Expanding numbers of nurse practitioners have filled the void left by the declining influence of physicians involved in behavioral health care.
However, the rise of nurse practitioners has not totally offset downward trends among physicians in terms of the general mental health workforce or in terms of national medication-assisted treatment (MAT) capacity, according to two recent Health Affairs studies.
The coronavirus pandemic worsened historic workforce struggles. A separate, recent analysis found the collective mental health workforce, including nurse practitioners, totals about 1.2 million.
In both Health Affairs pieces, the study authors said that regulatory barriers limit nurse practitioners from totally meeting demand.
“[There] is an urgent need for solutions to expand access to more Americans,” the workforce analysis study states. “The rapid growth of the [nurse practitioner] workforce suggests that policies facilitating the recruitment and training … may have a greater short-term impact on increasing the mental health workforce than physician-targeted strategies, especially in rural areas.”
From 2011 to 2019, the number of psychiatric mental health nurse practitioners (PMHNPs) treating Medicare patients increased by 162% to about 11,900 while the number of psychiatrists decreased by 6% to about 23,300, the workforce analysis finds.
As a result, the number of mental health visits decreased by 11% despite stable or increasing demand for services.
The study authors point out that psychiatrists increasingly won’t take Medicare. Other federal data show psychiatrists are most likely to not take Medicare.
Physician-level providers similarly have seen a decreasing role in MAT of late.
The Health Affairs MAT analysis found that the national capacity for buprenorphine, a medication largely used to treat opioid use disorder (OUD), increased at a stable pace through the pandemic.
Clinicians cleared to prescribe buprenorphine through the federal X waiver took on larger patient panels; the number of providers seeking these waivers slowed. Nurse practitioners grew their national capacity the most compared with physicians and physician assistants.
“In 2018 Q2 [nurse practitioners] accounted for only 6.8% of treatment capacity, but they reached 27.3% by 2022,” the MAT capacity study states.
Physician assistants expanded their share of the overall MAT capacity from 1.9% to 6.8%.
The underlying issue of fewer providers seeking X-waivers remains along with another historical issue, the study points out.
“Many X-waivered clinicians do not prescribe buprenorphine for the maximum number of patients allowed,” the MAT capacity study states. “Policy and practice leaders need to support growth in the buprenorphine-prescribing workforce and to facilitate clinicians prescribing to the maximum level allowed.”
In a 2018 report, the Office of the Surgeon General called “MAT combined with psychosocial therapies and community-based recovery supports” the gold standard for OUD treatment.