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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.

I never implied or said that they were inferior so that's twisting my words. I'm simply saying there are options - I guess it depends on what you are willing to tolerate. I went into a non-funded program knowing there would be concessions to be made early on until that debt was wiped away. I worked nearly 50-60 hours a week in grad school - now I am just well compensated for it so not much has changed nor does it feel arduous. What is the general definition of a comfortable lifestyle?

I guess I just hear a lot of people expressing dissatisfaction with compensation but there are definitely options out there to increase it if you are willing to make the concessions.
 

DynamicDidactic

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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.
I am not sure how the post was disingenuous. Seemed very candid and honest.

Not sure what was aggressive about that post. If anything, it seems to be lack of empathy as opposed to aggression. I also did not read anything that said others were inferior.

@voyeurofthemind states that others are not willing to work as hard (perhaps there is a hierarchy here but that was not explicitly stated). I will agree that this statement likely makes a lot of assumptions about other people's motivation, opportunities, and abilities. As other have pointed out, not everyone has the same resources and access to work.

I do disagree with your statement about debt. I am very fiscally conservative and avoid debt at all costs (hey yo!). I understand that other may be more liberal about debt. I disagree with loan forgiveness programs (at least how they are currently structured). I think people should avoid debt (e.g., school, cars). Perhaps the most predatory debt is school debt, especially for a doctoral degree in psychology.
 
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Justanothergrad

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I never implied or said that they were inferior so that's twisting my words. I'm simply saying there are options - I guess it depends on what you are willing to tolerate. I went into a non-funded program knowing there would be concessions to be made early on until that debt was wiped away. I worked nearly 50-60 hours a week in grad school - now I am just well compensated for it so not much has changed nor does it feel arduous. What is the general definition of a comfortable lifestyle?

I guess I just hear a lot of people expressing dissatisfaction with compensation but there are definitely options out there to increase it if you are willing to make the concessions.
I think its also good to adjust for hour work so as not to become lost to the value of your work competitively and to help keep earning in perspective. If you're working 40hour weeks for a given rate, that's substantially more earned power than 60hour week at the same rate and its important to keep that in mind when offering life advice because not everyone wants (or can) do that (and heck, life changes in opportunity). I agree with you that there are ways to maximize income (PsyDr has posted about that a lot), but that doesn't mean the route (unfunded program) provides an equal probability of getting there. Advice should be offered based on what is most probable. Oh yeh, and having a partner who makes six figures also helps with a lot of things, and is also highly atypical.

We can probably agree that less overhead means more takehome (thus, debt is lost money)
We can also probably agree that most people won't make your money and will earn substantially less always
We can also probably agree that not everyone who wants to get in the NBA gets in. Some may even 'deserve' it and not make it.
 
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R. Matey

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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).

Eh...exceptions don't make rules. Keep that in mind.

This post reminds me of an article I read in the American Counseling Association's magazine a number of years ago. The author was promoting a master's level counselor who made six figures in a desirable area by providing 35-40 hours of direct service a week in PP. I mean, sure....but it didn't convince me to stay in the field. I'm not sure I could keep that pace up for my whole career.

@voyeurofthemind states that others are not willing to work as hard (perhaps there is a hierarchy here but that was not explicitly stated). I will agree that this statement likely makes a lot of assumptions about other people's motivation, opportunities, and abilities. As other have pointed out, not everyone has the same resources and access to work.

This is key. Personal responsibility only works if everyone has the same access to the same or similar resources.
 
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I am not sure how the post was disingenuous. Seemed very candid and honest.

Not sure what was aggressive about that post. If anything, it seems to be lack of empathy as opposed to aggression. I also did not read anything that said others were inferior.

@voyeurofthemind states that others are not willing to work as hard (perhaps there is a hierarchy here but that was not explicitly stated). I will agree that this statement likely makes a lot of assumptions about other people's motivation, opportunities, and abilities. As other have pointed out, not everyone has the same resources and access to work.

I do disagree with your statement about debt. I am very fiscally conservative and avoid debt at all costs (hey yo!). I understand that other may be more liberal about debt. I disagree with loan forgiveness programs (at least how they are currently structured). I think people should avoid debt (e.g., school, cars). Perhaps the most predatory debt is school debt, especially for a doctoral degree in psychology.
I didn't state that the facts around the post were disingenuous. I was referring specifically to the implication - as others have noted - that the people who regret their choices only do so because they haven't worked hard enough or learned to accept sacrifice enough.

I agree with you that aggressive was probably the wrong word and lack of empathy is more appropriate.

I also acknowledge that I may be a bit touchy about certain aspects of this topic. As I mentioned, I have no skin in the game regarding debt and PsyDs, but I am sensitive about this issue that people should just "work harder"/more hours if they want to be more comfortable. Working 60 hours per week is certainly a personal choice, but it is not one that should be considered the norm or expected of others. Additionally, someone is not less of a clinician/researcher/psychologist because they do not want to work excessive hours. It's also been extensively discussed on this forum the issues with watering down the value of our hour if other professionals are willing to work 60+ hours per week as though that is normal and expected (see above).
 
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I never implied or said that they were inferior so that's twisting my words. I'm simply saying there are options - I guess it depends on what you are willing to tolerate. I went into a non-funded program knowing there would be concessions to be made early on until that debt was wiped away. I worked nearly 50-60 hours a week in grad school - now I am just well compensated for it so not much has changed nor does it feel arduous. What is the general definition of a comfortable lifestyle?

I guess I just hear a lot of people expressing dissatisfaction with compensation but there are definitely options out there to increase it if you are willing to make the concessions.
You're right, upon rereading, I see that you didn't state inferiority, I apologize for the assumption. However, I think we will have to agree to disagree on most other things. Of course there are options - but they aren't considered decent or comfortable by the average person. I don't think we have to agree on the general definition of a comfortable lifestyle, but I think we can all agree that for most people, 60 hours ain't it.
 
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Sanman

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You're right, upon rereading, I see that you didn't state inferiority, I apologize for the assumption. However, I think we will have to agree to disagree on most other things. Of course there are options - but they aren't considered decent or comfortable by the average person. I don't think we have to agree on the general definition of a comfortable lifestyle, but I think we can all agree that for most people, 60 hours ain't it.

Anecdotes are great, but I don't think we need to argue about comfortable lifestyles. The truth is simply that psychology, at any degree level, lags earnings of other career fields. Even those of us with doctorates are often only making money equivalent to master's level folks in other fields. Given those statistics, debt may be unwise for most people who want to enter into the field. There are more PsyD folks than there are good paying jobs. Which means someone will end up without a good job when the music stops and the consolation prize for losing this game of musical chairs is six figure debt with no good way of paying it back.

Salary Averages for us
 
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psych.meout

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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.

Congrats, it sounds like you have figured out what works for you.

That said, it's really important to consider what the modal outcome is for graduates of unfunded programs and for psychologists in general. Even at just full-time (i.e., 40 hours/week) you're likely well above the median earnings for clinical psychologists. Thus, while it might be great to use you as an aspirational example, it's unlikely that most psychologists in general will earn what you do, let alone ECPs, who have the lowest pay and the greatest need for income to start paying down their debts and get their personal and professional lives started. People can try to work the number of hours you are, but that doesn't mean they will be able to do so at all or at least at the remuneration you receive. There are simply not that many high paying jobs out there for psychologists for everyone to have two of them. This difficulty is reinforced by competition with mid-level providers and from other psychologists in the oversaturated areas where many unfunded students tend to set up shop (often near their grad programs).

Furthermore, while it's great to use loan forgiveness programs to eliminate this debt, it's not exactly a great idea to stake your financial future on them. You're relying on something that is politically tenuous, just imagine how easily the means testers or anti-government ideologues would cut PSLF if someone used you as an example of someone taking advantage of it. As unfunded programs tend to graduate very large cohorts (e.g., at least 80 students per cohort at NOVA), there is going to be substantial competition amongst students from these unfunded programs and between them and graduates from funded programs who want PSLF for themselves or just want the high paying jobs that would qualify. As others have already astutely pointed out and that I alluded to earlier, one of the reasons many grads selected unfunded programs is geographic limitations. Do you really think that people who weren't willing to move for the few years of grad school will be willing to move for ten years of PSLF, especially if they've already settled in the same city or state of their grad program? And that's not considering the perils of other loan forgiveness programs that result in tax bombs at the end or other issues.

Relatedly, unfunded programs tend to have worse outcomes than funded programs, which stem from poor quality control in admitting students (either those who are unprepared for grad school and those who will never be prepared and shouldn't become psychologists), too large cohorts, poor training, poor mentoring, etc. The most salient example of this are internship match rates. The aforementioned issues lead to unfunded programs having significantly greater difficulty matching their students to accredited internships than those of funded programs. If a psychologist did not complete an accredited internship, they are completely locked out of many of the higher paying jobs working for public and private entities. This also allows them to be exploited, explicitly or implicitly, by those employers who will higher them (e.g., bad splits, contracting work). Even if the psychologist had an accredited internship, many unfunded grad programs carry baggage which makes it difficult for their graduates to get their feet in the door for getting those high paid opportunities. Many psychologists here have spoken about how they don't even consider graduates from certain programs, while others may be considered, but are at the bottom of the pile after all the applicants from other programs are considered and crossed off. So, even those graduates from these programs who have good training may find it difficult to get those high paying jobs, even though they have even greater need than those from funded programs. If you combine these employment issues with the need for PSLF (or other loan forgiveness programs) and geographic limitations, you can see how much more difficult, if not impossible, things would be for the typical graduate of unfunded programs in handling six figures of debt.

Finally, the mentality of bootstrapping one's way out of debt or into a lucrative career is harmful to the profession as a whole. Even setting aside the issues of debt, expecting psychologists to work 60 hours/week, set up side hustles, or what have you to earn remuneration commensurate with their training and experience just entrenches the problems our field. That there are outlier success stories like you allows unfunded programs to trick the naive into accepting a huge burden that will severely hinder their future goals, as well as allowing these programs to continue pumping out graduates who are woefully unprepared to provide services to the public.
 
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beginner2011

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For reference, I took a look at the Bureau of Labor Statistics to see what the median hourly wage is for a clinical psychologist. Appears to be $48.94, with top 10% receiving $62.27/hour or more. Assuming @voyeurofthemind is working 60h/week and 50w/year then they're being compensated roughly $65 per hour. That puts them in the top 10%, possibly in the top 5%.
 
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erg923

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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.

This a great example of a "technically valid", but mostly ridiculous argument in support of taking on 2 and 3 times the amount of debt that the profession will support/give back to you in an average year.

Many don't want to work these hours (I don't). Further, doing this would be silly when you don't really have to. Unless you are Matt Damon...no one really wants to work 60+ hours/week. Work is called work for a reason, right? I assure you that your wife and children prefer something else. Further, most certainly won't end up actually doing this, even if they (initially) wanted/planned to. That's how life works.

This is simply one argument out of said debt. It is not a particularly reasonable or pragmatic one for most people.
 
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What is the big interest in “hustling” lately? I have no interest in hustling anymore. I hustled many years ago to get into a funded program. Now I’m old and tired. I work 15ish hours a week (in the summers). Not having crippling debt can really free up a person’s time.
 
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AbnormalPsych

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What is the big interest in “hustling” lately? I have no interest in hustling anymore. I hustled many years ago to get into a funded program. Now I’m old and tired. I work 15ish hours a week (in the summers). Not having crippling debt can really free up a person’s time.

Your status says Post Doc. Can you explain?
 

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For those who have said that average psychologist salaries aren't commensurate with education and skills - when and how do you see that changing?
 
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For those who have said that average psychologist salaries aren't commensurate with education and skills - when and how do you see that changing?
When? Honestly I don't. At least not in the short term. People value physical health more than mental health.

How? Changes in public stigma of MH and increased advocacy at the federal level for equality in reimbursement (e.g., billing modifiers, etc)
 
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WisNeuro

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For those who have said that average psychologist salaries aren't commensurate with education and skills - when and how do you see that changing?

At the ground level, it will not change. At least not without a massive overhaul of our healthcare system. I have no doubt in my mind that you will not see any kind of massive shift upwards in RVU reimbursement from CMS, in fact, we'll likely see some cuts here and there, and a lot of no movement, maybe a slight increase every so often to "make up for inflation." Insurance companies generally follow suit with CMS, with some paying more, some actually paying a lot less. So, payor mix doesn't matter as much as people think with insurance, with a few exceptions.
 
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There is a whole bunch of weird, goofy, non-validated stuff that gets done and disseminated by and in the name of psychologists. For example- here's something from an email I got advertising a training by a psychologist:


Current Research
Current research shows that various chemicals, neurotransmitter substances, and neuropeptides occur in the brain to form thoughts and behavior. Once they leave the brain and travel with the blood throughout the body, they shape energy flow, emotional responses, and health or disease in various organs, joints, and muscles. This biochemical bouquet creates the body language that helps us uncover information about ourselves that has been outside conscious awareness.

The body reveals information about one’s personality, goals, life struggles, and unfulfilled needs. For instance, the body will indicate how one responds to rejection, whether one can sustain an ongoing relationship, and if one works hard or forgoes responsibility. My students learn to assess themselves, their clients, and others in their lives with the goal of relationship enhancement. They learn exercises and techniques designed to change themselves in order to improve their lives.

While not the mode, this kind of stuff is not exactly unique either. If we want to be taken/paid seriously, this kind of stuff doesn't help!

As to the whole discussion of "side hustling"- the ability to quickly pick up a "side" hustle when needed is, IMHO, one of the nice things about being a well trained and multiply credentialled psychologist. I earn an above average/median base salary from my day job. It pays the bills, keeps me livin' the life ;) , and allows for some savings. When things come (like having a kid or two in college), i can pick up another class, see some more clients, etc. to help cover the costs. I'm not talking 80 hours per week- If i work a solid 40 hours, be efficient with my time (85-90% billable time), and occasionally put in an evening or weekend, I can get to between 125-150% of my "day job" salary. If crisis hits (like losing a job or really needing to leave a crappy positions), it's nice to have options.
 
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PsyDr

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Some opinions from someone who makes more, and used to work more:

1) The idea that psychology is a zero sum game is incredibly misguided and is likely holding people back. It simply doesn't follow the laws of economics when there is a third party payor, and when there are options to innovate.
2) Innovation is always possible. Someone got the CPT for psychometricians added. Same for the behavioral component for fMRI. Outside the typical clinical game, there are many many opportunities.
3) Jobs, by definition, pay you less than you bring in. It might be wise to consider this in #1.
4) In general, the career is defined by selling your time for money. Therefore, your income is generally limited by the time you are willing to sell. However, there are many work arounds for this problem. You can find payors that are willing to pay more. You can use technicians as force multipliers, so that you can bill more hours per day. You can sell other services that are not time defined. DO NOT TRY TO SELL A BOOK. Everyone tries that. It's embarrassing.
5) Psychologists should LOVE it when another psychologists makes bank. Negotiations benefit from references to averages, SDs, and all. Do you want to try to argue that you deserve $80k because that is the average (let's face it: you'd be dumb AF to say median), or would you like to say that you deserve $150k because that is the average?
6) It is foolish to bet on extraordinary outcomes. It is reckless to bet money you don't have. There is a reason the lotto doesn't take credit cards. I specifically avoid saying how much I make on here, because it is an outlier, and I do not want students to go to a crappy school, take on a ton of debt, and hope they can replicate an outlier experience of some ***** on the internet. ( I didn't have student loan debt).
7) There seems to be a sweet spot for work vs. quality of life. At least in my experience, at around 70hr/week you have to start paying for things to be handled (e.g., shopping, laundry, etc). At 90hrs+, money no longer matters because I was so tired I couldn't care how nice anything was.
8) @voyeurofthemind There is a danger in making money above the median. Imagine if you got offered $30k for a job. You'd laugh, right? Now imagine if almost all jobs are like that. Even if you don't need the money for your lifestyle, you are used to your work being valued higher. Beware.
9) There are many ways to increase psychologists' median salaries.

a. It is likely, that the best way to do so is to contribute to the APA and state practice directorates, and CALL (not email) your state senator when things come up such as new CPT codes. It's like $200/yr.
b. Support RxP, if only for the ability to order imaging because covid taught us the limitations of having no real telehealth services.
c. Support workers' rights stuff, as our services can only be used if workers are free to take time off work to get to our offices.
d. Track every 15 min interval of your day. Learn CPT codes for all of the things you do but don't think are billable: record review, team conferences, phone calls, etc. They exist. Start submitting those, even if they don't pay.
e. Watch how physicians work, try to mimic it. They set the rules in billing. It's stupid to fight it.
f. Memorize statistics. People respond to stupid things like, "48% of patients with X respond to Y."
g. Do NOT be one of those idiots that creates problems without having a solution. It makes our profession look childish. Looking at you, anyone that says "someone should do something.".
h. Work when you are at work! Process things on your own time. If the field looks like it is lazy, people will pay like it's lazy. If ER docs can have patients die, and go back to the next patient, you can get through another few sessions.
i. Know the usual and customary rates for your area. Sample them every year. Increase your rates every year when the insurance companies send out their annual survey. Encourage your colleagues to do so as well.
j. Use the Dr. title. I know, you like engendering comfort with your patients by having them call you by your first name. But it makes you look lesser.
k. Build up other psychologists in public, criticize in private! The profession has a sick tendency to snark at other psychologists publicly. It makes us look childish. Medicine doesn't do that. While the entire torture thing was awful, you can't tell me that there wasn't a physician in the background monitoring vitals. That didn't come up, because they kept their mouths shut.
l. Always know what you bring in. Use that information in negotiations. "You're offering $100k/yr, with about $25k in benefits. I'm guessing you think I'll bring in about $200k gross. Here's some numbers from the last two years that show I really bring in $350k. Would that change what you offer?"
m. Always negotiate HARD with insurance companies and always ask for raises.
n. Buddy up to as many legislators as possible. A muffin basket once a quarter costs like $200/yr. That's a cheap price to pay.
 
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futureapppsy2

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I think it’s kind of like the people who went to Argosy or Alliant at the height of the internship imbalance and matched to an APA accredited internship on their first try—is it possible? Sure. Should you bet on it working out for you and take on six-figures of debt on that assumption? Probably not.
 

BuckeyeLove

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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.

You sound like me 5 years ago. As soon as I got licensed I was doing as many evaluations I could take on, on top of my forensic evaluator state position. That drive lasted about 3 years before I realized my boss was exploiting me, after which I got some amazing advice and guidance from friends, as well as people right here on this forum. I saw the totality of compounding effects this lifestyle had on him and others similar, and I knew this wasn’t for me. 65-70 hours a week started to take a toll. Now 3 years later, I’m still doing about 55 a week, but the work itself is either a. less demanding (consulting) or b. I’m getting paid my actual rate, which always feels good. I ramble on about this just to say, hustle/grind life is not for me. If it is for others though, go for it. However, I second what others have said regarding your situation not being normative, as it sounds like you’ve set yourself up nicely with a niche. It seems most of these diploma mill grads are coming out as therapists, and only therapists, wanting to work in a private practice. No niche, no specialized training where there is a high need, just idealistic views of what a therapist actually does on a day to day basis, vs the reality for most. Then they’ve got 250k to pay back, that will never actually be able to happen.
 
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beginner2011

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Some opinions from someone who makes more, and used to work more:
Please write your book already. Seriously.

l. Always know what you bring in. Use that information in negotiations. "You're offering $100k/yr, with about $25k in benefits. I'm guessing you think I'll bring in about $200k gross. Here's some numbers from the last two years that show I really bring in $350k. Would that change what you offer?"
I was having a conversation with a VA administrator recently about factors that determine psychologist salary, and he indicated that VA salary has almost nothing to do with revenue to the system. From the sounds of it the largest factor is local income for psychologists, which is determined by survey. Of course, the VA is a different animal than almost any other position, but wanted to share that data point. This fact also speaks to your earlier points regarding the value to all psychologists of each individual psychologist finding ways to increase their income.

m. Always negotiate HARD with insurance companies and always ask for raises.

Can you briefly describe how someone in independent practice could negotiate HARD with an insurance company? I'm not licensed yet, but I can imagine being in a position to negotiate in the future. It's hard to imagine how to approach that scenario effectively.
 

WisNeuro

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Can you briefly describe how someone in independent practice could negotiate HARD with an insurance company? I'm not licensed yet, but I can imagine being in a position to negotiate in the future. It's hard to imagine how to approach that scenario effectively.

This will depend partly on your specialty area and saturation. If you are private practice, you can negotiate with insurers for your rates. If you do something that a boatload of other people already do in your area, you may not have a ton of leverage. If you can deliver a service in a specialty area that is harder to come by, you can negotiate a higher rate. This will vary by region and insurer. Some are willing to negotiate, some just flat out will not. Learn your area, talk to other professionals to see what range of rates they see, learn who to talk to at different payors.
 
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This will depend partly on your specialty area and saturation. If you are private practice, you can negotiate with insurers for your rates. If you do something that a boatload of other people already do in your area, you may not have a ton of leverage. If you can deliver a service in a specialty area that is harder to come by, you can negotiate a higher rate. This will vary by region and insurer. Some are willing to negotiate, some just flat out will not. Learn your area, talk to other professionals to see what range of rates they see, learn who to talk to at different payors.
Pardon my ignorance, but how would this work at an AMC where there's a department handling billing and separate credentialing?
 

WisNeuro

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Pardon my ignorance, but how would this work at an AMC where there's a department handling billing and separate credentialing?

Well, in most situations where you are working for an institution, the institution/healthcare org has their own contract with the insurance companies for reimbursement. You as an individual provider don't really have a say in that. In that case, I would do as @PsyDr recommended and chart our your productivity and baseline reimbursement for those activities. You can get a rough idea by looking at your projected RVUs and using the posted Medicare rate as a starting benchmark. It won't be exact, as you'll have your own payor mix depending on your area and the populations you serve, but it'll give you a rough ballpark.
 
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Sanman

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I was having a conversation with a VA administrator recently about factors that determine psychologist salary, and he indicated that VA salary has almost nothing to do with revenue to the system. From the sounds of it the largest factor is local income for psychologists, which is determined by survey. Of course, the VA is a different animal than almost any other position, but wanted to share that data point. This fact also speaks to your earlier points regarding the value to all psychologists of each individual psychologist finding ways to increase their income.


Yup, salary for VA is relatively fixed not accounting for slight changes. Their locality adjustments cover large areas that often have varied costs of living and their labor mapping sucks. This can all be to your advantage or disadvantage depending on how well you play the game.
 
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beginner2011

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Yup, salary for VA is relatively fixed not accounting for slight changes. Their locality adjustments cover large areas that often have varied costs of living and their labor mapping sucks. This can all be to your advantage or disadvantage depending on how well you play the game.

Interesting. How could one play the poor labor mapping to their advantage? Or are you saying one could live in a low COL area that has been labor mapped for high COL.
 

AcronymAllergy

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Interesting. How could one play the poor labor mapping to their advantage? Or are you saying one could live in a low COL area that has been labor mapped for high COL.

I certainly can't speak for Sanman, but I'd say the bolded is how to "play the system" so to speak. You can't control or negotiate the locality adjustment, but you can potentially control which adjustment you get roped into (based on which VA you work at) and where you live. Some areas have high locality adjustments based on very high local earnings, but without super high COL (e.g., Houston). Conversely, some areas have high locality adjustments but coincidingly very high COL (e.g., Hawaii, SF).
 
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Sanman

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Interesting. How could one play the poor labor mapping to their advantage? Or are you saying one could live in a low COL area that has been labor mapped for high COL.

No labor mapping is how many patients you see based on your job description. Most clinicians in the VA are rated at 80-90% clinical time with 10-20% for meetings. National might want you to see a minimum of 5 patients/day for most clinics. That is different from locality pay. However, IME, many dept heads do a poor job of making sure that people are as busy as they are supposed to be.

Example A: Psychologist in Manhattan in a busy general MH clinic seeing 8 pts per day with a long waiting list and the dept crying about access issues

Example B: Psychologist B in Syracuse NY in a women's clinic averaging 4-5 patients/day with low volume and no waiting list

Both of these clinicians are being paid exactly the same because they are in the same VISN and labor mapped as full-time clinicians. One is doing near twice as much work with a much higher cost of living. Who do you want to be?
 
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PsyDr

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Please write your book already. Seriously.


I was having a conversation with a VA administrator recently about factors that determine psychologist salary, and he indicated that VA salary has almost nothing to do with revenue to the system. From the sounds of it the largest factor is local income for psychologists, which is determined by survey. Of course, the VA is a different animal than almost any other position, but wanted to share that data point. This fact also speaks to your earlier points regarding the value to all psychologists of each individual psychologist finding ways to increase their income.



Can you briefly describe how someone in independent practice could negotiate HARD with an insurance company? I'm not licensed yet, but I can imagine being in a position to negotiate in the future. It's hard to imagine how to approach that scenario effectively.



1) I haven't set foot in a VA in over a decade. Some of this won't apply there. However, Gilead was founded by a VA research guy. He is now a billionaire. So there are opportunities to make money in the VA, but I don't know what they are.

2) VA income being valued on community incomes just solidifies my point. The APA has an RxP bill for the VA right now, which I think would be invaluable for incomes alone. I also really really really want psychologists to have the ability to order imaging. Not interpret them. Just order it. RxP would accomplish this.

3) There are tons of ways to negotiate with insurance companies:

a. When you get the contract, it is ALWAYS a good idea to call and ask, "can you come up on those rate a little"? 60 second conversation, you ask, then stay silent for 30-40 seconds in awkwardness, worth a few grand a year. Takes no knowledge, almost no effort. Worst they can do is say no. But you have to be okay with the silence.

b. For a bit more effort, actually READ your state's insurance rules. You'll want to look for terms like "necessary", "medical emergency", etc. I am aware of two non-rxp states wherein psychologists are legally allowed to use physician billing codes, and a few other states that prohibit insurance companies for not paying in certain settings like hospitals. Once you're done with that Russian literature length tome, read the state's workers comp rules. Some states have all sorts of loopholes. Also learn about the contact information for your state's insurance department. They are super helpful. (control F is your friend here).

c. So insurance rates are generally set as a percentage of the "usual and customary" rate in your area. Say you think you're worth $300/hr and you're contracted with Acme Insurance. You see the patient, and then send in a bill using a standardized form. This form says, "what CPT code are you using? How much are you charging for that CPT code? How many units of that CPT code? When? Where?, etc". About once a year, Acme insurance will take a look at the data, and potentially adjust how much they are paying you. Say it's just you, and one other guy. You're billing $500 per patient, and he's billing $300 per patient. There's some math, but it's kind of an average here. Those who have basic statistics courses will see the reasonable way to play this game..

d. If you are established, you get to renew contracts every now and again. If you are seeing a substantial percentage, you can tell the insurance that you'll just drop their contract, bill out of network (this is always a higher rate), and then report them to the state's insurance department anytime there is a delay in paying you after pre-auth. This is extremely aggressive and not for most. They will hate you for this. But they're not your friends, so who cares? Oh no, some lady in some other city doesn't like me! This will not work in areas with a lot of your specialty., unless you are some big name.

e. While coming to a group agreement to set a price is highly illegal, there is nothing illegal about commiserating with colleagues about what you're getting paid without making any agreement. In other words, make sure you know what the going rate is. I regularly have an assistant call other practices in my area, and survey what they are charging. Learn who to take advice from, who to ignore.
 
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Mama Bear

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Your status says Post Doc. Can you explain?

Yeah... how do I change that?

Probably the best way to identify myself is TT faculty. I only take on light work in the summer. I am technically still postdoc in the sense that I am accruing supervised hours toward licensure on the side, but I am not doing a formal postdoc.
 
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