Red tape keeps WA psychologists waiting for months to enter workforce

When Miriam Rubenson goes to work at Seattle Children’s each day, she treats some of the toughest cases: youth with serious psychological concerns, including those with multiple suicide attempts. Getting mental health treatment is difficult — demand is high, workforce shortages are extreme. And by the time many of these kids get to Rubenson’s psychiatry clinic, they have been on waitlists for two years. 

Rubenson has had a wait of her own. 

Technically, Rubenson isn’t allowed to treat these children by herself. She’s unlicensed and working as a postdoc.

For months she’s been waiting on Washington regulators to process her psychologist licensing application. A majority of people applying to become clinical psychologists in Washington state are facing delays and wait months or years to get licensed, new state Department of Health data suggests. 

Becoming a clinical psychologist in Washington requires at least nine years of postsecondary schooling, years of supervised training and, these days, months or years of pestering state officials to approve career-changing credentials. Insufficient staffing at the state’s credentialing department, inefficiencies in the review process and technical malfunctions are mucking up the path of hundreds of Washingtonians who aim to enter the mental health workforce each year.

Because she’s without a license, Rubenson’s work is supervised, the hospital can’t bill for some of her services, and she has a smaller-than-usual caseload. “This is not just a problem for me,” she said. “It’s a problem because we have this really dire mental health crisis in our youth right now.” 

Health facilities statewide report that there aren’t enough qualified applicants for psychologist job openings. 

Last fall, a quarter of Washington’s designated crisis responder services and mobile outreach teams — typically, county-run teams dispatched to help people during mental health crises — reported that open psychologist positions were vacant for an “exceptionally long” time, according to the Washington Health Workforce Sentinel Network. A fifth of behavioral health clinics, and 15% of primary care clinics reported the same.

A total of 3,444 people were licensed psychologists in Washington as of last year. Meanwhile, nearly 400 clinical psychologist applicants were in the queue to get licensed, DOH data from 2022 shows; if all are approved, they’d boost the existing workforce by about 11%. 

The backlog isn’t new. Last year at this time, for instance, 389 psychologist applications were pending.

“Access for me is the biggest and the saddest part of this story,” said Samantha Slaughter, director of professional affairs for the Washington State Psychological Association. “We have had numerous attempts trying to figure out where the problem lies, who is responsible. And I’m laughing because it has been eye-opening and disappointing the entire time.”

State officials say they’re working to smooth the process. DOH has hired three pro tem board members to assist the state’s Examining Board of Psychology as application reviewers. And the board, which monitors and enforces licensing requirements, has filled two other vacancies and added a new full-time member. 

“We are certainly committed to quicker and more simplified processes to get people through as quickly as they can,” said Shawna Fox, director of DOH’s Office of Health Professions.

“Relentless” process

Rubenson has completed her doctoral degree, a yearlong clinical internship and a postdoctoral program at Seattle Children’s. 

To practice independently, her next steps were to get the state’s approval to sit for the national licensing exam, study, pass and then complete more required tasks, including a state jurisprudence test and background check. 

A yearlong slog to get past the first step has set Rubenson back professionally and financially. She’s earning half the salary she’d make as an attending psychologist, she said. She has a pending job offer at Seattle Children’s, but can’t accept it until she’s licensed. For now, the hospital has extended her postdoctoral fellowship, where she makes $65,000. “I have a toddler,” she said. “Living in Seattle on a postdoc salary is not [easy].”

In the meantime, Rubenson heard from frustrated colleagues about a counterintuitive shortcut.

Apply to take the national licensing exam through another state, they told her. She applied to Colorado in December, hoping that would allow her to take the licensing exam sooner and shave a few months off the process while she waited for her Washington paperwork to go through.

It took Colorado just four days to approve her application. “My reaction was a combination of hilarity and anger,” she said.

A timeline Rubenson created of her struggles with Washington’s process details technical malfunctions including getting locked out of the application website. She had to switch to sending a paper application by mail. At one point, she reached out to her state representative for help.

As she waited, she logged lengthy email chains with DOH credentialing officials that were often answered by out-of-office replies or messages that other applications were ahead of hers. 

Rubenson is among 13% of applicants who are designated “non-routine.”

“Routine” applicants generally went through doctoral and internship programs accredited by the American Psychological Association and their applications are easier and quicker to process. Nonroutine applications are expected to take longer, Slaughter said, because these applicants went through training programs that require extra review by the state’s psychology regulatory board. But when Slaughter applied as a nonroutine applicant in 2009, she said, the process only took two or three months.

Rubenson doesn’t know why she’s considered nonroutine — she said her programs were accredited, and DOH didn’t answer her inquiry about the designation. 

Wren Yoder, who works at Swedish First Hill, has similar frustrations as Rubenson, though Yoder was considered a “routine” applicant. Yoder came to Washington for her postdoctoral work because she knew Washington’s licensing requirements are rigorous. She figured getting licensed here would make it simpler to transfer elsewhere in the future. 

Still, she didn’t expect so much red tape. After applying in March 2022, she began receiving requests to resend documents. Back-and-forth with DOH “went on for months,” she said. When she eventually reached a credentialing staffer by phone, the connection was terrible. 

“The person on the phone said, ‘Yeah, our phone system isn’t very good,’ ” she said. “The word ‘relentless’ keeps coming up, as just how expensive, laborious, the process is on top of working in a field that can lead to burnout, secondary trauma.”

“Doesn’t make sense”

Cassidy Gebhardt, who worked for about four years as a clinical psychologist in California, has been waiting two years to secure her Washington license.

In early 2021, she took a position at Monroe Correctional Complex, working with people who have serious mental illnesses and grave criminal convictions — a group she’s drawn to because they’re “the population that people want to forget about.”

Because she’s not credentialed, though, her job is now on the line.

Gebhardt has an inch-thick stack of correspondence with DOH, she says, including pleas for updates on her application. In September 2021 she was able to secure a one-year temporary license and was promoted to a credentialed role. But that has since expired, she still hasn’t heard back about her permanent license application, and she’s now worried she’ll lose her job. 

“I’m in a position that not very many people want. … And it would be heartbreaking for me to lose it,” she said. Her application being stalled “doesn’t make sense to me,” she added. 

In January, Gebhardt attended an Examining Board of Psychology meeting to press her case. 

After her testimony, the board discussed licensing wait times. Nearly half of routine applicants take six to 12 months to get their license, and another 19% take even longer. “I’m kind of blown away by that data,” board member Cedar O’Donnell said.

Fox, of DOH, didn’t comment on specific applicants, but said the “vast majority of licenses are completed and issued in a timely way.” About 80% of applications come from routine applicants, and 81% of those are licensed in less than a year.

Seven or eight reviewers are charged with processing all of the state’s behavioral health applications, psychologist licenses among them, said Blake Maresh, director of DOH’s office of customer service. 

Processing times depend on what time of year someone applies and how quickly they submit documents, he said. Military applicants and their spouses — which make up about 2% of the pool — tend to move through faster because state law prioritizes them over other applicants.

Yoder was finally approved in October to take the licensing exam, and in late January — 10 months after applying — got word that her license is now active. 

Rubenson has also heard back from Washington’s credentialing department. In mid-January, Washington approved her to sit for the national licensing exam. The ordeal with DOH brings to mind a concept she uses in therapy: that people are doing the best they can, and that they can also do better and try harder.

“I can’t even fathom how many potential steps and months are between where I’m at now and the end,” she said.