A dramatic shortage of psychiatrists in Wisconsin leads to long waits, lengthy trips and even abandoned treatment for many patients who need mental health services.
Ground zero for what several medical officials called a mental health care crisis is the part of the state mostly north of Eau Claire.
Ten contiguous counties in that region — Chippewa, Barron, Rusk, Clark, Taylor, Burnett, Washburn, Sawyer, Price and Lincoln — don’t have a single practicing psychiatrist, a plight facing 20 of the state’s 72 counties, according to a recent report by the nonpartisan Wisconsin Policy Forum. Three other area counties — St. Croix, Trempealeau and Jackson — have less than one psychiatrist per 30,000 residents.
“I look at that map, and I just cringe for our patients,” said Dr. Justin Schoen, who oversees mental health services for Marshfield Clinic Health System and is president of the Wisconsin Psychiatric Association. “It just turns into no man’s land north of Madison and Milwaukee, with a few exceptions.”
Schoen called the shortage a massive national issue, citing estimates that the United States would need 40,000 more psychiatrists to be considered adequately staffed and data indicating that more than 50 percent of practicing psychiatrists are over 55 years old. The average Wisconsin psychiatrist is 50 and 15 percent are 65 or older, the study shows.
“The numbers nationally are, quite frankly, terrifying,” he said. “And the numbers in Wisconsin are just as bad or worse.”
Lowell and Kathy Jacobson of Bloomer have seen the effects of the shortage up close and personal, both in seeking care for their adult daughter Amelia Olson and in helping other area residents navigate the system through their work with the National Alliance on Mental Illness.
While it’s not too inconvenient for Olson to go to Eau Claire for psychiatric care for her anxiety diagnosis — she was lucky enough to have an appointment just last week — Lowell Jacobson, president of the Barron County NAMI chapter, said the drive for treatment can be significantly longer for people from counties farther north.
That’s especially true when appointments aren’t available in Eau Claire County, which the study showed had 1.47 psychiatrists per 30,000 residents. The state Department of Health Services rates areas with fewer than one psychiatrist for every 10,000 residents as having a “significant shortage.”
A resulting problem, considering that a Substance Abuse and Mental Health Services Administration study indicated that nearly one in five Wisconsin adults had a mental illness in 2015, is that the waits for psychiatric appointments are often “incredible,” with the earliest appointment sometimes three months away, said Kathy Jacobson, who teaches a class for parents and children with mental illness and is secretary of the Barron County NAMI chapter.
“The drives and the time can be overwhelming for people wherever they can find services, if they can get services at all,” Lowell Jacobson said.
Lieske Giese, director of the Eau Claire City-County Health Department, pointed out that the Eau Claire Healthy Communities coalition identified mental health as one of the community’s top three priorities and created an action team to address the issue. The access crunch is exacerbated because Eau Claire County providers serve people in so many surrounding counties, she added.
Unfortunately, Lowell Jacobson said, the hurdles prompt some families to give up and try to get by without needed psychiatric services.
“That’s when bad things happen,” he said. “When treatment isn’t available, whatever the diagnosis might be, it just continues to spiral and becomes a compounding problem.”
Too often that results in individuals ending up in jails, which he said become society’s de facto treatment centers when people run out of options.
“The access crisis is for the individual in need and their family, and it is a growing crisis,” Lowell Jacobson said.
For the regional health systems providing psychiatric services, the shortage is a constant source of frustration.
“We are recruiting and recruiting and recruiting, but the need and the capacity of providers do not match,” said Toni Simonson, executive director of behavioral health for HSHS Sacred Heart Hospital and Prevea Health in western Wisconsin.
Despite the effort, Sacred Heart has no psychiatrists on staff at this time, although Simonson is excited that one has signed a contract to start in February.
As a result, she said, Sacred Heart has been paying contract psychiatrists to perform those services, a temporary solution that offers no long-term stability and costs significantly more than having a doctor on staff because the hospital also has to pay fees for flights, hotels and the companies that supply the providers.
“We are committed to providing behavioral health services and we’ll do what we need to do to provide those services, but financially it’s really a challenge when you have to pay that kind of overhead,” Simonson said.
Mayo Clinic Health System in Eau Claire has five psychiatrists on staff but also faces challenges in recruiting new doctors.
“It is not always possible to replace retiring psychiatrists, despite strenuous recruitment efforts,” said Dr. Robert Peck, chief medical officer for Mayo Clinic Health System in northwest Wisconsin.
Peck acknowledged that the Chippewa Valley could have twice as many psychiatrists and they still would all be busy. He also noted that some psychiatrists don’t have the capacity to take on any new patients.
The crux of the problem is the number of open positions — about 230 at this time in Wisconsin — far outpaces the number of new psychiatrists trained each year in the state, Peck said.
The same issue applies nationwide, where Schoen noted that only 900 to 950 new psychiatrists are licensed annually.
Schoen pointed to limited residency slots for future psychiatrists, low reimbursement rates for psychiatric services, low pay compared with other medical specialties and even the stigma of working in mental health as factors that cause the supply of doctors to be so out of line with demand.
But those factors combine to make psychiatrists very much in demand across the country.
“We are trying to recruit from a very limited pool. Psychiatrists now in this country can basically go anywhere they want and they have all the bargaining chips,” Schoen said, adding that he talked to a psychiatry medical student recently who said he gets multiple recruitment calls every day.
That competitive environment explains why officials at Marshfield Clinic Health System, which employs three psychiatrists in Eau Claire and one in Rice Lake, were so pleased recently to hire one to work in Eau Claire and another in Rice Lake.
In the short term, Schoen predicted the shortage will get even worse, although he is optimistic access will improve down the road.
In the meantime, more than half of adults who need mental health treatment aren’t getting it, according to a 2017 state Department of Health Services report.
The squeeze extends even to the most serious cases, as Schoen said there have been times recently when all of the psychiatric beds in the state were full and patients had to be boarded in hospital emergency rooms.
“That’s bad for the ER and bad for the patient,” he said.
Barb Habben, education coordinator for NAMI Chippewa Valley, said she sometimes tells desperate families who can’t get a psychiatric appointment that they might need to end up in the ER because that could be the only way they’ll be able to get treatment.
Other Chippewa Valley patients sometimes end up seeking care as far away as Green Bay, she said.
“It definitely is a critical issue for a lot of families,” Habben said.
The shortage of providers in rural areas is symptomatic of the larger trend in which rural northwestern Wisconsin is losing population and workers in many fields, said David Callender, a spokesman for Wisconsin Policy Forum.
To address the problem, the authors of the group’s report suggested that policymakers may want to consider increasing psychiatry residency class sizes or rural psychiatry residency programs, as about half of medical residents practice in the state where they train.
Mayo Clinic is tackling the issue head-on by starting a psychiatry residency program in Eau Claire, beginning in 2020. The program will increase access to care by having up to two residents per year training in Eau Claire.
“Most residents tend to practice close to where they trained, so this increases the chances these graduates will stay and practice in this area,” Peck said.
The Medical College of Wisconsin also launched psychiatry residency programs in Green Bay and Wausau last year.
In addition, health care officials said primary care physicians are providing more psychiatric care, often with consultation from staff psychiatrists, to help address the gap and widen the reach of the psychiatric workforce.
“The gap is substantial and it’s not going to close in the near future,” Simonson said. “If we want to provide people the treatment they need, we have to get that gap closed somehow.”