Retain clinician

How to retain clinicians if teletherapy continues its dominance

Posted in Hiring & Firing Staff, Overcoming hardships
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Even in the best of times, every mental health practice owner worries about how to retain clinicians. And as teletherapy became the dominant method for delivering mental health services, the nervousness increased. And now, it seems that teletherapy dominance may continue for a while. 

Certainly, this transformation has dramatically changed clinicians’ daily lives. And consequently, clinicians’ ties to their organizations have shifted. Therefore, owners and managers are apprehensive.

Some clinicians have decided to go it alone and continue to work from home. Yet, the flood of clinicians’ resignations has not occurred so far. Nevertheless, the concern persists. 

So as a preventive exercise, can we think about how to retain clinicians if teletherapy continues its dominance? Let’s begin by thinking about why clinicians join a group practice in the first place. 

Why clinicians join group practices

Several facets stand out when we examine why clinicians join a group mental health practice. I am going to focus on five. 

  1. Income & benefits
  2. Referrals
  3. Office space
  4. Community
  5. Back-office support

We could pick additional factors, but these seem to be the primary factors for joining a group practice. 

What changes if teletherapy continues to be the dominant delivery system 

Understanding how teletherapy affects the motivations for joining a group will help us see how to retain clinicians.

1. Do income and benefits change?

In most cases, teletherapy would not seem to affect the potential income and benefits that attract employees. However, the length of stay per client may be affected by teletherapy. Insurance companies are terrified that utilization rates (i.e., retention rates) will go up with teletherapy. 

But no one knows for sure whether the treatment delivery method affects the length of a treatment episode. Do clients stick in treatment for the same period when treatment is delivered via teletherapy versus face-to-face psychotherapy? 

It would seem that specific therapies are greatly affected by whether it occurs in person. For example, play therapy, hypnotherapy, and other experiential therapies seem better suited to in-person treatment. Perhaps one general principle is that the more experiential the treatment, the more challenging it is to recreate via teletherapy.

So, in summary, we can say a few things:

  • Utilization rates will likely go up with teletherapy
  • Some experiential therapies have more difficulty in a teletherapy market

But can we say how this will affect salary and benefits? I think we can. I believe that clinicians will not suffer any setbacks in income or benefits. If anything, they will benefit from the ease of access. Furthermore, I do not think group practices are disadvantaged in this environment for the reasons below. 

2. Do referral patterns change?

Clinicians are attracted to group practices because of the referrals they receive by being on the team. Therefore, retaining clinicians is partly about the continued sharing of referrals that come into the organization. 

But as clinicians become more established in a community and have more of their former clients out in the community, they become less dependent on the group. The need for referrals weakens over time as a clinician deepens and widens referral pathways.

But does the dominance of teletherapy change that dynamic? Possibly.  

Here is what is apparent. Specific referral-building tools will be less helpful. For example, recently, most practices have not been able to do open houses (a group activity) or take people out to lunch (a solo activity.) 

But the bigger question is, do the limitations of the pandemic have a more severe effect on group marketing activities than solo marketing activities?

Certainly, group marketing activities have taken a hit during the pandemic. But I would argue that solo marketing activities (case management, emails, phone calls, etc.) have taken a back seat to managing the enormous volume of cases and coping with Zoom burnout. However, there are rockstar clinicians who have kept up on personal marketing and will have an advantage. 

But I also think these marketing rockstars are motivated differently. They typically are not focused on the marketing implications of their excellent habits. They do good case management because they believe it is necessary for adequate therapy. 

In summary, then, I think it is a mixed bag on how referral networks have been affected by teletherapy dominance. And the super high demand for mental health services may overpower any marketing deficits, whether group or individually-based.

3. Will the dominance of teletherapy make space irrelevant?

It is clear that some clients prefer in-person psychotherapy, and some prefer teletherapy. Moreover, a third group will go along with whatever the therapist wants. 

Certainly, some therapists will never return to the office as long as teletherapy is an option. Office space is irrelevant to them. And as long as reimbursement rates for teletherapy remain equivalent to in-person rates, they have that option. State and federal law currently support this equivalence. However, if insurance companies return to the two-tiered payment system they prefer, the incentives change.

My prediction is that as the power of the pandemic recedes in the public mind, office space will again be relevant to retaining clinicians. Pleasant workspaces will continue to draw clinicians if for no other reason than to share with colleagues the weight of the work. 

4. Will teletherapy impede the recovery of nurturing workplaces?

Elsewhere I have written about how to maintain strong workplace cultures and communities. For example, see: How to create an organization with excited committed employees. I make some suggestions that work even when teletherapy is dominant, for example: 

  1. Take turns sharing one’s story. For instance, ask people to take turns on topics like:
    1. What formative events led to your choice to become a therapist?
    2. Who were the most influential/inspiring/heroic mentors in your life?
    3. Share some of your most satisfying client moments and share why.
  2. We may not be able to share a meal together, but we could order food for each household member timed to arrive during the meeting time.
  3. Watch the same movie and discuss it at the next meeting. 

Get creative. Involve your staff in finding ways to have fun with each other. We can still build community in our time together.

These special efforts were helpful during the thick of the pandemic. And those methods may continue to be necessary. 

In my mind, the goal is to demonstrate that we are providing safe spaces to share who they are. We are always seeking to express our commitment to our workers as people. I have written other pieces on those themes:

So back to the question: will teletherapy impede the recovery of nurturing communities? To the degree that clinicians resist re-engaging with the office staff, teletherapy facilitates distance. But I think for most, even those who are not in the office much, the community will continue to be an attractive feature and a prime reason to stay in a group practice.

5. How does teletherapy dominance affect back-office support?

Certainly, the pandemic tested every organization’s back-office operations. Scheduling and billing shifted overnight. And the rules continue to constantly change. Yet, now that these adjustments have occurred, the continued domination of teletherapy does not require ongoing adjustments. Our systems have changed. Some clinicians will appreciate what the back office did for them, and some will not. 

A more significant threat to retaining clinicians is the increasing ease of utilizing online practice management systems. Nowadays, therapists with a minimum of administrative time can do the basics required to stay in business. Of course, they are unlikely to do the administrative tasks as well as professional support staff. But if they do not mind doing the basics, they can get by. I think this will be the case no matter the fate of teletherapy.

So can group practices compete in a teletherapy dominant market?

I believe many of the reasons clinicians joined a group practice in the first place remain even in a teletherapy-dominant market. 

  • Income and benefits remain essentially the same. 
  • The same challenges remain for finding ways to connect with referral networks. 
  • Office space has a different meaning but is still desirable and attractive for retaining clinicians. 
  • While nurturing the workplace community requires creativity, clinicians are social people who largely want connections with colleagues. 
  • And we have already made the required adjustments to manage teletherapy. Its continued dominance does not require additinal changes.

I am confident in our organizations’ abilities to adjust to new environments. One central lesson from the pandemic is a newly discovered capacity–our organizations’ resiliency and ability to retain clinicians while normality gets redefined. I believe that will continue.

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