I have been feeling bad lately. Let me explain.
I work as a supervisor in a mental health program. I manage other clinicians, nurses, and psychiatrist who serve people with severe mental illness. It is a stressful job by itself and involves a lot of therapy, case management, medical follow up, consultation, traveling, etc. It is a job that not anybody can withstand or even consider taking, because it is not a typical mental health facility. The program is based on the PACT model (Programs of Assertive Community Treatment) and it involves intensive psychiatric and rehabilitation services , similar to what clients receive in psychiatric hospitals, but in the community. So you can imagine the amount or work and tension that we often experience in trying to help individuals with paranoia, delusions, disorganized thinking, and poor social skills remain living in their homes. Even though I may be describing it as a difficult job, it is very self rewarding. We are actually helping people stay away from institutions and jails simply because of the severity of their illness. We are helping them live normal lives like the rest of us.
But I recently started feeling really bad about my job because of the way the company sometimes treats our staff. They are not usually paid the salary that other facilities and hospitals in the community pay their clinical staff, plus they started hiring more bachelor levels so that the cost of hiring people would be less. So the competition has been an uphill battle which results in a high turn over rate.
Since I started working for this PACT program in 2011, we have had two full time doctors, and recently two part times. The two part time psychiatrists shared the case load of a total of 101 clients. The last two psychiatrists were working under a contract instead of being regular employees. But unfortunately , one of the two part time doctors decided to move out of the state for a better paying job (its usually because of the money) and we found ourselves planning to have one part time doctor cover while starting to recruit for another doctor to take over the other half of the caseload. The situation became more complicated when the company advertised the position and found a candidate who was willing to work full time instead, as a regular employee. Having a full time practitioner is what the PACT model is based on primarily and it facilitates the overall function of the program. So needless to say, the company had to make the difficult decision to “get rid of the part time psychiatrist” so that we can officially hire the new full time practitioner (who happens to be an ARNP who can do the same type of job as a psychiatrist). Of course, letting the remaining part time psychiatrist know was the hard pill to swallow. Not to mention informing the clients (once again) that their psychiatrist was resigning and they were going to be seen by a different practitioner. Our clients who all suffer from a severe and persistent mental illness, are already marked by difficult times in their lives, and change is one of the most difficult experience which can exacerbate their symptoms.
The CEO of the company is the one who negotiates with psychiatrists and makes the final decisions about which psychiatrist to hire. My supervisor and I interviewed the new candidate and we liked her, but the CEO was the one making the decision about moving forward with her, meaning that the part time psychiatrist who was still working with us had to go. Part of me said we were doing the wrong thing… that we should’ve looked for a another part time psychiatrist so that we wouldn’t have to lose the one we already had. I was informed that the CEO would then speak with the part time psychiatrist about our plans, which I was glad I did not have to do, although I wished we could have done something different so that we can keep the part time psychiatrist. But that was not my decision to make.
To make matters worse, last week, the part time psychiatrist approached me and asked me about what the company was planning to do with her if they find a full time practitioner. I was dumbfounded and caught off guard, not knowing what to say at the moment. I thought that the CEO had spoken with her about his decision already, but it turned out he had not informed her yet. So I had to tell her the truth at that moment, I don’t believe in lying or hiding things from people, especially staff people who work with me. But I also told her that the CEO should be speaking with her about the matter in more details soon. So, understandably, the part time psychiatrist seemed upset and said she will just resign.
I felt as big as an ant.
Here we are, literally getting rid of a part time person, a human being with a family to feed and a career to keep, so that we can replace her with a full time person who will take her place to “serve our clients.” The company has a budget to keep, so having one full time psychiatrist was more financially convenient. I understand the technicality and the business part of the reason why we need to make this decision. But the human side of the matter sucks.
So I feel bad. I feel we made a mistake. I wish I could have done something different and prevent having to get rid of the part time psychiatrist. I wish the CEO would have contacted the part time psychiatrist early and offer her to stay with maybe less hours, but still stay working with us along with the full time ARNP.
But it is too late now. She decided to suddenly resign , sooner than what the contract mandates. I can understand her anger and frustration. I also understand the need to have a full time practitioner who also has more flexibility with traveling and visiting our clients.
So I am split in half, feeling glad that we found a full time practitioner soon; but still feeling bad that we lost a very good psychiatrist and made her upset in the process.
At the end of the day, the ones suffering the most are our clients, who will have to face another change of providers. And most likely run the risk of increasing their symptoms of mental illness because of this transition they are forced to face.
It’s hard being a supervisor sometimes.