During a citizens advisory board meeting at the Cherokee Mental Health Institute on Friday, Dr. Daniel Gillette, the MHI clinical director and interim superintendent, informed those in attendance that Iowa is facing a severe shortage in psychiatrists.
"This is one of those slow motion train wrecks. The cars keep colliding and buckling while we watch," Gillette said.
According to Gillette, a recent university survey showed that there is a 29 percent vacancy for psychiatric positions that have been funded in the state. This is worse than any other state.
At least one of the reasons, according to Gillette is the "geographic modifier" used in the Medicare system that places Iowa at the bottom for compensation for services. This directly affects the compensation rate for Medicaid.
Gillette explained that Iowa is a victim of its honesty. Inflated costs were given by practitioners in most states in order to establish the geographic modifier.
"The places that did the most fibbing got the most and those that played by the rules got the least," Gillette said.
The geographic modifier affects other fields of medicine besides psychiatry, but it is one of the factors creating a critical shortage in psychiatry.
One of the advisory board members remarked that the low Medicare and Medicaid payments in Iowa has been a problem that both Iowa senators, Grassley and Harkin, have tried to resolve without success.
Two ways to make budgets for medical treatment go farther are the physicians assistants program and nurse practitioners program. Gillette explained that either of these medical practitioners cost about half as much as a doctor and can do about 90 percent of what a doctor does.
MHI has a P.A. program for those already certified as a P.A. who want to specialize in psychiatry. Three students can take the year-long program at a time.
The P.A. must work under the authority of a doctor but for many procedures, including prescribing most medications, can operate independently on a day to day basis.
The P.A. program at MHI was federally funded but is now funded through the state Department of Human Services.
Dr. Gillette said that Nurse Practitioner training in psychiatry has also occurred at MHI but that is dependent on a regular nursing program choosing to use the MHI for that purpose.