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Licensed clinicians point to low pay, administrative burdens and weak career pipelines as barriers to public‑system hiring
Summary
A panel of licensed professionals told the division that audits, complex enrollment systems (NCTracks), low Medicaid reimbursement, and limited career paths for bachelor‑level graduates deter clinicians from public‑system work; panelists suggested loan repayment, evidence‑based practice rates and stronger career ladders.
A panel of licensed clinicians told the Division of Mental Health, Developmental Disabilities and Substance Use Services that the public system faces multiple barriers recruiting and retaining licensed professionals.
Kelly Crosby, the division’s director and moderator, introduced the panel and said the division wants to understand "why we are struggling to get licensed professionals to come and stay in our public system." Panelists included Chastity (behavioral health director at RHA), Ryan Estes (licensed clinical social worker, Coastal Horizons), Jenny Gadd (licensed clinical social worker) and Michelle Ivy (chief program officer, Daymark Recovery Services).
Panelists emphasized a mix of clinical and administrative burdens. Jenny Gadd said clinicians frequently confront audits and post-payment reviews and struggle with NCTracks enrollment. "The thing I hear the most from colleagues is the audits, the post payment reviews ... and that sort of thing," she said.
Michelle Ivy described the compensation gap with commercial and hospital employers: "...they go get a job making $20,000 more a year working from home." She said low reimbursement rates and divergent private-insurer rules make it hard for public-system agencies to retain newly trained clinicians.
Ryan Estes described the clinical strain when specialty referral options are scarce in rural areas, leaving clinicians to manage complex social determinants of health without additional supports.
Panelists offered policy and program suggestions: targeted loan-repayment or long-reach payment programs, higher rates for evidence-based practices, credentialing and career ladders for associate-level clinicians, better onboarding and supervisor training, and clearer paths that make public‑system roles a viable career.
Kelly Crosby said the division will continue these conversations with stakeholders and follow up on grant and research work designed to quantify workforce supply and gaps.
