There is a nursing strike at Crozer in Delaware, protesting work conditions, pay, pensions and inadequate staffing. I'm all for supporting workers rights to negotiate but inevitably, when you work in healthcare, you get criticized for hurting the people you are serving. It's almost like if you are essential enough, you are supposed to have a higher calling that'd keep you from negotiating to do your job effectively.

I say this because as a social worker, people in our profession get roundly criticized at times, including by other social workers for striking. Now nurses in medical care's tasks are different than social workers but I think mental health care and other social service needs are essential and basic, so sometimes the criticisms are similar. The social work labor market isn't great. We've never been paid particularly well. It's worse now that everything is going fee-for-service, which means that typically, you get a job where you get paid by the client's health insurance policy, without regard to paperwork or case management needs and you often don't get things like health insurance (though some places allow you to buy into a group health plan). People also have to pay for their own supervision, usually by seasoned professionals who cut their teeth in the profession during much more forgiving times. I'm not a fan of places not providing supervision and I don't think you need supervision just for licensure—consulting with others around cases is a basic necessity in mental health care.


Typically, you can bill a health insurance company anywhere from 65 to around 100 dollars per session. You as a social worker might get anything from 22$ to 40$ but mostly more on the lower end of that scale. You get more for groups, though not much more and there is a much greater paperwork load. In a typical week, if you are super-productive and like a little therapy machine, you might see 30 people, after scheduling 35, though like that is a high workload that doesn't necessarily translate into quality care over the long-term, leading to burnout. So pay isn't great—right? The structure is kind of unsustainable too.

But the problem is that whenever I've seen social workers walk out of a job to protest work conditions, there is this criticism of walking way from people who need you. And it's frustrating because of the real problems structurally here because a fee-for-service model for therapy, like most healthcare, is really not a good model because it doesn't allow you to to successfully assess and provide care for people who need it the most. It's driven by insurance companies' assessments about what is essential or not, which can be decontextualized and done according other kinds of measurements. And if nothing else, there is a lot of bureaucratic red tape, which seems really unnecessary and inefficient and tries to wedge health care concerns into a competitive capitalist structure.

I'd wonder what you think because I've strongly made my POV known but I'm biased and would be curious how people view this from the outside. And if you aren't for strikes, what are other effective ways of negotiating better work conditions?