In this episode of Mental Health Pathfinders, APA President Dr. Theresa Miskimen Rivera discusses the outlook for her presidential year, and her focus on addressing the workforce crisis in psychiatry. She highlights the increasing demand for mental health services, the shortage of psychiatrists, and the administrative burdens faced by practitioners. Dr. Miskimen Rivera emphasizes the importance of advocacy, strategic planning, and member engagement to address these challenges and improve mental health outcomes across the nation.

Transcript for Audio

[00:00] Erin Connors: Welcome to Mental Health Pathfinders. Today we're joined by Dr. Teresa Miskemin Rivera, current president of the American Psychiatric Association. Her presidential platform focuses on tackling the workforce crisis in psychiatry through advocacy, strategic planning, and policy reform. She's working to reduce administrative burdens, expanding training opportunities, and ensure mental health remains a national priority.

Thank you so much for joining us today. We really do appreciate it.

[00:30] Theresa Miskimen Rivera: And thank you, Erin, for having me here today. I look forward to our conversation. And I know you have wonderful questions for me today, and I look forward to them. Go right ahead.

[00:41] Erin Connors: Right, yes, absolutely, let's get right to it. know, workforce concerns were as central to your platform in your campaign, and it continues to be a priority in your presidency. How do you define the workforce challenge as it exists? what does it require, a multi-year strategic approach?

[01:01] Theresa Miskimen Rivera: Yeah, great question. So let me start off with the current challenge is actually the result of many factors over time. We have been experiencing increased demand for mental health services and addiction services, especially over the past five years. And it is this increase in demand that actually collided with a shortage of psychiatrists. And in addition, we have unsustainable time grabs and that would be non-clinical and administrative burdens such as prior authorizations and EMR, that's electronic medical record documentation requirements. And the shortage, not stemming only for that increased demand, we need to acknowledge that it's also for many of us reaching retirement age and in addition, retraining and retention barriers that we are currently having.

And finally, in addition to all this, we must consider how all of these multifactorial situations are eventually affecting our well-being. So because we do have this unmet need and because this is just not an isolated event, so this is occurring across our nation, that is why it will require a truly coordinated effort and this, I believe, can be housed within the American Psychiatric Association and it should be and will be baked into our organization's goals and the mission. And ultimately, it will be informed by our members. And the reason why this is so important is because our members are currently experiencing all the effects of the workforce shortage and it's up close and personal.

[02:58] Erin Connors: You mentioned that psychiatrists are struggling with that growing administrative burden from prior authorizations to documentation overload. How do see the APA's role in addressing these non-clinical pressures?

[03:12] Theresa Miskimen Rivera: Again, great question. And our organization has and will continue a multi-prong approach to address non-clinical pressures. And how the American Psychiatric Association has done this and will continue to do this is through various channels. And I can tell you straight out, for instance, that as president-elect, I had the opportunity to work with our policy and advocacy team and talk with legislators to bring forth specific items that will help us to address these challenges. I talked about expanding telepsychiatry to expand the use of collaborative care. I oppose Medicaid cuts. And of course, most recently, I was able to be present and contribute to the launching of the Bipartisan Mental Health Caucus at the 119th Congress of the United States. And all of this to be able to be at that table to create viable and tangible solutions for the current mental health crisis in our country.

[04:28] Erin Connors: Let's talk about the APA Annual Meeting and what a great one it was this year. You we talked about the fact that you felt a little bit reinvigorated coming out of this year's Annual Meeting in Los Angeles. What were some of the most powerful takeaways for you in terms of workforce challenges and what kind of member feedback did you get?

[04:47] Theresa Miskimen Rivera: Yes, so you're absolutely correct. It was absolutely reinvigorating to see all the members come together. And it definitely was a very energetic and powerful meeting. I did hear loud and clear how the current workforce challenges are affecting not only individual practices, but also the well-being of our members. They were talking about how to take back the joy in practicing psychiatry how to leverage new technologies such as AI so that we can address some of the administrative burdens. In addition, I did hear about the need to continue and expand telepsychiatric services and how to expand our training programs to ensure that we are ready to tackle the current challenges that are facing our profession at this time.

[05:40] Erin Connors: You talked a little bit about some of the proposals and solutions to these workforce issues, including we can talk about collaborative care as well. Which of these do feel offers the most immediate potential impact? And where do you see the biggest implementation challenges?

[05:59] Theresa Miskimen Rivera: Yes, I believe that the most immediate potential solution lies on securing legislative action to incentivize primary care providers to develop and implement integrated care models. The reason being because this is a turnkey, and in my view, it's a turnkey solution. This is using our current workforce and then expanding. It's a workforce, an immediate workforce multiplier. And implementing collaborative care at the primary care offices will actually be that immediate solution so that we can be more effective as psychiatrists and we can actually then see more patients than we could in an individual practice. Now, the biggest implementation challenge I think it's related to increasing our pipeline. Why? Because this is something that cannot be done turnkey. This is something that takes years. A residency training program, it could be anywhere from four to five years, depending if you have a subspecialty. And it also requires a lot of work to secure budgets. So that pipeline expansion will require a longer term so that we could do this over time. So those are again the most immediate and the biggest challenge in my view.

[07:37] Erin Connors: Well, let's look ahead to 2026 and the annual meeting in San Francisco. You plan to launch a dedicated track on workforce issues. What do you hope members will gain from that conversation and how might it help drive policy and practice change?

[07:54] Theresa Miskimen Rivera: I'm actually very excited about having a track at that 2026 annual meeting in San Francisco. And I believe that the first thing is how is it that we're going to coalesce our members that are currently working on this multifaceted workforce challenge. What I hope from having the track is that we can then as an organization take the lessons learned and inform our organization's strategic plan. And I will want to see then long-term and short-term solutions that come up during that particular track. The discussion, I'm hoping, will be robust. And at the end of the day, we're going to be using that to implement viable and tangible solutions in a systemic way. And most importantly, I think that having that robust member engagement at that track and at the annual meeting in San Francisco is critical as this is to me the rate limiting factor for the success of this initiative.

[09:05] Erin Connors: And this could require some partner work as well. You noted the commitment to working with legislators and national stakeholders. What are some of the key messages you want APA to carry to policymakers this year about psychiatry's workforce needs?

[09:22] Theresa Miskimen Rivera: You know, this is a, I could be talking here for about an hour because there are many things that we could bring at that level. But most important, I think that the first thing that a legislator should be aware of is that the impact of the current shortage in the psychiatric workforce is not only to patients access, but at the end of the day, it impacts on mental health outcomes. And this is not just for some areas, this is really at a national level. I also think that they need to know that funding training programs, such as loan repayment programs and even scholarships can actually help build that pipeline over time. They should also consider that insurance parity and scope of practice policies can actually incentivize psychiatrists to be able to serve in under-resourced locations throughout the nation. And finally, I think that they should know that the APA, that the American Psychiatric Association, is that resource for data-driven, evidence-based mental health information that will support legislation and advocacy in the years to come.

[10:51] Erin Connors: So how do you see the one APA philosophy shaping APA's response to these challenges, especially in terms of staying adaptable and member driven?

[11:01] Theresa Miskimen Rivera: So this is something that as Dr. Wills began to talk about, I was increasingly motivated by it because in the end, it makes sense that we as an organization have a very strategic systematic way of looking at what are the major issues impacting our profession so that because we have such a wide member base that we will be able to really hit on those that the focus our attention on those particular issues that affect the majority of our members immediately. I think that the most important thing is that we have to be able to be nimble and we have to be able to really adjust and adapt to what is happening in our environment.

And how is it that we can bring to the table our best and our best energy and our best initiatives and ideas so that we can then shape the future of psychiatry in the years to come.

[12:11] Erin Connors: And you know, communication is key in a lot of these issues. You've emphasized communication and strategic planning as cornerstones of your presidency. What can members expect in terms of opportunities to stay involved and provide feedback and help shape the path forward?

[12:27] Theresa Miskimen Rivera: Yes, and this actually I really like because I've done a lot of this myself. First of all, I think that as members, we will have plenty of opportunities to contribute to the American Psychiatric Association's current strategic initiative. And the strategic plan, those of you that already have participated at the annual meeting know that there are many other opportunities coming up so that you can provide feedback. You can tell us where you think the challenges and our opportunities lay ahead. But to me, on a personal basis, where I have found the best use of my time and resources is actually in advancing the advocacy network. So in terms of what would be the most important opportunity to shape the path for people like me, clinicians, and working at the trenches is getting on with that advocacy pathway. So we really need to leverage the voice of our over 39,000 members. And if I may, this really is a call to action. I really encourage every single member that's hearing this podcast to go to our website. If you go to psychiatry.org, you can subscribe to the advocacy alerts and updates. When you sign up, you will actually have access to a platform to send generated impact letters to your elected officials. I have done that and I'm in New Jersey and I can tell you that my legislators have responded. I now have been able to create a relationship with the people that are in my neck of the woods so that they understand where I'm coming from, where is the rub, what's happening to my patients, what's happening to me as a practicing and board certified psychiatry. So it took me less than three minutes to send these letters and what I got was already a relationship with that legislator so they can have the information that they need. So at the end of the day, The call of action is make sure you get connected. Member engagement is the best resource we have within the organization. And as the incoming president, I can be reached at teamaskimonsychiatry.org. Please reach out, let me know how we can move this forward.

[15:07] Erin Connors: And that's a perfect way to end things today. Dr. Teresa Miskim and Rivera, thank you for your important work with the APA and I'm really looking forward to a great year ahead.

[15:16] Theresa Miskimen Rivera: Well, thank you for having me and I look forward to our continued collaboration and work. Take care.

[15:22] Erin Connors: And to our listeners, can catch Mental Health Pathfinders on all of your favorite podcast platforms. Thanks for listening.