Ontario should offer incentives to reverse psychiatrist shortage: report

TORONTO — A new report urges the Ontario government to offer incentives to psychiatrists in order to make up for a shortage it says is contributing to a growing mental health crisis across the province and the country.

The report, released Wednesday by the Coalition of Ontario Psychiatrists, says the province should also increase the number of psychiatry residency spots available to medical students and increase exposure to the field in medical school to six weeks.

The organization, which represents 1,900 Ontario psychiatrists, says boosting the ranks in psychiatry would help improve access to mental health at a time when demand continues to outpace supply, particularly in rural areas.

It says that while Canada as a whole is experiencing a shortage of psychiatrists, the situation in Ontario is “uniquely difficult to manage and continues to persist and deepen” despite a rise in psychiatrists’ workload.

The report says the average number of patients each Ontario psychiatrist sees per year outside of a hospital setting has gone up to 249 in 2013 from 208 a decade earlier, and psychiatrists are working, on average, an additional eight hours a week compared with 2007.

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The shortage is linked in the report to the large number of psychiatrists nearing retirement age, combined with a lack of a younger cohort to succeed them.

“Virtually all psychiatric care will be impacted by this demographic shift as over half of practising psychiatrists approach retirement,” the report says.

“These statistics are particularly concerning for rural communities, which are notoriously difficult to recruit new doctors to. A disproportionate number of near-retirement psychiatrists currently serve these areas, and often see high volumes of patients to compensate for the access issues.”

And though enrolment in medical school is growing, the percentage of applicants choosing psychiatry is declining, the report says.

“Governments are investing a significant amount of money into improving mental health services, which is great … (but) there’s some issues with access to treatment at this point, and if we don’t have enough psychiatrists to see those patients, then we may have issues with access to treatment still,” said Dr. Mathieu Dufour, the coalition’s co-chair.

If the shortage is allowed to worsen, wait times for treatment will increase, he said. The gap is particularly high when it comes to child psychiatry, which has seen a “sharp increase” in demand, he said.

“More work needs to be done to promote psychiatry as a profession for medical students,” Dufour said.

Increasing pay for psychiatrists would also make the profession more appealing, he said, noting that some medical specialties earn up to four times more.

“The fact that psychiatry has been at the bottom of the list for medical specialties, I do think that it plays a role in terms of the fact that we have difficulties recruiting candidates,” he said.

The report says psychiatrists receive lower base pay than other medical specialties and are more likely to lose billable hours to patients who don’t show up.

“It is particularly important for incentives to be considered for improving recruitment to underserved areas, including rural and remote communities, and for subspecialties,” the document says.

“Creating incentives for psychiatrists to specialize, in order to serve the growing demand for child psychiatric services and the growing aging population, will help address the ongoing shortage of subspecialists.”

Ontario’s Progressive Conservative government has earmarked $1.9 billion over 10 years for mental health, while the previous Liberal government had promised $2.1 billion over four years.

A spokeswoman said Health Minister Christine Elliott is aware of challenges regarding access to mental health services and the current supply of psychiatrists in the province.

The government is committed to enhancing mental health and addictions supports in Ontario, including psychiatrists, Heather Watt said Wednesday night in an email.

The Opposition, however, said Wednesday that the province needs to have a plan to address the shortage and its repercussions.

“Not only do we not see a plan, or even an acknowledgment, that we have a challenge around having enough psychiatrists in our province,” NDP Leader Andrea Horwath said.

“I think there needs to be a hard look at what’s failing our system. When you have a government that’s cutting back on mental health services and mental health funding it doesn’t send a signal to people are physicians in school now that psychiatry is a good path to take.”

Paola Loriggio, The Canadian Press