Saving the Medical Social Work Profession

30 Jun
 By: Sarah Luker  

NASW Ohio Chapter Intern    



Lately I have been hearing about the dying profession of medical social work. How can this be? As social workers we do such a great job in the hospitals and residential facilities that there is no way we could be pushed out of the medical profession! But are we as needed as we think we are? This is precisely what I would like to find out.    Social work, as we all know, is underappreciated and an underpaid profession in general. Now, more than ever there seems to be a significant job deterioration and value within the hospital setting. Recently, I have heard more and more concerns about people’s jobs and what this issue is doing to the profession of social work. I think that this should be an issue not only for medical social workers but for all social workers. Be aware that this affects our profession, its creditability, and the future of social work.     

For over 100 years, Social Workers have been leaders in the Medical field

As an intern at the NASW Ohio Chapter it has been my personal mission to advocate for medical social work. In doing this I have began researching medical social work and the roles that we play in the hospital. I also have stared to draft a survey for nurses who we work side by side with in the hospitals. Now, the reason why this survey is directed towards nurses is because they seem to be the  profession we are competing with in the hospitals. In order for us to move forward we need to know the perception other professionals.  In light of this, the purpose of the survey is to see what the nurse’s perspective is on medical social works and if they ultimately see any value in what we do. The eventual goal is for us to be able to work together with nurses, doctors and other medical professionals as a collaborative team. Not fighting each other over who is going to keep their job and constantly stepping on each other’s toes.     

For everyone reading this, let me know what you think about this issue and what could be done to save the medical social works profession. As I said before the NASW and I are in the process of researching and so any help would be appreciated. If there are any suggestions please let me know. This is a large and continuing issue that needs to be addressed at this time.

11 Responses to “Saving the Medical Social Work Profession”

  1. Bruce Arnold, LISW at 6:17 pm #

    Great idea to do the survey among nurses. They and the physicians are our greatest allies even though we are competing with the nurses. Many of them tell me they do not want our job when they see us taking care of problem patients and difficult families. Unfortunately administrators when needing to cut costs will choose to eliminate a social work position before a nurse position.

  2. Sarah Luker at 5:16 pm #

    Mr. Arnold, first off I want to thank you for taking the time to respond to the blog I posted and for supporting the idea of a survey. I have not talked to many nurses myself about this issue so your comments have been very helpful. Second, you are right, administrators look to cut costs by removing social work jobs, not by getting rid of nurses. One way we are trying to tackle this issue is by validating social work in terms quantitative data gathering. This is one of the main reasons for the survey that we are currently drafting. If you have any further comments or suggestions please feel free to do so.

  3. George Kuo, LISW-S, ACSW at 4:34 am #

    Agree about the need for a survey, although I think it should eventually be expanded to include other professionals the medical social worker networks with and between, including Hospitalists, long term care facility admission staff, adult/child protective services, and other other potential champions of our profession. Social work pay scales are cheap compared to nursing pay scales, and the value added skill sets that we provide towards customer service, regulatory compliance, patient rights, and other important aspects of the patient care experience are good selling points to administrators. With CMS, the RAC audits, Medicare over-payments, and the upcoming review of the 30 day readmission as a (poor)quality indicator, medical social work’s role in discharge planning and trouble shooting can really be central to the organization’s defense,cost-savings, etc. This is an opportunity we should be taking full advantage of. I think, unfortunately, that medical social work’s demise in hospitals has partially been our own fault, too. I found in my current position, for example, that taking an aggressive approach to cooperate, build consensus, and help the nursing case managers and others (like the coders in medical records, Hospitalists, etc.) do their jobs more effectively and efficiently versus resisting change, digging in my heels, and moaning about losing authority in certain functions has been the key to success in our collaborative relationship and teamwork. The latter approach simply didn’t work in some of my previous hospital settings. However, the other, greater and perhaps more insidious problem issue our profession faces, as I see it, is our own profession’s seeming liberal agenda and approach to dealing with societal problems (as represented and showcased in the NASW News), which run counter to most hospitals and business leaders nationwide. Hospitals and those who run and manage them, including administrators, executive boards, nurses,and doctors, are mostly conservative, Republican, manage the hospital like a business, and generally view health care reform as a threat (and those who support the Obama agenda as threats). Yet, social workers are known and seen as liberal, of the Democratic party, entitlement supportive (and therefore, fiscally irresponsible and wasteful), socialistic, and view health care reform as a good thing. Although this is in our history, I’m not sure whether this perception by others, especially those in power in hospitals, is especially helpful to our survival.

  4. Sarah Luker at 7:45 pm #

    Mr. Kuo, you bring up a lot of good points. First, while drafting the survey we have considered expanding it to other professionals in the hospitals that we work with. This is something that we plan and will be doing in the near future. So far we are just focusing our efforts towards nurses because we seem to be competing with this profession for jobs in the hospital. Ideally we want to work together and not against each other. Secondly, you also bring up the issue of pay, as social workers we all know we are underpaid. This is why we are beginning to look into cost-benefit relationships related our work, showing how we make a positive impact at the hospital and not wasting money. Because you’re right, hospitals are a business so we need to frame our worth with their language.

    The last issue that you brought up essentially highlights social work stereotypes and the social stigma that goes along with it. I cannot agree more! Some people, who hear the words ‘social worker’, automatically assume our ideals and political views. This is why I am trying to make this survey very clear in its agenda. We want to work as a team in the hospital but we also want to show our worth and not be cast aside. The survey has nothing to do with health care reform or whether the NASW supports Obama’s health care plan. Therefore, I will make sure when sending out this survey that it clearly states its purpose and intent.

    • George Kuo, LISW-S, ACSW at 2:01 am #

      Sarah, thanks for your comments and blog. I look forward to seeing your survey results, and predict that most nurses will express their own frustrations with the nature and scope of their work and, perhaps, the general absence of professional medical social workers as a viable resource for their patients and families. Like Mr. Arnold and you have said, I don’t think most nurses wanted medical social work to disappear. It certainly meant more work for them, and with the focus on shorter and shorter lengths of stay, more complex technologies related to discharge planning, and the need to justify our existence based on productivity measures recognized by Finance, maybe social work departments just haven’t adapted that well. I mean, unless your receiving some form of grant funding, inpatient social work services are almost entirely administrative overhead. Unfortunately, that relegates us to a value-added service that apparently does not necessarily directly contribute to the bottom line, except in certain specialized settings like in children’s hospitals, oncology units, psych units, and other care environments not normally associated with your average community hospital, where I think the demise of medical social work is much more prevalent. Anyway, good luck with the project. Starting by surveying nurses is a good place to begin.

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  6. Shehan at 5:10 am #

    Shehan BSW

    Here in Sri Lanka, I am doing BSW degree and my special subject is medical social work. Social worker is a most important part in Sri Lankan society since it’s a developing country. As a medical social worker there is a limited chance to practice in government hospitals, sometime they don’t allow us to enter to that field. Although we got a chance to practice in a hospital, they don’t give their support to handle cases as medical social worker since we have a very bureaucracy structure in the hospital sector. Most of the Doctors in Superior position and other professions always on bottom line, doc never allow other profession to come to up. In this case medical social worker faces to thousands of problems in hospital sector here in Sri Lanka. But as a social worker we should have strength to work for our profession to establish in Sri Lanka. Most of people don’t know what is medical social work, then we always giving a demonstration about “Medical Social Worker” like condom demonstration, What is this, how it look like, what is the purpose of it, how do we use it etc, then and only they give their concern to us.
    We should have more human resource in this field, but no one here to find. if we have one experienced medical social workers who has got some experience in this filed, he will be more valuable to our student gain knowledge from them, even listen to their experience. We have more theoretical knowledge but we don’t have experienced people because, that’s why we face lot of problems since no one to guide. Still only few students working for medical social work profession to established in Sri Lanka.

  7. Karen M at 3:17 am #

    In Medical Social Work specifically in Hospital based roles we need to decide if we are going to do social work or discharge planning- because when you mix the two together one has an agenda and the other doesn’t- One really shows the strengths of the Social Work profession and the other shows tasks that can be done by either a Nurse or a Social Worker. When the patient’s life history, culture, behavior and social supports are just as important as their diagnosis, treatment and length of stay then we can show everyone what we as Social Workers in Health Care have been saying all along- A person is not a disease or a disorder- and the interventions need to be as individual as our patients are… then maybe the decision makers will see what we see
    when we do are job every day- the whole patient.

  8. katy at 6:37 pm #

    when was this article postesd

  9. Laurel at 4:02 pm #

    HI Sarah,
    Were you able to conduct the survey? Do you have any results? I am a nurse and I see two challenges. I find nursing being delegated many non-nursing tasks/duties and secondly, many nurses/administrators do not understand and respect the SW profession. The nursing profession is changing and moving into more primary care duties with the Affordable Care Act and I am wondering about the profession of SW stepping up to the plate to help with the many aspects of assessing and addressing the social issues that are effecting individuals, families and our communities and subsequently their health.

    • George Kuo at 1:16 pm #

      Hi Laurel,
      Certainly someone will have to “step up to the plate” given our current and future healthcare environment, particularly if hospitals are to survive financially. For example, the complex social issues at the root of many hospital readmissions will force providers to establish closer collaborative networks with other healthcare providers and a working, mutually beneficial, partnership with the patients themselves. Everyone knows that the lack of finanical resources, social supports, community primary care and, in many cases, a pervasive lack of personal responsibility are what drives patients to return to the hospital. But, now providers are being penalized for many aspects of a patient’s attitude and care spectrum that formerly was not within their direct respononsibility. They will need to come up with innovative programs which address some of these social problems of the patient directly in their own home and community. Schools of social work could start focusing more on these opportunities, including more curriculm geared towards public health, clinical case management, etc.

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