Dr. Michael Washinksy, a private psychiatrist in Durango, can’t book new patients for appointments until mid-February.
The wait time is indicative of the regional and national shortage of psychiatrists, driven, in part, by a lack of residency positions for those studying the field, he said.
The shortage is more severe in rural areas, and his patients will drive from Alamosa, Cuba, New Mexico, and Utah for appointments, he said.
It is a problem health care providers in Durango are solving by offering appointments through secure live-stream video conferencing, a form of telehealth.
Mercy Family Medicine, Axis Health System and Pediatric Partners of the Southwest are among those providing appointments with psychiatrists via video.
Mercy Family Medicine, a primary care clinic, is the most recent to start offering the services. In October, the clinic started providing four telepsychiatry appointments a week for its existing adult patients, said Flow Wolf, the clinic’s manager of behavioral health. Mercy Family Medicine serves about 17,000 patients between its Horse Gulch medical campus and Mercy Regional Medical Center.
“This is our response to the dire shortage of psychiatry services available in Durango,” she said.
The new telehealth service at Mercy Family Medicine is not meant to take the place of ongoing psychiatric care, but it will provide an opportunity for the clinic’s adult patients to get diagnosed or receive medication recommendations, she said.
Mercy Family Medicine staff will refer patients for an appointment with Dr. Shaun Daidone, the medical director of the Integrated Behavioral Health Program for the Centura Health Physicians Group, she said.
Daidone will likely see patients only once via an iPad at either one of the clinic’s offices. But it is possible he might see them for a follow-up appointment, if he thinks it is necessary, she said.
The psychiatrist will also help determine if patients need to receive psychiatric care in town because they have more complex needs, she said. For example, a patient with schizophrenia or another complex diagnosis would need ongoing care.
As a behavioral health consultant with the practice, Wolf connects Mercy Family Medicine patients with ongoing psychiatric care, a task that has been challenging, she said.
In Durango, there are about six private psychiatrists, and some are part-time or accept new patients only occasionally, Wolf said. Washinsky is the only private provider accepting Medicare, a public insurance benefit for those older than 65, she said.
Care for older patients is critical because they can struggle with depression, anxiety and dementia issues as well as loss and grief, she said. But it’s tough for psychiatrists to provide care for older patients because of the administrative requirements, Washinsky said.
Axis Health System also serves Medicaid and Medicare psychiatric patients. After an initial assessment with a mental health clinician, the wait time for routine psychiatric care or medication management at Axis is four to six weeks, said Stephanie Allred, senior clinical director at Axis Health System.
To help fill the demand for psychiatric care, primary care doctors at Mercy Family Medicine will treat common mental conditions such as depression, anxiety and dementia, Wolf said. Behavioral health consultants, including Wolf, can also provide counseling and guidance to patients.
Both the primary care doctors and consultants will also regularly review patient cases with the new telehealth psychiatrist for advice, she said.
The telehealth service is part of a corporate initiative through Centura Health Physicians Group, and it is being introduced at about 10 other clinics, mostly in Denver, she said.
Washinsky said he is happy to see more telehealth care options becoming available in the community.
However, there are limitations to the service, that he noticed while providing psychiatric care via a live-stream for the Department of Veterans Affairs, he said.
Psychiatrists depend heavily on their patients to tell their own stories and additional observations can help supplement what the patient is saying, he said.
When communicating via live-stream video, the psychiatrist can’t determine the general feeling in the room or smell a patient, which can help determine an individual’s functionality, he said.
“Someone may tell you they are showering every day, but your nose tells you different,” he said.
Even as the region works to meet current mental health needs, it is likely that as the population ages, the need for mental health services will increase as more residents need dementia care, he said.