A gap analysis for future supply of and demand for psychiatrists in Austria

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.

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

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.

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.

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.

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.

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.