Many young psychiatrists enter the field wanting to open their own practice and do outpatient work, Dr. Weinstein said. Hospital work often involves treating higher acuity patients.
“Hospital-based work is harder. It doesn’t necessarily pay more. You’re looking for some very special people willing to work in hospital systems, and it’s a challenge to find them,” he said.
Houston Methodist is adding a residency for psychiatric nurse practitioners, hoping to train more behavioral providers interested in inpatient care. The first resident will begin training this fall, Dr. Weinstein said.
There can be a lack of hands-on experience in degree programs for psychiatric nurse practitioners, Dr. Weinstein said, something Houston Methodist is working to address.
“What we found from our attempts in hiring some psychiatric nurse practitioners is they’re not ready to start immediately after finishing training. They’re not ready for independent practice,” he said. “So we’ve got a residency program that is really very similar to what medical residents and psychiatric residents go through. It’s really an apprenticeship.”
Houston Methodist is one of the only hospitals in Houston maintaining an inpatient psychiatric unit, Dr. Weinstein said. The health system is taking a “two-prong” strategy to behavioral health — improving inpatient care for patients with medical and behavioral needs, and improving outpatient services.
Reimbursement is a long-standing challenge in behavioral health, one reason why not every hospital wades into psychiatric care.
More reimbursement for psychiatric care would go a long way, Dr. Weinstein said, but hospitals can also play a role in reducing costs.
“It’s incumbent on healthcare systems to try to provide a tiered system of access so that patients get the level of care they need and they don’t always get the most expensive care,” he said.
Houston Methodist is using a collaborative care model, embedding behavioral health professionals in primary care, Dr. Weinstien said.
“If you have programs like collaborative care, you hopefully will start reaching people before things get out of control, before they’re so severe that they’re no longer working, before our patients are unable to take care of their families,” he said. “Treating people in the community is much less expensive, keeps people well, keeps them out of the hospital. Ultimately that is much better for everyone.”
