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- Psychiatrists are retiring in Colorado Springs without a pipeline of replacements, experts say.
In 2013, the last time the community collected data on the number of psychiatrists per capita, there were only 9.1 practicing for every 100,000 people in the metropolitan area, according to Pikes Peak United Way’s Quality of Life Indicators Report. That was 37 percent below the national average at the time.
According to Mike Ware, CEO of the El Paso County Medical Society, the shortage has probably gotten worse — given the area’s explosive population growth and the number of psychiatrists who have recently retired.
“It’s gotten pretty extreme,” Ware says.
While many agree that the area also faces a shortage of other types of behavioral health workers — such as psychologists, therapists and addiction counselors — psychiatrists stand out from the rest because they must obtain a medical degree, giving them the authority to prescribe medications.
And a set of unique factors has led to their scarcity, advocates and industry representatives say: the state’s Medicaid expansion following the Affordable Care Act, the extension of the federal parity law to Medicaid plans (which required insurance providers to ensure equal access to mental health services), the pay gap for behavioral health providers (who make less than primary care providers and specialists), and reduced stigma around seeking care for mental health. The shortage evolved as the state also dealt with overwhelming demand for psychiatric beds — an admissions freeze now excludes most people outside the criminal justice system from state hospitals.
This past spring, state legislators approved House Bill 1357, which creates a behavioral health ombudsperson in hopes of holding insurers accountable for providing sufficient coverage for mental health care. The ombuds- person’s office will open a complaint line for consumers in January and must begin making annual reports to lawmakers in March.
But experts agree that the complex problem will take much more to resolve. For starters, there’s not much financial incentive for medical school graduates to choose psychiatry as a specialty — especially not in Colorado. A 2017 report by Milliman Research showed that nationally, Medicare reimbursement rates for behavioral health providers were 21 percent less than reimbursements for primary care providers in 2015.
In Colorado, the pay gap doubles: Behavioral health providers are paid 41 percent less than primary care providers, and 46 percent less than specialists.
Brenna Sturgeon, a licensed professional counselor and level 2 certified addiction counselor at Peak Vista Community Health Centers, says her team has had to hire more practitioners since the Medicaid and parity expansions a few years ago. But it’s not always easy to find the right people.
And there are fewer candidates, period, because psychiatry is looking less appealing as a career choice — compared to say, orthopedic surgery — for those leaving medical school with hundreds of thousands of dollars in debt.
This translates to high numbers of psychiatrists retiring without a pipeline of younger people to replace them, says Lori Jarvis-Steinwert, executive director of the National Alliance on Mental Illness (NAMI) Colorado Springs. New administrative requirements can make retirement especially appetizing for an aging workforce.
“A lot of them who’ve been practicing for a while are retiring in part because they would have to change their practice so much to continue to bill insurance,” Jarvis-Steinwert says. “The whole process of billing insurance and getting reimbursed by insurance [has] become so cumbersome that if you’re a sole practitioner ... you have to take on administrative staff.”
But an increasing demand for mental health care means some providers can afford to avoid the extra paperwork by having patients pay out of pocket and then bill insurance themselves, Jarvis-Steinwert says — which can make their services inaccessible to the low-income population.
Coincidentally, the Milliman Research report also found that Coloradans go out-of-network for mental health care about seven times as often as they do for physical care.
If a psychiatrist doesn’t take your insurance, though, it’s not necessarily because she wanted it that way. The decision is often made by the insurance companies.
After the Affordable Care Act imposed new economic demands on insurers, Ware says, they began shrinking the number of providers in their networks: “You get more people funneled to those providers, but in many cases it creates problems for people trying to get in as a new patient.”
Andrew Romanoff, president and CEO of Mental Health Colorado, says he’s even heard from mental health professionals who had been turned down by insurance companies.
“We’ve gotten a couple letters from folks who said, ‘Look, I’m willing to take these reimbursement rates, I’m willing to fill out the paperwork, I’m willing to jump through these hoops, but the insurance company [where] I applied to join the panel said they were full,’” Romanoff says. “That doesn’t really make much sense when you have policyholders who are waiting in line to get care.”
Romanoff’s organization was a main backer of House Bill 1357, and it continues to lobby for better enforcement of insurance laws and leveraging the state budget to expand access to care. However, Romanoff points out that change can also happen at the local level. Ten cities and counties (not including Colorado Springs or El Paso County) approved ballot measures this fall funding mental health and substance use resources.
Ware, of the El Paso County Medical Society, says fixing Colorado Springs’ psychiatrist shortage will probably take a decade. He believes expanding residency programs — the specialized training after medical school — in the area could help. Currently, though Penrose-St. Francis Health Services and Peak Vista offer residencies for other specialties, there are no such programs for psychiatrists in Colorado Springs.
“The more residency programs that we offer, the more likely those physicians are to stay,” Ware says. “We know that ... roughly 60 percent of physicians will stay within a 60-mile radius of where they did their residency program.”
Underserved areas can also attract providers through loan forgiveness programs. AspenPointe and Peak Vista are federally designated Health Professional Shortage Areas (HPSAs), which means they both offer such programs for behavioral health providers.
Romanoff believes expanding financial incentives is key to fixing the shortage, which does have a silver lining: “We’re making a dent in stigma so that more people are more comfortable seeking mental health care,” he points out. “That’s a good thing, although it doesn’t do that much good to seek it if they can’t find it.”