Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011–19

The supply of psychiatrists in the United States is inadequate to address the unmet demand for mental health care. Psychiatric mental health nurse practitioners (PMHNPs) may fill the widening gap between supply of and demand for mental health specialists with prescribing privileges. Using Medicare claims for a 100 percent sample of fee-for-service beneficiaries (average age, sixty-one years) who had an office visit for either a psychiatrist or a PMHNP during the period 2011-19, we examined how the supply and use of psychiatrists and PMHNPs changed over time, and we compared their practice patterns. Psychiatrists and PMHNPs treated roughly comparable patient populations with similar services and prescriptions. From 2011 to 2019 the number of PMHNPs treating Medicare beneficiaries grew 162 percent, compared with a 6 percent relative decrease in the number of psychiatrists doing so. During the same period, total annual mental health office visits per 100 beneficiaries decreased 11.5 percent from 27.4 to 24.2, the net result of a 29.0 percent drop in psychiatrist visits being offset by a 111.3 percent increase in PMHNP visits. The proportion of all mental health prescriber visits provided by PMHNPs increased from 12.5 percent to 29.8 percent during 2011-19, exceeding 50 percent in rural, full-scope-of-practice regions. PMHNPs are a rapidly growing workforce that may be instrumental in improving mental health care access.