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Jumping Off Our Deficient Funding Track is Key to Equitable Compensation
Some problems require more than gradual change. A leap in categories is needed for meaningful improvement. If you start with second-class compensation, progressing to the next level is quite challenging. Behavioral healthcare has been a marginalized field, and its workers have been compensated as such. If the goal is to get on the right track financially, a plan is needed to jump tracks.
This is well understood at the individual level. One must be sure to negotiate the best starting salary possible in a new job—subsequent annual increases are likely to be modest. Our field evolved under a stigma that suppressed its funding and associated compensation for employees. Comparing therapists with medical professionals comparably trained (e.g., nurse practitioners) exposes this discrepancy.
In an economy of scarcity, it can be disturbing to watch fights over slices of an undersized pie. We see this in pleas for equitable funding from various segments of the behavioral community. Can we increase funding for people with SMI without addressing addiction or less severe forms of distress? Are gains for one group likely to diminish potential increases for others? Are we stuck with a zero-sum gain?
Technology is the focus of a similarly upsetting resource battle, but this touches our entire healthcare system. Investments in tech have flooded our field in the past decade. For example, there has been a proliferation of digital products using techniques found in therapies like cognitive behavioral therapy. This tech funding has eclipsed any paltry increases seen for clinicians who deliver in-person therapy.
This is part of a tradition in healthcare. Recent comments by Charlie Baker, governor of Massachusetts and former CEO of Harvard Pilgrim Health Care, crystallize our country’s healthcare priorities. He describes a longstanding tendency to value technology-based care over time-based care, and he contrasts this with other advanced countries that tend to balance the two almost equally.
Time-based providers include primary and behavioral care clinicians. He notes that the entire US healthcare system has been built to support and enhance technological innovation. We can see this in our own field as funding flows for tech solutions while payer fee schedules are frozen for professionals. Some clinicians may get high private-pay fees, but this only distracts from the underlying problem.
None of this will change without planning. One strategy might be termed “catch-up” compensation. Salaries and insurance fees have been low for decades. We need to stop this trend and reverse years of inadequate funding. The goal is parity with medical pay rates, and small annual increases will not achieve this. We need plans for catch-up funding, by position, with medical roles as reference points.
This idea fits with another reality. Healthcare organizations are steadily acquiring behavioral companies. A good time to create parity in salaries is upon a transition in ownership. This problem will not self-correct. Better compensation being offered recently in a few well-funded companies changes little. They are likely to be the exception rather than a precedent-setting development.
Compensatory pay increases can be phased in over a few years since a single increase would be onerous. Where might this work begin? Behavioral executives negotiating mergers and acquisitions with healthcare entities could build such compensation increases into their agreements. This would create a new, equitable starting point for salaries.
Most people prefer to ignore this historically rooted problem. However, it bears emphasis that our field cannot recruit and retain the best employees without changes. Consider the findings of one state survey last year: “for every ten master’s level clinicians hired, approximately 13 master’s level clinicians left their positions.”
Inequities exist from top to bottom in behavioral pay scales, and yet shining a light on the issue is hard amid so many glaring problems. Public outrage about poor access to care is growing. We should consider linking these deficiencies. Both issues need attention and comprehensive solutions are best.
Generous investments in tech trigger another opportunity for creativity. When CFOs are ready to spend money on technology to improve their organization, it may be a good time to propose human capital investments. Why not nurture people to increase operational performance?
We should collaborate as a field in finding a path forward. Let us jump the tracks together. We should not only ensure individuals achieve equitable compensation, but also help them avoid the discomfort of solo negotiations. Yet compensation is not the only issue needing attention.
Trends impacting physicians for years soon will be shaping our field. The result will be a steady decline in the ranks of private practitioners. We should focus on potential issues for salaried employees. Some of their concerns are distinct from private practitioners. Our next article will address their challenges.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health. Carrie Singer, PsyD is executive director of Quince Orchard Psychotherapy and founder of TheraHub.
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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