As a psychiatrist who owns a small practice, I know the waitlist arithmetic well, and so does every colleague I talk to. More than 50 million Americans have a behavioral health condition in a given year, and fewer than half of those who need care get it in time. Psychiatrists bring expertise in severe mental illness, complex comorbidity, and prescribing, and there aren’t nearly enough of us, especially in rural communities and places with few resources. No realistic training pipeline will close that gap in the next decade.
So I don’t think the useful question is whether other clinicians will help care for psychiatric patients. They already do. What we should be asking is whether we design that care on purpose, with every professional working at the top of their training and staying in clear communication with one another.
The workforce has already shifted under our feet. In Medicare claims from 2011 to 2019, the number of psychiatric mental health nurse practitioners treating beneficiaries grew 162 percent, while the number of psychiatrists fell 6 percent. NPs’ share of prescriber visits rose from about 12.5 percent to nearly 30 percent, and passed 50 percent in some rural regions. Psychologists, social workers, counselors, nurses, and physician associates make up the rest of the team. The American Psychiatric Association has acknowledged that expanding scope of practice raises fair questions about how much quality varies. Its answer is effective supervision and collaboration rather than exclusion. I find that a helpful way to look at it. The real debate is about how the seats at the table connect, and much less about who deserves one.
The model with the strongest evidence behind it is collaborative care. A behavioral health care manager, often a social worker or nurse, follows patients in primary care and tracks their symptoms in a registry using tools such as the Patient Health Questionnaire (PHQ-9). A psychiatric consultant reviews the caseload every week, focuses on the patients who aren’t improving, and sends treatment recommendations to the primary care clinician.
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More than 80 randomized trials support this approach. A Cochrane review found better depression and anxiety outcomes than usual care for up to two years. The IMPACT trial roughly doubled the effectiveness of depression treatment, with equal benefit for Black and Latino patients. The Department of Veterans Affairs and Department of Defense (VA/DoD) depression guideline recommends collaborative care with high confidence and notes that having a psychiatrist guide treatment improves results. It also stretches our reach. With one to two hours of weekly case review, a single psychiatrist can contribute expertise to as many as 100 patients. For a specialty this short on people, that number matters.
In my view, these teams succeed because everyone knows their role, and the hierarchy matters only as far as it supports that. The care manager provides continuity along with brief therapies that have solid evidence behind them, such as behavioral activation and problem-solving treatment. Therapists offer the depth of psychotherapy that a 20-minute medication visit simply can’t. NPs and PAs widen access to assessment and medication management. Psychiatrists concentrate where our training adds the most value: diagnostic uncertainty, treatment resistance, serious mental illness, medical complexity, and the backup consultation that lets everyone else practice with confidence.
Good team care also depends on structured supervision and support, particularly for clinicians who are new to psychiatry. Postgraduate fellowships and organized oversight are investments in quality. Nobody should read them as a sign of distrust.
I won’t pretend any of this is easy. Collaborative care takes upfront investment in workflows, registries, and a real change in culture between primary care and mental health, though savings over the long run generally offset those costs. Its billing codes have made the model financially sustainable in many settings. Even so, adoption in actual practice still trails the evidence.
Turf arguments tend to treat every gain for one profession as a loss for another. Our patients don’t experience care that way. What they notice is whether someone answered the phone, whether anyone saw that their PHQ-9 score wasn’t moving, and whether a psychiatrist’s judgment was there when it mattered. No single profession is going to solve the shortage. Professions that choose to work as one team can make a real dent in it.
Ravi Singareddy is the founder and medical director of Empower Psychiatry & Sleep in north metro Atlanta, where he leads an interventional psychiatry practice offering transcranial magnetic stimulation (TMS) and Spravato (esketamine) for treatment-resistant depression. Double board-certified in psychiatry and sleep medicine, he brings more than two decades of clinical and academic experience to patients who haven’t found relief with medications alone. He is affiliated with Emory Healthcare.
His interest in neuromodulation dates back to his years as associate professor of psychiatry at Penn State College of Medicine. There, he taught annually on vagus nerve stimulation and novel depression therapies, and he published on long-term combined electroconvulsive therapy and vagus nerve stimulation in the American Journal of Psychiatry. He has authored numerous peer-reviewed papers on sleep disorders, insomnia, anxiety, and depression, with work appearing in Sleep, the Journal of Clinical Sleep Medicine, and Psychiatry Research.
Singareddy is a Fellow of the American Psychiatric Association and the American Academy of Sleep Medicine and practices measurement-based care, tracking outcomes to guide every treatment decision. He shares updates on Instagram.
