In response to the worldwide and nationwide shortage of psychiatrists, Santa Barbara County’s Department of Behavioral Wellness is increasingly relying on temporary psychiatrists. Currently, 4.5 of the county’s psychiatrists are full-time civil service employees and 13 are temporary employees. Three years ago, Behavioral Wellness had 7.5 permanent psychiatrists on its payroll. The temp workers sign up for a minimum of three-month shifts. Six-month stints are preferable, said Ole Behrendsten, head of Outpatient Services for Behavioral Wellness, and a year is ideal.
The county pays up to $240 an hour for temporary psychiatric services; that works out to slightly more than the $400,000 a year full-time shrinks are paid (with wages, benefits, and insurance — none of which are available to temp psychiatrists). Three years ago, the county spent $2.7 million for temporary psychiatrists; the year after that, $4.3 million; and this year, the number is closer to $5 million. Patient advocates have expressed concern that discontinuity of treatment caused problems for Behavioral Wellness clients. Behrendsten acknowledged discontinuity issues were “a real concern,” adding, “Patients don’t want to have to tell their stories over again.” He said the problem was less an issue now than it was two years ago because some temporary psychiatrists have been working for the county two to three years. Patient advocates objected that multiple psychiatrists sometimes lead to multiple diagnoses and abrupt changes in psychotropic drugs prescribed. Behrendsten said the shortage of psychiatrists is a worldwide phenomenon reflecting the relatively low pay psychiatrists receive compared to other medical professionals.