What do we know about the healthcare chaplaincy workforce, and what do we do with this data moving forward? Shelley Varner-Perez, MDiv, MPH, CPH, BCC

Response to and reflection on: White, K. B., Barnes, M., Cadge, W., & Fitchett, G. (2020). Mapping the healthcare chaplaincy workforce: a baseline description. Journal of health care chaplaincy, 1–21. Advance online publication. https://doi.org/10.1080/08854726.2020.1723192

In a recent session of APC Webinar Journal Club, Marilyn J. D. Barnes, Kelsey B. White, Cate Michelle Desjardins, and I discussed the aforementioned article about the chaplaincy workforce. The article includes many valuable insights about current demographics of the workforce: “pipelines” into the profession, potential barriers for people of color and other underrepresented groups, and planning for the future of the profession. The authors provide “nudges” around aspects of data infrastructure for professional chaplaincy organizations and the demand side of chaplaincy. Whether you are a manager, a bedside chaplain, a certified educator, a chaplain-in-training or educator-in-training, a healthcare administrator, a spiritual care researcher, or an aspiring leader, there is relevant and applicable material for your work and ministry.

A quick overview: this project received funding from a 2017 ACPE Innovation Grant Award. The study sample is large, with data examined for about 6000 chaplains, over 700 Certified Educators, over 100 CECs, and over 1200 CPE trainees. The results are preliminary – they provide a strong hunch but are not conclusive due to challenges with the sample, in this case, missing data. Preliminary just means “hold lightly,” or “interpret with caution.” Preliminary results can provide helpful insights about potential direction of the problem, but the magnitude of the problem seen in the data may not be reliable; data may overrepresent or underrepresent the true problem.

An important finding: those in training to become professional chaplains or certified educators appear to be more diverse than those currently in staff or educator roles, specifically they tend to be comprised of a greater proportion of Evangelical Protestants, individuals under 45 years old, and higher proportions of African American/Black identifying individuals. Gender representation was similar overall between groups. When compared with the U.S. population, there is a lower proportion of Asian-identifying or Hispanic individuals serving as board-certified chaplains or certified educators.

As a profession, we are continuing to learn how to utilize data to identify meaningful gaps and trends. Doing so will be of increasing importance in the competitive and challenging healthcare sector. With data in hand, chaplains can engage chaplaincy leaders and other healthcare leaders in conversations about strategic planning. A person or group cannot address a problem they do not know exists, or a problem for which the magnitude is not well understood.

As we think about impact on patient care, including quality and satisfaction, we do not have research about the impact of demographic concordance between care receiver and spiritual care providers. Demographic concordance includes age, gender, and race. Racial concordance refers to having a shared identity between a chaplain and a patient/family regarding their race; on the other hand, racial discordance refers to patients and chaplains having different racial identities (Shen MJ et al., 2018)[1]. In other words, receiving care from someone who looks like you. One might expand this to spoken-language concordance as mentioned in the paper’s discussion to speaking with someone who sounds like you. Anecdotally, there may be other factors of similarity or dissimilarity such as socioeconomic status and educational attainment that also may facilitate developing trust with patients and families. The bottom line is with or without demographic concordance, all chaplains are responsible for providing culturally competent care, which needs to be addressed in education and professional development.

As mentioned in the article, there are at least two levels at which to address cultural competence, diversity, and concordance. We talk about cultural competence, diversity, and concordance as an equity issue for those currently in and training for the profession of chaplaincy and chaplaincy education. It also is important to talk about cultural competence, diversity, and concordance as they relate to patient care and system level needs.

So, what do we do with this information? How might it inform our day-to-day chaplaincy practice, our professional development, chaplaincy education, our conversations with chaplaincy leaders and healthcare leaders? How do we consider the big picture now and for the future of the profession as well as the implications for spiritual care with individual patients and families at bedside? How do we think about recruitment, hiring, and retention in the chaplaincy workforce?

For a few high-level takeaways, I suggest we as a profession attend to the following tasks, and I invite you to create a priority list of your own. My takeaways for the profession include:

• ensuring underrepresented racial/ethnic groups have a clear pathway from education to professional chaplaincy
• discussing the religious affiliations of Chaplains and Educators compared to 1) those in training, 2) the U.S. population, and 3) healthcare users
• ensuring cultural competency trainings are translating to culturally competent care that meets the needs of patients and families. (This might also include staff who tend to be from a variety of cultural backgrounds).
• Discussing any barriers that may exist for millennials to enter chaplaincy training and workforce
• Increasing attentiveness to spoken-language, in addition to culture and religion, to improve our welcome of chaplains of Asian-identifying and Hispanic backgrounds

I am grateful we have this preliminary data to give us an idea of trends of concern and importance and to inform future planning and future directions in research. I appreciate the large sample from multiple professional chaplaincy organizations across training and professional levels, provided alongside national data about religious affiliation and other demographic factors. I find the multi-faceted recommendations for training, education, professional development, and demand-components to provide important future directions for research and practice.

[1] Shen MJ, Peterson EB, Costas-Muñiz R, Hernandez MH, Jewell ST, Matsoukas K, Bylund CL. The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. J Racial Ethn Health Disparities. 2018 Feb;5(1):117-140. doi: 10.1007/s40615-017-0350-4. Epub 2017 Mar 8. PMID: 28275996; PMCID: PMC5591056.