Skip to content
Psychotherapy Notes
  • Exam Prep
    • California LMFT Clinical Exam Prep
    • California LMFT Law & Ethics Exam Prep
    • California LPCC Law & Ethics Exam Prep
    • California LCSW Law & Ethics Exam Prep
    • National MFT Exam Test Bank
  • Advocacy
  • Books
    • Basics of California Law for LMFTs, LPCCs, and LCSWs (10th ed)
    • Saving Psychotherapy
    • Preparing for the 2023 California MFT Law & Ethics Exam
    • Preparing for the 2023 California Clinical Social Work Law & Ethics Exam
  • Blog
    • Blog home
    • Psychology
    • Professional Counseling
    • Family therapy
    • Clinical social work
    • Law and ethics
    • Education
    • Employment
    • Licensure
    • Public policy

Therapist shortage, or saturation? Depends who (and how) you ask

May 30, 2018 by Ben Caldwell

Marcelo Colmenero / Burst / Used under licenseCalifornia suffers from a severe and worsening mental health workforce shortage. In fact, much of the US is in the same boat. There simply aren’t enough qualified mental health professionals to meet our country’s needs.

At the same time, therapists in private practice often complain about their local markets being saturated. There are so many therapists in some places, it seems, that it’s hard to get a career off the ground.

As it turns out, there’s truth to both of these perspectives.

We don’t want to be where we’re most needed

As some bar-napkin math at this very blog showed a few years ago, therapists in California tend to cluster in urban areas, and in particular, in areas with money. (That informal-is-putting-it-lightly research was corroborated by the far more formal and detailed recent report. Its state maps by county are worth a look.) That’s not really surprising, but it is important in understanding how both shortages and saturation can exist at the same time. If you are able to work with severe mental illness in rural areas, there is huge demand for you. If you’re wanting to work with rich urbanites in a cash-pay practice, you’re going to have a lot of competition.

The supply-demand disconnect

Unfortunately, some of the more basic rules of supply and demand don’t seem to apply when it comes to mental health careers. Simply put, the jobs where there is the most need for mental health care — and the pay should therefore be highest — oddly don’t pay very well. While there might be more competition in a richer, urban area, if you can make a practice there work, you can make more money than you can in a higher-need area.

This is a known thing, particularly among those hiring for those high-demand jobs. Dawan Utecht, behavioral services director for Fresno County, told the Los Angeles Daily News last year, “Pretty much any licensed clinical position is hard to fill” in her county. Like many inland counties, they use prelicensed therapists for many jobs, but those therapists leave for better opportunities once licensed (and often even before that).

The LA Daily News was appropriately matter-of-fact:

Pay is a significant factor. Salaries for behavioral health professions are lower relative to other occupations with similar education and training requirements — meaning they get the same loan debt but less of a payoff.

While the solution here seems at first painfully obvious — raise salaries! The people you want have graduate degrees and years of experience! — public systems often struggle to raise salaries for mental health workers. In California, counties literally have $2.5 billion in mental health funds just lying around, but counties’ struggles in this area can be more procedural than financial. Getting approval for significant salary bumps can be an administrative and political quagmire. So other policy solutions are being considered instead, like increased use of telehealth.

In fairness to those public systems, it’s also true that rules about supply and demand aren’t working when it comes to the hiring process. It doesn’t make sense that so few therapists would be willing to move to a more rural or high-need area, or to work in a public system. Sure, pay may be lower than in an urban area or in private practice, but other factors should balance that out (lower costs of living, better benefits, better job security). It seems that a great many therapists would rather scratch and claw for a part-time, inconsistent, cash-pay private practice — a risky endeavor — than take the relative security of a salaried position in a high-need area.

Of course, each of us is entitled to our preferences. You could argue that I’m a great example of the problem. I have a part-time, cash-pay, private practice. I have a home and a family in Los Angeles. You couldn’t pay me enough money to move to an inland county. The point here isn’t that such choices are morally better or worse. Rather, it is to note the impact when such a large proportion of mental health workforce actively rejects the jobs where we’re most desperately needed.

It isn’t just a therapist workforce problem

The medical field is facing the same concern. General practitioners are desperately needed; much of the country qualifies as a shortage area. But since new doctors gravitate toward more lucrative specialty work, states have been gradually expanding the scopes of practice of others who can meet at least some unmet medical needs. Pharmacists, nurse practitioners, and psychologists have all stepped in to fill some of the gaps left by the country’s lack of physicians (and specifically psychiatrists).

That process should be instructive for therapists looking to see what the future holds. With a shortage of qualified mental health professionals in too many areas, more of our functions will be turned over to substance abuse counselors, peer counselors, and other professionals and para-professionals. Squirm as we might at the notion that our scope of practice is being encroached upon, it’s the only way for some areas to get the mental health care they need.

Ed. note: This post is presented here through a partnership with our friends at Prelicensed.com. Check out their great blog, and job listings for paid prelicensed positions (primarily for prelicensed MFTs in California).

Share this:

  • Email
  • Tweet

People who read this article also read

Post navigation
How do bad therapists stay licensed?
Podcast episode 9: Measurement with Casey Meinster
Saving Psychotherapy
Saving Psychotherapy: How therapists can bring the talking cure back from the brink
An action plan to improve your practice while helping the whole field. An unflinching, data-driven, and ultimately optimistic look at where we are and how your practice matters to all of our shared futures.
 
Get it on Amazon

People are reading

  • CareDash shuts down
  • Decoding counselor alphabet soup: LPC, LPCC, LMHC, and more
  • What's the difference between an MFT (or LMFT), an LPC (or LPCC), and an LCSW?
  • Eight interview tips when applying to an MFT graduate program
  • Therapists should not write Emotional Support Animal letters

Recent Posts

  • CareDash shuts down February 3, 2023
  • How to diagnose telehealth connection problems January 18, 2023
  • Are licensing exam prep courses a good value? January 17, 2023
  • MFTs, Counselors will become Medicare providers in 2024 [updated] December 21, 2022

Basics of California Law for LMFTs, LPCCs, and LCSWs – 10th ed

Basics of California Law for LMFTs, LPCCs, and LCSWs - 10th edition front cover (c) Copyright 2023 Ben Caldwell LabsTenth edition (2023). A concise, digestible summary of vital elements of state law for master’s level therapists and mental health professionals.

Online California MFT Law & Ethics Exam Prep

Matthew Henry via Burst / Used under licenseBe ready for your test in 7 days with our study plan, video lectures, and practice questions. All for less than half of what competitors charge.
 
Start now

Preparing for the 2023 California MFT Law & Ethics Exam

Preparing for the 2023 California MFT Law & Ethics ExamThe easiest way to get ready for California’s MFT Law & Ethics exam. Includes a study guide and more than 100 practice test questions with rationales.

Ben Caldwell Labs

Psychotherapy Notes is the official blog of Ben Caldwell Labs

All content and images © Copyright 2009-2023 Ben Caldwell Labs unless otherwise noted.
Some images are used under Creative Commons licensing (information embedded).

Ben Caldwell Labs, the Ben Caldwell Labs logo, and Psychotherapy Notes are registered trademarks of Ben Caldwell Labs Inc.

The opinions expressed on posts on this site are solely those of the author.
While this blog does sometimes cover legal issues, unless otherwise noted authors are practicing clinicians and not attorneys.
Nothing here should be interpreted as legal advice, nor should it be considered a substitute for consulting with a qualified attorney.
  • Exam Prep
    • California LMFT Clinical Exam Prep
    • California LMFT Law & Ethics Exam Prep
    • California LPCC Law & Ethics Exam Prep
    • California LCSW Law & Ethics Exam Prep
    • National MFT Exam Test Bank
  • Advocacy
  • Books
    • Basics of California Law for LMFTs, LPCCs, and LCSWs (10th ed)
    • Saving Psychotherapy
    • Preparing for the 2023 California MFT Law & Ethics Exam
    • Preparing for the 2023 California Clinical Social Work Law & Ethics Exam
  • Blog
    • Blog home
    • Psychology
    • Professional Counseling
    • Family therapy
    • Clinical social work
    • Law and ethics
    • Education
    • Employment
    • Licensure
    • Public policy
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.