- To Dr. Bruce Miewald, telemedicine licensure isn’t a means to acquire more patients and do more business. It’s an opportunity to reach out and help people in other parts of the country who need his expertise.
The Coeur D’Alene, Idaho-based physician who specializes in child psychiatry is poised to become one of the first in the country to complete the licensure process through the Interstate Medical Licensure Compact, which went live last year. Once completed, he’ll have the chance to work with health systems – and, more importantly, patients – in distant states where access to a psychiatrist is limited.
“I don’t need a business boost – I’m always very busy,” says Miewald, who’s been practicing for 27 years. “But there are places where I can be really useful.”
Miewald’s specialty is in strong demand all across the country. Between 1995 and 2013, the total number of adult and child psychiatrists in the US rose by 12 percent, to just under 50,000. Yet the number of physicians in the country rose by 45 percent during that time span, and the nation’s population increased by 37 percent, according to the Association of American Medical Colleges.
Meanwhile, according to the physician search firm Merritt Hawkins, close to 60 percent of the nation’s psychiatrists are 55 or older and about 48 percent are 60 or older and nearing retirement, making them the fourth-oldest group of doctors practicing among 41 medical specialties.
At the same time, the need for psychiatrists is intensifying.
“As accountable care organizations and managed care organizations seek solutions that meet the Triple Aim of improving care, improving health outcomes and reducing cost, they will increasingly turn to psychiatrists for their help and guidance,” the National Council for Behavioral Health reported in a March 2017 study on the national psychiatric shortage. “The lack of an adequately trained workforce, however, poses a serious challenge in meeting this demand.”
“Since the passage of the Affordable Care Act, more Americans are now insured and are seeking treatment,” Dr. Atul Grover, executive vice president of the Association of American Medical Colleges, told Forbes Magazine in a June 2017 story. “Mental health parity laws have resulted in better behavioral health coverage than there was 20 years ago. In addition, demand is higher because there is greater awareness of, and willingness to talk about, mental health issues.”
Miewald, who’s affiliated with Kootenai Health-Coeur D’Alene, is part of Insight Telepsychiatry, a New Jersey-based national telepsychiatry provider. He’d held licenses in the past to practice in Montana and Pennsylvania, and has long used a video-based platform to facilitate his practice.
“I was it – the only child psychiatrist for that population in the five northern counties” of Idaho, he says. “I used to see people who would have to drive 90 miles one way, and driving through Idaho in winter can be kind of interesting. So [telemedicine] gave me a chance to make that easier.”
But there’s a real need for his services in Iowa and West Virginia, and he’s looking to complete the IMLC process to make himself available, through Insight’s network, to hospitals and clinics in those states.
“I’m not seeing that it’s going to be much different from what I’m doing here,” he says. “It’s just that I’d like to help out where I’m needed.”
Casey Papp, InSight’s Quality and Compliance Manager, helped Miewald with the process. They started by supplying background information and filling out attestation and eligibility forms from Miewald’s home state. Once approval was granted in Idaho, they selected additional states within the IMLC network to apply for accreditation.
“Every state is a little bit different in what they want,” says Papp. “You have to make sure you have everything lined up. It’s easier [than before the IMLC was enacted], but it could be even easier.”
Still, Miewald says the compact gives physicians like himself an opportunity to help where they’re most needed. Using a telemedicine platform, he can schedule in blocks of time to see patients in those other states, fitting that in around his own workflow.
“In my experience, I’d say 99 percent of the people think it works just as well” as an in-person visit, he says of the telemedicine platform. “And it saves a lot of time and travel. And with the kids, in some ways they seem to enjoy it more.”