How to minimize the impact of staffing shortages

The law of supply and demand does not always follow traditional economic patterns in the healthcare market. Greater access to behavioral healthcare services today—thanks in large part to the Affordable Care Act—has been a boon to providers, causing demand for their services grow.

Yet, as behavioral healthcare services grow, so does the need for qualified staff to provide those services.

Keeping up

In this case, high demand is impacting the ability of behavioral healthcare organizations to maintain an ideal level of staffing as they seek to scale up operations. In fact, many programs are struggling to attract top-quality clinicians to fill new or vacant positions and to retain the staff they already have. There is competition for good workers, and the pipeline of new recruits isn’t as robust as some would like.

“We need to expand our workforce by at least 20,000 over the next two years in order to meet demand,” says Andrew Kessler, principal with Slingshot Solutions in Annandale, Va. “We have see a lot of increases in access to care over the last few years, but the number of professionals to provide the care has not kept up.”

What’s more, the problem is likely to become more acute as the current field of qualified professionals starts to retire.

“An Association of American Medical Colleges study from 2012 found that 59% of psychiatrists were over age 55—one of the oldest physician populations in any specialty,” says Kevin Thill, executive vice president for psychiatry at LocumTenens.com, a staffing organization in Alpharetta, Ga.

The retirement trend is already starting to be felt.

“We have seen a 21% increase year over year in the number of open days for psychiatrists,” Thill says.

According to a study released in June by physician recruitment firm Merritt Hawkins, the average starting salary for psychiatrists is $250,000—an 11% increase over this time last year, when salaries averaged $226,000. Experts point to increasing need to fill staff positions necessitating the increased pay.

Managing a staffing shortage

If behavioral healthcare organizations are unable to maintain a full staff, patients could face waiting lists for care, and heavier workloads for existing staff could lead to more frequent burnout or compassion fatigue. Markets with a particularly shallow pool of qualified candidates could be unattractive as expansion sites, in spite of any local need for services. Until unmet demand for talent eases, behavioral healthcare organizations must make the most of their strategies for attracting and retaining necessary talent.

1 Pay isn’t the only thing

When competition for talent is tight, behavioral healthcare organizations must make sure that they offer compelling employment opportunities in the marketplace. That means making sure pay levels are competitive, especially whenever demand is high enough to drive up pay levels significantly for certain positions and in certain markets.

“The price for practitioners has increased dramatically,” says Peter Walstrom, chief operating officer for Mandala Healing Center, an addiction treatment provider in West Palm Beach, Fla.

The center was recognized locally as a top place to work.

While keeping up with the going rate for workers’ wages in the market is one thing, overpaying for talent is something else entirely.

“Overpaying is a shortcut, and that’s the fool’s way,” says Walstrom.

By boosting salaries too much, treatment centers might attract good people initially, but it might not help to keep them if the organization is not a supportive employer. 

“It is a fine balance between making sure that we remain market-competitive in terms of compensation and creating a sense of loyalty to the organization and building trust among our team members, showing that we are looking out for them,” says Gina Sharp, president of Linden Oaks Hospital in Naperville, Ill.

Both Walstrom and Sharp emphasize the need to nurture a work environment that meets employee needs. For some employees, that might be flexibility in scheduling, opportunities for professional growth, the satisfaction that they are working for a high-quality provider, or some individualized perks.

“High-quality clinicians are not necessarily driven by money beyond what is necessary for a certain standard of living,” says Walstrom.

2 Don’t compromise standards

While pay bumps could begin attracting new candidates to the behavioral healthcare job market, they can be a double-edged sword. Casting too wide a net runs the risk of drawing in candidates who are neutral about their work and perhaps see it as just a means of bringing home a paycheck.

“Inflated wages have brought people into the industry, but those people are not necessarily seasoned and ready to hit the ground running,” says Walstrom.

Behavioral healthcare organizations with an immediate need for talent might be tempted to compromise when making hiring decisions. While few candidates will have everything an organization is looking for, it is important not to compromise core principles when selecting new hires, lest the organization as a whole suffer. Too many inexperienced or disengaged hires also will increase the burden on more experienced staff members who might feel obligated to train them in the middle of daily tasks or compensate for others’ ineffectiveness.

Attitude is also crucial. If an organization hires quickly without due diligence on the candidates as people, it runs the risk of introducing a negative element into the workforce.

“If you have an organization with too many people who don’t really care about doing a great job, those who do care are going to get really tired of being around people who don’t work as hard as they do and are not as invested as they are,” says Walstrom.

3 Manage current staff carefully

Whether the current growth in the behavioral healthcare field and proposed regulations to shore up the workforce will ultimately yield a larger pool of talent in the coming years remains to be seen. The future graduates who are now in college might gravitate to behavioral healthcare, but they will need time to complete their education and licensing requirements, especially for those pursuing PhD degrees. The immediate need will remain for some time.

“It is going to take a while for the market to catch up with the demand,” says Walstrom.

Until then, optimizing and retaining currently available staff is crucial to ensure adequate care for patients.

“We make sure our people are practicing at the top of their license and that we have the appropriate staff working in the right areas,” says Sharp.

For example, instead of having a psychologist welcoming a new patient, this can instead be done by a staff member with a bachelor’s degree, for example. Similarly, patients who require one-on-one care may not need a nurse-level practitioner to walk them to an exam room when a tech is available to do the job.

Behavioral healthcare organizations might also want to explore other innovations to use staff more efficiently. Rural areas that experience provider shortages are especially ripe for telemedicine technology.

“Telemedicine has the ability to help lessen provider shortages by using available providers more efficiently,” says Thill. “The main thing that needs to change to drive this innovation is less regulatory restriction around licensing across state lines and more equitable reimbursement for telemedicine treatment.”

4 Stay connected

In this tight labor market, experts recommend that behavioral healthcare organizations try to stay connected to staff even if they should leave the organization. Social media and other online forums can provide a channel to stay connected professionally.

Treatment centers might consider offering a mentorship program to stay in touch with those who leave work to pursue a higher education degree. The goal, of course, is to bring those former employees back into the organization at a higher level once they graduate.

“We have a good cohort of very talented and skilled nurses who are going back to school to become nurse practitioners,” says Sharp. “We have developed a pathway for them to successfully complete their master’s degree with a fellowship program that can help them gain additional training and education outside of their school experience.”

Where appropriate, contributing to grant and scholarship programs can also go a long way in attracting aspiring clinicians to your program.

5 Consider alternatives

Although healthcare workers must meet specific licensing and certification requirements, support-staff candidates that already have experience in customer service or other service-oriented businesses often make for good back-office and phone-center employees.

“We have started to look at the hospitality industry when recruiting employees for housekeeping, maintenance, facilities management and other roles,” says Walstrom. “These people are used to creating an exceptional customer experience, and they can help us to create an environment that patients enjoy and that helps them maintain their dignity.”

Experts recommend emphasizing the rewarding work that treatment centers do every day to help individuals with mental health and substance use disorders change their lives and transform their outlook for the future.

Joanne Sammer is freelance writer based in New Jersey.

Federal Investment

The Department of Health and Human Services’ (HHS) FY 2017 budget outlines a total of $132 million for programs that support the behavioral health workforce. Increases include $45 million to support additional loan repayment awards for behavioral health clinicians in underserved communities and $6 million for the Behavioral Health Workforce Education and Training program, now operating under SAMHSA and the Health Resources and Services Administration. According to HHS, funding will support an additional 2,650 behavioral health professionals and 2,750 additional paraprofessionals. Also, the budget proposes to establish a new $10 million Peer Professionals program in SAMHSA to increase the number of peers, recovery coaches, mental health and addiction specialists, prevention specialists and other counselors.