We Devalued the BSW
For decades, social work has increasingly organized its professional identity around the MSW, clinical licensure and psychotherapy. In doing so, we have allowed something remarkable to happen: the bachelor’s degree bearing the actual name of our profession has become insufficient for social work licensure in jurisdictions such as New York.
Think about what we are telling students. Earn a four-year Bachelor of Social Work degree. Complete hundreds of hours of field education. Study social welfare policy, human behavior, research, ethics, communities, organizations and social work practice. Graduate from a CSWE-accredited professional program. Then go back to school because your Bachelor of Social Work is not sufficient to obtain a social work license.
That should have produced a professional crisis years ago. Instead, we largely accepted it because social work had discovered another economic model: Therapy.
Social Work Bet Heavily on Becoming a Therapy Profession
Social work has gradually moved away from many of the functions that historically distinguished the profession such as, poverty, housing, community organization, social welfare, public systems, neighborhood institutions and material assistance. At the same time, clinical practice became increasingly central to professional identity. The MSW became the gateway. Clinical licensure became the prize. Private practice became an aspiration.
There is nothing inherently wrong with social workers providing psychotherapy. Mental health treatment is important, and clinical social workers provide valuable services. The problem is making therapy the profession’s dominant economic and professional strategy. Because the economic environment supporting that strategy is changing.
The Reimbursement Environment Is Changing
The federal government is restructuring Medicaid in ways that could significantly affect both beneficiaries and providers. Centers for Medicare & Medicaid Services (CMS) has already issued rules implementing an 80-hour-per-month community-engagement requirement for certain Medicaid adults beginning no later than January 2027. Independent researchers at the Urban Institute project that the combination of work requirements and more frequent eligibility redeterminations could produce substantial reductions in Medicaid expansion enrollment. Medicare payment policy is changing as well. Likewise, Social Security is increasing its focus on continuing disability reviews and program integrity. SSA announced this year that it is bringing medical Continuing Disability Reviews under direct federal processing. Taken together, however, the direction should concern a profession that has increasingly tied its economic future to reimbursable individual treatment. If public benefits become administratively harder to maintain, the effects ripple through the organizations serving low-income and disabled populations. And social workers disproportionately practice within precisely these systems. The therapist avenue may be considerably less lucrative in the future than it has been during its recent expansion. That possibility deserves serious discussion in every school of social work.