Patient Caseload and Hourly Wage Trends of Outpatient Dialysis Social Workers in the United States

BACKGROUND AND PURPOSE: This study examines patient caseload and hourly wage trends for social workers employed in outpatient dialysis facilities across the United States. In accordance with a Federal Medicare mandate, a Master's level social worker is required in every U.S. dialysis center because of the many psychosocial barriers to optimal dialysis outcomes. For example, dialysis social workers assist patients with issues such as coping with treatment regimes, pain management, end-of-life concerns, social role adjustment, and vocational rehabilitation. Studies in the literature indicate that high dialysis social worker caseloads are associated with lower patient satisfaction, less successful patient rehabilitation outcomes, and decreased ability to provide clinical social work interventions (Bogatz, Colasanto, & Sweeney, 2005; Callahan, Moncrief, Wittman, & Maceda, 1998; Merighi & Ehlebracht, 2002, 2005). The purpose of this study is to assess regional variations in caseloads and wages for dialysis social workers.

METHODS: A sample of 1,195 full-time (32 hrs/wk or more) social workers was obtained from all five National Kidney Foundation (NKF) regions in the United States: Region 1 (Northeast), Region 2 (Southeast), Region 3 (Midwest), Region 4 (Northwest), and Region 5 (West and Southwest). Survey respondents were recruited between December 2006 and July 2007 through the Council of Nephrology Social Worker (CNSW) listserv, local CNSW chapter events, and national meetings. A 34-item online survey was used to gather data on renal social workers' caseload, salary, job-related resources, and professional responsibilities. The survey took approximately 25 minutes to complete.

RESULTS: One-way analysis of variance was used to examine mean caseloads and hourly wages across all five NKF regions. Findings yielded significant main effects for caseload, F (4, 1149) = 7.56, p < .001, and hourly wage, F (4, 1190) = 68.82, p < .001. Post hoc tests revealed that Region 2 has a significantly higher caseload (M = 118) than Regions 1 (M = 105), 3 (M = 105), and 4 (M = 103), as well as a significantly lower hourly wage (M = $22.83) than Regions 1 (M = $25.37) and 5 (M = $27.20). Geographic Information Systems (GIS) technology was used to map caseload and hourly wages using longitude and latitude points calculated for each unique zip code boundary. The GIS maps displayed a distinctive pattern, i.e., “hot spots,” of high caseloads and low wages throughout Region 2. In this region, many social workers' caseload exceeded 160 patients (national M = 115), and their hourly wage was $20 or below (national M = $24.65).

CONCLUSIONS AND IMPLICATIONS: This study represents the first national effort of its kind to assess caseload and hourly wages together for dialysis social workers. Further, it uses GIS mapping to depict caseload and wage hot spots across the United States. The findings provide empirical evidence that can be used by CNSW, NKF, and policy makers in their efforts to reduce caseload and wage disparities that exist between social workers employed in the southeastern United States and other geographic regions.