Why I Want To Leave Social Work

It's been a while since I've updated this blog. I actually wasn't sure if I would actually come back to it, but given recent events I have some free time on my hands and should keep occupied. With that said, let's cut to the chase.

I'm burned out. After 10 years of being a social worker, I'm ready to leave the field. A few of the reasons are as follows: 

1) Emotional and physical exhaustion 

As we all know, social work is an extremely demanding job with high caseloads, emotionally taxing situations, and strict deadlines. Depending on how busy I am and how much caffeine I've had, I'm usually running on high alert so I could finish everything by the end of my shift and sit in traffic. Being in a continual state of stress has started wearing on me, and I find that as I age I'm not as physically and emotionally resilient as I used to be.  

The social work profession promotes self-care as a way to prevent burnout. This is nice and all, but how can you take care of yourself when you simply don't have the time, energy, or money to do so? This leads me to my next point: 

2) Unfair compensation 

Early in my career, I worked in a hospital where social workers and nurse case managers essentially did the same discharge planning functions. In addition to my social work duties, I was also responsible for arranging skilled nursing home placements, home health visits, ambulance transport, and durable medical equipment for patients. There were even instances where I had to arrange acute-to-acute transfers and helicopter transportation because there were no nurse case managers around at the time. This is fine. 

However, what is not okay was that I was paid significant less than nurse case managers. When I say significantly less, I mean up to 50% less for doing essentially the same job functions. Considering that a hospital social worker job requires a minimum of a masters degree, it's basically saying that a MSW is worth half a RN. While I've learned to accept that social workers with masters degrees are paid less than nurses with associates and bachelors degrees, is our graduate education really worth HALF as much? 

Furthermore, all of these professions (which only require an associates or bachelors) all pay higher than a social worker with a masters degree: nurses (RN and LVN), physical therapists, occupational therapists, nutritionists, respiratory therapists, medical laboratory technicians, speech therapists, radiology technicians, pharmacy technicians, etc. I realize that all of these hospital professions are important. I also realize that I should be thankful that I'm paid as much as I am as a medical social worker. However, social workers are important too (see "Dependencies" below). It's incredibly demoralizing that we have to get masters degrees (plus an extra two plus years on top of that for licensure) just to get paid less than people who didn't have to be in school for as long. 

Like other "Healthcare Heroes", social workers are also on the front lines. I've read multiple stories of social workers who comfort COVID-19 patients, including facilitating numerous "farewell" conversations with family members a day. Hospitals, health clinics, social service agencies, APS, CPS, etc. - they don't shut down because there's a global pandemic. We are out there serving, and some of us are dying as a result. We matter, and the fact that we are grossly underpaid and not acknowledged for our contributions (I was refused a "Healthcare Worker Meal" at a fast food restaurant because my badge only said "Medical Social Worker") is a travesty.

While I see things ever so slowly changing for the better, the NASW and social work profession in general has run on a martyr complex for too long. The mindset of "we didn't go into this for the money" has resulted in generations of social workers tasked with caring for others yet horribly underpaid. Self-care? That's cute, but not when many of us struggle with paying for our student loans and basic living expenses. 

3) Lack of respect

Most hospital professionals don't realize that medical social work requires a masters degree for an entry-level job. However, they realize that we 1) don't have extensive medical knowledge (since we went to graduate school to learn about social work and the psychosocial perspective, not the details of human medicine) and 2) don't get paid well. As a result, we are viewed as and treated like we are stupid. 

When I first described my job duties to my boyfriend-now-husband, he stated that it sounded like "glorified secretary work". Initially, I was so infuriated that I nearly broke up with him. Years later, as the nurse case manager ordered me to make copies of yet another chart to fax to a home health care agency, and everyone at work started viewing me as clerical help because of the number of hours I spent at a copy machine, I couldn't help but think that he was right. 

 No matter how I tried to educate my non-social worker colleagues about my scope of practice, nothing seemed to help with regards to how they viewed social work. My pay certainly didn't go up to match that of nurse case managers. I was viewed at as one of the "good social workers", who got her work done quickly, efficiently, and on time. A few coworkers even commented that I was "too good" or "too smart" for this job, which seemed to insinuate the view that social workers are less intelligent than those who go into STEM fields. 

Outside of work, family acquaintances would express shock at my parents that I went into social work. Those who work in hospitals basically assumed that I did paperwork and clerical work all day instead of clinical work. One nurse even mocked me for the lack of math classes in my masters program (to which I responded that I took calculus as an undergraduate). 

Eventually, I changed jobs and went to a hospital that seemed to have a better understanding of social work's function. While I wasn't necessarily getting paid any better, I also no longer had to do discharge planning clerical work. I suppose this helped keep me in the field a few extra years, but if everyone is going to think negatively of what I do anyway, I might as well do something that truly makes me happy. As I have told close friends, social work is my calling, but it's not my true passion in life. 

4) Dependencies 

"Dependencies" is a term I stole from my husband, who is a software engineer. He uses it to refer to the various groups he relies on for his work projects. This parallels to my job in that what he calls dependencies is what we hospital workers refer to as the interdisciplinary team model. This is where the different health professions (i.e. physicians, nurses, nurse case managers, physical/speech/occupational therapists, pharmacists, and social workers) communicate and function in tandem with the intention of providing quality care and safe discharge home. 

In terms of discharge planning, this includes nurses assessing patient needs, physical/speech/occupational therapists making recommendations for discharge needs, physicians writing orders/prescriptions for the appropriate interventions, and nurse case managers or social workers arranging everything. If any discipline drops the ball, the entire discharge falls through. 

When I actually did discharge planning, I wasted literal HOURS waiting for other people to finish their parts of the discharge. One example is waiting for physicians to write orders (because I can't get do anything unless I have a doctor's order), or waiting for them to call me back after leaving a voicemail message. Often, I would fax, email, or leave important forms or requests for letters in the chart, along with a phone call and note requesting for them to get it done by a specific date/time. More often than not, my email inbox would stay empty, my fax machine quiet, and papers in the chart blank.

As a result, I'd end up filling out the forms or writing the letters myself because I was running out of time. Yes, me, a lowly social worker, writing physician notes and filling out physician forms. I'd then have to chase down the doctor where ever they happened to to be and they would simply sign the documents without reading them.

Ever watch the film "The Devil Wears Prada"? This felt like my life. 

On top of that, if anyone on the interdisciplinary team didn't know what to, it suddenly became my job and my problem. I've had physicians ask me what specific medications to order for patients discharging home on hospice. I've had to tell physicians to write orders for generic medications because non-generics weren't covered by insurance. If a patient doesn't want to work with physical therapy because they feel tired, it's my job to fix it. If family members have medical questions and the doctor or nurse is too busy, the call is sent over to me. If a patient is frustrated because they haven't heard anything from their doctor, I have to calm them down. 

Outside of hospital staff, if a company doesn't deliver equipment on time (which seems to happen 90% of the time), it's my job to make that delivery happen. If family members are not picking up the phone, I have to do everything in my power - including calling dozens of times, leaving multiple voicemails, and calling the police if they still don't pick up - to reach them. 

When it comes to patients discharging from the hospital, so many things can go wrong. If an ambulance pick-up is late because of traffic, if a nurse didn't receive proper hand-off from the preceding shift's nurse about an impending discharge, if pharmacy lags in delivering discharge medications to the bedside, if a patient can't get certain tests done because the lab is backed up or radiology equipment is broken, if a doctor forgets to sign a form or write discharge orders, if all the nursing homes are full, if the equipment company is out of hospital beds, this all becomes my problem. It only takes one thing to go wrong for an entire discharge to fall apart. If a discharge falls apart, a patient has to stay in the hospital unnecessarily. If a patient is in the hospital unnecessary, insurance won't pay. If insurance doesn't pay, the hospital loses money, and I get blamed for it all. This makes my department, and professions as a whole, look even worse than it already does. 

Sometimes, I feel like medical social work is a group project where I do all the work, get all the blame if something goes wrong, and get zero credit when everything goes smoothly. How nice would it be to work a job that's not entirely dependent on the abilities of other people to do theirs? 

5) Monotony 

Most social workers will tell you that there's no boring day in social work. Unfortunately, this is not the case for me. My typical work day start at exactly the same time and ends at the same time (granted I get my work done). I have meetings and rounds at the same time each day. I eat lunch at the same time (or not at all). I essentially see the same types of patients every day, with variations on the degrees of complexity. In my opinion, I'm doing the same thing every day with very little mental stimulation. 

Perhaps working in an area that gives me a change of scenery (home health or CPS) might help, or maybe I'm just the type of person who'll never be happy in a traditional 9 to 5 job. What it boils down to it this: I'm bored. When I'm not bored, I'm stressed. 

6) Feeling like I'm not helping 

I went into medical social work to help people struggling in a hospital setting. Eventually, I came to the realization that my job wasn't to help people, it was to save the hospital money. Given the high patient turnover rate at inpatient hospitals, social workers don't have the luxury of time when it comes to their interventions. Providing emotional support and counseling? No, we don't have time for that. Essentially, our function is to put a band-aid on the issue and send patients their way before the hospital loses money. If I keep losing the hospital money, that's reflection of my abilities as a social worker and I end up losing my job. 

In my years in the field I've had to discharge countless homeless patients to the streets with nothing but a bus pass (because homeless shelters are full), break the news to elderly patients that they have to liquidate their assets to pay for nursing homes/care homes/caregivers, transport someone's parent to a nursing home 75 miles away (or pay thousands in hospital fees) because it's the only place with an open bed, convince an alcoholic patient to go to a sobering center knowing the place I'm sending them to is so overcrowded people sleep on the floor, and rush hospice patients home before families have even had time to process what's happening. 

Ultimately, I'm a cog contributing to what makes healthcare in this country so terrible. It's a business first, and the top priority is to make and save money. Yes, we feel sad about individual's social circumstance, but it doesn't change the fact that if we don't get them out within a specified timeframe, insurance will stop paying. 

To summarize, I'm tired, underpaid, disrespected, withdrawn, bored, and jaded. If I'm going to feel all of these things, I need to be brutally honest with myself and do something I actually love. Life is too short to be working a job where I count down the seconds to when I can finally clock out. 

Hence, I've cut back my work hours and gone back to school in a field completely unrelated to social work. I don't know where I'll end up once I'm done, but the fact that I'm studying something out of passion and independent of practicality has been liberating. While I have significantly less free time as a full-time student and part-time social worker, I'm somehow so much happier. 

There are a few reasons I want to maintain this blog. The first is as per my previous post, I am still a social worker at heart. Even though I may reach a point where I am no longer working as a social worker, I want to continue advocating for the social work profession and the people it serves. Secondly, I'm not going to get rich anytime soon. If anything, I have to be cheaper than ever thanks to my reduced work hours and the fact that I'm married to someone extremely frugal (more on him in future posts). I might as well share my experiences in hopes that those on similar financial footing find it useful. 

Wow, this was a rather long post. I'll try to update again soon, but we'll see given that school is starting up in a few weeks. If anything, I wanted to leave everyone with my critique of this profession. Thank you for reading.