title: Availability of outpatient care from psychiatrists: a simulated-patient study in three U.S. cities.
abstract: OBJECTIVE
  The study examined availability of psychiatrists for outpatient appointments in three U.S. cities.
  
  
  METHODS
  Posing as patients, investigators called 360 psychiatrists listed in a major insurer's database in Boston, Houston, and Chicago (N=120 per city) and attempted to make appointments. Callers claimed to have Blue Cross Blue Shield or Medicare or said they would pay out of pocket (N=120 per payer type, divided evenly across cities).
  
  
  RESULTS
  In round 1 of calling, investigators were able to reach 119 of the 360 psychiatrists (33%). Of 216 unanswered calls, 36% were returned. After two calling rounds, appointments were made with 93 psychiatrists (26%). Significant differences were noted between cities but not between payer type.
  
  
  CONCLUSIONS
  Obtaining outpatient appointments with psychiatrists in three cities was difficult, irrespective of payer. RESULTS suggest that expanding insurance coverage alone may do little to improve access to psychiatrists-or worse, expansion might further overwhelm the capacity of available services.
authors.affiliation: Ms. Malowney is with the Department of Population Health, Maimonides Medical Center, Brooklyn, New York. Ms. Keltz is an undergraduate student in the Department of History of Science, Harvard College, Cambridge, Massachusetts. Dr. Fischer and Dr. Boyd are with the Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, and Harvard Medical School, Boston. Send correspondence to Dr. Boyd (e-mail: jwboyd@cha.harvard.edu ).
authors.forename: Monica
authors.initials: M
authors.lastname: Malowney
authors.forename: Sarah
authors.initials: S
authors.lastname: Keltz
authors.forename: Daniel
authors.initials: D
authors.lastname: Fischer
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Boyd
mesh_terms: D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001900:Boston; D002641:Chicago; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D011570:Psychiatry / Q000592:standards* / Q000706:statistics & numerical data; D013781:Texas