Behavioral Health staffing challenges:
Inpatient psychiatry staffing has been a challenge at Region acute care facilities for the last several years.
Site 1. Acute inpatient quaternary facility with 70 inpatient beds.
About 4 years ago the psychiatry department of 8 psychiatrists resigned over a 10 day period. This was due to high work load and difficulty with weekend call coverage. This was a work and compensation model designed by the psychiatry group in alignment with the administrative team. When this happened oversight of the department transitioned to me. The work model was redesigned to a 7 days on 7 days off model and the majority of the docs were retained. This required the number of beds to be reduced and cost increased. Subsequently we developed a joint venture with a behavioral health hospital and built a 100 bed freestanding inpatient psychiatry hospital. The acute facility psychiatry unit was reduced to 40 beds as part of the process. These issues have resulted in ED overcrowding with behavioral health patients.
In spite of market level pay and improved work hours, psychiatry staff have been requesting more pay and retention bonuses.
Site 2. Acute inpatient tertiary facility with 25 inpatient beds.
Staffed by 5 psychiatrists representing about 3.5 FTE. The senior physician has announced his pending retirement. Now the other three are planning to resign due to work load concerns. We are actively recruiting replacements with little success. While employed by the medical group, this group has reported in through hospital leadership channels.
- Psychiatry is in high demand across the nation.
- Closure of inpatient psychiatry results in poor service to vulnerable community members.
- Closure of inpatient psychiatry results in Emergency Department backlog and longer length of stay.
- Telepsychiatry is helpful but has limited availability. Patients with behavioral health diagnoses can be admitted to general medical beds under the care of the hospitalist teams using the single bed certification process. Not an ideal way of caring for this population and not popular with hospitalist teams.
- With several staffing and compensation models over the years, psychiatry staffing has been difficult to maintain.