By Dr. Tom Milam, Chief Medical Officer, Iris Telehealth
LinkedIn: Thomas Milam, MD, MDiv
LinkedIn: Iris Telehealth
Expanding Access by Leveraging non-MD Providers to Augment Psychiatric Care
A projected shortage of nearly 20k physicians by 2050 signals that traditional models of behavioral health care delivery no longer meet the expanding needs of the U.S. population. In fact, they create barriers to timely, affordable treatment for many Americans through extended wait times, high costs, and limited availability.
Telehealth platforms have illuminated a clear path forward for expanding care access. Nurse practitioners (NPs), physician assistants (PAs), licensed therapists, and other qualified behavioral health professionals are demonstrating their ability to use technology to provide comprehensive care — from medication management to therapy — while maintaining exceptional clinical outcomes.
This evolution toward a care model that encompasses different types of qualified providers represents more than just filling gaps. It marks a fundamental shift that democratizes behavioral health care delivery, making quality treatment more accessible and affordable for all patients.
Why non-MD providers are taking a larger role
With one in two people worldwide developing a mental health condition in their lifetime, and up to 70% of individuals not receiving treatment, the demand for accessible care has never been more urgent.
Beyond expanding access, non-MD providers help create a more financially sustainable care system. These providers, such as NPS and licensed clinical therapists, typically deliver care at lower costs due to differences in reimbursement rates and salaries, while maintaining the appropriate clinical training and licensure needed to treat many mental health conditions effectively.
As patient demand surges, states are rolling out new healthcare regulations. Currently, nurse practitioners can practice independently in 27 states and Washington, D.C. — evaluating patients, ordering tests, and prescribing medication without physician oversight. Even in states requiring physician collaboration, NPs maintain significant autonomy in delivering comprehensive behavioral health care. These expanding practice rights directly address care shortages in underserved communities where access to psychiatric services has historically been limited.
Telehealth technology serves as a powerful enabler of expanded access and therapist and NP-led care because it eliminates geographical barriers and streamlines scheduling, allowing care providers to reach more patients. This technological integration has proven especially valuable in rural communities, where traditional in-person care options remain scarce.
As health systems increasingly recognize the advantages of expanded access through telehealth, stronger rural care coverage, and more cost-effective delivery, the question shifts from whether non-MD providers should play a larger role to how we can best leverage their capabilities to transform behavioral health care delivery.
Redefining behavioral health care through provider diversity
Acknowledging the value of non-MD providers marks an important first step toward solving the behavioral health care shortage, but implementing effective systems to maximize their impact is essential. Success requires more than recognition — it demands concrete action and systematic change.
To accelerate this transformation, healthcare organizations must support and empower these providers. These key actions can expand access to care:
- Implementing virtual care platforms that enable providers to reach underserved areas.
- Supporting independent practice rights for qualified non-MD providers.
- Creating streamlined referral systems between primary care and behavioral health specialists.
- Developing training programs that prepare non-MD providers for expanded roles in behavioral health care.
- Establishing clear protocols for determining appropriate levels of care based on patient needs.
As behavioral health care evolves, non-MD providers need an expanded role to create a more responsive and accessible system for all. This provider-inclusive model ensures that patients can receive appropriate care when and where they need it. By embracing a more inclusive model that leverages the capabilities of all qualified providers we can create a more equitable and sustainable behavioral health care system.