Social Workers in Health Care Are Not Expendable

Social Workers in Health Care Are Not Expendable

In March 2005, the National Association of Social Workers (NASW) and six major social work organizations held a Congress of Social Work that convened four hundred of the profession's top leaders to discuss what was happening with social services in the United States. One of the goals of this meeting was to look at barriers to good psychosocial care and to develop a common agenda for transforming the nation's social service landscape.

Predicted changes in the country's demographics over the next several decades are expected to significantly increase the demand for social-work services. With the aging of the baby boomer cohort and the continued lengthening of the average life span, the number and proportion of older Americans is quickly rising. It's predicted that by 2030, our country will have roughly 71.5 million people over the age of 65 more than double the amount in 2000. Given these changes, the Bureau of Labor Statistics estimates that the demand for new social workers will increase between 18 percent and 26 percent by 2014.

Through its newly launched Center for Workforce Studies, NASW set out to better gauge the adequacy of the current and future supply of the frontline social work labor force. This March, NASW announced findings from its first national study, "Assuring the Sufficiency of a Frontline Workforce: A National Study of Licensed Social Workers."

In partnership with the Center for Health Workforce Studies at the University at Albany, and with funding from the Atlantic Philanthropies, the John A. Hartford Foundation, Annie E. Casey Foundation and the Robert Wood Johnson Foundation, the center conducted a national survey of ten thousand licensed social workers.

The survey revealed much about the scope of frontline social work practice. Licensed social workers provide professional services to a broad cross-section of clients. The report illuminated the role of social workers in a variety of settings, but also generated concerns about the current and future supply of social workers. Among the key findings were:

  • The most commonly reported practice areas or specialties of licensed social workers are mental health (37 percent), child welfare/family (13 percent) and health (13 percent). Nine percent of social workers report their primary practice area as aging, and eight percent as school social work;
  • Social workers have advanced educational preparation and practice experience. Social workers with master's degrees have an average of fifteen years experience;
  • Client populations are frequently from vulnerable groups such as children and older adults or are individuals with serious physical or mental disabilities;
  • Social workers are significantly older than the U.S. civilian labor force. In the social work labor force, social workers aged 45-54 constitute 33 percent of the workforce; in the civilian labor force, that age group makes up 23 percent;
  • The geographic distribution of social workers is uneven, resulting in gaps in access for people in rural areas and small towns. More than 80 percent of licensed social workers provide services to older adults practice in or near cities, while only 3 percent practice in rural areas;
  • Over the two years preceding the survey, social workers experienced increases in paperwork, severity of client problems, caseload size, waiting lists for services and assignment of non-social-work tasks;
  • Social work salaries have a high variability. The wages of health social workers are higher than the average wages of licensed social workers overall (MSWs in medical settings earn $50,707);
  • Twelve percent of respondents report plans to leave the workforce in the next two years.

In particular, the NASW workforce study examined the sufficiency of the supply of professional social workers available to meet the needs of aging baby boomers a group that is expected to place unprecedented demands on health and social service systems in the near future.

In healthcare settings, social work professionals help patients examine their options and guide them through their health concerns. They also understand the impact of a diagnosis on the patient and others who play a critical role in the care-giving process. The Institute of Medicine's recent report on quality care clearly delineates the critical role of social workers in relation to an individual's cancer survivorship.

Unfortunately, the rhetoric of patient-centered and holistic health care is not supported by the reality of most reimbursement provisions and service offerings. Despite much evidence to the value of providing psychosocial services in healthcare settings, social workers risk becoming an expendable part of the health workforce.

The Future

NASW, the social work education community, advocacy organizations and employer stakeholders have partnered to develop a National Social Work Reinvestment Initiative that will assist in recruiting, retraining, and retaining the needed social work workforce. For example, incentives such as scholarships, stipends, and loan forgiveness are needed to attract social workers to the field of gerontology and health.

Three critical challenges to the social work profession were identified in our research: replacing retiring social workers; recruiting new social workers; and retraining the social work labor force. We know that if there are to be adequate numbers of social workers to respond to the needs of clients in this decade and beyond the sufficiency of this frontline workforce must not only be ensured, it must be prioritized.

Elizabeth J. Clark, PhD, ACSW, MPH, is executive director of the National Association of Social Workers, the world's largest organization of professional social workers, with more than 153,000 members.