Fellow Physician Leaders: Wtf is going on with recruitment/retention?

[DD214_DOC]

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

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[calvnandhobbs68]

Just happened upon this as you wrote this but yeah I might offer a few opinions:

1) I agree that anecdotally a lot of older doctors are just hanging it up right now. Across all specialities. Stock market was ripping the last 10 years so peoples 401ks were fat, COVID everywhere, systems putting more strain on physicians, dealing with ridiculous patient behavior/COVID deniers, etc. Even doctors who weren’t really planning on retiring, this pushed them over that edge.

2) I think you have a lot of people in psychiatry these days who don’t want to work a whole 5 days a week. Just from people I know, barely anyone does a full 5 days a week of patient contact time, it’s more like somewhere from 3-4.5 days (including myself). That’s kind of the appeal of psychiatry for a lot of us. So jobs that are going to require you to be on site 5 full days a week are annoying to that population. Some might call it lazy but I think in psychiatry in particular we see there’s more to life than work.

3) telepsych is absolutely another factor. I also know fellows who went to do 100% tele because they needed flexibility in terms of where to move or easier for them to take care of kids.

4) Individual/small group private practice is still relatively very easy to do for psychotherapists and psychiatrists. There are now a lot of resources online coaching people through how to do this including big Facebook groups about setting up practices, doing taxes, setting up LLCs, etc. So especially if the income difference isn’t huge, more people may be inclined to go do their own private practice or contract out to places.

 

[Celexa]

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

You're asking the wrong question, and in the asking showing the problem. Why aren't you asking the young physicians you're trying to recruit? There's plenty of us here.

You don't say if you're academic or not, which does matter. I can best speak to the academic exodus and lack of interest in junior faculty positions by my year mates (one lousy month left as a resident!) and our near-peers.

In my current department, they always depended on the name of our instituion being payment. Payment certainly wasn't in money or even schedules and flexibility. There were a few inpatient positions where residents do 90% of the work, so they held some appeal too. Only....

The dept leadership actively doesn't give a **** about clinician safety or the quality of patient care. They don't understand it and don't care to. They don't care to try and reduce the rising rates of violent incidents and the dept is poorer than it needs to be bc they don't have skilled admin staff. So no one wants to be here. No surprises there.

They also won't bend on the things that would make people stay. There are still plenty of people who want to stay connected to academics and teach. You want us to stay? Throw out your noncompete clauses. Let us work 40-60% FTE in academics, pay us what we're worth, let us have private practices on the side and still have benefits. And understand our work environments and care about our safety. If you're in academia you'll have people interested then. Maybe not forever, but at least for several years. If you can't change your terms of employment to be more desirable, you're in a losing game from the start.

 

[Bartelby]

A few thoughts as someone who has held a leadership role during the pandemic and as someone who has burned out during the pandemic:

1. The more people leave, the more people leave.

When members of the team start leaving, you start thinking about all the reasons you have considered going. You miss the team you worked with, and you see many of them landing places they are happy with. Things that you have put up with for years grate more on you. At the same time, you have to pick up the slack from all of these unfilled positions. When you do finally fill a position, you have to train the person (not so bad, but still extra work). And you often see leadership treating it not like some emergency to fill open positions, but rather taking their sweet time (not offering incentives etc) knowing that the people who remain will cover the extra work so that patients don't end up harmed on their watch. And if you do get temporary workers detailed to your team, you again have to deal with someone who doesn't know the system and the work. All of that grinds on you, and you start thinking about greener pastures.

2. Childcare is a nightmare right now, and has been for quite a while.

Daycare closes for a week or two at a time with COVID exposures. Daycare shortens its hours. Schools do distance learning. Schools refuse to take your kid when they have a sniffle. Your kid gets COVID, and everyone is out yet again. Schools and daycares are understaffed, and you sweat out when and how the next random closure will happen. Sure, you can hire some random backup care person to take care of your kids for days or weeks on end (if the kid isn't sick, most backup care people will not touch that right now). But are you really happy leaving your kid with a rotating series of random people who happen to be free? And many of us have teams that will bend over backward to accommodate things like having to be late by an hour Every Single Day because our daycare has limited hours again, but even so as physicians we have all been taught to show up and excel. It isn't easy knowing you are making things harder on your team with repeated absences and scheduling limitations. So you start thinking you should go for something more flexible, more part-time.

3. Telehealth is king.

Everyone is looking for telehealth roles right now. If you are offering something else, the above problems compound. And as sweet as telehealth is in many ways, it doesn't foster the same close team relationships (at least in my experience). Interactions via repeated zoom meetings just feel more generic, there is less spontaneous and genuine social engagement at work.

4. We all had a chance to re-evaluate priorities.

As already mentioned, many people have realized they want more personal time. I think part of this is a caused by burnout from the above, but part of it is realizing after shaking up a decades-long routine just how much we were working and what we were missing (as hard as it is to be out with kids over and over, you start to realize how little you were out with the kids before!). I think many of us are looking for more flexibility and personal time, at least for a while.

5. Retirements

Others already said it, but yes, many very senior people left right at the start of the pandemic. Understandably they didn't want to get COVID and didn't want to deal with the mess of working in / running programs through the pandemic. I think that added a great deal of strain on an already difficult situation, as many of the people who left were highly experienced and outstanding people.


Overall I think a lot has contributed. This post is more of a vent for me too. It's been a tough couple of years!

 

[Fan_of_Meehl]

Ask the people who left why they left.

Listen.

There is typically a massive gulf between MH 'leadership/admin' and the providers in the trenches. What many have experienced is a trenchant denial of reality on the part of leaders along with a tendency to 'blame the provider' for any and all problems with the system or care implementation. I have no idea if that's a problem where you work, but it just might be.

 

[hallowmann]

I don't have much to add to the very good posts above, but I do really want to emphasize how in demand we are right now and how out of touch a lot of employers seem to be. I can easily find a job making >$300k working 3-4 days a week where most of that telepsych. If I wanted to sell my soul I could make much more. I'm OK with a pay cut if it means I'm working how I want to for a population or institution I value or even a group of physicians whom I trust and respect, but I'm not going to give up money for less autonomy in both schedule and practice and longer hours. It doesn't make sense.

If you're finding it hard to attract people, then I would look for ways to either increase pay, increase schedule/work flexibility, or increase autonomy.

 

[erg923]

Again, probably not applicable to the OP's issues/concerns specifically, but here are some of the minimum requirements for a state government position for a "psychologist" in my state. I mean even homicide detectives have a rotating call schedule...

In my experience, varied schedule means "our flexibility, not yours." And the 24 hour call thing is just outrageously ridiculous and out of touch with what people will do for the very typical psychologist salary schedule here.

OTHER MINIMUM REQUIREMENTS
Must not have been convicted of a felony
Misdemeanor convictions will be considered on an individual basis
Must submit to a pre-employment drug screening
Must submit to a pre-employment polygraph test
Must provide one's own source of transportation
Must work a varied schedule
Must possess and maintain a valid driver's license
Must be on 24 hour call
Must have a valid license to practice psychology issued by the State of XXXX Board of Psychology of the Board of Medical Quality Assurance, or obtain within six months

 

[calvnandhobbs68]

The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

Also I forgot to address this. Gotta get over yourself with this “extremely obnoxious” thing. You mean people bailing after signing an offer or bailing after a verbal offer? Unless there’s a contract signed, there’s no deal. We don’t have any misgivings over how quick employers would dump us if they wanted to. This is a business. Unless you’re getting people who are like “alright see you Monday when I start” and then never show up.

 

[Ironspy]

Also, when do you disclose salary? In my experience it’s often done during the verbal offer and there’s pressure to give an answer on the spot. As an applicant, you can go through the whole process only to find out they want to pay you in jellybeans. Listing the salary up front avoids wasting everyone’s time

 

[nexus73]

We’ve got doctors retiring, or leaving for jobs with no overnight call obligation. We’ve interviewed 6 psychiatrists for one inpatient job the last 18 months and all have gone elsewhere. Reimbursement for psychiatry pales compared to what other specialties generate for the hospital so psychiatry is more of a cost center than revenue generator.

Little to no interest from hospital administration in expanding services or making the job a place people want to stay.

Instead constant battles over patient load (we should see more) and no pay for holding the phone on call (we don’t pay for call) and complaints we don’t see consults even though we do and only push back in the unnecessary ones where we can’t contribute to the patients care.

Oh, and we don’t see ED boarders soon enough, can’t you assign someone to come in at 7am to see the patients from overnight?? Will you pay that person extra to do a job nobody wants…. No? Okay then no we’ll see them at 9 or 10 or 11am to get them admitted.

How do you sell a candidate on a job where you’re constantly getting pushed to make the job less and less enjoyable with no pay increase in several years?

How can admin demand 16 patients a day for an inpatient doctor when they can’t fill the locums job for 18 months? You start demanding more work from these doctors and they’ll leave, then you’ll be eating more locums costs. It’s a complete disconnect from reality. Oh, the major metro area inpatient units 5 hours away see 16 per day? Well they have plenty of docs to take those jobs…and we don’t.. and the docs here want to see 8-12 per day. Don’t know what to tell you. —>next meeting, why aren’t you guys seeing more patients??

 

[Candidate2017]

A better title for this thread would be, "Why can't I get fools to work for me in terrible jobs with terrible pay, terrible hours, terrible conditions, terrible care, terrible support, terrible expectations, terribly abusive patients, while getting these fools to shoulder 100% of the liability (including accepting liability for a bunch of noctors) and taking 50% of their professional billings, while treating them as employees rather than autonomous professionals who are licensed to practice medicine?"

I challenge you to come down into the trenches. Spend 1 year working as an employed psychiatrist for any large system. And you will get your answers.

Though, I suspect you are a lot more aware than you let on, and 100% know why psychiatrists shun working for you. As an exec, look in the mirror. The problem and solution are looking you in the face. But, it's always easier to rant and blame physicians and their "obnoxious", inconvenient behavior.

 

[adiradirim]

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

Post the details about the job. That'll help us explain to you why nobody wants it.

 

[painballer27]

I can easily find a job making >$300k working 3-4 days a week where most of that telepsych. If I wanted to sell my soul I could make much more.

Really? What geographic area? Also what do you mean by sell your soul?

 

[Fan_of_Meehl]

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

I think this is a subset of the much larger problem of physicians (and other healthcare workers) finding themselves embedded in a system that seeks to strip them of autonomy/authority while simultaneously maximizing their levels of responsibility (for ***EVERYTHING*** negative that happens or is the result of flaws in the systems within which they practice). This trend of minimizing authority while simultaneously maximizing responsibility of providers in healthcare systems has been going on for many years and I think it is finally causing these systems to experience a 'breaking point.' Out of curiosity, I just Googled 'physicians leaving medicine' and it appears that this is a widespread problem in healthcare though--as yet--largely unacknowledged by the larger forces at play (insurance companies, government organizations, etc.) that truly determine what happens in the field. Due to increased ability (esp. within psychiatry) to provide telehealth services in the wake of COVID, that 'light bulb above the head' moment apparently has occurred for a lot of folks who realize that they don't necessarily have to be slaves anymore to systems/people who don't respect them or treat them well but--rather--hold them responsible for everything while denying them any professional agency or authority. They are behaving rationally. It will be interesting (and scary) to see what happens to healthcare delivery systems over the next decade or so because the trends that I have observed over the past couple of decades in the field of mental health (and, by extension, medicine) simply cannot continue. Something HAS to be done about the explosion of non-provider positions (esp. in government hospital systems) that create bullsh** busybody 'good-idea-fairy' do-nothing positions that do nothing but complicate and frustrate the work of providers who actually see patients. Doctors are not factory workers. Administrators are not gods. HR and PR employees are not high priests and priestesses. Much of the current system in place is founded upon such a delusional perspective and the cracks are starting to open up in the edifice and become canyons. Buckle up.

 

[hallowmann]

Really? What geographic area? Also what do you mean by sell your soul?

West for sure. Can do it in other regions with some looking. Selling soul means handing out benzos and stims like candy and/or commanding an army of midlevels, at which point I've seen people easily hit the $500+k range.

 

[smalltownpsych]

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

Maybe the applicant pool is not as impressive as in the past because the smart people aren’t applying to be a cog in a huge and typically broken system. It is relatively easy in our field to cut out the middlemen and work directly with the patients. All I need is a couple chairs in an office and I’m good to go. With an online portal for my clients to schedule and pay, I don’t even need front office staff. Now if I could just get someone to remember to water the plants.

 

[comp1]

This is not specific to MDs or healthcare. The same issues driving no recruitment in retail and the restaurant business are driving the lack of MDs. The labor market is dry. If anything, we are slightly better off because we can transition to near fully telework unlike fast food and can at least look further afield.

 

[Fan_of_Meehl]

This is not specific to MDs or healthcare. The same issues driving no recruitment in retail and the restaurant business are driving the lack of MDs. The labor market is dry. If anything, we are slightly better off because we can transition to near fully telework unlike fast food and can at least look further afield.

There are definitely broader trends afoot.

However, the concept of a 'dry' labor market with respect to MD's, healthcare, or mental healthcare is intriguing to me.

There certainly is no shortage of NEED for labor in the area of healthcare or mental health services.

 

[deleted1100659]

When I was looking for jobs, there were some days I would get >30 recruiter phone calls/voicemails a day in addition to mass amount email. When I would see these jobs that were "240k a year, call 4x a month, supervise 10 midlevels. etc, must be board certified!)". Just so out of touch. I worked my ass off in residency I don't think its wrong to want a good quality of life. There are a million jobs out there, and probably 50% of them have major strings attached. Admin will happily screw you over half the time, and when you raise concerns you get told stuff like "deal with it". I was told to "deal with it" at this job when i brought up the concern about the wave of benzo/stimulant rxs coming to me. So I did deal with it, I found a different job; and the current job has extreme difficulty hiring new providers, so I wish this lesson could be applied to all admins out there. Treat your employees with respect.

I don't expect to bow down to me or anything crazy, but it needs to be known that this market does not favor you. It favors us. Life is too short for any of us psychiatrists to put up with being used/abused. And we don't have to take it. Im not saying this directly applies to you, im saying in general, what my experience has been.

1. Is your city a nice city to live?
2, Is the money highly competitive compared to others in the area/state you live in?
3. Does the staff feel heard/respected?
4. How much liability are you giving your providers? Put yourself in their shoes and think about what their job is, and make sure you understand their role.

These are 4 things that have to always be kept in mind if you want to retain staff.

 

[dl2dp2]

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

You have to ask for a bigger budget for salary. I'm of the opinion that basically every recruiting problem can be solved if you are willing to invest in a higher salary.

Of course, that's what Amazon and Apple are doing.

You need to step up and do the same. The end.

 

[erg923]

You have to ask for a bigger budget for salary. I'm of the opinion that basically every recruiting problem can be solved if you are willing to invest in a higher salary.

Of course, that's what Amazon and Apple are doing.

You need to step up and do the same. The end.

I have my own theories about what is happening but in the last 3 years in two different senior and executive-level leadership positions, recruitment and retention has been abysmal. I'm sure others out there are also experiencing this and I'm interested in your thoughts and what may have been successful for you to mitigate this.

One continuing trend since the pandemic began is the, "seasoned", cohort of not only psychiatrists but other disciplines within BH/MH who were eligible for retirement changing their plans and deciding to go ahead and do it. There was a mass exodus in the first year of the pandemic but this is ongoing at a lower rate; it's the biggest source of staff loss for me.

Hiring actions receive a significantly lower number of applicants compared to pre-pandemic numbers and even within the first year of the pandemic. The pool of those who do apply isn't as impressive as in the past and withdrawing after accepting a tentative offer is a regular occurrence -- it's also extremely obnoxious. It's common enough at this point that I factor this into my hiring decisions and require subordinate supervisors to name at least one alternate from their interviews.

This is also in a system (federal government) that for years has been the, "holy grail", of employment; LCSW's are paid an absurd amount of money in this system (my supervisory LCSW makes over $100k/yr) and I'm certain that's the only reason enough of them are applying to positions to warrant interviews. They are still declining or withdrawing after initially accepting despite this.

I realize the job market has changed substantially in the last 2-3 years and most employers, mine included, are not evolving and adapting to maintain a competitive advantage in a market where demand is increasingly exceeding supply.

Competing with 100% remote telepsych opportunities is absolutely another factor. A third that nobody seems to be talking much about, though, is my impression that BH/MH providers are just burned out both from patient care and the toll the pandemic has taken on their work and personal lives. Many seem to just be, "done", and leaving clinical work entirely.

The problem is that all of the above is increasing pressure on the staff I do have to start looking elsewhere. Everyone wants to know the grand plan to fix the situation but I'm transparent with them and basically say given the circumstances, there isn't much of a plan -- unless I figure out how to clone people.

More venting than anything I guess but I am curious what others are seeing and experiencing.

Agree.. Please rid yourself of the notion that people taking the best offer for them and their family is to be "obnoxious" (they don't owe you anything) and is somehow "wrong" and that as an apparent physician leader, you don't have "a plan" (why not, that's your job!) and/or will not seemingly invest in vigorous root cause analysis and business problem solving with YOUR leaders to address the problem? Both these things probably need to change... yesterday. Your "theories" are just that. Theories. You should be gathering actual (people) data from your direct reports to support your theories. Your role is to be a leader AND a "thought leader" in the field of mental health services, not just a "hiring manager" right? At least, I would assume???

Also, have to agree with the notion that PP is King in psychiatry. I don't do much direct clinical work at all anymore, and if I did, would only do it myself. This is of course beyond your control, but I think it is something that needs to be taken into consideration here. The reasons behind it are reasonable and should be apparent, but it also probably says alot about how MH practitioners feel about the current state of large MH systems and hospitals, the work, and how they are being treated?

 

[Kokonaut]

I think this trend is reverberating throughout mental health in general. I work in a community mental health agency and moonlight in the ED on the weekends (LCSW); however, the company that I've worked for has been tone-deaf about ED coverage. Volumes are up, patients are more difficult to deal with, resources are stretched thin, and we're now expected to cover more patients (including doing telepsych assessments) for multiple sites with stagnant or even decreasing pay. It used to be a pretty great job on the side, but lately much less so. For every person who has to leave, that's another shift that needs to get covered by people who already don't feel like picking up any extra shifts. That has led to what appears to be a chain reaction as people keep leaving for greener pastures whereas staffing becomes ever more paltry.

If I had waited a bit longer to get hired at the community mental health agency, I would have even gotten a pretty little sign-on bonus (which seems quite rare pre-COVID for my profession).

 

[SeniorWrangler]

You're asking the wrong question, and in the asking showing the problem. Why aren't you asking the young physicians you're trying to recruit? There's plenty of us here.

You don't say if you're academic or not, which does matter. I can best speak to the academic exodus and lack of interest in junior faculty positions by my year mates (one lousy month left as a resident!) and our near-peers.

In my current department, they always depended on the name of our instituion being payment. Payment certainly wasn't in money or even schedules and flexibility. There were a few inpatient positions where residents do 90% of the work, so they held some appeal too. Only....

The dept leadership actively doesn't give a **** about clinician safety or the quality of patient care. They don't understand it and don't care to. They don't care to try and reduce the rising rates of violent incidents and the dept is poorer than it needs to be bc they don't have skilled admin staff. So no one wants to be here. No surprises there.

They also won't bend on the things that would make people stay. There are still plenty of people who want to stay connected to academics and teach. You want us to stay? Throw out your noncompete clauses. Let us work 40-60% FTE in academics, pay us what we're worth, let us have private practices on the side and still have benefits. And understand our work environments and care about our safety. If you're in academia you'll have people interested then. Maybe not forever, but at least for several years. If you can't change your terms of employment to be more desirable, you're in a losing game from the start.

I’m wondering if you’re a resident at my old institution. The physician leadership there were mostly Baby Boomers who were grandfathered out of the restrictions they put on all the less senior faculty, and they let the non-physician management do whatever they wanted. They had no interest in or awareness of what it’s like for junior or even mid-career faculty, the only alternatives were to find a comfortable niche or GTFO.

 

[Sushirolls]

I think this is a subset of the much larger problem of physicians (and other healthcare workers) finding themselves embedded in a system that seeks to strip them of autonomy/authority while simultaneously maximizing their levels of responsibility (for ***EVERYTHING*** negative that happens or is the result of flaws in the systems within which they practice). This trend of minimizing authority while simultaneously maximizing responsibility of providers in healthcare systems has been going on for many years and I think it is finally causing these systems to experience a 'breaking point.' Out of curiosity, I just Googled 'physicians leaving medicine' and it appears that this is a widespread problem in healthcare though--as yet--largely unacknowledged by the larger forces at play (insurance companies, government organizations, etc.) that truly determine what happens in the field. Due to increased ability (esp. within psychiatry) to provide telehealth services in the wake of COVID, that 'light bulb above the head' moment apparently has occurred for a lot of folks who realize that they don't necessarily have to be slaves anymore to systems/people who don't respect them or treat them well but--rather--hold them responsible for everything while denying them any professional agency or authority. They are behaving rationally. It will be interesting (and scary) to see what happens to healthcare delivery systems over the next decade or so because the trends that I have observed over the past couple of decades in the field of mental health (and, by extension, medicine) simply cannot continue. Something HAS to be done about the explosion of non-provider positions (esp. in government hospital systems) that create bullsh** busybody 'good-idea-fairy' do-nothing positions that do nothing but complicate and frustrate the work of providers who actually see patients. Doctors are not factory workers. Administrators are not gods. HR and PR employees are not high priests and priestesses. Much of the current system in place is founded upon such a delusional perspective and the cracks are starting to open up in the edifice and become canyons. Buckle up.

So this ^^^

And then we have this, which Big Box Shops are prone to generate, which furthers "PP is King"


Oh, and this:


Then we also deal with this:

 

[Fan_of_Meehl]

So this ^^^

And then we have this, which Big Box Shops are prone to generate, which furthers "PP is King"


Oh, and this:


Then we also deal with this:

Doc Vader, "Mini Vader! I have you now!!!"

 

[Alemo]

What the fu…

So many questions. Why is he German? Why is the Star Wars theme being played on a harpsichord? Why does he keep saying “buttocks”? Why is he familiar with using a mini voodoo doll? Really ruins the familiarity you need to have to find these funny.

I guess it’s still funny.

 

[Celexa]

I’m wondering if you’re a resident at my old institution. The physician leadership there were mostly Baby Boomers who were grandfathered out of the restrictions they put on all the less senior faculty, and they let the non-physician management do whatever they wanted. They had no interest in or awareness of what it’s like for junior or even mid-career faculty, the only alternatives were to find a comfortable niche or GTFO.

Sadly I'm sure it's a dynamic recapitulated in many academic depts. I suspect I'm not in the same one, though, if only bc the senior faculty actually ARE under the same restrictions as the junior faculty, or were at that point in their careers. That they've moved past it isn't as much a matter of grandfathering out as just building your academic niche. But without the inertia of having spent over a decade here already, there's basically no reason to stay. Particularly not in a metro where high end cash only private practice is thriving.