Issue link: https://beckershealthcare.uberflip.com/i/568709
43 CARE DELIVERY with other surgical and proce- dural-based specialties. ere is certainly something to be said as well about the employee morale of mental health and psychiatry workers. ere is no endpoint in a lot of cases. It's like cancer used to be: It's very difficult to go into be- cause you can't cure your patients and it weighs on the psyche. It can be tough on younger physicians, and when you couple that with pay that's not great and a high patient load, especially in inpatient set- tings, it becomes too much. Q: It looks like compensa- tion for psychiatry generally increased over the last cou- ple years. Is that what you are seeing and is that due to the shortage? TS: Over the last five years, com- pensation has hovered around $220,000 to $225,000. Psychiatry really has run into same problem as primary care. Demand will only push it so far. Psychiatry could be the most demanded specialty in the world, but if there is no money le in the system to pay psychi- atrists, compensation can only increase so much. Just like in family practice, we see a lot of hospitals gobbling up physicians so they are the employ- er, they write the check and they can maybe pay the psychiatrists more than those three- and four- man groups. Still, the way we pay doctors still hasn't changed. We are pretty aspirational in the way we talk about value-based care making more money. e reality is there is not a lot of room for the salary of a psychiatrist to go up to that of a neurosurgeon's. Psychiatry doesn't make a lot of revenue, so you can't raise salaries until you change reimbursement models and stop favoring procedural medicine over diagnostic medicine. Q: Is there anything else — besides the sheer lack of practitioners — that makes accessing mental healthcare difficult? TS: Everything else is a symptom of that shortage. It used to be he who dies with the most physicians wins and now it's really he who has the right physicians and engages in the right behavior in the right set- ting wins. Although we don't have enough practitioners, the ones we do have probably aren't practicing the type of mental health we really need. Physicians now are quali- ty-of-life-driven — it's not that money isn't important, but what their vacation schedule is, their control of the schedule and quality of work is more so. at's why you see an employment boom. ey can say, "I come in at 9 a.m. and I know what patients I am going to see." When you get into mental health, the only setting that occurs in is urban outpatient settings, and while we need those, we are still struggling with inpatient mental health. Q: Is there any way in the short-term, and in the long- term, healthcare organiza- tions can help combat the shortage? TS: Telepsychiatry and non-phy- sician clinical providers are two ways. Telehelath really came out of the mental health industry. at is going to be the way of the future whether we want to or not. at and psychiatrists, licensed social workers, nurse practitioners — all of those positions — are going to have to practice to the absolute limit of their skills, in a team- based effort managed by a doctor. Some groups are already there; some are not. Larger employers, mega-groups or mega-systems are going to have to be flexible with scheduling, use a compensation model that's flexible and use lo- cums, or part times, because men- tal health is notorious for flexible supply. It will behoove them to be as accommodating as they can be. Q: The report also noted psychiatrists are among the most difficult to recruit. What about psychiatrist recruitment is particularly challenging? TS: ey are going to have to lure more residents in the profession. Some of that could just be aware- ness about the challenging career path, but some of that is perceived. ey are going to have to start fo- cusing that issue and use, for lack of a better term, a PR campaign. e second part is policy. I'm not sure we can make it happen. We have seen a lot of changes — a lot we hope will be good — but we have not seen a significant policy or regulation to address supply. Until you see increased residency slots and fundamental changes, we are just putting Band-Aids on a gash. n