Availability of Outpatient Care From Psychiatrists: A Simulated-Patient Study in Three U.S. Cities

Objectives: The study examined availability of psychiatrists for outpatient appointments in three U.S. cities. Methods: Posing as patients, investigators called 360 psychiatrists listed in a major insurer’s database in Boston, Houston, and Chicago (N=120 per city) and attempted to make appointments. Callers claimed to have Blue Cross Blue Shield or Medicare or said they would pay out of pocket (N=120 per payer type, divided evenly across cities). Results: In round 1 of calling, investigators were able to reach 119 of the 360 psychiatrists (33%). Of 216 unanswered calls, 36% were returned. After two calling rounds, appointments were made with 93 psychiatrists (26%). Significant differences were noted between cities but not between payer type. Conclusions: Obtaining outpatient appointments with psychiatrists in three cities was difficult, irrespective of payer. Results suggest that expanding insurance coverage alone may do little to improve access to psychiatrists—or worse, expansion might further overwhelm the capacity of available services.