Therapists Have More Bargaining Power Than They Have in Years. Will They Use It?

The mental health professions aren’t immune from the Great Resignation happening throughout the US economy. In fact, there’s some evidence that mental health professionals are even more likely than the average worker to leave their jobs. Therapists were already struggling with burnout before the pandemic, and the pandemic only heightened the concerns of many. Stories now abound of mental health systems that are struggling with under high demand, in some cases unable to hire even enough therapists to replace those who are leaving. 

How Bargaining Power is Increasing for Therapists

Amidst all this stress, there may be a silver lining. This combination of high demand and low supply for mental health care gives therapists a great deal of bargaining power with employers and payors. It’s power that therapists may find unfamiliar, after years of grudging complaints about low insurance reimbursement rates and the long and expensive path to licensure. So, how will therapists use this new economic power? There are several possibilities, and they don’t apply equally to every therapist.

Negotiating insurance reimbursement rates

For those therapists who are in-network with insurance companies, some are finding those companies more receptive than they have been in the past to requests for rate increases. Some have even reported that insurers have proactively reached out to them to inform them of higher rates.  Insurers are under major pressure to improve their mental health coverage, given both the high demand and the struggles people faced accessing care through their insurance even before the pandemic. Despite parity laws, we’ve actually been moving farther away from parity for mental health care. Increased pay is perhaps the most direct way that insurance companies can recruit and retain in-network providers, improving access to care and parity compliance.

Negotiating pay increases and new benefits

Insurers aren’t the only ones that therapists are finding they can make new demands of. Replacing a clinician can cost an employer thousands of dollars more than taking steps to retain an existing employee, considering the costs of recruitment and onboarding. Therapists who have been wrestling with burnout or considering quitting might find their employers to be eager to work with them to improve the existing work environment. 

Of course, this is more feasible in some environments than others. While there can be exceptions, public systems on average may tend to move more slowly than private employers when it comes to improvements in pay or benefits.

Moving into private practice

For those clinicians working in public systems, the leap into private practice can seem like a major financial and career risk. Ironically, with so much present need, now may be among the least risky times to make such a move. While state and local rules vary, in many cases a therapist can launch a telehealth practice from a small temporary office or even their homes, avoiding the need to invest in a long-term office lease. And rather than having to invest heavily in marketing to recruit clients, many new practices fill quickly as clients struggle to find available care.

Of course, even the current level of demand doesn’t guarantee success in a private practice, and clinicians should still be thoughtful about making the leap. But one reason some therapists may be leaving their jobs is the realization that they can do well on their own.

Unionizing

It remains true that many therapists working for public mental health systems are legally prohibited from unionizing, and many others work in solo private practices where unionization is not possible. However, there’s also been some consolidation in mental health care, as investors have seen the opportunity to build profitable and streamlined mental health businesses at scale. Mental health apps are one part of this trend, but by no means the only one—many group practices have been growing as well.

When groups of employees work for the same employer, unionization becomes both possible and worthy of consideration. Unionized employees generally enjoy better pay and working conditions than their non-union counterparts, even in smaller companies. It’s no secret that large companies often try to stifle unionization efforts, and they wouldn’t need to do that if unions weren’t effective.

How to Make the Most of Your Negotiating Position

If you’re considering using your newfound negotiating strength, here are a few things to keep in mind. First, make a specific request. If you simply demand higher pay or better conditions, employers who want to work with you may struggle to understand—and provide—what you’re looking for. Making a specific request allows them to consider the cost, especially weighed against the possibility of your leaving.

Second, don’t issue threats or ultimatums. You’ll still want a positive and collaborative relationship with the employer or payor, and threats or ultimatums make the relationship more adversarial.

Third, have a timeline in mind. It’s unreasonable to ask an employer or payor to meet your demands within 24 hours, but you also don’t want to be left hanging, wondering whether they’ll respond to your requests. Assuming your timeline is reasonable, it may be worthwhile to state it clearly, though again, not as a threat. Something like “I would appreciate a response by [date]” can motivate a faster response without sacrificing the relationship.

Lastly, have a plan for what happens if the answer is no. In some situations, it makes good sense to take no for an answer, at least for now. It’s also okay if a no means that you step away from that job, role, or payor. As a corollary, you may also want to have a plan in mind for what happens if they say “no, but.” What’s the minimum you would want or accept in order to feel as though you had negotiated successfully?

Whatever your line is—if you are willing to use the power in your hands—your chances of success are at a peak. Now may be the best time to try.