August 26, 2019
Hutchings PC professionals face increasing caseloads, fear impact on quality of care
BY KATE MOSTACCIO
PEF members providing care to vulnerable patients at the state Office of Mental Health’s Hutchings Psychiatric Center in Syracuse fear growing caseloads, coupled with no additional staff, will have a negative impact on the quality of patient care they’re able to provide.
“We care for a very high acuity population of people, in terms of need for services,” said PEF member Dr. Spencer Brown, a children and youth psychiatrist 2 at Hutchings. “We’ve had one or more agencies cut down on intakes in the area, and a few entities ‘shut down’ entirely. Other than the welcome addition of two nurse practitioners, this clinic has had no influx of staff to accommodate our growing patient load — from about 200 to about 450 — in the past seven to eight years. And there appears to be no plan to limit the size of this clinic.”
Brown has been with Hutchings for almost three years, but has been in the field of psychiatry for nearly 25.
“It is not clear if the decisions being made that impact our ability to provide care are clinically sound or based on the needs of the patients we serve. Recent directives from Albany suggest that at least part of their solutions for dealing with the increasing numbers of patients is to cut back on the face-to-face time that we have with our patients, and to increase all providers’ caseloads. Therapists and prescribers won’t be able to do what they need to do to be as effective in terms of helping their patients,” Brown said.
PEF Executive Board member Gina Corona, a licensed master social worker 2 at Hutchings, said the patients there are those who truly need the additional care. “Many of our patients have been recommended to come to our clinic because of their high level of need,” she said. “It’s easy to say, ‘You will see more patients.’ But doctors should be able to dictate how long they feel they need to see a patient.”
Having come from other facilities, Brown knows the situation at Hutchings is far from unique. “This clinic could be even better if the resources were there,” he said. Brown said he’s been told that the budget is set by the state, and that in order to get more funding for any good or service, something else must be given up. He likened it to deciding which you wanted your children to have — electricity or meals on the table. “Neither one is a good choice.”
For Brown, the work is too important to compare to a fast food restaurant — with regard to “how many billions served.” “If we do our jobs right, the kid that we are seeing and helping out today will be far less likely to be on the other end of a gun holding someone up down the road,” he said. “If we intervene early, we can really help make big differences toward the options a person sees in her or his future.”
Corona met with the National Association of Social Workers recently and learned an enlightening statistic about caseloads. “For the patients we see, somewhere in the neighborhood of 35 to 45 should be the max,” she said. “Our staff carry between 60 and 75.
“Our patients and their families have multiple complexities,” she said. “They are struggling and that’s probably why we are so different than the private sector. Comparing us to the private sector is just ludicrous. We are doing very different work.”
Brown said he suspects that someone in Albany is making decisions on how many patients should be seen, based on some business model (a formula or grid), but this doesn’t take into consideration the complexity of the individuals — including whether they are children or adults, new versus established.
“We are really trying to meet the patients’ needs,” he said. “But we need time to listen, time to assess, and time to formulate sound treatment plans with them. Decreasing our time with our patients and their families will chip away at our ability to provide them the best possible care.”
Outgrowing the facility
Caseloads aren’t the only issue of concern at Hutchings.
Hutchings welcomes fellows from SUNY Upstate’s Psychiatry program — but this year it has been a struggle to find adequate and appropriate office space for the four participants. There have been instances when practitioners have needed to see patients in a conference room, Brown said.
“We’ve outgrown our space,” Brown said. “We’ve been scrambling for offices in our clinic. We can’t even provide a diaper changing area for our parents who must bring younger siblings to appointments. Some parents end up laying a blanket down on our waiting room floor out of desperation. It feels like we’re trying to do something with nothing.”
A blow to staff morale
All the changes and the problems are disheartening.
“When I started in this field, there was still an emphasis on the ‘art of medicine,’” Brown said. “Now it seems like it’s just the ‘business’ of medicine. It’s not satisfying to be providing this kind of care.”
“It’s scary,” Corona said. “I’m the mom of a child with special needs and as a mom, if my son’s treatment was directed by someone not qualified to deliver the service, I wouldn’t be happy. As a parent and a provider, I want to know that we are delivering the best care.”
She has heard from a number of staff that they are looking to vacate their positions. “They aren’t satisfied,” she said. “We really do recruit the best of the best here,” she said. “I’m concerned for the future. We all do this type of work because we care about people who need our help.”
Brown said he doesn’t think there is any intent to harm here. “I don’t think anyone is doing this on purpose,” he said. “I think we need to look at what we’re doing and what can we do to make it better. I understand they have a budget. We’re not feeling that we’re really collaborating to get the best for the patients and get the best outcomes in general.”
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