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Tuition Plan Should Help Bring Psychiatrists to Underserved Areas

Sen. Richard Codey is behind effort to increase access to ‘proper mental healthcare’

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For far too many Americans suffering from the effects of mental illness, real help is out of reach. A national shortage of psychiatrists has left scores of sufferers struggling to get a timely appointment or find an appropriate provider nearby, experts agree. The problem is particularly acute in low-income areas, both urban and rural.

A new proposal seeks to address the shortage here in New Jersey by offering tuition reimbursements for up to a year of medical school for psychiatry graduates who agree to serve in the state’s most underserved communities for up to four years. Former acting governor and Sen. Richard Codey, (D-Essex), a longtime advocate for mental health, introduced the measure Thursday along with Sen. Joseph Vitale, (D-Middlesex), who chairs the health committee.

As many as one out of every four Americans suffered over the past year from the effects of a mental illness, ranging from a bout of minor depression to a serious schizophrenic break. And experts have said their ranks will continue to expand as awareness of mental health grows and more patients are able to access affordable behavioral health treatment, thanks to national health insurance reforms.

Advocates for mental health services were quick to embrace the tuition reimbursement concept, which they said could help attract new talent to replenish a workforce that has shrunk over the years. A study by the American Medical Association found that while the national pool of physicians expanded 45 percent between 1995 and 2013, the number of psychiatrists grew only 12 percent over that period, while the United States population increased by 37 percent.

“This is exactly what the doctor ordered, so to speak,” said Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, whose members depend on psychiatrists for key aspects of their work. “One of the most critical reasons that people don’t have access to care is the shortage of psychiatrists.”

In 1991 New Jersey created a tuition reimbursement program designed to encourage doctors, dentists, and other practitioners to set up practice in communities that lacked enough medical providers. The program, run by Rutgers University, offers up to $120,000 to graduates who pursue some 16 specialties including primary care and family practice, OB/GYN, various nursing specialties, including midwifery and a handful of physician assistant roles. Psychiatry or mental health specialties are not included.

Wentz credited another program, the Social Services Student Loan Redemption Program, signed into law in 2005, when Codey was acting governor, for the graduates it funneled to state and community programs in underserved areas. That program was funded at $3.5 million a year for five years -- helping more than 800 students in its busiest year -- before the budget was cut and the effort essentially disappeared.

“Unfortunately there’s not a magic turnkey solution to suddenly creating additional psychiatrists,” Wentz said. She said of the Codey/Vitale proposal, “This addresses head-on the issue of incentivizing why someone might want to go into psychiatry and stay in New Jersey in certain areas where there are shortages.”

But Wentz and others, including Dr. Gary Rosenberg, a longtime child psychiatrist, stressed that as much as tuition reimbursements can help, providers still need to be able to make a living practicing in low-income communities. While Gov. Chris Christie has pledged an extra $127 million in the upcoming budget to increase reimbursement rates for Medicaid patients who seek mental health and addiction treatment, Wentz and other providers insist additional increases are needed in order to cover providers’ real costs.

Two years ago Rosenberg helped found a state-funded pilot project that connects pediatricians with psychiatrists who act as consultants when young patients need mental healthcare in addition to physical treatments. Like similar programs in other states, the effort was prompted by the lack of available psychiatrists -- a shortage that is even more severe among those trained to treat children and teens.

Dr. Debra Koss, head of the New Jersey Psychiatric Association, said her organization has long supported loan forgiveness programs and members look forward to working with Codey on this proposal. She said it will be particularly important to ensure the program applies to child and adolescent psychiatrists, who in the past were excluded from programs elsewhere when regulations failed to take into account that these providers serve an extra two years in a “fellowship” beyond the traditional psychiatry “residency.”

“There’s just a tremendous need that exists right now,” Koss said, “and we recognize there’s a discrepancy that exists in the availability of healthcare providers across the different regions of the state.”

Under the bill (S-2331) -- the text of which has not been made public yet -- the state Health Commissioner would identify target areas for the program based on health needs, economic indicators, and other factors. Graduates who live and are licensed in New Jersey could apply to the program to be reimbursed for up to one year of medical school if they establish or join a practice full-time in these areas. Participants must serve for four years, but could do so in one-year stints in different areas.

"My hope is that after investing four years of time serving in a community, practitioners will have established themselves and would look to stay longer, which is in everyone's best interests," Codey said. "Everyone has a right to access proper mental healthcare and hopefully by providing this incentive for psychiatrists to work in these underserved communities, we can provide that."

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