A PsyD story (mostly $$$ talk)

[WisNeuro]

How worried are people about Universal Health Care? I am starting to be increasingly anxious. If it happens, will private pay patients still exist?

Not terribly worried, honestly, if universal healthcare/public options are trotted out, there is more money to be saved with specialties/expensive services than squeezing blood out of the mental health turnip. Even if reimbursement continued to drop, I'd just go PP. Heck, even with high saturation in my specific area, Npsychs are booking out 4+ months. I am in January at the moment, and that's with pumping the brakes and referring some evals out to keep my wait list low. I'd likely have little problem filling a patient load if I went cash only if their only other option were waiting a year for an eval as I imagine other providers would also opt to go PP.

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[WisNeuro]

Completely agreed. I am in geriatrics, so largely medicare rates early on. Currently, debating full time cash only in the future vs PP side gig. This VA gig is cushy if I move down to where I work. Commute kills me.

Yeah, accepting medicare/aid in PP is a recipe for disaster, particularly if the majority of your patients are gero.

 

[Ollie123]

Well like I said above...I think your math is incredibly/absurdly/comically off on 200k annually for 20-25 hours of patient contact. You MAY gross that. You will not net that.

Some random things:
- At least in most of the country, $200/hr is high end. $150/hr is probably more typical. That bumps 200k down to 150k right there.
- That is a cash rate. If you take insurance, very few will pay that rate. Some will pay half that rate. Building a cash-only practice takes time and you have to be in the right setting. Most people want to use insurance. Then you have non-collection issues on top of that.
- Subtract out overhead. Let's say this drops you to 110k (could be more, could be less) even if you are able to make it work cash-only.
- You are self-employed, so tack on an extra ~7.5% of taxes beyond what W2 folks make.
- You have to buy your own insurance. If you have a large employer, chances are your health insurance is heavily subsidized. For me, it would work out to at least an extra $700/month to buy my own policy compared to what I have now.
- I get a 10% employer contribution to retirement that I would not get self-employed. This is tax-advantaged. There are certainly ways to set this up as a solo-practitioner, but it reduces your gross.
- 2 weeks of vacation is pretty awful. Especially when you consider you may still want to go to conferences or do other travel for professional purposes. This "hurts" you as a solo practitioner.
- I have never heard VA positions described as "highly demanding." Part of the draw is that they tend to be relatively chill compared to many other positions. That's not to say there aren't downsides, just that they are known for being kind of the opposite of high-pressure/high-demand.
- Private pay folks will frequently want evening/weekend hours. Most VA/hospitals will not.
- Many early-career folks will not be comfortable with the inconsistent paychecks that go along with independent practice. I think there is a lot to be said for building up the emergency fund and having some of a financial "cushion" before taking risks like that. I'm now at a point where I could easily handle it if my income varied tremendously month-to-month. That was definitely not the case the day I graduated.

There are many great reasons to go into PP and its certainly possible to do extremely well financially. In fact, it certainly offers the highest ceiling (virtually infinite) of any gig. However, its by no means an easy path to making 200k working basically part-time hours. Check your numbers and assumptions carefully before going down that road. I'm genuinely not trying to sound harsh, but we routinely get posts from people that do not appear to be checking the numbers closely or have misconceptions about how things work.

 

[Sanman]

Yeah, accepting medicare/aid in PP is a recipe for disaster, particularly if the majority of your patients are gero.

Mostly true, there is a way to make money though. Largely high volume work.

 

[WisNeuro]

Mostly true, there is a way to make money though. Largely high volume work.

I like my 30-35 hour weeks too much. Leaving work now, gym by 3 most days. Can't beat it.

 

[Sanman]

I like my 30-35 hour weeks too much. Leaving work now, gym by 3 most days. Can't beat it.

Me too, hence VA gig. The 60 min commute home now kills me. Otherwise, work day over already really.

 

[foreverbull]

I'm thinking here about the financial math in relation to a VA career, as well. Given what you all are suggesting regarding earning potential for psychologists, it seems odd to me that there are some highly competitive VA positions in major metro areas where pay is around $100k annual salary for the first 10 years (GS-13). These are positions that are highly demanding, and at least comparable in terms of labor/stress to 20-25 client hours/week in independent practice (which we're estimating at ~$200k annually).

Why are people chomping at the bit to take positions that are offering about 50% less in annual pay? It seems like folks here on the board generally have a great deal of respect for VA positions. What am I missing?

The $200K private practice estimate that you are using is, in my opinion, an overestimation. Part of it is that $200/hr is okay for a VERY seasoned psychologist in my area, but even then, is extremely financially limiting to many people unless you have a highly desired specialty or practice in a very wealthy area. The estimate is also too high given that there will be interruptions of service (canellations, occasional clients dropping off, or lag time between filling slots), business overhead--rent, marketing, insurances, licenses and CEs, decor, billing software, etc., taxes, and the like that will cut that income down by a large margin. If you plan to work in a wealthy area, plan to pay a ton for renting an office, for example. Then you have to buy your own health insurance for self and/or family, retirement plan, etc., and expect to carve out even more. So given all of these expenses combined with taxes, you're looking at actually making MUCH less than the number you came up with, even assuming a very steady client flow of cash-paying folks. In the realm of maybe $125K - $140K, perhaps, after taxes and all expenses.
Also, in private practice, the vast majority of clients want late afternoon/evening times, so you usually need to stack your clients into those prime times (3-7 are peak hours), generally speaking, unless they are privileged enough to have flexible work schedules, or you're filling up your Saturdays, so availability, scheduling, and your own preferences around work times can be a limiting factor income-wise as well.
These are things that people who haven't been in private practice haven't experienced yet.

Thus, people might choose a VA job because of the immense work that goes into starting a business and just wanting to clock in, work, and clock out (with benefits and job security) rather than risk losing money on a business venture without having ever had the training to start a business. I lost money in the first six months, so I probably made pennies in my first 12 months. This is not something that many folks have the luxury of risking, financially speaking. Job security is motivating for many folks, I think.

EDIT: I just saw @Ollie123 's post and agree completely!

 

[beginner2011]

Well like I said above...I think your math is incredibly/absurdly/comically off on 200k annually for 20-25 hours of patient contact. You MAY gross that. You will not net that.

The $200K private practice estimate that you are using is, in my opinion, an overestimation.

Ok, thanks for taking the time to describe some of these elements in more detail. If'm understanding correctly it sounds like these are some of the considerations:

Overhead (i.e., space, cancelations)
Benefits (i.e., insurance, retirement, paid leave)
Administrative (i.e., collecting from insurance, gathering a caseload)

Overhead
Space: ~$1k/mo (made up number)
Cancelations: ~5% (made up number)

Benefits
Insurance: ~$1k/mo
Retirement: ~10% annual salary (~$10k/yr)
Paid leave: 30d = 6 weeks per calendar year

Administrative
Collecting: ~5m per case on avg; 10% opportunity cost on 50m hour of therapy?
Gathering a caseload: ??

So let's do the math again assuming the most conservative numbers I've seen so for from more experienced folks. Why don't we jump ahead to year 5 for both careers, because I'm not sure how to account for gathering a caseload:

$150 per session
30 sessions per week

Independent practice, before costs:
$150/h * 6 clients/day * 5 days a week * 46 wks/yr = $207,000

Overhead costs: 207000*.05=10350(cancelations)+12000(rent) = $22350
Benefits costs: insurance=$12000
Administrative costs: 207000*.10(collecting)=$20700

Independent practice (estimated) = $151,950

VA salary in major metro area (e.g., Philadelphia) after 5 years (GS-13, Step 5): 108,900

Overhead costs: zero
Benefits costs: +10%(401k)=11,000; -$150 premium for insurance=1800; net cost=+9200
Administrative costs: zero

VA position (estimated) = $118,100


If I'm doing the math right, then in your 5th year as a staff psychologist you're taking about a 20% pay cut to work at the VA.

What am I missing here?

 

[Sanman]

VA gives you 401K match so subtract an extra 3-4% percent in PP. VA is guaranteed raise/step increase. PP may mean flat rate or pay cut over time if taking insurance.

I can pick at the numbers, but you get the gist. Now calculate that with the average insurance rate of $75-90/hr rather than the $150/hr. Reality is likely a mix. Also, you are not full in PP for at least 1-2 years. Not making $150/hr for at least 5 years.

 

[AcronymAllergy]

VA is appealing because it's "easy," in that it's straightforward. You don't have to worry about billing insurance, typically have some level of administrative support, don't lose money if you have a no-show (and your pay isn't contingent on RVUs), have a very set schedule, and don't have to do anything to recruit/develop a patient pool. Benefits are generally good, although less so than in the past. Referral to other services is pretty easy. And you sometimes have the opportunity to work with great and/or well-known clinicians (this can be a draw for the bigger VAs especially). As was mentioned above, there's a lot to be said for security, consistency, and a "known quantity." Also, it's usually easy to get involved in training.

The main downsides are nearly all administrative/bureaucratic, including sometimes having little to no control over your schedule, and pay that effectively tops out quickly. If there's a change to title 38, that may change to at least some extent. One VA can look a lot different from others based almost entirely on mid- and upper-level leadership. Although I'd imagine that's the same anywhere.

I think two of the biggest rate-limiting factors to earning more money in psychology are inefficiency with work product and habits, and hesitation to work >40 hours/week. And as a field, toss on historically lackluster (although maybe improving?) advocacy. Maybe some avoidance of thinking outside the box, because when it comes to earning money, we're not used to it.

 

[iliketohelppeople]

You're never walking away with 100% of the fee, PP, group, or institution. As far as what Ollie has said, I totally agree with him. Most psychologists are missing the motivation and/or intelligence to maximize their earnings.

I think I miss the "outside the box" thinking to maximize my earnings in seeing innovative opportunities. Open to suggestions about things that I can read or look into that may help. I think my current thoughts include possibilities of moving into other areas that may benefit from the skills I have gained (e.g., quantitative + qualitative analysis, story-telling, delivering feedback, working with diverse stakeholders).

While I have a solid foundation in general psych assessment, sometimes I wish I took the neuro route.

 

[Sanman]

I think I miss the "outside the box" thinking to maximize my earnings in seeing innovative opportunities. Open to suggestions about things that I can read or look into that may help. I think my current thoughts include possibilities of moving into other areas that may benefit from the skills I have gained (e.g., quantitative + qualitative analysis, story-telling, delivering feedback, working with diverse stakeholders).

While I have a solid foundation in general psych assessment, sometimes I wish I took the neuro route.

Not sure about things to read, there are others that might have more suggestions. That said here is a tip to success in my life. When the people around you go "Ugh, that is so hard..I don't want to deal with it/I would never do that", I see $$$ signs.

 

[Ollie123]

I think you are still shorting the costs a little, overestimating revenue some, (again...all private pay is certainly achievable, but not easily), and not fully accounting for all W2 benefits but it is much closer. You also snuck in a ~50% increase in weekly contact hours that needless to say makes a huge difference compared to your earlier posts My main concern was that you made it sound like you would take home 200k for basically part-time hours!

Anyways, my point is not that someone "cannot" make more in independent practice. They absolutely can. Someone in PP working their tail off almost certainly WILL do better financially if they have good business acumen. My point was just that it is a bit more nuanced of a difference than you were originally making it out to be and comes with some added uncertainty/risk and other downsides. If you are in a position to assume that risk and don't mind the downsides (or don't even consider them downsides) - go for it! VAs have a low ceiling and you will often see folks transitioning out in that 5-10 year windoe for that reason. AMCs have a much higher ceiling, but way crazier hours

 

[Sanman]

I think you are still shorting the costs a little, overestimating revenue some, (again...all private pay is certainly achievable, but not easily), and not fully accounting for all W2 benefits but it is much closer. You also snuck in a ~50% increase in weekly contact hours that needless to say makes a huge difference compared to your earlier posts My main concern was that you made it sound like you would take home 200k for basically part-time hours!

Anyways, my point is not that someone "cannot" make more in independent practice. They absolutely can. Someone in PP working their tail off almost certainly WILL do better financially if they have good business acumen. My point was just that it is a bit more nuanced of a difference than you were originally making it out to be and comes with some added uncertainty/risk and other downsides. If you are in a position to assume that risk and don't mind the downsides (or don't even consider them downsides) - go for it! VAs have a low ceiling and you will often see folks transitioning out in that 5-10 year windoe for that reason. AMCs have a much higher ceiling, but way crazier hours

Agreed with Ollie. To ballpark it, I think you can add between $20-40k in benefits to the GS-13 salary to estimate total compensation. While you can make more in PP, APA salary survey 2015 shows less than 10% of survey respondents made more than $180k. The numbers are likely closer than you think.

 

[PsyDr]

I hate this so much.

Ok, thanks for taking the time to describe some of these elements in more detail. If'm understanding correctly it sounds like these are some of the considerations:

Overhead (i.e., space, cancelations)
Benefits (i.e., insurance, retirement, paid leave)
Administrative (i.e., collecting from insurance, gathering a caseload)

Overhead
Space: ~$1k/mo (made up number)
Cancelations: ~5% (made up number)

Benefits
Insurance: ~$1k/mo
Retirement: ~10% annual salary (~$10k/yr)
Paid leave: 30d = 6 weeks per calendar year

Administrative
Collecting: ~5m per case on avg; 10% opportunity cost on 50m hour of therapy?
Gathering a caseload: ??

So let's do the math again assuming the most conservative numbers I've seen so for from more experienced folks. Why don't we jump ahead to year 5 for both careers, because I'm not sure how to account for gathering a caseload:

$150 per session
30 sessions per week

Independent practice, before costs:
$150/h * 6 clients/day * 5 days a week * 46 wks/yr = $207,000

Overhead costs: 207000*.05=10350(cancelations)+12000(rent) = $22350
Benefits costs: insurance=$12000
Administrative costs: 207000*.10(collecting)=$20700

Independent practice (estimated) = $151,950

VA salary in major metro area (e.g., Philadelphia) after 5 years (GS-13, Step 5): 108,900

Overhead costs: zero
Benefits costs: +10%(401k)=11,000; -$150 premium for insurance=1800; net cost=+9200
Administrative costs: zero

VA position (estimated) = $118,100


If I'm doing the math right, then in your 5th year as a staff psychologist you're taking about a 20% pay cut to work at the VA.

What am I missing here?

1) You’re missing a work ethic by trying to only work 30hrs a week. Aim for 40 like everyone else in America.

2) add in one group a week or one assessment that you write after hours like most. See where those numbers go. When you get higher paying work, those numbers start looking paltry.

3) Contributing to retirement isn’t a loss. Now start throwing 25% of your gross into a sep ira. Compare a decade of those numbers to a VA retirement. (E.g., $~45k x 20 years x 7% real returns per annum which isn’t the real formula at all). Oh look you’re a multimillionaire.

4) Now leverage that capital to buy a building, put it into an FLP, and rent it to your llc and whoever else. Compare a decade or two of that money to something else. Cause I hate you.

5) while you’re at it, buy an SUV under your llc and expense under the 6000lbs rule. Looks like a cheap car to me.

6) since were bored, we’ll hire your spouse and kids as admin (when they hit legal age to work), and then pay directly into a Roth IRA for them. Compounded that’s multimillionaire status for your kids when they retire. (Looks around for VA stuff similar)

7) start taking more expensive work. Because now you have a base.

8) learn how to do things like going to a conference in a beach location and using it for a vacation that’s a tax write off.

I swear you lazy bastards are gonna kill me.

 

[Sanman]

I hate this so much.




1) You’re missing a work ethic by trying to only work 30hrs a week. Aim for 40 like everyone else in America.

2) add in one group a week or one assessment that you write after hours like most. See where those numbers go. When you get higher paying work, those numbers start looking paltry.

3) Contributing to retirement isn’t a loss. Now start throwing 25% of your gross into a sep ira. Compare a decade of those numbers to a VA retirement. (E.g., $~45k x 20 years x 7% real returns per annum which isn’t the real formula at all). Oh look you’re a multimillionaire.

4) Now use that capital to buy a building, put it into an FLP, and rent it to your llc and whoever else. Compare a decade or two of that money to something else. Cause I hate you.

5) while you’re at it, buy an SUV under your llc and expense under the 6000lbs rule. Looks like a cheap car to me.

6) since were bored, we’ll hire your spouse and kids as admin (when they hit legal age to work), and then pay directly into a Roth IRA for them. Compounded that’s multimillionaire status for your kids when they retire. (Looks around for VA stuff similar)

7) start taking more expensive work. Because now you have a base.

8) learn how to do things like going to a conference in a beach location and using it for a vacation that’s a tax write off.

I swear you lazy bastards are gonna kill me.

Nah, not gonna kill you. But I will grab popcorn and get a table close by when you go out on a date that 21 year old.

Seriously though, I think everyone knows business done right is more successful than any job. That said, I think VA is one of the best traditional jobs out there for many graduating psychologists.

EDIT: Besides no one said you can't do VA + PP.

 

[foreverbull]

Ok, thanks for taking the time to describe some of these elements in more detail. If'm understanding correctly it sounds like these are some of the considerations:

Overhead (i.e., space, cancelations)
Benefits (i.e., insurance, retirement, paid leave)
Administrative (i.e., collecting from insurance, gathering a caseload)

Overhead
Space: ~$1k/mo (made up number)
Cancelations: ~5% (made up number)

Benefits
Insurance: ~$1k/mo
Retirement: ~10% annual salary (~$10k/yr)
Paid leave: 30d = 6 weeks per calendar year

Administrative
Collecting: ~5m per case on avg; 10% opportunity cost on 50m hour of therapy?
Gathering a caseload: ??

So let's do the math again assuming the most conservative numbers I've seen so for from more experienced folks. Why don't we jump ahead to year 5 for both careers, because I'm not sure how to account for gathering a caseload:

$150 per session
30 sessions per week

Independent practice, before costs:
$150/h * 6 clients/day * 5 days a week * 46 wks/yr = $207,000

Overhead costs: 207000*.05=10350(cancelations)+12000(rent) = $22350
Benefits costs: insurance=$12000
Administrative costs: 207000*.10(collecting)=$20700

Independent practice (estimated) = $151,950

VA salary in major metro area (e.g., Philadelphia) after 5 years (GS-13, Step 5): 108,900

Overhead costs: zero
Benefits costs: +10%(401k)=11,000; -$150 premium for insurance=1800; net cost=+9200
Administrative costs: zero

VA position (estimated) = $118,100


If I'm doing the math right, then in your 5th year as a staff psychologist you're taking about a 20% pay cut to work at the VA.

What am I missing here?

Your rent is looking low for an expensive metro area, generally speaking, and your benefit costs were supposed to be in the $22K range, not $12K (insurance plus retirment at 10K). I don't know how you would calculate "paid vacation" unless you set aside additional income for that. That will pull you down another $10K alone + pulling aside income for "paid vacation" for a full month = which would be over $10K again based on being 1/12 of your salary. So drop down $20K+ right away and you're now at $132K pre-taxes, which is even closer to the ballpark range of the VA, but without the cushy hours, with additional admin and work burdens around your business, etc.
I'm not seeing where the other business costs are going...I'm assuming you lumped them into "administrative?"

Remembering that peak hours are 3-7 or 3-8, that now puts you working a potentially difficult schedule to get 30 hours spread out over 6 days at peak times. In practice, this would be tough for many people to give up every evening during the week, so many would choose not to work every evening during the week unless they don't want a social life outside of work.

I applaud your attempts to calculate the math, but again, the numbers in PP tend to be more complicated in practice because expenses can fluctuate greatly based on client flow, insurance rates increasing, trainings, etc.

Thus, if the added benefits of private practice are only $15K or so over the VA in an established practice that took years to build (based on your own math with 30 clients in PP after 5 years), yet you don't have the burden of carrying on a business or working evening hours, that to me explains why people opt for the VA. Plus the VA has paid holidays in addition to paid vacation time.

 

[Ollie123]

Academic affiliate VAs can serve as an amplifier of sorts if you are in a hybrid space. Can make more money combining AMC with VA. Also, there are administrative and higher level research positions that bring you past GS13. Also, there are ways, to address psydrs retirement advantaged accounts option, to get some similar action. Eg tsp + a 457. If one is also paying attention to such things, there are fsa and hsa vehicles that can further advantage tax savings. Of course if you’re taking in the income to let you take advantage of a lot of these things you quickly run into income limits on some of the more popular options. Hence, one big advantage to running your own shop are write-offs and controlling income on a year to year basis.

There are a lot of ways to make money if you think about it and flexible and willing to work.

Oh absolutely - that's what many of our VA-research folks around here do since there is no way someone on their 5th or 6th R01 takes GS-13 pay when they could double it elsewhere. I'd strongly consider doing so myself if I can worm my way in there (I'd be going the other direction though since I'm all university-side right now)...though admittedly less for the benefits and more for access to different grant lines. Seems like a great deal, albeit I would need another three PhDs to understand how the heck their benefits package works.

Anyways - hopefully this discussion illustrates that there are certainly plenty of make money in the field. Its just that most of those do not involve <only> seeing patients and doing 3-4 hours of work on your "busy" day I was mostly just trying to push back against the idea that one can just focus on seeing a few patients a day and make a killing. I think that is where people fall into the trap. Even if we don't all agree on whether most people go into psychology to make money, I think we can all agree that most don't enter the field because they want to take advantage of solo 401k and tax writeoffs while renting space they purchased through a seperate LLC to other clinicians, etc. etc. Which isn't condemning either side....just an acknowledgement that it certainly isn't what most people are thinking about when picking a career. Certainly someone looking at the financial success of the person doing that is going to be very disappointed if they want their day-to-day to look like that of a front-line clinician...

 

[msgeorgeeliot]

Nah, not gonna kill you. But I will grab popcorn and get a table close by when you go out on a date that 21 year old.

Seriously though, I think everyone knows business done right is more successful than any job. That said, I think VA is one of the best traditional jobs out there for many graduating psychologists.

EDIT: Besides no one said you can't do VA + PP.

This is a terrible joke for a professional listserv setting. Some participants here have expressed interest in data points about women not wanting to engage in this community. @Sanman , consider me a reliable killjoy. You can do better than this.

 

[Sanman]

This is a terrible joke for a professional listserv setting. Some participants here have expressed interest in data points about women not wanting to engage in this community. @Sanman , consider me a reliable killjoy. You can do better than this.

I could and yet I didn't. I'm okay with that.

EDIT: We disagree that this is a professional listserv.

 

[beginner2011]

I think I did a pretty good job accounting for everything folks mentioned. Benefits (insurance/retirement) is in there on both ends (a generous 10% retirement match from employer, which I think is higher than reality), paid leave is in there (46 weeks = 52-6 = 6x5 = 30 days of paid leave). It's all in there, maybe take a closer look if you're skeptical. I know I was pretty lazy annotating the math.

I would love to believe that taking on a VA career would allow me to have my cake and eat it to. It would be nice to think that it was a lucrative financial option, allowed for a good work-life balance, and also allowed me to do meaningful work with folks who are often marginalized and low-resource. Unfortunately, whenever I look at the numbers I get a strong suspicion that working at the VA is at least a bit of a financial sacrifice. Which seems odd to me, given that VA careers have sometimes been characterized as a totally cush position. Maybe the current political climate has undermined the VA's ability to remain competitive?

Ultimately, I think I would be quite comfortable with some financial sacrifice in order to do work that's more important to me, though. At this point it does seem likely that, if I am fortunate enough to have the opportunity to take a staff position in my preferred location, I would be willing to accept the (relatively minor) financial opportunity costs. I do appreciate you all helping me see that the costs are probably not as major as I was initially thinking.

I'm curious now, because this goes back to the original point that came up earlier. The irritation people had when they see others who say things like "we didn't go in to this field for the money". What I've described above -- is that the kind of attitude that irritates you?

 

[Sanman]

I'm curious now, because this goes back to the original point that came up earlier. The irritation people had when they see others who say things like "we didn't go in to this field for the money". What I've described above -- is that the kind of attitude that irritates you?

At least for me, what irritates me about that attitude is you literally did get into it for the money (if you didn't just go volunteer somewhere, don't need the money right?) . That attitude is used to foster ignorance and accepting poor pay. If enough people accept low pay and never learn how much they are earning (many clinicians that are employed have no idea how much insurance reimburses for their services), that makes it tougher for those of us who expect to be paid appropriately based on our knowledge and time. It sets the expectation that we DESERVE to be paid poorly. Physicians don't only do it for the money, but you wouldn't see a licensed physician accept a $60k full-time gig and say that, would you?

 

[msgeorgeeliot]

I could and yet I didn't. I'm okay with that.

EDIT: We disagree that this is a professional listserv.

Gee! My recollection from the moderators @futureapppsy2 and @AcronymAllergy is that the tone of discussions needs to be professional or else threads will be shut down. If you can’t do better than make jokes about the fun use of 21 year olds by older scientists, I really don’t know what to say to you.

 

[Sanman]

Gee! My recollection from the moderators @futureapppsy2 and @AcronymAllergy is that the tone of discussions needs to be professional or else threads will be shut down. If you can’t do better than make jokes about the fun use of 21 year olds by older scientists, I really don’t know what to say to you.

Then they are welcome to moderate my comments and let me know that.

 

[beginner2011]

I appreciated some of the earlier comments by folks who pointed out the false dichotomy in thinking either people were "only in it for the money" or were totally naive and had no idea what the value of their labor was. Seems like some good ol' B&W thinking to me.

I think it's possible to have pursued a career as a Psychologist primarily because of an interest in doing the work (and thus not the money), and also be discerning about the career decisions one makes based at least in part on the relative value of one's labor.

 

[Sanman]

I appreciated some of the earlier comments by folks who pointed out the false dichotomy in thinking either people were "only in it for the money" or were totally naive and had no idea what the value of their labor was. Seems like some good ol' B&W thinking to me.

I think it's possible to have pursued a career as a Psychologist primarily because of an interest in doing the work (and thus not the money), and also be discerning about the career decisions one makes based at least in part on the relative value of one's labor.

Exactly

 

[AbnormalPsych]

I love my private hospital gig because it covers 100% of what I want for my benefits situation, plus a more than comfortable salary. And it allows me to be in PP on the side. Delaying grad school to find the right fit, and as a result, being debt free prior to starting my career, makes this a very good situation to be a high earner with financial stability.

 

[PsyDr]

Nah, not gonna kill you. But I will grab popcorn and get a table close by when you go out on a date that 21 year old.

Seriously though, I think everyone knows business done right is more successful than any job. That said, I think VA is one of the best traditional jobs out there for many graduating psychologists.

Gee! My recollection from the moderators @futureapppsy2 and @AcronymAllergy is that the tone of discussions needs to be professional or else threads will be shut down. If you can’t do better than make jokes about the fun use of 21 year olds by older scientists, I really don’t know what to say to you.

This is a reference to a joke that I made when we were discussing the difference between the legality of an action and the merits of an action. I pointed out that it would be completely legal for me to date a 21 year old, but probably a bad idea. Which it would be because we would have limited things to talk about and I get tired way easier.

If you are saying that an adult woman cannot freely enter into a dating relationship with another adult, then I can’t see how there is equality.

 

[erg923]

Gee! My recollection from the moderators @futureapppsy2 and @AcronymAllergy is that the tone of discussions needs to be professional or else threads will be shut down. If you can’t do better than make jokes about the fun use of 21 year olds by older scientists, I really don’t know what to say to you.

I know your proud to be an agitator here, but I am gonna have to "gaslight" this.

Edit: Nevermind, looks like others already explicitly did it for you,

 

[beginner2011]

I love my private hospital gig because it covers 100% of what I want for my benefits situation, plus a six figure salary. And it allows me to be in PP on the side. Delaying grad school to find the right fit, and as a result, being debt free prior to starting my career, makes this a very good situation to be a high earner with financial stability.

How/why did you choose a private hospital position over a VA or AMC?

What are the downsides of working in a private hospital like you do right now?

 

[WisNeuro]

How/why did you choose a private hospital position over a VA or AMC?

What are the downsides of working in a private hospital like you do right now?

Answer to this is going to be, it depends based on the hospital. They are wildly different in terms of productivity, bureaucracy, support, etc.

I chose a non-VA hospital setting for much better pay, and a ton of flexibility. I can come in and see patients whenever I want as long as I make a general target for RVUs, which is pretty low comparatively. I often take long weekends without using PTO by just putting in a couple extra hours on other days. When I was in the VA, they were very serious about being in the hospital during your tour of duty. For example, if I had no shows that week, I could have zero work to actually do, but still had to come in and sit in my office. I got a lot of reading done in the VA. Here, if I don't have work to do, I simply go home/gym/movie etc. This is definitely not every hospital setting, though, I probably have it easier than most.

 

[Therapist4Chnge]

Depends on the mix of PP, especially when it comes to forensic work. I haven't gotten too heavy into it just yet, but my "doing someone a favor" rate is $250/hr. If you're straight up doing clinical work and taking insurance, VA is probably your best bet. If you want to only take certain high paying insurance and go cash only, or do some forensics, the VA is the clear loser. On a per hour compensation basis, one can do much better than the VA.

This has also been my experience. My per hour billing is much higher in PP, but the added overhead costs and startup costs are higher, so the first year or so billing was lower, but in the long run there is a lot more money to be made in PP.

 

[cara susanna]

Reasons I like the VA:
- Consistent schedule, no having to work evenings or weekends unless I want to. At my clinic we also have the opportunity to flex our time or work alternative schedules if so desired.
- You get paid even if patients don't show or don't schedule
- Access to workshops, seminars, trainings, top notch EBP trainings, focus on evidence-based therapy
- Multi-disciplinary - I don't have to worry about the psychiatrist calling me back, there are options for case management, etc
- You get all federal holidays off. That's 11 days per year. Psychologists also get a good deal of sick leave and annual leave--which are separate, by the way.
- Flexibility in role - you can get involved in teaching, research, training, outreach, etc.
- Don't have to worry about billing or therapy session cutoffs (okay, the latter can actually be a problem in the VA in the opposite manner, but on the flip side it's great to be able to see someone as long as you need to).
- Good benefits
- General flexibility in a geographical sense - you can transfer to other locations and facilities fairly easily if you need to move.

I should add that I've only ever worked in the VA so I don't know what it's like on the outside. Obviously some or maybe even all of these things are available in other types of jobs, but this is why I like the VA myself.

 

[iliketohelppeople]

Academic affiliate VAs can serve as an amplifier of sorts if you are in a hybrid space. Can make more money combining AMC with VA.

@Jon Snow or someone else who knows. What does typical structure of pay look like for combining AMC with VA look like? For instance, if someone has a VA position, but then is also a AMC Associate Clinical Prof, is the person on the GS-scale but then gets additional level of pay somehow? Is it pretty dependent upon the specific AMC/VA combo and/or specific job? Or would that be dependent upon grants that one is able to get being on top of VA salary?

 

[Therapist4Chnge]

One big “advantages” to working in the VA can be lifestyle, advice described previously....set hours, workload/productivity requirements, good benefits, etc. The money can be relatively competitive for the first few years, particularly if you come in from fellowship as a G-13, BUT it quickly caps out bc of marginal increases (they call “step increases”), as there is rarely an ability to go GS-14, unless you take an administrative/lead position.

Not all VA positions are created equal. Also, beware of contract positions within the VA, as they tend to require high productivity and worse pay bc you are usually employed by a third party company and NOT the VA. CBOC (community based outpatient clinics) positions can also vary greatly.

 

[AbnormalPsych]

How/why did you choose a private hospital position over a VA or AMC?

What are the downsides of working in a private hospital like you do right now?

It is a good balance for me between being bored/frustrated out of my mind (VA) and stressed to death (AMC).

I didn't like many things about the rigidity and politics of working in VA, most of them probably due to my oppositional personality. It was a stable gig though, and probably a good spot for many fresh grads to make that last developmental shift into an independent professional.

My private hospital allows me much more flexibility to operate however I want, as long as I get the job done. I am involved in cases that are more interesting to me, my salaray and benefits package nets me way more for the equivalent amount of weekly hours, and I have the ability to flex my schedule how I want (hello 3 day weekends). I have competent clerical staff and schedulers as well as there being a lot more resources available - which I find very important for my happiness. For instance, yesterday, my hospital treated several psychologists on my team to a nice lunch out in our nearby downtown area. If I want/need anything (e.g., furniture, office supplies, computer equipment, ergonomic equipment) - I ask and get it, fast. That would never happen at VA - there would be 250 forms to fill out months to wait. I once requested and waited 6 months to get a trash can in my office at VA. Seriously.

Downsides are that I have many fewer holidays. I think 6 or 7. But I do get a lot of PTO. I am also expected to be slightly more productive that at VA (face to face time). My job is also not as secure as VA. I or my hospital could end our relationship whenever we wanted. I am also noticing my system is hiring a lot more masters level folks. This is concerning for job security as well as patient care and administrative philosophy differences.

 

[AcronymAllergy]

Mod Note: For fear of derailing the thread, I'll reply only briefly, but I did want to respond to an earlier inquiry--while SDN is not a professional listserve in the sense of, say, that of a professional society (e.g., APA divisions, AACN, etc.), we do ask that all members strive to contribute positively, and to remain professional, courteous, and respectful in their posts. Hope that helps.

RE: Jon Snow's last post, I could definitely see VA research gigs being more enjoyable/advantageous than clinical gigs, depending on various factors.

 

[beginner2011]

It is a good balance for me between being bored/frustrated out of my mind (VA) and stressed to death (AMC).

I didn't like many things about the rigidity and politics of working in VA, most of them probably due to my oppositional personality.

Does it seem like the boredom was a common experience for other folks in VA? At my site, staff psychologists seem to be busy with clinical work, engaged in training or research, and generally anything but bored. Frustrated, yes, but not bored. I imagine this varies by site. I'm curious if maybe I'm assuming people feel engaged and fulfilled, while in reality they're bored? Are you in Neuro? I know things are sometimes quite different for Neuro folks.

I didn't like many things about the rigidity and politics of working in VA, most of them probably due to my oppositional personality.

RE: rigidity. Was it the lack of flexibility in scheduling (tour of duty) and process (CPRS/patient scheduling/intake protocol/etc.)? Or was there some other kind of rigidity that you didn't like?

RE: politics. Do you mean national/governmental politics, or do you mean office politics?

I am also noticing my system is hiring a lot more masters level folks. This is concerning for job security as well as patient care and administrative philosophy differences.

How many other psychologists are on staff at your facility? Are there any psychologists in leadership? My understanding is that one of the reasons the VA has so many psychologists is that there are many in leadership, who are then able to influence culture and the hiring process. Is that something you notice an absence of as a private hospital psychologist?

 

[erg923]

I found myself bored because psychotherapy, especially the brief behaviorally-focused kind done in primary care can get very boring. "Doc, I can't sleep" has got to be the most boring clinical complaint on the face of the earth, and that's like 50% of what i was seeing in primary care.

We did not have the option of flexing time at my VA, which I thought was ridiculous...both for employees and patients. Mandates from VACO often seemed so far removed from reality and actual helpfulness, it brewed a sense of bewilderment and lack of control that fueled burnout. Psychologists in leadership is only a good thing if they are advocating for common sense, applying clinical science, and empowering psychology/psychology staff while doing it. That was really not my experience with most of the psychologists in leadership positions at the VA.

 

[beginner2011]

Feeling really grateful for y'all sharing a bit about your experiences. Coming out of my grad program I feel extremely well prepared in many domains, and also pretty naive about non-R01 research/alternate career pathways.

Psychologists in leadership is only a good thing if they are advocating for common sense, applying clinical science, and empowering psychology/psychology staff while doing it. That was really not my experience with most of the psychologists in leadership positions at the VA.

I'm trying to understand how psychologists in leadership wouldn't advocate/apply/empower in the ways you described. This may get a little too specific for a public forum like this, but I'm super curious and I hope you'll feel comfortable sharing some thoughts.

Why get into leadership if not to address those 3 domains? Is it possible that there are efforts, but hands are tied even at the higher levels of leadership? Is this just a structural VA problem?

What would be a practical/tangible example of how leadership isn't doing those things?

What would be different/how would things be different if leadership was advocating for common sense, applying clinical science, and empowering psychology staff?

 

[Sanman]

Feeling really grateful for y'all sharing a bit about your experiences. Coming out of my grad program I feel extremely well prepared in many domains, and also pretty naive about non-R01 research/alternate career pathways.



I'm trying to understand how psychologists in leadership wouldn't advocate/apply/empower in the ways you described. This may get a little too specific for a public forum like this, but I'm super curious and I hope you'll feel comfortable sharing some thoughts.

Why get into leadership if not to address those 3 domains? Is it possible that there are efforts, but hands are tied even at the higher levels of leadership? Is this just a structural VA problem?

What would be a practical/tangible example of how leadership isn't doing those things?

What would be different/how would things be different if leadership was advocating for common sense, applying clinical science, and empowering psychology staff?

Most psychology chiefs are middle managers. Having been a middle manager in my career it is a really thankless job. It is mostly taking what you are told to do by your boss and making it palatable for those that you supervise. Kind of like feeding kids their vegetables. The really good ones know when to push back on their bosses when those on the front lines that they supervise are struggling. The bad ones just do as they are told, look out for themselves, and see it as **** rolls downhill.

 

[erg923]

Feeling really grateful for y'all sharing a bit about your experiences. Coming out of my grad program I feel extremely well prepared in many domains, and also pretty naive about non-R01 research/alternate career pathways.



I'm trying to understand how psychologists in leadership wouldn't advocate/apply/empower in the ways you described. This may get a little too specific for a public forum like this, but I'm super curious and I hope you'll feel comfortable sharing some thoughts.

Why get into leadership if not to address those 3 domains? Is it possible that there are efforts, but hands are tied even at the higher levels of leadership? Is this just a structural VA problem?

What would be a practical/tangible example of how leadership isn't doing those things?

What would be different/how would things be different if leadership was advocating for common sense, applying clinical science, and empowering psychology staff?

Psychologists in leadership (at the VA) don't just supervise psychologists. Their job is administrative oversight (supervision) of multiple disciplines, and they have a variety of priorities. Think enforcing metrics and mandates from VACO, JACHO, the medical center director, etc. The job description of a program manager or service chief does not have an explicit priority or goal of advancing psychology and the psychologists, per se. Some can chose to do that. Many dont, or cant.

 

[WisNeuro]

I'm trying to understand how psychologists in leadership wouldn't advocate/apply/empower in the ways you described. This may get a little too specific for a public forum like this, but I'm super curious and I hope you'll feel comfortable sharing some thoughts.

In the VA, and other places, but especially the VA, people tend to "fail upwards." Mid-level leadership positions tend to be so much of a hassle and extra work, that the "raise" does not really cover the added hours and/or soul crushing nature of the job. As such, many times, no one wants the jobs, and the incompetent get the position. Not all of the time, just a good deal of it. At my last VA, they literally went around and begged people to apply to the Outpatient Mental Health lead position when someone stepped down. In the end, one of the two people I had pegged as the worst possible people to lead the department got the job. Not because they nailed the interview, or succeeded on merit, but simply because better suited people could not be enticed to take it.

 

[futureapppsy2]

In the VA, and other places, but especially the VA, people tend to "fail upwards." Mid-level leadership positions tend to be so much of a hassle and extra work, that the "raise" does not really cover the added hours and/or soul crushing nature of the job. As such, many times, no one wants the jobs, and the incompetent get the position. Not all of the time, just a good deal of it. At my last VA, they literally went around and begged people to apply to the Outpatient Mental Health lead position when someone stepped down. In the end, one of the two people I had pegged as the worst possible people to lead the department got the job. Not because they nailed the interview, or succeeded on merit, but simply because better suited people could not be enticed to take it.

Additionally, the VA has a nasty habit of making psychologists fill leadership positions as "interim [fill in the blank]", giving them a ton of extra duties and responsibilities with no release from other duties or increase in salary, and then refuse to ever actually hire them in the position that they are "interim [fill in the blank]" for.

 

[ClinicalABA]

Reasons I like the VA:
- Consistent schedule, no having to work evenings or weekends unless I want to. At my clinic we also have the opportunity to flex our time or work alternative schedules if so desired.
- You get paid even if patients don't show or don't schedule
- Access to workshops, seminars, trainings, top notch EBP trainings, focus on evidence-based therapy
- Multi-disciplinary - I don't have to worry about the psychiatrist calling me back, there are options for case management, etc
- You get all federal holidays off. That's 11 days per year. Psychologists also get a good deal of sick leave and annual leave--which are separate, by the way.
- Flexibility in role - you can get involved in teaching, research, training, outreach, etc.
- Don't have to worry about billing or therapy session cutoffs (okay, the latter can actually be a problem in the VA in the opposite manner, but on the flip side it's great to be able to see someone as long as you need to).
- Good benefits
- General flexibility in a geographical sense - you can transfer to other locations and facilities fairly easily if you need to move.

I should add that I've only ever worked in the VA so I don't know what it's like on the outside. Obviously some or maybe even all of these things are available in other types of jobs, but this is why I like the VA myself.

I'd say this is all pretty much true of my setting. We are technically a multi-site, group private practice of psychologists and speech therapists, associated with a larger home-based ABA services company. In comparison to the VA, I don't have the same easy access to multi-disciplinary services (other than BCBAs and SP/L therapists, nor do I have the geographic flexibility. Alos no govt pension. I do, however, have opportunities to directly increase my pay above my salary by seeing more clients through an incentive program that is basically profit sharing. The company also is affiliated with a masters program and I get to adjunct for additional payment. Also get all licensure/certification, ceu, and PLI reimbursed, as well as up to $2500 a year in student loan reimbursement.

My most financially lucrative job as a psychologist (as far as base salary) was an administrative position as director of operations of a private ABA company. WAY to many headaches, risks, and travel for me. To a big hit in salary when left (my choice) but was able to quickly make it up with a combo of me doing more and my wife doing more in her job.

I guess, in summary, there are many options out there with a doctorate in psychology other than VA and outpatient PP. To tangentially address the OP- I will add that I have co-workers doing the same thing as me with PsyDs from expensive programs in which they racked up some debt.

 

[futureapppsy2]

Bumping this, as I think that the OP should be required reading for anyone considering an unfunded or not fully funded program.

 

[voyeurofthemind]

Just remember folks, this is kind of a best case scenario in the unfunded program life choice.

Frankly, I hear all these woe is me stories but I came from a non funded program ($145,000k ) and I couldn't be happier with my choices. Current combined income is $195k a year (private part time 15 hours a week, full time correctional setting). I am on track to have loans forgiven in five more years. Salaried job provides full comprehensive health benefits and retirement with a pension. I just bought a second home and am renting out my first to build assets (disclosure - I do have a partner that makes in the low 100s as well so that helps).

I live a very comfortable lifestyle. Bottom line most people on this post who are dissatisfied with their income / debt aren't willing to work the 60 hours weeks I do nor are they willing to work jobs that offer various compensation for loan repayment in different forms. I enjoy what I do and while I am definitely grinding, it's satisfying to achieve my financial goals early. By my early 40's I'll be where I want to be with no debt and quite a nice income and will be able to cut back on my side work.

Work hard and sacrifice some of the "I want to only work here or there etc" - play later.

 

[WisNeuro]

Frankly, I hear all these woe is me stories but I came from a non funded program ($145,000k ) and I couldn't be happier with my choices. Current combined income is $195k a year (private part time 15 hours a week, full time correctional setting). I am on track to have loans forgiven in five more years. Salaried job provides full comprehensive health benefits and retirement with a pension. I just bought a second home and am renting out my first to build assets (disclosure - I do have a partner that makes in the low 100s as well so that helps).

I live a very comfortable lifestyle. Bottom line most people on this post who are dissatisfied with their income / debt aren't willing to work the 60 hours weeks I do nor are they willing to work jobs that offer various compensation for loan repayment in different forms. I enjoy what I do and while I am definitely grinding, it's satisfying to achieve my financial goals early. By my early 40's I'll be where I want to be with no debt and quite a nice income and will be able to cut back on my side work.

Work hard and sacrifice some of the "I want to only work here or there etc" - play later.

Kudos, I genuinely think it's great you're making it happen. However, I do think it's nice to have the choice not to have to grind after starting work to pay off a mountain of debt. Or the freedom to leave a place of employment if it's a ****ty environment. There aren't many people who say it is absolutely impossible to pay off great amounts of debt as a psychologist, we are just saying that in almost ever circumstance, it WILL limit the choices you can make for a good deal of time. And, for every "I made it story" I hear 20 more of the kind of someone putting off buying a home they want until their 40's or 50s because they cannot get a down payment together.

 

[Sanman]

Frankly, I hear all these woe is me stories but I came from a non funded program ($145,000k ) and I couldn't be happier with my choices. Current combined income is $195k a year (private part time 15 hours a week, full time correctional setting). I am on track to have loans forgiven in five more years. Salaried job provides full comprehensive health benefits and retirement with a pension. I just bought a second home and am renting out my first to build assets (disclosure - I do have a partner that makes in the low 100s as well so that helps).

I live a very comfortable lifestyle. Bottom line most people on this post who are dissatisfied with their income / debt aren't willing to work the 60 hours weeks I do nor are they willing to work jobs that offer various compensation for loan repayment in different forms. I enjoy what I do and while I am definitely grinding, it's satisfying to achieve my financial goals early. By my early 40's I'll be where I want to be with no debt and quite a nice income and will be able to cut back on my side work.

Work hard and sacrifice some of the "I want to only work here or there etc" - play later.

Good for you. That is a high salary and if you are willing to work in a correctional/prison setting, you will get paid for it. That said, I think we can admit a couple of things:

1. Your salary is significantly above the norm and you are working two jobs to get there.

2. Many people that come here unwilling to move to different part of the country to attend a fully funded program are unlikely to be willing to work in a prison setting or work two jobs. Some may be willing to work hard and simply not gain entry into a funded program.

3. You would be making equal money without the debt or need to work a side job should you have attended a funded program.

 

[thebalmofhurtminds]

Frankly, I hear all these woe is me stories but I came from a non funded program ($145,000k ) and I couldn't be happier with my choices. Current combined income is $195k a year (private part time 15 hours a week, full time correctional setting). I am on track to have loans forgiven in five more years. Salaried job provides full comprehensive health benefits and retirement with a pension. I just bought a second home and am renting out my first to build assets (disclosure - I do have a partner that makes in the low 100s as well so that helps).

I live a very comfortable lifestyle. Bottom line most people on this post who are dissatisfied with their income / debt aren't willing to work the 60 hours weeks I do nor are they willing to work jobs that offer various compensation for loan repayment in different forms. I enjoy what I do and while I am definitely grinding, it's satisfying to achieve my financial goals early. By my early 40's I'll be where I want to be with no debt and quite a nice income and will be able to cut back on my side work.

Work hard and sacrifice some of the "I want to only work here or there etc" - play later.

I think it's frankly quite disingenuous and rude to imply that people who do not want to work 60 hours per week and/or wait to "play" until they are in their late 40's are somehow inferior. 60 hours per week is really not a general definition of a "comfortable lifestyle."

I came from a fully funded program, no debt, etc. - and I still felt like your post was unnecessarily aggressive towards those who are not "grinding" as hard. Having to work your butt off just to have no debt in your FORTIES is not something I would recommend to others. Those "woe is me" stories can help others make better decisions. I'm glad that you're happy with your choices, but I think you should acknowledge that most people would not be - and to be honest, it's more understandable for them not to be.