5 Min Read.

Filling that integrated care position at your clinic feel tough? You are not alone. Positions for mental health professionals of all types in primary care have grown in the last few years (see our job board and our map) and the options for mental health professionals have also expanded with telehealth uptake, which has resulted in a much more competitive employment marketplace. So, what to do if you are hurting for providers? A patient, forward-looking approach is what we counsel.

Is There A Workforce Shortage?

First, let’s address a question that is often misunderstood: whether a workforce shortage exists or whether demand has increased creating a shortage? It is easy to reflexively assume that the issue in the field is the lack of adequate numbers of workers. According to the most recent modeling provided by the Health Resources and Services Administration (HRSA) shortages are only expected for psychiatrists and addictions providers by the year 2030 whereas all other mental health professions are expected to have adequate or over-supply. 

Now, this data is based on pre-pandemic conditions and so it is possible that demand for services may still outpace worker supply going forward. However, the perception of worker shortage is not one we can assume exists. It may simply be that the allocation of workers is poorly distributed, creating over-supply in certain areas and worker deserts in others, as is suggested by this study on the distribution of co-location of medical and behavioral health providers. In other words, your hiring problem is not so much that we do not have enough mental health professionals but rather that a combination of other factors is impeding your hiring process. Here’s a likely short list of those conditions that may be hampering your efforts:

• Competition with telehealth vendors that promise ease of practice and flexibility
• Workers are more selective given the pandemic and are looking for greater flexibility
• Training for integrated primary care still lags training for specialty care resulting in relatively lower supply and interest
• Location is still a key factor in worker selection of employment, with rural/ remote locations struggling to find providers
• Salary expectations have increased with inflation and with the perception of workforce shortage/ turnover issues

A final consideration that is fodder for a future blog post is a factor that often goes unaddressed: training of mental health providers in appropriate dosing and titration of care is deficient and leads to poor allocation of resources (poor population-based care). In other words, small portions of the population are receiving more care than they need leaving less resources for the rest of the population. This is a particularly important skill now considering the reported post-pandemic rise in mental health demand. But that is an argument for another day.

What Can You Do?

A lot of this you cannot control as an employer. However, there are some themes here that as an employer you can attend to and with some forward-thinking approaches you can adapt the positions you are hiring for to be more competitive. Note that a key theme of the list of challenges is the desire for flexibility. Flexibility is code for: more control over my time and thus more control over my wellbeing. The lure of telehealth is the ability to control time and effort and to do so from the comfort of home. So, you may want to create positions that allow for or even have built-in flexibility. 

Many clinics are doing this by sustaining their pandemic-era telehealth practices and integrating those workflows with in-clinic work, often with a rotation for personnel so that team members do not remain disconnected from their care teams. More progressive clinics offer diverse work responsibilities so that clinicians are able to do more than just see patients 5 days per week. We recommend that high volume work typical of models like PCBH are sustainable at best 4 days per week, so this should be built into the job description. CFHA is definitely a fan of the 4-day work week as a model for healthcare going forward. We have transitioned to a 4-day work week ourselves. Another way to help clinicians mitigate the impact of clinical work is to simply allow for part-time work. So, you may want to post your job and indicate that individuals interested in part-time work should also apply.

Salary is becoming a bigger issue across the entire workforce so it makes sense that this would be felt in behavioral health specifically, so attending to your baseline salary in your posting is crucial. We suggest paying just north of the averages in your areas which is conceptually supported by the reality that the skill set required of an integrated team member is typically higher than most community positions. CFHA is working on a national survey of behavioral health providers in integrated care positions and should be able to report on regional variations later this year. That said, if you are posting a position with a 4 or 5 at the beginning of the salary amount you are putting yourself at a disadvantage in most any region of the country and across any license type. The adage also holds true that you get what you pay for.

Openness to early career pre-license professionals is also good strategy. Many clinics underestimate the ROI of investing in a young professional working towards their licensure because they over focus on immediate revenue. Given how difficult it can be to find and keep qualified personnel, we have found that the investment of waiting for an MSW, for example, to work without generating reimbursement for two years while working towards their LCSW, is well worth the investment over a 5-7 year trajectory because of the likelihood of both getting what you really want in a professional and the ability to keep that talent during high productivity years (early career). So, patience pays off.

Lastly, but perhaps more importantly, make sure that you are listening to your existing staff about what works and doesn’t work well in the role you have created. Yes, we need patients to be seen, but are the working conditions facilitating this goal or are things like your EHR, your productivity metrics or your leadership structure getting in the way? Do they make working at your organization feel like work instead of missional vocation? 

Behavioral health workers are just like many other workers in this era who value time, flexibility and mission and who are feeling the economic impact of years of payment inequities and recent inflation. Ignoring these realities and impatiently trying to find the first warm body available at the lowest cost is a sure-fire way to have a high turnover position and long, frustrating hiring periods.

For more on the workforce, make sure to attend CFHA’s annual conference which centers on the integrated care workforce including several plenaries highlighting the key challenges and possible solutions.

Photo by Eric Prouzet on Unsplash