Having trained in and worked in integrated care for almost two decades, I will add the following as the largest issues:
Currently most of my present work is in the setting you worked in.
1. Business operations having no idea what you do or how to appropriately measure your "productivity".
Yep, just slapping "points" or "percentages" on productivity with no real underpinning for it. Additionally even if well intentioned, a lot of just not really understanding the settings or the work and middle/upper management of both facilities and the companies that third party employ providers suddenly dropping "exciting new changes" that aren't based in the reality of the work. Or they implement a change or policy because the facility "complains" to the providing company about something and instead of thinking clinically they knee jerk a protective stance and then there's more miscommunication and hoops to jump through. Or middle managers sitting at home looking at spreadsheets and asking why aren't providers busier "there's so many patients to see!" without considering logistics or patient need.
2. Lack of reimbursement for collaborative care meetings means these are good ideas that get short-changed for "billable" services. Even in salaried positions, RVUs are the main measure of performance.
Yep. Especially if you opt for fees for service vs salaried. And even the salaried folks often find their productivity and days get impacted the more they spend on trying to collaborate.
3. Poor morale/communication from overworked primary care and medical providers. PCPs have so many other things to be doing, worrying about a patient's feelings are not always on the priority list. This can translate to a lack or referrals or many poor referrals due to lack of time for proper screening.
True, I've met quite a few of them who either dump referrals "everyone needs psych" or just prescribe medications or send them to ER if they even mention they're depressed, then pikachu face ask "where was psych?!"
4. Patient dumping - the belief that difficult patients all need psych follow-up. Some people are just a pain.
On the daily. And while most of these providers and nurses are well intentioned, they really don't have the training or understanding to really know what a valid psych referral reason might be. Or they just don't want to deal with the patient and can check off in the chart, "referred." Or the circle of referring patients to psychiatry or another department then having them referred back because "it's emotional." I've been surprised how, some medical doctors and many psych nurses or psychiatrists really have a lack of foundational understanding of mental health.
5. Poor pay - private practice simply offers better reimbursement for less training. As hospital staff for many years that trained interns and post-docs, I can't tell you both the happiness and the sting of seeing first year grads that I taught in private practice pull down more than me with less headaches.
Pay can be good or bad depending on the company and the boundaries one sets.
6. Lack of stability in many hospital systems - This is a higher level issue.
Private equity comes in and disrupts with negative results for patients and staff.
I'll add mis-using depression and symptom screeners and facilities "boosting" numbers to access more money and profits and having non-clinical or non-medical staff trying to dictate who must be seen or who shouldn't be seen. Midlevels in management positions ordering around providers based on nothing but their "feeling" of what is "best." And of course overall lack of knowledge or understanding from other disciplines about what constitutes a mental health crisis or versus normal thoughts and emotions in a crappy situation and environment. Or not understanding nuances such as "patient reports they wish they wouldn't wake up, patient is suicidal" then you see patient and they're 98 years old talking about how they've lived a good life and feel it's their time and that god will take them when they're ready. Which is of course different than SI.
