Title
Health and Human Services and Human Resources recommending the Board consider the following:
1) Approve revisions to the Psychiatrist class specification creating a Psychiatrist I and Psychiatrist II alternately staffed classification.
2) Approve the new salary for Psychiatrist I/II classification.
3) Approve the bargaining unit designation change from El Dorado County Employees Association (Local 1) to Unrepresented Management.
4) Approve a per diem, hourly Psychiatrist classification at a higher hourly rate than the full time Psychiatrist classification; and
5) Adopt Resolution 175-2013 effecting these modifications.
FUNDING: Funded primarily by MediCal, Mental Health Services Act (MHSA), Realignment.
Body
Fiscal Impact/Change to Net County Cost:
Approval of this recommendation will not result in a budget impact or change to Net County Cost. Costs for two psychiatry positions are already included in the Agency's budget, and if recruitments are successful, will result in an actual reduction in costs due to savings as a result of fewer contract psychiatrists.
Background:
All Medi-Cal eligible individuals are entitled to receive medically necessary mental health services through the county mental health program. These services include both in-patient and out-patient services and psychiatric care.
In 2011, the Board approved a salary increase for the classification of Psychiatrist to $16,578 (top step monthly). Despite extensive recruitment efforts, no qualified candidates were identified to fill the County's vacancies. As a result, the position has gone unfilled which has inhibited the County from being able to provide the level of service that meets the department's expectations.
Since 2011, Human Resources has conducted two separate, continuous recruitments. The first recruitment was opened for 328 days (5/10/11-4/2/12) and resulted in eight (8) applications received; four (4) applicants met the minimum qualifications and were referred to the Health and Human Services Agency (Agency); however no one was selected. The second recruitment opened on April 3, 2012 and as of September 10, 2013 (525 days), 33 applications have been received; five (5) applicants met the minimum qualifications and were referred to the Agency. One individual was hired on July 9, 2012, however, on January 25, 2013 that individual resigned from the position to accept a job with the State Department of Corrections and Rehabilitation at Folsom Prison at a much higher rate of pay.
A current salary survey of our comparable Counties revealed that of the three (3) that hire Psychiatrists as full time employees (Amador, Placer, and Yolo), our salary is lower than all but one; Yolo County. Yolo County does not have a Psychiatric Health Facility, therefore, no on-call or call back is required of those individuals. Even so, the Yolo County representatives stated they have been unable to identify, recruit, and/or retain Psychiatrists as full time employees. As a result, they are exploring other avenues including contracting for services, recruiting for the position with assistance of a Professional Recruiter, and Locum Tenens. Our other comparable counties (Nevada, Sacramento, Sutter, and Yuba) contract these services; Sacramento, through UC Davis; and Nevada, Sutter and Yuba utilize separate employee contracts with individual Psychiatrists. In all of these cases, the cost is considerably more per hour than the County pays its full time Psychiatrist.
Since there is limited availability for Psychiatrists, Human Resources expanded the comparable employer pool to include the State of California due to our proximity to Folsom State Prison and the loss of our last incumbent to that agency. It was found that, due to a 2006 Federal Court Order which raised the salaries for Psychiatrists, the current top step for the classification of Staff Psychiatrists working for Folsom State prison is $23,496 per month. While salaries vary, Staff Psychiatrists working in State Mental Health Facilities make approximately $22,833 per month. This is $6,918 and $6,255 more per year, respectively, than the County currently pays for the Psychiatrists classification for similar work.
The passage of recent laws (The Mental Health Parity and Addiction Act and the Affordable Care Act) increased access to Mental Health services for clients seeking affordable care. While this is good news for patients seeking affordable care, the increased number of clientele will only create an even greater challenge to Counties to recruit and retain qualified Psychiatrists and other mental health professionals due to increased demand and a limited supply of Psychiatrists.
AGENCY |
CLASSIFICATION |
Top Step/hrly |
Top Step/mon |
# FTE |
#FILLED |
Amador |
Psychiatrist |
$109.69 |
$19,013 |
1 |
1 |
Placer |
Psychiatrist |
$114.86 |
$19,909 |
5 |
1 |
Yolo |
Psychiatrist |
$91.86 |
$15,922 |
3.5 |
3.5 |
Nevada¹ |
Psychiatrist |
$150.00 |
$26,000 |
1 |
3.0 (PT) |
Sacramento |
Psychiatrist |
$140.00 |
$24,267 |
N/A |
3.5 (all) |
Sutter² |
Psychaitrist |
$123.00 |
$21,320 |
N/A |
5.0 FT/3.0 PT |
Yuba³ |
N/A |
|
$ - |
|
|
CA Corr/Rehab |
Psychiatrist |
$135.55 |
$23,496 |
3 |
All Filled |
|
|
|
|
|
|
EDC⁴ |
Psychiatrist |
$95.64 |
$16,578 |
|
|
|
|
|
|
|
|
|
|
|
|
|
EDC DIFF |
|
|
|
MEAN/hrly |
$123.57 |
-23% |
¹ Majority paid at this hourly rate
² Highest rate paid. Covers both Sutter and Yuba Counties
³ Psychiatrist services provided by Yuba/Sutter Mental Health in Sutter County
⁴ Represents current salary
Reason for Recommendation:
All data suggests that the salary for Psychiatrist should be increased in order for El Dorado County to compete with other agencies to recruit and retain qualified candidates. It is recommended that the salary for the classification of Psychiatrist II be increased to $21,798 per month (Step 5). While this results in an increase of $5,220 per month, it should be noted that because of the inability to fill the position, the County has been forced to contract for Psychiatrist services in order to ensure mandated service levels. The downside to contracting this service is the lack of continuity of care for individual patients. Based on the client population and their needs, this can have devastating results.
In FY 2012/2013 El Dorado County received a total of 2,439 hours of contract psychiatry services (the equivalent of 1.17 FTE) at a total cost of approximately $562,000 which included a 10% administrative fee relative to handling the contracts, reviewing invoices, billing, etc. If the Board of Supervisors elects to adopt the recommended salary rate, the County would be able to afford 2 full time Psychiatrists for the same cost as the contracted services while vastly improving the overall service delivery to patients.
By creating an alternately staffed classification (Psychiatrist I and Psychiatrist II), it will provide HHSA with the flexibility to hire a Psychiatrist who has graduated from an accredited medical school and completion of a psychiatric residency, as well as eligible to be certified by the Medical Board of California. The Psychiatrist II classification will apply to individuals who have been certified by the Medical Board of California.
In addition, create a per diem, hourly Psychiatrist classification at a higher hourly rate since benefits will not be provided. We anticipate this will increase the availability of psychiatric services at a more cost effective rate than a full time psychiatrist with benefits.
Action to be taken following Board approval:
Human Resources staff will update the salary schedule and continuous job posting.
Contact:
Pamela Knorr, Director of Human Resources
Concurrences:
HHSA, Human Resources, EDCEA Local #1