Psychiatric Mental Health Ai Scribe
Psychiatric Mental Health Ai Scribe
If you spend any time online in mental health groups, you have probably seen debates about how many patients a psychiatrist or psychiatric mental health nurse practitioner should have on their panel. Some clinicians prefer a smaller panel and longer sessions, while others run high-volume medication-management practices. These differences often create tension, with comments implying that anyone with a large panel must be unsafe or “churning” patients.
The challenge is that these discussions rarely match the research.
There is no study that defines a correct or incorrect number of patients for outpatient psychiatry (1). This is important to understand because it means the field does not have evidence establishing a safe maximum panel size or a danger threshold.
Many published studies that report very small “caseloads” for psychiatrists are using definitions that do not resemble real outpatient practice. Some studies only count patients who are formally assigned to a psychiatrist as the legal care coordinator, which dramatically undercounts the true number of patients psychiatrists see in outpatient work (6, 7). Other studies use insurance roster data that exclude patients who pay cash, patients seen under a different NPI, or patients who are shared with therapists and primary care clinicians (9). When you look closely at how these studies measure “panel size,” the numbers simply do not match reality.
In actual outpatient psychiatry, most clinicians see 10 to 20 patients per day, several days a week, with follow-up intervals that often range from 1 to 3 months. This naturally creates panels of five hundred to more than one thousand active patients, especially in practices focused on medication management. This is not unusual. It is the norm in many parts of the country where access is limited and demand is high. And nothing in the research says this is unsafe (1, 2, 3).
In fact, some research shows that increasing follow-up frequency does not improve patient outcomes for conditions like depression. A study published in The American Journal of Managed Care found that patients did just as well when psychiatrists scheduled follow ups less often, which also improved access and reduced wait times (2). This supports what many clinicians already know: a higher-volume practice can actually help communities by increasing appointment availability when patients need care the most.
Large national datasets also do not define a correct panel size. The Veterans Health Administration, which publishes some of the most robust mental health utilization data, focuses on staffing ratios rather than panel size. Their findings show that access and continuity improve when there are enough clinicians for the overall population, but they do not identify any specific number of patients per psychiatrist that is unsafe (3, 4).
Other research from the United Kingdom, Australia, and the Netherlands echoes the same pattern. Studies discuss caseload distribution, burnout, and workflow, but none identify a single caseload limit or a recommended volume for psychiatric providers (5, 6, 7, 8). Instead, they highlight that the real challenges come from administrative workload, documentation pressure, and system structure.
This is the part that matters most. The risks to safety in a busy psychiatric practice rarely come from the number of patients. They come from everything that happens around the visit. Long documentation hours. Prior authorization letters. Medication education that has to be typed over and over. Refill messages. Portal questions. All of these tasks pull time away from direct patient care.
For providers who choose or want a higher-volume practice, the key is not reducing the panel. The key is reducing the administrative burden so that clinical time stays protected. PMHScribe was built for precisely that reason. When documentation is generated from the transcript, medication education is automatically generated, and letters and summaries are produced without typing, then clinicians can safely manage larger panels without losing time, quality, or continuity.
For providers who prefer smaller panels, these tools matter just as much. Efficiency lets clinicians spend more time on psychotherapy, deeper discussions, and the aspects of care that benefit from more time and emotional energy.
The bottom line is that panel size is not a moral issue. It does not reflect whether someone is a good or bad clinician. It does not measure safety or competence. There is no evidence that large panels are unsafe, nor that small panels are inherently better. The goal in outpatient psychiatry is to match practice style with clinician preference, capacity, support systems, with community needs.
With the right tools and the right workflow, clinicians with both small and large panels can deliver safe, effective, and meaningful psychiatric care.