Psychiatric manpower in British Columbia.

The ideal psychiatrist population ratio of 1:11 000, as accepted by the Ministry of Health in British Columbia and the British Columbia Medical Association, is probably inadequate since it does not take into account increased utilization and demand, the ageing of the population, the reduction in the work week of psychiatrists and the expected absence of of increased productivity of psychiatrists. The increase in utilization and demand reflects treatment of disorders with high prevalence and chronic outcomes whose needs were previously met, rather than psychiatrists "chatting with the worried well", as is sometimes alleged. The concentration of psychiatrists in Vancouver reflects the needs of both tertiary care and migration of psychiatric patients. It is not a local aberration and does not reflect over supply. An adequate psychiatrist to population ratio for large geographic areas is less than 1:10 000. The ratio for urban areas has not yet been determined, but is probably less than half of the overall ratio. In any case, more study of this issue is required before draconian health policy measures are undertaken to solve a perceived problem which may not exist.