The occupational transformation of the mental health system

Health Affairs

Volumn 22, Issue 5, 2003, Pages 177-188

  Scheffler, Richard M ^a,b   Kirby, Paul B ^a  

^a Department of Health Economics and Public Policy ^*

^b School of Public Health   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PSYCHOLOGY; ECONOMICS; EPIDEMIOLOGY; FORECASTING; HEALTH CARE MANPOWER; HEALTH INSURANCE; HUMAN; INCOME; MANPOWER; MENTAL HEALTH SERVICE; PROFESSIONAL PRACTICE; PSYCHIATRY; SOCIAL WORK; UNITED STATES;

FORECASTING; HEALTH CARE SURVEYS; HEALTH MANPOWER; HUMANS; INCOME; MANAGED CARE PROGRAMS; MENTAL HEALTH SERVICES; PROFESSIONAL PRACTICE; PSYCHIATRY; PSYCHOLOGY, CLINICAL; SOCIAL WORK, PSYCHIATRIC; UNITED STATES;

EID: 1542471070     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.22.5.177     Document Type: Review

References (35)

1. Bureau of Health Professions, Area Resource File (ARF). The American Medical Association (AMA) reports somewhat higher figures: 40,731 clinically active psychiatrists for 1998. For the data analysis in this paper, we have exclusively used the ARF figures.
2. R.W. Manderscheid and M.J. Henderson, eds., Mental Health, United States, 2000 (Rockville, Md.: U.S. Department of Health and Human Services, 2000), chap. 20. The figure for social workers is the number of members of the National Association of Social Workers (NASW) with master's or doctoral degrees. The NASW estimates the actual number of practicing social workers to be at least twice this figure.
3. M. Gibelman and P. Schervish, Who We Are: A Second Look (Washington: NASW Press, 1997).
4. NASW Practice Research Network, Practice Research Survey 2000, "Practice Area, PRN 1, 3, 2000," www.socialworkers.org/naswprn/area. pdf (4 April 2003).
5. See Note 2.
6. ARF (psychiatrist data); and Manderscheid and Henderson, eds., Mental Health, United States, 2000 (psychologist and social worker data).
7. Manderscheid and Henderson, eds., Mental Health, United States, 2000.
8. ARF.
9. Population figures are from the Census Bureau; psychiatrist counts are from the ARF. For all calculations of providers per 100,000 population, the total population (adults and children) was used.
10. The graphs are available from the authors on request; send e-mail to rscheff@uclink.berkeley.edu.
11. Variation around the income gradient lines for psychiatrists and psychologists largely fits the regional patterns discussed earlier. For example, northeastern states typically have rates of these professions above the gradient line. There is no regional pattern of variation for social workers. For all professions, the District of Columbia is the most notable outlier, with vastly higher numbers of providers per 100,000 population than any state. Several of the District's unique characteristics can account for this, including the presence of federal psychiatric facilities and the access of federal employees to mental health coverage that is relatively generous compared with that of the private sector generally.
12. Because of data limitations, data on regional and metropolitan/ nonmetropolitan distribution over time are available only for psychiatrists and child psychiatrists. Detailed findings are available from the authors.
13. We analyzed metropolitan distribution using the U.S. Department of Agriculture Economic Research Service's rural-urban continuum code for the practice location of each psychiatrist; these data are a component of the ARF. Details and results of this analysis are available from the authors.
14. AMA, Physician Socioeconomic Statistics, 2000-2002 editions (Chicago: AMA, various years). In 1998 the mean net income of psychiatrists was $146,800, compared with $205,400 for all physicians (in 2000 dollars).
15. American Psychological Association, Salaries in Psychology (Washington: APA, 1995 and 2001).
16. NASW, Practice Research Network, Practice Research Survey 2000, "Social Work Income 2, PRN 1, 6, 2002," www.socialworkers.org/naswprn/ income2.pdf (10 February 2003).
17. R.M. Scheffler, S.L Ivey, and A.B. Garrett, "Changing Supply and Earning Patterns of the Mental Health Workforce," Administration and Policy in Mental Health 26, no. 2 (1998): 85-99.
18. AMA, Socioeconomic Monitoring System Survey, 1998.
19. D.P. Pingitore et al., "Comparison of Psychiatrists and Psychologists in Clinical Practice," Psychiatric Services 53, no. 8 (2002): 977-983.
20. See R.M. Scheffler, "Managed Behavioral Health Care and Supply-Side Economics," Journal of Mental Health Policy and Economics 2, no. 1 (1999): 21-28, for a discussion of this issue.
21. Open Minds, Yearbook of Managed Behavioral Health Market Share in the United States, 2000-2001 (Gettysburg, Pa.: Open Minds, 2001).
22. AMA, Socioeconomic Monitoring System Survey, various years.
23. One effect of increased managed care participation is on fee discounting. Psychiatrists with half or more of patients in managed behavioral health care plans report a much higher percentage of patients receiving fee discounts, compared with psychiatrists with no patients in managed care plans. R.M. Scheffler et al., "Managed Care Fee Discounts in Psychiatry: New Evidence," Journal of Behavioral Health Services and Research 27, no. 2 (2000): 215-226.
24. In recent survey research on psychologists in California, more than 60 percent reported receiving payment from managed care plans. D.P. Pingitore et al., "Professional Psychology in a New Era: Practice-Based Evidence from California," Professional Psychology: Research and Practice, 32, no. 6 (2001): 597-606.
25. For example, National Center for Health Statistics, Health, United States, 2002 (Hyattsville, Md.: DHHS, 2002), reports that 53.4 percent of California's population was enrolled in HMOs in 2001. Massachusetts had the second-highest percentage, 44.3 percent, while the national average was only 27.9 percent.
26. The data on psychologists and social workers are for 2002 and come from the California Department of Consumer Affairs, which compiles licensure data. Data on psychiatrists are available for 1999 only, from the ARF, but since the psychiatric workforce size nationally has been stable, we feel justified in using these 1999 data in calculating the 2002 ratio of the three professions. All figures for psychiatrists in this section include child psychiatrists.
27. Our source suggests that clinical social workers and psychiatrists provide a slightly higher proportion of patient services than those professions' representation in the provider network would indicate.
28. M. Olfson et al., "National Trends in the Use of Outpatient Psychotherapy," American Journal of Psychiatry 159, no. 11 (2002): 1914-1920.
29. M. Olfson et al., "National Trends in the Outpatient Treatment of Depression," Journal of the American Medical Association 287, no. 2 (2002): 203-209.
30. See W. Goldman, "Is There a Shortage of Psychiatrists?" Psychiatric Services 52, no. 12 (2001): 1587-1589, for a discussion of this issue.
31. M. Olfson, S.C. Marcus, and H.A. Pincus, "Trends in Office-Based Psychiatric Practice," American Journal of Psychiatry 156, no. 3 (1999): 451-457.
32. H.A. Pincus, "The Future of Behavioral Health and Primary Care: Drowning in the Mainstream or Left on the Bank?" Psychosomatics 44, no. 1 (2003): 1-11.
33. J. Daw, "New Mexico Becomes First State to Gain Rx Privileges," Monitor on Psychology 33, no. 4 (2002): 24-25.
34. E.H. Wagner, "The Role of Patient Care Teams in Chronic Disease Management," British Medical Journal (26 February 2000): 569-572.
35. J. Unützer et al., "Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial," Journal of the American Medical Association 288, no. 22 (2002): 2836-2845.