Using Locum Tenens to address rural psychiatry shortages

The United States has a perpetual mental health need that is hurting rural areas. 

At any given point, around 44 million U.S. adults suffer from a form of mental illness, with 10 million of those cases being seriously debilitating, according to data shared by the Substance Abuse and Mental Health Services Administration. 

The impact of neuropsychiatric disorders is often devastating on families and communities. As the leading cause of disability in the U.S., mental health problems account for 18.7 percent of all years of life lost to premature mortality. The American Foundation for Suicide Prevention reports that suicide is the 10^th leading cause of death in the U.S., accounting for over 47,000 lives lost in 2017 alone.

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Although medical science has taken great strides in understanding, diagnosing, and treating mental health in recent years, patients only see those benefits if help is available in a particular area. A recent study in the American Journal of Preventive Medicine found that a significant majority of rural counties (65 percent) do not have a psychiatrist and nearly half (47 percent) of the same counties do not have a psychologist.

Dr. Heather Cumbo, a board-certified psychiatrist based in Tampa, FL, works temporary medical assignments called locum tenens in rural areas. She has seen this urgent need for medical help outside of urban centers firsthand.

"There are not a lot of resources for people who have mental health needs in rural areas," said Cumbo. "As a result of the significant demand currently across the United States, there are not enough psychiatrists to cover that need."

Hindered by shortages and stigmas

The National Council for Behavioral Health recently estimated that the healthcare industry could see a shortage of up to 15,600 psychiatrists by 2025. The American Association of Medical Colleges estimates that there could be a shortfall of over 122,000 physicians by 2032, as demand far outstrips the number of new doctors entering the field. Specialists like psychiatrists are expected to make up just over half of that number. 

Several factors contribute to this growing problem, including more people seeking help as awareness of mental health needs increases.

Rural populations already have lower access to overall health care with regard to affordability, proximity, and quality when compared with people in urban areas, according to the United States Department of Agriculture. Historically underserved areas-particularly rural areas-will feel an even more significant shortage crunch in years to come.

"I work in a rural community that doesn't have a physician in their inpatient unit and another clinic that has a list of 250 patients waiting to see a doctor,” said Cumbo. “I’m taking care of people that otherwise would not have any mental health care at all.” 

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Complicating rural America’s lack of healthcare and mental health professionals is the persistent stigma against treating mental health problems. Although the acceptance of acknowledging, understanding, and treating mental health problems has improved in recent years, the change is slow and primarily driven in urban areas.

Creating healthy populations with locum tenens

"As a Locums physician, I’m always being introduced to different clinical settings and working in different states," said Cumbo. "I think this has broadened my ability to be a well-rounded physician because I can see the deficits and strengths within the healthcare systems where I have worked."

Hospitals in rural areas can struggle to attract full-time physicians, especially those with high-demand specialties, but hiring people for locum tenens assignments can help improve patient outcomes. Similarly, those hospitals might bring in locum tenens physicians to implement new programs, provide relief for regular staff, or give recruiters more time to find new permanent physicians.

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“I’m working in areas that have no physicians, so not only is it equally gratifying to me as far as my own independence but I’m also able to give back to my community,” Cumbo said. "I am part of a team that takes care of patients in crisis, so to be able to actually help children and the elderly has been very rewarding because I know I’m meeting a need that is in high demand."

Having more help at hand will not only provide better outcomes in emergency situations but will also improve overall community health. From preventative care to overcoming long-held stigmas against mental health, offering access to mental health care in rural areas is a boon for those communities.

As the medical care provider shortage deepens, the disparity between urban and rural areas is likely to see an even stronger impact. Solutions like locum tenens are one way to improve service and provide rural communities with the care they need.