VA Woefully Short Of Psychiatrists

Outreach for depression.

A VA Inspector General report has determined that the VA is woefully short on psychiatrists.

A just-released report based on a December 2014 study says that 94 of 140 health care facilities needed additional psychiatrists to meet demand.

The report attributed the shortage to many issues including the high cost of hiring qualified doctors, a large amount of time existing doctors spent on duties other than treating patients, and lack of a centralized hiring process and performance management system.

The VA has been working on hiring more psychiatrists for years, in April 2012, the former Secretary of Veterans Affairs announced VA would hire approximately 1,600 additional mental health clinicians. Later in 2012, VA got approval from Congress to temporarily increase psychiatrist pay and in November 2014 VA was given final approval to increase the maximum psychiatrist pay to $250,000. The VA did hire 1,600 mental health clinicians which included 57 psychiatrists. However, in 2014 the VA said it needed to hire another 2,700 employees in the mental health field.

As a result of this hiring initiative and pay increase VA spent nearly $6.7 billion on mental health care services in fiscal year 2014, a 24% increase from fiscal year 2012. During this time VA increased the number of psychiatrists by nearly 15%.

However, the report noted that despite this 15% increase in employees, the number of individual veterans who received outpatient care from a psychiatrist increased by only about 9%.

The average number of patients visits per psychiatrist during a 1-year period was 502 veterans, while the facility with the highest number of visits saw 1,114 per doctor per year. Given that the average work-year has 260 work days in it, those psychiatrists at the busiest VA hospital saw nearly 4 patients every day. The report did not state if quality of care suffered as a result of this large workload.

The report went on to say though, that throughout the VA psychiatrists spent only around 22 hours per week with patients, and determined that poor time management resulted in 25% wasted time, when psychiatrists could have been with patients, but instead were idle or involved in other duties.

As a result of the investigation, the Inspector General recommended that local VA facilities work with VA headquarters to develop a balanced staffing plan based on nationwide need. The report also said that time and productivity management for medical personnel, especially those in the mental health field is especially difficult. The number of veterans a single psychiatrist can safely and effectively manage varies widely based on type of mental disorder. Therefore the Inspector General recommended that the VA determine new nationwide standards by September 2016.


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