Psychiatric residency program provided $3M in state funding; Hutto hopes effort develops psychiatrists

The program is being developed with the Tri-County Commission on Alcohol and Drug Abuse, which broke ground earlier this year on a $2.4 million expansion.

State Sen. Brad Hutto, D-Orangeburg, said rural South Carolina doesn’t have enough psychiatrists. The $3 million will go toward a worthwhile effort in training psychiatrists and hopefully keeping them in the state.

“They get trained in Charleston, they get trained in Columbia at the medical schools, and they end up staying there. They don’t come out here. … Part of the issue we saw was, ‘Well, where are we going to create these training slots?’ If we created them in South Carolina, maybe we can incentivize them to stay in rural South Carolina. So we’re bringing them to Orangeburg,” Hutto said.

The Orangeburg Area Mental Health Center already has psychiatrists, but outside of the OAMHC there is one part-time psychiatrist available in Orangeburg, Bamberg and Calhoun counties.

The residency program will include 10 residents per year, with residency being a four-year process. Organizers expect the program to have 40 residents in training for mental health and addiction by the fourth year of the program.

Training for the first 10 residents began in July and will run through June 30.

“The residents will rotate through several MUSC Health-Orangeburg’s primary care practices, as well as MUSC Health Orangeburg’s outpatient neurology practice. In addition, they will rotate through the emergency department and inpatient departments,” TCCADA Executive Director Mike Dennis said.

He continued, “The plan was for HopeHealth to work with us, and they likely will in future years; however, for this first year, the following entities are also partnering with us: S.C. Department of Mental Health and several county community mental health centers; S.C. Department of Alcohol and Other Drug Abuse Services and the county alcohol and drug abuse agencies in each county; the Dorn VA Medical Center and Bamberg Family Practice.”

Dr. Mark Kilgus is the residency program’s institutional official who makes sure it fulfills all accreditation requirements. He said the program in Orangeburg will have four distinctive features, including being “inquiry-oriented.”

“We’re going to ask questions. We’re not just going to do things just to do things. We’re going to figure out if they really will make a difference. Number two, we’re community based. Number three, and I think this is huge, is we’re spiritually minded,” Kilgus said.

“What does that mean exactly? Well, it means that we understand that humans are more than just a physical being. We also exist spiritually, and that’s where our personhood lies. That’s part of our relationships. Then the fourth kind of distinctive is that we’re longitudinally designed,” he said.

What does being longitudinally designed mean?

“Most programs are set up where you do 13 four-week rotations, and you exclusively do one thing for four weeks, and you move on and do another thing. In this program, residents spend like one day a week doing neurology, two days a week doing primary care, one day a week doing consults in the hospital, or emergency psychiatry, and then one day in the community in the mental health centers,” Kilgus said.

Residents also travel as far as Aiken, Lexington and Greenwood.

Dr. Carly Keenan is a fourth-year resident who transferred from another program to help get the Orangeburg program started.

“The nice thing about this program is that it’s embedded in the community, which gives you more direct access to some of the needier patients in the vicinity and a little bit more flexibility in terms of how we set things up and how we proceed forward,” Keenan said.

“This is my second time being in a brand-new program. … I am very familiar with starting up new programs and the hurdles that come with that. I’m familiar with the longitudinal training model, which is something that’s pretty unique to the program, as well. I know what it looks like to try and start something like that from scratch,” she said.

Dr. Pete Loper, program director, said, “The really powerful point about Dr. Keenan’s experience is not only are we able to increase access within the construct of the community and community mental health spaces here locally and throughout the state, but she also has a special interest in helping patients with mental illness who have special needs. … She is going to be working in spaces that serve those specific populations, as well. There’s a tremendous need for that.”

Loper said increasing psychiatric care access is not, however, the only goal of the program.

“One of the core components that this program is really formed by is it is inquiry-oriented. We’re consistently seeking to explore and better understand. We’re training our clinicians on not just what to do, but how to think through a process and really how to conceptualize and think about a patient as a whole,” he said. “We’re all about quality as we increase quantity.”

Dr. Doris Páez is a core faculty member in psychotherapy as part of the program. She said the program’s innovation is key.

“By necessity, psychiatrists do a lot of medical management. So they now have the opportunity to kind of go back and holistically treat patients. So they can do the medication management, they can do evaluation, but they can also do therapy. That is critical. So they will be at every step with their patients,” she said.

Páez continued, “They’re going to be doing a lot of psychotherapy. So they’re getting trained in that now, which is unique to our program. Then next year they will actually be doing psychotherapy.”

TCCADA Deputy Director Dee Robinson, who is responsible for program safety and quality, said “The most exciting part of this program is that the sky is the limit of what it can touch. We’ve had conversations with DJJ, for example, and the ability to help them with evaluation. We’ve talked to our local detention center about being able to help with that population, as well.”

“It really can change the workforce and the amount of access that individuals have to psychiatric care,” she said, noting that hopefully the residents will remain in the rural area upon graduation.

Kilgus said, “Psychiatry is a scarce medical specialty. Sixty percent of existing psychiatrists are going to retire within the next 10 years. So part of this is workforce development.”

The program’s programmatic funding will come from the S.C. Department of Health and Human Services with funds appropriated by the S.C. Legislature.

Dennis said, “The S.C. Department of Alcohol and Other Drug Abuse Services will also provide some funding for indigent clients with substance use disorders. The commission is seeking other funding sources, including federal funds, for the program.

The residency program will include both pediatric and adult training.

Hutto said, “We really need psychiatrists. With the mental health issues that children are experiencing, we’ve got to increase the number of psychiatrists locating in rural areas.”

Dennis said the program, “is huge for our area and for South Carolina. We have an opportunity to train psychiatrists with a focus on community-based psychiatry with a heavy emphasis on rural areas, where the shortage of psychiatrists is even more pronounced than in more urban areas.

“Our program will also have an emphasis on the co-occurrence of substance use and mental health issues, which is unique. We are the only program in South Carolina that is not based out of a large hospital system.”