To the Editor.
—The article by Dr Weiner1 impels the following comments.Weiner shows in his Table 2 that HMO staffing for psychiatry in the seven Kaiser plans and Kaiser Portland at 3.8 per 100 000 population and 4.8 per 100 000 population, respectively. The same table shows the 1992 US supply of psychiatrists at 12 per 100000 population. This, of course, documents a significant oversupply of psychiatrists.However, it is important to recognize that managed care generally, and HMOs particularly, are thought to significantly underutilize psychiatrists. This is done by limiting utilization of the mental health benefit to "acute conditions." In some areas, this is permitted by state statute. The sickest patients with psychiatric disease and the most expensive to care for have schizophrenia, bipolar disorder, and/or multiple psychiatric diagnoses, including substance abuse and medical comorbidities. These disorders tend to be chronic, intermittent, and/or relapsing. Management of care
Veenhuis PE. Forecasting Physician Workforce Requirements. JAMA. 1995;273(2):112-113. doi:10.1001/jama.1995.03520260031019