Rural areas suffer from psychiatric care shortage

FINDLAY — Rural areas are battling a shortage of psychiatrists. Psychiatrists located in these areas, like Dr. Chris Steiner, often see up to 100 patients a week. "We did a need-based assessment for our community. They said Hancock County should have 12 psychiatrists. We are not near that," said Steiner, a psychiatrist at the Psychiatric Center of Northwest Ohio in Findlay. There are only four psychiatrists and a handful of nurse practitioners located in Hancock County. "We see twice the national average in terms of number of patients per psychiatrist, just because we're trying to meet the need," he said. "Our office last year, the Psychiatric Center of Northwestern Ohio, had 25,000 encounters." Steiner personally sees 85-105 patients a week. On top of that, he visits hospitals to conduct consultations for other doctors. He estimates he sees patients in at least 20 counties. "We're the top micropolitan in the United States, as they say," said Steiner. "But with all intents and purposes, we really are a rural community." Rural areas are defined as counties "that are not part of a Metropolitan Statistical Area (MSA)," according to the U.S. Office of Management and Budget Definition. The U.S. Bureau of Labor Statistics considers Hancock County a rural, nonmetropolitan area, as of May 2023. Studies have shown there is a disparity in mental healthcare between those that live in a rural area vs. those that live in an urban setting. "It is estimated that as many as 65% of nonmetropolitan counties do not have psychiatrists and over 60% of rural Americans live in designated mental health provider shortage areas," reports one study by the National Institutes of Health. Working and learning in a metropolitan area can be more convenient, too — most psychiatrist residencies in Ohio are located in big cities. FREIDA, the American Medical Association's residency database, lists 11 psychiatric residency programs in the Buckeye State: one each in Toledo, Dayton and Cincinnati; two in Columbus; one in Chillicothe, a metropolitan area near Columbus; three in Cleveland; and two in Akron, a metropolitan area near Cleveland. The local Blanchard Valley Health System currently offers residency programs for operations, general medicine, intensive care, ambulatory care, geriatrics, infectious disease and pharmacy administration, but not psychiatry. "We're actually too small (for a psychiatry residency). To do a residency, you need a big hospital with a lot of patient throughput, (and) you need a diverse patient population," Steiner said. There is a push to establish more residency programs in rural communities. Last year, the U.S. Department of Health and Human Services invested $11 million to fund the creation of rural residency programs. Each award recipient would receive $750,000 to help with accreditation, curriculum development, faculty and resident recruitment and consultation services to help navigate the development of the residency. But individual psychiatrists, like Steiner, do what they can to promote psychiatry in rural areas. "I teach rural psychiatry," Steiner said. "I've taught that class for Wright State University, University of Toledo and Case Western Reserve University." He urges his students to consider practicing in a rural area, because there are benefits. "Cost of living's lower out here, you get to have more integration in the community, that type of stuff," said Steiner. "But there're other folks who just simply don't want to live in a small town." He said students who already have ties to rural areas have the best chance to return to those communities. "I grew up in Bluffton. My mom was actually the social worker for Orchard Hall (in Blanchard Valley Hospital) for 25 years. So I knew this community," he said. "I've inspired a couple of my medical students to go into psychiatry and then they decided to go back to where they grew up. "So that's what it is, getting young people who have some sort of a connection to this community to come and stay."