Monday, March 15, 2010

Social Workers Are Awesome

In 1927, Francis Peabody remarked that "The secret of the care of the patient is in caring for the patient." Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in todays era, perhaps the group that best personfies this central caring ethic of medicine are medical social workers.

I know we should avoid generalizations, but isn't it the case that all social workers are nice? Perhaps it is this niceness, combined with their knowledge and skills that makes them so indispensable. It is often the social worker on the team that understands what is really going on with the patient and identifies the key details that make it possible to effectively care for them. It is because they know what to ask, and patients and families are comfortable confiding in them.

Geriatrics practice would be impossible without social workers. I definitely see this in our Geriatrics clinic. Many patients are referred to Geriatrics because things seem to be falling apart in terms of their ability function independently at home. After I do an initial evaluation, I have to admit that I sometimes feel kind of bewildered. There is almost never a single underlying cause of the patient's problems---as the Fiddler on the Roof song goes, it is a little bit of this, a little bit of that (or perhaps a lot of this and a lot that). There is always a complex interaction of medical, social, and environmental factors that can not be separated from each other.

So, after I do my initial evaluation, a politely excuse myself from the exam room and knock on the door of our social worker, Karen. She somehow always has time for my unannounced visit to discuss the patient, often even adding the patient that day to her overbooked schedule. After talking through the issues with her, what was bewildering starts to become clear, and we are able to start formulating a plan for the patient. I end up returning to the exam room more confident we will be able to come up with a plan that will help the patient.

Can you believe there are still doctors who will dimissively refer to some patient issues (usually psychosocial issues) with a comment such as, "that's social work." The tone often implies they think the issue is not their problem, or even worse, they think addressing the issue is beneath them. Perhaps we should continue to encourage physicians to remark, "that's social work" but train our students to know that means they are dealing with something of particular importance that will take great skill to manage.

I know very little about the structure of social work training. However, it seems efforts to improve medical education could learn something from social work training. Social workers tend to be better than most physicians at communicating with patients, and many patients are more comfortable talking to a social worker than their doctor. The ability of social workers to uncover key elements of the history that physicians fail to identify suggests we can learn some basic skills of physicianship from them. It sure seems we would be better doctors if more elements of social work training were included in our training.

Given the importance of the medical social worker, you would think this would be a well paid position. However, according to the Bureau of Labor Statistics, the median salary of medical social workers is only $46,000 per year. Only 10% earn over $70,000 per year. This seems strikingly low for a position that requires extensive education (many social workers have masters degrees), requires very high level skill and judgment, and is so indispensible. I wonder what the reasons for this are. Is this because social work tends to attract individuals committed to helping others and who are therefore less concerned with monetary rewards? Is it because social workers are so focused on others that they are less effective at negotiating their compensation? Or is this the legacy of workplace gender discrimination, as historically, woman have been more likely to enter social work than men?

We are currently in the middle of Social Work Month 2010. This year's theme is Social Workers Inspire Community Action. But day in and day out, social workers make things better for our patients. In truth, every month is social work month.

16 comments:

Christian Sinclair, MD said...

I totally agree that medical social workers are undervalued and underpaid by the medical system as a whole. I am glad to work in a discipline (Hospice & Palliative Medicine) that makes them such an integral part of the team. I would add that they also are underutilized for their skills/talent and are typically encouraged to fulfill duties such as filling out paperwork/forms with patients and families. Sadly the system places a much higher priority on the paper than actually talking to them.

Great post Ken

Patrice Villars said...

Happy Social Worker month!! IMHO, social workers may be the most valuable people to have on an interdisciplinary team. Social workers are highly skilled professionals who wear the dual hats of providing emotional support and helping with practical planning. When you think about it, this is the crux of the work we do in a well-functioning palliative and/or geriatric team. AND this is what patients report is most important to them facing advanced illness. Many masters level social workers are also licensed to provide psychotherapy as independent practitioners. While I agree that medical providers’ skills would be enhanced with more of these elements, why not additionally remember that we have an amazing and often underutilized resource sitting right next to us (if we are lucky)? Social workers ARE awesome. May all social workers live long (with quality and only if they want to) and prosper!

CCramer said...

In Florida, Social Workers get paid even less then the national average! These are poorly paid dedicated individuals with advanced training and big hearts...
I think they are undervalued beacuse our society and medicine doesn't really value the "soft stuff". That's why Palliative Care, Geriatrics, Holistic Care...all those "soft" skills are looked down on by the "real" physicians who do the life-saving surgeries and high tech interventions...

But patients are more impressed by the person who was nice to them (often a patient care tech, dietary assistant, housekeeper). Everyone on the healthcare team has immense value! And a good Social Worker is priceless!!

Bravo to all those Social Workers out there who are working hard for low pay and often little respect & kudos (now don't get me started on Chaplains--another awesome part of the team!)

Queen Bee said...

Under paid and under appreciated in general, social workers are indispensable in geriatrics. (I wish the social worker in my department would be funded for full time instead of part time work.) This post articulates their importance beautifully. Happy Social Worker month!
Debi Onken, MSN GNP-BC

Mike Steinman said...

More often than not, I find the single best thing I can do for my patients in geriatrics clinic is to arrange for them to see the social worker.

Eric Widera said...

I think one of the problems in medical education is that we don't really learn what the competencies are for other disciplines. This leads us to assume the competencies based on the limited interactions we have with various disciplines in the clinical setting, giving us only a small snapshot of their abilities. The first time I ever got training on what social workers really do was in my geriatrics fellowship.  It's a shame that it took that long to get some understanding of their true value.   

Eric Widera said...

I think one of the problems in medical education is that we don't really learn what the competencies are for other disciplines. This leads us to assume the competencies based on the limited interactions we have with various disciplines in the clinical setting, giving us only a small snapshot of their abilities. The first time I ever got training on what social workers really do was in my geriatrics fellowship.  It's a shame that it took that long to get some understanding of their true value.   

Anne Johnson said...

Ken, what a nice post! One of the joys of being a social worker in a Geri-Pal setting is the opportunity to work as part of a team. A few years ago I co-taught a class on interdisciplinary teamwork, and as part of the exercise we each took on a different professional identify and came up with what we thought were appropriate interventions. It was fun and instructive, and I really did enjoy being the psychiatrist.

I've been a social worker in non-profit settings, hospital settings and government settings, and the latter is definitely the best-paid - let's hear if for the VA!

LeighSW said...

Thanks for the great post, Ken! It's nice to see that you value and understand what a social worker can provide- this is a gift for your patients! In my own hospice team, some RNs are much better than others at knowing when to update me or involve me in a closed system. We function so much better as a team when each discipline is utilized vs. one person acting as the Lone Ranger. While I was in grad school, we often joked that we weren't in it for the money. I make less than the national average but my starting salary was about 10,000 more than what most of my classmates were offered, so I was shocked and thrilled! I'm glad to earn a livable wage but hearing from my team, patients, and families that I've helped or made a difference is what really keeps me going.

gigila said...

I want to thank Ken for writing about social workers and all who have commented since. I have worked as a nursing home social worker for nearly sixteen years. Fifteen of those years were with a bachelor’s degree. I make around the national average. In September 2009 I graduated with a MSW. I have not received a raise and am expected to begin to pay back my student loans this month. Despite having a MSW I will continue to most likely to make less than an LPN with less years of experience. Instead of talking about how we are under appreciated and compensated, what can we do as a profession to begin to be appreciated and compensated for the amount of education we do have?

Nora O'Brien, John A. Hartford Foundation said...

It’s wonderful to see social workers getting the recognition they deserve. Thank you! We wholeheartedly agree that social workers should be an integral part of health care teams. Geriatrics- trained social workers are uniquely suited to coordinating comprehensive services for older adults and their caregivers, both in and beyond health care settings. That’s why we support interdisciplinary team training (www.gittprogram.org) and created the Geriatric Social Work Initiative (www.gswi.org) to ensure that all social workers receive training in geriatrics.

Aurora said...

I agree! What a lovely and well-thought-out post. It's nice to see the underpaid, underappreciated social workers highlighted for a change. Well done!

-Aurora at MDiTV.com

Linda said...

Wow, I jusst cae across this blog today & must say this is a morale booster for this hospice social worker. I'm passing it along to my colleagues. Thanks!!
Linda

Teri said...

Thank you for making my day! I am so thrilled to hear another professional, especially physician acknowledge the talent and expertise of the social work profession. I agree that we are too often dismissed, yet when the going gets tough, who gets the call?
I wish that our national organization would focus more on equity for soical workers in pay and professional standing in the communities we serve.
I will be passing your article on to my student social workers who are leaving to start their careers as Master Level social workers.

Hold my hand: a social worker's blog said...

What a sweet post!

Thank you.

Doris
www.doris-socialworker.blogspot.com

Anonymous said...

Hi I feel bless to have had the previllage to study Social Work and to practice for 17 years so far. It has been a wonderful and learning experience.