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2015 County-Level Analysis of U.S. Licensed Psychologists and Health Indicators

Luona Lin, Karen Stamm and Peggy Christidis

APA Center for Workforce Studies

Date created: March 2016

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Executive Summary

Based on data from state licensing boards of 50 states and the District of Columbia in 2012-2015, this report presents a county-level analysis of the distribution of licensed psychologists in the United States. It also examines the relationship between the distribution and population health outcomes. Major findings include:

Higher concentrations of psychologists were found in the Northeast and along the Pacific coast areas. The concentrations of licensed psychologists in the South and the Midwest areas were significantly lower.

Higher concentrations of licensed psychologists were generally located in urban areas. Counties with higher rural population were associated with both lower numbers and lower concentrations of licensed psychologists.

Counties with higher concentrations of licensed psychologists were comparably healthier, with lower mean numbers of poor mental and physical health days per month, and smaller percentages of the population reporting smoking, excessive drinking, obesity, physical inactivity, or diabetes.

Lower concentrations of licensed psychologists were found in the South. The South Region, where both the number and the concentration of licensed psychologists were significantly lower compared to other areas in the nation, also had significantly worse outcomes on most health indicators.

Introduction

The purpose of this report is to provide an overview of the distribution of licensed psychologists in the United States at the county level and to understand how this distribution relates to population characteristics and health outcomes.

In this report, licensed psychologists were defined as active, doctoral-level licensed psychologists. Data for licensed psychologists in 2012-2015 were obtained from state licensing boards from the 50 states and the District of Columbia. Where data from multiple years were available, the most recent state licensing board list from each state was used.1 The data on health indicators used in this report were obtained from the Robert Wood Johnson Foundation’s 2015 County Health Rankings, which combined county-level health indicators from a number of federal data sources, such as the Behavioral Risk Factor Surveillance System and Center for Disease Control and Prevention. 

Section 1 of this report analyzes the numbers of licensed psychologists by county, as well as their overall geographic distribution. Section 2 links county-level data on licensed psychologists with health indicators and examines relationships using regression analysis. Strengths and limitations of the methodology of this report are discussed in the conclusion. Appendix Aopens in new window (PDF, 335KB) contains documentation of terms and definitions included in this report, Appendix Bopens in new window (PDF, 429KB) presents the data and methodology of the report, and Appendix Copens in new window (PDF, 5MB) includes additional figures on county-level licensed psychologists and health indicators.

1. Licensed Psychologists by County

According to the 2012-2015 State Licensing Board lists, there were approximately 106,000 licensed psychologists in the United States.2  Figure 1opens in new window (PDF, 358KB) displays the distribution of these licensed psychologists by county. Approximately 34.5 percent of the counties in the nation had no records of licensed psychologists and were treated as zeroes. 66.4 percent of counties had no more than five psychologists, and 74.6 percent of counties had no more than ten psychologists. Larger numbers of psychologists were found in the Northeast and along the Pacific coast, while relatively smaller numbers were found in the South.

Figure 1: Number of Licensed Psychologists by County, 2012-2015

Figure 1. Number of Licensed Psychologists by County, 2012-2015
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U.S. Census Bureau, 2014 County Cartographic Boundary Shape files.

Figure 2opens in new window (PDF, 244KB) displays the concentration of licensed psychologists (i.e., the number of licensed psychologists per 100,000 population in the county) across the nation. The pattern is very similar to Figure 1, with higher concentrations of licensed psychologists in the Northeast and lower concentrations in the South. Table 1opens in new window (PDF, 122B) lists the numbers and concentrations of licensed psychologists by Census Regions and Divisions.3

Figure 2: Number of Licensed Psychologists per 100,000 Population, 2012-2015

Figure 2. Number of Licensed Psychologists per 100,000 Population, 2012-2015
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U.S. Census Bureau, 2014 Population Estimate and 2014 County Cartographic Boundary Shape files.

Table 1: Number and Concentration of Licensed Psychologists by Census Region and Division, 2012-2015

Table 1. Number and Concentration of Licensed Psychologists by Census Region and Division, 2012-2015
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U.S. Census Bureau, 2014 Population Estimate.
Note: Concentrations of licensed psychologists are presented by the number of licensed psychologists per 100,000 population.
(+) Statistically higher than all other areas in the nation (based on independent samples t test)
(-)  Statistically lower than all other areas in the nation (based on independent samples t test)

Figure 3opens in new window (PDF, 400KB) presents a hot spot analysis4 of the distribution of licensed psychologists in the country. Hot spot analysis uses geographic inferential statistics to identify areas with statistically higher or lower numbers of licensed psychologists. Figure 3 identifies “hot spots” of licensed psychologists in the Northeast, most of California, and around the cities of Miami and Seattle. By comparison, a large “cold spot” of licensed psychologists stretched from the South to the center of the nation.

Hot Spot Analysis on the Number of Licensed Psychologists, 2012-2015

Figure 3. Hot Spot Analysis on the Number of Licensed Psychologists, 2012-2015
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U.S. Census Bureau, 2014 County Cartographic Boundary Shape files.
Note: This map was based on the Getis-Ord statistic generated from hot spot analysis. Number of licensed psychologists were statistically compared to the national mean. Counties in Hawaii, Oklahoma, and Utah were included in the analysis based on state means of licensed psychologists per county.
Please see online version of this map for full range of color codes.

In addition to the differences at the Region/Division level, the distribution of licensed psychologists also varied between urban and rural areas.5  Higher numbers and concentrations of licensed psychologists were generally found in urban areas. In the state of New York (see Figure 4opens in new window (PDF, 164KB)), for example, New York County (Manhattan, with no rural population) had 3,394 licensed psychologists, or 209 licensed psychologists per 100,000 population. By comparison, in relatively more rural counties (i.e., those with over half of the population categorized as rural) in the state of New York, there were only 17 licensed psychologists per 100,000 population.

Distribution of Licensed Psychologists in the State of New York, 2012-2015

Figure 4. Distribution of Licensed Psychologists in the State of New York, 2012-2015
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U.S. Census Bureau, 2014 Population Estimate and 2014 County Cartographic Boundary Shape files.

The number and concentration of licensed psychologists were negatively correlated with the percentage of rural population across the nation. Counties with more rural populations were associated with both lower numbers (r = -0.33, p < 0.001) and lower concentrations (r = -0.41, p < 0.001) of licensed psychologists. Of the 734 counties that were entirely rural in the nation, 2.4 percent had 1-4 licensed psychologists, 4.0 percent had five or more licensed psychologists, and the remaining 93.6 percent of counties had no records of licensed psychologists.

Figure 5opens in new window (PDF, 519KB) depicts the number of licensed psychologists in relation to specific groups of the population, such as older adults, adolescents, and racial/ethnic minority populations. The patterns of the distributions are similar to the overall distribution of licensed psychologists, with higher concentrations of psychologists in the Northeast and lower concentrations in the South. However, the distribution of licensed psychologists in relation to the older population was relatively more uneven across the country, with much more geographic variation compared to its distribution in relation to the younger population. The concentration of licensed psychologists in relation to racial/ethnic minority populations was lower along the Pacific coast.

Figure 5: Number of Licensed Psychologists in Relation to Groups of Population, 2012-2015

Figure 5. Number of Licensed Psychologists in Relation to Groups of Population, 2012-2015     
Source: American Psychological Association, 2012-2015 State Licensing Board Lists; U. S. Census Bureau, 2014 Population Estimate and 2014 County Cartographic Boundary Shape files.

2. Licensed Psychologists and County-Level Health Indicators

An analysis using cross-sectional multiple linear regression found that county-level concentrations of licensed psychologists were significantly associated with a number of county-level health indicators, even when controlling for various demographic, socio-economic, health insurance-related and other environmental variables (see Appendix Bopens in new window (PDF, 429KB) for details of the analysis.) Counties with higher concentrations of licensed psychologists were generally healthier. According to the analysis, on average, every one licensed psychologist per 1,000 population in a county was associated with estimates of:6

0.8 percentage-point fewer adults with poor or fair health;
0.2 fewer poor mental health days per month;
0.3 fewer poor physical health days per month;
3.3 percentage-point fewer adults who were obese;
3.5 percentage-point fewer adults who were physically inactive;
3.0 percentage-point fewer adults who were smokers;
3.9 fewer teen birth cases per 1,000 females ages 15-19;
1.7 percentage-point fewer adults who reported excessive drinking; and
1.2 percentage-point fewer adults with diagnosed diabetes in the county.

Results of this analysis reveal correlations only and do not by themselves justify any claims about causal relationships.

The correlations between the concentrations of licensed psychologists and county-level health indicators were closely associated with the geographic patterns of the population’s health outcomes. Looking at population health status at the county level (Figure 6opens in new window (PDF, 190KB)),7 there was a cluster of poor health outcomes in the South Region for most indicators. This cluster corresponded to the area with a low concentration of licensed psychologists, as shown in Figure 2, and the “cold spot” of licensed psychologists identified in Figure 3.

Figure 7opens in new window (PDF, 276KB) shows the concentration of licensed psychologists in relation to several county health indicators (percent population obese, smoking, or physically inactive).8 Higher concentrations were found in the Northeast and the West for all of the measurements, indicating areas with higher numbers of licensed psychologists as well as better population health outcomes. Lower ratios were mostly located in the South, with lower numbers of psychologists and worse health outcomes.

Table 2(a)opens in new window (PDF, 153KB) and Table 2(b)opens in new window (PDF, 147KB) list population health indicators by Census Regions and Divisions.

Figure 6: County-Level Health Indicators: Reported Poor or Fair Health, Poor Mental Health Days, and Poor Physical Health Days, 2006-2012

Figure 6. County-Level Health Indicators: Reported Poor or Fair Health, Poor Mental Health Days, and Poor Physical Health Days, 2006-2012      
Source: Robert Wood Johnson Foundation, 2015 County Health Rankings; U.S. Census Bureau, 2014 County Cartographic Boundary Shape files.

Figure 7: Number of Licensed Psychologists and Behavioral Health Indicators: Smoking, Obese and Physical Inactivity, 2006-2012

Figure 7. Number of Licensed Psychologists and Behavioral Health Indicators: Smoking, Obese, and Physical Inactivity, 2006-2012
Source: American Psychological Association, 2012-2015 state licensing board lists; Robert Wood Johnson Foundation, 2015 County Health Rankings; U. S. Census Bureau, 2014 Population Estimate and 2014 County Cartographic Boundary Shape files.

Table 2(a): Health Indicators by Geographic Region and Division, 2006-2012

Table 2(a). Health Indicators by Geographic Region and Division, 2006-2012
Source: Robert Wood Johnson Foundation, 2015 County Health Rankings.
(+) Statistically higher than all other areas in the nation (based on independent samples t test)
(-)  Statistically lower than all other areas in the nation (based on independent samples t test)

Table 2(b): Health Indicators by Geographic Region and Division, 2006-2012

Table 2(b). Health Indicators by Geographic Region and Division, 2006-2012 (Continued)
Source: Robert Wood Johnson Foundation, 2015 County Health Rankings.
(+) Statistically higher than all other areas in the nation (based on independent samples t test)
(-)  Statistically lower than all other areas in the nation (based on independent samples t test)

Conclusion

This report provided an overview of the distribution of licensed psychologists at the county level and its relationship to population characteristics and health outcomes. Licensed psychologists were unevenly distributed across the country, with higher concentrations located in the Northeast, along the Pacific coast, and generally in urban areas. The concentration of licensed psychologists was significantly related to a number of health indicators: counties with higher concentrations of licensed psychologists were comparably healthier. In the South, not only was the concentration of licensed psychologists significantly lower, but the population’s mental, physical and behavioral health were also significantly worse than in other areas in the country.

As the estimated numbers of licensed psychologists were based only on state licensing board records with zip codes, one limitation of this report is that it may provide undercounts of the mean numbers and concentrations of licensed psychologists. In contrast, the strength of this report lies in the large number of records acquired from the state licensing boards. Although a complete list of licensed psychologists from all counties is currently unavailable, the existing sample of licensed psychologists by county was large enough to analyze the distribution of licensed psychologists in the nation, and to allow for hot spot and regression analyses. Although the relationships between the distribution of licensed psychologists and health indicators can only be understood as correlational and not causal, these findings capture important geographic patterns in the health of the U.S. population and will help identify regions in which there are shortages and high demand for licensed psychologists. 

Footnotes

1 See detailed documentation on source of data for licensed psychologists in Appendix Bopens in new window (PDF, 429KB).

2 The total number of licensed psychologists was based on all records from state licensing boards in 50 states and the District of Columbia. County-level analysis was based on records with zip codes in 3,078 out of 3,192 counties in the nation. Due to large proportions of missing zip codes, no records in Hawaii, Oklahoma and Utah (comprising the remaining 114 counties) were included. Numbers of records for all states were summarized in Appendix Bopens in new window (PDF, 429KB)

3 This report divides the United States into four geographic Regions and nine geographic Divisions as defined by the U.S. Census Bureau. See detailed documentation in Appendix Aopens in new window (PDF, 335KB).

4 Hot spot analysis identifies statistically significant spatial clusters of high values (hot spots) and low values (cold spots). See detailed documentation on hot spot analysis in Appendix Bopens in new window (PDF, 429KB).

5 This report uses the 2010 Census Urban and Rural Classification. See detailed documentation in Appendix Aopens in new window (PDF, 335KB).

6 All estimates are statistically significant at p < 0.05. See definitions for health indicators in Appendix Aopens in new window (PDF, 335KB).

7 County-level maps for health indicators in addition to Figure 6 are included in Appendix Copens in new window (PDF, 5MB).

8 County-level maps of number of licensed psychologists in relation to other health indicators, in addition to Figure 7, are included in Appendix Copens in new window (PDF, 5MB). Note that maps on number of licensed psychologists in relation to poor mental health days and poor physical health days were not shown due to the incomparability between measurements of licensed psychologists (count) and the indicators (days).

American Psychological Association. (2015). State licensing board lists [Unpublished special analysis]. Washington, DC: Author.

Robert Wood Johnson Foundation. (2015). 2015 County Health Rankings National Data (XLS, 9MB).

Robert Wood Johnson Foundation. (2015). 2015 CHR Analytic Data Documentation. 

U.S. Census Bureau. (2014). Annual estimates of the resident population: April 1, 2010, to July 1, 2014. 

U.S. Census Bureau. (2014). Cartographic Boundary Shapefiles – Counties.

U.S. Census Bureau. (2013). Regions and Divisions of the United States. 

U.S. Census Bureau. (2010). 2010 Census Urban and Rural Classification and Urban Area Criteria.

Recommended citation: American Psychological Association. (2016). County-Level Analysis of U.S. Licensed Psychologists and Health Indicators. Washington, DC: Author.

This report describes research and analysis conducted by staff members of the American Psychological Association’s Center for Workforce Studies. It does not constitute official policy of the American Psychological Association.

The authors thank Howard Kurtzman and Jaime Diaz-Granados for valuable input on previous drafts of this report.