America is experiencing a physician shortage—and it’s expected to get worse. It not only impacts the general population, but also means many college students may not receive the care they need. According to the Association of American Medical Colleges (AAMC), the U.S. could be short anywhere from 54,100 to 139,000 physicians by 2033. Similarly, there is expected to be a shortage of between 14,280 and 31,109 psychiatrists within the next few years, which will leave psychologists, social workers, and others in the behavioral health field overextended and at risk of burnout.

As of April 17, 2023, the Health Resources and Services Administration (HRSA) reports that over 160 million people live in a designated mental health professional shortage area (HPSA). To remove the HPSA designation, more than 8,000 practitioners and healthcare workers are needed across the United States and its territories. Similarly, the Kaiser Family Foundation (KFF) found that almost 157 million people reside in a HPSA. The severity of this community health problem varies from specialty to specialty (e.g., Primary Care Physicians, Dental Health), but these stats highlight the significant shortage of mental health professionals in the healthcare workforce, impacting the general population along with college campuses.

Why are there challenges providing adequate mental health resources to students?

The American Psychological Association (APA) suggests the following reasons why higher education is struggling to keep up with the mental health needs of students.

• Student mental health is worsening – During the 2020-21 school year, more than 60% of college students met the criteria for at least one mental health problem, according to a Healthy Minds Study. The pandemic and its long-lasting impact cannot be underestimated, with the CDC reporting in August 2020 that 25.5% of college-aged individuals (18 to 24) had experienced suicide ideation over the past 30 days. More recent findings from the KFF found that half (50%) of adults aged 18-24 reported anxiety and depression symptoms in 2023, in comparison to about a third of adults overall.
• Traditional counseling center model is often not sufficient – Even before provider burnout from the COVID-19 pandemic, the number of students seeking mental health treatment was growing. The campus counseling center model alone may not be able to solve the clinician and behavioral health provider shortage and service disparities.
• More students are seeking help – Progress has been made to de-stigmatize mental health issues and help-seeking behavior. This empowers those who were formerly silent sufferers, those who otherwise might not step forward and proactively seek support for mental health concerns. This signals progress, but it also means that colleges and universities need to be ready for additional students to seek help, with scale and bandwidth to meet more students’ needs.
• College students face a variety of challenges – College students today balance an array of challenges and stressors, from coursework, relationships, and adjustment to campus life to economic strain, social injustice, mass violence, and various forms of loss in the wake of COVID-19.
• Lack of funding – According to the APA, the rising demand for mental health services hasn’t been matched by a corresponding rise in public health funding for personnel, which has led to higher caseloads. The nationwide average annual caseload for a full-time college counselor is 120 students, with some centers averaging more than 300 students per counselor.

As part of our commitment to high-quality care of college students, TimelyCare recently received URAC accreditation for Telehealth. We are proud to be one of only 37 healthcare organizations, and the first virtual care provider focused exclusively on college and university students, to actively hold this accreditation status. URAC is the independent leader in promoting healthcare quality by setting high standards for clinical practice, consumer protections, performance measurement, operations infrastructure and risk management. URAC is also recognized as the leader in telehealth accreditation. 

In addition to the high standards that URAC holds for healthcare quality, TimelyCare decided to pursue this accreditation because our mission is to improve the health and well-being of college students through virtual medical and mental health care. It demonstrates our team’s commitment to quality care, enhanced processes, patient safety, and improved outcomes. As a result of going through this process, we developed an organizational framework for continuous quality improvement that meets the demands of the market and exceeds industry standards.

To help provide more context on what URAC accreditation for Telehealth means to TimelyCare and our college and university partners, we’ve put together some of the most frequently asked questions about the accreditation.

The use of telehealth accounted for fewer than 1% of outpatient visits prior to the pandemic. But between March and August of 2020, that percentage jumped up to 13%. While overall telehealth usage for outpatient visits leveled out to 8%, the demand for virtual mental health care remains high, with one report finding that 62% of consumers prefer a virtual visit for their regular mental health visits. The report stated that consumers said they would prefer a virtual visit even after it is deemed safe to be in person. However, as people return to regular in-person medical and mental health care, 6 out of 10 people who used virtual care say they would prefer both digital and in-person access to health services in the future. Clearly, there’s a demand for a hybrid model of care. But what does that mean for higher education?

The rise of telehealth in education

Campus closures and social distancing to reduce the spread of COVID-19 compelled many colleges and universities to deliver more care services remotely. The federal government supported the move during this period by removing regulatory barriers and payment policies. For example, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights said it “will not impose penalties for non-compliance with the regulatory requirements under the HIPAA Rules against covered healthcare providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”

The urgent need to support students coupled with relaxed policies and penalties made online platforms for medical and mental health services an effective solution for expanding healthcare—and rightly so. PubMed studies show that virtual health effectively treats depression, anxiety, sleep, stress, alcohol use disorders, PTSD, and eating disorders in college and university students.

Colleges and universities added online services for student mental health and well-being using various platforms, including phone apps, video visits, online modules, webinars, and text messaging. Adding virtual services became a big part of helping higher education leaders deliver the care needed by college students during a global pandemic. And, it showed that virtual healthcare could play a prominent role in serving students in the future.

What is a hybrid model of care?

A hybrid model of care brings together the best of telehealth and in-person treatment. It uses technology for video conferencing, patient monitoring, appointment scheduling, and follow-up. In the hybrid model of care, the barriers between in-person and virtual care disappear and telehealth is infused throughout the system, creating seamless care pathways and patient experiences. And contrary to one myth about virtual care, it does not mean replacing on-campus clinicians and staff. Rather, it’s meant to fill gaps in care.

A few other myths:

The U.S. Census Bureau reports that adults ages 19-34 had the highest uninsured rates of any group in the U.S. And even if students are insured, they’re likely to be on their parent’s plan, which may not cover out-of-state or out-of-network providers. Expanding college students’ access to care is important. But the seamless integration of care into the lives of students is equally (if not more) important.

Health care access is defined as being able to get the health care coverage one needs when it is needed, and at an affordable cost. Unfortunately, a study on student access to health care confirms that college-aged young adults are overrepresented in the uninsured population, with one disproportionately affected population being traditionally underserved minority students. Students with private health insurance coverage are often functionally uninsured, having difficulty paying for healthcare. This forces uninsured and functionally uninsured students to rely on school-sponsored health insurance plans for access to care. The study notes that these plans often have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for students.

What happens when there are barriers to care?

College is stressful for students. In fact, nearly all college students complain about significant stress. It’s normal for students to feel worried, anxious, restless, or sad from time to time. Common health challenges for students also include anxiety, depression, eating disorders, and substance abuse. Additionally, psychiatric disorders such as bipolar disorder and schizophrenia often emerge when people are in their late teens to early thirties. If these feelings or mental health symptoms persist, they can interfere with daily living and academic performance. Without treatment, college students are more likely to drop out, abuse substances, and commit suicide.

According to the 2021 Center for Collegiate Mental Health Annual Report, college students are increasingly experiencing and reporting mental health issues. Findings suggest that some students may be at a higher risk for mental health challenges, including undocumented students, veteran students, and LGBTQ students. Students from low socioeconomic backgrounds and have low social support are also at a higher risk, especially considering the increasing cost of attendance and related food insecurity issues.

Simply put, students need easily accessible care to stay healthy, engaged, and on the graduation path. Research confirms that having health insurance is associated with:

• Better health
• Lower health care costs
• Less debt

In contrast, not having health insurance is associated with:

• Higher rates of preventable deaths and illnesses
• More difficulty paying medical bills and higher debt
• The use of less effective and more expensive medical care

A report by Healthy CUNY and CUNY Graduate School of Public Health and Health Policy found that those students who have access to their parent’s health insurance are more likely to enroll in college than those whose parents lack coverage. Young people who have access to health insurance via a parent are 5% to 22% more likely to enroll as full-time students than individuals without parental health insurance.

The CUNY report asserts this:

“Several plausible pathways may link having health insurance with outcomes that influence academic success in college students including better use of preventive services, thus avoiding more serious illnesses and absences or leaves; earlier intervention for depression, an important cause of academic problems; fewer unintended pregnancies as a result of better access to contraceptive care; better management of chronic conditions such as diabetes and asthma; and lower medical debts that could interfere with tuition payments. To our knowledge, empirical studies have not yet tested these hypotheses.”

In the Healthy CUNY survey, 13.5% of CUNY undergraduates — over 33,000 students — reported that some health problem had interfered with their school work. Overall, 13.2% of CUNY students reported they had been diagnosed with a chronic condition in the last five years, with asthma, diabetes, and hypertension the most commonly reported illnesses. Students with one or more chronic conditions were more likely to have a grade point average of less than 2.5, to have failed out of a degree program, and/or to have taken a leave of absence from school.