With one out of every 31 kids (3.2%) diagnosed with autism in the United States, ABA practice owners like Pessy Raitman, MS Ed., BCBA, LBA, can’t hire board-certified behavior analysts (BCBAs) fast enough. “We’re always in hiring mode,” she says.
She and her partner, Chayalah Hurwitz, M.S. Ed., BCBA, LBA, are practice owners of Lighthouse ABA, with around 150 BCBAs supporting children in New York and North Carolina. As clinician-owners, they maintain high standards for hiring new BCBAs, despite a national shortage.
With an estimated deficit of nearly 300,000 BCBAs nationwide, many providers are being forced to make difficult decisions about staffing, supervision and service delivery. The struggle to meet care needs in rural areas is especially acute.
For ABA business owners, the hiring challenge is a test of whether their clinical model, operations and workforce strategy are strong enough to sustain the necessary growth to meet local needs without compromising care.
Some practices, like Lighthouse ABA, are finding a way forward by rethinking how they deliver care, build culture and set up operations.
Why the BCBA Shortage Is More Than a Hiring Problem for ABA Practices
At the same time that demand for ABA services is rising, payer pressures are moving in the opposite direction. In some markets, reimbursement models limit the number of BCBA supervision hours covered, placing more responsibility on fewer clinicians.
That leaves behavior technicians delivering most of the direct care with limited supervision. “They only have to do, for example, 40 hours to become certified,” says Raitman.
Without adequate BCBA oversight, practices face increased exposure to the following:
- Inconsistent care
- Incomplete or inaccurate documentation
- Compliance issues
- Unreliable outcomes
Raitman says this is where standardizing operations through clear guidance, supervision and even an app can improve care and reduce liability.
BCBA Retention Strategies: Why Clinical Support Matters More Than Salary
In a competitive hiring environment, compensation alone isn’t enough to attract and retain BCBAs. What differentiates practices is how they recruit clinicians through the hiring process and onboarding and then how they nurture them once they’re on staff.
For example, at Lighthouse ABA, Raitman says, “People feel that our whole agency is clinical-based as opposed to business-based, so it makes a very big difference in the way we’re able to hire BCBAs. People in the field want to be making a difference in children’s lives, and it’s not about whether they’re making more money for the company.”
The owners’ clinical background has allowed them to establish structured, ongoing support for BCBAs. They set up for their employees what they themselves would want from an employer, including:
- Supportive clinical supervision
- Direct access to senior supervisors
- Continuing education (CEUs) with renowned experts in the field
- Regular exposure to new research
The result is a culture where clinicians don’t feel isolated, despite working remotely. “It could be a very lonely field, so we try to be as supportive as possible, with a lot of communication and check-ins,” says Raitman.
How Remote BCBA Supervision Expands Access to Rural and Underserved Areas
To keep up with demand, many ABA practices, like Lighthouse ABA, have expanded beyond their local hiring markets. “We have to hire a lot of BCBAs who are remote, which gives BCBAs the flexibility to work from wherever they are. In some states, there’s a very big distance between homes in home-based services,” says Raitman.
COVID accelerated the shift toward remote BCBA work, making it possible to:
- Recruit clinicians across state lines
- Serve rural and underserved populations
- Match providers with patients based on language needs
The behavior technician is in person with the client, but the BCBA can be anywhere while providing services as long as they’re licensed in the state where the client is located. It’s relatively easy to get licensed in a new state as a BCBA, unlike many other clinical licenses.
Still, remote supervision introduces new operational and clinical challenges. “It’s not as effective as in-person supervision,” says Raitman.
To make remote models work, Raitment recommends stronger systems, including:
- Clear communication
- Structured supervision
- Reliable and simplified data tracking
How Operational Efficiency Improves ABA Care and Supports BCBA Workloads
Managing a constantly growing remote workforce has forced the Lighthouse ABA team to streamline their onboarding, operations and documentation. They use AI to automate the hiring process, so potential candidates get immediate responses and don’t slip through the cracks.
Once new BCBAs are hired, they go through a streamlined onboarding process so they can begin working as soon as possible.
Then, a custom Lighthouse ABA app for documentation helps reduce administrative tasks and increases accuracy and compliance. “Paperwork is a very big issue for BCBAs, so we try making it as smooth as possible,” says Raitman.
The app also helps BCBAs track client data. ABA care is highly data-driven, so accurate and complete documentation systems directly affect clinical quality. “Every single response is data-driven, so the BCBA is analyzing the data,” she says.
Raitman has found that reducing friction at every stage, from application to case management, helps prevent candidate drop-off and accelerates time to productivity.
How to Build a BCBA Workforce Pipeline for Long-Term Growth
Rather than relying solely on external hiring, Lighthouse ABA is simultaneously developing its internal talent by encouraging behavior technicians to accrue clinical hours toward BCBA certification.
Supporting behavior technicians as they work toward certification, allows them to:
- Grow their BCBA pipeline
- Offer career growth to improve retention
- Ensure consistency in training and clinical standards
How Company Culture Helps ABA Practices Attract and Retain BCBAs
In a field with more job openings than clinicians available, culture plays a central role in both recruitment and retention. Raitman says having clinician practice owners and clinical supervisors helps their practice attract other mission-driven clinicians. “Our culture is that the child comes first. It’s very clear that we’re here for the children,” she says.
Every BCBA who begins in their company senses this difference immediately when they’re matched with a hands-on clinical supervisor. They offer a lot of hand-holding, especially for new BCBAs. Supervisors also ensure the practice maintains the same quality of care in every case. For example, they send out a checklist of what to expect on their first day and hold weekly meetings with a clinical supervisor throughout their first case.
“People are in this field to make a difference in a child’s life, so reinforcing that mission and backing it with real support helps BCBAs know they’re in the right place,” says Raitman.
How ABA Practices Can Thrive Despite the BCBA Shortage
There’s no indication that the BCBA shortage is temporary. Instead, the growing need for ABA services, combined with lower reimbursement rates, will continue to affect ABA practices for the foreseeable future.
Business owners who focus on culture, clinical support, leadership and operational efficiency are better positioned to succeed in a tough hiring economy.
Actionable Strategies to Overcome the BCBA Shortage in Your ABA Practice
- Strengthen clinical supervision models to provide consistent oversight and support
- Identify and eliminate hiring bottlenecks that reduce your potential candidates
- Offer standardized and structured remote supervision to help you maintain quality and compliance
- Invest in internal training and career growth to nurture future BCBAs
- Build a mission-driven culture that prioritizes both patient outcomes and support for your staff at all levels
Learn how CM&F can help protect your ABA practice as you scale your workforce, manage risk and navigate evolving clinical and operational challenges.
