Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2460–2466 | Cite as

Factors Associated with Psychiatrist Opt-out from US Medicare: an Observational Study

  • Jiani Yu
  • Anupam B. Jena
  • Pinar Karaca Mandic
  • Ezra GolbersteinEmail author
Original Research



Concerns exist about availability and access to psychiatric services in the USA. For Medicare beneficiaries, one impediment to psychiatric services is the extent to which psychiatrists have opted out of the Medicare program.


This study describes geographic variation in rates that psychiatrists opt out of Medicare, and assesses physician-level and geographic-level predictors of opt-out.


Retrospective cross-sectional analysis of data describing psychiatrists’ opt-out status as of March 2017 linked to data on psychiatrist location, psychiatrist characteristics (obtained from a comprehensive US physician database), and market area–level characteristics.


27,838 psychiatrists in the USA

Main Measures

Whether a psychiatrist had opted out of Medicare as of March 2017.

Key Results

Overall, 7.0% of psychiatrists (1940/27,838) opted out of Medicare as of March 2017. Opt-out rates varied substantially across states and within states. Physician-level factors independently associated with opt-out included: older age (psychiatrists > 65 years were 2.6 percentage points more likely to opt vs. psychiatrists < 35 years old, p = 0.03), greater years of experience, female gender (female psychiatrists were 2.6 percentage points more likely to opt out than male psychiatrists, p < 0.001), graduation from a top-20 ranked medical school (1.7 percentage points more likely to opt out of Medicare, p < 0.001), and domestic medical graduate (domestic graduates were 7.3 percentage points more likely to opt out of Medicare vs. foreign graduates, p < 0.001). Adjusting for other individual- and geographic-level factors, psychiatrists who practiced in areas with more psychiatrists per Medicare beneficiary were less likely to opt out (p < 0.001).


The overall likelihood that psychiatrists opt out of Medicare is significant and varies considerably across regions and by characteristics of psychiatrists.


psychiatry Medicare workforce access to care 



Dr. Jena received support from the Office of the Director, National Institutes of Health (DP5OD017897).

Compliance with Ethical Standards

The study was approved as exempt from review by the institutional review board of the University of Minnesota.

Conflict of Interest

Dr. Jena received support from the Office of the Director, National Institutes of Health (DP5OD017897), and has received consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group; Dr. Karaca Mandic received no support from any organization for the submitted work, and provides consulting services to Precision Health Economics that have no relation to this manuscript; all remaining authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5246_MOESM1_ESM.docx (336 kb)
ESM 1 (DOCX 335 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jiani Yu
    • 1
  • Anupam B. Jena
    • 2
    • 3
    • 4
  • Pinar Karaca Mandic
    • 4
    • 5
  • Ezra Golberstein
    • 1
    Email author
  1. 1.Division of Health Policy and Management University of Minnesota School of Public HealthMinneapolisUSA
  2. 2.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  3. 3.Department of MedicineMassachusetts General HospitalBostonUSA
  4. 4.National Bureau of Economic ResearchCambridgeUSA
  5. 5.Department of FinanceUniversity of Minnesota Carlson School of ManagementMinneapolisUSA

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