Going Back to School and Job Paths

[PsychMajorUndergrad18]

Hello Everyone,

I have a few different potential opportunities and/or paths that I can take for the future and was just wondering what you all think is the better option. My ideal goal so far is to become a teaching professor or adjunct professor while doing some form of clinical work. The main question I have is which field should I go into to potentially teach down the road: psychology or social work? I looked on HigherEdJobs and I found more jobs for psychology than social work. I also have the opportunity to go back to the college I graduated from to finish courses to get my BA in Psychology (I only have six courses left). This may help me get my GPA a little higher and also potentially get letters of recommendation from professors instead of just from my supervisors at my job (I currently work full time at a grocery store). Is it better to have letters of recommendations from professors or supervisors or both? Or is it better to just attempt to apply to masters in psychology or MSW programs first? My undergraduate GPA was a 2.69 and I have not taken the GRE.

So long story short:

Which Subject is better to teach in or have more opportunities in: Psychology or Social Work?
Should I finish my BA or try to apply to graduate school?
Is it better to have letters of recommendations from professors or supervisors or both?

Thank you all!

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[AbnormalPsych]

Very brief overview:

If you want to teach you'll need a doctorate. Some community colleges might have opportunities at the masters level, but they are rare.

If you want to do clinical work, both paths work. One is quicker, one is more in depth.

With a GPA like that it would be very difficult to get into a doctorate program without other experiences to fill out an application. Perhaps research lab volunteer work while enrolled in a masters. That can give you more time to get the GPA up and research experience to see if a doctoral education and 4-5+ years commitment is the right path.

For letters of rec: Professors 100%. Unless there is something really really important and valuable you haven't mentioned that your grcoery store supervisor could speak to about you at the day job and its relation to the graduate studies and work.

 

[PsyDr]

1) Clinical programs have a GPA cut off of 3.0.
2) Most programs are inundated with applicants that far exceed a 3.5GPA
3) In this arena, the term “letters of recommendation” refers to letters from relevant sources, such as professors or clinical work. It never refers to letters from generic sources, such as non academic, unrelated work employers, or family members.
4) Adjunct basically translates to “part time”. It’s not really a career.
5) "teaching professor" is usually a professor, who got the job due to his/her research history, and has to do some teaching as a side job.
6) Let’s pretend you’re on the admission committee for either graduate program. There are 100 applications in front of you, for 15 positions. You’re instructed to throw away the sub 3.0 GPA applications, because that metric is reported to higher ups. What’s the easiest way to do your job?
7) I mean this with all kindness, but DO NOT use letters from your grocery store job.

 

[Sanman]

I think you need to take a step back and really think about what you want to do. Your GPA will significantly hamper your chances of getting into a graduate program and from the sounds of it you don't have any relevant work experience yet. First do a lot more research into what is required for the different fields. Then I would think about two things:

1. How to get your GPA above 3.0?
2. How to get some relevant experience in whatever field you want to pursue?

Some SW programs may allow a gpa below 3.0, but I imagine that they would want relevant work experience/commitment to the field.

If you want to work in the field sooner/need money, I would look into what it would take to get an ABA certification if you want to work with autism or consider an LPN in psych nursing rather than going back for a general psychology degree.

What is your current undergraduate degree in?

 

[The Cinnabon]

I'm just a lowly post-bacc, but something I did hear is that if you're interested in a higher-ed teaching career it's actually not a bad idea to teach at community colleges. Often community colleges do have a tenure system but far less (if any) research requirements. You can make a decent amount of money doing it, but it's highly variable based off of the location you're teaching.

Anecdotally I do know someone pulling in around 120-140K now that teaches a CC in the Chicago suburbs, they also have tenure. Obviously there are far more lucrative paths, but that doesn't mean teaching has to be a destitute path if you're interested/passionate about it.

 

[ClinicalABA]

...If you want to work in the field sooner/need money, I would look into what it would take to get an ABA certification...

BCBA certification requires a masters degree in ABA (or in related field with appropriate approved ABA course sequence, a minimum of 1500 (but could be 2000, depending on the nature of your program) hours supervised coursework, and passing grade on certification exam. Generally takes students 2.5-3 years from time of entering program to eligibility to sit for BCBA exam. You can, however, begin accruing supervised fieldwork as of the beginning of your first graduate ABA course (as opposed to finishing a set amount of coursework first before being eligible to accrue licensure required field work). Many (most?) states also require licensure as and ABA provider, so that could be another test or additional coursework/field work (though I have not encountered that). Long story short, the ABA route won't be much quicker to the licensed/certified masters level clinician position than an LCSW or LMHC pathway. However- at least in my area- the starting pay is much higher.

OP- I'm curious about your seeing more psych teaching jobs than social work. I'm betting that's full-time positions. There are certainly more social work masters programs than clinical/counseling psych masters or Ph.D. programs. My hunch is that the masters programs are more likely to use adjuncts and more likely to recruit locally (but also don't have the same requirements for instructors to have a Ph.D). I have a full-time clinical day job, but adjunct teach two courses in each Spring and Fall semester, and one in the Summer. I get paid 5K per adjunct course now (in an ABA program), and get one TA for every five students enrolled over 9. IME, that's on the high end of adjunct pay per course (it's typically around 3.5k), and the whole TA thing is pretty unusual. I've also been interested in/offered full time (10 month) teaching gigs at a smaller state U (undergrad psych only). The pay was SUBSTANTIALLY less (~40%) than my clinical job at the time. You have a lot to think about and a lot of work to do, but somebody has to do it, right? Best of luck

 

[Sanman]

BCBA certification requires a masters degree in ABA (or in related field with appropriate approved ABA course sequence, a minimum of 1500 (but could be 2000, depending on the nature of your program) hours supervised coursework, and passing grade on certification exam. Generally takes students 2.5-3 years from time of entering program to eligibility to sit for BCBA exam. You can, however, begin accruing supervised fieldwork as of the beginning of your first graduate ABA course (as opposed to finishing a set amount of coursework first before being eligible to accrue licensure required field work). Many (most?) states also require licensure as and ABA provider, so that could be another test or additional coursework/field work (though I have not encountered that). Long story short, the ABA route won't be much quicker to the licensed/certified masters level clinician position than an LCSW or LMHC pathway. However- at least in my area- the starting pay is much higher.

Now you have me googling stuff. See what you have done. It has been a long time since I looked into this at all.

You are correct about BCBA, but the Board Certified Assistant Behavior Analysis certificate is a bachelors level certification. I would bet it pays better than grocery store wages. If the OP can get the certification, the psychology major may be worth it. Without it, I am not sure it is worth the trouble.

 

[PsychMajorUndergrad18]

Thank you all for replying!

Do you think getting a BSW degree would help my GPA get higher in order to apply for MSW programs? I would be able to get experience after getting my BSW. Do you all think clinical or counseling psychology is out of the picture for me? What other ways is there to get relevant work experience?

 

[ClinicalABA]

Now you have me googling stuff. See what you have done. It has been a long time since I looked into this at all.

You are correct about BCBA, but the Board Certified Assistant Behavior Analysis certificate is a bachelors level certification. I would bet it pays better than grocery store wages. If the OP can get the certification, the psychology major may be worth it. Without it, I am not sure it is worth the trouble.

Economics and salaries are a little strange nowadays. Dependent on your area, there may not be that big a difference between service industry salaries and Assistant Beh. Analysis (BCaBA) certification. One issue is that the BCaBA certification is not a consistent requirement for insurance reimbursement. For example, in the ABA treatment branch of my company, insurance requires that services be designed and supervised by a masters level, state licensed behavior analyst (LABA), which in almost all case is a BCBA. The programs are implemented by non-licensed, non-certified staff under the supervision of the LABA/BCBA. Because the BCaBA (or the even more introductory level RBT- registered behavior technician) is not required, it's not always paid better. I have been in this field for ~30 years, in public and private schools, home based ABA programs, inpatient and outpatient clinics, and adult residential programs (with ASD, TBI, ID, severe MH, and dementia populations). I think I have only encountered 1 actual BCaBA certificant. It's a largely irrelevant certification.

 

[Sanman]

Economics and salaries are a little strange nowadays. Dependent on your area, there may not be that big a difference between service industry salaries and Assistant Beh. Analysis (BCaBA) certification. One issue is that the BCaBA certification is not a consistent requirement for insurance reimbursement. For example, in the ABA treatment branch of my company, insurance requires that services be designed and supervised by a masters level, state licensed behavior analyst (LABA), which in almost all case is a BCBA. The programs are implemented by non-licensed, non-certified staff under the supervision of the LABA/BCBA. Because the BCaBA (or the even more introductory level RBT- registered behavior technician) is not required, it's not always paid better. I have been in this field for ~30 years, in public and private schools, home based ABA programs, inpatient and outpatient clinics, and adult residential programs (with ASD, TBI, ID, severe MH, and dementia populations). I think I have only encountered 1 actual BCaBA certificant. It's a largely irrelevant certification.

I'll take your word for it. I know several folks with the BCaBA certification that got good paying jobs out of college in major cities as my undergrad alma mater offered the ability to be certified via a track in the psychology major. Granted, this was almost 20 years ago (God that can't be correct, I'm far too young and good looking for that to be true), so I will defer to you on this one as you have more recent/relevant knowledge.

As far as economics and salaries, things are absolutely strange. Even if the pay is equal, it seems worthwhile if the OP can secure a decent paying job and access to letters of rec by a fellow such as yourself. If it is not used, then my internet advice is worth every cent the OP paid for it.

 

[ClinicalABA]

Thank you all for replying!

Do you think getting a BSW degree would help my GPA get higher in order to apply for MSW programs?

If you do well. If you have not/will not successfully addressed the issue that led to your previous 2.69 GPA, it likely won't help. As far as clinical/counseling psych, it's always an option. You can always pursue opportunities to make yourself more competitive for funded clinical/counseling doctoral programs. Unfunded programs are also an option, but often not worth the costs, and several are of questionable quality. To go the funded Ph.D. route, your looking at what sounds like a year or two getting that GPA up with undergrad courses (and or demonstrating academic ability in a psych masters program). You'd also likely need a few good years of research experience which your may or may not get paid to do. You're then looking at another 5-6 years of graduate training/predoctoral internship, plus maybe another year of postdoctoral internship before being licensed eligible and being able to make the "bigger" bucks. During this training, you can make some money with stipends and side gigs, but probably not a lot. It is also likely that you would have to move to a different part of the country at least 1-2 times. It's a long road, but if you are young (say early to mid-twenties), motivated, willing to work, and have the flexibility to uproot your life a few times, you can do it. It's what we all did, to a varying extent. If you're older, have a family to help support, and are tied to a specific geographic area, it may be a very rough road and not financially worth it. Realistically, if you know you're just not a very good student and struggle with things like writing well, math/statistics, and overall organizational skills (you'll have a lot of reading/writing to do), the clinical/counseling doctoral route may not be for you.

 

[ClinicalABA]

I'll take your word for it. I know several folks with the BCaBA certification that got good paying jobs out of college in major cities as my undergrad alma mater offered the ability to be certified via a track in the psychology major. Granted, this was almost 20 years ago (God that can't be correct, I'm far too young and good looking for that to be true), so I will defer to you on this one as you have more recent/relevant knowledge.

It could be a regional thing too. It's just not required where I am (at least yet) and I don't see them around (nor do I see the training programs for them). The BCBA certification on the other hand is a very efficient path, with some pretty good salaries very early career. With the same length of training as an LMHC, you start at 65K++, vs. ~35-40K. Many service industry jobs in my area are also starting at $20+/hour.

Just for point of reference, the CMS rate for CPT code 97153 (treatment by a technician under supervision) is $16.37 per 15 minutes, with not differential for BCaBA/non-BCaBA. The nature of the work (e.g. travel time between client homes) means that the typical technician is operating at sub- 75% efficiency, with max possible billing 25-30 hours per week for a 40 hour salary plus benefits. Margins are tight and volume is currently down (tough to find staff), plus cancellations are up (still some pandemic related concerns). Not a lot of incentive to hire to pay more for a BCaBA when not necessary (regulatorily or clinically)

 

[R. Matey]

Thank you all for replying!

Do you think getting a BSW degree would help my GPA get higher in order to apply for MSW programs? I would be able to get experience after getting my BSW. Do you all think clinical or counseling psychology is out of the picture for me? What other ways is there to get relevant work experience?

You could go this route and still teach on the side, but the opportunities might be fewer. Alternately, you might find supervision of other LCSWs equally rewarding.

 

[Sanman]

It could be a regional thing too. It's just not required where I am (at least yet) and I don't see them around (nor do I see the training programs for them). The BCBA certification on the other hand is a very efficient path, with some pretty good salaries very early career. With the same length of training as an LMHC, you start at 65K++, vs. ~35-40K. Many service industry jobs in my area are also starting at $20+/hour.

Just for point of reference, the CMS rate for CPT code 97153 (treatment by a technician under supervision) is $16.37 per 15 minutes, with not differential for BCaBA/non-BCaBA. The nature of the work (e.g. travel time between client homes) means that the typical technician is operating at sub- 75% efficiency, with max possible billing 25-30 hours per week for a 40 hour salary plus benefits. Margins are tight and volume is currently down (tough to find staff), plus cancellations are up (still some pandemic related concerns). Not a lot of incentive to hire to pay more for a BCaBA when not necessary (regulatorily or clinically)

I find LMHC/LCPC to be the worst degree regarding financial return.

 

[PikminOC]

I find LMHC/LCPC to be the worst degree regarding financial return.

Really? They bill the same as the psychologists and social workers near me. 150 to 250 initial. 150 to 200 follow ups.

 

[R. Matey]

Really? They bill the same as the psychologists and social workers near me. 150 to 250 initial. 150 to 200 follow ups.

Traditionally, they have had less access to opportunities like the VA or major healthcare systems but I've noticed there's been a shift towards treating these two providers the same in the past five years or so. In some states, all psychotherapy codes are billed the same rate, in others, psychologists have better access to paneling and are paid better.

With the same length of training as an LMHC, you start at 65K++, vs. ~35-40K.

You need to contend with the BLS figures as this is is far from national median. It may be possible in some places, but I wouldn't bank on it.

 

[Sanman]

Traditionally, they have had less access to opportunities like the VA or major healthcare systems but I've noticed there's been a shift towards treating these two providers the same in the past five years or so. In some states, all psychotherapy codes are billed the same rate, in others, psychologists have better access to paneling and are paid better.



You need to contend with the BLS figures as this is is far from national median. It may be possible in some places, but I wouldn't bank on it.

In addition to panel difficulties, they also cannot bill Medicare, so the floor is much lower for them.

 

[WisNeuro]

In addition to panel difficulties, they also cannot bill Medicare, so the floor is much lower for them.

There was a very recent change in this aspect. There are certain codes they still cannot bill, but I think the therapy codes opened for them.

 

[ClinicalABA]

You need to contend with the BLS figures as this is is far from national median. It may be possible in some places, but I wouldn't bank on it.

Poor sentence construction on my part- let me fix it:

"With the same length of training as an LMHC, you a BCBA starts at 65K++, vs. ~35-40K for an LMHC.

The LMHC figures may be a little low, but not too off from bottom 10%. I think my original construction may have come across as saying saying the LMHC would make 65k. Sorry for any confusion.

 

[smalltownpsych]

Really? They bill the same as the psychologists and social workers near me. 150 to 250 initial. 150 to 200 follow ups.

In this area, some of them bill close to my rates, but if they don’t take insurance they aren’t getting many clients and at least one insurance contract in this area reimburses them for 75% of what I refused to take because it was so low. Very hard for a midlevel to fill up their panel with cash pay unless they have some extra skills, training, and experience. Having EMDR “certification“ won’t cut it either.

 

[Sanman]

There was a very recent change in this aspect. There are certain codes they still cannot bill, but I think the therapy codes opened for them.

Hmm, you are correct. Does not take effect till Jan 2024 apparently. MFTs too. It's about time.

 

[MAClinician]

Poor sentence construction on my part- let me fix it:

"With the same length of training as an LMHC, you a BCBA starts at 65K++, vs. ~35-40K for an LMHC.

The LMHC figures may be a little low, but not too off from bottom 10%. I think my original construction may have come across as saying saying the LMHC would make 65k. Sorry for any confusion.

Actually in MA, the state recently introduced Community Behavioral Health Centers (CBHCs) and unlicensed masters level folks are being hired for around $60K. Straight out of grad school. At least in the southeastern part of the state. Not sure about central/west, but since it is state mandated, agencies were picked by the state to be CBHCs, and the state identified initial salaries for the positions I’m guessing it’s pretty similar. This is strictly in MA and can’t speak for other states.

 

[R. Matey]

Actually in MA, the state recently introduced Community Behavioral Health Centers (CBHCs) and unlicensed masters level folks are being hired for around $60K. Straight out of grad school. At least in the southeastern part of the state. Not sure about central/west, but since it is state mandated, agencies were picked by the state to be CBHCs, and the state identified initial salaries for the positions I’m guessing it’s pretty similar. This is strictly in MA and can’t speak for other states.

That's interesting. Any sense of what their caseloads are like?

 

[ClinicalABA]

That's interesting. Any sense of what their caseloads are like?

Here's a link to the job listings for the one in my area:

Career Opportunities - Clinical & Support Options Inc careers

TOUGH work (ER admits; shelter supervision; etc.). I interned at a CMHC in Boston, and it was a whole lot of case management with an SMI population. Super high no-show rates, with many clients just falling off the radar entirely. I really hope they are getting 60K to do that work- It's important and very difficult. Link doesn't give salary (and it looks like FFS is also an option, but that's a sucker's bet with the cancellation rates). I interviewed with this agency WAY back when for a psychologist position, and the offer was downright insulting (like a 45% pay cut, with an increase in expected productivity to do much more difficult clinical work than I was doing at the time). Having taught in an LMHC program in the area, I can guarantee that we did not prepare LMHC's for that kind of work.

 

[R. Matey]

TOUGH work (ER admits; shelter supervision; etc.). I interned at a CMHC in Boston, and it was a whole lot of case management with an SMI population. Super high no-show rates, with many clients just falling off the radar entirely. I really hope they are getting 60K to do that work- It's important and very difficult. Link doesn't give salary (and it looks like FFS is also an option, but that's a sucker's bet with the cancellation rates). I interviewed with this agency WAY back when for a psychologist position, and the offer was downright insulting (like a 45% pay cut, with an increase in expected productivity to do much more difficult clinical work than I was doing at the time). Having taught in an LMHC program in the area, I can guarantee that we did not prepare LMHC's for that kind of work.

Yeah, that's kinda what I thought. I had a job similar to this my first year or so out as an pre-licensed counselor and it was sheer misery: high acuity, high no show, pay was in line with the national median for LMHCs so not bad for someone without a license, but still tough to live on. So I do hope they actually pay people adequately to do these jobs now. Even 60k for a high burnout job hardly seems worth it, IMHO.

Wholly agree that we don't prepare people to do this work in counseling programs. Most LMHC students see themselves in niche private practices and have little understanding and training to deal with that level of acuity.

 

[Sanman]

Yeah, that's kinda what I thought. I had a job similar to this my first year or so out as an pre-licensed counselor and it was sheer misery: high acuity, high no show, pay was in line with the national median for LMHCs so not bad for someone without a license, but still tough to live on. So I do hope they actually pay people adequately to do these jobs now. Even 60k for a high burnout job hardly seems worth it, IMHO.

Wholly agree that we don't prepare people to do this work in counseling programs. Most LMHC students see themselves in niche private practices and have little understanding and training to deal with that level of acuity.

I think this a point that needs to be addressed by the system as a whole. We need mid-levels with the skills for these jobs and they are not trained for anything but outpatient non-acute practice (which is what everyone wants). Psychologists have the skills, but they would be even more underpaid in such a position given the training costs and there is usually a fixed budget for most of this stuff. I would hope that training is available for these jobs so that the need can be met.

 

[PikminOC]

In this area, some of them bill close to my rates, but if they don’t take insurance they aren’t getting many clients and at least one insurance contract in this area reimburses them for 75% of what I refused to take because it was so low. Very hard for a midlevel to fill up their panel with cash pay unless they have some extra skills, training, and experience. Having EMDR “certification“ won’t cut it either.

75 percent reimbursement for much much less of education.

 

[Sanman]

75 percent reimbursement for much much less of education.

True but 75% of a below Medicare rate can be a lot lower. Allowing them onto Medicare panels should help get rates up for everyone.

 

[WisNeuro]

True but 75% of a below Medicare rate can be a lot lower. Allowing them onto Medicare panels should help get rates up for everyone.

I doubt it, actually. If there is more billed to Medicare, I'm predicting another audit in which they look at highly billed codes (of which therapy codes are already in that category from the last audit) and a possible lowering of RVUs in those codes, in which they will justify the lowering by the fact that midlevels will be a good portion of those providing these care services. Probably a good thing for access in the general population, but I sincerely doubt you will see this being a good thing for doctoral level reimbursements.

 

[R. Matey]

75 percent reimbursement for much much less of education.

How much do psych NPs bill for med management codes?

 

[WisNeuro]

How much do psych NPs bill for med management codes?

If it's Medicare, 85% of physician reimbursement. Medicaid will vary by state, and insurance by region LCD

 

[Sanman]

I doubt it, actually. If there is more billed to Medicare, I'm predicting another audit in which they look at highly billed codes (of which therapy codes are already in that category from the last audit) and a possible lowering of RVUs in those codes, in which they will justify the lowering by the fact that midlevels will be a good portion of those providing these care services. Probably a good thing for access in the general population, but I sincerely doubt you will see this being a good thing for doctoral level reimbursements.

You might be correct. That said, it some of the private insurers were using LMHC/LCPCs to keep their rate artificially low, they may not have the option to do so any longer. So the Medicare rate might go down a bit, but the insurance rate for something like Cigna/Bravo, might need to go up. It's a constant game.

 

[WisNeuro]

You might be correct. That said, it some of the private insurers were using LMHC/LCPCs to keep their rate artificially low, they may not have the option to do so any longer. So the Medicare rate might go down a bit, but the insurance rate for something like Cigna/Bravo, might need to go up. It's a constant game.

Insurers usually move in lockstep with Medicare rates, i.e., reimburse X% of Medicare.

 

[Sanman]

Insurers usually move in lockstep with Medicare rates, i.e., reimburse X% of Medicare.

True, but some are below Medicare whereas some are a percentage above the Medicare rate. Hopefully, more of the commercial insurers will be pushed to some percentage above the rate. I am sure Medicaid will still be terrible. At the end of the day, it depends on what panel/payor source you use to fill your slots.

 

[PikminOC]

True but 75% of a below Medicare rate can be a lot lower. Allowing them onto Medicare panels should help get rates up for everyone.

I don't see many therapists who take Medicare

How much do psych NPs bill for med management codes?

I'm completely out of network so I don't know

 

[R. Matey]

I think this a point that needs to be addressed by the system as a whole. We need mid-levels with the skills for these jobs and they are not trained for anything but outpatient non-acute practice

Returning to this point, I think because clinical mental health counseling grew up through academic traditions that typically emphasizes humanistic approaches, there's been a wide disconnect between training and what the job typically looks like, especially if you're unlicensed. There are more pushes towards EPBs, but how these are actually taught to students is another matter. Also, two years of training without a formal residency path to licensure is a short time to get a lot done. Hopefully, students are at least coming in a bachelor's degree in psychology.

 

[WisNeuro]

True, but some are below Medicare whereas some are a percentage above the Medicare rate. Hopefully, more of the commercial insurers will be pushed to some percentage above the rate. I am sure Medicaid will still be terrible. At the end of the day, it depends on what panel/payor source you use to fill your slots.

In an ideal world, sure. However, in my experience, I doubt that will happen.

I don't see many therapists who take Medicare

I'm completely out of network so I don't know

Well, if they are masters level, non-SW, they can't.

 

[ClinicalABA]

OP (and other students or students to be)- I know this thread has strayed a little from the original question, however stick around a pay attention. This reimbursement rate/policy stuff is our present and your future. Sadly, you may not encounter a lot of talk of such things in your graduate programs (especially doctoral programs with full-time faculty who may not deal with insurance on the clinical side). Knowing your potential value to the system (not your "worth"- you're all priceless with your eagerness and enthusiasm!) is an important consideration in planning your education and careers. When you hear things like "CPT code" or "CMS rates" and don't know what we're talking about, don't check out of the discussion because it's boring, confusing, etc. Rather, pester us with questions about how (not just "how much") we get paid to do what we do.

 

[MAClinician]

That's interesting. Any sense of what their caseloads are like?

Can only speak for my agency and another one nearby as I have former colleagues that work the other place. My agency expects 1300 billable hours a year so 100+ a month, which averages 25-28ish a week for full time hourly (NOT FFS) in a 40 hour week. The other agency I believe has similar expectations. And an hour = 1 45 min session. Caseloads will vary, some clients seem weekly, others biweekly etc so depends on where clients are at in treatment. Unfortunately in community mental health there are a lot of “long term” clients who stick around for the stability of support. But it’s rare for a clinician to have 100+ clients. Lol

 

[R. Matey]

Can only speak for my agency and another one nearby as I have former colleagues that work the other place. My agency expects 1300 billable hours a year so 100+ a month, which averages 25-28ish a week for full time hourly (NOT FFS) in a 40 hour week. The other agency I believe has similar expectations. And an hour = 1 45 min session. Caseloads will vary, some clients seem weekly, others biweekly etc so depends on where clients are at in treatment. Unfortunately in community mental health there are a lot of “long term” clients who stick around for the stability of support. But it’s rare for a clinician to have 100+ clients. Lol

Gtk, thanks. Sounds like you're on an outpatient team. Interestingly, MA is one of the higher paying states for LMHCs, with the mean salary at about $55k.

 

[PikminOC]

In an ideal world, sure. However, in my experience, I doubt that will happen.



Well, if they are masters level, non-SW, they can't.

I don't see many psychologists and therapists who can take Medicare, take Medicare.

 

[PikminOC]

I think this a point that needs to be addressed by the system as a whole. We need mid-levels with the skills for these jobs and they are not trained for anything but outpatient non-acute practice (which is what everyone wants). Psychologists have the skills, but they would be even more underpaid in such a position given the training costs and there is usually a fixed budget for most of this stuff. I would hope that training is available for these jobs so that the need can be met.

The acuity I'm seeing in outpatient is very high right now.

 

[smalltownpsych]

The acuity I'm seeing in outpatient is very high right now.

Same here. Not sure what that meant as far as the topic at hand though.

 

[PikminOC]

Same here. Not sure what that meant as far as the topic at hand though.

It has to do with midlevels and their roles.

 

[Sanman]

The acuity I'm seeing in outpatient is very high right now.

There are plenty of high acuity outpatients. However, I don't think that this is what midlevels are trained to manage or often want to see. Mild to moderate acuity is often preferred by a,lot of therapy practices.

 

[Sanman]

I don't see many psychologists and therapists who can take Medicare, take Medicare.

It depends on the setup. Many smaller groups/solo practices will not as they cater to the highest payor. However, I have worked with larger specialty groups who do. It really depends on the setup.

 

[PikminOC]

There are plenty of high acuity outpatients. However, I don't think that this is what midlevels are trained to manage or often want to see. Mild to moderate acuity is often preferred by a,lot of therapy practices.

They may want to see the less acute but they can't control what walks in the door. So they are seeing the more I'll too.

 

[PikminOC]

It depends on the setup. Many smaller groups/solo practices will not as they cater to the highest payor. However, I have worked with larger specialty groups who do. It really depends on the setup.

Out in pp land, I rarely see Medicare taken by therapists, no matter the size of the group

 

[WisNeuro]

I don't see many psychologists and therapists who can take Medicare, take Medicare.

I see plenty. There's a slight bit of a wait, but I can easily get my older medicare folks in to see a psychologist or SW for therapy within a month most of the time, particularly with SWs This will get even easier once master's degree folks can bill for it.

 

[Sanman]

They may want to see the less acute but they can't control what walks in the door. So they are seeing the more I'll too.

Somewhat true. We used to screen out more acute and complex cases over the phone at my old PP and refer them to other resources. There were a few who snuck through, but not too many. Now, if you don't have many clients coming in...