Frustrated about potential income for psychologists

[deleted1129370]

That is part of bootstrapping a business in the beginning. I worked that many hours for about the first 3-4 yrs of my career for other folks and decided to slow down because it was not worth working that hard as an employee. You can always slow down a bit on the clinical hours, but you will get hit on estimated taxes for that year.

One of the benefits of waiting to start your own business is the savings you accumulate that allows you to take it slower. On the other hand, you have the energy of youth and no young kids to worry about at the moment. So six of one and half a dozen of the other....

I had spent the year prior to 2023 and much of 2023 building up a savings that allowed me to at least pay myself for several months if I needed it, but to also re-invest in the business. I didn't want to take on any debt aside from some mild credit card debt to operate. I am okay with the pace thus far, but I can see this not being sustainable a year from now, so I approach each day as another opportunity to do something for my business that moves it into a direction I want it, which for me, is getting enough patients to keep all 4 of my other psychologists' schedules filled consistently.

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[smalltownpsych]

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.

You are working too hard. 😁
I am scheduled for 30 hours and will typically work about 10 hours more than that doing admin stuff. Occasionally I will spend the weekend at the office putting together new furniture or some such so might have an additional 10 to 15. If I counted the thought and planning, I might get to 80. We have decided to give our office manager a raise today because she is rocking it and one reason why I am able to work less hours.

 

[Therapist4Chnge]

It blows my mind that people do direct interventions for <$200/hr. I'd rather work less and spend my time elsewhere trying to get my hourly up than try and grind out cases taking insurance $. I know I'm fortunate to not need to take insurance, but that's more of a function of how I setup my biz and chose my patient populations than it does with competence or years in practice. It doesn't happen overnight, but within 2-3 years it is definitely possible.

I am still doing back office stuff in year 3, but I'm slowly replacing my time with hired help, now that I know what is needed. I've always had a billing company, admin to hand scheduling/calls/etc, and a psychtech. The gamechanger for me is adding a bookkeeper to handle my accounting and books. I wanted to first understand and do everything before I handed it off bc cashflow informs on what is working and what isn't.

If you are directly competing with midlevels you are doing something wrong. Even a 100% therapy practice can carve out a niche and charge more. A generalist psychologist has a lot of transferable skills, but no one teaches you how to do that part. Find good biz mentors and other doors will open up.

I worked 6hr over the weekend and probably 8hr today, and that pays for my week by Monday afternoon. I have another IME tomorrow, so I'll be working most of the week, but by choice. While just having time slots and a schedule booked out for months can offer a bit of cashflow security, I stay more nimble and try not to schedule clinical appts more than 3-4wks bc I don't want to be overburdened with clinical work and have my forensic and legal consulting squeeezd bc it's 2-2.5x the hourly revenue and I can do most of it at home.

 

[Sanman]

It blows my mind that people do direct interventions for <$200/hr. I'd rather work less and spend my time elsewhere trying to get my hourly up than try and grind out cases taking insurance $. I know I'm fortunate to not need to take insurance, but that's more of a function of how I setup my biz and chose my patient populations than it does with competence or years in practice. It doesn't happen overnight, but within 2-3 years it is definitely possible.

I am still doing back office stuff in year 3, but I'm slowly replacing my time with hired help, now that I know what is needed. I've always had a billing company, admin to hand scheduling/calls/etc, and a psychtech. The gamechanger for me is adding a bookkeeper to handle my accounting and books. I wanted to first understand and do everything before I handed it off bc cashflow informs on what is working and what isn't.

If you are directly competing with midlevels you are doing something wrong. Even a 100% therapy practice can carve out a niche and charge more. A generalist psychologist has a lot of transferable skills, but no one teaches you how to do that part. Find good biz mentors and other doors will open up.

I worked 6hr over the weekend and probably 8hr today, and that pays for my week by Monday afternoon. I have another IME tomorrow, so I'll be working most of the week, but by choice. While just having time slots and a schedule booked out for months can offer a bit of cashflow security, I stay more nimble and try not to schedule clinical appts more than 3-4wks bc I don't want to be overburdened with clinical work and have my forensic and legal consulting squeeezd bc it's 2-2.5x the hourly revenue and I can do most of it at home.

This is a function of business acumen and good personal finance skills rather than experience. I know experienced psychologists with seven figure earnings and I know experienced psychologists accepting $50/hr that worked for me. At the end of the day, that is more about how much you need the money than any sort of clinical expertise.