Psychiatrists: Recruit, Retain, Rebalance

Victoria has far too few psychiatrists to provide anything close to the level of service required.

Funding Isn’t the Problem

Contrary to some peoples’ impression, this is not (primarily) about a lack of funding. No dedicated funding is required for a psychiatrist to come here and open a practice. They need a BC license and can bill MSP for their services. If they want to work at Island Health clinics (which, among other things, pay some overhead costs), there are 20+ job listings for open (funded) positions, several posted for years. So it’s not just a money thing.

Recruitment and Retention

Recruitment and retention of psychiatrists are problems. Without going into details, I can safely say that we’re here despite a wretched recruitment/hiring experience. Given the shortage of psychiatrists, it was shocking how badly it was handled. Retention has also been a significant problem. We’ve had lots of psychiatrists leave, many who retired or fell ill, but also many who didn’t find working here to be a good fit for them.

Many people who’ve left (and many still here) aren’t shy about sharing their stories.

We need a more professional approach to recruitment and retention. That means ownership and accountability. There are proven approaches to this if we want to make it a priority.

Someone has to own it and be accountable. You don’t just post a job ad on Health Match BC and hope for the best.

Marketing

Marketing ties into recruiting. Psychiatrists don’t grow on trees, and while there aren’t nearly enough throughout Canada, we can do more to attract our fair share. Yes, this is a zero-sum game, and our gain will be someone else’s loss.

But honestly, this is Victoria. Tell me that reaching out to someone in Winnipeg in the middle of January wouldn’t at least pique their interest. And in the province next door, there is a government actively at war with its doctors, many of whom are very pissed off right now.

Two years ago, a Westshore GP placed an ad in a national trade magazine for doctors. He was recruiting to replace another doctor at the practice who retired. The ad featured lovely pictures of the adjacent beach, office-grown pineapple, etc. How rarely we see this kind of initiative!

Psychiatry in Victoria has a bit of an inferiority complex and maybe a bit of a backwater reputation because it’s not Vancouver. And there are (ahem) challenges in practicing here. But if we are successful at making some of the changes we’ve all been discussing recently, we should have something positive to share. People are excited to be part of something on the way up.

Finally, BC has historically paid psychiatrists at or near the bottom of all provinces. Plus it’s expensive to live here. That’s many potential candidates’ first reaction. But the story has significantly changed in just the last few years, and compensation is now far more competitive. Nobody will know that if we don’t reach out.

A few examples: outpatient fees raised to match inpatient fees; new billing codes for phone calls, emails, longer consults; substantial fee bump for psychiatry to reduce inter-provincial and inter-specialty fee disparities; fee premium to offset higher overhead costs in Victoria.

Marketing would likely require a small amount of new funding for resources and personnel.

Rebalance

Psychiatrists in Victoria see too many people for one-time consultations but do not provide enough ongoing treatment. Worse, one-time consultations are often not sufficient to help family doctors and particularly wasteful for many patients with chronic mental health concerns.

This likely started out as a temporary stopgap to deal with a mismatch in supply and demand at VMHC. It has turned into a permanent state of affairs. This imbalance of services needs to be measured and corrected.

Slightly tangential, but many psychiatrists are scared off at the thought of opening a private practice in the community, especially ones newer to practice. Few are exposed to community psychiatry in residency, and it’s often looked down on by the psychiatrists in academic centres who train them. This is a missed opportunity to provide a broader mix of treatment. It can also help attract or retain people who, for whatever reason, do not want to practice within Island Health.

Related: see all Victoria posts here