After the Great Resignation, many healthcare workers were burnt out. Now, behavioral health leaders are picking up the pieces and navigating an increase in service demands at all levels of care.
Before they can do so, Omar Fattal, MD, system chief for behavioral health at NYC Health + Hospitals in New York City, and Sophie Pauze, senior director strategy and impact, said crafting a recruitment strategy is key.
“We’re all here at the end of the day to create access for New Yorkers to access inpatient services and outpatient services,” Dr. Fattal said. “But in order to have access, you need a workforce. You need people to be able to work at our facilities, and as we expand our programs, you need to be able to keep up and hire even more people.”
As the largest safety-net hospital in the country, NYC Health + Hospitals is rebuilding the behavioral health workforce one program at a time. From loan repayment to developing administrative leaders and centralized clinical placements, the system aims to pair a financial benefit or professional development benefit with every service obligation across all disciplines.
“We introduced a comprehensive workforce strategy for [the] behavioral health workforce at large, and this strategy spans recruitment, training and retention in addition to really focusing resources — both human capital resources and financial resources — on the strategy. … Having a dedicated strategy in place makes a difference,” Ms. Pauze said.
A three-year service obligation paired with loan repayment has proved effective for all staff, spanning from nurses to psychiatrists. The system has awarded $7.3 million in student debt relief to over 200 of its behavioral health clinicians — 52 new staff and 149 incumbent staff — through the loan repayment program since launching in 2022. Through 2027, the program will support 40 additional staff with the $1.1 million in funds that remain.
“The three-year inflection point, based on our historical workforce data, represents a really key turning point, and whether a staff member is going to stay at [NYC Health + Hospitals] or move on to another opportunity. So that three-year service obligation was really designed with that data point in mind,” Ms. Pauze said.
The system hopes to promote work-life balance, and student loan repayment allows clinicians to maintain both, Dr. Fattal said. While the system uses a universal eligibility criteria for the program, NYC Health + Hospitals is intentional about what positions it pursues. Right now, psychiatrists are in focus.
“Our team looks very closely at our workforce data ahead of each award cycle to ensure that we’re screening and prioritizing awards that really reflect current vacancies and current workforce needs,” Ms. Pauze said. “We’re really focusing awards in areas that are going to serve our workforce and our systems needs right away.”
Through grant funding, the system hired a dedicated project manager to operationalize the program, handling administrative capacities and additional paperwork and creating a personable experience, she said.
“That other key is opening it up to everyone that we learned this the hard way, that you cannot have a program like that and then limit it to one discipline, because it will backfire. It will alienate the other disciplines [that are] going to be offended and saying, ‘Why didn’t you include me? I have student loans as well,’” Dr. Fattal said.
A second program — NYC Health + Hospitals’ behavioral health nursing ladder — assists incumbent nursing support staff in entry level areas to earn a nursing license. The system covers tuition, including support through the enrollment process, in partnership with City University of New York schools, Dr. Fattal said. In return, the graduate commits to a multi-year service obligation, serving as a licensed nurse in behavioral health.
Another focus is centralizing clinical placements for psychiatric nurse practitioners, physicians assistants and social workers within the system. A standardized intake form is filled out and participants are paired with an educational component to provide contextualized knowledge for newcomers to the system, Ms. Pauze said. Last year, the program placed around 200 students across disciplines.
“When it comes time for graduation and full-time employment, I can very closely and in a very targeted way focus my recruitment outreach on the standout students right who have expressed an interest in working here and who would be a great fit for our system,” Ms. Pauze said. “Every year [we] have a cohort who are coming back to work as full time staff. They then become the next generation of preceptors who can train future students.”
The system also provides a yearlong fellowship for early career psychiatry attendings, she said. Participants complete the educational component, site visits and meet with system leaders in pursuit of becoming leaders in the system. In a similar program, third-year psychiatry residents doing rotations at the system also complete educational components and meet leaders with the goal of converting them into full-time employees.
Lastly, the social work clinical licensure program helps social workers pass licensure tests in order to unlock financial mobility, Ms. Pauze said. Eighty-two social workers are enrolled, and many have passed their clinical licensure tests and will move into senior roles.
She said although some processes and programs are standardized, personalization is key to the system’s results.
