More than 60% of America's practicing psychiatrists are 55 years of age or older, and likely to retire within the next decade. These specialists provide a significant portion of behavioral health services. So what does the future hold for both the behavioral health workforce and their patients? In this conversation, Dylan Panuska, PsyD, clinical psychologist and manager of behavioral health integration with Endeavor Health, showcases examples of how workforce productivity, retention and patient satisfaction are positively impacted by a key factor: integration.

Learn more about behavioral health integration at https://www.aha.org/center/emerging-issues/market-insights/behavioral-health-integration/behavioral-health-integration-treating-whole-person

Tom Haederle

The overall aging of America affects health care as much as any other field. For example, more than 60% of our currently practicing psychiatrists - who provide a significant portion of behavioral health services to patients - are over age 55 and are likely to retire within the next decade. So, how to recruit, train, and retain enough people to meet the future demand for behavioral health services in our nation?

Tom Haederle

Integration may hold the key.

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Rebecca Chickey, senior director of behavioral health services with AHA, we hear how the dismantling of the traditional silos between behavioral health and primary care practice benefit patient and provider alike. Her guest is Dylan Panuska, a clinical psychologist and manager of behavioral health integration with Endeavor Health in Illinois.

Tom Haederle

Dr. Panuska shares real world examples of how integration can increase workforce productivity, satisfaction, and retention for both primary care and behavioral health clinicians.

Rebecca Chickey

Dylan, thank you for being here today with us. To set the tone, can you please share just the workforce shortage realities in the behavioral health workforce? Maybe provide a couple of examples of what's going on in your own organizations. Challenges around recruitment, retention, worker satisfaction. Just give a sense to the audience of the realities that are going on in the field right now.

Dylan Panuska, PsyD

So health care is stressful, right? And takes a special set of characteristics in a person to be drawn to that field. And the workforce shortage is also really coming about from just - particularly in behavioral health - a huge increase in demand for behavioral health services, where, I mean, really, there's just simply not enough behavioral health professionals across the spectrum to meet the demand, particularly staying within traditional models of care.

Dylan Panuska, PsyD

Dylan Panuska, PsyD

And I think as an industry, it's really about looking at what are some different solutions and innovations that we can implement to better meet the demand for services, while also keeping retention and increasing recruitment of qualified practitioners.

Rebecca Chickey

And I think that's what we're here today to discuss. That is one of those solutions, not the sole solution by any means, but one of the solutions is the value of integrating physical and behavioral health care, and how that can help with workforce satisfaction, recruitment and retention. And I'll add another really just soul-settling statistic to the one that you shared.

Rebecca Chickey

And that is over 60% of our current psychiatrists, and admittedly, behavioral health work is done by a broad team of individuals in the field, whether it's psychologist, social workers, counselors, marriage and family therapists. So we're not just speaking about psychiatrists, but just in that one specialty area, 60% are age 55 or older. And while not everyone wants to retire at 65, a lot do.

Rebecca Chickey

So just looking out over the next decade, there could be a significant drop off in the current workforce. I know you've had some experience at Linden Oaks, which is now part of Endeavor Health, integrating physical and behavioral health. Can you share how you've seen it help improve worker satisfaction and retention of those workers?

Dylan Panuska, PsyD

So I had the distinct privilege and opportunity to grow our behavioral integration program over the last ten years with Linden Oaks and Endeavor Health. I was fortunate enough to be that original pilot person for it. So one of the areas that behavioral integration really helps with retention and recruitment is through each role, being able to practice within their scope and better supporting other disciplines.

Dylan Panuska, PsyD

I describe it this way often where, really the magic of behavioral health integration is the patient is able to receive both their behavioral health care and their primary care within the same setting. And when you have satisfied patients, you also have more engaged physicians, therapists, psychiatrists across the board. One of the other big areas that BHI, or behavioral health integration really helps with is it enhances the patient care team and system of care where you can work smarter, not harder.

Rebecca Chickey

So let me dig into that last point just a little bit. Working smarter, not harder. That seems to me that's a way to increase productivity. Not only can the behavioral health team be able to practice their full scope of practice to their full license, but they can be able to better support their other clinicians and health care workers that are working with the patient.

Rebecca Chickey

Is that what really helps productivity? Is it also maybe that satisfaction drives productivity? What's your opinion?

Dylan Panuska, PsyD

Another really important part of it is a lot of patients present in primary care with some component of either psychosocial stressor or behavioral health condition present. By having both of those disciplines in one place, it really keeps a busy clinic working efficiently while also providing high quality patient care. I have two examples just from the past month where patients present in primary care with some sort of behavioral health crisis or they're identified as having some degree of suicidal ideation.

Dylan Panuska, PsyD

And when you have behavioral health right on site to be able to come in for a warm handoff, help with the assessment and evaluation recommendation for next steps, that one helps reduce sort of emotional load or burden on the primary care physician and primary care team, helps make sure the patient is navigated to the most appropriate and safest level of care.

Dylan Panuska, PsyD

And you have the behavioral health expert right on site to help direct those pieces. It's a really fun role reversal, I guess is how I'll describe it, where that behavioral health professional is really helping navigate and guide that patient experience and safety of care.

Rebecca Chickey

So I don't want to put words in your mouth. Keep me honest here, Dylan. Please. But I think it's an interconnectedness that integration provides between meeting the patient's needs...having the clinicians whether they're the primary care clinician or the behavioral health clinician, be able to work together to meet those needs and not have that frustration of the physical health need isn't being met, or the mental health need or substance use disorder need for treatment isn't being met.

Rebecca Chickey

That it's that interconnectedness and the ability to treat the whole person that's a key factor in driving improve satisfaction and productivity because you feel better about the job you're doing.

Dylan Panuska, PsyD

Absolutely. And when we're able to have that like multi-disciplinary approach and easy access of communicating, you know, for primary care, that's what behavioral health and with behavioral health have, you know, of course, having greater access to the primary care physician in the primary care team, coordination ends up being just so much easier where historically health care has functioned in big silos.

Dylan Panuska, PsyD

And so it's been hard to, you know, for primary care to know what behavioral health doing and vice versa. And from a predictive standpoint, it can help reduce like duplicative work. And then also it's making sure that the correct role or person is helping a patient navigate one of their needs. So as a psychologist, I'm going to be much more tapped into not only the resources that are available to a patient from a behavioral health standpoint within our own behavioral health Linden Oaks and Denver Health System, but also what other resources and opportunities are available to the patient within the community and how to help get them connected.

Dylan Panuska, PsyD

The other thing that, I'll say a lot about behavioral health integration, particularly in busy primary care practice, is we give the gift of time. When there's a behavioral health component that can, you know, really take a lot more time to fully and adequately address. And primary care physicians and mid-level NP, PAs' schedules are overloaded. Back to that idea of, you know, workforce and not having enough primary care physicians either. When you have psychology or social work professional counselors on site, that warm handoff takes place.

Dylan Panuska, PsyD

So we sort of step in, and help navigate and manage behavioral health needs. And the primary care physician is able to move on and stay within the bounds of their schedule, also leading to happy physicians. So EPIC, our most common EMR, but they have a term they call "pajama time." So, it's time spent from health care providers outside of office hours in EPIC documenting, responding to in-baskets, things along those lines. When behavioral health is onsite and integrated it can help reduce that amount of pajama time or time spent outside of the office, not just from a pure time in-basket or documenting standpoint, but we all get into

Dylan Panuska, PsyD

this field because we're compassionate and trying to help people. And so the mental load of wanting to navigate somebody and not knowing how to do that weighs on people. And so now they have, immediate access to the team members that can really help offload or unload that burden that they've really historically have carried.

Rebecca Chickey

That's great. I think one of the things I would say is that the magic of integration. I'm loving this work, Dylan. I'm going to use it over and over. The magic of integration is to allow time for all of the individuals involved in the treatment of a patient to decompress. They may still have pajama time but it's not going to be spent on the EMR, so that's a good thing.

Rebecca Chickey

So just got a call from a primary care physician who's leading a small but mighty multi-specialty in primary care. I mean, so family medicine, internal medicine, etc. They're considering embracing integrated care to convince them to do so.

Dylan Panuska, PsyD

In my experience in growing behavioral health integration at Endeavor Health and Linden Oaks, where I've been mostly successful is in starting with the why we should integrate. And when you're able to start with why and have you know, solid, positive, patient stories to help support that, that's really where it starts to sell itself. At the beginning of it when we were looking for a pilot, it's like primary care is designed for, well, primary care.

Dylan Panuska, PsyD

What if we bring on these patients with behavioral health conditions to the practice and back to the why. It was, well, they're already there adding behavioral integration. The why to it is really to help better treat and improve the lives of patients through whole person care. And then one of the other things I'll say is behavioral health integration is hard.

Dylan Panuska, PsyD

But that's okay because hard things are hard. Or the other way I usually describe it is primary care was not designed with behavioral health in mind. So it requires somebody and a team of people to be very persistent and clearly communicating and engaging all of the stakeholders along the way. And one of the things that can be challenging in behavioral integration is really everybody has to be engaged and shift their idea of how both primary care and behavioral health meet the patient's needs, including the patient.

Dylan Panuska, PsyD

It is not a traditional model of behavioral health, and it is so much more than just a brief solution focused individual therapy. And what's really amazing is when you bring these two pieces together, it really ends up being more than the sum of its parts.

Rebecca Chickey

Integration is more than the sum of its parts. Integration improves outcomes. It's a magic that can give the gift of time. The gift of time goes to all of those involved in the treatment program, but to the patient as well, because when they're able to have more time to live a healthier, productive life, that is, as my father used to say, without your health, you have nothing. Having better health,

Rebecca Chickey

it's priceless. We can't put a price tag on that. So, Dylan, thank you so much for sharing your expertise and time with us here today. We're very grateful to you and to your team and, keep up the great work.

Dylan Panuska, PsyD

My pleasure. Thank you for having me and can't imagine practicing psychology any other way.

Tom Haederle

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