The US is Facing Massive Social Worker Shortages – What Can be Done About it?
While you can find social workers in hospitals and public clinics around the country, there is a serious gap between supply and demand, and things are only going to get worse. The United States is facing a massive social worker shortage by 2030. There are already serious regional shortages in rural areas and specific states, but the shortfall will equal tens of thousands of professionals nationwide in just a few years. How many social workers do we have, and how many do we need? What factors are contributing to the social worker shortage? And more importantly, what can be done about it?
The Current State of Social Work in the United States
There is a serious discrepancy between where services are required and where they’re available. There are certain areas of the country with few or no psychologists available. This maldistribution is worse in poor and rural areas, though those are the areas with proportionally greater need.
When asked, doctor and professor at John Hopkins University, Ron Manderscheid, stressed the severity of the situation. He also addressed the disparity between areas. “If you live in New York, or Chicago, you will get the best behavioral health services using state of the art tools”. He said. “But if you live somewhere like Iowa, or counties with a population of 15,000 or less, you’ll have trouble getting any kind of service.”
Over 85 percent of counties have insufficient or no behavioral health services. Nearly two thirds of counties have no psychiatrist. This is because more than half of healthcare social workers work in hospitals in metro areas.
The Factors Contributing to the Social Worker Shortage
There are an estimated 700,000 social workers in the United States as of 2018. The total number of jobs is expected to grow 11 percent over the next decade, significantly faster than the overall job market’s growth.
The HRSA issued a report forecasting the supply and demand of professionals in the social work field. This includes social workers, counselors, psychologists, marriage and family therapists, and substance abuse specialists. They predict a shortfall of more than ten thousand full time employees in these areas by 2025. But there are many factors that can explain why these shortages. Some of them include:
- Relatively high educational requirements required for the job
- Lack of funding and incentives for workers in rural areas
- Incredible professional demands
- The increasing complexity of challenges that social workers face
- The looming retirement wave hitting the profession
While some of the issues might be directly related to the profession, issues like the demographic shift will be harder to mitigate. Especially when considering that a portion of these workers retiring, along with any others, will be in need of assistance as well.
The Greatest Challenges Social Workers Face
The American population is aging. The number of people over age 65 was 43 million in 2012. It will hit 84 million in 2050. This dramatically increases the demand for social workers for a variety of reasons.
Far fewer people can rely on family members for care, and the elderly have far more health related and mental health issues than the young. This makes it essential for social workers to have interventions for promoting health in an aging population and have the expertise to deal with issues like dementia and isolation. This gray wave will drive demand for social workers who work in nursing homes and care facilities.
Manderscheid also had something to say about the current capacity of the workforce, which he described as “soft” due to high turnover. “We have a huge amount of churn,” he said. He also addressed some concerns about the next generation of workers and managers, specifically Millennials. “When you work your way down to Millennials, you find that many have never really taken hold in the field.” This is a serious issue for the behavior health service, and it’s not uncommon for Millennials to move to another position after one or three years. Gen Xers who now have to replace their boomer bosses as managers may not have the experience necessary either, he said.
The Breakup of the American Family
Social media hasn’t really brought us together either. Nor do online connections make up for the decreasing amount of social support the average person has. This is partially due to the breakup of the American family, though increased social mobility and smaller families overall contribute to this as well.
This has contributed to a sharp rise in social isolation. And we now know that social isolation is incredibly harmful. It contributes to actual physical pain and hormone imbalance. Social workers are now asked to help the isolated so that their mental and physical health can be improved.
Homelessness and Incarceration
Homelessness remains a serious issue in the United States. An estimated half a million people are homeless on a given night. This can impact people’s health in many ways, and the effects can last a long time. These issues are compounded by increasing housing costs, though many homeless people suffer from mental problems and addiction. Social workers are asked to develop new policies and interventions to help bring these people home.
The United States has one of the highest incarceration rates in the world as well. Approximately eleven million people go to jail every year. This is a financially and socially expensive proposition. So is the tendency of people to return to prison for violations of probation or parole or get arrested later for something else.
Social workers are asked to support “decarceration”, helping remove people from institutions, prevent them from returning, and try to reduce the odds others are institutionalized in the future. However, any strategy must protect the public safety as well. For example, many people who hit Emergency Rooms are in need of mental health services, but they end up in prison, instead.
The Opioid Crisis
Doctor Joe Parks, head of the National Council for Behavioral Health, stated that the opioid epidemic has dramatically increased demand for behavioral health services, though relatively few behavioral specialists have the right training to help them. He says that a small minority of addicts get the specialty care that makes a major difference in their trajectory.
However, he did mention that The Affordable Care Act was able to provide some relief. According to him, only 10 percent of people dealing with substance abuse disorder were able to get the help they needed before the ACA. “Under the Affordable Care Act, we were able to raise that number to around 17 percent.” But that’s still not enough according to him. “That means that around 83 percent are still not getting the care they need. These are still crisis levels.”
This means that more than four out of five with a substance abuse problem don’t get the specialized help they need. This results in more emergency room visits for drug overdoses, more deaths, and more people in prison instead of rehab.
Secondary Issues Affecting the Social Work Profession
An estimated 44 million Americans experience a diagnosable mental illness. However, that number isn’t stable. An estimated one in ten children has a serious mental health issue. The number of adolescents suffering from mental illness is on the rise, notably depression. The youth depression rate was 8.5 percent in 2011 and 11 percent in 2014, and a whopping eighty percent of young adults have limited or insufficient treatment.
This is going to increase the number of adults in need of mental health services. Yet half today don’t receive treatment. Making matters worse, these adults are in greater need of social worker support. This trend is also driving demand for mental health specialists in the social work field. Another side effect of this trend is that it increases the complexity of cases that social workers face.
Domestic violence remains a serious problem. There are an estimated ten million abuse victims every year. Many of the victims and assailants end up dealing with the criminal justice system as well. Family focused interventions can identify abuse early and stop it, minimizing long term harm and costs. Society is starting to invest in prevention because of the high return on the investment.
School districts are beginning to provide more funding “wraparound” services that provide support for students in ways that teachers can’t. This includes nurses and social workers. It creates new opportunities for social workers, but it also increases demand for social workers on the whole.
Possible Solutions to the Looming Social Worker Shortage
Addressing pay rates would improve retention in the industry, but it isn’t the only solution; increased recruitment of social workers would help as well. The greater complexity of cases social workers face is leading employers to require a master’s degree in social work. However, it is hard for someone to earn a master’s degree if they are working in the social work field.
Online education could be one of the solutions, allowing people who want to move into social work to complete the necessary degree and permit those with only a bachelor’s to become qualified for a larger number of positions. Institutions like Florida State University offer an online master’s social work that professionals can follow while keeping their positions. This is one of the few solutions that could close the rural services gap, among other issues.
More government programs like the Behavioral Health Workforce Education and Training program and employers paying for the education of local talent to become qualified social workers would reduce the cost of recruiting someone from a big metro area and hoping they stay for a few years. A related solution would be increasing the number of scholarships and loan repayment programs for those who agree to work in under-served areas.
We need to do a better job of filling the pipeline. A larger than expected number of social workers and mental health workers are Baby Boomers. Interest in social work as a profession dropped off in the 1980s. For example, while there are some Generation X’ers in social work, there are relatively few Millennials. Making social work more attractive as a profession and deliberately recruiting younger professionals could help prevent a shortage. Raising pay rates and improving work conditions would make the profession more attractive, too.
There are systemic issues that hurt the profession, as well. Low reimbursement rates for mental health services through government programs force counselors to work in private practice on the side to pay the bills. This contributes to burnout. The solution is to raise compensation rates for behavioral health providers to match other clinical specialties. As a side benefit, it would reduce the number of clinicians with cash-only practices and limited healthcare network acceptance that increases the cost for patients paying out of pocket. Forcing insurers to pay more for mental health coverage can also close the gap.
Shortages Also Open the Door to Opportunity
While social work was never viewed as one of the highest paying positions, things are changing due to rising demand, increased funding, and pressure from the public. Median pay for social workers is currently around $50,000 a year for the country as a whole. Here are some of the highest paying states for social workers.
The 10 States That Pay Social Workers the Best Based on Adjusted Salaries:
- New Jersey
- North Dakota
The highest paid social workers in the country live in Illinois. Social workers there earn roughly $56,000 a year. While California may be famed for its social safety net and pays social workers around $60,000 a year, it didn’t make the list because of living costs. The same goes for Hawaii, which pays social workers roughly around $56,000 a year on average.
Demand for social workers is expected to grow by 11 percent from 2018 to 2028, which is much higher than the national average.
Social workers are on the front lines of many different issues. Collectively, they’re underpaid and overworked. There are a variety of solutions that could address these issues and prevent the looming shortfall in the profession. The hard part is getting them in place so that those in greatest need don’t lack the support they require.