Area mental health providers face lack of psychiatrists

David Sehr is an "aberration" in psychiatry. He loves the job from which most of his peers steer clear.

Sehr is an inpatient psychiatrist, a position area mental health hospitals and clinics struggle to fill.

"We've lost a lot of really great candidates because they were not interested in working with an ER overnight and taking call from multiple ERs, working weekends and rounding (making rounds) on inpatients," said Sehr, who has been a psychiatrist at Mountain Crest Behavioral Health in Fort Collins for five years. "(But) this is sort of my deal. I like it here."

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Sehr's job includes treating the most critical patients with the most daunting needs so they can move on to less intensive care.

While most strive to avoid such a job, Sehr thrives on it.

"Granted, when I'm working here on a Sunday afternoon or getting called at 2 in the morning, private practice might seem more appealing,'' he said.

Thanks but no thanks

There is plenty of demand for mental health services in Larimer County. Clear View Behavioral Health opened in Johnstown in November because one third of patients at the private hospital's sister facility, Peak View Behavioral Health in Colorado Springs, were from Northern Colorado.

Psychiatrists, unlike psychologists, can prescribe medications and have medical training.

Clear View community liaison Ethan Dexter said hiring psychiatrists is "the biggest challenge" for the new hospital, which has hired five so far. Eventually, Clear View hopes to have up to 10.

Mountain Crest Behavioral Health, UCHealth's mental health site that offers inpatient care, has been trying to hire a psychiatrist for more than a year. SummitStone Health Partners faces a similar issue, with two prescriber positions — psychiatrist or psychiatric nurse practitioners — open for at least a year. One was filled June 17. The other remains opened as of Monday.

That has forced area providers to become more nimble, utilizing nurse practitioners instead of psychiatrists to met a the demand for mental health care.

"Flexibility is the name of the game," said Cyndi Dodds, SummitStone Chief Operations Officer, adding there is a national shortage of psychiatrists.

"We simply do not have the numbers to meet the demand," Dodds said. "One person was looking at four other states and ended up finding another state that better met his family needs."

Part of the problem is salary.

UCHealth Director of Behavioral Health Services Monica Smith said psychiatrists in Northern Colorado typically earn an annual salary between $200,000 and $280,000. Forbes named the field one of the worst paying jobs for doctors, along with family practitioners and pediatricians.

Local clinics are competing with each other and state and national clinics for a limited number of recruits who have multiple, more appealing options than inpatient care.

Private practice or primary care offices offer more traditional hours and less intense patient needs than inpatient services.

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Smith's eight psychiatrists are each on call seven or eight weekends a year. On-call weekends include working Saturday and Sunday and making themselves available overnight if a patient is processed. Hospitals require an order from a psychiatrist to admit patients into psychiatric care, Smith said.

That's at least seven two-week stretches without a break a year.

"Most psychiatrists look at that and say, 'I don't have to work that hard,'" Smith said.

That's not to say it's easy to find a psychiatrist even for cushier jobs.

Carl Nassar, a therapist at Heart-Centered Counseling in Fort Collins, said the collaborative of therapists, which began as Nassar's private practice in 1999, abandoned the idea of hiring a psychiatrist because they were "completely unable to find one.

At area mental health hospitals, however, giving up on finding psychiatrists isn't an option.

"It would be like sending someone to open heart surgery without a physician to do the surgery," Smith said.

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Combating the shortage

Clear View is taking a slow but steady approach, opening programs gradually and hiring accordingly. Since November, the hospital has opened two adult inpatient programs, which serve 32 patients at a time, a senior program that serves 16 and a medical detox that serves 16.

The hospital has served more than 700 patients since opening.

Mountain Crest uses recruiters to identify candidates then sell them on the Fort Collins lifestyle to win over candidates, touting a collaborative model and positive culture, Smith said.

At SummitStone, Dodds relies on recruiters and internal referrals. She moves "immediately" if she thinks someone is interested in taking a job and tries to be "as flexible as possible."

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They reach out to schools, with SummitStone speaking to Colorado State University seniors twice a year.

The organization is considering partnering with Thompson and Poudre school districts to start educating high schoolers on the benefits of working in mental health.

Sehr said it will take showing young minds the benefit and thrill of his professional setting to fix the problem.

In a world where private practice seems more appealing, he wants medical students to see the pros of inpatient care.

"You would be very supported from the hospital system and what you want to do," he offered. "There is a very good group of providers here. A good share have been here over a decade ... I think that stability means a lot."

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