Should community mental health workers have unions? What about counselors in private practice? The question of therapists and unions is one that has been being asked a lot lately. I mentioned in a previous blog post that counselors that are not in private practice make an average salary of just $35,000/year in Boston. This pay typically doesn’t come with any benefits either. Therapists often don’t get health insurance, paid-time-off, sick days, or over-time. And given that the average age of a therapist is over 65, we can assume that a lot of therapists are unable to afford to retire due to this low pay.
So, should all therapists just cut out the middle-man and go into private practice? Although that would be great, going into business for yourself isn’t possible for everyone and unrealistic. Is the solution that agency counselors need to unionize and pressure the agencies to pay them more? I actually don’t think that would work either and I’ll explain why. When I was thinking about forming a group practice, I crunched the numbers. I suddenly understood why the agencies paid me so little; it was because they couldn’t afford to pay more. The insurance companies reimburse at a set rate, and the agencies have a lot of overhead. They have to rent an office, pay for administrative staff, hire an office manager, and then finally give themselves the little bit of money left over to make the whole venture worth while. It wasn’t that the agencies were greedy, it was that they had to work with the parameters set by the insurance companies. They really can’t afford to pay their counselors more.
What I think would be more helpful would be if therapists could use the “collective bargaining power” of a union to negotiate higher reimbursement directly from the insurance agencies. As I’ve mentioned before on this blog, reimbursement rates for counselors are 59% less than what they were in 1992. So over 20 years ago, therapists were making about 60% more than they do now. That’s really bad when you consider how much less the cost of living was 20 years ago, as well as the cost of getting a Masters degree in comparison to today. That doesn’t seem fair to me. Another one of the problems is that the insurance calls the reimbursement that is given the “negotiated rate”, but there is no negotiation what-so-ever. Counselors are handed a contract and simply told to take it or leave it. If there was an actual negotiation process, I think that would be more fair. Perhaps that’s what a union is for.
One argument against unions is “that’s what we have associations for”. This may be a fair argument. Recently, GIC insurance switched from having United manage their mental health reimbursement to having Beacon Health Strategies do it. For many therapists, Beacon was only paying about half of what United did. This was a drastic pay cut for therapists. Imagine if your employer suddenly decided to pay you only half of what you were getting before. I think it’s fair to say that most people would be very upset by that. So the APA (American Psychological Association) asked all of the psychologists in Massachusetts to boycott GIC. And they did! This was quite the show of force from the APA. It is yet to be seen if this is going to make a difference however, as GIC is yet to renew their contract with Beacon or not. But we will see.
Although our associations do a lot, the problem is that only a small percentage of therapists belong to these associations. Association membership costs money and a lot of therapists don’t see the value in it when they are getting paid so little. Also, associations are divided between psychologists, counselors, social works, and then many sub-groups as well. These small groups don’t have the power of one united force speaking for all mental health workers. Imagine what the effect would have been if ALL therapists had boycotted GIC. I think that would have been much more effective in pressuring GIC to either drop Beacon or to get Beacon to increase their reimbursement. I think that if therapists were more united then we really could have “negotiating power” when it came to insurance reimbursements.
Is it time for therapists to get a union? What do you think?