Do the ends justify the means?

[medium rare]

A bit of an aside, but a psychologist with solid clinical skills, decided commitment and a bit of business savvy can pretty assuredly make $200k+ in full-time private practice. I’ve been in private practice for over a decade and easily make well above that figure for a 40-clinical-hour week. Insurance-based practices are overwhelmed these days and self-pay practices are booming - even in rural areas. There is good money to be made in private practice. A psychologist should not be charging less than a master’s-level clinician.

That being said, I would never consider taking on that level of debt for a clinical psychology doctorate. Relocating for approximately 5-7 years is more than worth the lifetime debt burden of attending the local program. You can always return; Boston isn’t going anywhere.

---

Members don't see this ad.

 

[medium rare]

Most master’s level folks in my area charge the same rate I do with 3-4 years LESS training.

You need to raise your fees.

 

[WisNeuro]

A bit of an aside, but a psychologist with solid clinical skills, decided commitment and a bit of business savvy can pretty assuredly make $200k+ in full-time private practice. I’ve been in private practice for over a decade and easily make well above that figure for a 40-clinical-hour week. Insurance-based practices are overwhelmed these days and self-pay practices are booming - even in rural areas. There is good money to be made in private practice. A psychologist should not be charging less than a master’s-level clinician.

That being said, I would never consider taking on that level of debt for a clinical psychology doctorate. Relocating for approximately 5-7 years is more than worth the lifetime debt burden of attending the local program. You can always return; Boston isn’t going anywhere.

Unfortunately.

 

[foreverbull]

This is really helpful information on private practice! I have seen that some masters level folk charge similar rates to PsyD's. In your experience, do you think there is a large pay difference between masters and PsyDs?

Glad you found it helpful.

No, I don’t, unless you have nothing to set you apart with a masters degree (a specialty) and can’t build up a positive reputation over time with high quality services to the community. It’s possible to make similar amounts.

 

[foreverbull]

You need to raise your fees.

I will if I practice outside of my middle class community and/or eventually, but I’ve discussed this quite a bit in here. My community isn’t as well-off as nearby cities. Also, my going rate is actually pretty standard for ECPs in PP across the board (from folks I know in other cities as well who start out), but master’s level folks inflate their rates to match psychologists in my area, regardless. So it’s not necessarily an issue of me undercharging, but extremely high cost of living causing rates to inflate for those with master’s degrees too.

And even at my current rate, most who call can’t afford it. Another reason I haven’t raised it yet.

 

[Peacemaker36]

William James is a viable option for someone who is very wealthy. I'm not saying it's the best option, but there is a certain level of wealth that makes dropping $400K no big deal. When you have that kind of privilege, the cost of grad school isn't even a factor. Why would a person worth millions of dollars not choose the path with significantly more clinical training than an MSW offers, especially if at the end of it they earn a doctorate?

Anyone without multiple millions of dollars should pay attention to this thread.

 

[Qwerk]

No, I don’t, unless you have nothing to set you apart with a masters degree (a specialty) and can’t build up a positive reputation over time with high quality services to the community. It’s possible to make similar amounts.

This has been my experience, too, at least in NYC. Ph.D.s/Psy.D.s in private practice here don’t seem to charge much more than M.S.W.s, and the master’s-level therapists who charge less seem to be doing it out of guilt (judging by our conversations), not because they can’t get more. My rate is on the high end for my area and I have no trouble getting private pay clients.

Getting a doctorate is a no-brainer if it’s funded and you want to do the kind of work that the program prepares you for. I’m not trying to devalue the training these degrees provide. But from a purely economic standpoint, it seems nuts to go into significant debt if your goal is private practice. If OP is worried about the length or quality of training in a master’s program, there are plenty of psychotherapy training institutes in Boston, and they don’t charge $400k.

 

[ClinicalABA]

More so student loans, but would be interested to hear your thoughts on general as well

I pay ~480 month in loans (mainly undergrad, with some living expense loans from grad school as I went to a fully funded program). I make a very good salary, but that loan amount is still very noticeable (it means less for retirement, basically). It was very noticeable when I started paying it back and was making half as much as I do now. I think it's a reasonable loan payment for this profession. 4-figure monthly loan payments would be untenable barring major lifestyle changes (which would cancel out many of the potential the benefits of the degree in the first place!)

 

[morganegreen]

A bit of an aside, but a psychologist with solid clinical skills, decided commitment and a bit of business savvy can pretty assuredly make $200k+ in full-time private practice. I’ve been in private practice for over a decade and easily make well above that figure for a 40-clinical-hour week. Insurance-based practices are overwhelmed these days and self-pay practices are booming - even in rural areas. There is good money to be made in private practice. A psychologist should not be charging less than a master’s-level clinician.

That being said, I would never consider taking on that level of debt for a clinical psychology doctorate. Relocating for approximately 5-7 years is more than worth the lifetime debt burden of attending the local program. You can always return; Boston isn’t going anywhere.

This is very helpful information on private practice! Does the 200K include associated fees/rent? What was the pay like when you first started in your private practice and how much did you need to invest up front?

 

[JeyRo]

I'm a survivor of a professional program, now 18 years out from graduation. Started with 140K of debt out of grad school and have whittled it down by about half. Been working at the VA for all this time. Due to the timing of my graduation, I ended up with an extremely low interest rate (1.625%) so that made repayment somewhat easier (that and I had no undergraduate debt). Has been a monthly payment of a little under 600 bucks since I started repayment.

Just this year I was both offered and awarded the maximum Education Debt Reduction Program funds (zeroing out my debt within 5 years) - but I've also simultaneously applied to PSLF under the new rules announced by the Biden Admin. So, either way - I'm (apparently) done.

That being said, I maintain what I've said before. If I had to do it over again, I would not have gone to my professional program. I would have taken more time, applied to a funded masters program, tried to make myself more competitive to funded programs. The fact I've gotten somewhat lucky and have been privileged to a certain degree so that I could absorb (and eventually get forgiven) this debt does not make what I did a good idea - not in the least.

 

[deleted106747]

I'm a survivor of a professional program, now 18 years out from graduation. Started with 140K of debt out of grad school and have whittled it down by about half. Been working at the VA for all this time. Due to the timing of my graduation, I ended up with an extremely low interest rate (1.625%) so that made repayment somewhat easier (that and I had no undergraduate debt). Has been a monthly payment of a little under 600 bucks since I started repayment.

Just this year I was both offered and awarded the maximum Education Debt Reduction Program funds (zeroing out my debt within 5 years) - but I've also simultaneously applied to PSLF under the new rules announced by the Biden Admin. So, either way - I'm (apparently) done.

That being said, I maintain what I've said before. If I had to do it over again, I would not have gone to my professional program. I would have taken more time, applied to a funded masters program, tried to make myself more competitive to funded programs. The fact I've gotten somewhat lucky and have been privileged to a certain degree so that I could absorb (and eventually get forgiven) this debt does not make what I did a good idea - not in the least.

Agreed. I went to a funded program, but took out loans due to the low stipend, in the (very) high five figure range. I did not get a good interest rate and was shocked to see my balance going up despite my monthly payments. Debt seriously impacted my life choices — everything from home ownership to holidays to career. I too was extremely lucky and got EDRP. Being student loan debt free has showed me the HUGE difference in QOL it makes. Not only because of what’s affordable but because of the peace of mind. It worked out okay for me, but I would never recommend anyone do it. I feel like I was very unusually fortunate.

 

[medium rare]

This is very helpful information on private practice! Does the 200K include associated fees/rent? What was the pay like when you first started in your private practice and how much did you need to invest up front?

After expenses and before taxes. Private practice start up will vary depending on how good you are at getting the word out that you’re there, marketing a niche, and self-pay vs insurance.

 

[WisNeuro]

After expenses and before taxes. Private practice start up will vary depending on how good you are at getting the word out that you’re there, marketing a niche, and self-pay vs insurance.

Also, start up costs will vary wildly depending on whether or not you do assessment.

 

[borne_before]

Also, start up costs will vary wildly depending on whether or not you do assessment.

Word, I keep 10k in the emergency fund just to outfit a testing operation.

 

[WisNeuro]

Word, I keep 10k in the emergency fund just to outfit a testing operation.

I've known I was going PP a few years before doing so, so I just accrued some used pieces here and there so I only had a few here and there to get once I went full pp.

 

[Therapist4Chnge]

Clinicians often underestimate how long it will take to get paid. Many think that they'll just collect cash/payment before an appt, but most can't just start 100% cash pay. Expect a bunch of $$ to flow out before you start getting it coming in consistently. Assessment practices can be more costly bc of buying the materials, testing laptop, etc.

 

[AcronymAllergy]

Clinicians often underestimate how long it will take to get paid. Many think that they'll just collect cash/payment before an appt, but most can't just start 100% cash pay. Expect a bunch of $$ to flow out before you start getting it coming in consistently. Assessment practices can be more costly bc of buying the materials, testing laptop, etc.

Agreed, and it's definitely not just for clinical/insurance work. I'd plan on allotting a good 30- to 60-day window of delay. It won't take that long every time, but you also don't want to be in a position where you're needing that Medicare or BCBS patient's insurance payment from last week to make rent or pay your staff.

Although on the assessment side, it can be great incentive to get your reports done quickly (that and keeping your referral sources happy).

 

[Therapist4Chnge]

Agreed, and it's definitely not just for clinical/insurance work. I'd plan on allotting a good 30- to 60-day window of delay. It won't take that long every time, but you also don't want to be in a position where you're needing that Medicare or BCBS patient's insurance payment from last week to make rent or pay your staff.

Although on the assessment side, it can be great incentive to get your reports done quickly (that and keeping your referral sources happy).

100% agree.

In regard to turnaround time for payment, while some people will see patients who pay at the time of the appt, that isn't going to be the norm for most starting out. I can't really speak to commercial insurance (or medicare / medicaid) because I haven't taken that in years, but I do take my state's workers comp insurance, and there was a noticeable lag from the day I submitted my info to having it appear (correctly) in the various systems. What a lot of clinicians don't realize, is that while you agree to accept workers comp, you have to be enrolled with EACH WC insurer individually. I'm still "out of network" for all of them, but it takes time for them to process your initial info. Legal work is still best done on retainer, but I still find lags in payment for certain situations. There are also 3rd party companies that work as matchmakers for experts and lawyers, and even the best ones have turnaround times of ~21-30 days.

 

[deleted1100659]

Hi

I was recently accepted to a PsyD program outside Boston and work at one of top psychiatric hospitals outside of Boston.

I chose to go the PsyD route because I enjoy clinical work over research and because PhD programs are incredibly competitive. I also need to stay in the area for family. The COA over 5 years is going to be $400,000. While I have been working so hard over the last 3 years to work towards my PsyD, $400,000 is a lot of money and does not seem worth it. One avenue people have suggested is doing public service loan forgiveness program - working in underserved locations while paying student debt for 10 years, then the remainder of your loans will be forgiven. However, I have had heard of people not having the remainder of their loans forgiven after serving underserved populations for 10 years - so this does not seem like a trustworthy option.

So, then my next option is to go into private practice as soon as possible after graduation. However, I have no idea how truly feasible that is and how much one would make when starting in private practice.

Overall, I am trying to figure out if I can justify the debt given then earning potential. I would love to hear from other people who have received their PsyD, their experience repaying their loans, and any helpful information regarding private practice.


Thanks

I just saw this and..400k???!! Medical school cost me less then that. That's crazy. That is not a realistic option at all and would avoid like the plague.

 

[WisNeuro]

I just saw this and..400k???!! Medical school cost me less then that. That's crazy. That is not a realistic option at all and would avoid like the plague.

Yeah, that's a good amount over the loans my wife took for out of state undergrad and med school combined.