– Five days a week, Dr. Karen Pajari drives from her home in Ely, Minn., to start seeing her psychiatric patients at Range Mental Health Center in Virginia at 7:30 a.m.

Starting with patients from the chemical dependency treatment center, she works through the day, but doesn't have time to do it all. By mid-June, she had patients scheduled through August and into September.

"I could do with about 10 hours more a day if I could stand it," Pajari said.

She enjoys her job, Pajari said, but admits "I've made several efforts to retire." She's 71.

If there's any health care shortage in rural areas that exceeds primary care, it's psychiatry.

The Health Resources and Services Administration designates "shortage areas" across the country in dentistry, primary care and mental health.

In Minnesota, all but the counties surrounding the Twin Cities and Rochester are designated as shortage areas for mental health. Although large, mostly rural areas of the state also are designated as shortages for primary care, there are more exceptions — including the immediate Duluth area and all of Lake County.

At the Range Mental Health Center, which serves about 7,000 people a year, the crunch became a crisis in mid-April, when one of two psychiatric nurse practitioners left the clinic. The nurse practitioner's 700 patients were divvied up between Pajari — who already had 800 patients — and the remaining nurse practitioner, Pam Jarvis. The overall staff is considerably larger, but only Pajari and Jarvis can prescribe medications.

"We both work long hours, see a lot of patients and are very tired," Pajari said.

Laura Tovar, recently named the center's co-CEO with Mary Carpenter, said their top priority is rebuilding the psychiatry department. They enlisted a recruitment firm that promised three "nibbles" from prospective professional staff persons within 90 days. In the first 30 days, they heard from none, Tovar said.

There's an even greater scarcity within the scarcity: child and adolescent psychiatrists. "I don't think we have one on the Range at all," Tovar said.

Pajari and Jarvis treat only the most serious mental illnesses, leaving the rest for the family doctors, Pajari said.