Comparing Physicians' Perceptions of Access to Behavioral Health Resources in Rural and Urban Practices

Rural communities face persistent shortages of behavioral health clinicians, requiring primary care physicians to assume expanded mental health care roles. Our study assessed physicians' access to behavioral health resources, such as referral networks, licensed and non-licensed mental health providers, and telehealth supports, and examined whether perceived sufficiency of access upon referral differs between rural and urban physicians.

We analyzed data from the 2022 National Sample Survey of Physicians, a nationally representative survey of active US physicians. Practice ZIP Codes were categorized as rural or urban using Rural Urban Commuting Area (RUCA) codes. Descriptive statistics were calculated, and weighted logistic regression assessed the association between rurality and physician perceived sufficiency for mental health providers upon referral. Models were adjusted for physician demographics, specialty, and practice characteristics.

Most respondents practiced in urban settings (93.1%). Fewer than half of physicians (38.1%) reported access to licensed mental health providers, and only 10% reported access to call-in services or non-licensed support providers. A quarter (24.4%) of respondents agreed that patients had sufficient access upon referral. Rural physicians more often reported referral relationships with accessible mental health providers (55.3% vs. 44.5%). In adjusted models, rurality was not associated with sufficient access to behavioral health services upon referral.

While rural behavioral health workforce shortages receive much attention, both rural and urban physicians reported limited access to mental health resources. These findings highlight gaps in behavioral health infrastructure across geographical settings and opportunities to strengthen referral networks, telehealth support, and integration of mental health services across practice settings.