Fee-For-Service Providers’ Perspectives on their Role: A Mixed-Methods Study

Overview: Clinicians employed as fee-for-service (FFS) contractors face multiple challenges when entering an FFS therapist position. The current study provides an insight into the individual experiences of FFS therapists, the advantages of FFS work, the challenges of the FFS work; and positive meditations to improve the FFS workProposal text: Most FFS clinicians are recent graduates of master’s of social work or mental health counseling degrees that place a considerable emphasis on teaching clinical work but focus less on the particular knowledge, skills, and training that is unique to and required for FFS clinical practice. Thus, recent graduates and novice clinicians hired for FFS positions suffer from this training and education gap.
In this study, we provide an insight into the individual experiences of FFS therapists. We asked 88 participants to fill out a 55 five questions survey and participate in an interview about their experiences, the structure of their work, and challenges. Specifically, we focused on what they perceived as the pros and cons of their role as FFS therapists and ways the role can be improved.
The experiences of the participants teach us that the FFS work is very complex and yet rewarding. Our study shows that the FFS model is far from being perfect; both for the therapists and their clients. Nonetheless, many clinicians choose the trade-offs between low remuneration, limited support by agency and supervisors with the positives of the FFS job; having the flexibility to make their own schedule, take time off whenever they wish (though unpaid), and have the platform to rapidly earn the clinical and supervisory hours needed for independent clinical licensure.
We recognize that participants have used a variety of survival tactics to manage their FFS job. These tactics included: having another job that provides health insurance, receiving external supervision, writing notes and treatment plans during sessions, learning the patterns of clients to better predict late cancelations and no-shows, and finally leaving the FFS job as soon as they receive their independent clinical licensure.
Another takeaway from participants’ inputs is the fact that the FFS model can be challenging for anyone without sufficient economic privilege. Specifically because most of the time, the FFS model does not provide health insurance, sick time or vacation time and the compensation is insufficient, uncertain, and depends on clients showing (or not) for sessions. In addition, the lack of incentive to continue vis-a-vis compensation, training, or support and supervision, creates pressure to move to private practice rather than continue working in community mental health and not-for-profit agencies. This reality leads to high levels of staff turnover and jeopardizes clients’ continuity of care and recovery.
The results can inform those who are currently in the field or entering the field, supervisors, and agency administrators.