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Number of psychiatrists providing telemental health varies across US
The percentage of psychiatrists practicing telemental health varied across the U.S. between 2014 and 2016, from less than 1% in some states to about 20% in others, according to Medicare data. Those who did use telemental health were typically in practice for a shorter time, and more likely to practice in rural areas.
Throughout the U.S., many people don’t have access to specialty mental health care, but telemental health — video visits between a patient and a remote mental health specialist — may address these barriers, according to Ateev Mehrotra, MD, MPH, from Harvard Medical School, and colleagues.
“Telemental health has grown rapidly but unevenly across the nation,” they wrote. “Little is known about the characteristics of psychiatrists associated with the use of this technology.”
Therefore, researchers compared the characteristics of psychiatrists who did or did not use telemental health using data from a 20% random sample of psychiatrists who provided care in the Medicare fee-for-service program (2014 to 2016).
Those with more than 100 telemental health visits were considered high-use psychiatrists. The investigators linked national practitioner identifier data with Doximity data to determine sex, years of practice and medical school type. They identified physician characteristics associated with telemental health use after controlling for state of practice using multivariable logistic regression.
Of 28,567 psychiatrists included in the analysis, 1,544 (5.4%) delivered 377,440 telemental health visits and 622 of those (40.2%) psychiatrists provided 100 or more such visits.
The study showed notable variation across states in the percentage of psychiatrists providing telemental health, with highest observed in North Dakota (24.2%) and Wyoming (19.6%) and the lowest in Massachusetts (0.1%).
Compared with the 27,023 psychiatrists who did not use telemental health, psychiatrists who did were less likely to have peer-reviewed publications (21.2% vs 25%; P < .001) and to be in solo practice (9.1% vs. 23.6%; P < .001) as well as more likely to practice in rural areas (24% vs 6%; P < .001). Psychiatrists who used telemental health also had fewer years of experience:
- 0 to 19 years of experience: 26.9% vs. 22.8%;
- 20 to 30 years of experience: 29.9% vs. 23.1%;
- 31 to 40 years of experience: 21.5% vs. 23.7%; and
- 41 or more years of experience: 12.8% vs. 22.4%; P < .001.
However, Mehrotra and colleagues found that size or type of practice, physician sex and location of medical school were not associated with telemental health use.
“The variation across states in the fraction of psychiatrists providing telemental health is notable,” the researchers wrote. “This variation might be driven by needs of the local community and state laws and regulations governing reimbursement of telemedicine and licensure.” – by Savannah Demko
Disclosure: Mehrotra reported grants from the NIH. Please see the study for all other authors’ relevant financial disclosures.