Since 2012, psychiatrists at Cherry Hospital have collected at least $2 million in extra pay for working nights and weekends – while some take leave during the day to work a second job.
Instead of scheduling doctors to work shifts around the clock as part of their normal duties, Cherry administrators staff nights and weekends with psychiatrists who volunteer to work for extra money. More than $400,000 of that “extended duty” pay went to the managing psychiatrists who made the schedule and also volunteered to work for extra pay, state records show.
Cherry’s costly staffing and scheduling differs from the state’s other psychiatric hospitals in Morganton and Butner. Several psychiatrists at Broughton regularly work nights as part of their job; that hospital has spent roughly 40 percent of what Cherry has in extra pay. At Central Regional, the hospital pays residents from nearby universities to handle nights and weekends.
For at least a year, Cherry Hospital has served fewer mentally ill patients than it can hold. Since a new facility opened in September, administrators have said they will not open its 100 additional beds until they hire more psychiatrists. Patients across Eastern North Carolina in need of those slots are waiting days – sometimes more than a week – in emergency departments poorly equipped to care for them.
State Health and Human Services Secretary Mandy Cohen, hired by Democratic Gov. Roy Cooper in January, is not pleased by the imbalances at the three hospitals and the slowness of opening new beds at Cherry. She said she expects to make changes immediately.
“I expect more from our team,” Cohen said Wednesday in an interview.
In an interview last week, Cherry Hospital leaders defended their staffing and compensation, saying they have been good stewards of the state’s resources.
“Absolutely, I’ve got no question,” said James Mayo, the hospital’s medical director.
Mayo received a $38,000 raise in January, bringing his annual salary to $288,000. Mayo has also received a total of $194,000 in extended pay from from 2012 through 2015 for seeing patients on nights and weekends, records show. He is on track to get nearly $80,000 in extra pay this year.
Mayo said his compensation is justified because of the scope and difficulty of his responsibility. He said that his salary is now more in line with peers elsewhere. His new salary, however, is about $50,000 more than his counterparts at the two other state psychiatric hospitals.
“The market for psychiatrists right now is skyrocketing,” Mayo said. “I would write an article about how do the state facilities get into a market and recruit people to take care of poor people the same way you take care of people who have resources to go to other facilities.”
Allowing ‘flex time’
The News & Observer has examined operations at the state’s three psychiatric hospitals since March, reporting first that Cherry Hospital leaders had doled out hefty raises to its psychiatrists on Jan. 1. Their counterparts at Central Regional and Broughton hospitals got none.
Last month, the N&O reported that 100 beds remain empty at Cherry’s new facility, while doctors at Broughton Hospital in Morganton carried heavier patient loads.
Cohen learned of problems at Cherry when the N&O interviewed her staff on May 11. She then assembled and dispatched a team of auditors, human resource officials and budget experts to each of the three hospitals to review operations.
“We are stewards of state resources,” she said. “It is fair for folks to hold us to a high standard and that we have consistency across our institutions.”
An N&O analysis of state records and psychiatrists’ schedules shows significant inequities in pay, perks and duties for psychiatrists at the three state hospitals:
▪ At Cherry, psychiatrists are assigned to work Monday through Friday 8 a.m. to 5 p.m. Though the hospital must be staffed 24 hours a day, night and weekend duties are voluntary. Those doctors are paid extra for taking the shifts, straight hourly pay equivalent to their hourly base pay.
At Broughton, three doctors work four nights as part of their normal schedule. At Central Regional, those shifts are covered by psychiatric residents at nearby universities.
▪ From 2012 through 2015, Cherry hospital paid 18 psychiatrists $1.32 million extra to tend to patients overnight and on weekends. The hospital is on track to pay about $720,000 this year to psychiatrists working those shifts. (No records are yet available for 2016.)
In those same four years, Broughton Hospital in Morganton paid a half-million to psychiatrists covering nights and weekends.
▪ At Cherry, 14 psychiatrists take regularly scheduled “flex time” during the week, which amounts to roughly 100 hours, or an average of 8 hours per doctor. About half of them take that time to work second jobs at clinics, other hospitals and private practice.
While some psychiatrists at Central Regional and Broughton also have second jobs, they do not take flex time during the week to work them, according to a review of schedules at the three hospitals. Cherry psychiatrists are expected to make up those flex time hours on other days, but no one monitors it, hospital supervisors said. Time sheets are completed based on an honor system.
Cohen said her team is reviewing policies immediately on working second jobs and how to account for flex time.
“We want to make sure we pay folks for the work they do, and they work hard,” Cohen said Wednesday. “But I don’t want to pay them for work they are not doing.”
▪ At Cherry, a significant share of the extra compensation for overnight and weekend shifts has gone to two managers, James Mayo and Paul Kartheiser. Neither carry patient loads during the week but sign up to work weekend and overnight shifts.
Both Mayo and Kartheiser are on track to earn more than $70,000 in extra pay this year. That’s more than double the annual earnings of the hospital’s health care technicians, who must work overnight shifts as part of their job.
The managers’ counterparts at Broughton and Central Regional collected little or no extra pay beyond their base salaries from 2012 through 2015, according to data from the State Treasurer’s Office.
Mayo and Kartheiser defend the way doctors at Cherry are scheduled and compensated. They say that some Cherry psychiatrists perceive night and weekend duty as a burden. If working those shifts was part of their job requirements, they said they would have to offer “significantly more” than $230,000 as a base salary.
They also say they have decreased the length of stays for acute patients, which makes beds available more quickly.
“The extended duty system we have in place is likely the most efficient system and the most cost-effective system that you could design for the needs that we have in our hospital,” Kartheiser said.
The two managers say they volunteer to work overnight and weekends shifts because they enjoy treating patients. The overnight and weekend assignments also allow them to evaluate the operations of the hospital more closely, they said.
“It’s an added advantage to my position in that I get to see people, how our processes are working,” Mayo said.
Their time, however, is costly. When Mayo works a 24-hour weekend shift, which he does twice a month, it costs taxpayers $3,321. When a psychiatric nurse practitioner works a weekend shift in place of a psychiatrist, it costs 60 percent less.
Extra pay for night duties
Compensation for medical professionals can be complex and varies between public and private facilities and specialization. At some hospitals, doctors are paid extra to work nontraditional shifts. At others, they are assigned these shifts as part of their job; some facilities rotate those duties.
North Carolina’s three public mental health hospitals treat patients in dire psychiatric distress. Day or night, they must be equipped to accept a new patient or calm a violent one.
For the last few years, Cherry administrators say they have had difficulty recruiting psychiatrists, in part because of the demands of the job. Mostly, though, they blamed recruitment challenges on low salaries.
Administrators say they need to hire eight more psychiatrists to fully staff the new 313-bed facility that opened in September. To do it, the hospital’s administrators petitioned last fall leaders at the state Department of Health and Human Resources as well as the Office of State Human Resources to boost the salary for newly hired psychiatrists to $230,000.
To be fair to the psychiatrists already on staff, they handed out nearly $500,000 in raises, bringing each up to $230,000. Managers Mayo and Kartheiser also got increases.
As part of their petition for raises, a recruiter prepared a list of recruitment packages for psychiatrists at both public and private facilities that was inaccurate on several points, including showing an early-career psychiatrist’s salary at the VA Hospital in Fayetteville as $320,000, when that was the top of the salary range.
The N&O asked those facilities about their scheduling and extra duty policies. The employers listed on Cherry’s petition say they rarely pay extra for overnight and weekend duties for psychiatrists. The Veterans’ Affairs Administration, for example, has a policy forbidding extra compensation above annual salaries. A VA spokesman said that night and weekend duties are part of the job for staff psychiatrists.
No limit on extra pay
In North Carolina, professionals and managers who work for the state are typically not eligible for overtime pay. When these employees work beyond 40 hours, they can take time off work as compensation.
In 1974, state officials carved out an exception for doctors working in jobs that are hard to fill. Over the years, they expanded the policy to include more medical professionals.
The policy had a few restrictions. Extra pay was capped at 20 additional hours each week. To take advantage of it, the agency had to make a case that it was necessary because of staff shortages in critical positions.
Staffing at the state’s mental hospitals has been in flux for more than a decade as state leaders have tried to push patients with mental illness out of hospitals and to serve them in their communities. The state closed one of its psychiatric hospitals, Dorothea Dix in Raleigh, in 2010 and has launched major construction projects at three remaining facilities.
Mayo directed Dix in its final years. He became medical director of Cherry Hospital in December 2010.
In 2012, Mayo asked that psychiatrists be approved to receive extended pay.
Mayo said he recalled his days as a young clinician, racking up so many extra hours that he didn’t have the time to take off. One December, he said he had more than 200 hours to cash in but no time or desire to use it.
“If you do the comp time for every weekday night, you are losing two workdays during the week,” Mayo said. “That’s not a sustainable way to do it.”
From 2012 through 2015, Mayo collected $194,000 in extended duty pay. Kartheiser earned $150,000, state records show.
Another psychiatrist working for the state also earned a considerable amount of extended duty pay. Thomas Larson collected $205,000 in extra pay during four years for working extra shifts while he was medical director at R.J. Blackley, a state-run addiction facility in Butner.
In 2015, Larson petitioned the state Office of Human Resources to lift the 20-hour cap on pay for extended duty hours at his facility. Larson said in an interview that he believed lifting the cap would help him entice staff psychiatrists to volunteer for overnight shifts while alleviating that duty for doctors who preferred to work a traditional schedule.
State human resources leaders agreed to test the program at Larson’s facility and one other.
On Aug. 31 of last year, Larson updated human resources officials about the program. He gave it good reviews.
In October, human resources officials lifted the cap for medical professionals already approved for extended pay at all facilities run by DHHS. On Oct. 1, Larson left R.J. Blackley to fill a newly created management position at Cherry Hospital.
Like Mayo and Kartheiser, Larson soon received a big pay boost. After a $32,700 raise in January, he now earns $250,000.
In an interview, Larson said that he had already been looking for other jobs before taking the one at Cherry. He said his meeting with state human resources officials had nothing to do with his upcoming move to Cherry.
None of the three Cherry managers carry a patient load, which would help the hospital make use of the 100 empty beds and alleviate the bottleneck of patients in emergency departments. Mayo and Kartheiser said they couldn’t juggle more duties.
“The demands of this job,” Mayo said. “There literally isn’t time to do that.”
Cohen says, however, that those supervisors will be directed to see patients, beginning immediately.
“In an ideal world, those supervisory psychiatrists would not have a patient load,” she said. “But we are not in an ideal world. We are in a tough situation.”
Database manager David Raynor contributed to this report.
Locke: 919-829-8927 or @MandyLockeNews
Good pay, extra pay
Two supervisors at Cherry Hospital have piled up substantial amounts of “extended pay” by working some night and weekend shifts, records show:
Dr. James Mayo, Cherry’s medical director
Base, $266,157; extended pay, $12,273
Base, $266,157; extended, $54,937
Base, $245,623; extended, $80,442
Base, $245,623; extended, $46,232
Base, $287,924; **extended, $79,718
Dr. Paul Kartheiser, Cherry’s assistant medical director
Base, $177,865; extended, $11,116
Base, $177,865; extended, $40,275
Base, $180,644; extended, $47,213
Base, $230,000; extended, $51,905
Base, $274,344; extended, $71,223
Source: Data from North Carolina Treasurer’s Office and State Controller
* 2016 data has not yet been released
** Projections based on sample schedules for first five months of 2017 and calculations based on base pay rate of each doctor.