Nine of Utah's 10 highest state salaries, outside academia, are earned by psychiatrists at the Utah State Hospital for the mentally ill.
Those figures between $273,000 and $480,000 in salary and benefits surprise some mental health consumers, who would like to see more money routed to other public mental health services, particularly the hospital's lower level staff who they believe works more frequently with residents.
And Rep. John Dougall, R-American Fork has previously raised questions about compensation of medical staff at the hospital. "Whenever I see a number that large that's being funded with taxpayer dollars it causes me concern," he said. "It causes one to say 'Is that really a necessary expense'?"
But experts and studies suggest the salaries are in line with those nationally. And with the spreading shortage of psychiatrists, the state could be forced to pay even more if the hospital lost doctors and had difficulty recruiting.
Whether Utah has an actual deficit of psychiatrists is a matter of debate, but experts agree mental health professionals are in high demand. Directors of publicly funded institutions such as the hospital and University Neuropsychiatric Institute (UNI) say they have lost psychiatrists to the U.S. Department of Veterans Affairs in Utah and Intermountain Healthcare because of higher salaries.
Utah's growing population and the prevalence of such common disorders as depression is exacerbating the need for mental health experts.
The problem seems to be growing nationally: The National Resident Matching Program, which tracks medical school graduates' residency acceptance, says fewer U.S. students graduating from medical school chose to specialize in psychiatry over the past several years. Though large metropolitan areas such as Chicago and New York have an adequate supply of psychiatrists, less populated areas are particularly in need, said Sidney Weissman, professor of clinical psychiatry at Northwestern University.
"The ability of our society to deliver mental health care to rural areas is significantly impaired," he said.
In Montana, one wing of a new mental health facility for veterans was unable to take patients for about a year because it could not fill three psychiatrist positions. Though staff is now being hired, veterans had to travel all over the country including Utah to get help.
Time with patients • The American Psychiatric Association suggests that school loan debt may be playing a role in students' decision to seek more lucrative careers. For the first time, UNI turned to a head hunter this year as it worked to fill several psychiatric jobs.
"It's not uncommon to see people with $200,000 debt coming out of [medical] residency," said Ross VanVranken, the institute's executive director.
For those who do choose psychiatry as a career, some private sector jobs can pay significantly higher. A 2011 survey of psychiatrists nationally found that more than half made between $175,000 and $300,000 excluding benefits.
In fact, a 2011 Utah public employee salary survey found that state employees in the medical field make about 10 percent less than those in the private sector. Yet benefits are very good: state employees contribute about 10 percent of health care benefit costs where private industry employees typically pay between 15 and 29 percent, the analysis found.
Higher private sector pay isn't the only factor. Working at a state hospital means caring for severely ill patients who may be unresponsive to treatment. Improvement can take years. And staff have a higher risk of being assaulted.
"If you hire people for low wages and get them to come and they only stay briefly then you have major turnover problems and that's negative in terms of care," said Michael Hoge, a professor at the Yale department of psychiatry.
Even so, salaries can seem inordinately high to those receiving service.
Tommy Tanzer of Park City, whose adult stepdaughter was treated successfully for schizophrenia at the state hospital several decades ago, believes paying too much for the people at the top is what tends to happen with government-run institutions. Yet he fears financial pruning could occur if the issue gets too much attention.
"Mental health has already suffered so many cuts, I wouldn't want them to suffer any more," he said. "But I think it would be a great thing to redistribute the money down lower to the people who actually spend a lot of time with the patients."
The average salary for a psychiatric technician at the hospital, including benefits, is $33,564. A registered nurse makes, on average, $50,552 including benefits. The hospital has about 750 full-time staff. Fourteen are psychiatrists.
"In the recovery, the people who the patients deal with daily really have more of an impact than the doctors or psychiatrists," said Michelle Vance, 22, who was at the hospital from 2008 to 2009 for bipolar issues and anxiety. She now studies social work at Salt Lake Community College.
"I met with my doctor maybe 15 minutes every week, 30 minutes if I was lucky," she said.
John Burnett, 21, also a former patient at the state hospital, was surprised to hear how high the salaries are considering what he felt was the poor condition of some of the buildings.
"I feel that for the amount they're getting paid and how much they interact with patients it's kind of [imbalanced]," said Burnett, whose struggle with major depression led him to the hospital. "They mostly prescribed medications. They have basically little interaction with the patients."
Public service • As a psychiatrist in the forensics unit at the state hospital, Paul Whitehead's duties include making detailed diagnoses, assessing medication, identifying medical problems, analyzing risk assessment, writing reports and testifying in court.
"The average physician psychiatrist working at the state hospital is not driven by materialism or salary," he said. "They're striving for excellence in public service and public health."
Whitehead, who emphasized that his net income is well below his salary and benefits package of $360,281, said he's had an interest in community health issues dating back to his time at the University of Utah medical school.
He pointed out that one explanation for the many hours doctors work at the hospital is the ongoing needs of patients.
"Unlike many other government agencies, the provision of health care never takes a holiday," he said. "There always needs to be coverage for the numerous patient beds here in the hospital."
Psychiatrists who choose to take on-call time at the hospital may receive significantly higher compensation because of the pay for extra hours, which are necessary by law due to the urgent, unpredictable needs of patients. In fact, compensation has gone down for some doctors over the last two years now that the hospital is fully staffed, said Dallas Earnshaw, the hospital superintendent.
"Why would they come here if there weren't some kind of additional perk?" he said. "Part of the state benefit does help me recruit staff, not just state doctors."
But Utah doesn't offer the highest pay: A 2010 review by the National Association of State Mental Health Program Directors Research Institute suggests that moving to South Dakota would be the most lucrative choice for psychiatrists at state hospitals. The pay there, excluding benefits, tops out at $305,000.
Kent Roundy, a psychiatrist in the top earning group at the Utah State Hospital who receives $273,657 in salary and benefits, is happy to be there supervising the care of 30 patients.
"We have the ability to treat the most mentally ill and have a tremendous amount of administrative support and political will to help us do that," he said. "We're starting to lose that as physicians in other places."
Roundy said he is aware that public mental health, including the state hospital, is "relatively less funded" so the staff tries to be good stewards of public money. Still, he understands why some people might be frustrated.
"Everybody in the U.S. has a right to have a voice in the management of tax dollars," he said.
Reporting contributed by Jessica Miller.
Salary and benefits by the numbers
Some community members criticize the high pay of psychiatrists at Utah State Hospital, but many other state employees earn as much or more:
University of Utah football coach Kyle Whittingham • $1.5 million
University of Utah orthopedics professor John T. Smith • $1 million
University of Utah chief of the Division of Otolaryngology Clough Shelton • $1 million
Utah State Hospital clinical director and psychiatrist Richard Spencer • $480,869
Utah Transit Authority chief executive officer John Inglish • $351,891