Given challenges of maintaining psychiatry, NP or PA staff onsite 24/7, recommend that the standard for completion of a psychiatric evaluation be changed from "time of admission" to within 24 hours of admission with this level staff being available 24/7 for consultation. Overall, concerned about the substantial increase in expectations around all medical services while, at the same time, the overall maximum daily reimbursement rate is decreasing.  This, at a time when the limited supply of medical personnel are being pulled away from the public sector to the private, for-profit sector by rates of pay we cannot compete with.