Minnesota's highest-paid state government workers are not college presidents, investment officials, Supreme Court justices or the governor.

The top earners of state taxpayer dollars are — by an overwhelming margin — psychiatrists.

Mental health experts have long ranked among those making the most in the state's massive workforce. But the trend has become far more pronounced in recent years.

Fourteen of the 20 state workers who earned the most money in 2021 were psychiatrists. A decade earlier, five of the 20 top-paid staff worked in mental and behavioral health centers.

"If we choose as a state to run these services, we need to run them well," said Deputy Commissioner Chuck Johnson of the Department of Human Services.

Johnson said paying psychiatric staff well is important to prevent safety issues the state has seen in the past.

"We need to have the staffing there, particularly the clinical-level staffing, that has the appropriate training to provide effective treatment and help stabilize people and get them back to the community," he said.

Two psychiatrists earned more than $500,000 in 2021, each making about five times the salary of Gov. Tim Walz, according to state payroll data on more than 59,000 people working for various state agencies, boards, Minnesota State colleges and universities and the court system. The data does not include University of Minnesota staff.

Psychiatrists' pay stands out from a sprawling government workforce with thousands of college faculty, corrections officers and administrative specialists because the state does not hire many other doctors, said Sue Abderholden, executive director of the National Alliance on Mental Illness Minnesota.

"We should be comparing their salaries to the medical field and not necessarily to other state employees," she said. "It's the only part of health care that the state provides. So if the state provided other health care — cancer treatment, other types of health care — they wouldn't be the highest paid."

But even compared to others in their field, the median pay for the 19 psychiatrists listed as full-time state employees last year was high at $344,075.

The average pay for psychiatrists in public and private sectors nationwide was less than $250,000 in 2021, according to the U.S. Bureau of Labor Statistics. The average for those working in psychiatric and substance abuse hospitals — like many of Minnesota's top earners — was around $247,000.

Minnesota employers must pay higher than the average national rate for psychiatrists, said Allison Holt, the physician chief of mental health and addiction services at M Health Fairview. The hospital system recently had consulting firm Gallagher review market-rate compensation and found that to be competitive, it needs to pay in the top quarter of the national rate.

"Let's be honest, Minnesota doesn't have the greatest weather so if the choice after residency is going to a warmer location or coming to Minnesota, we lose out," Holt said.

Holt and state officials said psychiatrists in the government's ranks often serve people with very complicated medical needs. Many of them, they said, have been civilly committed by a court, have volatile behavior and could face criminal proceedings.

"This is not someone in a plush New York office, right, seeing people who have mild depression," said Abderholden said. "They are working with people who have some of the most serious mental illnesses. So you need to have someone who has a lot of experience."

The state had problems with patient care and safety over the past decade at the St. Peter and Anoka-Metro regional treatment centers. Regulators had to step in at the St. Peter location, and a federal review of the Anoka center found the state endangered patients by using generic treatment plans rather that providing sufficiently individualized care.

Around that time, in 2016, the Department of Human Services requested a pay increase for such jobs. State psychiatrists' salaries have climbed since.

"Psychiatrists help to ensure that we're doing a good job treating people and the better the treatment is … the fewer challenges we'll have with safety issues, with behavioral challenges," said Johnson, the department deputy commissioner.

Before the pay bump, the department had been struggling to get people to apply for the very specialized positions serving complex patients, according to Minnesota Management and Budget (MMB), the agency that handles human resources for state government. It had been taking more than a year to hire psychiatrists for some of the open positions.

Human Services had to contract with out-of-state professionals to meet minimum staffing requirements and was paying $236.40 an hour for the care at the time, along with travel fees, MMB spokesman Pat Hogan said.

"This arrangement could neither be sustained financially, nor did it meet standards for care, especially for people with complex mental and physical illnesses," Hogan said in a statement.

The department has been able to retain psychiatrists since the state increased their pay, he Hogan said.

Among the psychiatrists working for the state, Shabeer Ahmed at Anoka-Metro Regional Treatment Center is at the top of the pay list.

The state government's highest-paid employee for the past five years, he earned $581,550 in 2021, up 72% from 2016.

Ahmed and other top-paid psychiatrists declined to comment for this story.

Ahmed had a compensation rate of $160 an hour last year, but his base pay wasn't the highest — that distinction goes to Mansco Perry, executive director the the State Board of Investment. Perry, who is retiring this year, earned more than $212 hourly.

But Ahmed's regular pay was boosted by $262,447 in other wages and a small amount of overtime, a common theme among many of the state's top earners.

The bulk of that other compensation for medical professionals comes from being on call, according to a Department of Human Services spokesman, though he noted it could include other things such as expense reimbursements.

Minnesota leans heavily on the psychiatrists it employs, and they have a lot of responsibility, said state Sen. Jim Abeler, R-Anoka, who chairs the Senate Human Services Reform Committee. But he said he was surprised by just how much they make.

"It's simply a matter of supply and demand. There are not enough psychiatrists to go around in the industry," Abeler said. "Does it trouble me? I'm surprised, but given the shortage of psychiatrists it doesn't seem unreasonable."

Psychiatrists rank 199th of 576 in-demand professions in Minnesota, according to state Department of Employment and Economic Development data. The demand is expected to grow amid a looming wave of retirements that has some in the field nervous.

In Minnesota's metro areas, 30% of psychiatrists planned to leave the profession within five years; 17% in small towns and rural areas planned to leave, according to a 2021 Minnesota Department of Health workforce survey.

Getting more people into medical residency programs in the state and ensuring the pay is sufficient to entice people to work and stay in Minnesota is critical, many in the industry said.

"Attracting and retaining psychiatric physicians is central to a stable, well-resourced system of care," said Linda Vukelich of the Minnesota Psychiatric Society. "Minnesotans who rely on our state's public mental health system deserve equal access to high quality care."

Data editor Mary Jo Webster contributed to this report.