‘It Is Time to Acknowledge’ the Role of Nurse Practitioners Amid Mental Health Care Shortage

Psychiatric mental health nurse practitioners (PMHNPs) are entering the field at a rate far exceeding psychiatrists, a trend that reveals significant opportunities for policy reform.

The number of PMHNPs in the field skyrocketed in the past five years, while the number of psychiatric residency matches grew at only a linear rate, according to a new Health Affairs report.

Medicare reimbursement data echoes this finding. The number of PMHNPs with a Medicare National Provider Identifier number shot up by 134% from 2013 to 2019, while the number of psychiatrists increased by only 15%.


Meanwhile, patients are struggling to get access to mental health care. More than 75% of all U.S. counties are experiencing a shortage of any type of mental health worker and 96% of all counties have a shortage of mental health prescribers, according to the American Psychiatric Nurses’ Association. 

American mental health patients, therefore, are increasingly relying on NPs during a time of significant need.

Empowering NPs

Despite the unmet need for mental health care, NPs are often prevented from practicing at the top of their education and license.


“First, to realize the full potential of the growing NP primary care and behavioral health workforce, they must be allowed to practice at the top of their education and license, without artificially imposed scope of practice restrictions,” Health Affairs authors wrote.

States that give primary care NPs the ability to have full practice authority and remove the requirement for NPs to provide care from regulatory contracts with physicians have improved access to care without sacrificing quality or cost-effectiveness, research has shown.

Twenty-seven states have already done so, and these states may also be able to more successfully recruit and retain NPs.

Softening requirements for NPs benefit physicians, too. When NPs operate more independently, physicians and NPs both experience increased productivity.

NP education funding

Medicare’s graduate medical education (GME) payment system receives federal funding to the tune of $15 billion annually, but NPs are ineligible to receive a slice of the funds. Additionally, funds for physicians go primarily to hospitals rather than community-based settings where most primary care is delivered.

“GME has become a major source of the problem, rather than the solution,” read the report. “We need enhanced federal funding for education of ALL primary care providers, and programs that prioritize interprofessional programs and programs in community-based settings, especially in rural and underserved areas.”

Shortage measurements

The federal government measures health professional shortage areas and medically underserved areas are determined using numbers of physicians only. NPs and physician assistants (PAs) are not included in assessments, despite trends demonstrating that the bulk of the growth in the workforce stems from NPs and PAs.

Research from the USC-Brookings Schaeffer Initiative for Health Policy even questioned the broadly claimed behavioral health workforce shortage. It suggested that there is not evidence across all provider groups and geographies to demonstrate an aggregate shortage of mental health practitioners.

“Why are we willfully ignoring reality?” the Health Affairs report asked.

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