Caseload and Hourly Wage Disparities Among U.S. Dialysis Social Workers

BACKGROUND AND PURPOSE: This study examines patient caseload and hourly wage disparities of 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 regimens, 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 a decreased ability to provide clinical social work interventions (Bogatz, Colasanto, & Sweeney, 2005; Callahan, Moncrief, Wittman, & Maceda, 1998; Merighi & Ehlebracht, 2002, 2005). The aim of this study is to assess regional variations in patient caseloads and hourly wages for dialysis social workers.

METHODS: A sample of 1,055 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 (South), and Region 5 (West and Southwest). Survey respondents were recruited between March 31 and June 21, 2010 using the Council of Nephrology Social Worker (CNSW) listserv. A 130-item online survey was implemented 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, 1035) = 5.46, p < .001, and hourly wage, F (4, 1054) = 63.93, p < .001. Post hoc tests revealed that Region 4 has a significantly higher caseload (M = 125) than Region 3 (M = 112), and hourly rates for Regions 1 ($28.71) and 5 ($30.63) both differ significantly from Regions 2 ($25.57), 3 ($25.58), and 4 ($25.48). 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 display a distinctive pattern of high caseloads and low wages specifically in Arkansas (M = 157 patients, $21.62/hour) and Mississippi (M = 159 patients, $22.13/hour) compared to the national means for patient caseload (121) and hourly rate ($27.17).

CONCLUSIONS AND IMPLICATIONS: This study represents an important national effort to assess caseloads and hourly wages together for dialysis social workers. Further, it uses GIS mapping to highlight disparities in caseloads and hourly wages 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 discrepancies that exist between social workers employed in the southern United States and other geographic regions.