It appears that it is becoming harder to make a living as a psychiatrist, or any other mental health counselor. We suspect that a hidden cause in this decline has something to do with the decline and fall of the profession itself, as more scandals rack psychiatry, and industry repute is left in tatters and shreds. Of course, they pin the blame on a number of other reasonable factors. But maybe they need to look in the mirror every once in a while, instead of trying to gain sympathy from government. People are reminded that if it wasn't for government funding, psychiatry as a medical specialty would be dead already.
From this report
When Heather Pierce sat down and did her taxes for last year, she was a bit surprised to learn that she earned only about $23,000 in 2006.
The Berlin psychiatrist said her income was far higher when she began practicing 20 years ago.
"I'm not looking for sympathy because I love what I do," she said this week. "But the reality is that I have not had a raise in four years."
More than a dozen Vermont psychiatrists working in the public and private sectors held a morning-long hearing at the Montpelier Statehouse on Tuesday and painted a picture of a mental health system that is nearing a crisis.
Years of low reimbursement rates from the government and the health insurance industry coupled with the difficulty in counseling Vermonters suffering from mental illnesses, a process that seems to defy traditional health improvement tracking, have brought the state's community system to a point of cracking, psychiatrists said.
"We need to keep these issues on the front burner," said Ken Libertoff, the executive director of the Vermont Association for Mental Health and the organizer of the meeting. "Otherwise over the next several years we will see this field greatly diminished."
Alice Silverman, a St. Johnsbury psychiatrist, said it is impossible to find an available psychiatrist for emergencies in the Northeast Kingdom. Those working in that area are booked for weeks, she explained, creating a major gap in mental health services in a troubled part of the state."There is not enough care," Silverman said. "The system is breaking. It's a crisis and this is shameful."
Jennifer FauntLeRoy, a Rutland psychotherapist, said her three years of sessions with a 40-year-old abuse survivor with serious health problems totaled $8,990 in costs. But the total amount paid by Medicaid ended up being just over $6,000, she said.
FauntLeRoy said sometimes she makes as little as 25 cents over minimum wage for the public mental health work she does. By comparison, she might make more than $30 an hour conducting private sessions for those who can afford out-of-pocket costs for sessions.
"I'm going to be out of business in five years if I continue getting Medicaid at this rate," she said.
Montpelier psychiatrist Francis Kalibat distributed a copy of Cigna Healthcare's preferred psychiatrist network in Vermont – the list of 15 doctors in the state that the company sends its consumers to.
Of those 15, Kalibat said he found only three who are taking patients right now. The rest of the list was full of out-dated information, doctors who have wait lists of up to a month even for urgent cases and one person who wasn't even a psychiatrist.
Kalibat referred to the list as "Cigna's phantom network of psychiatrists."
"If you are with Cigna, you are paying good money for a policy you can't use," he said.
Cigna Healthcare could not be reached for comment Wednesday.
Much of the frustration at the meeting was focused on the health insurance companies, and several psychiatrists expressed frustration at the recent news that officials such as former Blue Cross and Blue Shield of Massachusetts CEO William Van Faasen received about $19 million in extra compensation and bonuses last year – all while their own reimbursement rates are stagnant.
Leigh Tofferi, the director of government, public and community relations for Blue Cross and Blue Shield of Vermont, said its medical reimbursement rates are based on local and regional market rates.
Because the health care organization only has 200,000 members in Vermont – a small pool compared to most other states – it contracts its mental health services administration to Magellan Health Services, a Connecticut-based company, Tofferi said.
"My understanding is that the reimbursement rates are based on market analysis," he said. "We try to find a balance that will provide access and value for our customers."
Catamount Health – Vermont's new program for the uninsured that was rolled out this fall – also worries psychiatrists.
A provision in that law states that the "carrier shall pay a health care professional the lowest of the health care professional's contracted rate." Jonathan Weker, a psychiatrist from Montpelier, pointed out that members of his field are among the few that are subjected to contracted rates.
"This makes me wonder why I would want to become a Catamount provider," Weker said.
Christine Oliver, the deputy commissioner of Banking, Insurance, Security and Health Care Administration for Vermont, said that provision was added at the request of MVP Health Care.
"The problems with reimbursement rates for the mental health field seem to be a systemic issue," Oliver said. "The thinking was that it was better to address that and other access issues in specific legislation later on, which it seems the Legislature plans to do next year."
Rep. Michel Fisher, D-Lincoln, the vice-chairman of the House Human Services Committee, said that provision will be one of the issues he hopes to investigate when the second half of the legislative session begins in early January.
"The challenge for us is to boil down these concerns to a legislative agenda that is reasonable," Fisher told the group of psychiatrists on Tuesday.
Concerns over the health of the state's mental health system comes at a time when advocates and lawmakers will be looking to the coalition of psychiatrists across the state to take over the patient load that is now going to Waterbury's Vermont State Hospital.
Rep. Ann Donahue, R-Northfield, a prominent advocate for mental health issues in the Vermont House, said the community system needs a boost if lawmakers are going to shift away from the troubled and federally-decertified state hospital.
"There is a concern here that we really have lost some ground over the last few years," Donahue said.
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