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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 17, Issue 1, 2014. Pages: 9-18
Published Online: 1 March 2014

Copyright © 2014 ICMPE.


 

A Gap Analysis for Future Supply of and Demand for Psychiatrists in Austria

Monika Riedel,1* Gerald Röhrling,1 Thomas Czypionka,1 Siegfried Kasper2

1 Institute for Advanced Studies (IHS), Vienna, Austria
2 Chair, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

* Correspondence to: Monika Riedel, Institute for Advanced Studies (IHS), Stumpergasse 56, 1060 Vienna, Austria.
Tel.: +43-1-59991 229
Fax: +43-1-59991 555
E-mail: riedel@ihs.ac.at

Source of Funding: The Institute for Advanced Studies, Vienna, received funding for the underlying research report from Österreichische Gesellschaft für Neuropsychopharmakologie und Biologische Psychiatrie (ÖGBP).

Abstract

Using administrative data, we calculate different scenarios of future use and supply of psychiatrists’ services in Austria until 2030. Demand for services is derived from utilization data and calculated separately for hospital and non-hospital services. Supply projections are based on a stock and flow model. Outflows are based on past activity patterns and current legislation on retirement. To model inflows we account for the effects of recently introduced entrance barriers into medical education. Scenarios take several factors into account, like the shifting sex composition of the medical workforce, re-migration of foreign students, and the impact of entrance barriers on enrolment and drop-out rates. Depending on scenario assumptions, demand for psychiatrists will increase by 19% to 52%. But in all supply scenarios, supply will decline from 2016 onwards, thus widening gaps between supply and demand. Even in the most optimistic scenario combination, demand will exceed supply from 2023 onwards.

 

Background: In the recent past, a rising caseload demonstrates increasing demand for psychiatrists, and ageing of the current mental health workforce will soon result in growing numbers of retirees. Under these conditions there is some concern whether we soon will face widening gaps in supply.

Aims of the Study: This study calculates projections of future use and supply of psychiatrists' services in Austria until 2030. Resulting gaps are calculated for different scenarios.

Data and Methods: We mostly use administrative data from several public authorities. To estimate the demand for services, we start from utilization data rather than medical need for services, as we do not have sufficient epidemiological information for Austria. We define several scenarios for the future development of use, all calculated separately for hospital and non-hospital services. Future supply of psychiatric services is projected by applying activity levels to projected numbers of physicians, which are calculated using a stock and flow model. Outflows are modeled using assumptions derived from past activity patterns and current legislation on retirement. To model inflows, we need to gauge the impact of recent developments: Entrance barriers into medical education were introduced, Austria experienced a surge of medical students coming from Germany, and medical schools implemented quotas for different nationalities. Scenarios take several factors into account, like the shifting sex composition of the medical workforce, re-migration of foreign students, and the impact of entrance barriers on enrolment and drop-out rates.

Results: Depending on scenario assumptions, demand for psychiatrists will increase by 8% to 52%. But in all supply scenarios, supply will decline from 2016 onwards, thus widening gaps between supply and demand. Even in the most optimistic scenario, supply will have fallen below current levels by 2030.

Discussion: Compared to current rates of service use, a gap between supply and demand will start to widen soon. In the most optimistic combination of scenarios, demand will exceed supply from 2028 onwards, and the projected gap will amount to about 5% of projected demand for services in 2030.

Limitations: Gaps could be miscalculated due to lack of more detailed data, such as retirement patterns of psychiatrists. Shifting responsibilities between psychiatrists and other (mental) health workers as well as changes in psychiatrists' “productivity”, e.g. due to more effective medications, were not modeled but would affect results.

Implications for Health Policies: It will be necessary to improve working and training conditions in order to avoid emigration and to attract a sufficient number of young entrants into the profession.

Received 24 April 2013; accepted 23 December 2013

Copyright 2014 ICMPE