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Compensation Benchmarks for Our Workforce Can Provide Needed Context
A good way to make concepts real is to monetize them. For example, stigma not only has an emotional impact, but it also has economic consequences for those needing or providing care. Similarly, our society values medical solutions more than psychosocial ones like psychotherapy and counseling. Can we quantify this for those working in our field? One simple metric is compensation.
How do stigma and less valued services drive the salaries of people working in our field? While it is commonly known that salaries are lower in our field, direct comparisons with medical care are challenging due to differences in education and training. Physicians and nurses dominate medical care, whereas the amount of education for our professionals falls between that of MDs and RNs.
A reference point is needed for comparison, and we have one in the burgeoning group between MDs and RNs—master’s prepared Nurse Practitioners (NPs). They provide an appropriate reference point for comparing the salaries of our clinicians. Data from May 2021 from the US Bureau of Labor Statistics or BLS indicates that NPs make an average of $118,040 annually.
NP salaries range from a high in California of over $151,000 to a low of $95,000 in Tennessee, with the mean salary being well over $100K in most states. This represents powerful recognition for a specialty founded in 1965. It grew to having about 15,000 practitioners over a decade later and 120,000 about 25 years after that. There are more than 325,000 NPs today.
Their ranks have grown in step with their compensation. This exemplifies the growth of a specialty devoid of stigma and grounded in our country’s dominant medical model. NPs are lower-level clinicians (versus PCPs) dispensing basic primary care services. Psychotherapy is a complex service in every instance. If anything, an argument might be made that therapy merits higher pay than NP services.
Recent decades have witnessed a growing appreciation for the pervasiveness of behavioral health problems and yet, as Ron Manderscheid notes, “for longer than 2 decades, we have known that our behavioral healthcare workforce was not large enough to serve the number of Americans with behavioral health conditions.”
Many people are drawn to our field, if not its salaries. BLS reports wages by specialty. Data exist for licensed healthcare positions like psychologist and social worker, but not for psychotherapist. BLS reports average salaries in 2021 for psychologists ($99,010) and social workers ($62,310). Salary.com lists the average salary for the general position of psychotherapist as being $64,726.
How should we regard this salary gap? Psychologists have higher educational degrees and yet earn $19,000 less than NPs on average. NPs and social workers achieve comparable degrees, and yet the pay gap is over $55,000. We can presume other licensed therapists with master’s degrees are in a similar range. This gross disparity reflects the relative economic valuation of medical versus psychosocial care.
The gap also speaks to the difference between working with a general population and a stigmatized population. We cannot determine which factors drive more of these differences, but our field should keep these standards and comparisons in mind. As the consolidation of behavioral health services into medical settings and large corporations proceeds, we must continually raise awareness.
What about exceptions? Psychiatrists are a separate category since they are physicians who do little or no therapy and earn high incomes managing medications. Some private practice therapists report high incomes. However, our field is likely to follow trends of business consolidation in healthcare that have increasingly led physicians of every specialty into employed positions. This is likely our direction as well.
Our people may increasingly become employees, but their salaries will not automatically match those in the rest of healthcare. Are NPs the right benchmark for therapists?
Clinicians should begin to ask when their compensation will be in line with NPs or whatever benchmark makes better sense. Our executives should work with senior managers in the large medical corporations acquiring them on a plan for employee compensation to gradually match comparable medical staff. CFOs will likely assume that our existing compensation structure should remain in place.
They need to be educated. Our market rates have been depressed by stigma and the second-tier status of psychosocial services. Moreover, much of the traditional underfunding of behavioral healthcare stems from the pre-parity norm of inequitable insurance coverage. CFOs must learn the history of our field as integration proceeds. Kind words about the importance of behavioral health are insufficient.
As any new employee knows, the time to get equitable pay is on signing and not at some distant date. Executives in behavioral healthcare must lead this campaign since approaching change one employee at a time will fail. All stakeholders in our field will benefit if we are able to attract and retain the best people. Let us move one step closer to having behavioral care on par with medical care.
Ed Jones, PhD, is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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