Therapy Only - Expected Salaries?

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Skvader

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At this point in time, I am only interested in conducting individual/couples/family therapy. I have no interest in conducting research, nor do I feel like I would want to teach in a college setting in the future. I am aware of the benefits of being able to conduct testing and to do administrative work; however, I know it is not NECESSARY to have a doctorate degree in order to become the director of an organization (which is something I may be interested in after several years' experience in the field).

I have compared therapists' salaries to clinical psychologists' salaries; however, the Bureau of Labor Statistics does not distinguish between psychologists who ONLY conduct therapy, vs. psychologists who do a variety of things. Are there any psychologists on this forum who can provide some insight as to what kinds of salaries I could expect, if I were to earn a PsyD degree and only conduct therapy? I realize that different settings (ex. hospital, non-profit org, private practice) would cause the salary range to vary, but I would appreciate any information anyone has nonetheless. =)
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The better question is , Who would hire you as a psychologist to only do therapy when they could hire an MFT/LPC/LCSW for much cheaper? If you choose private practice and have a therapy only practice there is a natural glass ceiling due to reimbursements per 1hr of work. If you worked 8-5 with 1 hour for lunch, filled every hour every week and got paid $100 per session (not a reality with insurances) you could max gross $3200.00 per week. In reality a good practice has 20-30% openings, cancellations, no-shows, and the averge reimbursement for 90806 in my state is about 70$ putting your gross at $1570.00 per week. With a solo practice you may spend as little as 30 % for overhead and supplies, but more likely around 50% putting your weekly gross at $784.00. If you were consistent all year you could net about $42,300 per year.
 
Skvader said:
At this point in time, I am only interested in conducting individual/couples/family therapy. I have no interest in conducting research, nor do I feel like I would want to teach in a college setting in the future. I am aware of the benefits of being able to conduct testing and to do administrative work; however, I know it is not NECESSARY to have a doctorate degree in order to become the director of an organization (which is something I may be interested in after several years' experience in the field).

I have compared therapists' salaries to clinical psychologists' salaries; however, the Bureau of Labor Statistics does not distinguish between psychologists who ONLY conduct therapy, vs. psychologists who do a variety of things. Are there any psychologists on this forum who can provide some insight as to what kinds of salaries I could expect, if I were to earn a PsyD degree and only conduct therapy? I realize that different settings (ex. hospital, non-profit org, private practice) would cause the salary range to vary, but I would appreciate any information anyone has nonetheless. =)
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Unless you work for a VA hospital, if you want to do therapy only after getting out of grad school, that means doing third-party billing or working for an agency. When I worked for a consulting firm doing testing and therapy in nursing homes, I made an embarassingly low salary in the 20s for the year I did it. I'm seeing jobs posted in Portland Oregon for therapy jobs for psychologists with Kaiser that quote between 45-80 per year.

Here's the stats from "indeed.com" when you ask for salary averages, nationwide, using "psychologist therapist" as keywords (I can't vouch for accuracy): http://www.indeed.com/salary?q1=therapist+psychologist&l1= They say about 61K. Note that for "psychologist" as keyword, the average bumps up to 68K. So "therapist psychologists" get paid significantly less, most likely, than "psychologists" writ large.

I would say if you have a PsyD and want to do therapy ONLY (as in, no assessment), you're wasting time on the degree. At a bare minimum, psychologists distinguish themselves from their masters-level counterparts because of their training in testing. You can't hope to get paid more than they do if you're just another therapist.
 
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stigmata said:
The better question is , Who would hire you as a psychologist to only do therapy when they could hire an MFT/LPC/LCSW for much cheaper? If you choose private practice and have a therapy only practice there is a natural glass ceiling due to reimbursements per 1hr of work. If you worked 8-5 with 1 hour for lunch, filled every hour every week and got paid $100 per session (not a reality with insurances) you could max gross $3200.00 per week. In reality a good practice has 20-30% openings, cancellations, no-shows, and the averge reimbursement for 90806 in my state is about 70$ putting your gross at $1570.00 per week. With a solo practice you may spend as little as 30 % for overhead and supplies, but more likely around 50% putting your weekly gross at $784.00. If you were consistent all year you could net about $42,300 per year.
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Agree. Also, you would have to pay someone else to conduct testing on your patients/clients and send you the results to help you and guide you with the therapy.
 
"Therapy only" can work, but it is more about your business skills than your clinical skills. Taking insurance will cut your fee by 40-50% ($65-$75/session instead of $125-$150/hr), so you'll need to make it up on volume. There are "cash only" practices, but they are much harder to build up, and they are not really feasible for an early career psychologist (at least at first). I know people who are 5-10 years out who make 6-figures...BUT they are in larger cities and they put in a lot of hours.
 
Don't forget about college counseling centers. The average licensed psychologist practicing in this setting probably makes 60-75k. Not a kings ransom but not bad for steady work, no insurance hassles, and good benefits. If you supplement with a private practice a few evenings a week you're looking at 100k without too much trouble.

It is a lot of clinical hours though. Not for everybody, but many psychologists have made this work.
 
It's really not easy to do full time clinical work. I know people who love therapy and even they get burnt out on it.

And, yeah, keep no-shows and cancellations in mind as well.
 
cara susanna said:
And, yeah, keep no-shows and cancellations in mind as well.
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That's the beauty of college counseling - no shows just give you an hour to do your paperwork. Makes no difference with respect to how you're paid.
 
psychmama said:
That's the beauty of college counseling - no shows just give you an hour to do your paperwork. Makes no difference with respect to how you're paid.
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True. Since I'm currently doing a practicum in a college counseling setting, I can say that it does seem to be one of the nicer gigs if you're looking for steady therapy work without the headaches and hassles of private practice. In the center I'm at, there are two Psy.Ds, one LCSW, and one Ph.D, who is the director. Only two of those are full-time, however, which is something else to keep in mind - the availability of full-time versus part-time positions.

Edit: Also, you won't get rich doing this, even working at a private college.
 
Don't forget to subtract out taxes for any money you plan on making. Uncle Sam wants his pretty penny when you work and when you die...
 
I used to work at a nationally recognized prestigious group practice. The psychologists there don't take insurance, have published many books/articles in their field, and are board certified etc. They also advertise a ton on the web. Even with all this, it would take a psychologist 1 year to build her case load. Many of the psychologists saw only between 15-25 patients per week because of cancellations and did not have a full case load. WE never had a wait list for the year that i worked there and few of the psychologists were able to have a full case load. Also, they would then have to deduct 50% due to rent and office expenses and had no benefits or health insurance. I don't know how much they made exactly, but i do know that they had to have another job on top of this one or had to leave due to the salary.

I would recommend against getting the doctoral degree if you just wan to do therapy.
 
ClinicalPHD5 said:
Also, they would then have to deduct 50% due to rent and office expenses and had no benefits or health insurance.
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Wow...whoever owns that practice is making a killing. Overhead for contract employees w/o benefits really shouldn't exceed 15%-20% of the gross billing, unless their margins are really tight for some extraneous reason. Support staff tends to be included once you hit the 20% range, at least from what I've seen. I guess if people are willing to give away half, I can't fault the owners for asking for it. If I was the owner, I'd at least buy them a holiday gift!
 
Jon Snow said:
I had someone offer me that. Wanted to practice one day a week, they wanted 50% and a non-compete agreement. Heh.
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That's just greedy! I can see a 30% rate if there is no minimum monthly commitment and it is literally turn-key, but damn..that's rough. I know some people get stuck needing post-doc hours for licensure, but 50% is still highway robbery. Maybe when I look to setup shop I'll advertise my "special, short time only terms for the real go-getters!" rate of 50% holdback AND I'll throw in a potted plant! There will be a line out the door! I'll be rich! :laugh:
 
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Skvader said:
At this point in time, I am only interested in conducting individual/couples/family therapy. I have no interest in conducting research, nor do I feel like I would want to teach in a college setting in the future. I am aware of the benefits of being able to conduct testing and to do administrative work; however, I know it is not NECESSARY to have a doctorate degree in order to become the director of an organization (which is something I may be interested in after several years' experience in the field).

I have compared therapists' salaries to clinical psychologists' salaries; however, the Bureau of Labor Statistics does not distinguish between psychologists who ONLY conduct therapy, vs. psychologists who do a variety of things. Are there any psychologists on this forum who can provide some insight as to what kinds of salaries I could expect, if I were to earn a PsyD degree and only conduct therapy? I realize that different settings (ex. hospital, non-profit org, private practice) would cause the salary range to vary, but I would appreciate any information anyone has nonetheless. =)
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There are many private practice psychologists in my city who conduct primarily therapy only and make a very good living via insurance. They typically see between 35-40 clients per week with an average insurance reimbursement of $70-$90/hour based on 48 weeks/year. For those with whom I've spoken, total overhead (includes everything) runs about $15,000-$25,000 year. These folks are reliably pulling down ~$120,000/year after expenses and before taxes. And, this is solely dealing with insurance (with most referrals coming via insurance panels). In my area, insurance companies are hard up for "willing" providers as most psychologists on the panels are either not accepting new patients or have wait times of a month or more.

There is also a rapidly growing number of private practice psychologists in my city who do not take insurance as an in-network provider. The other two psychologists in my suite do not take insurance and charge $150/50-minute session. Their total overhead is about $27,000/year (same as mine) for a very nice, posh office, full-time secretary/office manager, and all expenses. One grossed $260K and the other $225K last year (2010). Both of them conduct therapy only - no testing or assessment.

It is possible to make money as a private practice therapist. You just need some basic business sense (or not if you're going to play the insurance game).
 
medium rare said:
There are many private practice psychologists in my city who conduct primarily therapy only and make a very good living via insurance. They typically see between 35-40 clients per week with an average insurance reimbursement of $70-$90/hour based on 48 weeks/year. For those with whom I've spoken, total overhead (includes everything) runs about $15,000-$25,000 year. These folks are reliably pulling down ~$120,000/year after expenses and before taxes. And, this is solely dealing with insurance (with most referrals coming via insurance panels). In my area, insurance companies are hard up for "willing" providers as most psychologists on the panels are either not accepting new patients or have wait times of a month or more.

There is also a rapidly growing number of private practice psychologists in my city who do not take insurance as an in-network provider. The other two psychologists in my suite do not take insurance and charge $150/50-minute session. Their total overhead is about $27,000/year (same as mine) for a very nice, posh office, full-time secretary/office manager, and all expenses. One grossed $260K and the other $225K last year (2010). Both of them conduct therapy only - no testing or assessment.

It is possible to make money as a private practice therapist. You just need some basic business sense (or not if you're going to play the insurance game).
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I have personally not met anyone who makes this kind of money in private practice--even people who are well known in the field. These psychologists are in the top 0.5%. You may be in a city that has a lower supply of psychologists. Where i live, psychologists have to wait to get on insurance panels. Plus, if you change $150 per hour and make over $200,000, you are seeing over 40 patients per week and working about 70-80 hours per week total. You would have to see 10 patients per day and have them all show up, which is very unlikely to happen. Plus, i think its a self-care issue and most psychologists would not want to see this many clients in one day. My professors told us that for self-care they don't see more than 6 patients per day.
 
ClinicalPHD5 said:
Plus, i think its a self-care issue and most psychologists would not want to see this many clients in one day. My professors told us that for self-care they don't see more than 6 patients per day.
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I think this is a really important point. When trying to calculate potential salaries in private practice, people often assume that they can see clients back to back to back all day and be fine. At my practicum site last year, I ended up seeing clients for 6 straight hours once every two weeks. It was a nightmare. I could never do that to myself daily, or even weekly. I'm not saying some psychologists can't take on more, but I know my personal limits would hold me to about 5-6 clients per day and no more than around 28 per week. Of course, considering no shows, I could probably be on the books for a few more.
 
Not to turn this into a business 101 discussion...but one of the biggest limitations of a traditional therapy-based private practice is that you only get paid for the time you see people, and not just for your time. It's a classic active v. passive income stream limitation. The people that make the most money almost always have a high rate of billable hours relative to total hours worked. One of the easiest things to do is bill for partial hours (i.e. 45min hour, with your note taking <15min) and aggregating the time on the back-end for other billable work. Lawyers and consultants are the best at this because they tend to bill in 6min increments and/or have fixed-priced contracts where they can raise their hourly rate by being more efficient with the hours needed to complete their job. This is more relative to assessment work (cash pay, not insurance).
 
I just wanted to make the point that many therapists (the ones who aren't on insurance panels) charge patients for missed sessions unless they reschedule and/or notify well in advance.
 
psychmama said:
I just wanted to make the point that many therapists (the ones who aren't on insurance panels) charge patients for missed sessions unless they reschedule and/or notify well in advance.
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Very true, and this can be particularly poignant in neuropsych-based practices, where a no-show could essentially cause half or all of your day to be a wash.
 
stigmata said:
And they get them to pay how??
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Well when it's ongoing therapy there's a relationship and an incentive to keep to the original agreement. Of course that entails laying out the ground rules clearly when you start with a new client. No surprises.

I know some therapists insist on payment at each session. Many do not however. Therapists in general seem to be a soft-hearted bunch -- this is not always an advantage when you're running a business. I know it will be something I struggle with when I start my practice.

But hey -- us therapists have to put food on the table too!;)
 
stigmata said:
And they get them to pay how??
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I saw 9 patients today - all cash only. 5 in the traditional therapy hour (4 meds and therapy, 2 therapy only) and four 30 minute med checks with minimal therapy. 1 therapy/meds patient was a no-show with no cancellation 24-hours in advance. I charged my full rate to his credit card which I have on file for these occurrences.

I explain to patients in detail (in my patient registration/practice policies and during a brief verbal conversation at the first meeting) my financial policies and provide them time to ask questions. I explain that I do not double-book or over book and that the scheduled time is reserved for them; if they do not show or fail to cancel within 24 hours, they will be charged for the time. And, yes, I do charge them. I find that this greatly reduces later no-shows and also 'weeds out' the patients who are not fully invested in treatment. And, if it's a meds patient, then no more Rx's until they pay their balance.

BTW, today's no-show ended up calling later in the day, apologized for forgetting his appointment, and stated that he expected to be charged for the missed time.
 
Probably a philosophical debate, but in talking to other psychs and observing practice, the predominant business model seems to be that "my time" is being reserved, and thus if you miss your appt, you are charged for that time in which therapy would have taken place.

I realize some might say its not great practice to charge for a service you didn't actually provide. However, I suppose my argument would be that the service WAS provided (at least the time was reserved for the work) you just weren't present for it.;)
 
medium rare said:
I saw 9 patients today - all cash only. 5 in the traditional therapy hour (4 meds and therapy, 2 therapy only) and four 30 minute med checks with minimal therapy. 1 therapy/meds patient was a no-show with no cancellation 24-hours in advance. I charged my full rate to his credit card which I have on file for these occurrences.

I explain to patients in detail (in my patient registration/practice policies and during a brief verbal conversation at the first meeting) my financial policies and provide them time to ask questions. I explain that I do not double-book or over book and that the scheduled time is reserved for them; if they do not show or fail to cancel within 24 hours, they will be charged for the time. And, yes, I do charge them. I find that this greatly reduces later no-shows and also 'weeds out' the patients who are not fully invested in treatment. And, if it's a meds patient, then no more Rx's until they pay their balance.

BTW, today's no-show ended up calling later in the day, apologized for forgetting his appointment, and stated that he expected to be charged for the missed time.
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I will, at least anecdotally (and based on what my supervisor at the site has said, this extends beyond just your and my experiences), agree that charging some type of rate reduces no-shows. It also at least seems to increase adherence to the therapy itself, with this possibly being a factor of the "weeding out" process you've mentioned. Conversely, our charging no rate at one of the clinics at which I work can go a long way to initially contributing to our clients' feeling that it's acceptable to "drop in" as-needed for therapy. This last point is compounded by the fact that many overburdened agencies are only able to provide such drop-in sessions, with clients then assuming this model is the normative and preferred method of service delivery.
 
erg923 said:
Probably a philosophical debate, but in talking to other psychs and observing practice, the predominant business model seems to be that "my time" is being reserved, and thus if you miss your appt, you are charged for that time in which therapy would have taken place.

I realize some might say its not great practice to charge for a service you didn't actually provide. However, I suppose my argument would be that the service WAS provided (at least the time was reserved for the work) you just weren't present for it.;)
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Every 6-12 months this debate surfaces on one or more of the listservs, and I think it is a worthwhile discussion. I fall in the "you are paying for my time" camp, and I fully expect to utilize a cancellation fee when I start my private practice. It's a business first, not a charity. As long as everything is stated explicitly up front, the owness is on the patient. Holding patients accountable can be a good thing FOR THEM, and not just for your business. If you do not value your time, your patient will not value it.
 
How do you deal with patients who don't pay? You can't abandon the patient either.

It is very confusing. I don't go to get a haircut and then say I can't pay for it.
 
GroverPsychMD said:
How do you deal with patients who don't pay? You can't abandon the patient either.

It is very confusing. I don't go to get a haircut and then say I can't pay for it.
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What I have seen is having them sign the cancellation/no show policy in advance. You set a fee that they will owe if they don't give you X (24?) hours notice. I've seen $75 before as that fee. For those with insurance, it provides an incentive because they would pay more out of pocket for missing than for actually showing up.

You bill them and if they don't pay, you could theoretically go to collections. You might let one or two slide. T4C recently mentioned that you can also have them sign a waiver for you to charge their credit card if they no show - eliminating some of these issues.
 
Pragma said:
What I have seen is having them sign the cancellation/no show policy in advance. You set a fee that they will owe if they don't give you X (24?) hours notice. I've seen $75 before as that fee. For those with insurance, it provides an incentive because they would pay more out of pocket for missing than for actually showing up.

You bill them and if they don't pay, you could theoretically go to collections. You might let one or two slide. T4C recently mentioned that you can also have them sign a waiver for you to charge their credit card if they no show - eliminating some of these issues.
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Was going to say the exact same things. For neuropsych evals, given that those can be half-day or whole-day affairs, the no show/cancellation fees I've seen have ranged from about $150 to half the cost of the eval, depending on the type of patient.

Edit: And yes, I've definitely noticed frustrations (in private practitioners especially) with respect to the views of patients regarding not paying for/not showing up to mental health-related appointments and care vs. other types of service.
 
I had posted my frustration about this in an earlier thread. You can have a cancellation policy, but if the client gets upset about the cancellation fee you have to make a decision over whether or not it is worth losing the client over that fee. If you do not want to lose the client, you may have to not charge them for the missed session. It is a business decision. Having their CC in advance will cut down on the problem of getting the cancellation fee, but can still anger a client. The problem becomes that because you sit there and understand their other problems, they expect you to understand when they cannot make it.

On a sidenote, where are people seeing $65-75k college counseling center openings? The ones I see are more like $35-45k to start.
 
Sanman said:
I had posted my frustration about this in an earlier thread. You can have a cancellation policy, but if the client gets upset about the cancellation fee you have to make a decision over whether or not it is worth losing the client over that fee. If you do not want to lose the client, you may have to not charge them for the missed session. It is a business decision. Having their CC in advance will cut down on the problem of getting the cancellation fee, but can still anger a client. The problem becomes that because you sit there and understand their other problems, they expect you to understand when they cannot make it.

On a sidenote, where are people seeing $65-75k college counseling center openings? The ones I see are more like $35-45k to start.
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I haven't looked very extensively at all, but for a newly-minted and unlicensed practitioner, the salaries I remember seeing were in the range you mention. For supervisory-level positions, I think they were in the 50-60k-ish range, with more toward the former than the latter.
 
I joined a group practice in a large Canadian city at the end of last year that is comprised of, among others, two other psychologists. 100% percent of the work the psychologists do is psychotherapy. The practice is largely fee-for-service, and psychotherapy sessions are $170. Seeing 20-30 patients per week will produce yearly incomes of $163,200 to $244800 (before costs and tax). Because the practice splits overhead much of what psychologists earn per session they keep. I know of many group practices in my city where psychologists only do psychotherapy and make over $150,000 per year - in other words, making a really good income doing only psychotherapy is not unheard of. I have an interest in working with professionals with substance abuse issues, and repeatedly turn away referrals because I am currently working only one day per week in private practice.

I've said it before, but the Canadian situtation for psychologists seems VERY different from the U.S. situation.
 
OMG. How hard is it to move to Canada?! Just out of curiosity, does Canadian medical coverage ever cover psychotherapy or is it typically something that people pay out of pocket for? We bill $150/session, but in the 3 years I have been in PP, I have not had a single client pay that (or anything close to it). Most insurances pay in the neighborhood of $70, which I have to split 50-50 with the practice.

Best,
Dr. E
 
Doctor Eliza said:
OMG. How hard is it to move to Canada?! Just out of curiosity, does Canadian medical coverage ever cover psychotherapy or is it typically something that people pay out of pocket for? We bill $150/session, but in the 3 years I have been in PP, I have not had a single client pay that (or anything close to it). Most insurances pay in the neighborhood of $70, which I have to split 50-50 with the practice.

Best,
Dr. E
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It isn't hard to move to Canada at all :) Canadian medical coverage does NOT cover psychotherapy services by a psychologist. Many people have some coverage through their jobs, or through other forms of insurance (e.g., motor vehicle, worker's safey insurance). My practice does not deal with insurance, however. Patients pay out of pocket and are given an invoice which they may use to get some costs reimbursed. We have approximately 12-20 patients pay out of pocket each day.
 
GIven that he works in a large canadian city, this is hardly a shocker. It is the same as having a successful practice in any city with a good number of high earners. Dr.E works in a smaller area and has a less than stellar split within the practice. Keep in mind that the numbers mentioned are gross and no one has mentioned overhead costs (which can get high in a large metro area). Keep in mind that even at $70/ session (though I usually count $85 with co-pay) you gross $100,800 for 30 pts/wk (48 weeks) or $122,400 for $85.
 
Sanman said:
GIven that he works in a large canadian city, this is hardly a shocker. It is the same as having a successful practice in any city with a good number of high earners. Dr.E works in a smaller area and has a less than stellar split within the practice. Keep in mind that the numbers mentioned are gross and no one has mentioned overhead costs (which can get high in a large metro area). Keep in mind that even at $70/ session (though I usually count $85 with co-pay) you gross $100,800 for 30 pts/wk (48 weeks) or $122,400 for $85.
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Just to clarify, I wouldn't describe my city as a smaller area. Although it isn't on the scale of something like NYC or LA, it falls solidly in the top 20 of US cities in terms of population. But, yes, my split is awful.

Dr. E
 
P.S. Insurance reimbursement does seem to vary quite a bit by area. A friend of mine (also a psychologist in PP) who lives in a somewhat smaller town about 4 hrs away gets about $100 per session from the same insurance company that pays me $70. I can't quite make sense of that, but I guess it is what it is.

Dr. E
 
Doctor Eliza said:
P.S. Insurance reimbursement does seem to vary quite a bit by area. A friend of mine (also a psychologist in PP) who lives in a somewhat smaller town about 4 hrs away gets about $100 per session from the same insurance company that pays me $70. I can't quite make sense of that, but I guess it is what it is.

Dr. E
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Business 101: supply and demand

Your market is more saturated and they can afford to pay less because of competition. Smaller areas afford fewer choices and mean the clinician has more leverage. Contrary to popular belief insurance reimbursements are not all the same. They vary by region and payor.
 
Sanman said:
Business 101: supply and demand

Your market is more saturated and they can afford to pay less because of competition. Smaller areas afford fewer choices and mean the clinician has more leverage. Contrary to popular belief insurance reimbursements are not all the same. They vary by region and payor.
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Of course, yes. I guess what i meant to say was that it would be surprising to me if her market were less saturated than mine. I think these things can be hard to predict.

I think we all can agree that insurance companies don't pay us what we are worth! :)

Best,
Dr. E
 
Doctor Eliza said:
Of course, yes. I guess what i meant to say was that it would be surprising to me if her market were less saturated than mine. I think these things can be hard to predict.

I think we all can agree that insurance companies don't pay us what we are worth! :)

Best,
Dr. E
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It doesn't really suprise me as most psychologists seem to gravitate to cities...especially the young and single ones. If you look at the distribtions you see that the Northeast actually gets the worst reimbursements and the south does the best.
 
Doctor Eliza said:
I have to split 50-50 with the practice.

Best,
Dr. E
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ahhaa!! This is not right Dr. E. You should fight for a better percentage. I feel that maybe if you were getting a better cut you would enjoy the PP more. I think if I was getting a 50/50 cut I would be really upset too. :( You're a licensed clinical psychologist, you definitely deserve better in my opinion.
I would also contact the insurance billing department and see exactly why your friend is getting a higher rate then you. It could be based on supply/demand of geographic locations...but maybe it's something else, a glitch perhaps
 
valentinoRossi said:
ahhaa!! This is not right Dr. E. You should fight for a better percentage. I feel that maybe if you were getting a better cut you would enjoy the PP more. I think if I was getting a 50/50 cut I would be really upset too. :( You're a licensed clinical psychologist, you definitely deserve better in my opinion.
I would also contact the insurance billing department and see exactly why your friend is getting a higher rate then you. It could be based on supply/demand of geographic locations...but maybe it's something else, a glitch perhaps
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Oh-my-word.
 
Sanman said:
I had posted my frustration about this in an earlier thread. You can have a cancellation policy, but if the client gets upset about the cancellation fee you have to make a decision over whether or not it is worth losing the client over that fee. If you do not want to lose the client, you may have to not charge them for the missed session. It is a business decision. Having their CC in advance will cut down on the problem of getting the cancellation fee, but can still anger a client. The problem becomes that because you sit there and understand their other problems, they expect you to understand when they cannot make it.

On a sidenote, where are people seeing $65-75k college counseling center openings? The ones I see are more like $35-45k to start.
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https://jobs.ucsb.edu/applicants/jsp/shared/frameset/Frameset.jsp?time=1345700636218
 
AleksM said:
It isn't hard to move to Canada at all :) Canadian medical coverage does NOT cover psychotherapy services by a psychologist. Many people have some coverage through their jobs, or through other forms of insurance (e.g., motor vehicle, worker's safey insurance). My practice does not deal with insurance, however. Patients pay out of pocket and are given an invoice which they may use to get some costs reimbursed. We have approximately 12-20 patients pay out of pocket each day.
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I've posted before on this thread about this issue; I agree with the above and would add that it is not unique to Canada. More and more of my psychologist colleagues in private practice are limiting their insurance participation or getting off panels completely. What I've found in my experience is that there IS a market for psychotherapy and people will pay for it.

My city is mid-sized and known for its high-quality of life. Not surprisingly, there are lots of psychologists here. No one I know of is hurting for business. In fact, it tends to be the opposite if anything. I hear more psychologists saying that they are limiting new patients or not accepting patients at this time.

I routinely see between 7-16 patients per day (depending on the time booked - 0.5 vs 1 hour) and all of them pay out of pocket. And, no, my practice does not 'cater' to wealthy people. I do have many patients who are in the higher SES range, but most are typical middle-class folks. Don't assume there is no money in private, outpatient psychotherapy.

As far as collecting, it's not abandoning a patient if they don't pay their bill. If they have an outstanding balance, you are under no obligation to further provide services if they haven't paid. Same for no-shows. What I've found is if you take some time discussing this with the patient at the beginning, then there is little room for misunderstanding or confusion. They may be upset at having to pay, but they do pay. I've never lost a patient (of which I'm aware) due to billing for no-shows that are not canceled appropriately.
 
medium rare said:
I've posted before on this thread about this issue; I agree with the above and would add that it is not unique to Canada. More and more of my psychologist colleagues in private practice are limiting their insurance participation or getting off panels completely. What I've found in my experience is that there IS a market for psychotherapy and people will pay for it.

My city is mid-sized and known for its high-quality of life. Not surprisingly, there are lots of psychologists here. No one I know of is hurting for business. In fact, it tends to be the opposite if anything. I hear more psychologists saying that they are limiting new patients or not accepting patients at this time.

I routinely see between 7-16 patients per day (depending on the time booked - 0.5 vs 1 hour) and all of them pay out of pocket. And, no, my practice does not 'cater' to wealthy people. I do have many patients who are in the higher SES range, but most are typical middle-class folks. Don't assume there is no money in private, outpatient psychotherapy.

As far as collecting, it's not abandoning a patient if they don't pay their bill. If they have an outstanding balance, you are under no obligation to further provide services if they haven't paid. Same for no-shows. What I've found is if you take some time discussing this with the patient at the beginning, then there is little room for misunderstanding or confusion. They may be upset at having to pay, but they do pay. I've never lost a patient (of which I'm aware) due to billing for no-shows that are not canceled appropriately.
Click to expand...

To be fair though, your NP credential probably plays a significant role in your PP success. In my town, there are a handful of seasoned psychologists with good reputations who don't participate in insurance. Early career folks cannot pull it off around here. On the other hand, more and more psychiatrists in my community are withdrawing from panels. There is a huge shortage of psychiatrists around here and the significant demand allows them to see reasonably large caseloads without having to deal with insurance.

Dr. E
 
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