PORTLAND – Dr. Joan Leitzer, a Portland-based psychiatrist, has been “retiring for months.”
“I am doing it the old-fashioned way,” she said, and is working to get each of the approximately 60 patients in her practice transferred to a new provider before she retires.
But psychiatrists, psychiatric nurse practitioners and other mental and behavioral health counselors are in short supply in Maine, a state with an aging population and an aging workforce. And there aren’t enough younger people entering the profession to balance it out.
“This is a real nightmare for the community,” said Dr. Jeff Barkin, a practicing psychiatrist and the former president of Tri-County Mental Health Services based in Lewiston. A psychiatrist is a medical doctor who specializes in mental health and is licensed to prescribe medication.
Though primary care physicians can prescribe psychiatric medications, they do not have the same specialized training as psychiatrists, so people with more complicated mental health needs generally benefit more from treatment by psychiatrists, Barkin said.
Adding to the short supply, the field does not have enough funding to boost services and to offer incentives to recruit new hires, which became more dire following former Gov. Paul LePage’s cuts to Medicaid, or MaineCare, in 2014.
“It’s hard work and it’s not as well paying, so I think that folks don’t necessarily make community behavioral health” a focus in their careers, said Catherine Ryder, Tri-County’s chief executive officer. “If you come here, it’s because you’re mission-driven and got a fire in your belly.”
That makes it nearly impossible for nonprofit, community-based organizations such as Tri-County to compete with large hospital networks or other medical fields that pay competitive wages.
“We have had postings up for years inviting people to interview with us,” Ryder said.
From 2015 to 2020, the number of licensed psychiatrists practicing in Maine decreased by nearly half, according to data from the U.S. Bureau of Labor Statistics. As of May 2020, there were 110 psychiatrists in Maine.
Tri-County Mental Health Services, for example, has more than 3,000 clients in Androscoggin, Franklin and Oxford counties as well as others statewide, and is just one of many community health organizations, hospital clinics and private practices serving clients with mental health needs.
This has left an “acute need” for services in Maine that has been made even more acute by the mental health impact of the pandemic to the general population and the financial hit it caused to a number of clinics and psychiatry departments, which had to either temporarily or permanently shut their doors, Barkin said.
Christina Reed, 30, knows that “acute need” personally. Her primary care physician put her on a waiting list to see a therapist over nine months ago.
She was working a minimum wage job at a day care at the time and couldn’t afford to see a psychiatrist out of her insurance network, so her primary care physician was treating her complex post-traumatic stress disorder as she waited to get off the list.
“I was not in good shape,” Reed said. “It was really hard for me to just understand what was going on with me and just trying to get by, really just the day-by-day to maintain relationships and maintaining a job.”
Reed’s saving grace was the landscape business she started last year: She was gardening at Barkin’s house one day when his wife came out to chat. Reed’s doctor had put her on a new medication and she wasn’t feeling well, so Barkin’s wife asked him to talk with Reed.
“Basically, he connected me with Tri-County services and within three weeks, I had a therapist,” said Reed, who began working as Barkin’s administrative assistant at his Portland office a few weeks ago.
“Without being able to see my therapist, I mean, I most likely wouldn’t have a job. I probably would not still be living in my apartment,” she said. “Honestly, I just, I really don’t know where I would have been if I didn’t meet Jeff.”
Reed said her chance encounter with Barkin “was the best thing that ever happened to me.” She still hasn’t gotten a call back about the waiting list her primary care physician put her on.
Reed may be one of the luckier ones, though, because she was actually able to see someone.
“We really have a crisis in our state,” Leitzer said. “The bottom line is there are too few clinicians, period, and there are too few of those who accept insurance,” which is of note for Maine, which has the oldest population in the country.
The U.S. Centers for Medicare and Medicaid Services reported in 2020 that 347,452 Mainers were enrolled in the federal health insurance program for people 65 years and older and those with certain disabilities.
As of May 3 of this year, 77,838 people were enrolled in MaineCare, the state’s free or low-cost health insurance program for low-income households or individuals with disabilities or other factors.
Leitzer, the Portland psychiatrist, still doesn’t have a set date for when she’ll actually get to retire. She hopes that by this fall each of her patients will have found a new provider. But until then, she’ll keep making calls.
Story by Emily Bader, Sun Journal