I’m a primary care doctor at a clinic providing care to uninsured and under-insured patients in central Texas. As COVID-19 cases rise around the country, one thing has become crystal clear: social workers are more critical to our work than ever, and we don’t have enough of them.
I’m reminded of this one day with a patient I’ll call David. It’s late September, and he’s back for a 3-month follow-up visit. Behind the pane of a face shield, I look at his phone as he shows me pictures. By now I’m used to the blur as the shield fogs from my mask, but it adds to the disorienting feeling of these moments.
In the clinic room, his own vision blurs as tears flow freely down his cheeks. We look at FaceTime screenshots from last week: his elderly mother in a hospital bed, her face obscured by tape and tubes; his similarly bedridden cousin with a fully gowned nurse in the background; a man in his twenties smiling and hugging a squirming toddler. He shows me those who are already dead, and those who are left behind.
I don’t want to dismiss the grief that hangs in the air like an unseen cloud, but the ticking clock forces me to push ahead. “David, I’m concerned about your blood pressure and sugar,” I say. His numbers are worsening. He nods his head wearily, explaining how he lost his health insurance along with his job and can no longer afford his medications. His grief comes in waves and he can’t sleep. He is suffering.
What my patient needs in this moment is compassionate counseling and guidance through the maze of health insurance. But the system that I work in allows me just 15 minutes per patient, and there is no help. I rush to explain how to apply for emergency insurance while eyeing his med list to determine what I may need to cut. We both leave the clinic drained and depressed.
Even before the pandemic, our healthcare system was difficult to navigate. Amidst this once-a-century pandemic, combined with economic depression and racial inequality, it is completely overwhelming. That’s why we need different types of specialists: social workers and community health workers (CHWs).
Social workers offer important psychological and social counseling and support, not just for the patient but for their families as well. In the most difficult situations, they help families prepare for a future without their loved one, or with a loved one now impaired by COVID-19. CHWs are members of a local community who provide linkage to services like housing, transportation, food and insurance. Both social workers and CHWs weave together pieces of our fragmented system like a patchwork coat to protect those most vulnerable. Without them, patients are often left in the cold.
A growing body of research shows the benefit of social work on patients’ psychological well-being and their ability to manage common medical conditions like diabetes and depression. By preventing the most dire and expensive outcomes, these social services ultimately reduce costs and improve health. Social workers and CHWs have also been shown to decrease burnout for clinicians.
Yet most primary care practices do not employ social workers or CHWs because the fee-for-service insurance systems that govern the majority of healthcare in the U.S. do not reimburse medical practices for social services. In order for us to provide the best possible care for patients like David, we need the healthcare and political systems to invest in social services.
Specifically, Congress should provide funds in upcoming stimulus bills to hire and train social workers and CHWs, particularly for healthcare systems that serve poor communities. The $2.2 trillion CARES Act, signed into law on March 27, 2020, included $130 billion to support hospitals and clinics, but did not specifically allocate funds for hiring social work staff.
We should also implement the recommendations of the 2019 National Academies of Science Report on social work in healthcare: invest in a social care workforce, collect and share data on social needs, and change payment models to incentivize social work in healthcare. Medicaid and Medicare should include provisions for social workers in clinics, especially those in underserved communities.
Social workers alone will not fix our broken healthcare system. But our patients, our communities, are suffering now. Funding social workers will provide some relief to the most vulnerable patients, and as a secondary benefit, aid healthcare providers on the front-lines who care for them.
Dr. Aliza Norwood, MD, is an assistant professor in the Departments of Population Health and Internal Medicine at Dell Medical School at the University of Texas at Austin, and is a Public Voices Fellow of The OpEd Project.