Physician Shortages Drive Growth in telePsychiatry

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The present shortage of psychiatrists has reached national crisis levels, specifically in rural areas where there is little to no access to timely, quality care. Today, nearly one in five patients in emergency departments has some sort of behavioral or mental health issue—this number continues to rise as the number of psychiatrists decreases. Avrim Fishkind, MD, talks candidly about how physician shortages drive growth in telePsychiatry.

Why are you passionate about telePsychiatry?

I started practicing at a time when finding a psychiatrist without an 8- to 12-week wait proved challenging. During my training as a physician, hearing this complaint became not only exhausting, but pushed me to find a solution.

While living in Texas, I saw firsthand how public agencies struggled to accommodate patients and provide effective mental health care services. Can you imagine trying to cover an area the size of Texas? With the shortage of psychiatrists due to lack of physician interest in relocating to small towns, there was only one way we would ever each the rural areas—telemedicine. All of the sudden, there was solution to reach these far-flung populations.

How does the work you do for SOC allow you to drive growth in telePsychiatry?

In 2007, I founded JSA Health and grew it into a leading behavioral health telemedicine company. SOC acquired JSA Health last year, combining resources and expertise. Together, we are growing our vision of providing access to expedited psychiatric treatment in settings where it might not otherwise be possible.

SOC is now the largest acute telepsychiatry provider in the U.S., providing quality patient care at a much larger scale. I’m excited to be a part of that.

What part of telePsychiatry fascinates you most?

In telepsychiatry, we often refer to a nebulous yet important term—therapeutic relationship. This term is defined by the idea that when interacting with a patient, a physician must work quickly to establish an empathetic caring relationship. Often times patients are not familiar with an on-screen psychiatrist. In those situations, physicians have to make it a priority to build this therapeutic relationship quickly, in fact within the initial 2-3 minutes of the encounter. It is important to ensure the patient is comfortable enough to disclose pertinent information and also to trust us to treat them appropriately.

When referencing telemedicine, the initial perception is often that physicians aren’t able to make this connection and create an effective therapeutic relationship. However, with the increase in all online transactions and interactions, things are very different now—friendships, relationships, even business partnerships can begin through some form of online channel. Selling the idea of forming an effective relationship through telemedicine is no longer the hardest part of the job.

What part of being a telePsychiatrist do you find most difficult?

Believe it or not, the most difficult part of my job is regulation. Technology and telemedicine have outpaced the government’s regulatory environment in many states. Trying to change regulations to enable the use of telemedicine has been painstakingly slow and a real source of frustration.

A current topic of discussion is CMS regulations which state that a board-certified American-trained psychiatrist—no matter how talented—who is living outside the U.S. cannot practice telemedicine in the U.S. (i.e., provide a tele-consult with a U.S.-based facility.). The obvious problem with this is maintaining adequate staffing. After all, when it’s overnight in New York City …it’s a physician’s daytime in London. In order to provide 24/7 emergency services, psychiatrists then have to work evenings, overnight, even weekends. This leads to burn-out, further reducing the psychiatrists in practice.

What do you do when you aren’t seeing patients?

I spend lots of time living the art of mindfulness, or living in the moment. It’s a state of active, open, intentional attention on the present. I love on and laugh with my wife, twins, friends and neighbors … listen to the dynamics and timbres of classic bebop jazz on vinyl … feel the vibration of the engine and the grip of the tires as I race my  track car, and inhale the smell of barbeque on the grill.


Dr. Fishkind is a past president of the American Association for Emergency Psychiatry and has designed multiple comprehensive psychiatric emergency programs, including Psychiatric Emergency Rooms, 23-Hour Observation Units, Mobile Crisis Outreach Teams, Crisis Residential and Stabilization Units, Crisis Hotlines, and short-term Crisis Counseling Units. Intimately familiar with what it takes to manage a team of telePsychiatrists, Fishkind uses his passion and expertise to create more effective interactions between SOC physicians and patients.


SOC Telemed provides hospitals nationwide with immediate, 24/7 access to highly-qualified psychiatrists for help with their emergency psychiatric patients, general evaluations, as well as C&L consultations. If you’re interested in joining our telepsychiatry team, learn more about how to connect with us here.