By Neftali Serrano, PsyD, 2 Minute Read

In recent years, the struggle to retain and recruit behavioral health providers has intensified within primary care. A closer examination of this trend reveals a significant underlying cause: the selection bias rooted in the mental health provider training process. This bias not only shapes the career preferences of these professionals but also impacts the operational dynamics of primary care and integrated health environments.

The Genesis of Bias in Mental Health Training

The journey of a behavioral health provider begins in graduate education, where the curriculum is predominantly designed to produce specialty therapists. This specialized training environment inherently attracts individuals with specific characteristics and work preferences. These individuals often seek autonomy, predictability, and the freedom to choose their clientele, aligning perfectly with the offerings of online therapy platforms like BetterHelp and others.

These platforms provide an attractive proposition for such professionals, offering complete control over their schedules, structured workdays, and the autonomy to select their patients. This model of work is in stark contrast to the dynamic, team-oriented, and fast-paced environment of Primary Care Behavioral Health (PCBH) or the Collaborative Care Model (CoCM).

The Integrated Care Conundrum

Integrated care environments, such as those in PCBH or CoCM settings, demand a unique set of skills and attributes from their clinicians. These settings require teamwork, flexibility, rapid decision-making, and a collaborative approach with primary care colleagues. The very nature of integrated care — with its emphasis on shared responsibilities, varied patient needs, and interprofessional collaboration — clashes with the preferences of professionals trained in a more traditional, specialty-focused manner.

The discrepancy between the training environment and the actual requirements of integrated care roles leads to a misalignment in job expectations and satisfaction. Consequently, professionals who were trained in a specialty-focused environment often find themselves ill-suited to the demands of integrated care, leading to higher turnover rates and difficulties in recruitment for these settings.

In short, we keep recruiting a workforce for specialty care and on the backend of training try to siphon off as many as possible to fit primary care. It’s no surprise then when a BHC is lured by an online therapy provider where they can set their own hours, choose their clients, and completely manage their schedule from the comfort of their home.

Bridging the Gap

To address this mismatch and improve retention and recruitment in integrated health centers, several strategies can be employed:

1. Reform Educational Programs: Revise the curriculum of mental health training programs to include components that emphasize teamwork, flexibility, and integrated care principles. This approach would help in preparing future clinicians for the realities of working in integrated health environments. We here at the Collaborative Family Healthcare Association are definitely interested in working with accrediting bodies to help support primary care behavioral health workforce development.
2. Promote Interprofessional Education: Encourage opportunities for mental health trainees to collaborate with other healthcare professionals during their education. This exposure can foster a better understanding and appreciation of the integrated care model.
3. Adjust Recruitment Strategies: Tailor recruitment efforts to specifically target individuals who exhibit a preference for teamwork, adaptability, and interdisciplinary collaboration. Highlighting the dynamic and varied nature of integrated care work can attract the right candidates. Your interview process could even include a question like, do you see yourself working for an online therapy company one day?
4. Enhance Job Satisfaction: Implement organizational changes in integrated care settings to align more closely with the preferences of mental health providers. This could include offering more flexible scheduling options, creating opportunities for specialization within the integrated care framework, and fostering a supportive team culture. We can’t bend infinitely to the whims of the current workforce, however, there are some ways we can make primary care more enticing with the right amount of flexibility (eg. some telehealth days?) and team culture.

By addressing the selection bias at the front-end of mental health provider training and making strategic changes in the integrated care work environment, we can create a more sustainable and satisfying career path for behavioral health providers in these settings. So, if you are a director or clinic facing these challenges, you are definitely not alone. The competition is real and the current reality of academic training for mental health professionals is what it is. Our hope is that this changes over the next decade and we begin to see young people enter the profession with an eye towards primary care from the get-go. Until then, online therapy and other specialty therapy options are going to be steep competitors for the available workforce.