A Decline in Psychiatric Salaries

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.

Protesting Conflicts of Interest in Psychiatry

An interesting letter to the editor in Psychiatric News regarding Conflicts of Interest, by Alan Stone, M.D. - Cambridge, Mass.

At our APA annual meeting in San Diego in May, I attended a symposium that continues to trouble me. It was unlike any other APA symposium I have attended over the past 40 years.

Various speakers presented different kinds of evidence about the ways large pharmaceutical houses distort the results of clinical trials and mislead psychiatrists about the relative merits of their products. One shocked clinician finally asked the question that I imagined was on everyone's mind—I paraphrase her words, "How am I to sort my way through all this misinformation so I can do what is best for my patients?" One of the speakers suggested that she subscribe to his independent newsletter. But the reality is that most ordinary practitioners continue to be awash in misinformation.

Perhaps the most troubling moment for me came when the discussant for the symposium, one of the most distinguished psychiatrists in the world, put the various presentations in perspective. What it boiled down to was that huge sums of money are at stake, it is a high-risk industry, and the pharmaceutical companies are not entirely evil. Most experts who know anything and whose opinions are worth having will be retained by drug companies, so the legalistic approach of focusing on conflicts of interest will eliminate only the knowledgeable experts from decision-making panels.

All this I had heard before, but then he confirmed a shocking and fraudulent practice of misinformation that one of the presenters had described.

Drug companies control their own clinical research, have it written up by science-writing firms created for that purpose, and then shop it around to find an academic with the right credentials to be the first author. The academic's resume grows, the career prospers, more captive experts are created, and the drug company plants more misinformation in our journals.

Other psychiatrists at the symposium seemed well aware of this fraudulent collaboration; I was not. But when the symposium discussant acknowledged that he had himself been asked to participate in this kind of obvious deception, I was compelled to believe it exists. The discussant then said, "We all know who is doing it, and the solution is to shame them." I am not one of the "we" who knows who the academics are who have done this or who are doing it, but surely it is an offense equal to plagiarism.

Unfortunately the discussant did not identify any of the offenders who have done or are doing this, so to my knowledge the shaming did not begin at that May symposium in San Diego. I would therefore like to remind the "we who all know" that section 2 of APA's principles of ethics require us to "strive to report physicians. . .engaging in fraud or deception to appropriate entities."

Someone once said about the medical profession that medical etiquette is more important than medical ethics. Unless the shaming begins, that damning judgment will once again be proven correct.

Strong Opposition to the Diagnosis of Video Game Addiction.

Now we all know that such an addiction would be treated with heavy medications, and maybe some electro-shock, possibly in the style of Clockwork Orange (Well, maybe not Clockwork Orange.) But the search for new diseases to medicate suffered something of a setback over the weekend with heavy opposition to the designation at the American Medical Association's annual meeting. As seen in this report

Doctors backed away on Sunday from a controversial proposal to designate video game addiction as a mental disorder akin to alcoholism, saying psychiatrists should study the issue more.

Addiction experts also strongly opposed the idea at a debate at the American Medical Association's annual meeting. They said more study is needed before excessive use of video and online games--a problem that affects about 10 percent of players--could be considered a mental illness.

"There is nothing here to suggest that this is a complex physiological disease state akin to alcoholism or other substance abuse disorders, and it doesn't get to have the word addiction attached to it," said Dr. Stuart Gitlow of the American Society of Addiction Medicine and Mount Sinai School of Medicine in New York.

A committee of the influential physicians' group had proposed video game addiction be listed as a mental disorder in the American Diagnostic and Statistic Manual of Mental Disorders, a guide used by the American Psychiatric Association in diagnosing mental illness.

Such a move would ease the path for insurance coverage of video game addiction.

Even before debate on the subject began, the committee that made the proposal backed away from its position, and instead recommended that the American Psychiatric Association consider the change when it revises its next diagnostic manual in 5 years.

The psychiatrist group has said if the science warrants, it could be considered for inclusion in the next diagnostic manual, which will be published in 2012.

Dr. Louis Kraus of the American Academy of Child and Adolescent Psychiatry and a psychiatrist at Rush University Medical Center, said it is not yet clear whether video games are addictive.

"It's not necessarily a cause-and-effect type issue. There may be certain kids who have a compulsive component to what they are doing," he said in an interview.

But addictive or not, too much time spent playing video games takes away from other important activities.

"The more time kids spend on video games, the less time they will have socializing, the less time they will have with their families, the less time they will have exercising," Kraus said. "They can make up academic deficits, but they can't make up the social ones."

The AMA committee will consider the testimony and make its final recommendation to the AMA's 555 voting delegates, who will vote on the matter later this week.

The Entertainment Software Association, which represents the $30 billion global video game industry, said more research is needed before video game addiction should be categorized as a mental disorder.

2nd International Psychiatric Convention to be held in Katmandu

As seen in this report

The 2nd International Convention of the Psychiatrics is to commence in Kathmandu from November 17.

The three-day Convention with the motto of 'Social Conflict and Psychological Health: Challenges for the Psychiatrics' is being organised by the SAARC Psychiatric Federation.

According to the spokesperson of the Convention Dr. Saroj Prasad Ojha, the Convention will focus on issues related to possible effect of the decade-long conflict in the social live and the ways of prevention.

A 15-member managing committee constituted under the convenorship of Senior Psychiatrist Prof. Dr. Mahendra Kumar Nepal of the Tribhuvan University Teaching Hospital has completed all necessary preparation for the Convention.

Various international officials including President of the World Psychiatrist's Association Prof. Juan E. Mezzich will be taking part in the programme to discuss on the possibility of their role in present pretext of Nepal.

A total of 200 Psychiatrist's from the USA, European Union, Australia and SAARC countries are expected to participate in the Convention.

This would seem to be one way to avoid those pesky protesters that seem to manage to show up is slightly less remote places. But you never know ....

Town undecided on what to do with closed psych hospital

The Fairfield State Hospital in Connecticut was established in 1933, and was closed in 1995. Facilities included a large farm, a sewage treatment plant and a dozen major buildings as well as staff housing. In 1998, Fairfield Hills consisted of 100 buildings on a 185-acre campus. Fairfield Hills was one of the largest mental health facilities in the state until it closed its door in 1995. At its peak it housed over 4,000 patients. The main campus consists mostly of large 2-3 story buildings ranging in size from 15,000-200,000 square feet. There are alot other smaller buildings on the edge of the campus that had served as living quarters for staff. Architecturally, the buildings of the complex are more interesting than many other institutional buildings built during the 1930s.

The Newtown, Connecticut community currently has plans underway to find new uses for the complex. As seen in this report, the town is still discussing what to do with the facility, having rejected the most recent master plan from the Planning and Zonning Commision. More details here

Fairfield Hills had a reputation for problems between administrators and employees as well as other unpleasant issues such as patient escapes, mistreatment of patients, and mysterious deaths.

There are an unusual number of websites dedicated to the former facility.