Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Psychiatr Serv. 2009 Oct;60(10):1315-22. doi: 10.1176/ps.2009.60.10.1315.
This study compiled national county-level data and examined the geographic distribution of providers in six mental health professions and the correlates of county-level provider supply.
Data for six groups--advanced practice psychiatric nurses, licensed professional counselors, marriage and family therapists, psychiatrists, psychologists, and social workers--were compiled from licensing counts from state boards, certification counts from national credentialing organizations, and membership counts from professional associations. The geographic distribution of professionals was examined with descriptive statistics and a national choropleth map. Correlations were examined among county-level totals and between provider-to-population ratios and county characteristics.
There were 353,398 clinically active providers in the six professions. Provider-to-population ratios varied greatly across counties, both within professions and overall. Social workers and licensed professional counselors were the largest groups; psychiatrists and advanced practice psychiatric nurses were the smallest. Professionals tended to be in urban, high-population, high-income counties. Marriage and family therapists were concentrated in California, and other mental health professionals were concentrated in the Northeast.
Rural, low-income counties are likely candidates for interventions such as the training of local clinicians or the provision of incentives and infrastructure to facilitate clinical practice. Workforce planning and policy analysis should consider the unique combination of professions in each area. National workforce planning efforts and state licensing boards would benefit from the central collection of standardized practice information from clinically active providers in all mental health professions.
本研究汇编了全国县级数据，考察了六种精神卫生专业人员的提供者在地理上的分布情况，以及与县级提供者供应相关的因素。
从州委员会的许可计数、国家认证组织的认证计数和专业协会的会员计数中，为六个群体——高级实践精神科护士、持照专业顾问、婚姻和家庭治疗师、精神科医生、心理学家和社会工作者——汇编了数据。通过描述性统计和全国专题地图，检查专业人员的地理分布情况。检查了县级总数之间、提供者与人口比例之间以及县特征之间的相关性。
在这六个专业中有 353398 名临床活跃的提供者。提供者与人口的比例在县与县之间差异很大，无论是在专业内部还是总体上。社会工作者和持照专业顾问是最大的群体；精神科医生和高级实践精神科护士是最小的群体。专业人员往往集中在城市、人口多、收入高的县。婚姻和家庭治疗师集中在加利福尼亚州，其他心理健康专业人员集中在东北部。
农村、低收入县可能是干预措施的候选者，如培训当地临床医生，或提供激励和基础设施，以促进临床实践。劳动力规划和政策分析应考虑每个地区特有的专业人员组合。国家劳动力规划工作和州许可委员会将受益于从所有精神卫生专业的临床活跃提供者那里集中收集标准化实践信息。
