The president of the Yukon Medical Association says the number of Yukon psychiatrists has to double - from two to four - in order to handle all the needs in the territory.
For about the last five months, there has been no on-call psychiatrist covering Whitehorse General Hospital. For months before that, there was only one.
YMA president Dr. Alison O’Hearn said with only two psychiatrists in the territory, it’s too much to ask them to be available 24 hours a day while also running their own practices and covering all the other needs across the Yukon.
“It is a problem, we realize that, and we are trying very hard to recruit at least two more full-time physicians for psychiatry, and once we have that the hope is we will be able to provide 24-hour on-call services (again),” she said.
As things stand, two resident psychiatrists cover a territory of more than 30,000 people.
Between the two of them they work with the mental health branch, alcohol and drug services and the Department of Justice while also running their own practices.
Sometimes they split being on-call for patients at the hospital.
But Dr. Armando Heredia was the only one officially on-call starting in January until walking away in July.
The second doctor is on maternity leave and her replacement will see patients at the hospital, but is not officially on-call.
“I didn’t want to walk away from the hospital because there was a need. But at the same time it led to a lot of burnout and a lot of loss,” Heredia said.
The veteran doctor has been working in the territory for more than 13 years. He said attracting psychiatrists has always been a problem.
During his career he said he’s gone long stretches where’s he’s been the only psychiatrist in the territory.
The on-call psychiatrist helps at Whitehorse General Hospital’s secure medical unit. It’s run by doctors, social workers and specially-trained nurses and is meant for people struggling with psychiatric concerns who need short-term care.
More severe cases might start in Whitehorse but are medevaced Outside to forensic hospitals.
Being on-call involves going to the hospital every day for at least three or more hours to check in on the patients in the unit, Heredia said.
It also involves being available 24-hours to deal with emergencies or calls from hospital staff looking for advice.
Even when there are only two psychiatrists available, it’s a lot, O’Hearn said.
“If we only have two psychiatrists for the whole territory they’re all maxed out, booked up months in advance for referrals,” she said.
“Coming in for half of your day every day of the week, you’re halving the services in the community.”
This is not the first time there has been a gap where no psychiatrist was available to hospital staff, she said.
Instead of reaching out to a local psychiatrist for advice, Yukon doctors now call a B.C. phone number where a psychiatrist is on-call 24 hours a day.
“They can say these are the medications I would recommend or I would recommend sending the patient out,” O’Hearn said.
But Yukon patients no longer get face-to-face meetings with a psychiatrist at the hospital.
“If there’s not currently a psychiatrist on-call then the family doctor (working at the hospital) would look after them to the best of their ability in hospital, talk to the on-call person down south,” she said.
“If they’re really sick we’d send them out. If they’re not we’d keep them and discharge them and then we’d set them up with a meeting with a psychiatrist in the community.”
O’Hearn said the YMA is doing what it can to recruit new doctors, including psychiatrists. That means representatives are going to forums to talk to medical students and residents about coming to the Yukon, she said.
The Department of Health and Social Service says it is aware of the YMA’s concerns and is also trying to find solutions, spokesperson Pat Living said in an email.
“Based on the Canadian Psychiatric Association calculations, one psychiatrist per every 8,400 people is warranted. For 39,000 population then the number would be 4.6 psychiatrists,” Living said.
Outside of the hospital emergencies, the department offers visiting geriatric, pediatric and adolescent psychiatrists, she said.
There are also psychiatric services at mental health services and addictions services and the expansion of telepsychiatry.
Heredia said the Yukon needs a psychiatrist position working out of the hospital, not just on-call positions.
“You need people actually there during the day, and then you use your on call for overnight or weekends,” he said. “Just like they do for surgeries, just like they do for all the other specialties.”
There also needs to be adequate compensation from the Yukon Department of Health and Social Services for psychiatrists working at the hospital, he said.
According to Heredia, when the most recent contract was negotiated with the Department of Health and Social Services a few years ago, the way psychiatrists were paid changed.
It used to be a contract with a set rate, he said. But that was changed to a fee-for-service model.
The on-call fee “doesn’t cover the amount of time you spend at the hospital. The time you spend in the hospital is a lot more than the time you would spend in an out patient visit,” Heredia said. “Everything that goes to the hospital is an emergency, it’s when patients are gravely ill and need the most support and care. It’s the most time consuming.”
Heredia, who doesn’t have any other contracts with the Health Department, estimates he’s lost tens of thousands of dollars as a result of the change.
Heredia said after all these years he was left feeling burnt out and unsupported, but that doesn’t mean he has ruled out coming back if the department comes up with a better contract.
“If you can’t keep up, then people get angry at you. But nobody looks at (the fact) that you’re the only one. What they look at is that ‘I’m not getting the help I need.’”
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