When Susan Whitney was a doctor at Kaiser Permanente, her co-workers went missing in prison.
Whitney’s staff first provided mental health care in the region’s prisons before joining the state’s largest health care provider. Working conditions for doctors at Kaiser were so bad, Whitney said, that his colleagues wanted to go back.
“They can provide better care,” said Whitney, who will retire from Kaiser at the end of 2021. “It’s a better work environment.”
Kaiser mental health doctors are overloaded with patients and wait times between appointments can be six weeks or more, according to doctors who spoke to them. and Capital & Main. (Business conditions mean that doctors outside of Kaiser often see patients on a weekly or biweekly basis, although cases vary.)
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The California Department of Health Care (DMHC) is now launching a “non-standard investigation” to determine if Kaiser is offering quality health care.
When asked about his problems, Kaiser pointed to a nationwide shortage of doctors.
“The need for mental health in America has never been greater and at the same time it is more difficult to provide,” Kaiser representatives said in May. “Across the United States, mental health experts report that the need for mental health services has increased by 30% since the beginning of the epidemic.”
Kaiser said filling hundreds of vacancies in California is a priority.
“We recently launched a $500,000 initiative to find and hire physicians to fill more than 1,000 mental health vacancies at Kaiser Permanente, more than 400 of which are in California. ,” Yener Balan, Kaiser’s vice president of health and specialty services, told Capital & Topic in a comment March 29.
“The challenge we face is that all mental health professionals are drawn from the same, limited pool of talent.”
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Kaiser, whose mental health problems are well-documented, is expected to earn $8.1 billion in 2021, according to a company filing. In 2021, credit rating agency Fitch rated Kaiser bonds AA- for the company’s “good and sustainable earnings record.”
Susan Whitney states that Kaiser’s understaffing “is a combination of greed and the constant stigma of treating mental health the same as physical health.
“I don’t believe they’re going to deal with physical health issues the same way,” he said.
Caseloads reached into hundreds, some say
Emily Ryan, a licensed social worker, started working at Kaiser in Sacramento in 2005. On the same subject : Health officials Promote Identification of Potential Bacteria in Local Water. Her workload at Kaiser was “terrible,” she said.
“I can believe that there is a difficulty for them [hiring today], there is a lack of any kind of workers at the moment,” he said. “In 2005 it was not. In 2008, when we faced the economic crisis, it certainly wasn’t, and we are facing the exact same problems.
Dr. Mickey Fitzpatrick, who worked in the Bay Area city of Pleasanton, said he had hundreds of cases at Kaiser before going into private practice. “If even a group of those new people wanted to meet as often as suggested, I didn’t have the opportunity to see people for weeks to months at a time,” he said.
In rural Kern County, Kaiser employs 35 mental health workers to serve about 100,000 Kaiser members, according to data from the National Union of Healthcare Workers. There is no limit to the number of cases doctors can handle, and they face a constant onslaught of new patients.
“I have employees who were working while seriously ill, but they felt like if they canceled one day, their patients would have to wait another six to eight weeks,” said Whitney. “People are waking up in the middle of the night worrying about illnesses.”
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Exodus to more lucrative private practice?
American health plans limit access to mental health care to reduce costs, according to Richard G. Frank, a senior fellow at the Brookings Institution and four director of the USC-Brookings Schaeffer Initiative for Health Policy. On the same subject : Against “Public Health”. Other health care organizations have been accused of undermining their mental health by not hiring enough doctors – or not paying them enough. available for counseling sessions – prompting migration to cheaper private practice.
This is the plan, Frank said. Mentally ill people are more expensive than physically healthy people – not because the cost of care is higher, but because mentally ill people often come with more health care needs. physically.
A 2020 study by the consulting firm Milliman Inc. analyzed 21 million people with insurance and found that patients with behavioral health costs 3.5 times more than patients with no health needs.
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“Ever since mental health insurance began to be covered in the 60s and 70s, the motivation has been to avoid enrolling people with mental illness in your plan,” Frank said.
Over time, the same laws that mandate health plans to offer mental health care as well as their physical health care have greatly increased. On October 8, 2021, the Gov. Gavin Newsom SB 221, which would require mental health appointments to be rescheduled within 10 days of the previous session.
When asked about charges against Kaiser under the new law, the California Attorney General’s Office declined to comment, citing “a possibility or an ongoing investigation.”
Regulation and enforcement of health plans in California falls to the Department of Managed Health Care, which fined Kaiser $4 million in 2013 for overbooking its doctors. at. Kaiser and DMHC in 2017 after millions of dollars in fines and numerous injunctions against the company. The decision established a six-pronged plan to address mental health issues and forced Kaiser to hire a counselor to oversee the process.
After the decision, Kaiser created Connect 2 Care, a phone system, to shorten wait times for new psychiatric patients. Doctor consulted by Capital & Main said Kaiser created its centers to satisfy regulators, and Connect 2 Care has been criticized by the American Psychological Association.
In May 2022, the agency notified Kaiser of its investigation into mental health services.
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“We appreciate DMHC’s interest and responsiveness in understanding how we are working to provide exceptional care for those who rely on us for their mental health services,” wrote Kaiser in a statement.
“Kaiser Permanente meets California’s regulatory standards for initial appointments for mental health and wellness on average more than 90% of the time. We encourage physicians to document treatment recommendations, including all first and follow-up times, and increase any challenge in the organization to their manager, according to the policy.
Kaiser’s network of psychiatrists may be stronger than the numbers suggest. A 2021 lawsuit filed against Kaiser by the San Diego City Attorney’s Office alleges that more than 30% of the doctors listed on Kaiser’s list were not actually available to patients: Some contact information was listed incorrectly, some retired, some not in school. within Kaiser’s network, and some have not been tested at all.
“Kaiser’s books are so wrongly taught that they harm the health of their own customers, as well as their pocketbooks, while not being illegal. unfairly allowing the company to recruit more people to the detriment of its potential customers,” said the city of San Diego in his cry. .
San Diego also filed lawsuits against two other major companies, Molina Healthcare of California and Health Net, for maintaining inaccurate psychiatrists’ records.
Hundreds have left in recent years
Data from the National Union of Healthcare Workers, which represents Kaiser therapists, found that physicians leaving Kaiser in increasing numbers over the past three years: in June 2019 to November 2020, 469 physicians left Kaiser, with annual attrition rates of 8% each. year in Northern California and 5% per year in Southern California. This may interest you : How Queer Chefs Reclaim bottom line food. From December 2020 to May 2022, 850 lawyers left Kaiser, and the average annual turnover was more than 12% in Northern California and 10% in Southern California.
Kaiser doctors and experts at Capital & Main working conditions are blamed for the exodus of doctors from the company. Former Kaiser physician Mickey Fitzpatrick will beat his old hourly rate, he said, to $73.73 in April 2021, after 10 years in the plan. In the Bay Area, therapists often charge $250 or more for 50-minute sessions.
“My graduates want to go to Kaiser for work, and they do,” said Dr. Gilbert Newman, vice president for academic affairs at the Wright Institute, a private school for psychology in California. “They often leave Kaiser because they don’t like the work they do. They don’t like being told you can’t see enough people to help them.”
Kaiser therapists can get into trouble with their managers when they recommend clients for regular check-ups. In November of 2021, marriage and family therapist Tanya Veluz was called into a meeting with three of her managers after she advised patients to return. Managers reviewed a list of those customers, questioning their need for care.
“They dealt with each case,” Veluz said, “and for a couple who were really high in distress they said, ‘It’s fair, we understand why you want more support for this. case.”Every other case they challenged my medical judgments. . To … the questionnaire does not indicate the level of suffering you are requesting.”
The authorities also questioned his estimates for the length of treatment of his patients, Veluz said. Patients, Veluz felt, needed sessions for two to six months.
Veluz said his manager told him it was impossible to know how long the patient would need treatment. Veluz disagreed, citing his extensive clinical experience as well as “lots of research” to support his findings. He said that one manager threatened his license.
When asked about the incident, Kaiser representatives did not directly comment. On July 19, the company said it is on a “multi-year journey to improve the way mental health is delivered in America today” and is expanding his special care and placement of mental health professionals in medical settings. The company has “increased procedures to support our doctors when they are unable to schedule a follow-up appointment” and a “professional hotline.”
Ken Harlander, a marriage and family therapist, trained at Kaiser’s Bakersfield clinic with Susan Whitney, and went into private practice last year. Harlander avoided delays between appointments at Kaiser by booking returning patients to areas reserved for new patients, where he was called to the “principal’s office,” he said. .
“That’s what happens when you try to push back,” he said. “When you ask, ‘Why are we selling a product that we can’t deliver?’ you don’t get answers.”
Richard G. Frank agrees that post-epidemic demand strengthens Kaiser’s argument, but says that the reluctance of insurance plans to compete with private practices is the real reason behind the shortage. lawyer.
“I think there’s a grain of truth there, but I think it’s exaggerated,” he said. “What health plans often say is that they can’t hire all the people they want to hire at the current rate. That’s not the same as saying, ‘Hey, there’s no chance.'”
But for Ken Harlander, it wasn’t the pay that drove him into private practice — the company’s best benefits were made for low hourly wages. Harlander said he left because Kaiser was overbooked and was preventing him from doing his job properly.
“It’s great not having to work there anymore,” he said. “I practice good medicine.”
Because of its benefits, Kaiser always attracts applicants, according to Harlander. “More people work at Kaiser than the county or Medi-Cal work,” he said. “They can open positions and hire people to leave if they want. Nor should they change their salary structure. If they say we’re hiring five doctors, they’ll have five candidates right now.”
