What Do We Know about the Current and Future Psychologist Workforce? Karen Stamm, PhD Director, Center for Workforce Studies Virginia Behavioral Health Summit September 27, 2018
The opinions expressed in this presentation are those of the author and do not constitute official policy of the American Psychological Association. Slides are available at the APA Center for Workforce Studies website under Presentations http://www.apa.org/workforce/presentations/index. aspx
Learning Objectives Describe trends in psychologist diversity in the training pipeline and workforce Identify patterns in the provision of psychologist services and the associated implications for cultural competency Discuss the implications of a psychologist supply that is projected to be insufficient to address unmet need for mental health services
APA Center for Workforce Studies The mission of the Center for Workforce Studies is to collect, analyze, and disseminate information on the psychology workforce and education pipeline. Psychologist vs. psychology Psychologist - person with a doctorate in psychology Psychology - discipline
Training Pipeline: 2018 Gender Diversity of Psychology Doctoral Students Male 22% Health Service Psychology Male 35% Research Female 78% Female 65% Source: APA Graduate Study in Psychology, 2018. APA Office of Graduate and Postgraduate Education and Training
Training Pipeline: 2009 Race & Ethnicity of Psychology Graduate Students African- American/Black 10% Hispanic/Latino 9% Asian 6% American Indian/Alaska Native 1% Multiethnic 3% Caucasian/White 71% Source: APA Graduate Study in Psychology, 2009. APA Center for Workforce Studies
Training Pipeline: 2018 Race & Ethnicity of Psychology Graduate Students African-American/Black 12% Hispanic/Latino 14% Asian 7% American Indian/Alaska Native 1% Multiethnic 4% Caucasian/White 62% Source: APA Graduate Study in Psychology, 2018. APA Office of Graduate and Postgraduate Education and Training
Training Pipeline: Diversity of Doctoral Students in Health Service Psychology Programs % Female % White % Racial/ Ethnic Minority (Black, Hispanic, or Asian) % Other race 2012 78.0 65.7 25.6 8.6 2013 77.8 65.5 25.8 8.7 2014 77.6 64.9 26.2 8.9 2015 77.3 64.5 26.5 9.1 Source: Page et al. (2017). Understanding the Diversity of Students and Faculty in Health Service Psychology Doctoral Programs.
Training Pipeline: Psychology Doctoral Degrees by Gender 2006 Men 27% 2016 Men 25% Women 73% Women 75% Source: National Center for Education Statistics, IPEDS Completions Survey.
Training Pipeline: Psychology Doctoral 2008 White 76% Degrees by Race/Ethnicity: Hispanic 10% Black/AA 7% Asian 6% American Indian 1% White 69% 2016 Hispanic 13% Black/AA 10% Asian 6% 2+ races 2% Source: National Center for Education Statistics, IPEDS Completions Survey.
Psychologist Workforce Diversity Gender: 59% women Racial/ethnic minorities: 14% Sexual orientation: 7% gay, lesbian, or bisexual Disability status: 6% reported at least one disability Mean age: 55.7 years (SD = 12.7) Career stage, defined by years since doctorate Early career (1-10 years) Mid-career (11-20 years) Senior career (21-30 years) Late senior career (31+ years) Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report
Diversity by Career Stage: Gender & Race/Ethnicity 100% 80% 60% Percents by Gender 23.3 27.8 41.3 61.9 100% 80% 60% Percents by Race/Ethnicity 21.8 15.9 10.6 9.0 40% 20% 76.7 72.2 58.7 38.1 40% 20% 78.2 84.1 89.4 91.0 0% 0% Female Male White Minority Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report 12
Diversity by Career Stage: Sexual Orientation & Disability Status Percents by Sexual Orientation Percents by Disability Status 100% 80% 9.0 7.7 7.9 4.6 100% 80% 6.0 4.8 5.4 6.9 60% 40% 91.0 92.3 92.1 95.4 60% 40% 94.0 95.2 94.6 93.1 20% 0% 20% 0% Heterosexual Gay/lesbian/ bisexual No Yes Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report 13
Diversity Implications The training pipeline and new doctorate recipients are predominantly White and female Slow change is occurring toward greater racial/ethnic diversity Comparison to overall psychology workforce demographics The workforce has higher percentages of women (69%), similar proportion of racial/ethnic minorities (14%), and lower age (mean = 48.9 years) (2015 American Community Survey) In 2013, psychology research doctorates were ~48% women, ~16% racial/ethnic minorities, and had a mean age of 54 years (Hur et al., 2017) Comparison to U.S. population 51% women, 35% racial/ethnic minorities (U.S. Census, 2015)
Cultural Competency Overall preparedness by graduate training to work with diverse populations Mean = 3.44 (SD = 1) on 5-point scale Higher ratings in earlier career stages Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report
Knowledge Ratings about Working with Diverse Populations Age Group Children Adolescent Older Adult Race/Ethnicity Black/African American Asian American Indian/Alaska Native Pacific Islander/Native Hawaiian Hispanic Sexual Orientation/Gender Identity Gay/Lesbian/Bisexual Transgender Chronic Conditions & Disabilities Clients living in poverty Clients living with chronic Illness Clients with physical disabilities Clients with intellectual disabilities Clients with cognitive disabilities Other Populations Military Immigrant Rural Religious 0 1 2 3 4 5 Mean Knowledge Early Career Mid-Career Senior Career Late Senior Career Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report
Knowledge Rating Highlights Psychologists in earlier career stages reported higher knowledge ratings for most population groups Exception older adults had an opposite pattern where psychologists in later career stages reported higher knowledge ratings Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report
Characteristics of Psychologists Providing Services to Diverse Populations Are psychologists more likely to treat patients who match their own characteristics? Generally yes. A larger proportion of psychologists of color treated racial/ethnic minority patients frequently/very frequently Ex. 48% of psychologists of color vs 32% White psychologists frequently/very frequently provided services to Hispanic patients A larger proportion of older psychologists treated older adults frequently/very frequently 48% psychologists age 65 or older vs. 37% of psychologists overall frequently/very frequently provided services to older adults Source: 2015 APA Survey of Psychology Health Service Providers Fact Sheets
Cultural Competency: Resources Utilized Resource Utilization Index 10 8 6 4 2 0 Early Career Mid-Career Senior Career Late Senior Career Resource Source: 2015 APA Survey of Psychology Health Service Providers: Career Stage Report 19
Cultural Competency Implications A more culturally competent psychologist workforce is emerging Yet competency self-ratings may not improve patient outcomes (APA Handbook of Multicultural Psychology, 2014) Why is cultural competency higher in earlier career stages? Proximity to graduate training? Knowledge fading over time? Changing workforce demographics?
And now for something completely different. and how it relates to weather forecasts
Psychologist Workforce Projections Overview Projections address supply and demand for licensed doctoral-level psychologists (practitioners) from 2015-2030 Full-time equivalent (FTE) psychologist = works an average of 39 hours per week Starting point is ~95,000 licensed doctoral-level psychologists who are active in the workforce Assumption - Supply and demand are in balance nationwide in 2015 Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Psychologist Supply Supply Inputs Licensed psychologists active in the workforce New entrants Workforce patterns Migration across states Supply Scenarios Baseline Assumes current patterns continue in the future Increase/decrease # graduates by 10% Retire 2 years earlier/later Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Psychologist Demand Demand Inputs Current service utilization patterns Projected population demographic changes Demand Scenarios Baseline Assumes current patterns continue in the future Affordable Care Act Continued ACA expansion Unmet need Address estimated 20% unmet need for mental health services Geographic equivalence Uninsured people in rural areas had same utilization patterns as insured people in metropolitan areas Racial/ethnic equivalence Entire U.S. population had same utilization patterns as non-hispanic white populations Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Psychologist Workforce Projections 2015-2030 125,000 120,000 121,340 Demand (Address 20% Unmet Need) Full-Time-Equivalent Psychologists 115,000 110,000 105,000 100,000 95,000 90,000 114,220 107,410 101,120 95,180 2015 2020 2025 2030 Year Supply (Baseline) Demand (Baseline) Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Psychologist Workforce Projections for Virginia Virginia Year Supply Demand State-level map tool: http://www.apa.org/workforce/ data-tools/interactive-statelevel.aspx Supply- Demand 2015 2,930 2,360 570 2020 3,360 2,430 930 2025 3,680 2,490 1,190 2030 4,050 2,550 1,500 Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Workforce Projections Key Points Psychologist supply is projected to be insufficient to address unmet need Increasing supply by increasing the number of graduates and delaying retirement narrows but does not eliminate this gap Demand (service utilization) is considerably lower than unmet need Addressing supply alone may not address unmet need Complex financial, social, cultural, and geographic factors represent barriers to care Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Top Reasons for Unmet Need 1. Could not afford the cost of treatment (38%) 2. Thought could handle the problem without treatment (28%) 3. Did not know where to go for services (21%) 4. Did not have time (20%) 5. Health insurance does not pay enough for mental health services (13%) 6. Concerns about being committed or having to take medicine (12%) 7. Might cause neighbors or community to have negative opinion (11%) Source: SAMHSA, 2016 National Survey of Drug Use and Health
Workforce Projections Limitations Projections may underestimate demand Projections use traditional definitions of mental health services May not capture psychologists role in health services (obesity, smoking, pain management, chronic illnesses) or certain venues (primary care, integrated care) Lack of specialty data Terms are not consistent with those used in psychology Ex. Employment settings Offices of health practitioners vs. Psychologists in private practice Demand is based on utilization, not need Projections predictions Source: APA, 2018, Psychologist Workforce Projections 2015-30.
Workforce Projections Implications Do we have enough psychologists? Better question: Do we have the right psychologist workforce? Age groups - Older adults Race/ethnicity Hispanic populations Employment settings Hospitals Geographic location - South
Areas Where Demand is Projected to Grow Older adults Council of Professional Geropsychology Training Programs 16 doctoral programs 20 internship programs 17 postdoctoral programs Hispanic populations 5.5% of psychologists can provide services in Spanish (2015 APA Survey of Psychology Health Service Providers) 4.4% of psychologists are Hispanic (2015 APA Survey of Psychology Health Service Providers)
Areas Where Demand is Projected to Grow Hospitals - 19% growth in demand by 2030 Percent 70 60 50 40 30 20 10 0 Early Career Mid-Career Senior Career Late Senior Career Employment Setting Sources: APA, 2018, Psychologist Workforce Projections 2015-30 & 2015 APA Survey of Psychology Health Service Providers: Career Stage Report
Areas Where Demand is Projected to Grow The South Relatively fewer psychologists in the South and middle of the country than in the Northeast and CA Relationships between the distribution of psychologists and health indicators More psychologists = healthier populations Fewer psychologists = less healthy populations Source: APA, 2016, County-Level Analysis of U.S. Licensed Psychologists and Health Indicators
Conclusions Cultural Competency Training Pipeline & Workforce Demographics Psychologist Workforce Projections Diversity
References: Center for Workforce Studies American Psychological Association. (2016). 2015 APA Survey of Psychology Health Service Providers. Washington, DC: Author. Retrieved from http://www.apa.org/workforce/publications/15-health-serviceproviders/index.aspx American Psychological Association. (2016). County-level analysis of U.S. licensed psychologists and health indicators. Washington, DC: Author. Retrieved from http://www.apa.org/workforce/publications/15- county-analysis/index.aspx American Psychological Association. (2017). Career stages of health service psychologists: Special analyses of the 2015 APA Survey of Psychology Health Service Providers. Washington, DC: Author. Retrieved from http://www.apa.org/workforce/publications/15-health-servicecareer/index.aspxamerican Psychological Association. (2017). Degrees in psychology [interactive data tool]. Retrieved from http://www.apa.org/workforce/data-tools/degrees-psychology.aspx American Psychological Association. (2018). Psychologist workforce projections 2015-30. Retrieved from http://www.apa.org/workforce/ publications/supply-demand/default.aspx
References: Other Sources American Psychological Association. (select years). Graduate Study in Psychology [special analyses]. Hur, H., Andalid, M., A., Maurer, J. A., Hawley, J. D., & Ghaffarzadegan, N. (2017).Recent trends in the U. S. behavioral and social sciences research (BSSR) workforce. PLoS ONE, 12(2), e0170887. https://doi.org/10.1371/journal.pone.0170887 Page, C., Buche, J., Stamm, K., Lin, L., Christidis, P., & Beck, A. (2017). Understanding the Diversity of Students and Faculty in Health Service Psychology Doctoral Programs. Retrieved from http://www.behavioralhealthworkforce.org/project/recruitment-andretention-of-a-diverse-health-service-psychology-workforce/
For more information, please visit the APA Center for Workforce Studies website: www.apa.org/workforce Questions? Contact kstamm@apa.org Thank you!