Psychiatrists Among Top-Paid Washington State Employees

11/03/2009

They are among the top–paid state employees in Washington: psychiatrists who work in the prison system and in the state's mental hospitals. In fact, if you look at a list of the top–100 paid state workers — not including higher education employees — more than half are psychiatrists. Correspondent Austin Jenkins went to find out who these doctors are and what they do. He profiles one at Western State Hospital near Tacoma.

On Ward C–7 the day starts with a treatment team meeting.

Nurse: "We're going to start with J.O. this morning. Anxious to go to groups, he is visible on the ward, he's taking his medications."

Nurse Vicki Kallahan–Storwick briefs Dr. Daniel Ruiz and the team on the status of the patients. Ruiz follows up with the diagnosis.

Ruiz: "This gentleman is new on the ward. He came with significant psychotic symptoms. "

And a treatment plan for each patient. Ruiz has been a psychiatrist at Western State for eight years. He came here straight out of residency at the University of Washington. It's a second career in medicine for him. Before becoming a psychiatrist, Ruiz was a general physician in Puerto Vallarta, Mexico. His path to psychiatry began with a personal story.

Ruiz: "I do have a brother with schizophrenia."

Ruiz says his brother's struggle with mental illness gives him a special understanding of the toll it takes on the patient and the family.

Ruiz: "You know having my brother stopping his medications and disappear and we find him in another city in rags with several missing teeth and we thought he was dead and those kinds of things."

Today Ruiz's brother is stable. And that's partly why he says he's in the business of hope. Hope that his patients too can be stabilized and reintegrate into society.

Ruiz unlocks a door and leads me on a short tour of the locked ward. It looks like a cross between a hospital and a nursing home. It's pretty bare bones. As we enter the common living space an agitated patient starts yelling at Dr. Ruiz.

Ruiz: "Just a minute please, one minute please, one minute please."

Dr. Ruiz says one of the main challenges of working in a state hospital is most of the patients he sees are involuntarily admitted. They're not the criminally insane. But they do pose a risk to themselves or others. Some are homeless. The average length of stay here is six to ten weeks. On any given day, Ruiz is in charge of some 30 patients. Ruiz says he likes the challenge of working with patients who are not only mentally ill, but often physically sick as well.

Ruiz: "The interaction between medicine and psychiatry is very, very significant. We have patients who have diabetes, obesity, hyper–tension and I find that complexity — possibly because of my extensive medical background — more interesting."

Ruiz admits to frustrations and even heartache. The worst is when a former patient commits suicide. Fortunately, Ruiz says, that's rare. But it's the successes that keep him working in this environment.

Ruiz: "It's very satisfying to see the most disabled or humble or the poor or the mentally ill to be able to help them get well and be discharged and recovery their dignity as human beings."

Dr. Ruiz and his fellow state psychiatrists earn about $160,000 a year. That's a little less than the governor. But to be fair, far less than some of the doctors at the University of Washington Medical School. That said, Ruiz believes taxpayers are getting their money's worth.

Ruiz: "Well what it tells us that you know we're some of the most specialized professionals the state has and one of the most important services that the state provides is mental health — basic mental health."

Ruiz adds that because you can make more in private practice it's hard to recruit psychiatrists to come work for the state. But he likes the job and says he can imagine finishing out his career caring for some of the sickest and most down on their luck patients in Washington state.

I'm Austin Jenkins reporting.

© Copyright 2009, KUOW