By Alison Knopf
As the opioid crisis continues, opioid treatment programs (OTPs) are going to face big challenges in the workforce, experts say. “We’re going to face a lack of access, even in areas where there are a lot of programs,” said Zachary C. Talbott, a certified MAT advocate and member of the national board of directors of NAMA Recovery. Mr. Talbott owned and operated Counseling Solutions Treatment Centers from 2015 until they were acquired by BayMark Health Services in August of this year. “We need to add slots and we need to hire more staff,” said Mr. Talbott.
“We are a talent-poor industry in certain areas of the country,” he told AT Forum. “It is so difficult to train and to retain a quality workforce.”
One pitfall is the “warm-body syndrome,” when an employer has someone who is there, but isn’t competent to do the rigorous work entailed in OTPs. “It’s critical that our approach include nursing schools, social work schools, medical schools─to make sure everyone getting trained is competent in the medical treatment of substance use disorders,” he said.
Training, Not Turnkeys
And it’s incumbent on the OTP to provide training─this is not a “turnkey” operation.“ You can recruit a good doctor or counselor, but I have yet to find someone who knows about methadone,” said Mr. Talbott. “This is part of the reason there’s a reluctance to expand─it’s hard enough to find staff for our existing programs.”
When opening new clinics, directors can be difficult to find as well, because the director must know the state regulations, Mr. Talbott added.
In addition to Mr. Talbott, we talked with Joe Pritchard, CEO of Pinnacle Treatment Centers, and Peter Morris, group president of Acadia Healthcare, for this article, which focuses on the “clinical” (counseling) and “medical” (prescribing) sides of the OTP workforce.
National Consortium Targets Four Main Issues
Workforce development is one of the four main issues of focus by the National Consortium of Opioid Treatment Providers, a group consisting of Acadia, BayMark, Aegis, New Season, and Behavioral Health Group. (The other main issues are Medicaid coverage, Medicare coverage, and commercial insurance payers.)
“We know this is industry-wide, not just our organization,” said Mr. Morris. “Internally, we’ve looked at where we are in the market, and certainly at certain areas that have been problematic, with salary and benefits. We have added some benefits this year that we didn’t have before.”
Indeed, one of the first things Talbott’s Counseling Solutions staff were rewarded with when he sold to BayMark was comprehensive benefits, including health care, which he couldn’t afford to provide previously.
On the recruiting side, it’s important to respond immediately when a candidate expresses interest in working with a center, said Mr. Morris. Acadia has started using the same approach for job candidates as for patients: “We measure how many hours it takes to get back to patients and get them in for an admission,” said Mr. Morris. “We’re using that same approach with recruitment─you can’t let it sit for 24 hours in this competitive environment, you need to strike while the iron is hot.” In other words, if you say, “Come in next Tuesday for an interview,” the candidate may well have been hired somewhere else before then.
There is the possibility that physicians could be harder to find, because of buprenorphine being administered through office-based opioid therapy (OBOT) clinics, said Mr. Morris.
Pinnacle, like Acadia, has a full continuum of services, with everything from residential care to detoxification to sober housing to OTPs. This makes it easier to recruit prescribers, he said. “We utilize medications throughout the continuum, so someone can move seamlessly up and down the scale. This is what a lot of prescribers are looking for.”
Typical OBOT prescribers fall into two categories: the physician who wants to be able to prescribe buprenorphine only for patients in his or her own practice; and the prescriber who wants to “be part of the answer to the bigger problem, but doesn’t have the infrastructure to do that,” said Mr. Pritchard.
But gradually the prescribers are starting to realize that the medical side─the medication─is “just one part of the equation,” said Mr. Pritchard. “They see the patient, write the prescription, and it takes 15 minutes,” he said. “There’s no real continuity of care.”
Pinnacle is recruiting medical staff, including nursing and primary care staff, from medical schools, and is also looking at residents in addiction and psychiatry as part of the hiring pool. “A lot of the doctors want to moonlight to make some money during residency, so we bring them in,” said Mr. Pritchard. “These are people who don’t want to just write a scrip─they want to be part of a more comprehensive practice,” he said. “These are the physicians we want to attract.” The opioid epidemic is headline news, and young medical students who are drawn to help, need to know where to work. OTPs are an ideal location.
According to Mr. Morris, the biggest hiring problem seems to be counselors, in particular in certain areas of the country like Massachusetts, where Acadia has 12 clinics. There is also competition in rural areas like West Virginia and Wisconsin.
“We try sign-on bonuses, which can be helpful,” he said. The new counselor gets half of the sign-on bonus when he or she first starts working, and the rest in a period of time. Acadia also uses referral bonuses in problem areas.
Another good place to find workers is job fairs, especially at local universities, said Mr. Morris.
Recruiting counselors is difficult because of the schedule, as well. It’s not as bad as it was years ago, when counselors and nurses had to be at work by 4 or 5 in the morning, said Mr. Pritchard. “It was a grueling schedule, but the world is changing, fortunately,” he said. “We schedule counseling appointments.”
While many patients must come in every day to get their medication, as they progress through treatment, they need fewer and fewer counseling sessions, he said. Still, it’s important for the staff to be available, as family meetings also take place. “It shouldn’t just be limited to 5 AM to noon, and then the place shuts down,” he said.
Pinnacle also does a lot of training, making sure counselors know that “getting off medication shouldn’t even be part of the discussion,” said Mr. Pritchard. Counselors are attracted to a milieu where there is comprehensive care, said Mr. Pritchard. “They like to feel that this isn’t a place where people get their medication and check in with me once a month, that this is true engagement.”
Once you have good staff, how do you keep them? Because of turnover, it’s important to constantly analyze the competition landscape─how much other workers in the area are getting paid─as well as the benefits package offered. Soft benefits like staff luncheons and team-building events also help retain employees.
“We foster local leadership to try to do something different, so we stand out from our competitors,” said Mr. Morris. “But that part of the equation is up to the local leadership; we have to train our local leaders.”
Facilities also must balance zoning requirements with the need to be part of mainstream health care─and indeed, OTPs are part of mainstream health care. But society still hasn’t come to terms with that. “We want to be on Main Street USA as much as possible,” said Mr. Morris. “We don’t want to be down the back alley─historically we’ve been thrown in that category of liquor stores and strip clubs, but we want to be good neighbors, and we are.” This attitude─and the environment─helps to attract and retain good workers, he said.