Why is Finding a Psychiatrist so Difficult?

Psychiatrists are licensed physicians (MD or DO) who have completed a four-year specialty residency training in psychiatry. This includes training in accurate diagnosis and the safe and effective use of medication, psychotherapy, and other treatments for a wide range of concerns. Because it takes 12 years for one U.S. psychiatrist to complete their education and training, with a limited numbers of residency spots available to train them, there simply are not a lot of psychiatrists. Most of Kentucky is designated a mental health shortage area. This means we lack a sufficient number of professionals to meet the needs of Kentucky. At the time of this study, there were only 360 psychiatrists practicing clinically within the state of Kentucky.

22.9% of adults seeking care in Kentucky for a mental health condition in 2022 reported they were unable to receive the treatment they needed. And 53.5% of all adults in Kentucky with any mental health need did not receive care in 2022. MHA 2022 report.

Understanding where psychiatrists are located can help individuals make important decisions about how to access care. This information can also help psychiatrists and healthcare systems determine where opportunities are to reach more patients. When Kentuckians can access timely, high-quality care, our whole state benefits.

Methods

Using available online public data that includes practice location, we can get a general picture of where most psychiatrists in regular, active practice within Kentucky are located. These numbers will not be exact, as some psychiatrists may have moved, retired or otherwise changed their practice since the data for this article was collected in 2023. However, we can get a general sense of where psychiatrists tend to live and work in the Bluegrass. The psychiatrists included consist of outpatient psychiatrists but also psychiatrists that only see patients in the hospital, or that only work with special population such as in the Veterans Administration. Psychiatrists in rural areas may travel between clinics, splitting their time between locations. The data included may not be able to accurately reflect situations where a doctor practices in multiple physical locations, though this may account for only a small portion of practices.

Not included in these numbers are physicians who in 2023 indicated they were retired, semi-retired, work as an administrator, or do not live or physically work within Kentucky. Also not included were psychiatrists who primarily work as locums tenens, as these are doctors that travel to cover clinical services temporarily and may not routinely work within Kentucky.

How Many Kentucky Psychiatrists are There?

At the time this data was conducted in July of 2023, there were only 360 psychiatrists in active, regular clinical practice within Kentucky.

Ideally, there should be, at minimum, one psychiatrist per 10,000 people to meet typical mental health needs of a population. Unfortunately, Kentucky has more than its share of certain conditions and has the second highest rate of depression in the country. Therefore, the minimum number of psychiatrists needed to meet local needs may be higher than the goal of 1 psychiatrist per 10,000 people. Kentucky has a ratio of 1 psychiatrist per 12370 people. This means that Kentucky has a shortage of psychiatrists, even if rates of all mental health conditions were equal to that in other areas of the country. What this number doesn’t show is the huge discrepancy between locations in Kentucky and access to psychiatrists.

The highest concentrations of psychiatrists in Kentucky are: Louisville with 127 psychiatrists and Lexington with 78 psychiatrists in local practice. Much of Kentucky has too few psychiatrists to meet local needs. Many counties have no local psychiatrist at all.

What to do if there isn’t a psychiatrist near you

Unlike in the past, we now have several options for seeking out care. There are three options:

Travel

Larger metropolitan areas often have more behavioral health resources available. This includes general psychiatrists and sometimes options for more subspecialized care. It is not unusual in Kentucky for patients to commute an hour or more to larger cities in Kentucky such as Louisville or Lexington, or even to nearby cities outside our state such as Nashville, Tennessee or Cincinnati, Ohio. There are also options for treatment at centers further out of state that offer in-person psychiatric care on a national level for complex illness or for those who have not responded to typical treatments for their condition. Travel can be very time consuming, often incur additional costs, and may not be an option for many patients.

Online Care

Telehealth, often delivered as online visits, has greatly expanded access to specialty care for patients across Kentucky. Telehealth platforms are often easy to learn and use for both patients and doctors. However, a stable internet connection that can support video is necessary for these types of visits. Another consideration is that not all conditions are appropriate for telehealth. An online psychiatrist you see may determine you need in-person care, but if they are in another state, they may not be familiar with the local in-person resources in your area. Some patients prefer online visits with a doctor located within Kentucky for this reason.

There are many types of online companies that provide behavioral health care but what they offer can vary widely. It is common for online behavioral health sites to advertise psychiatric care, but you may not have the option to see a doctor board certified in psychiatry. Any online company should be upfront about the credentials of who you will see for your care, and it is your right to know who is providing you with services. This is true whether someone is seeing you for therapy, evaluation, or prescribing medication. A range of professionals can provide behavioral health care or prescribe psychiatric medications. A psychiatrist is a medical doctor with an MD or DO degree that has completed a psychiatry residency (four years of supervised patient care). To be board certified in psychiatry, psychiatrists must then pass a lengthy examination and participate in a certain amount of continuing education to maintain this certification.

If you would like to use telehealth, research what online companies offer and how responsive they are to patient concerns. Some questions to consider: Does the company provide you live access to your treating professional? How long are the appointments and what sort of support is provided if a problem arises between appointments? Does the company focus just on writing prescriptions for a couple types of medication, or do they offer care that takes into consideration your individual health, other medications you take, and accurate diagnosis before recommending treatment? Being informed helps you make the best choice for your needs.

Other Professionals

Patients in psychiatry shortage areas will often seek out other professionals for needs such as medication or psychotherapy. Not all conditions require a psychiatrist’s training and expertise to treat. In fact, most prescriptions in the United States for medications for depression are written by primary care. If you are being treated by primary care or another professional but feel that your symptoms are still a concern, talk with your doctor or treating professional about treatment options including other resources in your area. Incorporating therapy in addition to a medication treatment can provide additional benefits for many symptoms and concerns. Sometimes, such as for conditions like moderate to severe depression or anxiety, medication can help therapy work more optimally by reducing symptom intensity.

A discussion with your treating professional about your individual needs and concerns can help you decide the best treatment options for you—whether that care is obtained locally, through travel, or online.

References and Resources

1. 2024 Health Professional Shortage Area (HPSA) Map—Mental Health. Human Resources and Services Administration. HPSAMH.pdf (hrsa.gov)

2. 2022 Adult Data Report. Mental Health America (mhanational.org) https:/www.mhanational.org/issues/2022/mental-health-america-adult-data#five

3. CDC 2023 National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020 https/www.cdc.gov/mmwr/volumes/72/wr/mm7224a1.htm?s_cid=mm7224a1_w

4. American Psychiatric Association (APA). Find a Psychiatrist Tool: https://finder.psychiatry.org/s/

* The information provided in this article is based on available public data in 2023 and may not include all psychiatrists practicing in Kentucky or may include psychiatrists that have since retired or moved. It is important to consult with your doctor or therapist about possible psychiatry referrals, as they will often have an understanding of available resources specific to your area. You may also wish to consult the American Psychiatric Association “Find a Psychiatrist” tool at psychiatry.org (lists only those psychiatrists who are APA members and choose to opt-in to the search) or ask your insurance company for a list of psychiatrists in your network.