CA saturation

[aequitasveritas]

I've had my own private practice up and running for 6 months in So Cal.
...4 patients. 1.2.3.4....in 6 months. I've has some assessments and some other patients come in for short term stuff, but 4 consistent at this time.

And I accept insurances, including Medicare.
...and I'm well respected and rather hooked in in this town.

This is crazy folks. Luckily I have a steady forensic gig 3-4 days a week.

Every time I go to a professional mixer I end up witnessing a multitude of mid level providers gabble on in front of me re: their amazing specialties etc. I recently spoke with a BA level therapist....BA! I cut him short and passive aggressively told him I'd offer a free first consultation meeting for supervision, and walked away. Couldn't keep the show up for that one. In my same suite there is a ****ing "hypnocoach" and a "sober coach", neither of whom have any discernible training. Sat.ur.ated!

I'm just pissed, and venting, but I really do think the PP field is on the downhill roll.

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[cara susanna]

BA level therapist? Is that even allowed?

 

[Ollie123]

Its the "Life Coach" market - one doesn't even need a BA to do it, sadly. The problem is that the nature of therapy renders it inherently difficult to regulate. Where do we draw the line between therapy and communication between two people that isn't therapy? I mean obviously, we all know the difference but drawing a legal distinction would be extraordinarily difficult. I still can't help but think we could do a much better job than we have been though...

 

[WisNeuro]

One of the reasons CA has never been on my list of places to move to.

 

[AcronymAllergy]

One of the reasons CA has never been on my list of places to move to.

Ditto, although I worry about the possibility of this degree of saturation spreading elsewhere. It's disheartening to say the least. And I agree, Ollie--we've done a fairly horrible job of regulating most aspects of what we do, starting from day 1 (i.e., grad admissions and training).

 

[erg923]

Using the term "psychotherapy" or "psychological" to describe your work/job duties is illegal in this state if you are not licesned under our board of psychology

 

[NeuroTrope]

I'm in CA...it's saturated. You have to specialize and distinguish yourself (forensic, neuro) to make it and then it's an uphill climb. That said, the folks who are trained at the solid CA sites (UC's, USC, etc.) seem to overall do well since they combine both the training credentials and the networking opportunities. PP is tough though there's a huge population that'll pay for assessment work that you can break into if you're persistent.

 

[ela]

Eeesh. . . I interviewed recently for internship at a UCC in CA, in a city to which my spouse would really like to move, where s/he has a multitude of opportunities career-wise. Im torn. It seems like a good way to get a foothold in what is obviously a saturated market...but THEN what? Stories like this. . eesh.

 

[DynamicDidactic]

Every time I go to a professional mixer I end up witnessing a multitude of mid level providers gabble on in front of me re: their amazing specialties etc. I recently spoke with a BA level therapist....BA! I cut him short and passive aggressively told him I'd offer a free first consultation meeting for supervision, and walked away. Couldn't keep the show up for that one. In my same suite there is a ******* "hypnocoach" and a "sober coach", neither of whom have any discernible training. Sat.ur.ated!

this reminds of that NYT article not too long ago about these mixers and how credentials don't really matter.

 

[Therapist4Chnge]

CA is a glaring example of much of what is wrong with our profession: saturated markets, mid-level encroachment, poor regulation, splintered leadership, piss-poor reimbursement, etc. I would never consider moving to CA unless it was for a solid academic gig (e.g. UCSD, Stanford, etc) AND my sig other had a sweet gig. The cost and BS associated with The People's Republic of CA is off the charts. The networking example is perfect. I can't imagine the range of idiots selling their unlicensed and unregulated services. /CA Rant.

 

[aequitasveritas]

Using the term "psychotherapy" or "psychological" to describe your work/job duties is illegal in this state if you are not licesned under our board of psychology

Very true...but it does not stop them, and nobody else says anything.

 

[aequitasveritas]

CA is a glaring example of much of what is wrong with our profession: saturated markets, mid-level encroachment, poor regulation, splintered leadership, piss-poor reimbursement, etc. I would never consider moving to CA unless it was for a solid academic gig (e.g. UCSD, Stanford, etc) AND my sig other had a sweet gig. The cost and BS associated with The People's Republic of CA is off the charts. The networking example is perfect. I can't imagine the range of idiots selling their unlicensed and unregulated services. /CA Rant.

Could not agree more. Very tough. Sunshine beach runs make it nice, but this is a tough work climate to succeed in. I've practiced in other states and found the benefit of less saturation, but the overall life style of CA is pretty nice. We will see if I can make it here or not.

 

[NeuroTrope]

You gotta admit, "polar vortex" is just a nonsensical phrase around these parts.

 

[psyche27]

Could not agree more. Very tough. Sunshine beach runs make it nice, but this is a tough work climate to succeed in. I've practiced in other states and found the benefit of less saturation, but the overall life style of CA is pretty nice. We will see if I can make it here or not.

When you look at the numbers of licensed psychologists per state it's easy to see the saturation. When I looked a few years ago California had over 17,000 licensed psychologists. The next closest state was New York with 11,000 - and keep in mind New York doesn't have a state exam unlike California. Want a market that isn't saturated? Try Wyoming. I think there was something like 290 licensed psychologists at the time.

It's definitely a tough state to succeed in, but worth it if you stick it out in my opinion.

 

[KillerDiller]

When you look at the numbers of licensed psychologists per state it's easy to see the saturation. When I looked a few years ago California had over 17,000 licensed psychologists. The next closest state was New York with 11,000 - and keep in mind New York doesn't have a state exam unlike California. Want a market that isn't saturated? Try Wyoming. I think there was something like 290 licensed psychologists at the time.

It's definitely a tough state to succeed in, but worth it if you stick it out in my opinion.

Out of sheer curiosity, I ran some numbers. It seems that the same percentage of the population are psychologists in both Wyoming and California (.49% vs .48%). I couldn't find an up-to-date count of licensed psychologists in Wyoming with just a cursory search, but your number looks correct given data from 5-10 years ago that I did find. I wonder why the outlook seems so different in California.. Maybe it's the climate of masters-level service providers. Or, maybe it's the market for more new-age services and life coaches in California versus Wyoming.

 

[WisNeuro]

When you look at the numbers of licensed psychologists per state it's easy to see the saturation. When I looked a few years ago California had over 17,000 licensed psychologists. The next closest state was New York with 11,000 - and keep in mind New York doesn't have a state exam unlike California. Want a market that isn't saturated? Try Wyoming. I think there was something like 290 licensed psychologists at the time.

It's definitely a tough state to succeed in, but worth it if you stick it out in my opinion.

You're going to have to adjust those numbers for population. Per capita would be a better measure of saturation rather than the flat rate number.

 

[AcronymAllergy]

Out of sheer curiosity, I ran some numbers. It seems that the same percentage of the population are psychologists in both Wyoming and California (4.9% vs 4.8%). I couldn't find an up-to-date count of licensed psychologists in Wyoming with just a cursory search, but your number looks correct given data from 5-10 years ago that I did find. I wonder why the outlook seems so different in California.. Maybe it's the climate of masters-level service providers. Or, maybe it's the market for more new-age services and life coaches in California versus Wyoming.

I wonder if part of it has to do with the particular city/region of CA (e.g., LA or SF vs. a more rural area).

 

[erg923]

True, try finding an actual psychologist is Yreka, Susanville, Alturas, or Chowchilla.

 

[aequitasveritas]

The life coach and MFT market has boomed here in CA; as we have such a therapy oriented populace charlatans pour in from every which way to become a guru complete with cult following. In some other states, people seek tx in dire times of for SMI, which can scare off mid level providers. I've held a practice in CT, and although it's a more therapy oriented state than most, the seriousness of problems was apparent upon tx seeking. CA obv is not the opposite but I do find a legion of providers at all levels who aspire to be, and/or r only comfortable with the idea of "high functioning" clientele, and only here in my golden state do we have such presumptions (that one can set up a beach side practice and barter tx for coconut water and straight cash from clients who roll up in Ferraris and have only the wish to self explore and such). In any case I do think this (dramatized of course) mentality affects the mass of mid level providers in addition to other factors.

I attended another mixer last night. It was a good time. One thing that struck me was peoples awe that I will and can treat all ranges of functioning, including severely impaired, disabled, and psychotic patients.....in addition to the Ferrari driving tuna we all see to be fishing for. Oh, and a mid level provider initially tried telling me she did psych testing.

I received several cards, ALL of them were LMFT.

 

[Therapist4Chnge]

….and a mid level provider initially tried telling me she did psych testing.

That would really bother me (if they actually named assessment measures). I see this pretty frequently in regard to "cognitive assessment" and OTs and SLPs. I decided a few years back to not get involved in the semantics of how they evaluate cognition and how a neuropsychologist would handle it. If I was in direct competition with them (e.g. private practice, opposing side in a court case, etc) and their claims were far out of line from their scope of practice, then I would take a very different stance.

 

[aequitasveritas]

More news folks...
I just has an insurance company reject a treatment request to see a patient as out of network. Their reason? 'Geographical...there are over 300 (network providers on this one ins panel!!) in your provider area"

Lovely

 

[Therapist4Chnge]

More news folks...
I just has an insurance company reject a treatment request to see a patient as out of network. Their reason? 'Geographical...there are over 300 (network providers on this one ins panel!!) in your provider area"

Lovely

This is the kind of case you make sure the pt. knows exactly what the insurance company said.

That's ridiculous btw.

 

[Pragma]

That's ridiculous btw.

I'm assuming this depends on the fine print of the plan, but I am not sure why it would make a difference to them to pay the usual and customary charges to an OON provider, unless it is an HMO type plan and they don't have OON benefits unless there aren't any providers around.

 

[aequitasveritas]

I'm assuming this depends on the fine print of the plan, but I am not sure why it would make a difference to them to pay the usual and customary charges to an OON provider, unless it is an HMO type plan and they don't have OON benefits unless there aren't any providers around.

It's a PPO. I've used it before. The company rhymes with Shamtham Broo Schmoss

 

[Sanman]

I would not be surprised if they have negotiated lower than customary fees in the area due to the number if providers. Part of the reason I for out of the NYC area.

 

[Therapist4Chnge]

I'd guess at least half of the posts on the billing listserv I read are about NY (mostly NYC) insurance companies.

 

[Sanman]

Is it therapy or assessment? There are a lot of problems with neuropsych in NY. NY is not an easy place to work either. In the end, I found my niche, but it is incredibly tough to find your place there and make a decent living.

 

[Pragma]

Is it therapy or assessment? There are a lot of problems with neuropsych in NY. NY is not an easy place to work either. In the end, I found my niche, but it is incredibly tough to find your place there and make a decent living.

I'd imagine that NY will be the next CA with regard to saturation, although they have higher licensure standards and haven't created a system that circumvents minimal standards of training and allows people to work unpaid for years at a time. Who knew, New Yorkers are more humane than Californians? Maybe the difference is marginal

 

[Sanman]

I'd imagine that NY will be the next CA with regard to saturation, although they have higher licensure standards and haven't created a system that circumvents minimal standards of training and allows people to work unpaid for years at a time. Who knew, New Yorkers are more humane than Californians? Maybe the difference is marginal

However, we are the only state that will license psychoanalysts. So, there are different issues...

 

[aequitasveritas]

This is straight therapy for an axis I dx

 

[erg923]

What the French, toast! Ridiculous!

 

[paramour]

It's a PPO. I've used it before. The company rhymes with Shamtham Broo Schmoss

We have the same problem with them. We have a couple both seeking treatment individually, with one paid OON and the other denied because there are plenty of in-network providers available in the area. If the member has OON benefits, then it shouldn't really matter. Process the frakkin' claim under their OON benefits.

 

[Therapist4Chnge]

It is appalling what insurance companies try and get away w on any given day. I'm still fighting stuff from as far back as Aug of last yr.