Frustrated about potential income for psychologists

[Tom4705]

This is part question and honestly, part vent. For clinical psychologists that don't specialize in neuropsych or forensics, but practicing clinical psychologists that do assessments and treat patient populations with psychotherapy, are you unhappy with your income? I have seen posts online of fully licensed clinical psychologists making 80-90k......GROSS. Not net, but gross. Its not everyone but its a substantial portion of psychologists. To me, after all the training, that is disturbing. All the research experience needed in undergrad for a CHANCE to get into a PHD program, where the acceptance rate for many of them is LESS than many medical and law schools, (and by the way those professions on average make far, FAR more money with a similar length of education.) Then 5-7 years of nonstop research, psychotherapy training, writing a thesis, defending the thesis, the post doctoral training, passing the EPPP exam, amongst other things. I know people will constantly say not to get into the profession for the money, that you have to love psychology, I get that.....but what if you love psychology, are passionate about the line of work AND want to make a good living? I see so many other professions, even some in the mental health field like psych NPs, that have a fraction of the education and training in terms of total time in school and they make 110-140k right after graduation starting out as a MINIMUM. What's more, they can bill for therapy while essentially having no training in it. It's not to single them out, just using them as an example. There are many others.


In my view, no clinical psychologist working full time should be taking in any less than 100k NET, assuming they didn't have any crazy overhead expenses. I get there's more nuance to it, but......man. Any advice or encouragement I really need. I have the passion, I love the field, but I also love money and want a comfortable life. If I don't end up pursuing this path it wouldnt be because of the length, difficulty, or rigor. Im fine with all of that. It would be the unbelievably low income for all of that rigor relative to other professions. It bothers me that you almost need an additional set of marketing and buisness skills whereas other providers just need to hang out a shingle and they make a great living.

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[Sanman]

You can easily make more than 90K gross income. That is honestly an entry level salary. Most VA psychologists make more than that. Now, whether you choose to move beyond that is up to you.

 

[Shiori]

I make about $130,000 in the VA. I'm early career and it's not a high cost of living area. I don't think I've seen any positions recently below 100,000 here.

 

[BuckeyeLove]

I mean I guess I’ve gotta ask what your expectations were? The psychologists back in the day (80s) were definitely pulling in more relatively (pre managed care) in private practice therapy work. But I have relatively low stress low productivity and insane flexibility with a govt gig and do well. That’s just my one gig not including side stuff. My physician friends are WAY more stressed and make more, but I also love chilling and leisure and cheaper malpractice insurance a lot so… if you wanna grind and hustle though the sky legit is the limit.

 

[AcronymAllergy]

I mean I guess I’ve gotta ask what your expectations were? The psychologists back in the day (80s) were definitely pulling in more relatively (pre managed care) in private practice therapy work. But I have relatively low stress low productivity and insane flexibility with a govt gig and do well. That’s just my one gig not including side stuff. My physician friends are WAY more stressed and make more, but I also love chilling and leisure and cheaper malpractice insurance a lot so… if you wanna grind and hustle though the sky legit is the limit.

To add to this, although not always the case, physicians often work a lot. The average physician works around 50 hours/week, I believe. Which isn't ridiculous, but is still likely higher than the typical psychologist.

If a psychologist pulled the same average hours as, say, a general surgeon, they still wouldn't make surgeon money, but they'd probably make a decent amount more than the average psychologist. And without any night/weekend call, need to scrub in, or medical emergencies. If you owned your own practice, you could also wear scrubs if you really wanted to, but would look pretty silly.

 

[WisNeuro]

If you are grossing 80-90k as a psychologist, that's on you. So many job openings with low 100s as the starting salary. You could even do a PP therapy practice on easy mode through a Regus rental and make so much more than that.

 

[Tom4705]

If you are grossing 80-90k as a psychologist, that's on you. So many job openings with low 100s as the starting salary. You could even do a PP therapy practice on easy mode through a Regus rental and make so much more than that.

What is a Regus rental?

 

[AcronymAllergy]

If you are grossing 80-90k as a psychologist, that's on you. So many job openings with low 100s as the starting salary. You could even do a PP therapy practice on easy mode through a Regus rental and make so much more than that.

90834 pays ~$115-ish per at Medicare rates, I believe. 90837 pays $150-160+.

Work that into the math for seeing however many patients/week with inclusion of a reasonable no-show rate. So if seeing 6 patients/day, 5 days/week, 48 weeks/year, with a 10% no-show rate, your gross would be around $150k if you saw only Medicare patients and billed only 90834. Would be close to $200k if you billed all 90837.

 

[AcronymAllergy]

What is a Regus rental?

Regus is a professional office space rental company. They're in most major cities and many smaller ones.

 

[Tom4705]

90834 pays ~$115-ish per at Medicare rates, I believe. 90837 pays $150-160+.

Work that into the math for seeing however many patients/week with inclusion of a reasonable no-show rate. So if seeing 6 patients/day, 5 days/week, 48 weeks/year, with a 10% no-show rate, your gross would be around $150k if you saw only Medicare patients and billed only 90834. Would be close to $200k if you billed all 90837.

What is the differences in billing? Is it feasible/realistic to bill only 90837 full time?

 

[WisNeuro]

What is the differences in billing? Is it feasible/realistic to bill only 90837 full time?

If you want to be frequently audited, sure.

 

[eeor1006]

Are those 80s-90s jobs you saw college counseling centers? My understanding is that those jobs tend to pay less because you either have summer off or have very little to do during summer months.

I'd recommend looking at the VA psychologists in your area or areas you want to live in the future. That should give you an idea what you can expect to make when you graduate. At least the offers I got hover around that number.

My base salary is in mid 120s. End of the year teaching and RVU bonus is 50ish. Licensed for two years

 

[psychconsultant]

In NYC, 90k is the typical starting salary for full-time, entry-level psychologists working in academic medical centers (Columbia, Mt Sinai, NYU, etc). The typical workload includes 20 billable hours per week, supervising one post-doc and one psych intern, and teaching didactics a few times per year. In private practice, there is a severe oversupply of psychologists currently in NYC, resulting in reduced income. MSWs have managed to become the dominant mental health providers here.

 

[PsyDr]

If you want to become a psychologist, become a psychologist.

If you want to make a billy, go into finance and discover a market inefficiency. You can’t become a teacher and complain about not making neurosurgeon money.

It’s ~$100/hr. A 40 hr work week is 2000hrs/yr. The math isn’t complex. Work more, earn more. Slack and earn less.

Some of those survey numbers are drastically affected by those who are on the “part time PP so I can drop the kids off and pick them up after school” track.

The only thing you’re missing: When you are in PP, the goal is to have a very minimal salary, and move the rest of the money into dividends, defined benefits, retirement funds, etc. That skews the surveys. Well, that and the slackers.

 

[R. Matey]

Also, for the 1000th time, a great way to maximize your income is by minimizing your expenses. $130k with $100k in student loans feels a lot different than $130k without them.

 

[Sanman]

In NYC, 90k is the typical starting salary for full-time, entry-level psychologists working in academic medical centers (Columbia, Mt Sinai, NYU, etc). The typical workload includes 20 billable hours per week, supervising one post-doc and one psych intern, and teaching didactics a few times per year. In private practice, there is a severe oversupply of psychologists currently in NYC, resulting in reduced income. MSWs have managed to become the dominant mental health providers here.

Which is why NYC can be a terrible place to practice.

 

[bcliff]

FWIW: My overall compensation as an ECP neuropsychologist at an R1 AMC is around $150k/yr (i.e., base salary, professional development / travel funding, incentive / bonus pay, benefits, retirement, etc.) with realistic productivity expectations and good technical and administrative support (e.g., 3-4x evaluations per week with full psychometry support, with other expectations related to research and training). To OP's point, I am a neuropsychologist, though. I live and work in a low CoL medium sized city.

 

[biscuitsbiscuits]

Which is why NYC can be a terrible place to practice.

Can be. It's also a place with a market for $500+/session cash pay therapy practices if you can find a niche. So if you can figure that out, to repeat what someone else said, the sky is the limit.

 

[Sanman]

Can be. It's also a place with a market for $500+/session cash pay therapy practices if you can find a niche. So if you can figure that out, to repeat what someone else said, the sky is the limit.

The number of folks doing that is a bit overblown. If you can, good for you. That said, overhead is so expensive you still might not be doing much better than someone in an upper middle class area of a smaller city/suburb charging $250/hr.

 

[The Cinnabon]

The number of folks doing that is a bit overblown. If you can, good for you. That said, overhead is so expensive you still might not be doing much better than someone in an upper middle class area of a smaller city/suburb charging $250/hr.

The Chicagoland area still seems like a big city psychologist's dream with the low COL for its size.

I'm sure someone with 8 children, whom they all send to Naperville private schools, and about 4 million dollars in debt will now reply to this saying I'm a fool who is delusional.

 

[biscuitsbiscuits]

The number of folks doing that is a bit overblown. If you can, good for you. That said, overhead is so expensive you still might not be doing much better than someone in an upper middle class area of a smaller city/suburb charging $250/hr.

True that's not the modal setup, it's the sky's-the-limit setup. However, it's pretty common to see psychologists here with 100% teletherapy practices charging $300-350/session OON.

 

[Sanman]

True that's not the modal setup, it's the sky's-the-limit setup. However, it's pretty common to see psychologists here with 100% teletherapy practices charging $300-350/session OON.

Not saying it cannot be done (Hell, I may do it soon as I am still licensed there). Having lived and worked there, I also know a few of those folks. Many have spouses in finance or tech pulling in $300k+ and don't worry about volume. They often came from money as well and had school paid for. Don't come out of school with $200k of debt and think this is a viable plan.

I also know lower key folks that own practices with 7-8 figure annual revenue in lesser known areas.

 

[ThatPsyGuy]

The Chicagoland area still seems like a big city psychologist's dream with the low COL for its size.

I'm sure someone with 8 children, whom they all send to Naperville private schools, and about 4 million dollars in debt will now reply to this saying I'm a fool who is delusional.

Live in a suburb and hit the metra to get downtown in ~20 minutes.
If there's a setup like that in any major city, that would be the move.

 

[The Cinnabon]

Live in a suburb and hit the metra to get downtown in ~20 minutes.
If there's a setup like that in any major city, that would be the move.

Chicago proper isn't that much more expensive than its surrounding suburbs, in-fact It can be a great deal cheaper. I could certainly understand the reservation if you have kids, but me personally, I could never understand wanting to live in the suburbs w/o kids.

Even with kids, my dad eventually decided to move back to downtown Milwaukee proper during my latter teens. The northern suburbs there can be a bit ... Snooby.

 

[R. Matey]

Even with kids, my dad eventually decided to move back to downtown Milwaukee proper during my latter teens. The northern suburbs there can be a bit ... Snooby.

That's putting it lightly

 

[ThatPsyGuy]

Chicago proper isn't that much more expensive than its surrounding suburbs, in-fact It can be a great deal cheaper. I could certainly understand the reservation if you have kids, but me personally, I could never understand wanting to live in the suburbs w/o kids.

Even with kids, my dad eventually decided to move back to downtown Milwaukee proper during my latter teens. The northern suburbs there can be a bit ... Snooby.

Depends on what you want. If you're living alone and want to rent? Go crazy. A bunch of affordable apartments around the city.

If you're living alone/with a partner and want a condo? Also go crazy, kinda. You can find a couple of beautiful steals in some of the northern, like Edgewater, and Southern, like Motor Row areas of the city. Or something smaller anywhere else.

If you want a big space? Get money to buy a large enough property in the city, or hit the suburban slide. You get more mileage out of that....I don't know, $450k (??? is this what people buy houses for now) out of the city proper while not being too far using transit.

 

[The Cinnabon]

Depends on what you want. If you're living alone and want to rent? Go crazy. A bunch of affordable apartments around the city.

If you're living alone/with a partner and want a condo? Also go crazy, kinda. You can find a couple of beautiful steals in some of the northern, like Edgewater, and Southern, like Motor Row areas of the city. Or something smaller anywhere else.

If you want a big space? Get money to buy a large enough property in the city, or hit the suburban slide. You get more mileage out of that....I don't know, $450k (??? is this what people buy houses for now) out of the city proper while not being too far using transit.

Depends on the area for home ownership. Naperville looks more expensive than Chicago, I imagine places in say lake county are similarly priced, but if you go a bit out to say McHenry County you can find some pretty amazing steals on houses.

And yeah, I guess I was moreso referring to "needing" space if you don't have kids, but I've always been a bit of a minimalist so YMMV

 

[The Cinnabon]

That's putting it lightly

I never really minded places like Shorewood and Whitefish Bay. Granted, it seems pretty messed up those suburbs aren't considered Milwaukee proper.

But once you get into Mequon, Cedarburg, etc. ... It's amazing how insular those places and their attitude are.

 

[WisNeuro]

I never really minded places like Shorewood and Whitefish Bay. Granted, it seems pretty messed up those suburbs aren't considered Milwaukee proper.

But once you get into Mequon, Cedarburg, etc. ... It's amazing how insular those places and their attitude are.

Can confirm.

 

[Sanman]

Depends on what you want. If you're living alone and want to rent? Go crazy. A bunch of affordable apartments around the city.

If you're living alone/with a partner and want a condo? Also go crazy, kinda. You can find a couple of beautiful steals in some of the northern, like Edgewater, and Southern, like Motor Row areas of the city. Or something smaller anywhere else.

If you want a big space? Get money to buy a large enough property in the city, or hit the suburban slide. You get more mileage out of that....I don't know, $450k (??? is this what people buy houses for now) out of the city proper while not being too far using transit.

The east coasters and the west coasters are laughing at that.

 

[The Cinnabon]

The east coasters and the west coasters are laughing at that.

As a teen I daydreamed about owning a nice little house close to the Pacific in SoCal.

I'm pretty sure becoming a psychologist has murdered that dream barring divine intervention or a solid lottery ticket.

 

[Sanman]

As a teen I daydreamed about owning a nice little house close to the Pacific in SoCal.

I'm pretty sure becoming a psychologist has murdered that dream barring divine intervention or a solid lottery ticket.

Depends on how big you are dreaming. I have shopped some waterfront property (and a few light houses thanks to SDN) on the east coast and it is certainly in the realm of possibility for me. Now, it won't be in the Hamptons or Martha's Vineyard, but there are other options. Seen a few I like in the high six figure to low seven figure range.

 

[MCParent]

I lucked out with my house in Austin (which you can see on my episode of House Hunters!). Doubled in “value” in the couple years I owned it. Austin was terrible for housing, at least as a professor I could avoid traffic by going early or late, depending on what I needed to be on campus for.

We live in the Chicago burbs now (Elmwood park, right by oak park. We looked at places in oak park but I couldn’t stand upright in most of the basements). I wouldn’t call the area cheap. I wouldn’t be able to afford the place we have now if I was still making what I made as a tenured professor.

 

[albatross_at_crossroads]

You could even do a PP therapy practice on easy mode through a Regus rental and make so much more than that.

WisNeuro - why do you always read my mind this is my plan once I (finally) become independent. Hopefully the commercial real estate market doesn't crash by then. Or maybe in that case I go with PsyDr's plan of buying the building where I practice and getting rich that way. Decisions decisions

On topic: OP, while most programs don't really teach this, good psychologists also need to learn about business, marketing, taxes, etc. in order to be successful in their career and earn at their real value. While you can't expect the pay of a physician or high profile investment banker, you can earn decently if you negotiate/self-advocate (if employed) or learn the business side (if self-employed).

 

[Spydra]

Where are you seeing those salaries for fully licensed psychologists? I'm a resident working toward licensure and make 95k in a low cost of living area. Whenever I browse job ads in low to medium cost of living places I'm seeing 120k minimum for fully licensed psychologists.

 

[Sanman]

Where are you seeing those salaries for fully licensed psychologists? I'm a resident working toward licensure and make 95k in a low cost of living area. Whenever I browse job ads in low to medium cost of living places I'm seeing 120k minimum for fully licensed psychologists.

Salaries run the gamut. I once applied for a full-time faculty position in NYC paying $35k (and didn't even get an interview, lol).

 

[Psychai]

If you are grossing 80-90k as a psychologist, that's on you. So many job openings with low 100s as the starting salary. You could even do a PP therapy practice on easy mode through a Regus rental and make so much more than that.

I'm curious what you all would suggest when that is what staff psychologist jobs at the the local AMC and big hospitals are offering, and the local VA has said they can't hire until fiscal year 2026. I'm not opposed to exploring private practice, but I would have liked to work on a team as an early career psychologist.

 

[WisNeuro]

I'm curious what you all would suggest when that is what staff psychologist jobs at the the local AMC and big hospitals are offering, and the local VA has said they can't hire until fiscal year 2026. I'm not opposed to exploring private practice, but I would have liked to work on a team as an early career psychologist.

I would suggest either moving or going into private practice if the jobs in your area are well below market value.

 

[smalltownpsych]

I used the years of relatively lower paid jobs after licensure to build my skill set in both psychology and business. Starting my third year of running a practice and looking to net 150k plus my salary of 50k. Still building a team and referral sources and delivery model and next step is to buy some property for the business, either residential or business or combination thereof. There are lots of companies making money off mental health and there are opportunities. Identifying a target market and coming up with a strategy to rash them and monetize it is not really that hard for someone with a psychologists abilities. I told my new post doc that I am putting about 80% of my energy into therapy and 10% into supervision and 10% into marketing and 10% into business management and was putting another 5% into assessments but have stooped that since we are scheduling those for him to do when he arrives in a couple months. 😉
Also, being good with math is obviously important.

 

[BuckeyeLove]

idk man my dad has lived in chicago since 91. Been going there since then. It used to be really fking cool. Then the millennials invaded from every suburb in the country, drove up prices, and no one there even has a chicago accent anymore. It's also 50 minutes to get anywhere at certain times of days. especially if you have no choice but to take the dan ryan.

 

[AcronymAllergy]

I'm curious what you all would suggest when that is what staff psychologist jobs at the the local AMC and big hospitals are offering, and the local VA has said they can't hire until fiscal year 2026. I'm not opposed to exploring private practice, but I would have liked to work on a team as an early career psychologist.

I'd second the recommendation to enter private practice or consider moving, if possible. You can always apply and attempt to negotiate, but if there aren't any other jobs in the area paying more, it could be an uphill battle.

I can understand the pull to apply for those positions if they're all that's available. The downside is that it undervalues you and it's harmful for the field as a whole, as it sends the message to those administrators that what they're paying is what psychologists are worth and willing to accept. In my opinion, giving PP a go is probably worth it for you (and the field).

Alternatively, you could take one of the AMC/hospital jobs and then build out a PP on the side. But if those AMCs are paying (what I consider to be) under market value for a psychologist, I suspect they may also have restrictive non-competes, regardless of whether those non-competes would stand up to any sort of legal challenge.

 

[R. Matey]

I would suggest either moving or going into private practice if the jobs in your area are well below market value.

Tangentially related to this thread, what are some of the hallmarks of a good group private practice set up for those of us in early career? I was looking for one part-time last year, but everything in my locale that was advertising seemed pretty sketch (e.g., wildly high estimates of earning potential with very few actual clinicians at the practice).

 

[WisNeuro]

Tangentially related to this thread, what are some of the hallmarks of a good group private practice set up for those of us in early career? I was looking for one part-time last year, but everything in my locale that was advertising seemed pretty sketch (e.g., wildly high estimates of earning potential with very few actual clinicians at the practice).

Partially depends on where you are and what you are looking for. If someone is not willing to move above the 50/50 split, I'm out, no further negotiation needed. After that, I want to know where they get their referrals from, how those referrals get divvied to providers, what do they provide admin-wise, benefits, etc? The only reason to join another practice is to not deal with the admin hassles (scheduling/billing/non-clinical phone calls/etc). If they don't take care of that, no reason for me to be there. I'd also be curious as to the longevity of current providers there. Have they been there long, or is it a revolving door?

 

[Sanman]

Partially depends on where you are and what you are looking for. If someone is not willing to move above the 50/50 split, I'm out, no further negotiation needed. After that, I want to know where they get their referrals from, how those referrals get divvied to providers, what do they provide admin-wise, benefits, etc? The only reason to join another practice is to not deal with the admin hassles (scheduling/billing/non-clinical phone calls/etc). If they don't take care of that, no reason for me to be there. I'd also be curious as to the longevity of current providers there. Have they been there long, or is it a revolving door?

I would add to this when do you get paid and whether the split is for billables or collections. These are especially important if you are insurance based.

That said, many of the folks here are also speaking from the perspective of a mid-career person who is often married. If I walk away tomorrow, I have a spouse with a high income and plenty of savings with which to pay my bills and start a private practice. When I started, I was poor, single, and needed the money for rent, food, and student loan payments. This is to say, there may not be anything to do about a bad job or local market in the short-term. In the long-term, get your personal finances together and make good decisions.

One of the reasons I have done a 180 on APA politics as I have gotten older is that the field has been pushing more for specialties and team based approaches to care in things like health psych. Yet, we don't make more for the additional education, hospitals often pay poorly, and most of us can make more money in private practice. That said, a specialty will make finding a w-2 job easier.

 

[Therapist4Chnge]

I don’t think anyone has said the quiet part out loud….if you work for someone, you likely will be significantly limited in how much you make over the years. Owning your own practice allows you to keep more of the $ you earned.

 

[quickpsych]

Alternatively, you could take one of the AMC/hospital jobs and then build out a PP on the side. But if those AMCs are paying (what I consider to be) under market value for a psychologist, I suspect they may also have restrictive non-competes, regardless of whether those non-competes would stand up to any sort of legal challenge.

Non-competes are now illegal for most jobs and employers per the FTC. They can have them in their contracts, but good luck enforcing them. It's a great step forward for many industries.

Also in general, lots of good tips and advice in this thread about expected income, opportunities, and ensuring you feel you're getting fair compensation.

 

[WisNeuro]

I don’t think anyone has said the quiet part out loud….if you work for someone, you likely will be significantly limited in how much you make over the years. Owning your own practice allows you to keep more of the $ you earned.

Definitely agree. But, at the same time, some people either hate doing, or are really bad at the business part. For those people, if they can find a good practice with a fair split, it can be worth it for them.

 

[AcronymAllergy]

Non-competes are now illegal for most jobs and employers per the FTC. They can have them in their contracts, but good luck enforcing them. It's a great step forward for many industries.

Also in general, lots of good tips and advice in this thread about expected income, opportunities, and ensuring you feel you're getting fair compensation.

Yes, we'll see how pretty much all non-competes play out with the new FTC rule. Importantly, the rule doesn't apply to non-profits. We'll also see how it does in surviving legal challenges. But I hope it pulls through intact.

 

[smalltownpsych]

In November, I will be getting a raise to $120,000. I started at $95,000 six years ago. I do a mix of neurodevelopmental evals (which is my ego dressing up what I actually do when testing for ASD, ADHD, SLD, ID, etc.), therapy and parent management training in a multispeciality medical clinic. I have a pretty full book, but the expectation for full time work is 75% of 35 hours a week. Honestly, it's pretty cake, and as the autism specialist i've been given basically free range.

Other things to consider:

• I make way more than I thought I would. But, I prolly make about as much as a school psych would who works full time instead of the 180 or 200 day school psych contract.
• Professional satisfaction. I see some really joocy patients. Super interesting. It also jacks off my white savior complex a little because most of my patients are hella poor and "diverse." I tried the working with wealthy whites private pay model and lasted about six weeks.
• I get to consult with so many professionals. I love seeing my colleagues. When a patient no-shows, I can go dink around and visit many people who I call friends.
• I've gotten to know many families, I love watching their development, seeing them in the hallway, etc. When I dxd a kid with asd at 22 months, and now they're five and can talk, that's pretty rad.
• I never take work home. I see my first PT at 8am and dip around 315-330 most days.

Compensation summary:

• $115,000 right now.
• $2000 in CME/phone allowance (every other year)
• Professional liability covered (I had a board complaint and they circled the wagons around me, got the good JD/PHD psych lawyer I wanted; I can do that three times. It cost 10k).
• One week off for CME.
• One week sick time.
• I think I get like six weeks PTO.
• Decent insurance at affordable rates for myself and my family.

Could I make more? Yeah. But my god does it sound like a lot of work.

That last part is right on. It is a lot of work and this week I am feeling it. That sounds like a pretty decent setup and it is important to look at the entire compensation package.

 

[AcronymAllergy]

That last part is right on. It is a lot of work and this week I am feeling it. That sounds like a pretty decent setup and it is important to look at the entire compensation package.

Agreed. There are various (tax and other) benefits when you work for yourself, but if you're comparing solo/independent contractor total net earnings to just the salary portion of an employed position, it's not really apples to apples.