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Health Services Department recommending the Board approve advanced step placement of a licensed Psychiatrist at Step 5 of the salary range for this position, plus addition of advertised signing bonus; if approved, the candidate is available to begin working in a part-time capacity effective pay period 19.
FUNDING: Medi-Cal, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), Mental Health Realignment, and Mental Health Services Act (MHSA) funding.
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Fiscal Impact/Change to Net County Cost: There is no Net County Cost associated with this placement.
The salary range for the Psychiatrist classification extends from $70.63/hour at Step 1 to $85.85/hour at Step 5. With a Step 5 placement, the proposed part-time (20 hours per week) position will result in a salary cost of $89,284 per year, or $3,434 per pay period. Due to the Department's inability to fill its two (2) vacant Psychiatrist allocations, recent recruitments were approved to be advertised with a signing bonus up to $6,000, to be paid in equal installments each pay period over the first year of employment. This signing bonus would add compensation of $230.77 per pay period during the first year. Therefore, the annual salary cost (at Step 5), with this signing bonus, would be $95,284, or $3,665 per pay period for this proposed part-time position. The resulting fully burdened per minute billing rate (at Step 5, plus signing bonus, with applicable indirect and overhead charges) would still remain under the State Maximum Allowable rate of $4.82 per minute for Medi-Cal billable psychiatry/medication services. Due to significant salary savings being experienced in the Mental Health Division's budget as a result of position vacancies, there are more than enough appropriations to cover this proposed part-time position at Step 5 placement, with signing bonus. Offsetting revenue/reimbursement is available through a combination of Medi-Cal/EPSDT, Realignment, and MHSA funding.
Background: The Mental Health Division presently has two (2) vacant full time Psychiatrist allocations. The Division has been working closely with Human Resources and has been actively engaged in recruiting Psychiatry applicants since early 2009. Even with significant advertising, these recruitment efforts have produced limited numbers of applicants. To date, job offers have been made to qualified candidates, but they have not been accepted, with salary being referenced as a primary reason.
As a result of these unsuccessful recruitment efforts, Human Resources recently conducted a psychiatry salary survey, comparing the County of El Dorado with thirteen other similar-sized counties. Results of that salary survey indicated that to be in the range of these comparator counties, El Dorado would need to increase the salary range for the Psychiatrist classification by at least 16%; however, even with that increase, the County's range for Psychiatrist would remain below the going pay rate for Psychiatrists in other organizations (e.g., private psychiatric hospitals, correctional facilities, etc.). In addition, during a site review of the Mental Health Division that was conducted in April 2010 by a State-contracted External Quality Review Organization (EQRO), it was noted that “The MHP [referencing the County of El Dorado Mental Health Plan] has worked to improve all aspects of its psychiatric coverage, including recruitment, retention, supervision and scheduling. The MHP has also arranged to provide a signing bonus. Despite these efforts two psychiatrist positions remain vacant. The most effective element would be to raise psychiatry pay to a level competitive with the regional market.”
Note that any increase in psychiatry pay applied to the Psychiatrist job class would also need to be applied to the Mental Health Medical Director and Psychiatric Clinician classifications in order to maintain reasonable salary classification relationships within the psychiatry series. Rather than considering this option at this time, the Health Services Department is recommending that the Board approve an advanced Step 5 placement, and signing bonus, for a current candidate who is willing to accept a position under these conditions. The current candidate is a licensed, board-eligible Psychiatrist, who also has specialized training/credentials enabling him to provide child and adolescent psychiatry services.
Reason for Recommendation: Approval of the recommendation to hire the candidate at a Step 5 placement, with a $6K signing bonus, would provide much-needed adult psychiatric services, as well as services in the highly specialized area of child psychiatry.
Action to be taken following Board approval:
Health Services Department to hire candidate with Step 5 placement and $6K signing bonus.
Contact: Kathy Lang