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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TheRuralHealthResearchGatewayprovidesaccesstoallpublicationsandprojectsfromeightdifferentresearchcenters.Visitourwebsiteformoreinformation.
ruralhealthresearch.org
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CenterforRuralHealthUniversityofNorthDakota
501N.ColumbiaRoadStop9037GrandForks,ND58202
Contactinformation
HollyAndrilla,[email protected]
WWAMIRuralHealthResearchCenterhttp://depts.washington.edu/uwrhrc
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TheRuralHealthResearchGatewayprovidesaccesstoallpublicationsandprojectsfromeightdifferentresearchcenters.Visitourwebsiteformoreinformation.
ruralhealthresearch.org
Signupforouremailalerts!ruralhealthresearch.org/alerts
CenterforRuralHealthUniversityofNorthDakota
501N.ColumbiaRoadStop9037GrandForks,ND58202