As addiction treatment providers across the country struggle to recruit and retain health care professionals and staff, Americans with substance abuse disorders can be left waiting for services — a delay that can make the difference between life and death.
The federal Substance Abuse and Mental Health Services Administration estimates about 10 percent of Americans with substance use disorders receive treatment. Experts have attributed that low percentage, in part, to the lack of providers.
Despite a 2014 federal push to grow the behavioral health workforce, that gap is expected to grow in the coming years, with SAMHSA projecting significant shortages of psychiatrists, substance abuse and behavioral disorder counselors and substance abuse social workers by 2025.
U.S. Rep. Katherine Clark, D-Melrose, is looking to change that.
The congresswoman, along with Kentucky Republican Rep. Hal Rogers, has sponsored legislation that seeks to encourage more people to enter the substance abuse disorder treatment field by offering student loan repayment to those who agree to work in high-need areas — places with a shortage of mental health professionals or a high rate of drug overdose deaths.
Clark, whose bill would allow eligible participants to seek repayment up to $250,000, said the proposal comes in direct response to workforce concerns raised by treatment providers across Massachusetts.
The congresswoman worked with treatment officials to craft the legislation’s student loan repayment system in a way that mirrors similar programs that aim to entice workers in other sectors of the health care industry.
“We’ve seen this be very successful in other models of medical treatment and we hope that this will be a good way of building the workforce that we need to address the opioid crisis,” Clark said in a recent interview.
“We have a workforce crisis in addiction treatment, not only in Massachusetts, but we’re seeing it other parts of the country. I think that this is a step that can be part of the answer.”
To qualify, participants must agree to work in full-time substance use disorder treatment jobs in high-need areas for up to six years. Eligible positions include direct patient care roles such as physicians, registered nurses, social workers and recovery coaches, among others.
Association for Behavioral Healthcare President and CEO Vic DiGravio, who worked with Clark’s office on the bill, said the student loan repayment program could go a long way toward growing the workforce and lowering turnover.
Although much of the conversation around addressing the opioid crisis has focused on the need for more treatment beds, DiGravio stressed that “opening a new treatment facility is not going to work if you don’t have the staff.”
“As crazy as it sounds, finding the capital to build a state-of-the-art facility and furnish it and everything is the easy part,” he said.
DiGravio said members of ABH struggle to hire and keep addiction treatment staff as demand grows in response to the opioid crisis, with some workers leaving for better salaries and others experiencing burnout.
While some members can afford to pay for high-level positions like doctors and psychiatrists with annual salaries above $200,000, that amount is typically about a quarter less than what those same workers could make at acute care hospitals or other facilities, he said.
That, coupled with student debt, makes it hard for many to stay in addiction treatment long-term, DiGravio said.
“If people are reading this and saying, ‘This is a giveaway to rich doctors,’ nothing could be farther from the truth,” he said.
DiGravio added that doctors and those with advanced degrees are not the only ones who could benefit from Clark’s bill, as its intentionally broad language could apply to “any loan for education or training for a substance use disorder treatment job.”
He noted that direct care workers also often leave their positions at treatment facilities to take better paying jobs in order to make ends meet.
“On the lower end of the spectrum, for direct care workers, what is not all that uncommon is that people leave our members to go work at McDonald’s or Wendy’s because they can pay better hourly wages than our members can,” DiGravio said.
Katherine B. Wilson, the president and CEO of Springfield-based Behavioral Health Network Inc., said as a designated health care shortage area, her organization has already benefited from other loan repayment programs similar to the one in Clark’s bill.
“It’s very helpful for getting people to take a look at us. If we have a professional who comes to us — a social worker who has $40,000, $50,000 worth of tuition payment loans that they have to pay back — they could apply for a job and they could apply for the loan repayment,” she said. “And we do have individuals who have gotten some pretty impressive amounts of money to pay off their loans.”
Although that program has helped recruitment efforts, Wilson acknowledged that BHN still faces challenges in hiring experienced professionals given the salaries it can offer potential workers — amounts she said are often set through state contracts and are not always market-rate.
“We might have to take people with less experience to start with because they’re willing to take lower compensation than a really experienced individual. And then we will provide training and support and supervision to help them get to the level of experience that we need, but that may take a little bit of time, and it takes time away from our really experienced staff to provide them that support,” she said. “It’s an expensive endeavor.”
Henry Julio East-Trou, executive director of the Gandara Center in West Springfield, said Clark’s proposed loan repayment program could particularly help organizations like his, which can face additional challenges when trying to recruit the diverse, bilingual staff needed to provide culturally sensitive services to Western Massachusetts’ Hispanic community.
East-Trou said a student loan repayment program would make clinics like Gandara more competitive with hospitals and other facilities in attracting such in-demand professionals. He said he has had to recruit workers from Spain because he can’t find enough Spanish-speaking providers in Massachusetts.
Beyond workers, stakeholders argue that those seeking addiction treatment could be among the biggest beneficiaries under Clark’s bill.
“If somebody is suffering from an opioid addiction and they wake up one day and say, ‘This is it, I’m going into treatment, because I don’t want to live like this anymore,’ if they can’t get into treatment for two or three days, then that whole impetus they had when they woke up could be gone,” DiGravio said.
He added that workforce shortages have also created gaps between when patients leave detox and begin the next phase of treatment.
Another challenge, Wilson said, is that organizations like hers “might not be able to offer a long-term relationship with a professional residential provider, or a direct care support staff” due to turnover.
“That’s a difficult change for people to sustain,” she said. “It doesn’t mean the quality of what we do isn’t good, but it’s hard to sustain consistency in the quality when you’re having to bring in new people.”
Clark said she’s hopeful the measure, which recently cleared the House Energy and Commerce Committee, will pass the chamber along with other bills related to addressing the opioid epidemic by Congress’ summer recess.
U.S. Sens. Joe Donnelly, D-Ind., Lisa Murkowsi, R-Alaska, and Maggie Hassan, D-N.H., have introduced a companion version of the bill in the Senate.