The State of the Profession in a COVID World
Curt and Katie chat about the current state of the Mental Health Profession. We give our opinion on a recent report from SimplePractice, looking at what they included as well as what we think is missing. We explore how COVID has impacted burnout rates and give action steps professionals can take to support each other as we continue to move forward as a field. We also talk about barriers in our field and what is coming next.
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Click here to scroll to the podcast transcript.
In this episode we talk about:
- 0:53: What do Curt and Katie think about the report? And how do demographics and length of time in the field impact how long clinicians stay in the profession?
- 2:27: Who feels burned out the most and what are action steps professionals can take to help each other with this problem?
- 7:44: How do financial burdens and parental burnout impact a clinician’s ability to work in this field?
- 10:50: How do insurance regulations create barriers for clinicians and clients?
- 15:38: How has COVID impacted use of technology in the field and accessibility to care?
- 18:55: Who are the therapists in the field and who are they working with (demographics)?
- 23:18: How do social justice issues impact burnout rates?
“If we don’t address both the access issues, as well as the diversity issues, I think mental health stays broken.” — Katie Vernoy, LMFT
- 24:56: What comes next for our profession?
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GreenOak Accounting specializes in working with therapists in private practice, and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly service options that can be catered to a practice’s needs – from basic bookkeeping to premium CFO services. Other specialized services include Profit First Support, compensation planning, and customized KPI Dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice, and offer unsurpassed support along the way.
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Who we are:
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
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Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
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Full Transcript (autogenerated):
Curt Widhalm 00:00
This episode is sponsored by SimplePractice.
Katie Vernoy 00:02
Running a private practice is rewarding, but it can also be demanding simple practice changes that this practice management solution helps you focus on what’s most important your clients by simplifying the business side of private practice like billing, scheduling, and even marketing.
Curt Widhalm 00:18
Stick around for a special offer at the end of this episode.
Katie Vernoy 00:23
This episode is also sponsored by GreenOak Accounting.
Curt Widhalm 00:26
At GreenOak accounting, they believe that every private practice should be profitable. They’ve worked with hundreds of practice owners across the country to help them gain Financial Peace of mind and assist them with making smart financial decisions.
Katie Vernoy 00:38
If you’re interested in speaking with a member of their team, visit their website at greenoakaccounting.com today.
You’re listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 01:01
Welcome back modern therapists. This is the modern therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about all things therapists, therapists related, and today’s episode we are going to be discussing from our friends over at SimplePractice, they came out with a report called the state of the mental health profession, impact of COVID-19. And they had done a survey of a lot of mental health professionals from all across the United States. And this was published here in the first part of 2021. There’s about 2500 respondents on this, and we are going to go through and talk about some of their findings, some of our reactions to this, and maybe kind of look at the way that Katie and I do the way that our profession goes forward. So Katie, what are your first thoughts on what you’re finding out of this report? We’ll also link to this in our show notes at mtsgpodcast.com but Katie, what are your thoughts on this?
Katie Vernoy 02:06
I think a lot of the report feels very common sense, I think there’s a lot that we know, intrinsically or or instinctively, maybe that’s a better word that is really showing up in this report. But I think it does have some good data that shows us things more concretely, to me, there’s there’s definitely things that are of concern, that I feel like we probably want to address, maybe not in this episode. But like as a society as a profession. We want to address these things. And one of them is the differential way that demographics and length of time in the profession impact clinicians, because to me, there’s a sense that when folks have been in the profession longer, and they actually stay in the profession, I think there’s a different way that we approach it versus the time stirring, which we’re new in the profession and have a little bit less control. I feel like that’s a little vague, but but maybe we can dig in. And I can point out some of those thoughts. I think it’s it’s something where we need as the two of us being experienced clinicians who have chosen to stay in the profession for this length of time, may want to reflect on why our newer colleagues or colleagues of color and color colleagues with other types of marginalized identities are having some different struggles than we are.
Curt Widhalm 03:29
So one of the first sections of this report is specifically diving in on this is who feels burnout the most. And this was broken down into aged categories with percentages of people who’ve always or often have feelings of burnout, those who rarely have it and those who report no such feelings and really stark differences in some age groups here 27% of those aged 35 and under reported always feeling burnt out. And these numbers go down in the higher categorical areas based on age 20% of 36 to 45 year olds 18% to 46 to 55 year olds, 13% of 56 to 65 and only 6% of those age 66 or older. And to me there’s, you know what you’re talking about here of oftentimes, younger therapists don’t have as much control over what their practice is, as you’re mentioning that your pre license you’re working in agencies, you might not have as much of an opportunity to have control over your case loads when you see people how you see people that oftentimes being in this profession longer ends up affording us either the ability to shape our practices or private practices in the way that we want from moving up into supervisory or managerial positions that give us more control over our day to day. We also in this I think are missing that there. Usually a lot of survivorship bias that comes into questions like this. And this was something that we had originally first talks about in the very first therapy reimagined conference that you had I did our presentation on that, when it comes to Later career therapists and the research that’s done on them, the people who are going to burn out and leave the field have long already burnt out in the field. And so the survivorship bias here might also be that those people who have a longer career have given me in some of those older age categories, have either a learned how to deal with the stresses better, might have easier abilities to control their schedule, but also just might be more naturally inclined to handling the kinds of stresses that come because those people who are feeling beartown, to those younger categories, might be the ones that have already left the field by the time to get to those older age categories.
Katie Vernoy 06:03
Another thing that I’m thinking about too, is that this is really broken down by age, but not necessarily time in the profession. And as therapy is a great second, third, fourth career and oftentimes can be a retirement career, folks who have had other careers have different financial situations, may be less likely to be burned out in later, later ages, because they have designed it that way. They have that financial buffer that someone starting in the career in their 20s and 30s, may not have and and they also have some of the skill sets from working in potentially high intensity professions like corporate careers, and that kind of stuff, where they can then turn to those skill sets to help manage those things. So to me, it’s, it’s something where I agree survivorship biases here, I think there’s also differential experiences when people enter the field at different ages, because I think that there’s different things that you bring to the table.
Curt Widhalm 07:02
So one of the takeaways here, one of the action steps when it comes to using this kind of data is, if you’re a younger therapists, feel free to reach out for some help. And if you have some capacity as an older therapist, as a supervisor, as a manager, you might notice this kind of stuff a little bit more being a risk factor with some of the younger therapists that you might be working with, if it’s within your capacity to kind of check in with some of these early career therapists, younger therapists a little bit more to see how they’re doing. This might be something that helps to alleviate and normalize some of the ways that we react to burnout rather than it just being kind of a well, we’ve all dealt with it at some point. Good luck kids sort of aspect.
Katie Vernoy 07:50
Yeah. I think the other piece, and this is something where it sounds like one in five respondents under 35 wouldn’t choose their profession if they could start over. And so that potentially means that they are more likely to leave the profession, or they won’t be the word of mouth to say, hey, being a therapist is cool. In our series of fixing mental health care in America, we referenced the RAND report and those types of things, where we’re looking at what is needed in society. And we need more therapists, we need more mental health providers. And so as a manager, as a supervisor, as a professor, as someone who is potentially in a position to mentor or steward someone into the profession, or to succeed in the profession, you know, like help them out, it’s our profession could really go the way of the dodo bird, if we don’t have enough people that are actually entering the field.
Curt Widhalm 08:45
And there’s things in this report that speak to this. And there’s some things that Katie and I have discussed with a number of our episodes here before but the financial burdens on younger therapists these days are much higher than they have been in the last 40 years and costs of getting degrees is eight to 10 times higher than it was for people who got the same kinds of degrees in the 80s. Here’s our annual shout out to saving psychotherapy by Dr. Ben Caldwell.
Katie Vernoy 09:18
But I think it’s more than annual at this point.
Curt Widhalm 09:23
But something that is in this report is also the parental burnout that is likely going to be associated with younger therapists that younger therapists are going to tend to have younger kids, but we’ve talked about this in one of our previous episodes about just kind of the therapist, partner responsibilities sorts of things, but younger therapists tend to have younger kids biological demographically, that it’s a lot harder to parent a infant to three year olds than it is going to be to parent a later teenager, when it comes to just self sufficiency sort of things. And those are going to be harder to parent than adults, kids who have launched out of the house and are fully independent on their own. And this is likely a contributing factor to part of this report from simple practice here just about how much this parental burnout is contributing to people trying to balance the work that they do find the right space to be able to work from home and have kids in the other room, and how it affects their ability to work with clients.
Katie Vernoy 10:36
And I think that oftentimes, and we’ve seen this in the larger society, is we do have a very feminized field. And we have another conversation to have about that. But a lot of women end up doing or, or a female identified folks end up doing parenting, that they end up being the ones that take that responsibility on. And so many folks who were required to do the parenting ended up either decreasing or leaving their work in order to do that during the pandemic. And oftentimes, it’s very hard to kind of go back from that, whether it’s with, you know, with a private practice, you can kind of add clients and stuff like that. But I think with within our field, it’s not as easy just to kind of pop in and out of jobs. Because there there are different kind of parameters that people are looking at. And work gaps oftentimes are very feared because of the impacts on clients. And so to me, I feel like being able to really understand who therapists are, and how life and society are impacting them is very important, because we want to support people, all people with all situations being able to be therapists, because if we don’t, we don’t have the lived experience that a lot of our clients need.
Curt Widhalm 11:51
Shifting to chapter two of this report on talking about the state of insurance, and looking at insurance regulations and barriers in the insurance system that’s making it stressful and expensive for clinicians to take insurance. There’s a number of quotes that are listed in here. Things like current insurance, reimbursement and time spent with billing are driving people away from accepting insurance. And I fully resonate with that kind of stuff. Currently, insurance reimbursements and time spent with billing are driving people away from accepting insurance. I know I can resonate with that you take insurance, you might have a little bit more of a background into this year.
Katie Vernoy 12:37
I think for insurance, there is a double edged sword to it a little bit because there is the reimbursement and time spent that’s that’s awful, right. In some places it is improving, I think there is room for negotiation, different states have different insurance, reimbursement rates that actually are more aligned with cost of living California is pretty awful. But I think other states kind of do better with that. The thing that I’m really seeing related to insurance, and I don’t know that it’s necessarily addressed in this report, but I think you and I’ve talked about potentially doing another episode on this is that there are large provider networks slash group providers that are negotiating directly with insurance companies and bringing on therapists to kind of take away all of that. But that means that that can increase availability of insurance. for insurance providers, I think there’s a lot of folks who are worried that if they don’t take insurance, that they won’t be able to have a full caseload, there’s access issues. And yet, with the state of the insurance right now, at least as I perceive it, it just isn’t sustainable to do a full insurance practice on your own in some areas. Because there’s there is all that oversight, there is the negotiation that you want to continue to do with insurance companies to get your rates increased. There’s a lot of chasing things down. And if you don’t want to have a biller that can be onerous, and create a lot of that busy work that is inane and exhausting. And so to me, I feel like I think we’re going to be seeing a shift and how clients access therapy when they want to use insurance. And I think that providers who are in private practice may end up at best having a hybrid practice, at worst may not really be able to be competitive, and consistent with other types of therapists that are providing insurance or that are using insurance because of some of these systems that some of these kind of things are that are being built up about it. But I know you and I have talked about doing a whole other episode on kind of the future of and the commoditization of therapy and kind of large companies taking over the healthcare space, including therapy. So I’ll leave that there. But I think that there has been for me anyway, there’s been a big need to be able to provide insurance because people were struggling financially. I think that’s not necessarily really the case in the economy didn’t really have the tank that people thought it was going to. But it is a lot more work for a lot less pay. And so I think there’s going to be a mismatch unless clients start going to these bigger providers that are willing to take on all of the burden and have therapists do that just do the therapy. So more to discuss there. But I think insurance is still going to be a big player in mental health. It’s just whether or not kind of you and me as private practitioners are going to be involved in that at all.
Curt Widhalm 15:30
I think geographically, this has a long known place in our fields that appear in large, wealthy urban areas, there’s less of a pressure to take insurance. And as a state of the profession report points out said places where it might be more rural, specifically pointed in this report is like the Midwest, where it’s significantly more clinicians who would have to be on insurance panels. And the numbers here in the report say that 75% of clinicians who responded to the survey in the Midwest are on an insurance panel, compared to a national average of 64%. So regionally, this is going to affect some people more than others. And those people who are on insurance panels are also the ones who were reporting that they’re taking more clients than they feel that they can handle right now. 30% compared to only 19% of those who do not accept insurance. So just putting some numbers to what you’re talking about here. We do have a episode coming out here in the next couple of months that we’ll be talking about some of this stuff like Katie previewed here as well. Chapter Three, state of technology. I think most of us are going to be doing at least some telehealth continuing on.
Katie Vernoy 16:47
Yeah, we’ll link to CAMFT, the California Association of Marriage and Family Therapists did a similar report and talked about, you know, kind of telehealth and that shift and the pandemic. And the majority of providers were not doing telehealth prior to the pandemic, you know, or not doing a significant amount of telehealth, and now the majority of providers are going to keep telehealth. And so I think that’s actually great. I was doing telehealth prior, I think you were too maybe a little bit of telehealth as well. And it’s nice to have a hybrid practice. And so, in the simple practice report, it says only 2% are not going to continue offering telehealth and I know that there are definitely therapists who absolutely hate it, I see you Ofra. And I also know that there are people who absolutely adore it and want to do 100% telehealth because they don’t want the overhead of an office. And so we talked about this and post pandemic practice. But I think that there is a lot of access, convenience, different types of therapy you can do with telehealth that may be very accessible for folks, or beneficial for folks so that you can kind of keep a practice that has a little bit more opportunity for you. I guess.
Curt Widhalm 17:59
One of the things that simple practice report points out that we haven’t talked about yet is the infrastructure problem of good internet. And this being a issue across the country of being able to have good enough internet to have regular, good quality video Sessions is a problem that many people face. And while this is definitely a necessity for reaching clients in those areas that a lot of these telehealth laws are designed to help those who can’t be reached by clinicians that there’s too few mental health workers who are there. It’s a necessity, and really to continue to build and provide on our national mental health system, telehealth is going to have to be a cornerstone of it. But it goes hand in hand with the ability to have good internet in those places. We’re no better if those people cell phone coverage. If it sucks, and you’re only hearing every fifth word, it’s more frustrating to be on it than it is to not really be a part of the conversation at all. And the same thing is gonna be happening with our our telehealth here that we’re reliant on getting good internet to people in those places in the first place. And some of the clinicians responding to this report are facing that on the delivery end to that further places a burden on those clinicians and a further frustration for them.
Katie Vernoy 19:30
Yeah, I think we did talk about this a little bit in the conversation with the RAND folks and I, I feel like the call to action in this regard is maybe identifying and understanding any kind of laws or infrastructure around internet so that we can actually provide better coverage for mental health care, because I think that would that would make a huge difference. So before we close up, I do want to circle back to something a little bit earlier in the report, because I think it is important to look at and it’s it’s something that I think was very resonant for me. And it also, I think I have a personal response to it because of the way that my practice is evolving. And, you know, I am currently a hybrid practice but may not continue to take insurance, which then would would impact this for me, but looking at who are therapists, demographically, when we look at 66, and older 95% are white clinicians, 3% are other and 2% are black, when we go down to 35, or under, so people who are aged 35 and under, it’s still inordinately more white people, it is 77%. But now we’re up to 7% black therapist, 4% Asian therapists, 4% Hispanic therapists and 7% other therapists, and there is an increase in diversity with newer therapists. This is exciting. And I hope that trend continues. Because I think that there’s a need to have more lived experience opportunities for clients and folks that can, you know, people will go to therapy, if they see that therapist look like them. I think the thing that I’m I’m looking at, as well is in this next part, it says that 53% of white clinicians reported not working with any underserved populations. And so there’s a few things that I’m drawing from this one is white people are generally working with rich white people. I think. And I guess it doesn’t talk about in this section, it doesn’t talk about demographics. But I’m also thinking about income potential because of reimbursement rates from insurance, I’m thinking about access. And you know, if we have so few therapists that are black, Asian, Hispanic, or I guess it says other specialty, so I don’t know if that what that means on this report. But I think if we don’t, if we don’t support our younger clinicians, with that have a larger, you know, it’s a more diverse population of therapists. Access for some of these underserved populations and simple practice lists them as low income or unsecured clients, LGBTQ population, Medicaid recipients, populations with disabilities, and veterans. If we don’t address both the access issues, as well as the diversity issues, I think mental health stays broken.
Curt Widhalm 22:36
As you’re talking about this, I’m looking at some of these comparisons here. And well, not quite to the same extremes, I’m seeing some very similar trends with Asian therapists, as white therapists have not working with as many of the underserved populations, black and Hispanic therapists seem to have similar numbers to each other. Just by comparison here, and looking at traditionally where the demographics of these two different groups come from that we’ve known historically, that way therapists, as you pointed out, tend to come from wealthier backgrounds to start with. And this gets maybe even into some of the model minority influences that has led to Asian therapists into some of the same similar trends, I don’t know that would be kind of the area where I would want to research more into this to see if that’s where that trend comes from. But speaking to black and Hispanic therapists, what we do know as far as trends go, is that a lot of white therapists enter into this field because they had a good experience with therapy, typically as a child or as a young adults that led them into this fields, whereas a lot of the research that’s emerging about black and Hispanic therapists is that they’re entering into this field because they didn’t have those good experiences, and are more likely to be returning back to working with the communities that would be underserved in the first place. And so the motivations for entering into the profession are quite different. Just from the get go on this. Yeah. As I’m also hearing you talk, one of the thoughts that I had is going back to the burnout question, and especially around age groups. This is also a year with a tremendous amount of social justice action, which tends to be things that younger people are involved with in the first place. And before anybody shoots us off an email or complains on social media to us. I’m not saying that older people don’t but statistically, yes, younger people are the ones who are more involved in these social justice movements, which has been a huge emotional piece of this last Last year for a lot of the world, but especially here in the United States. And so if you add the social justice burden on top of everything else that we’ve already discussed, I can see how that’s potentially another factor that can be explained in this report or that isn’t specifically called out in this report.
Katie Vernoy 25:21
I agree. I think there’s so much that younger therapists clinicians of color, especially have been facing in the past year given, especially the racial injustices that have been increased or spotlighted this year. And so I think that has to go hand in hand with some of these other types of burnout that people were experiencing. And so call to action here, I think is take care of each other. I don’t know. I mean, it seems like this is a pretty systemic issue.
Curt Widhalm 25:58
There is a summary at the end of this report. Now, what comes next. And this is even where some practices wording on this. And the challenge with kind of this institutional support is not really been clear of what it is. You know, I see Dr. Caldwell floated here directly, but I just know from a lot of our conversations with him that a lot of this whole section has his fingerprints all over it.
Katie Vernoy 26:29
Curt Widhalm 26:30
Yeah, there’s, there’s no quoting here, there’s no way to put the industry on pause. People are always going to need mental health care. We can’t tell people stop coming to therapy. Well, we just reorganize what we do. Yeah. And we do, as a field end up placing so much emphasis on individual responsibility for things like self care. And self care has been hard, especially if you’re in one of those groups that we’ve been talking about the you know, do you have kids, it’s not like you can like, keep the babysitter an extra couple of hours during the pandemic here. Like if you’re overworked, seeing a bunch of clients and having the parental responsibilities in the background and the educational responsibilities of teaching them from online school and all of that kind of stuff. Back to Caldwell does, but that, as far as getting some structural fixes, means having laws, policies and practices insured, fair and timely reimbursements, things that make telehealth care easier, and enables providers to lead more balanced lives. I will point back to the presentation that we did right before the pandemic, at the foundations of connection conference in Hawaii, about some of the structural self care things too. And if you’re in a place of influence within your organization, or even if this just means for yourself, of being able to really help create systems around nice closures to your workday, having a balanced flow throughout your work week. These are things that can be applied on both the micro and the macro levels. But just Dr. Caldwell suggesting here. We do need some systemic influential changes when it comes to things like insurance, and our ability to continue to practice here.
Katie Vernoy 28:27
So I’m looking forward to kind of continuing the conversation on what’s next. I think that there’s a lot of innovative things that are exciting, and they’re innovative, things that are terrifying, that are coming about that may impact some of these areas for good or for ill. And I think that there are opportunities for advocacy that may come out of the huge mental health need that we’re seeing at this time. And so if you haven’t started listening to our series on fixing mental healthcare in America, I would suggest that we’ll link to it in the show notes. We’ll also put the structural self care, or I think it’s structuring self care. I don’t know what the podcast title is, but we’ll put some links to some of the relevant episodes, as well as this report and the camp’s report in the show notes. But really, what this is saying is, this is hard. We know it’s hard. We’re gonna keep doing therapy because people need therapy. But let’s see if we can find ways to support ourselves but also fix the system.
Curt Widhalm 29:30
You can find our show notes at mtsgpodcast.com, follow us on our social media. And till next time, I’m Curt Widhalm with Katie Vernoy.
Katie Vernoy 29:38
Thanks again to our sponsor, simple practice.
Curt Widhalm 29:41
Simple practice is the leading private practice management platform for private practitioners everywhere. More than 100,000 professionals use simple practice to power telehealth sessions schedule appointments, file insurance claims market, their practice and so much more. All on one HIPAA compliant platform.
Katie Vernoy 29:59
Get your first two months of simple practice for the price of one when you sign up for an account today, this exclusive offer is valid for new customers only. Please note that we are a paid affiliate for a simple practice I will give a little bit of money in our pocket if you sign up at this link simplepractice.com/therapyreimagined. And that’s where you can learn more.
Curt Widhalm 30:20
This episode is also sponsored by green oak accounting.
Katie Vernoy 30:24
Green oak accounting specializes in working with therapists and private practice and they have helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly service options that can be catered to a practices needs, from basic bookkeeping to premium CFO services. Other specialized services include profit, first support, compensation planning, and customized KPI dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice and offer unsurpassed support along the way.
Curt Widhalm 30:55
If you’re interested in scheduling a complimentary consultation, please visit their website at greenoakaccounting.com/consultation to learn more.
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