Tuesday, January 21, 2014

State agencies look to KU Med for help with psychiatrist shortage

By BEN UNGLESBEE, The Lawrence Journal-World

A widespread shortage of psychiatrists throughout the state has some state agencies looking to the Kansas University Medical Center for help in training more.

Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, said his agency recently hired a consultant to review its operations.

The consultant found that the agency, which manages three hospitals and contracts with 27 community mental health centers, needed to budget for more than three extra psychiatrists to meet its service needs.

"The problem with that is we can't even come close to filling the psychiatrists that we have budgeted," Sullivan said.

Throughout the state all but five counties — Douglas, Johnson, Sedgwick, Shawnee and Wyandotte — are federally designated mental health professional shortage areas.

William F. Gabrielli, who chairs KU Med's psychiatry department, said rural areas have trouble attracting psychiatrists because the incomes are lower, there are fewer jobs available for working spouses and there is "less of a community of doctors," making practice more difficult without a professional network.

Broken pipelines

Gabrielli also attributed the shortage of psychiatrists to changes in a state program that once provided incentives for psychiatry students who promised to work in underserved areas after graduation. The program has since been narrowed by the state to excluded psychiatry and other specialties.

Additionally, Sullivan pointed to the loss of Topeka's Menninger Clinic, a world-renowned psychiatric clinic that moved to Houston in 2003, as another broken pipeline for trained psychiatrists.

Sullivan's department and other state agencies are trying to reverse the loss. In the short term, some of the state's mental health needs can be met by telemedicine, Sullivan said. 

But in the long term his department wants to see an increase in psychiatrists coming out of KU Med, the state's only public medical school.

Making that happen wouldn't be easy or cheap. Gabrielli said the school currently has about 10 general psychiatry residencies for each year's class. That's a small fraction of total medical residencies at KU Med.

Making matters more difficult, each psychiatry residency costs KU Med about $100,000. "People have come to me and asked, 'Can you add another 10 doctors?'" Gabrielli said. "That would be a huge undertaking."

Expanding training

Gabrielli suggested that a rural training track could be set up to train students at community mental health centers, state hospitals and other mental health providers across the state. That would require finding capable mentors, housing for students and a host of other logistical details, but Gabrielli thinks it could be done for roughly the same amount of money as a residency in the current system.

Gabrielli and Sullivan both said covering some education costs for students who practice in rural areas in the state could also help alleviate the shortage.

Officials in the Kansas Department for Aging and Disability Services and other agencies have approached Gabrielli with questions about increasing the number of residents at KU Med, he said. "The discussions are early."

Sullivan said he plans on having detailed discussions with Gabrielli and others at the Med Center in the coming weeks. Ultimately Sullivan and others would need to go to the Kansas Board of Regents and the Legislature.

Conversations at the legislative level could begin soon, though Sullivan doesn't anticipate winning approval for expanded psychiatry training by the start of the next fiscal year.

For now the state might have to keep scraping along without the psychiatrists it needs. 

"This has been a problem that's been growing for both hospitals and the mental health centers for the last couple years," Sullivan said. "We've increased pay… but we're still not having much success with recruitment or retention."