Physicians and Nurse Practitioners (NPs) both are in short supply in the U.S., especially in the field of mental health. So, how do we expand our mental health workforce to meet this demand and what role do NPs play in this ever-changing healthcare climate?
To start, it helps to understand the training and role of nurse practitioners. All NPs start out as Registered Nurses and have clinical experience as nurses. To transition to the advanced practice NP role, the nurse must complete a master’s or doctoral level education program and complete advanced clinical training. NPs are trained and certified in their specialty and may practice only within the scope of that specialty (i.e., Acute Care NP, Psychiatric Mental Health NP, Family Health NP). This differs from the training of a physician which may include rotations in several specialties before completing their residency in their selected field.
With a background in nursing, NPs focus on building a relationship with the patient which fosters overall health and well-being. They prioritize spending time getting to know patients, listening to their needs, and including patients in the decision-making process along with providing the highest level of evidence-based care.
Filling a gap in care
The number of Psychiatric Mental Health NPs (PMHNPs) has grown in recent years, a welcome trend considering the rapidly increasing need for care. According to a recent Harvard T.H. Chan School of Public Health study, the number of PMHNPs treating Medicare beneficiaries increased by 162% from 2011 to 2019, even as the number of psychiatrists treating that patient population declined by 6%.
“The supply of psychiatrists in the United States is inadequate to address the unmet demand for mental health care,” the study concludes. “PMHNPs are a rapidly growing workforce that may be instrumental in improving mental health care access.”
Some of this demand is being driven by positive factors. People are increasingly more aware of the importance of mental health and there is less stigma around seeking treatment. Meanwhile, more insurers are offering comprehensive mental health care coverage, eliminating a financial barrier to treatment. However, regardless of factors, it’s clear the need for mental health services is urgent.
Across all fields of psychiatry, there are more patients than there are providers. The American Psychiatric Nurses Association (APNA) estimates that:
- One in five Americans live with a mental health condition
- Only 44% of U.S. adults receive the mental health care they need
- Only 20% of children in the U.S. receive the mental health care they need
PMHNPs and telehealth
The increased adoption of telehealth has enabled PMHNPs to provide much-needed mental health services to historically underserved populations.
A 2022 Kaiser Family Foundation study on the role of telehealth in addressing the mental health needs of Americans during the pandemic shows the share of outpatient visits being conducted virtually reaching 39% by mid-2021. More than half of rural patients (55%) reported using telehealth outpatient services during that period. This is not surprising, given that 80% of counties in rural regions have no practicing psychiatrists, according to the Harvard study mentioned above.
Just as patient satisfaction surveys underscore the valuable role PMHNPs play in providing mental health services, studies show that patients treated by NPs have equally favorable clinical outcomes to patients treated by physicians. Expanding the use of PMHNPs also reduces the financial burden to patients and healthcare systems.
For healthcare organizations seeking to provide more patients with access to mental health services, PMHNPs may be an ideal fit for your clients and business. Much depends, however, on where your organization is located and where its patients are located. That’s because PMHNPs are subject to state regulations that specify what kind of care they can provide.
Nearly half of U.S. states (23) grant NPs full autonomy, allowing them to diagnose and treat patients as well as prescribe medications without the oversight of a physician. NPs in these states may also operate an independent outpatient practice or clinic.
Another 16 states limit NPs’ autonomy, typically requiring them to practice under a collaborative agreement with a physician, though with some degree of independence, typically after a period of supervised practice.
Finally, 12 states restrict NPs to working directly with a psychiatrist or other physician throughout their entire career. NPs in these states must have a formalized collaborative practice agreement in place to prescribe medication to a patient, formulate a diagnosis or order diagnostic testing.
Every year more states move toward autonomous practice for NPs. Significantly, the VA has granted nurse practitioners fully autonomous practice, enabling the agency to better engage caregivers for our veterans.
An organization that has worked with a nurse practitioner in the past typically wants to work with NPs again because they’ve had a good experience. For organizations in restricted practice states, obtaining guidance on the physician supervision process is helpful and a great place to start.
If your organization hasn’t worked with nurse practitioners in the past, I would strongly encourage you to reach out to somebody who has and ask them about their experience. I’d be willing to bet that you’ll hear how PMHNPs benefited their organization and, more importantly, their patients and the community they serve. And be sure to ask about their improved patient satisfaction scores!
Dr. Tom Milam
Dr. Tom Milam manages Iris Telehealth’s team of clinicians and guides them in telemedicine and industry best practices. He received his undergraduate degree from WVU in Anthropology, graduating summa cum laude, and received his M.D. from the University of Virginia. His residency training in psychiatry took place at Duke and UVA. Dr. Milam has served in a leadership role throughout his psychiatric career and spearheaded the telepsychiatry initiative at his previous hospital. Dr. Milam is also an ordained Episcopalian priest and got his Master of Divinity Degree from Yale.