TORONTO — Wondering why the wait time to see a psychiatrist in your city is taking so long? While there may be dozens of psychiatrists in your neighbourhood, the delay may have to do with how the professionals choose to practice.
The issue of wait times for mental health services has been thrust into the spotlight in recent years. Canadian psychiatrist Dr. Paul Kurdyak wanted to know if it’s truly a shortage of specialists that’s causing a backup.
Turns out, there’s an abundance of psychiatrists in Toronto where wait times are lengthiest. And in some towns and cities there are nine times fewer psychiatrists, but they’re seeing far more patients while taking on new ones, according to a new Institute for Clinical Evaluative Sciences study.
In Toronto, psychiatrists on average saw 181 outpatients (105 new), while low-supply regions saw 431 patients (233 new).
“There’s this sort of extreme end where this group, because their practices are so small, they don’t provide much in ways of access to care. They see fewer than 40 patients, but very frequently and for fairly long,” Kurdyak told Global News.
“A substantial number of these psychiatrists saw fewer outpatients, while their colleagues in low-supply, non-urban areas had more patients,” he said.
Kurdyak is an ICES scientist while holding a posting as an emergency department psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto.
For his study, Kurdyak studied the patterns of all full-time psychiatrists and the needs of their patients across the province. It’s the first to investigate psychiatrist supply and how their practice habits affect Canadians’ access to mental health services.
In Toronto, there are 63 psychiatrists per 100,000 people — which is the highest in the province. But 10 per cent of full-time psychiatrists are seeing fewer than 40 patients a year. About 40 per cent saw fewer than 100 patients.
On the other end, in non-urban parts of the province there are only seven psychiatrists per 100,000 people. Only 10 per cent saw fewer than 100 patients a year.
In short, there are nine times more psychiatrists in Toronto, yet this group is seeing half as many patients as their outnumbered counterparts in low-supply areas.
“It’s very striking. For me, it quantifies what we expected but the magnitude of the differences we saw were very strong,” Kurdyak told Global News.
He’s certain the same situation is happening across the country, too. Anecdotally, there’s been reports of shortages and lengthy wait times in Saskatchewan for child psychiatrists.
Research out of B.C. suggested that out of 230 psychiatrists in Vancouver, only six were accepting consultations with new patients.
The fee schedule in Ontario may be a factor in how psychiatrists practice, Kurdyak suggested.
In high supply regions, such as Toronto, psychiatrists see fewer patients, but they see them much more and for longer. These patients tend to be wealthier and less likely to have had a psychiatric hospitalization. The fee schedule doesn’t regulate the frequency or length of visits and it doesn’t consider the severity of illness.
But, for now, Kurdyak’s study doesn’t explore why psychiatrists choose to practice this way. He calls it an “obvious” next step that would look at self-governing physicians working within a publicly-funded system.
“It requires a lot of debate about how psychiatrists are to practice to facilitate those in need of our services,” he said.
In the U.S., U.K. and Australia, for example, psychiatrists have moved into consultant roles on multidisciplinary teams so they’re collaborating with doctors, nurses and other frontline health care workers.
Kurdyak’s full findings were published Tuesday morning in the journal Open Medicine.