Sometimes you just get tired. Tired of mountains of paperwork, tired of insurance reviews if you “go outside of the normal expected range” by offering more than one session per week when a client really needs it. Tired of greedy insurance companies dictating care; you can’t do 60 minute sessions more than 15% of the time or face audits, reviews, nasty letters and other legal bullying. There are whole hosts of things preventing quality care in the name of ever higher profits for the insurance giants. You get tired of having a doctorate or other graduate level degree, licenses and certifications yet making less money than your local car repair shop. Sure, you can leave managed care IF your client base can afford to pay out of pocket but what if your chosen clientele is the average person that simply cannot afford to pay out of pocket for health care?
I started working in the human services while still in high school; first as a peer leader and then as a stress management trainer and public speaker. My first national presentation was when I was 16 or 17 (I forget which but it was cool). Other than a year or so in the for profit business sector and a few month break when finishing my bachelors’ I have worked in nonprofit mental health. I’ve enjoyed working with diverse clientele. I have been blessed to work with everyone from those with anxiety and depression to schizophrenia to autism. I have worked in outpatient, inpatient, partial, locked wards, prison (internship), clinical school and public schools as well as home based services. I have worked in the trenches and I have excelled. I have been blessed to be able to say that except for a very few clients the vast majority thought I did an excellent job; many have credited me with saving their lives (which I deny, I simply helped them save themselves).
Years ago I grew disillusioned with the system of care often found in large corporate programs and founded a small independent nonprofit. We had no money, no equipment to speak of (no fax machine, no real computers only some used medical grade file cabinets, hand-me-down furniture and a small office) but we had a heart dedicated to making real and lasting change regardless of profit margins. We focused on people, not privilege. We really made a difference in the lives of countless individuals and families. Despite being poor and having an unlisted number, we continued to grow year to year except for one; we improved furniture, improved and expanded our office and even added a 2nd location, not because we needed a larger catchment area to keep full but because we simply could not expand our offices anymore and needed more space. Our new location which is operational but still under construction in parts will offer about 7,800 square feet of space on about 50 acres of land. We serve more folks than I ever could have imagined, many for free. We also have become a preferred site of several colleges for training graduate level interns. It is not uncommon to have folks apply for an unpaid internship position in their first month or so of graduate school.
What was once a lone clinician is now about 7-10, with many more wanting to join the practice regardless of the low pay and long hours. Most who visit the program, both clinical professionals and clients describe it as “a dream, what mental health care should be instead of what it usually is.” Still, we spend every month looking for ways to keep the lights and other bills paid as we continue to improve services and expand programming for those in need. We offer free, fresh organic produce that is grown on our farm, to anyone regardless of income and hope to one day offer housing assistance and other related programming including job skills training.
And the insurance companies continue to grind at us. The cost of programming continues to rise while reimbursement remains stagnant; one raise since we opened our doors over a decade ago and then it was a small percentage, nothing even close to the rate of inflation. Our bills continue to grow, internet, lights, supplies, mortgage, insurance, maintenance etc. while donations have slowed due to the ever growing pay gap between the haves and the have nots.
We explore options: we could go into teaching, get tenure, a pension and security while making a fair pay. We could go into research, we could go into for profit care or even worse, we could begin working for the insurance companies themselves. They have approached us on occasion and offered more pay than we could have imagined which would then increase once we show our ability at cost reduction (i.e. denying care). Imagine a world where your income is directly increased by the number of people that you deny care for? It’s all legal and many people look up to the folks that do it…
You can list a million reasons why you may want to leave health care and I wouldn’t stop you. There are many other things that you can do with your time and there are much easier ways to make a living than spending day after day working in the trenches of human emotion, pain and devastation. You may indeed be better off in another field for all I know.
So while I can’t change your mind and I lack the power to change the overall system, I ask you just one humble question: do you want the bastards to win? If we, the people that are trying to make real and lasting change allow ourselves to be run out of the profession by greedy corporate folks, only the greedy will remain because the truth is this: if you stop caring about the quality of care and focus on quantity of care, there are millions to be made. Sure, few are getting better in that system but the shareholders are enjoying the ride.
If you want to make a difference, work in the system while also trying to change it. Continue to look for ways to change the paradigm. Look for non-conventional means of financing and look for ways to be dynamic in a world that appears to frown on common sense and common decency. Above all, I know you could leave health care and maybe your life would be easier if you did, but what of your clients? What of the core reasons why you entered this field in the first place? If you are not the agent of change, who will be?
As for me, well, I find our system disgusting and dirty and filled with greed and uncaring companies. I’ve known this for years and there are times the stink of the system feels like it will never wash off, but I stay. I stay for a better future for those we serve. I stay because I refuse to let the uncaring win. I’ll stay because I am needed and when that changes, then and only then will I leave health care.
(From a recent talk about the profession).
________________________________________________________________________ "Doc Warren" Corson III is a counselor and the clinical & executive director of Community Counseling of Central CT Inc. and Pillwillop Therapeutic Farm (www.docwarren.org).