County-level supply of psychiatrists in Texas: current levels and projections through 2030

Shortages of psychiatrists are among the most acute in the health care industry. Over the past twenty years, the demand for psychiatrist care has far outpaced the supply of these physicians. To help address a growing need for demand and supply analysis of psychiatrists, this study uses a stock and flow microsimulation model to estimate the current (2018) and projected (2019 – 2030) supply of psychiatrists at the county level in Texas.

Current supply of psychiatrists was estimated for each county in Texas using the July 2018 physician licensure file from the Texas Medical Board. Physicians who identify with psychiatry either as a primary or secondary medical specialty are included in estimating psychiatry supply. We also account for number of hours worked per week in order to estimate psychiatrist supply in full-time equivalent units. Physician FTEs by location were further adjusted by using a gravity model to account for proximity to population centers. The resulting supply FTEs estimated are more reflective of physician availability to residents in each county than location-based FTEs.

The supply FTEs were subsequently used to compute availability ratios for each county, defined as the number of psychiatrist FTEs per 100,000 residents. Our analysis compares total supply and availability ratios for rural and urban counties in the State. The results of this paper support the conclusions of other studies – that shortages are more acute in rural counties than in urban areas. However, our results also provide a more robust measure of the degree of availability at the county-level.

Projections of psychiatrist supply through 2030 were developed by using a stock-and-flow microsimulation model. The current (2018) stock of psychiatrists was adjusted at an annual time step by using the inflow of psychiatrists through new entrants from the graduate medical education pipeline, net transfers in from other areas or specialties, and adjusting for outflows and attritions due to retirement, decease, career change, and transfers to other areas or specialties. The results indicate that current trends of supply and availability ratios are projected to continue for at least 15 to 20 years, indicating a worsening shortage situation if trends in demand for psychiatrist care are maintained.