Thursday, February 08, 2007

Discover Your Inner Hero

I have to admit I've never seen the television show Heroes. I understand the idea behind the show is that ordinary people discover they have extraordinary powers. That got me thinking about medical heroes. Usually when I hear that term I think about people like Dr. Edward Jenner who discovered the vaccination for small pox, or Walter Reed and his colleagues who voluntarily infected themselves with yellow fever to see if their vaccines worked. Medical heroes are people who do big, great things and cure diseases.

I dunno, I'm more fond of the television Heroes' common-man definition. I like the ordinary anonymous docs who go out every day and do extraordinary things. I like the public psychiatrists.

I wish there were more of them. Of the six remaining state hospitals in Maryland, three have psychiatrist positions that have been standing vacant for months. I won't even mention how tough it is to find public psychiatrists to work in corrections.

It's not for lack of trying. In the 1970's our state created the Maryland Plan, a program sponsored jointly by the University of Maryland and the Maryland Department of Mental Hygiene to train and recruit psychiatry residents for employment in the public sector. The Maryland Plan was supposed to be a model program that would fill the physician recruitment needs of our state facilities. It hasn't, not even after closing one hospital.

So where are the doctors? There are 180 psychiatry residency programs in the country; Charm City has two of them and they turn out a dozen or so psychiatrists a year. One of the programs is within walking distance of my prison. They're not walking in my direction.

According to the U.S. Department of Health and Human Services health workforce analysis for Maryland:

"There were 1,093 psychiatrists, 5,390 psychologists and 8,000 social workers in Maryland in 2000. This was equal to 21.3 psychiatrists, 101.5 psychologists, and 150.6 social workers per 100,000 population. Maryland ranked 5th among states in psychiatrists per capita (emphasis mine), 1st among states in psychologists per capita, and 31st among states in social workers per capita."
A search of the Maryland Psychiatric Society's directory will turn up 24 doctors under the category "public mental health system" but you'll get 192 if you search for "psychotherapy".

To add insult to injury, we can't even get public health service docs to work here because the Federal government has decided our need isn't great enough. To qualify for the loan repayment program psychiatrists have to work in a designated Health Professional Shortage Area (HPSA) with a need score of 19 or higher (on a scale of 0 to 100). The HPSA score is based on a convoluted algorithm involving poverty levels, demographic data and the number of mental health professionals in a given population. With a psychiatrist-to-resident ratio of 5000 to 1, Maryland doesn't even come close to the required 20,000 to 1 ratio needed to be a HPSA. There are no sites in Maryland with a need score this high. Correctional facilties get their own scoring system based on annual intakes and average length of stay, but again none of our facilities meet HPSA criteria even though we have longstanding open vacancies.

We're missing a few heroes. And they don't know what they're missing.