Teri Fritsma is a number cruncher, lead health care workforce analyst for the Minnesota Department of Health, but sometimes she feels more like a weather forecaster or a ship’s navigator, constantly scanning the horizon (or actually the data) for coming economic storms.
A little over a year ago, Fritsma saw a storm coming, and she decided it was time to sound the alert. The numbers revealed that Minnesota’s psychology workforce is aging at a rapid pace: A survey of the state’s 3,824 licensed psychologists found that despite high rates of workplace satisfaction, as many of a quarter of respondents were over 65 and planning on retiring in the next five years. And this silver tsunami was likely to be an ongoing problem, Fritsma worried: More than half of the state’s licensed psychologists are over the age of 55.
“When I saw the median age of psychologists in the state I was shocked,” Fritsma said. “Here at the Department of Health, we always talk about the dentistry workforce and how old they are, but psychologists are even older.”
In the best of times, this coming mass retirement might feel like a blip, or an expected baby-boom-fueled ebb in the economic tide, but what truly concerned Fritsma was the fact that the number of new psychologists entering the workforce doesn’t come close to making up for the coming loss.
As Fritsma describes her concern, imagine a bar graph: “When you look at the number of Minnesota psychologists that are entering the cohort of workers aged 34 years and younger or 44 years and younger, those cohorts are significantly smaller than the 65 and older and the 55 to 64 cohorts. You have this critical mass of psychologists that are aging out. The younger cohorts are not as large. So the profession is shrinking.”
Fritsma first presented this data in May 2016 at the Minnesota Board of Psychology Continuing Education Conference. Since then, she’s been continuing to sound the alarm — just as the mental health needs of Minnesotans are growing more complex, nearly 1,000 of the state’s licensed psychologists will soon step away from the profession.
“There’s no other way to put it,” Fritsma said. “We are soon going to be losing a lot of this workforce, and we don’t have enough new people coming up to fill the gaps.”
The impact of mass retirement
The truth is that all workers, even the most essential ones, eventually need to retire. But who will tend to the mental health needs of Minnesotans after as many as 25 percent of the state’s licensed psychologists leave the profession?
Many people in the state get their mental health care from providers who aren’t licensed psychologists. Licensed independent clinical social worker (LICSW), licensed marriage and family therapists (LMFT) and licensed professional clinical counselors (LPCC), for instance, also provide mental health counseling services. Several thousand are licensed to work in the state. These positions all require at minimum a master’s-level degree.
Psychologists, who since 1991 have been required in Minnesota to earn a doctoral degree, are especially trained and qualified to counsel clients with complex mental health needs, Fritsma said. While the data shows that LICSWs, LMFTs and LPCCs are on average younger than licensed psychologists and growing at greater rates, Fristma said that psychologists, with their years of education and stringent internship requirements, fill a specific and unique role in our mental health care system.
“Psychologists alone are trained to conduct formal psychological assessments,” she said.
Today there are 1,540 Minnesotans per licensed psychologist in the state. While that number is generous when compared to the situation in other parts of the country, the vast majority of licensed psychologists in Minnesota are based in the Twin Cities metro area.
Greater Minnesota is already facing significant shortages in psychology services, which means that people in those regions who want to see a licensed psychologist often must wait months and travel many miles for their appointments.
Regional inequities aside, it is important to contrast the current reality with what the numbers say the future is likely to hold, Fritsma said.
“Let’s say we have exactly the right number of psychologists in the state right now. Research shows that population of psychologists isn’t getting any younger. Minnesotans’ mental health issues aren’t getting any simpler. For us to lose a quarter of the psychology workforce in the next five years? Are we going to have a shortage? The projections say that’s exactly what going to happen.”
Not everyone in the mental health field shares Fritsma’s level of concern.
“It’s true that 57 percent of licensed psychologists in Minnesota are 55 and older,” said Bruce Bobbitt, president elect of the Minnesota Psychological Association. “But it’s also true that 43 percent are 54 and younger.”
That 43 percent of licensed psychologists age 54 and younger are working hard and contributing to their field, Bobbitt said, as are the 57 percent over 55. Though a large percentage of survey respondents said they planned to stop working in five years, psychology is a career where people can continue to work well past average retirement age, he added.
And recent trends have seen more licensed psychologists entering the field at a later age, often after working in another field.
“We’ve seen some people delay professional activity until after they’ve done other things in their lives,” Bobbitt said. “The prototype graduate student in psychology used to be someone popping right out of college and going to their graduate degree. I was that way. We now have more people coming into the field when they are older, more women who come with previous work experiences.” This means that these newly minted psychologists are likely to work longer, too, he posited.
William Robiner, professor at the University of Minnesota’s departments of Medicine and Pediatrics and director of Health Psychology and the Director of the Psychology Internship at the University of Minnesota Medical School, said that advanced age doesn’t have to mean an end to a psychologist’s practice.
“There is some national data about psychologists that has found they are working well into their 70s,” Robiner said. “It’s not a physically demanding job. If a person can talk, they can still be a psychologist. Almost 20 percent are still working by age 75. It is something that people can keep doing part time into their 80s.”
A true shortage?
How many psychologists does Minnesota need? Until 1991, Minnesota required just a master’s degree in psychology for licensure; when the licensing requirement was changed to a doctoral degree, those practicing under the old rules were grandparented in. This means, Robiner explained, that the state actually may have been oversupplied with licensed psychologists.
“For many years, our numbers were inflated relative to national numbers,” Robiner said. “Before [the Ph.D. requirement] Minnesota had a much higher per-capita rate of psychologists. Over time we’re going to come in closer to the national numbers.”
Fritsma said she believes that the need for psychological services is out there, that getting closer to the level of other states should not be Minnesota’s goal.
“We need more people in the profession,” she said. Even now, before the looming retirement hits, she continued, “there is a strong argument that we already have a psychologist shortage. Some evidence for that is if you look at the population-to-provider ratio, everything is worse in the rural areas. In urban areas there is one psychologist for every 1,300 people. In rural areas of Minnesota, there is one psychologist for roughly every 11,000 people.”
What would be the ideal psychologist-to-citizen ratio? Fritsma isn’t certain.
“Wrapping your head around what constitutes a shortage is a really tricky proposition,” she admitted. “Who’s to say if we have enough right now? I personally don’t have a magic number, but I think it’s more than what we have now — and definitely more that what we’ll have in five years.”
Robiner said that while he understands Fritsma’s concerns, he’s not certain what the ideal number of psychologists should be in Minnesota.
“People talk about the numbers of psychologists per 1,000 residents.,” Robiner said, “but that discussion doesn’t really get at a scientific answer: How many psychologists do we actually need per 1,000 people? How do we figure that out?”
The larger concern, he said, is the unbalanced statewide distribution of psychologists — and the reality that most psychologists in the state are white.
“I grew up as a Jewish kid in Brooklyn,” Robiner said. “I was fortunate to grow up in a diverse area that was diverse long before Minnesota was diverse. From my personal experience, I know that people can learn to provide services for people who are not like them. The bigger question is, ‘Do people from diverse cultures really want to see somebody who looks different than they do? And how can we encourage people from diverse backgrounds to enter the profession?’ ”
Take a look at the graduates of Minnesota’s colleges and universities, and you’d have to wonder: How could there possibly be a shortage of licensed psychologists in the state?
Here’s a fun fact that Fritsma likes to quote: “In the last roughly 10 years, from July 2006 to June 2014, Minnesota colleges produced just under 15,000 bachelors graduates in psychology. It is one of the most popular majors. But less than 1 percent of those graduates, or about 19 people, went on to pursue a doctorate in psychology. And of those who do purse a doctorate, only half go on to become licensed and practice in psychology.”
Why the disconnect? There are a number of theories, including that psychology is a good, practical-sounding undergraduate major, but the reality of earning a doctorate may feel daunting — and impractical. The programs are competitive, the time commitment is serious and the financial cost is high.
It wasn’t that way when Bobbitt was earning his psychology degree. “Back in the day, people were funded in grad school by federal grants,” he said. “The National Institute of Mental Health (NIMH) used to fund training in psychology. I got out of the U of M with no debt. Those sources of funds have pretty much gone away. Anecdotal data is that young psychologists today are carrying substantial amounts of debt — up to as much as $250,000.”
Even idealistic people interested in helping others must take pause at the idea of costs as real as those, Fritsma said. The investment to become a psychologist is big. Students interested in a helping career can’t be blamed for conducting a cost-benefit analysis of their options.
“Say I want to have a career that helps others,” Fritsma said. “The investment to become a licensed psychologist is high. You might be somebody who’s interested in health care in general so then the comparison becomes, ‘I could become a psychologist and earn $37 an hour, but I’d have to get a doctorate — or I could become a RN and go to school for less time and still get $36/hr. I hear people are desperate for nurses.’ ” Here Frtisma paused, and chuckled, wryly: “I’m an economist at heart. It always comes back to the money. People make decisions that way, and who can blame them?”
Hope on the horizon?
The future for licensed psychology in Minnesota doesn’t have to be described as bleak, Bobbitt said. There has been growth in the number of universities in the state offering doctoral level psychology degrees — and growth in the number of students pursuing those degrees.
“Are we growing the field on the doctoral level?” Bobbitt asked. “I’m of two minds on this issue. I’m concerned that senior psychologists are retiring. But I’m very positive about these new training programs.” (Doctoral level psychology programs are now available at the University of Minnesota, the University of St. Thomas, St. Mary’s University, Mankato State University and the for-profit Argosy and Capella Universities.)
“I know some of the students from these programs,” Bobbitt said, “and they are excellent. The young people and who are early in the field now are approaching it with a lot of energy and exuberance.”
Robiner said that he has actually seen an increase in the number of psychologists being trained in the state. “But I don’t know if has been keeping up with the change in population,” he added. “The population in this state has been expanding and diversifying. The number of psychologists per 1,000 citizens has actually increased in the last decade. Whether it is leveling off now, I’m not certain.”
In 2015, in an effort to address the rising costs of graduate education, mental health professionals willing to work in underserved areas of the state were added to the state loan forgiveness program, helping them to pay off an average of 60 percent of their graduate school loans. Licensed psychologists taking part in the program are required to work for a specified number of years after graduation in those communities. Hopefully relationships will be built and some will put down roots.
Robiner said he also sees promise in the move toward including licensed psychologists in treatment teams at primary and specialty care clinics around the state.
“The current trend to integrate psychologists into these settings is exciting,” he said. “If we have enough people deployed in those settings that opens up huge opportunities for everyone.”
Even with all of those opportunities opening up, Robiner agreed that the need for more licensed psychologists still exists.
“I’m not saying that there aren’t desperate waiting lists at times. There are. If somebody wants to see me, it is typically going to be a few weeks or closer to a month before they can get in. And I know from personal experience that we could use to have more psychologists in the practice here at the U of M.”
What will it take to turn the situation around? Fritsma isn’t sure. Maybe the answer is more loan forgiveness programs for psychology doctoral students, increased publicity around training programs and psychology careers, and beefed-up salaries and reimbursement rates for licensed psychologists. Whatever it takes, Fritsma said she’ll continue to sound the alarm. It’s just too important to ignore.
“I would say anecdotally from the work that I’m involved in, you hear about employers screaming for psychologists, about patients waiting months to get an appointment,” she said. “This profession is just too important for everyone’s health. We need to be thinking of solutions.”