The authors used the RAND Dynamic Retention Model to determine the most cost-effective way to increase the force size of the uniformed mental health provider workforce; specifically, accessing more providers or retaining more providers. The authors also compared military compensation for psychiatrists, clinical psychologists, social workers, and mental health nurse practitioners with expected civilian compensation for these types of providers.
Authors
Lawrence, Anthony, Mattock, Michael G., Schwam, Daniel, Hepner, Kimberly A., Calkins, Avery, Donofry, Shannon D.
- Division
- RAND National Security Research Division Personnel, Readiness, and Health Program
- Pages
- 152
- Published in
- United States
- RAND Identifier
- RR-A2256-1
- RAND Type
- report
- Rights
- RAND Corporation
- Series
- Research Reports
- Source
- https://www.rand.org/pubs/research_reports/RRA2256-1.html
Table of Contents
- Cost Trade-Offs Between Accessing and Retaining Uniformed Mental Health Providers 1
- About This Report 3
- RAND National Security Research Division 3
- Summary 5
- Issue 5
- Approach 6
- Key Findings 7
- Recommendations 8
- Recommendation 1. The U.S. Department of Defense Should Widen Mental Health Provider Accession Pipelines 8
- Recommendation 2. The U.S. Department of Defense Should Increase Retention Bonuses for Uniformed Mental Health Providers 8
- Recommendation 3. The U.S. Department of Defense Should Review Special and Incentive Pays for Mental Health Providers on a Regular Basis to Ensure That They Support Retention Goals 9
- Contents 11
- Figures and Tables 13
- Figures 13
- Tables 15
- Introduction 17
- Mental Health Care Needs of Service Members 18
- The Military Health System Mental Health Provider Workforce 19
- Military Mental Health Provider Shortages 21
- Costs of Accession and Retention 23
- Accession Cost 23
- Retention Cost Special and Incentive Pays 26
- Trade-Offs Between Accession and Retention 26
- Modeling Trade-Offs with the RAND Dynamic Retention Model 30
- Focus on Active-Duty Providers 31
- Organization of This Report 31
- Methods 33
- Overview of the Dynamic Retention Model 33
- Simulating Trade-Offs with the Dynamic Retention Model 35
- Data Sources for the Dynamic Retention Model Estimation 36
- Military Retention 36
- Military Compensation 36
- Civilian Earnings 38
- Military and Civilian Pay for Mental Health Providers 41
- Military Compensation for Mental Health Providers 41
- Military Compensation by Years of Service 43
- Changes in Military Compensation over Time 44
- Civilian Earnings for Mental Health Providers 53
- Determining Civilian Pay for Each Provider Type 53
- Comparing Military and Civilian Pay 63
- Summary 64
- Dynamic Retention Model Model Fit and Simulations 67
- Model Fit 68
- Responsiveness to Increases in Retention Bonuses 70
- Trade-Offs Between Accession and Retention and the Break-Even Level of Training Cost 77
- Summary 82
- Summary and Recommendations 83
- Strengths and Limitations 83
- Key Findings 86
- Expected Annual Real Compensation for Fully Trained Board- Certified Psychiatrists Decreased from Fiscal Year 2014 Through Fiscal Year 2022 86
- With the Exception of Psychiatrists Military Mental Health Providers Earn More Than Civilians 86
- Military Mental Health Providers Vary in How Responsive They Are to Relative Changes in Retention Bonuses 87
- It Is More Economical in the Long Run to Expand the Accession Pipeline 87
- Recommendations 88
- Recommendation 1. The U.S. Department of Defense Should Widen Mental Health Provider Accession Pipelines 88
- Recommendation 2. The U.S. Department of Defense Should Increase Retention Bonuses for Uniformed Mental Health Providers 89
- Recommendation 3. The U.S. Department of Defense Should Review Special and Incentive Pays for Mental Health Providers on a Regular Basis to Ensure That They Support Retention Goals 89
- Special and Incentive Pay Policy and Data 91
- Special and Incentive Pay Policy for Military Mental Health Providers 91
- Special and Incentive Pay Policy for Psychiatrists 91
- Special and Incentive Pay Policy for Psychologists Social Workers and Mental Health Nurse Practitioners 93
- Accession Bonuses 95
- The Mental Health Provider Workforce 96
- Trends in Compensation over Time 103
- Civilian and Contractor Mental Health Providers 107
- Civilian Mental Health Providers 107
- Contractor Mental Health Providers 108
- Summary 109
- The Dynamic Retention Model 111
- Structure of the Dynamic Retention Model 111
- Additional Information on Dynamic Retention Model Estimation Data 112
- Military Retention Profiles 112
- Calculation of Pay Lines 112
- Dynamic Retention Model Parameters 114
- Parameter Estimates 114
- Incorporating Multiyear Special Pay and Retention Bonus for Psychologists Social Workers and Mental Health Nurse Practitioners 116
- Mental Health Nurse Practitioner Results 119
- Civilian Earnings for Mental Health Professionals 123
- Estimating Percentiles of Civilian Earnings by Occupation and Age 123
- American Community Survey Data 123
- Methods for Calculating Earnings Percentiles 124
- Tobit Regression Results 127
- Earnings Percentiles 127
- Authorizations and End Strength of Military Mental Health Providers 139
- Abbreviations 143
- References 145
