Psychotherapeutic Care in Austria 2026–2040: An FTE-Calibrated Simulation of Workforce, Funding and Care Capacity

Background/Objectives: Psychotherapeutic care in Austria faces the transition introduced by the Psychotherapy Act 2024 (PThG 2024), an aging profession, and a need far exceeding publicly funded provision (potential capacity ≈669,000 vs. ≈199,250 publicly (co-)funded patients per year in 2022). Methods: We developed an FTE-calibrated Monte Carlo simulation (30,000 iterations per scenario, 2026–2040; anchors: 21 treatment hours/week, 13 units/patient/year) distinguishing potential, accessible, and fully funded capacity while treating supervised trainees as a separate, survey-anchored capacity line whose capacity rises with insurance funding, including the PThG 2024 transition (master’s entry 2026/27; the old pathway ends in 2038), a static robustness matrix at the 2023 capacity anchor (need 5–12%; intensity 13–40 units/patient/year) and weekly-hours-anchor sensitivities (21/15.8/13.3 h/week). Results: At 13 units/patient/year, the expansion scenario closes the median care gap from 2028 and the partial-funding scenario from 2032, largely by funding the services of trainees who are already treating under supervision; at 30 units/patient/year, even a full expansion covers only ≈30% of a 9% need at the 2023 anchor (≈49% with projected 2040 capacity); and under lower weekly-hours anchors, the gap closes later or not at all. The 2038 end of the old pathway produces a workforce-growth cliff: sustaining growth requires about 1500 master’s places per year with matching phase-3 places. Population needs dominate cost uncertainty (Spearman ρ up to 0.79) ahead of the activation rate; exploratory cumulative follow-on costs up to 2040 approximate €83/13/1 billion (A/B/C). Conclusions: Activating existing capacity—including trainees’ services, whose capacity line rests on a single unweighted survey and expert assumptions—is the dominant short-term lever; master’s and phase-3 places determine workforce growth after 2038; and in higher-intensity treatment scenarios, capacity expansion becomes indispensable.