Psychiatry services are integral to providing mental health care to the target population that is the responsibility of the HHSA through its Medi-Cal Mental Health Plan (MHP) contract with the State of California Department of Health Care Services. Many counties, including Shasta, have extreme difficulty in filling psychiatrist vacancies due to the national shortage of psychiatrists and the lower pay offered when compared to other employers of psychiatrists. Consequently, Shasta County has implemented continuous recruitments to fill vacancies, and there is an existing continuous recruitment for two Senior Psychiatrist positions for the HHSA’s Children’s Services and Adult Services Branches. HHSA has been trying to fill these positions since before April 2013, and has recently retained a professional search agency (Merritt Hawkins) through an agreement approved by the Board of Supervisors.
Currently, HHSA fulfills its mandate to provide psychiatric services to seriously and persistently mentally ill Medi-Cal beneficiaries by contracting with locum (temporary) agencies, who provide HHSA with qualified board-certified physicians who live in distant communities to provide telepsychiatry services over video links. While these services are high quality and meet all state regulations, it is not the same as having an in-person physician for our patients. We currently pay $185 per hour for adult psychiatry services and $220 per hour for adolescent psychiatry services, for an annual cost of approximately $842,400. By significantly raising the salary of the Senior Psychiatrist position and increasing the stipend for board certification in adolescent psychiatry, we can better compete for the limited pool of available psychiatrists. If we are able to identify and hire one adult and one adolescent psychiatrist at these new salaries, we estimate the total cost for salary and benefits of these two psychiatrists and the increased salary to the Chief Psychiatrist to be $695,303, a cost savings of $142,227 compared to our current cost to utilize two locum psychiatrists. More importantly, we will be able to offer our valuable patients an in-person relationship with their psychiatrist.
The Chief of Psychiatry is responsible for oversight of clinical mental health services delivered by medical staff, including physicians. Oversight responsibilities include ensuring that professional medical standards are upheld, problem solving clinical and/or administrative conflicts that can occur between medical staff, and chairing Medical Systems of Care (MedSOC) committee activities. This position is responsible for overseeing medication prescribing practices, both for internal and outside contracted providers, including acute inpatient psychiatric facilities both out-of-county and locally. The proposed Salary Resolution would also increase this positions salary to be 5% more than the Senior Psychiatrist position due to the oversight provided to all of the prescribing staff.
California Children’s Services (CCS) provides specialty medical services to children with qualifying disabilities. These services are an entitlement to qualifying beneficiaries and include physical and occupational therapy where it can improve or sustain physical and cognitive functioning. These services must be delivered through qualified Occupational Therapy (OT) and Physical Therapy (PT), and ensure that children have the greatest chance of overcoming the disabilities to reach their full potential as adults.
OT and PT professions require extensive education and intern training. To become a licensed PT a doctorate is now required and new OTs must achieve a Master’s degree. Educational programs are limited, and with an aging population and an increased awareness of the rehabilitative value of occupational therapy and physical therapy services for children and adults with disabilities, there are more and more job opportunities for therapists in hospital, outpatient, long-term care, and private practice settings. Nationally there is a shortage of licensed OT/PTs and salaries continue to increase as employers compete for qualified candidates. The CCS program within HHSA - Public Health currently has one OT/PT position that has been vacant since August 27, 2016, as well as a recent vacancy due to the upcoming promotion of an existing Occupational Therapist to the position of Therapist Supervisor. In the recent past, positions have remained vacant for more than a year, which is why there is currently a continuous recruitment in place for the OT/PT vacancies. If the salaries of the OT/PTs are raised, it will also be necessary to raise the salary of the Therapist Supervisor to maintain a 5% differential and avoid compaction.
Local physicians prescribe therapy regimens to CCS for therapy services for qualifying children. Due to staff shortages we may not be able to provide these prescribed therapy services fully if we cannot more quickly fill OT/PT vacancies when they occur, as mandated through our CCS state agreement. If CCS is unable to provide these services due to lack of licensed therapists, physicians have the ability to refer children to other providers of OT/PT services, and CCS is responsible for the associated costs. These costs are significantly higher than the cost for HHSA CCS therapists to provide these services, even with the proposed wage increase.
In an effort to fully analyze the existing market for these professionals, the HHSA has contracted with Merritt Hawkins recruitment services. Merritt Hawkins reviewed the starting salaries of physicians and advanced practitioners around the nation during 2015-2016. Their findings indicate that Shasta County’s salaries for the positions of Chief of Psychiatry, Senior Psychiatrist, OT, and PT positions are significantly lower than average national salaries. To be sufficiently competitive to attract qualified candidates, the following increases in the wages for these professionals are proposed: (1) 12% for the Chief of Psychiatry; (2) 10% for the Senior Psychiatrist, as well as an increase in the stipend for child/adolescent psychiatry board certification from 5% to 10%; (3) 4% for the Occupational Therapist; (4) 4% for the Physical Therapist; and (5) 3% for the Therapist Supervisor.