MSW in private practice

[TMS@1987]

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how can an MSW get into private practice? how much do they usually make in private practice? how does their salary in private practice stack up against a PhD/PsyD in private practice?

 

[Jennifer820]

Yes and No
As a licensed MSW (LCSW) you will be able to bill some insurances directly but you will always have to have supervision--that is not allowed to independently practice.
I dont know about specific charges, but there is a difference in what you can charge--in the midwest a definite difference in client demand--we have a lot of LCSW/LCPC but psychologists are always in demand

 

[pingouin]

Yes and No
As a licensed MSW (LCSW) you will be able to bill some insurances directly but you will always have to have supervision--that is not allowed to independently practice.
I dont know about specific charges, but there is a difference in what you can charge--in the midwest a definite difference in client demand--we have a lot of LCSW/LCPC but psychologists are always in demand

Ummm.. I'm going to have to disagree with Jennifer on the bolded part. In my state, the LCSW allows you to practice independently. I have the MSW LCSW combo, and will have had my private practice for 3 years in January. Although I certainly underwent supervision in order to get my license (many years ago), I have no supervisor now. I collaborate with the psychiatrists with whom I share patients, but they do not oversee or direct my practice in any way. I carry my own malpractice insurance per the requirements of the managed care companies I'm on panel with (and because I have common sense). When I am stuck or experience a dilemma, I seek out supervision because that is best practice (and again, because I have common sense). I am able to bill Medicare directly (and do), as well as Medicaid (but don't because my state's sucks and I refuse to work with it), and many private insurances.

Regarding charges, I set my rate at what I believed to be competitive in my area. This will vary depending on your location: rural areas are typically cheaper, urban typically more expensive. I'm in the Midwest; I have no doubt that my fee would be different if I was on one of the coasts. I work with some managed care and EAP panels, some people I know accept cash-only. Overall income will depend on rate charged, rate accepted (ie, sliding scale? managed care? full-fee only?), number of patients seen per week, individual vs group therapy, and probably some other variables I'm not thinking of- oh- like overhead expenses (rent, phone, office supplies, license fees, malpractice insurance, continuing ed).

Regarding getting into private practice, you would have to be licensed first, which is usually a minimum of 2 years of paid supervised clinical experience post-masters. I've only known one person who got their private practice going immediately post-licensure, and that was mostly because she has a niche (eating disorders). Otherwise, most people find that it takes them several years to get more experience, network, make contacts, etc.

There are a multitude of threads on this from previous posters, so I'd suggest you do a search. I know I have some really long posts about licensure processes, etc., which may be helpful to you.

 

[TMS@1987]

that was a fantastic response, thank you for that. but I would like to know, how do u get a niche? do u need specialized training for it? or do u just need to be into it and just want to work with that group specifically?

 

[Therapist4Chnge]

Stay out of eating disorders, no work there...nope, none at all, keep on moving, nothing to see there......😀

You need to be trained and supervised in a specialty area, at least that is what people are SUPPOSE to do. I don't know the particulars of the SW ethical codes, but I'm guessing it is similar to psychology, which means you can only practice in areas of competence. I'd advise that if you decide to go into a niche area, to get formal training and supervision because it will cover your butt if there are any problems. The reason I bring this up is I've seen some train wrecks of therapists who 'specialize' and it is evident that they have no idea what they are doing, and their patients were worse off because of them (READ: Malpractice and liability issues that could have some nasty consequences.)...ironically in the area of eating disorder work.

Private practice fees are whatever the market will bear. This goes back to why people should find their niche, since it is much easier to charge more for specific work....compared to trying to charge more than everyone else for 'generalist' work.

-t

 

[socialcog]

I'll say a couple of words about the field tomorrow. I am so tired. sleepy time **yawn. nighty night.😴

 

[PsyKardinal]

Fantastic responses pingouin and T4C.

Jeff

 

[pingouin]

Stay out of eating disorders, no work there...nope, none at all, keep on moving, nothing to see there......😀

🙄 Yeah, because there's not enough work to go around in that area, is there? 😎

You need to be trained and supervised in a specialty area, at least that is what people are SUPPOSE to do. I don't know the particulars of the SW ethical codes, but I'm guessing it is similar to psychology, which means you can only practice in areas of competence. I'd advise that if you decide to go into a niche area, to get formal training and supervision because it will cover your butt if there are any problems. The reason I bring this up is I've seen some train wrecks of therapists who 'specialize' and it is evident that they have no idea what they are doing, and their patients were worse off because of them (READ: Malpractice and liability issues that could have some nasty consequences.)...ironically in the area of eating disorder work.

I agree with T4C on all of this. ALL of it- including the trainwrecks of therapists thing. To answer the OP's question practically about establishing a niche, let me suggest a few things:

1. Find a job in that area- ie, eating disorders? Work at a treatment facility as a tech. Substance abuse? Same thing. Get exposure to that patient population, and to the type of professionals who work in that field. It may not be what you think it is.
2. When you're arranging practicums, try to find one working in that field/niche. This will give you a year's worth of experience, minimum.
3. Take any and all practice-oriented electives which apply to your niche.

You also would need to be aware of things like comorbidities; for example, an eating disorder therapist HAS to be up on substance abuse assessment and treatment, as well as know affective and anxiety disorders and personality disorders pretty well.

All of the above experience involves one thing I haven't mentioned yet: networking. If for no other reason, you need to have some time under your belt in order to meet people who could provide you with referrals. Plus keep in mind that some insurance panels, such as United Behavioral Health, require 5 years work post-LICENSE before they will allow you onto their panel.

All that said, I've seen a lot of people on here lately who are are talking about going into a grad program straight out of undergrad. My best advice is to not rush. Take some time, take a couple of years off.. grad school will still be there, and you have the rest of your life to work. I took a year off between UG and grad, and *still* had my MSW before I turned 24. I won't say that I regret it, but I will say that some more life experience under my belt probably would have been helpful in retrospect.

to everyone

 

[Therapist4Chnge]

I'd second the recommendation for tech work. I have worked on both the therapy and tech side, and each provided some great insight into the process.

As for areas to know backwards and forward:
1. Substance Abuse
2. Axis-II (r/o for borderline seems like an every day thing, since it is so over-dx'd.)
3. The same can be said for bi-polar vs. medically related mania/psychosis/etc. MDD is Dx'd all over the place, but this is often related to the ED and shouldn't be a separate Dx.
4. Medications. Not only do people come in heavily/overly medicated, but often with odd mixes and unusual dosing. It is helpful to understand what does what.

-t

 

[pingouin]

Oh yeah- medications. That's a must-know, thanks T4C. You've got to know what people are taking, and why they might be on that.

I'd just like to emphasize that the first two years post-masters are critical as far as learning goes. You're not able to practice independently, which is fine, but I strongly recommend finding really solid learning experiences and quality supervision.

I'd like to hear PsyKardinal check in on this, but I think the one thing that TRULY set the tone for some of my success is my early experience post-masters. I worked in crisis services (telephone and mobile assessment) for three years after graduating, and I would recommend getting this type of experience to anyone entering mental health. Learn how to manage clients who have serious mental illnesses, suicidal thoughts and actions, and self-injury. Learn how to do a thorough suicide assessment and safety planning. There is not a job I have worked since where these skills haven't come in handy on many occasions. I just kind of fell into it (they had an open job and I needed one), but loved it and realize now how invaluable it is to every aspect of what we do.

 

[PsyKardinal]

Pingouin and T4C have provided some fantastic answers. I agree with both that the two to three years out of school are extremly critical in developing the skills of being a clinician.

SUPERVISION not by someone that is just competent but by someone that is competent and great clinician is critical, they will force you think outside of your box and help hone and develop your critical thinking clinical skills. Take the time to find a good supervisor that you can work with. I know it can be expensive to pay for supervision particularly when many sites will provide it for free. Spend a few weeks asking around and get the supervision you need.

Multiple part time jobs to get your experience, I worked 60 and 70 hours a week, in multiple areas but still concentrated on one main focus. I particularly enjoy working with children/adolescents. So I worked part time in an outpatient substance abuse clinic, a community mental health center, inpatient hospital on the children's unit, and then in crisis/admissions taking calls in ERs and other areas. I was lucky that I was able to work with a wide variety of clients beyond the children/adolescent scope but I kept a major part of my focus there.

Learn the meds and DSM. It is a means to communicate. Yes you personally may not like subscribing to the medical model but we all need a basis to understand what is happening with clients. The DSM is a major starting point particularly when you are on the phone, or running through an ER taking report from a 1st year resident with no clue about the differance between psychosis and panic attacks (that was a fun night). Particularly learn to differentiate between the qualities of DXs, such as Mild-Moderate-Severe.

Get experience asking the tough questions to little old ladies. If everyone thinks granny in the assessment room is all sweet and nice and could never hurt anyone and has been passing out cookies to everyone. Ask her about homicidality/suicidality/psychosis....she may actually want to dump a box of rat posion in the water well. Not too many folks ate any more of her cookies after that.

Hold yourself to the highest ethical standard, do not let the business of putting money in the hospital or your pocket, let you make a bad call.

Ok So I was seriously verbose on that post, but I am going on a minivaction this weekend and will not likely post again until late on Monday. Hope everyone has a great weekend. Make sure the cookies have sugar in them. 😛

 

[chippedogic]

This thread has been very informational. I like the advice about having multiple part-time jobs. Could you go into more depth here? Also would you recommend this for pre or post receival of ones degree... Is it wise to have more than one clinical supervisor post-degree?

I can understand the idea of receiving multiple contacts (through more than one job) and more 'depth-of-experience' in subject matter/s, so, therefore, would it not be recommended if one wanted their own practice some day (as a generalist say LCSW) to only have one supervised site that would give depth into a particular angle or ideal?

Thanks ahead of time for any thoughts/responses.

 

[PsyKardinal]

The multiple part time jobs angle comes in after you recieve your degree and or license. Most if not just about all agencies, hospitals, or practices will not hire you to do much beyond case managment with out those first.

Typically when you are working on your 3000 hours to gain full licensure you have one supervisor, I do not think you can contract with multiple supervisors. Although one supervisor can supervise you across several part time jobs if you keep everyone informed and set things up that way during the interview process to get those jobs.

Jeff

 

[chippedogic]

Ah, ok I see. In the 'community meantal helth hospiral/organization' I work for those who are case managers on the MA/MSW level make and do the same as those on the BA/BS/BSW level given that no licensure has been issued. Breadth of experiences are an important factor in, at least our, modus operandi. Thanks Jeff.

 

[pingouin]

The multiple part time jobs angle comes in after you recieve your degree and or license. Most if not just about all agencies, hospitals, or practices will not hire you to do much beyond case managment with out those first.

Typically when you are working on your 3000 hours to gain full licensure you have one supervisor, I do not think you can contract with multiple supervisors. Although one supervisor can supervise you across several part time jobs if you keep everyone informed and set things up that way during the interview process to get those jobs.

Jeff

Second this. To my knowledge, you may not have concurrent licensure supervisors. If you terminate supervision with one person, there is paperwork to be filled out to transfer supervision to someone else who is qualified.

Yes, one supervisor could oversee several part-time jobs, but honestly that would be a major hassle. You'd have to coordinate all work-setting supervisors to agree, not to mention the HIPAA issues of having outside supervision... blech. Now, you COULD do a full-time job, and have something part-time on the side which is experience but doesn't officially count toward your hours. (ie, full-time case manager for supervision purposes, but pick up some PRN hospital hours)


Regarding the BA/BSW vs MA/MSW and scope of practice.. chippedogic, are they doing the *exact* same thing? At our local CMHCs, the bach-level workers have a smaller case load of needier people. The masters-level people have much larger case loads, but the acuity of the illnesses is lesser, and they provide some oversight to the bach-level workers.

 

[chippedogic]

Second this. To my knowledge, you may not have concurrent licensure supervisors. If you terminate supervision with one person, there is paperwork to be filled out to transfer supervision to someone else who is qualified.

Yes, one supervisor could oversee several part-time jobs, but honestly that would be a major hassle. You'd have to coordinate all work-setting supervisors to agree, not to mention the HIPAA issues of having outside supervision... blech. Now, you COULD do a full-time job, and have something part-time on the side which is experience but doesn't officially count toward your hours. (ie, full-time case manager for supervision purposes, but pick up some PRN hospital hours)


Regarding the BA/BSW vs MA/MSW and scope of practice.. chippedogic, are they doing the *exact* same thing? At our local CMHCs, the bach-level workers have a smaller case load of needier people. The masters-level people have much larger case loads, but the acuity of the illnesses is lesser, and they provide some oversight to the bach-level workers.

haha. for the most part everyone is so swamped that is is difficult to determine who is and isnt in regards to degree levels since most forms of case management and groups are focused around similar topics and treatment modules. my perception/s could be blurred though.