The Hippo


Jun 27, 2019








Positions (mostly) filled
Despite nationwide shortages, state mental hospital is staffed up

By Ryan Lessard

 New Hampshire Hospital’s clinical staffing is now stable, according to Dartmouth’s head of psychiatry, despite a contract kerfuffle this summer, an exodus of about a dozen clinical staff last year and a national shortage of psychiatrists.

The shortage  
New Hampshire Hospital is a state-run mental hospital, but its psychiatric clinicians are staffed by Dartmouth-Hitchcock. Earlier this month, Dartmouth and the state settled a contract dispute over its staffing of New Hampshire Hospital, the inpatient psychiatric institute in Concord. At issue was whether Dartmouth had the required 11 general psychiatrists on staff, plus a geriatric psychiatrist, and whether it had reported its numbers accurately to the state. The hospital was short by two psychiatrists. 
The most recent available staffing report from the state dated July 31 shows there are 10.8 full-time equivalent general psychiatrists out of 11 and a geriatric psychiatrist.
In May, Gov. Chris Sununu fired the CEO of the hospital over the issue. Dartmouth rejoined at the time saying it had reported the numbers accurately and that the state was making it “impossible” to fulfill staffing levels because of statements from the governor and other state officials suggesting Dartmouth was untrustworthy.
Dr. Alan Green, the head of the psychiatry department at Dartmouth’s Geisel School of Medicine, said the psychiatry field has changed a lot over the past couple decades.
“Many of the psychiatrists … are older and retiring and I think there’s been a problem that there hasn’t been development of enough new psychiatrists over the last 20 years,” Green said. “So there’s, at this point, a national shortage of psychiatrists.”
According to a 2015 report by Merritt Hawkins, only about 6,000 new psychiatrists will graduate from medical school over the next four years, while about 12,500 current psychiatrists will retire over that period.
Making the shortage even more sharply felt is heightened demand for psychiatric services. Green said that the demand has risen especially in the past five years commensurate to the public’s recognition that people with mental disorders aren’t getting adequate care across the country. More than ever before, psychiatrists are working collaboratively with primary care offices, he said.
“And that’s put an even further strain on … psychiatrists. There simply aren’t enough of them,” Green said.
He said that difficulty is certainly felt here. At New Hampshire Hospital, they’ve been able to fill the posts they need to fill for now, but when someone gets promoted internally, there will probably be a longer lag time to fill that vacated position, Green said.
Last year, Cheshire Medical Center/Dartmouth-Hitchcock Keene closed its psychiatric wing because it couldn’t recruit enough psychiatrists. But New Hampshire Hospital has some things Cheshire didn’t have, which may have helped with recruitment.
Finding new recruits
Green said one of the biggest advantages New Hampshire Hospital has is its connection with the medical school. They will often hire fresh grads, and most of the psychiatrists who have worked there trained at Dartmouth, he said. Plus, the mental hospital is a popular training site for residents.
“That’s made it possible for us to recruit really top-notch people, psychiatrists, advance practice nurses and others, to work at what is really a wonderful hospital,” Green said.
Talented psychiatrists are often looking for a place that’s a center of learning and research, and New Hampshire Hospital often fits the bill because of its association with the medical school, Green said.
Lisa Mistler, a psychiatrist at the mental hospital and the president of the New Hampshire Psychiatric Society, agrees the affiliation with the school was key when the mental health hospital was trying to find the clinical staff it needed to become stable. She said the success it had at hiring psychiatrists was “remarkable” considering the nationwide shortage.
Part of that success was due to Dartmouth stepping up its recruitment efforts.
At it’s peak, it had a recruiting task force of about half a dozen people working to find the clinical staff the mental hospital needed to meet the requirements of the contract. Dartmouth, with the help of an outside firm, did outreach to thousands of psychiatrists and advanced practice psychiatric nurses through mailers and cold calling and events, according to Dartmouth recruiter Kyle Hayman. Then the recruiters set up over 100 initial interviews with candidates for New Hampshire Hospital. Hayman said that was significantly more than previous years and Dartmouth spent upward of $100,000 in the past year’s recruitment efforts.
“We have a very active recruitment system,” Green said. “We basically scour the national network.” 
Currently, Hayman said, the hospital still has four clinical positions to fill for a geriatric psychiatrist, an addiction psychiatrist and two general adult psychiatrists. 

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