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With Too Few Psychiatrists to Go Around, Wisconsin Experiments with 'Telepsychiatry'

Ann-Elise Henzl
Dr. Richard Barthel demonstrates telepsychiatry technology by dialing up his nurse, Laurel Berglund, in Appleton.

A mismatch between the supply of psychiatrists and patient demand is causing long wait times for appointments.

One of the main reasons there aren't enough psychiatrists to go around is the sheer volume of patients, according to Pete Carlson. He's head of Behavioral Health for Aurora Health Care.

Carlson says mental health parity laws and the Affordable Care Act have opened the door.

"We have so many more people that have coverage. There's been some improvement in really destigmatizing mental health care, so more people are accessing services," Carlson says.

Carlson says another cause of the shortage is the fact that psychiatrists are retiring at a greater rate than medical schools produce them.

Dr. Jeffrey Marcus of the Wisconsin Psychiatric Association adds that it's tough to lure medical students from other specialties. "We're relatively lower on the compensation scale, and students come out of medical school significantly in debt, sometimes $200,000-$300,000 in debt," he says.

"In some areas of (Wisconsin), patients have to wait 3-6 months to see a psychiatrist," Dr. Jon Lehrmann says.

Because of the shortage, it's getting harder to see a psychiatrist.

"The waiting list is getting longer and longer," says Dr. Jon Lehrmann of the Medical College of Wisconsin. He says the problem is more pronounced outside of Milwaukee and Madison.

"In some areas of our state, patients have to wait 3-6 months to see a psychiatrist. It's just not acceptable," Lehrmann says.

One way the profession is seeking to ameliorate the shortage is by exploring telepsychiatry. Child psychiatrist Dr. Richard Barthel uses it at the Medical College of Wisconsin. His office is in Wauwatosa, but the technology allows him to "meet" with patients in Appleton. Barthel has a big TV screen in his office in Wauwatosa. It's connected to a screen in his second office, 100 miles away.

Barthel says there's not much of a difference between telepsychiatry and in-person meetings, when it comes to connecting with patients. Yet he says it's only a partial solution to the shortage in his field.

"Every patient I see up there is a patient I can't see down here," Barthel says.

The profession is using other strategies to stretch the supply of psychiatrists. Dr. Jerry Halverson, with Rogers Memorial Hospital, says a method growing in popularity involves having psychiatrists see fewer patients, and instead, advise other doctors.

"Looking at different ways to integrate mental health into physical care, having a psychiatrist available to give consultation to help the doctor feel more comfortable taking care of a more complicated patient," Halverson says.

The field also is looking for ways to grow its ranks. Solutions include offering loan repayments for residents who stay in rural areas after medical school.

Pete Carlson of Aurora warns there's no time to waste. "With the Baby Boom generation going into retirement and aging, there is going to be a tremendous number of people that are going to need services, and at this point, I'd say we're very challenged in that respect," he says.

Last year, the Kaiser Family Foundation calculated the severity of the psychiatrist shortage. The analysis said Wisconsin needs more than 200 additional psychiatrists.

Ann-Elise is WUWM's news director.