Begin With the End in Mind to End the Psychiatrist Shortage

One of Stephen Covey’s principles is to “begin with the end in mind.” The goal is to provide high quality mental health care to people. So we need to listen carefully to all the stakeholders including, first of all, our patients and their families. We should do that before we start talking about the barriers to the goal. What do they want (What Patients Want from Doctors: Quality Time, Laughs…Beer – The Practical Psychosomaticist)?

We could then reach into the past for some of the roots to our present problems with shortage of psychiatric beds and psychiatrists. One of them certainly is the closing of so many of our longer term, subacute psychiatric hospital beds, the deinstitutionalization movement beginning in the 1960s, Are We all Pulling Together? – The Practical Psychosomaticist.

The shortage of psychiatric beds and psychiatrists are barriers to the goal. The shortage of psychiatric beds in Iowa was a topic for discussion at a recent meeting of the Iowa Regents with University of Iowa Health Care leaders. There’s also a shortage of psychiatrists, see links and

One legislator is proposing giving newly minted psychiatrists income tax breaks, Income tax breaks may keep psychiatrists in state. Giving incentives to doctors to stay in Iowa makes sense. Removing disincentives also might be helpful, one of which would be getting rid of the Maintenance of Licensure (MOL) pilot projects, which are wasteful, duplicative, and costly:

Reflections on the MOC and MOL…and Excellence – The Practical Psychosomaticist

The latest information about MOL is that a licensee would “substantially” be in compliance if he or she is enrolled in Maintenance of Certification (MOC), itself a controversial process. Why bother making MOL a condition of medical licensure? Adding another layer of costly administrative, regulatory burdens is not likely to attract psychiatrists to Iowa. And reaching back again into the past leads us to one of the reasons for the MOC and MOL that some state medical boards and certification boards often point to: the high-profile disasters of our failures in delivering safe care to patients, The Bristol Inquiry: Heart of the MOC? – The Practical Psychosomaticist.

What are the real motives for offering income tax breaks, loan forgiveness, and mouse-clicking documentation for the regulatory capture machine? The motive is rooted in compassion. If empathy for our patients is not the main reason for all that we do in this enterprise, we should think hard.

Using a little imagination wouldn’t hurt. To that end, another way to help achieve the goal of bringing both high quality mental health and medical care to Iowans would be implementing an integrated care delivery system to the growing number of outlying clinics, such as the Iowa River Landing (IRL). This would be in line with the truism that preventive mental health care goes a long way toward promoting optimum outcomes for chronic physical health problems such as diabetes mellitus, Integrated Care – The Practical Psychosomaticist.

If we did all these things, could we write our troubles in the sand–and leave our legacy in the world?

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