioralhealthprovidersupplyextendbeyondthewell-knownshortagesofpsychiatriststoincludeclinicalpsychologists,psychiatricnursepractitioners,socialworkersandcounselors.

•Thenon-coreruralcountieshavethegreatestshortages,17% donothaveabehavioralhealthprovider

•Theprovidertopopulationratioofpsychiatrists,psychologists,psychiatricnursepractitioners,andsocialworkersinnon-corecountiesislessthanhalftherateofmetropolitancounties.

•ThereissignificantregionalvariationinthesupplyofbehavioralhealthproviderswiththeSouthandMidwest havinglessthanhalf thepercapitasupplythantheNortheast

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LimitationsPrimarycareprovidersnotincludedinanalysis

PhysicianAssistantsnotincludedintheanalysis

NotallprovidersareintheNPIfile

ProvidersusetheirNPInumbertobilltheCentersforMedicareandMedicareServicesforservicesprovided• SomeprovidersbillusinganinstitutionalNPInumber• Someprovidersbillunderanotherperson’sNPInumber• Differsbytypeofprovider

Socialworkersandcounselorsmaybeunder-representedinthiswork.

Psychiatrists,PsychiatricNursePractitionersandPsychologistsarewellrepresentedintheNPIwhencomparedtootherdatasets(e.g.AmericanMedicalAssociationPhysicianMasterfile)

NextSteps– theruralbehavioralhealthworkforce

PCP’sdeliveralotofbehavioralhealthvisits,especiallyinruralareas.Howdoweincludethosevisitsinestimatingcareavailabletoruralresidents?

PossibledatasourcesincludeMedicaredata– WWAMIRHRCmaybeaddressingthisinYear2– examiningwhotreatsMedicarebeneficiariesforanxietyanddepressioninruralAmerica.

RoleofotherprofessionsinruralbehavioralhealthdeliveryincludingBehavioralHealthAides,PhysicianAssistants,(non-psych)NursePractitioners.

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Contactinformation

HollyAndrilla,MShollya@uw.edu206-685-6680

WWAMIRuralHealthResearchCenterhttp://depts.washington.edu/uwrhrc

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TheRuralHealthResearchGatewayprovidesaccesstoallpublicationsandprojectsfromeightdifferentresearchcenters.Visitourwebsiteformoreinformation.

ruralhealthresearch.org

Signupforouremailalerts!ruralhealthresearch.org/alerts

CenterforRuralHealthUniversityofNorthDakota

501N.ColumbiaRoadStop9037GrandForks,ND58202