Frustrated about potential income for psychologists

[ClinicalABA]

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.

Yeah. I frequently evaluate whether or not I should branch out and do my own thing. Setting up and S-corp, hanging up a shingle, and offering myself to the public for ASD and child psych testing could work out very well financially, with POTENTIAL income higher than what I earn working for somebody else. Realistically, I have ~10 more years of doing this stuff (I'm turning 55 in August), and want to maximize what earn over the next years, but also don't want to kill myself. It's important to realistic evaluate not only what you can do (with an overall best case scenario cost benefit analysis of doing it), but also the likelihood of you actually doing it. In my case, I make enough to generally do what I want to do. Someone else (my agency) takes care of the "nonsense"- billing, rent, testing materials and supplies. They also pay for my CEUs, conference attendance, licensure fees, and professional organization memberships. I get student loan reimbursement, company PLI (e.g., malpractice insurance), and reimbursement for my own PLI policy. A credentialling department monitors all my licenses and certifications, and provides gentle reminders to stay on top of things (including CAQH updates and attestations). I could do a lot of that stuff for myself, but I know I'm not great at that kind of thing, so that's all a valuable service. I'm also not responsible for other employees doing their job and paying their bills. I think I'm good with that type of responsibility, but I've done that and don't want to do it anymore.

As @PsyDr mentions above, if you want to make billions, don't be a psychologist. If you want to make more, work more. My years of working hard (e.g., always exceeding minimum billable requirements, and often by a substantial amount; taking on special projects (teaching in affiliated grad programs- for which I'm paid; being a generally cooperative, non-trouble making employee; helping others out even when it's not technically my job) has set me up to be able to ask for more, contingent on my doing more. I recently went to my owner with some pretty reasonable requests for being able to do more and make more (e.g., teach outside of affiliated programs; do some private testing on the side), all with the expectation that I would continue to meet the demands of my "day job." End result was some negotiation, but generally favorable result for me, including receiving a good financial split on doing some extra work for my agency. Owner didn't like the idea of me working for anybody else (even myself), but the good will I have created and the value I have brought to the company (and the income I have brought to him) led to an overall favorable outcome that will benefit me and family financially, not really cost the agency anything (revenue neutral-to-maybe make a bit of money), and contribute to the overall mission of the agency in a mutually beneficial way (for me, the agency, and our clients).

TLDR- know yourself and your actual abilities, work hard, play nice with others and don't be jerk, self-advocate assertively (but not aggressively or passively), and- just as importantly- establish and know your value and be willing to make changes if others don't recognize that value. That will lead to you having several options for making a good living as a psychologist.

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[WisNeuro]

As has been implied in several comments here, this thread is not well titled. The potential income for psychologist is quite high. As borne out from anecdotes here, with some of us well into physician salary range, as well as more comprehensive salary surveys. Now, the median income, that's another story.

 

[BMedPsych]

I’m finishing up my second year of postdoc, just accepted an AMC position with 130k+ starting salary (not including benefits) that is predominantly clinical. In general, in my search most starting salaries ranged from 105-118, with a decent amount of room for increase in clinical and res/clinical AMC positions. I would be less familiar with research/university positions, but I didn’t encounter anything offering as low as you mentioned even as starting.

 

[PsyDr]

The commonwealth of Massachusetts just passed a law that guarantees Uber drivers a minimum hourly wage of $32.

 

[WisNeuro]

The commonwealth of Massachusetts just passed a law that guarantees Uber drivers a minimum hourly wage of $32.

Bostonians about to pay out the ass for cab rides.

 

[PsyDr]

Bostonians about to pay out the ass for cab rides.

Some low level therapists are about to become Uber drivers.

 

[Sanman]

Some low level therapists are about to become Uber drivers.

Betterhelp is going to have to up its game in MA.

 

[WisNeuro]

Some low level therapists are about to become Uber drivers.

I dunno, younger millenials/GenZ can't seem to work more than 4 hours a day, 4 days a week, so we'll see. They might prefer ****ty telehealth jobs so they don't have to go out in public.

 

[Sanman]

I’m finishing up my second year of postdoc, just accepted an AMC position with 130k+ starting salary (not including benefits) that is predominantly clinical. In general, in my search most starting salaries ranged from 105-118, with a decent amount of room for increase in clinical and res/clinical AMC positions. I would be less familiar with research/university positions, but I didn’t encounter anything offering as low as you mentioned even as starting.

Glad to hear this. I think a large part of the problem is many of the most recent salary surveys being 10 years old at the point.

 

[Sanman]

I dunno, younger millenials/GenZ can't seem to work more than 4 hours a day, 4 days a week, so we'll see. They might prefer ****ty telehealth jobs so they don't have to go out in public.

As someone who enjoys working from home and the reduced overhead it brings in terms of vehicles and commuting, I cannot blame them.

 

[Sanman]

Yeah. I frequently evaluate whether or not I should branch out and do my own thing. Setting up and S-corp, hanging up a shingle, and offering myself to the public for ASD and child psych testing could work out very well financially, with POTENTIAL income higher than what I earn working for somebody else. Realistically, I have ~10 more years of doing this stuff (I'm turning 55 in August), and want to maximize what earn over the next years, but also don't want to kill myself. It's important to realistic evaluate not only what you can do (with an overall best case scenario cost benefit analysis of doing it), but also the likelihood of you actually doing it. In my case, I make enough to generally do what I want to do. Someone else (my agency) takes care of the "nonsense"- billing, rent, testing materials and supplies. They also pay for my CEUs, conference attendance, licensure fees, and professional organization memberships. I get student loan reimbursement, company PLI (e.g., malpractice insurance), and reimbursement for my own PLI policy. A credentialling department monitors all my licenses and certifications, and provides gentle reminders to stay on top of things (including CAQH updates and attestations). I could do a lot of that stuff for myself, but I know I'm not great at that kind of thing, so that's all a valuable service. I'm also not responsible for other employees doing their job and paying their bills. I think I'm good with that type of responsibility, but I've done that and don't want to do it anymore.

As @PsyDr mentions above, if you want to make billions, don't be a psychologist. If you want to make more, work more. My years of working hard (e.g., always exceeding minimum billable requirements, and often by a substantial amount; taking on special projects (teaching in affiliated grad programs- for which I'm paid; being a generally cooperative, non-trouble making employee; helping others out even when it's not technically my job) has set me up to be able to ask for more, contingent on my doing more. I recently went to my owner with some pretty reasonable requests for being able to do more and make more (e.g., teach outside of affiliated programs; do some private testing on the side), all with the expectation that I would continue to meet the demands of my "day job." End result was some negotiation, but generally favorable result for me, including receiving a good financial split on doing some extra work for my agency. Owner didn't like the idea of me working for anybody else (even myself), but the good will I have created and the value I have brought to the company (and the income I have brought to him) led to an overall favorable outcome that will benefit me and family financially, not really cost the agency anything (revenue neutral-to-maybe make a bit of money), and contribute to the overall mission of the agency in a mutually beneficial way (for me, the agency, and our clients).

TLDR- know yourself and your actual abilities, work hard, play nice with others and don't be jerk, self-advocate assertively (but not aggressively or passively), and- just as importantly- establish and know your value and be willing to make changes if others don't recognize that value. That will lead to you having several options for making a good living as a psychologist.

The truth of the matter is this, there is no shortcut here. If you want to earn more, then you will likely work harder or do something other people are unable or unwilling to do. This holds true for everything from oil rig workers to prison psychologists. Pick your poison.

One of the reasons, I have not left the VA to go into PP is that the VA has thrown money and benefits at us in recent years. I renegotiated my contract with them and have a pretty cushy gig now. I can go PP, but will work harder and not get all this paid leave for vacations and sick kids. Also, will not add to my pension. Each of us has to find the best path forward individually. There is no silver bullet. That said, there are some universally bad situations (private equity owned companies, 50% or lower splits, etc.)

 

[PsyDr]

I dunno, younger millenials/GenZ can't seem to work more than 4 hours a day, 4 days a week, so we'll see. They might prefer ****ty telehealth jobs so they don't have to go out in public.

According to the Harvard business review, millennials work .2hrs/week less work hours, but with an increase of efficiency of over 30%. The average American worker has increased efficient more than 50% since 2008, with an overall increase in productivity of 1.5% PER YEAR according to BLS.

Using the media to tell people that they are not working enough is a great for others to profit

 

[The Cinnabon]

I dunno, younger millenials/GenZ can't seem to work more than 4 hours a day, 4 days a week, so we'll see. They might prefer ****ty telehealth jobs so they don't have to go out in public.

 

[WisNeuro]

According to the Harvard business review, millennials work .2hrs/week less work hours, but with an increase of efficiency of over 30%. The average American worker has increased efficient more than 50% since 2008, with an overall increase in productivity of 1.5% PER YEAR according to BLS.

Using the media to tell people that they are not working enough is a great for others to profit

I stand corrected on millennials' work hours. Though I'm still convinced of younger millennial and Zs inability to engage in face to face social interactions without great discomfort.

 

[Sanman]

I stand corrected on millennials' work hours. Though I'm still convinced of younger millennial and Zs inability to engage in face to face social interactions without great discomfort.

If it is not a problem and overblown because writers have to publish stuff who cares.

If it is true, I imagine my telehealth private practice will be filled well into my retirement years teaching young people how to interact with each other.

 

[albatross_at_crossroads]

According to the Harvard business review, millennials work .2hrs/week less work hours, but with an increase of efficiency of over 30%. The average American worker has increased efficient more than 50% since 2008, with an overall increase in productivity of 1.5% PER YEAR according to BLS.

Using the media to tell people that they are not working enough is a great for others to profit

This is definitely something to keep in mind, that productivity has increased for the average worker but in most cases the pay has not kept up.
I am totally on board with 4 days work weeks, especially when you are not compensated fairly, so that at least you get some semblance of having a life. If I would work for a big corp, I would advocate for reduced work days or work hours.
When working for yourself it's a different ball game, since you get paid for what you work, and can decide how much depending on your needs.

And I think in general our work culture has not been helping. People who are more rested and have more free time are more able to think for themselves and make important changes/improvements in society. When you're barely keeping your head above the water, there is almost no critical thinking and no progress.

Tangential but still on topic: what do you folks recommend to increase business knowledge? I have been learning about business finances/taxes and was looking at some of the business school entrepreneurial courses, but those don't seem as good of a match for starting a private practice and keeping it thriving. Once I am on that path, I am considering joining some local groups to network and maybe find mentorship, but I don't have a clear idea of what it would take to build a PP from the ground up and continue to expand it. I am not a neophyte, since I have worked in both the private and public sector, but those were established organizations and I only spent about 3-4 years in each. Any tips on how to continue learning/prep for this once I am licensed would be very appreciated!

 

[smalltownpsych]

This is definitely something to keep in mind, that productivity has increased for the average worker but in most cases the pay has not kept up.
I am totally on board with 4 days work weeks, especially when you are not compensated fairly, so that at least you get some semblance of having a life. If I would work for a big corp, I would advocate for reduced work days or work hours.
When working for yourself it's a different ball game, since you get paid for what you work, and can decide how much depending on your needs.

And I think in general our work culture has not been helping. People who are more rested and have more free time are more able to think for themselves and make important changes/improvements in society. When you're barely keeping your head above the water, there is almost no critical thinking and no progress.

Tangential but still on topic: what do you folks recommend to increase business knowledge? I have been learning about business finances/taxes and was looking at some of the business school entrepreneurial courses, but those don't seem as good of a match for starting a private practice and keeping it thriving. Once I am on that path, I am considering joining some local groups to network and maybe find mentorship, but I don't have a clear idea of what it would take to build a PP from the ground up and continue to expand it. I am not a neophyte, since I have worked in both the private and public sector, but those were established organizations and I only spent about 3-4 years in each. Any tips on how to continue learning/prep for this once I am licensed would be very appreciated!

I have found that you can learn as you go in business. It’s really not that hard or complicated. Consulted with an accountant to get started. What is hard is knowing what kind of practice you want to operate and understanding the market and the needs in the community and how to reach those people and then provide excellent service. If you are providing a good service that is needed, people will find you and stick with you. Retention is always more important than acquisition. Whether that is with customers or employees or referral sources. I don’t spend a lot of time or energy or dollars into networking and marketing as I put more effort into operations. Also, be cautious about how you identify needs in the market as people seem bad at appraisal of this and some testing is necessary to see what works. I stay pretty flexible because of this and try out different strategies within the scope of my overall plans. Don’t want to put all the eggs in one basket, but also don’t want to be chasing every whim. Good luck!

 

[PsyDr]

Tangential but still on topic: what do you folks recommend to increase business knowledge? I have been learning about business finances/taxes and was looking at some of the business school entrepreneurial courses, but those don't seem as good of a match for starting a private practice and keeping it thriving. Once I am on that path, I am considering joining some local groups to network and maybe find mentorship, but I don't have a clear idea of what it would take to build a PP from the ground up and continue to expand it. I am not a neophyte, since I have worked in both the private and public sector, but those were established organizations and I only spent about 3-4 years in each. Any tips on how to continue learning/prep for this once I am licensed would be very appreciated!

40% of my knowledge comes from mentors.
30% comes from making mistakes, admitting it, and learning from my mistakes.
10% comes from observing successful people, and learning from office staff.
10% comes from reading
10% comes from consults with expensive professionals

 

[Sanman]

This is definitely something to keep in mind, that productivity has increased for the average worker but in most cases the pay has not kept up.
I am totally on board with 4 days work weeks, especially when you are not compensated fairly, so that at least you get some semblance of having a life. If I would work for a big corp, I would advocate for reduced work days or work hours.
When working for yourself it's a different ball game, since you get paid for what you work, and can decide how much depending on your needs.

And I think in general our work culture has not been helping. People who are more rested and have more free time are more able to think for themselves and make important changes/improvements in society. When you're barely keeping your head above the water, there is almost no critical thinking and no progress.

Tangential but still on topic: what do you folks recommend to increase business knowledge? I have been learning about business finances/taxes and was looking at some of the business school entrepreneurial courses, but those don't seem as good of a match for starting a private practice and keeping it thriving. Once I am on that path, I am considering joining some local groups to network and maybe find mentorship, but I don't have a clear idea of what it would take to build a PP from the ground up and continue to expand it. I am not a neophyte, since I have worked in both the private and public sector, but those were established organizations and I only spent about 3-4 years in each. Any tips on how to continue learning/prep for this once I am licensed would be very appreciated!

Work at a small or newer group practice and pay attention. Don't sign a non-compete or work in an area of the field that you won't open a private practice in. You get to practice things with less risk.

As for advocating for less hours working for a big Corp, good luck. You are easily replaceable if you don't play ball.

 

[albatross_at_crossroads]

Thank you very much everyone, I appreciate your insights!

I have found that you can learn as you go in business. It’s really not that hard or complicated. Consulted with an accountant to get started. What is hard is knowing what kind of practice you want to operate and understanding the market and the needs in the community and how to reach those people and then provide excellent service. If you are providing a good service that is needed, people will find you and stick with you. Retention is always more important than acquisition. Whether that is with customers or employees or referral sources. I don’t spend a lot of time or energy or dollars into networking and marketing as I put more effort into operations. Also, be cautious about how you identify needs in the market as people seem bad at appraisal of this and some testing is necessary to see what works. I stay pretty flexible because of this and try out different strategies within the scope of my overall plans. Don’t want to put all the eggs in one basket, but also don’t want to be chasing every whim. Good luck!

I am expecting to learn by doing basically, and know that a lot of mistakes will happen. The retention part is a really great point - when you say investing in operations, do you mean things like the office, software (for keeping track of files, notifying clients, doing virtual care), or something else?

40% of my knowledge comes from mentors.
30% comes from making mistakes, admitting it, and learning from my mistakes.
10% comes from observing successful people, and learning from office staff.
10% comes from reading
10% comes from consults with expensive professionals

As always, PsyDr., I need to frame this to keep it somewhere always visible I definitely had in mind several of these, but still need to find some mentors.

Work at a small or newer group practice and pay attention. Don't sign a non-compete or work in an area of the field that you won't open a private practice in. You get to practice things with less risk.

Which is why I think this advice is also spot on. Non-competes are not something common in my region, which is great. My next step is indeed to work at a group practice and learn more.

As for advocating for less hours working for a big Corp, good luck. You are easily replaceable if you don't play ball.

Oh I am very aware of this. Which is why I chose not to continue with big corp because it's mostly a pipe dream. But who knows, maybe at some point in the future it will be feasible for others? This is why psychology is worth it for me, even if it doesn't earn the big bucks of finance or medicine - the flexibility; I can work for myself, for someone else, or move around and not have to care about "moving up or out".

Thank you again everyone!

 

[smalltownpsych]

Operations are about making sure that you have a well running system and by investing I am referring more to thought process and time. I have an office manager who takes on a lot of the work but if I don’t oversee it closely we will lose out on business because balls get dropped. Details are key. For example, if I cultivate a referral source and they send me a patient and we don’t respond quickly or efficiently or there is any type of system problem, we might not get a second chance. Many of my competitors lose business to us because they don’t answer the phone. If we took insurance then the logistics of operations would be related to efficiency a bit more and how to squeeze the nickels and eliminate waste.

 

[PsySeeker]

If you want to be frequently audited, sure.

That’s not true. Most of the folks I know almost exclusively bill it. I schedule it exclusively and I bill it nearly as often. No issues. This is the norm.

 

[WisNeuro]

That’s not true. Most of the folks I know almost exclusively bill it. I schedule it exclusively and I bill it nearly as often. No issues. This is the norm.

Highly dependent on region and payor. In some instances it is very true. Our state listserv and payor committee get messages about this fairly consistently.

 

[deleted1129370]

I'm a generalist, early career psychologist who is expecting to gross about $200K this year. My first year out of residency I was earning $126K at the VA with an additional $66K in earnings from income in private practice. Then I switched to private practice full time. For reference, I got licensed in late 2021.

 

[psych.meout]

I'm a generalist, early career psychologist who is expecting to gross about $200K this year. My first year out of residency I was earning $126K at the VA with an additional $66K in earnings from income in private practice. Then I switched to private practice full time. For reference, I got licensed in late 2021.

Are you doing assessment, therapy, or a mix?

What are your weekly hours like, e.g., total hours, billable hours, # of patients, etc.?

 

[deleted1129370]

Are you doing assessment, therapy, or a mix?

What are your weekly hours like, e.g., total hours, billable hours, # of patients, etc.?

I do mostly therapy, but some assessment. 99.9% of the income is from therapy.

I do about 28-30 patient facing hours (about 6 patients per day). I also do stuff outside of that to manage my business. I don't see it as work as I enjoy management, marketing, etc. I am usually managing others in my practice, emailing or messaging people in my practice outside of normal operating hours. It's definitely over 40 hours a week I am doing something for my business. Heck, I could be floating in my pool with a beer, the TV on and messaging my assistant who I am directing to do stuff. Or...I could be at a casino doing the same thing. We got displaced on Monday by the hurricane, so all morning I was texting or calling my assistant to run my practice for me while I was without electricity, internet, cell service. Eventually we drove to Austin that evening and I've been living out of a hotel seeing my patients and running my business.

 

[NeuroTrope]

Good neuropsychologists who do forensics in major metro areas clear 500-800k easy and I know a handful who are 1.5-2mm range.

 

[Sanman]

I'm a generalist, early career psychologist who is expecting to gross about $200K this year. My first year out of residency I was earning $126K at the VA with an additional $66K in earnings from income in private practice. Then I switched to private practice full time. For reference, I got licensed in late 2021.

Good neuropsychologists who do forensics in major metro areas clear 500-800k easy and I know a handful who are 1.5-2mm range.

It is possible to make great money as a business owner in many occupations. As mentioned above, I think a good question here is how much are folks netting off of clinical work and how much off of other business (legal work, managing other clinicians, etc.). In my mind, $250k is the upper limit on a solo clinical practice. Beyond that you are doing other things. I know psychologists grossing in the seven figures. That said, they run large practices (think 20+ clinicians) and that is a different skillset from clinical work.

 

[WisNeuro]

It is possible le to make great money as a business owner in many occupations. As mentioned above, I think a good question here is how much are folks netting off of clinical work and how much off of other business (legal work, managing other clinicians, etc.). In my mind, $250k is the upper limit on a solo clinical practice. Beyond that you are doing other things. I know psychologists grossing in the seven figures. That said, they run large practices (think 20+ clinicians) and that is a different skillet from clinical work.

If I was purely clinical, working FT, I'd gross 250-300k taking insurance with my clinical payor mix.

Edit: This would be for solo provider, doing my own testing. Working 48 weeks/year.

 

[Sanman]

If I was purely clinical, working FT, I'd gross 250-300k taking insurance with my clinical payor mix.

Edit: This would be for solo provider, doing my own testing. Working 48 weeks/year

So, I would assume a net of about $250k after basic expenses. I expected a gross of about $250-300k per clinician when I was managing folks. More medicare in the mix and some medicaid, but booking 40 clinical hours for 48 wks/yr

 

[WisNeuro]

So, I would assume a net of about $250k after basic expenses. I expected a gross of about $250-300k per clinician when I was managing folks. More medicare in the mix and some medicaid, but booking 40 clinical hours for 48 wks/yr

Depends on your payer mix and billing codes. If you look at it from an hourly billing perspective, particularly with one doing their own testing, therapists would be billing more. At least on an hour to hour basis. However, take that with a grain of salt as you'll be hard pressed to find a doctoral therapist who is willing to bill more then 20-25 hours in private practice working for someone else these days.

 

[Sanman]

Depends on your payer mix and billing codes. If you look at it from an hourly billing perspective, particularly with one doing their own testing, therapists would be billing more. At least on an hour to hour basis. However, take that with a grain of salt as you'll be hard pressed to find a doctoral therapist who is willing to bill more then 20-25 hours in private practice working for someone else these days.

I recently got a call from a nursing home company expecting 18 units of 90832 or 7 units of 90791 for full-time employees per day. Salary was $100-125k/yr. That is billing out $300-350k/yr. Now, presumably someone is doing that if they are expanding.

 

[WisNeuro]

I recently got a call from a nursing home company expecting 18 units of 90832 or 7 units of 90791 for full-time employees per day. Salary was $100-125k/yr. That is billing out $300-350k/yr. Now, presumably someone is doing that if they are expanding.

Yeah, the PE firms taking over nursing homes are paying doctoral providers like 30/70 splits. I'd have to imagine the only people taking those jobs are diploma millers who lack decent prospects.

 

[Therapist4Chnge]

18 90832 PER DAY?!

That’s beyond predatory. Same for the 90791.

 

[psych.meout]

Depends on your payer mix and billing codes. If you look at it from an hourly billing perspective, particularly with one doing their own testing, therapists would be billing more. At least on an hour to hour basis. However, take that with a grain of salt as you'll be hard pressed to find a doctoral therapist who is willing to bill more then 20-25 hours in private practice working for someone else these days.

Thee are so many psychology- and therapy-related subreddits filled with people who think seeing more than 20 patients per week is grueling labor that could only be kept up for a very short period of time and anything above 25/week is unethical and abusive.

I'm always wondering what these people do with the other half of their workweeks.

 

[WisNeuro]

Thee are so many psychology- and therapy-related subreddits filled with people who think seeing more than 20 patients per week is grueling labor that could only be kept up for a very short period of time and anything above 25/week is unethical and abusive.

I'm always wondering what these people do with the other half of their workweeks.

Personally, I don't mind of someone wants to work a .5 or .75 FTE, but just stop demanding to be paid 1.0 FTE for that work. It's not hard to template your notes and spend 3 mins to pump that baby out at end of session. Most of us figured this out in grad school.

 

[Sanman]

18 90832 PER DAY?!

That’s beyond predatory. Same for the 90791.

It's been that way for a while. Salaries have increased slightly over the years with rate changes. The line of predatory/fraud is a thin one in some of these places. They expect you to do as little work as possible. (16-20 min sessions, 30 min initials). Though, I imagine the places struggle to get clinicians now when they pay similar to Betterhelp and you need to leave your house. Prior to telehealth, there were plenty of folks using these places for quick cash or an early career jumping off point.

I like to keep tabs on these places for when I do jobs talks with interns/post-docs on what to look out for on the job hunt.

 

[deleted1129370]

It is possible le to make great money as a business owner in many occupations. As mentioned above, I think a good question here is how much are folks netting off of clinical work and how much off of other business (legal work, managing other clinicians, etc.). In my mind, $250k is the upper limit on a solo clinical practice. Beyond that you are doing other things. I know psychologists grossing in the seven figures. That said, they run large practices (think 20+ clinicians) and that is a different skillet from clinical work.

Indeed. I have hired on 3 new providers and I am slowly filling their schedules. My goal is to be bringing in $300K in passive income by end of next year, and then from there, keep growing (adding more providers) and making more money. I am very content with the earnings I make now. Much more than what I was making with the VA and the quality of life and flexibility I love the most. I love managing my business. I really don't like working for others, whether it be clinical or management. I am invested in doing right by my business because it's my baby I have built from scratch. I take pride in my business, thus the earnings are so much sweeter because they are directly proportionate to my efforts.

 

[psych.meout]

Personally, I don't mind of someone wants to work a .5 or .75 FTE, but just stop demanding to be paid 1.0 FTE for that work. It's not hard to template your notes and spend 3 mins to pump that baby out at end of session. Most of us figured this out in grad school.

Exactly. The people to whom I alluded will complain about being overworked at 20 patients/week and in the same breath lament their financial situation.

 

[deleted1129370]

The beautiful thing about private practice is that the income potential is practically unlimited unlike working for others, especially hospitals or clinics. I am positioning myself so that in the very near future, I won't have to really work and still bring in a nice $300K+ salary. For me, I would just manage the business, travel, see a couple of patients here and there (if I really wanted to), and that's it. For the time being, I have to put in the tough work and the hours. It's temporary "pain" but it's worth it in the long run. Honestly, life has been exponential better since leaving the VA.

 

[thebalmofhurtminds]

Thee are so many psychology- and therapy-related subreddits filled with people who think seeing more than 20 patients per week is grueling labor that could only be kept up for a very short period of time and anything above 25/week is unethical and abusive.

I'm always wondering what these people do with the other half of their workweeks.

Honestly, you're probably just seeing extremes from folks who are burnt out or as a reaction to increased expectation of workload in many hospital settings. We keep in touch with our former interns and for the therapy ones, their workloads are nearly always too high on postdoc and beyond. If they can get away with it, many hospital systems are certainly trying to get you to 7+/day.

 

[Sanman]

Thee are so many psychology- and therapy-related subreddits filled with people who think seeing more than 20 patients per week is grueling labor that could only be kept up for a very short period of time and anything above 25/week is unethical and abusive.

I'm always wondering what these people do with the other half of their workweeks.

Honestly, you're probably just seeing extremes from folks who are burnt out or as a reaction to increased expectation of workload in many hospital settings. We keep in touch with our former interns and for the therapy ones, their workloads are nearly always too high on postdoc and beyond. If they can get away with it, many hospital systems are certainly trying to get you to 7+/day.

There are ridiculous requirements on both ends of the spectrum and it really boils down to what people think they are doing there. We provide a service and are compensated for it. If you are getting $50 from medicaid and providing the same service as you would at a $250/hr cash practice, you have undervalued your services. In the same vein, hospital systems insistent on increasing your RVUs and then complaining about poor patient satisfaction, are also ridiculous. There is a balance to be made if you are going to make money in this business.

Lets put it this way. I am having my kitchen remodeled. When I was shopping for cabinets, I had the choice of cheap stock cabinets, semi-custom cabinets, or a custom cabinet builder. If you are custom building cabinets for less than stock cabinet prices, you are going to be very unhappy and rather poor cabinetmaker with a very pleased customer. On the other hand, if you work for a huge stock cabinet company (hospital, VA etc.) that is expecting you to produce something finished as nicely as a custom cabinet then they are deluding themselves about their product.

You can get pretty good results with basic cookie cutter solutions most of the time. However, in some situations, you need someone experienced in their craft to provide you with a better solution for your particular problem. In either case, you may need to pay a bit extra for that.

 

[deleted1129370]

I see about 30 people a week. I've been doing this for about a year and I will tell you, I am slowly approaching burn out.

 

[smalltownpsych]

I see about 30 people a week. I've been doing this for about a year and I will tell you, I am slowly approaching burn out.

30 hours of therapy patients a week is a lot to juggle and especially if you are running a business. I just looks at my schedule for next week and I am exactly at 30 hours. No wonder I’m tired. About 20 hours with the rest devoted to other tasks makes the most sense for me, but 20 hours and no other responsibilities is kind of a joke. I did 30 to 35 hours worth a week for many years when it was my only obligation.

 

[Tom4705]

30 hours of therapy patients a week is a lot to juggle and especially if you are running a business. I just looks at my schedule for next week and I am exactly at 30 hours. No wonder I’m tired. About 20 hours with the rest devoted to other tasks makes the most sense for me, but 20 hours and no other responsibilities is kind of a joke. I did 30 to 35 hours worth a week for many years when it was my only obligation.

If you don't mind me asking, what other tasks would be done with only 20 hours of psychotherapy a week?

 

[WisNeuro]

If you don't mind me asking, what other tasks would be done with only 20 hours of psychotherapy a week?

Self-care, learning about IFS, re-calibrating your EMDR placebo wagging device, posting on Reddit about burnout and gaslighting, etc.

 

[AcronymAllergy]

30 hours of therapy patients a week is a lot to juggle and especially if you are running a business. I just looks at my schedule for next week and I am exactly at 30 hours. No wonder I’m tired. About 20 hours with the rest devoted to other tasks makes the most sense for me, but 20 hours and no other responsibilities is kind of a joke. I did 30 to 35 hours worth a week for many years when it was my only obligation.

Agreed. 20 hours + working as a PP owner is much different than 20 hours + ....not much else.

 

[smalltownpsych]

If you don't mind me asking, what other tasks would be done with only 20 hours of psychotherapy a week?

Marketing, accounts receivable and payable and HR, clinical supervision, administrative oversight, facilities management. Employees are sometimes like kids in a family that think everything just happens and don’t realize the amount of work that goes into everything.

 

[Sanman]

Marketing, accounts receivable and payable and HR, clinical supervision, administrative oversight, facilities management. Employees are sometimes like kids in a family that think everything just happens and don’t realize the amount of work that goes into everything.

Facilities management....aka the office toilet is clogged and we are out of coffee. Things people don't think about when they don't own the business. Similar to renting vs home ownership. People always look at the upside vs the downside.

 

[deleted1129370]

30 hours of therapy patients a week is a lot to juggle and especially if you are running a business. I just looks at my schedule for next week and I am exactly at 30 hours. No wonder I’m tired. About 20 hours with the rest devoted to other tasks makes the most sense for me, but 20 hours and no other responsibilities is kind of a joke. I did 30 to 35 hours worth a week for many years when it was my only obligation.

Yeah, it's a lot. I've been seeing this many since about October of last year. I work about 80 hours a week. I see patients, then I am doing things for my business to grow and scale it.