Private Practice Income- Masters Vs Doctorate

[mindfulany]

Hey there so I am finishing a masters in mental health counseling and now deciding if I want to continue pursuing higher education and get my doctorate in clinical psychology or if I want to just start working and getting experience. My ultimate end goal is to have my own successful private practice and in all honesty eventually be able to build up to bringing home $100k or more. I’ve heard some say if I have the end goal of doing private practice attaining my doctorate is a waste of time as I can do it with just a masters but it seems a doctorate generates more earning potential. My questions are 1.) are my career/income goals attainable with only a masters or should I pursue the doctorate with my goals? 2.) how much difference is the earning potential in private practice for a masters clinician vs a doctorate clinician? Thanks for your help! I understand it is not about the money, I want to simply help improve others lives but I want to also attain my goal lifestyle/income and get the most bang for my buck in private practice!

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[AbnormalPsych]

Masters

 

[summerbabe]

My questions are 1.) are my career/income goals attainable with only a masters or should I pursue the doctorate with my goals? 2.) how much difference is the earning potential in private practice for a masters clinician vs a doctorate clinician?

If you want to work for somebody else as a W2 employee and want to make 6 figures with benefits, you’ll almost certainly need a PhD.

As for private practice psychotherapy, your floor is likely filling up your schedule with the lowest possible insurance reimbursement rates (minus operational costs + things like no shows).

The ceiling for your earning potential will be dictated by your entrepreneurship and factors such as how much you want to work so that can vary widely, regardless of degree. There's obviously a big difference getting the insurance rate for an hour of your time versus a cash pay client who pays a substantial premium for that same hour.

Does that mean the cash pay therapist or psychologist is necessarily a better counselor or that a PhD is guaranteed to earn more? Nope. But they definitely have a better business plan.

 

[BuckeyeLove]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

 

[AcronymAllergy]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

I suspect this could vary by site (just like with everything else in government). At the handful of VAs I've worked in, masters-level folks were most commonly therapists, even if they'd actually never had any therapy experience and had very little formal training in it. Although those in other services (e.g., PM&R or other inpatient areas) might work in more of a case management role. The salary numbers you mentioned line up with what I've seen as well, though.

 

[Sanman]

As I alluded to in the other thread just now and has been suggested by others, it really depends on what you want to do. Do you want to own your own private practice, work for someone else in private practice, or just have a regular job? If you want to own a business, how do yo plan on paying off your education while not earning a steady paycheck? If working for someone else, your earning power is based on what they are willing to pay you.

Part of being paid more is understanding how therapists are paid. Do you understand the business model?

 

[PsyDr]

This all depends.

1) What is your preferred location? Size of population, SES, COL, etc?
2) What is the market rate in your preferred location? Have you called around? Looked it up?
3) What is the overall population, the base rate of mental illness, percentage of those have insurance or the means to a psychotherapist, and how many of those people want to see one?
4) How many hours are you putting in? Are you working 80hr weeks to make that? Or are you working 30? Keep in mind that billable hours are different than time at work. There is a conversion factor for even the best attorneys and physicians.
5) If you are planning on being above average, why? What factor is going to separate you from the other masters' level clinicians? Why would someone choose you over the hundreds of cheaper online options?


$100k isn't that much.

 

[Kokonaut]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

Can confirm - roughly in line with ball park that I made as a medical social worker at university in an inpatient setting. Very not glamorous and job is nearly 100% disposition related.

I can't speak to private practice, but there is a wide degree of variation between something like working at the local CSB (Quite low, you'll be fortunate to break 50K) versus other settings such as a mental health community agency where you can pull in the 60-70 range.

 

[foreverbull]

You don’t need a doctorate to make $100k in private practice, but you need marketing and networking skills, a specialty that will pull people in and set you apart from others, a good reputation, fees that make sense for your community, and willingness to play the long game (ie waiting as you build up several years to hit that level of profit). If you start out full time hours in PP, you will build up slowly and income won’t come all at once but will take awhile as you fill your schedule (point being, plan to need a second income source via spouse or 2nd job initially before you turn a decent profit). You also need to teach yourself about business expenses/costs to start and expect a lot of unpaid admin time initially as you build your website, consult, read, etc.

You can’t typically make that number off of insurance-paying clients, so cash pay only would be my recommendation for the long run. But it’s doable as long as you don’t expect to make $100k right off the bat—it will take awhile.

Keep in mind that $100k gross in PP is before business costs, taxes, retirement, health insurance, and lost pay/cost of vacations with no PTO. It’s actually closer to $60-70k before taxes but after benefits spending and business costs (for example, I spent $10k alone for health insurance for 2 people for the year—it adds up fast). Once you factor in benefits and business costs, PP starts to even out with salaried jobs more, so food for thought as you decide if it’s worth the energy and time.

 

[WisNeuro]

Do you only want to do therapy? If so, stick with the masters and start doing research about business practices and take some successful colleagues out to dinner to pick their brains.

Want to have the ability to do assessments and some high paying legal work? Doctoral degree would be the way to go. Depending on your fees, payer mix, income sources, you can do considerably better than salaried jobs, and the tax benefits are pretty substantial at certain levels. But, it takes some work/connections to get to that point depending on how business minded you are and what the local climate is for certain types of work.

 

[mindfulany]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

this is good to know! So could you expect the same salary ceiling for someone in private practice or would that differ? Thanks for the help

 

[mindfulany]

As I alluded to in the other thread just now and has been suggested by others, it really depends on what you want to do. Do you want to own your own private practice, work for someone else in private practice, or just have a regular job? If you want to own a business, how do yo plan on paying off your education while not earning a steady paycheck? If working for someone else, your earning power is based on what they are willing to pay you.

Part of being paid more is understanding how therapists are paid. Do you understand the business model?

I do not understand much of this which is why I have so many questions and am so confused. I want to eventually own my own private practice and be self-employed one day. Am I expecting to do this directly out of school or in the first year or so, absolutely not but I have the goal to one day own my own private practice which is why I’m so curious what a reasonable expectation can be salary wise and if my goal is achievable of a net income of $100k+. I was planning to go to medical school but have since begun to shy away from it and now am entering an industry I know much less about and don’t know what are reasonable expectations as much of my career research was dedicated to researching the medical field so now I’m trying to figure out the best route/degree for attaining my goals of owning my own private practice and my income goals! I’m very confused and just trying to figure out what makes the most sense for what I want to achieve and there is so much conflicting info on the Internet. Thanks for your help!

 

[Mercury in Taurus]

this is good to know! So could you expect the same salary ceiling for someone in private practice or would that differ? Thanks for the help

If it is your own private practice, you set your fee or sliding scale fees for cash clients. $$$ differ depending upon many factors, such as your location and the populations you are attracting and trained to treat. There are therapists charge $80 for a full session (53+ mins) and someone in Berkeley CA charges $200 for a 45 min session. You can look up in Psychology Today and see how much therapists charge in the area(s) you plan to practice.

 

[Mercury in Taurus]

I do not understand much of this which is why I have so many questions and am so confused. I want to eventually own my own private practice and be self-employed one day. Am I expecting to do this directly out of school or in the first year or so, absolutely not but I have the goal to one day own my own private practice which is why I’m so curious what a reasonable expectation can be salary wise and if my goal is achievable of a net income of $100k+. I was planning to go to medical school but have since begun to shy away from it and now am entering an industry I know much less about and don’t know what are reasonable expectations as much of my career research was dedicated to researching the medical field so now I’m trying to figure out the best route/degree for attaining my goals of owning my own private practice and my income goals! I’m very confused and just trying to figure out what makes the most sense for what I want to achieve and there is so much conflicting info on the Internet. Thanks for your help!

Do you have a mentor or able to connect with a mentor through the professional development assistance of your school, a local professional association, or a subdivision of a national association? It might be more beneficial for someone who is advanced in the field and owns/operates a private practice and knows you personally to guide you.

 

[R. Matey]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

I'd say it's less of a temperament thing and more of a way these jobs are structured in government agencies. Since master's level providers are only qualified to do psychotherapy, they schedules are filled to the brim with psychotherapy patients, which can be quite the treadmill leading to burnout etc...

OP: Relatedly, one factor to consider in income as a private practitioner is how many hours doing psychotherapy you can sustain in a given week. I've known some master's level folks to make ~90k in PP, but they were killing themselves to do so. Those who weren't and did well are specialized in some niche area.

 

[summerbabe]

this is good to know! So could you expect the same salary ceiling for someone in private practice or would that differ? Thanks for the help

A parallel might be the restaurant business. Why can some select restaurants sell a burger for $40 while others sell them for $4? And the average might be $10-$15? A private practice is a business ultimately so figuring out what type of niche you can fill consistently and how to do so will determine your ceiling.

 

[mindfulany]

A parallel might be the restaurant business. Why can some select restaurants sell a burger for $40 while others sell them for $4? And the average might be $10-$15? A private practice is a business ultimately so figuring out what type of niche you can fill consistently and how to do so will determine your ceiling.

This analogy makes perfect sense, so it’s really more or less how you market yourself, the quality or service you give, and the way you network more so than anything and degree really is irrelevant? Am I getting that right?

 

[mindfulany]

I'd say it's less of a temperament thing and more of a way these jobs are structured in government agencies. Since master's level providers are only qualified to do psychotherapy, they schedules are filled to the brim with psychotherapy patients, which can be quite the treadmill leading to burnout etc...

OP: Relatedly, one factor to consider in income as a private practitioner is how many hours doing psychotherapy you can sustain in a given week. I've known some master's level folks to make ~90k in PP, but they were killing themselves to do so. Those who weren't and did well are specialized in some niche area.

This is good info, what are some examples of “niche areas”? Thanks for your help!

 

[mindfulany]

Do you have a mentor or able to connect with a mentor through the professional development assistance of your school, a local professional association, or a subdivision of a national association? It might be more beneficial for someone who is advanced in the field and owns/operates a private practice and knows you personally to guide you.

I am very ignorant in this area and have been looking for something exactly like you described but don’t know where to even begin. Where or how would I find someone willing to mentor or explain the ins & outs of the local climate to me? Thanks for help!

 

[mindfulany]

If it is your own private practice, you set your fee or sliding scale fees for cash clients. $$$ differ depending upon many factors, such as your location and the populations you are attracting and trained to treat. There are therapists charge $80 for a full session (53+ mins) and someone in Berkeley CA charges $200 for a 45 min session. You can look up in Psychology Today and see how much therapists charge in the area(s) you plan to practice.

In my area on Psychology Today I see people with masters degrees charging anywhere from $70-200 for a session, most seem to be landing around $100-125 for a session, cost of living is pretty good where I live so I feel like you could do pretty good here with charging in those areas.

 

[AcronymAllergy]

I do not understand much of this which is why I have so many questions and am so confused. I want to eventually own my own private practice and be self-employed one day. Am I expecting to do this directly out of school or in the first year or so, absolutely not but I have the goal to one day own my own private practice which is why I’m so curious what a reasonable expectation can be salary wise and if my goal is achievable of a net income of $100k+. I was planning to go to medical school but have since begun to shy away from it and now am entering an industry I know much less about and don’t know what are reasonable expectations as much of my career research was dedicated to researching the medical field so now I’m trying to figure out the best route/degree for attaining my goals of owning my own private practice and my income goals! I’m very confused and just trying to figure out what makes the most sense for what I want to achieve and there is so much conflicting info on the Internet. Thanks for your help!

My short answer would be--a net income of >$100k is definitely going to be more easily attained and more of a "sure thing" via medical school. Is $100+k achievable as a masters-level practitioner? Yes. Is it the modal outcome? No.

Much can depend on aspects other folks have mentioned above, including local market factors (e.g., how many potential patients/clients are there and what are they able/willing to pay, how many other therapists are there, what services will you provide and how might they set you apart), your own business acumen and "hustle," and how much you're willing to work.

 

[mindfulany]

You don’t need a doctorate to make $100k in private practice, but you need marketing and networking skills, a specialty that will pull people in and set you apart from others, a good reputation, fees that make sense for your community, and willingness to play the long game (ie waiting as you build up several years to hit that level of profit). If you start out full time hours in PP, you will build up slowly and income won’t come all at once but will take awhile as you fill your schedule (point being, plan to need a second income source via spouse or 2nd job initially before you turn a decent profit). You also need to teach yourself about business expenses/costs to start and expect a lot of unpaid admin time initially as you build your website, consult, read, etc.

You can’t typically make that number off of insurance-paying clients, so cash pay only would be my recommendation for the long run. But it’s doable as long as you don’t expect to make $100k right off the bat—it will take awhile.

Keep in mind that $100k gross in PP is before business costs, taxes, retirement, health insurance, and lost pay/cost of vacations with no PTO. It’s actually closer to $60-70k before taxes but after benefits spending and business costs (for example, I spent $10k alone for health insurance for 2 people for the year—it adds up fast). Once you factor in benefits and business costs, PP starts to even out with salaried jobs more, so food for thought as you decide if it’s worth the energy and time.

How do you do cash pay only? The client would cover the entire cost out of pocket, is that correct? And if you do allow insurance but charge $125 a session how does that work, does the insurance company cover the whole thing or a portion and then the client pays the remainder out of pocket as the co-pay? And now much of the insurance coverage do you actually get to take home vs cash pay? Thanks!

 

[mindfulany]

This all depends.

1) What is your preferred location? Size of population, SES, COL, etc?
2) What is the market rate in your preferred location? Have you called around? Looked it up?
3) What is the overall population, the base rate of mental illness, percentage of those have insurance or the means to a psychotherapist, and how many of those people want to see one?
4) How many hours are you putting in? Are you working 80hr weeks to make that? Or are you working 30? Keep in mind that billable hours are different than time at work. There is a conversion factor for even the best attorneys and physicians.
5) If you are planning on being above average, why? What factor is going to separate you from the other masters' level clinicians? Why would someone choose you over the hundreds of cheaper online options?


$100k isn't that much.

In my area on Psychology Today I see people with masters degrees charging anywhere from $70-200 for a session, most seem to be landing around $100-125 for a session, cost of living is pretty good where I live so I feel like you could do pretty good here with charging in those areas. I live in the Midwest in a metro area but have the ability to work in city, a suburb, or more rural for whatever offers best opportunity. As for what separates me from others I am not sure yet as I am still finishing my masters, what advice or extra training would you suggest that can help separate oneself or any specific niche that’s better than another? Thanks for your help and input!

 

[Mercury in Taurus]

I am very ignorant in this area and have been looking for something exactly like you described but don’t know where to even begin. Where or how would I find someone willing to mentor or explain the ins & outs of the local climate to me? Thanks for help!

There are many more, but you can start here if seem fits:

Networking | Association for Contextual Behavioral Science

contextualscience.org

Professional group membership for psychology graduate students

Membership and involvement in professional groups and organizations can complement work conducted in the classroom or laboratory.

www.apa.org

 

[Sanman]

This analogy makes perfect sense, so it’s really more or less how you market yourself, the quality or service you give, and the way you network more so than anything and degree really is irrelevant? Am I getting that right?

Somewhat, lets take this analogy a step further. Whether you went to the best culinary school in the country or worked your way up at Dennys, a burger is a burger to some degree. People are willing to pay for nice ambiance (a nice office), but not $40 for a burger from a takeout joint just because you trained at the best culinary school. What if you were the only thai restaurant in the area (the only OCD therapist, autism therapist, etc)? How much could you charge then?

 

[PsyDr]

In my area on Psychology Today I see people with masters degrees charging anywhere from $70-200 for a session, most seem to be landing around $100-125 for a session, cost of living is pretty good where I live so I feel like you could do pretty good here with charging in those areas. I live in the Midwest in a metro area but have the ability to work in city, a suburb, or more rural for whatever offers best opportunity. As for what separates me from others I am not sure yet as I am still finishing my masters, what advice or extra training would you suggest that can help separate oneself or any specific niche that’s better than another? Thanks for your help and input!

1) Those are rhetorical questions. You have to invest the time to find the answers for yourself. McDonalds doesn't just open up a franchise in a field. They identify where they can do business through market research (e.g., median household income, education, competition). If you don't know how to do that, learn. A simple web search is not close to enough. What is the typical office rent? NNN? Overhead? Turnover? Loss? area income? Most popular employer? Educational level? Who will provide your health insurance?

2) I mean this in all kindness: If you won't spend the time to learn how to open and operate a business, do not do it. There is no one to help you once you do it. The bills will keep coming, whether you have 1000 patients or 0.

3) It's a little silly to ask for recommendations for specialties. You have to have an aptitude and interest for niches, same as choosing a general profession. It's like me asking, "Should I become a professional athlete?".

 

[Sanman]

3) It's a little silly to ask for recommendations for specialties. You have to have an aptitude and interest for niches, same as choosing a general profession. It's like me asking, "Should I become a professional athlete?".

Yes, you should become a professional badminton player. You should also send me tickets when you do.

 

[Therapist4Chnge]

In my area on Psychology Today I see people with masters degrees charging anywhere from $70-200 for a session, most seem to be landing around $100-125 for a session, cost of living is pretty good where I live so I feel like you could do pretty good here with charging in those areas. I live in the Midwest in a metro area but have the ability to work in city, a suburb, or more rural for whatever offers best opportunity. As for what separates me from others I am not sure yet as I am still finishing my masters, what advice or extra training would you suggest that can help separate oneself or any specific niche that’s better than another? Thanks for your help and input!

This is where marketing and running a profitable business will almost always top credentials....but it is all in how your pitch yourself and your services. For a lot of people, they will work a FT job for an org, and build up a private practice on the side. If/When you can carve out your area, then you can increase your referrals to your private practice. At some point it could become too much (a good problem) and then you can decide if splitting off from the FT job is the right call. This is one of the most common ways people get into private practice. Others will jump right in...but success/failure tends to have more to do with networking, business acumen, and other non-clinical considerations.

I have worked w. some great mid-level/MS folks, and they have worked across a range of areas. Most kept a small private practice on the side, particularly those who did more administrative/coordination of care work in their FT, as it allowed them to still do clinical work. Others would do contracted work for a 3rd party, so the 3rd party refers people to you, and you see them for a set fee. Some clinicians will do side work seeing EAP (employee assistance program) patients. Companies can offer 4-6 (or whatever) sessions to address specific employee problems like substance abuse, but they are meant to be time limited and specific to the problem. Some will contract out the initial sessions, and other times they will have an internal person, who then refers out after the covered sessions have been completed. This kind of work is much more likely to be through networking, but they can be good gigs. I know a number of clinicians over the years who picked up "coverage" for a few companies, so whenever an employee qualifies for services, the clinician gets sent a referral. The smartest would negotiate a payment to be "available"....so they still get $$ even if they don't get a referral for 3+ months. Again....that's much more about negotiation, as I doubt most places would offer that off of the bat...unless they have had a really hard time finding someone to take the work.

I've also seen some clinicians who work with the city/state, whether it be court-mandated or voluntary for the referred person. Again, networking helps here and it isn't something that someone fresh out of school would likely encounter. However, if you work for 1-3 years, you'll likely learn about different opportunities in your community. One of the biggest challenges is that a FT job at the MS-level tends to not pay great, but if they have good medical/retirement/benefits...it can be a good opportunity for 1-3 years to get your private practice work going.

There are other opportunities, but it really depends on what area you want to work.

 

[mindfulany]

1) Those are rhetorical questions. You have to invest the time to find the answers for yourself. McDonalds doesn't just open up a franchise in a field. They identify where they can do business through market research (e.g., median household income, education, competition). If you don't know how to do that, learn. A simple web search is not close to enough. What is the typical office rent? NNN? Overhead? Turnover? Loss? area income? Most popular employer? Educational level? Who will provide your health insurance?

2) I mean this in all kindness: If you won't spend the time to learn how to open and operate a business, do not do it. There is no one to help you once you do it. The bills will keep coming, whether you have 1000 patients or 0.

3) It's a little silly to ask for recommendations for specialties. You have to have an aptitude and interest for niches, same as choosing a general profession. It's like me asking, "Should I become a professional athlete?".

This all makes sense and see how many of my questions are difficult to answer but I wasn’t looking for direct concrete answers to any of these questions more just a little more elaboration as I am completely new to the field and just finishing my degree. I will certainly do the heavy lifting, and do my due diligence before just hopping into opening shop or deciding anything but am just trying to understand everything as much as possible and get some advice/insight from those of you already in the field who have the experience and expertise to provide any sort of feedback! I will take your advice in stride and be sure to do the appropriate research and background exploration to find what appears to be best! Thank you for your input and help, I truly appreciate all help & feedback on my journey!

 

[Mercury in Taurus]

This all makes sense and see how many of my questions are difficult to answer but I wasn’t looking for direct concrete answers to any of these questions more just a little more elaboration as I am completely new to the field and just finishing my degree. I will certainly do the heavy lifting, and do my due diligence before just hopping into opening shop or deciding anything but am just trying to understand everything as much as possible and get some advice/insight from those of you already in the field who have the experience and expertise to provide any sort of feedback! I will take your advice in stride and be sure to do the appropriate research and background exploration to find what appears to be best! Thank you for your input and help, I truly appreciate all help & feedback on my journey!

There are life coaches charge $250/session or a $3,000-5,000 monthly membership fee. There are art therapists charge a reasonable fee per session and live a fulfilling life in making difference in enhancing other lives. There are therapists struggling to fill their calendar with bookings while others have a waitlist or have to periodically close their referral portal due to high demand.

There are practitioners on my network posting Open for New Referrals announcements with their scheduling link that sound so desperately $$$ hungry. As soon as a new referral is posted in the community, there they are immediately soliciting their services. Personally, I have never referred a client to any of providers who presented to be money hungry. Not even the ones that I could not wait to transfer.

PP is a business. Even doing it part-time, it involves dedication and requires out-of-session time that is non-billable. It takes time to build your referral network, your reputation, and business goodwill. Goodwill is an intangible asset, and $$$ will come when you master what you do. We all are developing creatures. While you are still finishing your master's, this is the best opportunity to connect with your peers, professors, and supervisors. Money is a byproduct of success. Using $$$ as the measure of success probably will lead us to live an empty life (the cynical side of me speaking).

Know your strengths, limitations, and areas for growth. If you wonder what your hidden strengths are, the Highlands Ability Battery (HAB) has a free online version.

It is not about how much you can charge. Personally speaking, it is more about what kind of services that you provide, your availabilities, how may hours you are willing to work and still be able to remember the details of your patients reporting from the previous sessions...

 

[foreverbull]

How do you do cash pay only? The client would cover the entire cost out of pocket, is that correct? And if you do allow insurance but charge $125 a session how does that work, does the insurance company cover the whole thing or a portion and then the client pays the remainder out of pocket as the co-pay? And now much of the insurance coverage do you actually get to take home vs cash pay? Thanks!

You just don't get paneled on insurance and say you are cash pay only, so clients pay your full fee (i.e. $125 in your example for every session).

If you take insurance, you either take what they say they'll pay you or try to negotiate rates. It will be less than your rate, usually a lot less. It may be something like $75-$90 or so. Your clients will also pay a co-pay (like $20 out of the $80 total that you get, then insurance pays $60 and that's all you get for the session). You are not allowed to ask your clients to pay your cash pay rate as their copay to make up the difference or that would be insurance fraud. Insurance will take a lot longer for reimbursement, which is more difficult and more time-consuming to keep billing and submitting forms compared to the cash pay clients who get charged full fee the day of the session by you directly without any 3rd party.

 

[jtpesek]

Been a long time since I last logged in! I forgot how much I loved the discourse here! I own a private practice with 10 therapists - all fully licensed as LPCs in Alabama. We can see Medicaid, etc. yada yada - however in putting together those we bring on we hired former school counselors, therapists with multiple licensures and graduate degrees in various mental health fields, we hired our supervisor from the psychiatric hospital many of us trained in, we established a contract with the local police department to administer psych evals for all potential new hires (MMPI-3 Has a police specific version), we make sure to follow up with the primary care doctors of adult patients when referred and the pediatricians as well... we maintain very close referral relationships with psychiatric providers we trust, we make sure to educate ourselves on all things counseling, all thing psychology and all things current in the world of psychotropic medication and neuroscience - not because we want to scope creep - but so we can speak the same language for congruent care.

You can make well over the $100,000 mark this way - BUT this took me 12 years and a second undergraduate degree at 30 in psychology (I wanted to thoroughly understand the underpinnings of mental health) and 4 years running an opiate dependency outpatient clinic for my uncle who is a psychiatrist. I paid my dues getting the state requirement of 3,000 clinical hours seeing Medicaid patients for someone else's practice and agreed to split it 50/50 with them.

I specialized in OCD - joined the IOCDF, take CE trainings in that specialty to "actually" specialize...

Sweat equity, willingness to learn and some humility and you will get those 6 figures. Is it worth it to you? It is to me - I love going to work each day.

 

[smalltownpsych]

I just opened up a cash based private practice. As a licensed psychologist, I think I have an edge on the competition and I think the variety of training experiences and the critical thinking skills that go into becoming a psychologist are a part of that. I also spent the last ten years working for various organizations and getting paid well as I was developing more skills, knowledge, and networks. During the last 8 of those I made quite a bit over 100k and worked with and supervised a lot of MA level folk who were making between 50 to 70. Also, I don't think that trying to make it into private practice straight from school would have worked for me. So was pursuing a career as a psychologist worth it? For me it has been and if my newest venture doesn't go belly-up, then we'll see further.
Just my own little case study to add to the mix.

 

[smalltownpsych]

Master's level people I know tend to top out at around 60-70 in most of the governmental agencies I've either worked in or know of. They also tend to hate life, because usually their job is more related to dispositional issues, while the therapy (they want to do) is provided by doctoral level providers. Just food for thought.

I suspect this could vary by site (just like with everything else in government). At the handful of VAs I've worked in, masters-level folks were most commonly therapists, even if they'd actually never had any therapy experience and had very little formal training in it. Although those in other services (e.g., PM&R or other inpatient areas) might work in more of a case management role. The salary numbers you mentioned line up with what I've seen as well, though.

Just wanted to highlight these quotes because they are key to why it could make sense to go a different direction than just the cheapest quickest route to private practice. Clients that are cash pay tend to have higher expectations for experience and tend to be discriminating consumers.

 

[BuckeyeLove]

Just wanted to highlight these quotes because they are key to why it could make sense to go a different direction than just the cheapest quickest route to private practice. Clients that are cash pay tend to have higher expectations for experience and tend to be discriminating consumers.

Missed hearing from you @smalltownpsych ! Glad you've ventured back on over to the board! Your insights were incredibly helpful to me years ago, just wanted to say thank you.

 

[smalltownpsych]

Missed hearing from you @smalltownpsych ! Glad you've ventured back on over to the board! Your insights were incredibly helpful to me years ago, just wanted to say thank you.

You’re welcome and it is good to be back. My last job was very demanding and there are no no-shows in residential treatment which is when I would tend to post on here prior. Also, I was surrounded by colleagues so that community support need was met more in-person so you guys are like my fall back friends. lol 😂

 

[Sanman]

You’re welcome and it is good to be back. My last job was very demanding and there are no no-shows in residential treatment which is when I would tend to post on here prior. Also, I was surrounded by colleagues so that community support need was met more in-person so you guys are like my fall back friends. lol 😂

You really know how to make us feel wanted.

 

[smalltownpsych]

You really know how to make us feel wanted.

The truth is that I was surrounded by a lot of non-psychologist therapists with varying degrees of competence/rigorous thinking processes so it is nice to be back with my people.
I pounded my fist on the table during quite a few "case conferences" aka treatment team meetings. Fortunately, the owner had my back and was an experienced and brilliant psychiatrist. When he sold the business to eguity investors and my new boss was a non-clinician who thought they could make treatment decisions, it was time for me to go.

 

[Therapist4Chnge]

The truth is that I was surrounded by a lot of non-psychologist therapists with varying degrees of competence/rigorous thinking processes so it is nice to be back with my people.
I pounded my fist on the table during quite a few "case conferences" aka treatment team meetings. Fortunately, the owner had my back and was an experienced and brilliant psychiatrist. When he sold the business to eguity investors and my new boss was a non-clinician who thought they could make treatment decisions, it was time for me to go.

Sadly, this is happening more and more. When investment firms and other corp entities start investing in healthcare....it is almost universally bad for the clinicians...at least the good ones.

 

[Sanman]

Sadly, this is happening more and more. When investment firms and other corp entities start investing in healthcare....it is almost universally bad for the clinicians...at least the good ones.

Pretty much. I could not see returning to that environment again without a huge pay bump. There is a lot of stress and liability without the compensation to make it worth it.

 

[Therapist4Chnge]

Pretty much. I could not see returning to that environment again without a huge pay bump. There is a lot of stress and liability without the compensation to make it worth it.

There are growing opportunities out there for psychologists and psychiatrists to supervise mid-levels in these corp takeovers...but it's almost always a bad deal for the clinician between the increased liability and ratio of mid-levels per -iatry/ology provider. Most view it through an MD/DO and NP/PA model, but I don't trust them to have the infrastructure in place to do it right. Just my $0.02 based on the opportunities that have been offered to me in the past couple of years. Start-ups are trying to get into this area too, with similar pitfalls.

 

[Sanman]

There are growing opportunities out there for psychologists and psychiatrists to supervise mid-levels in these corp takeovers...but it's almost always a bad deal for the clinician between the increased liability and ratio of mid-levels per -iatry/ology provider. Most view it through an MD/DO and NP/PA model, but I don't trust them to have the infrastructure in place to do it right. Just my $0.02 based on the opportunities that have been offered to me in the past couple of years. Start-ups are trying to get into this area too, with similar pitfalls.

This was my previous job. The three issues I had (as you mention) were the supervisor to provider ratio, lack of clinical offset to properly manage everyone, and relative lack of pay. Seeing patients and managing over a dozen people paid on par to a GS-13 gig where I manage no one. Pretty much the reason I don't want a GS-14 supervisor gig either. The pay is not worth the headache. Having your own PP is a better option all around.

 

[R. Matey]

Sadly, this is happening more and more. When investment firms and other corp entities start investing in healthcare....it is almost universally bad for the clinicians...at least the good ones.

Better Help just sent me another mailing with a $2k signing bonus that went straight into the trash for basically these reasons.

 

[Sanman]

Better Help just sent me another mailing with a $2k signing bonus that went straight into the trash for basically these reasons.

How long do you need to work there to keep the $2k signing bonus? I would see one client for $2060.

 

[R. Matey]

How long do you need to work there to keep the $2k signing bonus? I would see one client for $2060.

You're not going to believe this, but the mailer doesn't stipulate.

 

[smalltownpsych]

Would you believe that I actually work for Betterhelp? While I was getting things in place for my private practice and doing a little skiing, I figured I could make a little money at the same time. I filled up unbelievably quickly and just as quickly found out that online is not the same efficacy for a number of reasons. Probably the worst aspect is how trivialized psychotherapy becomes. It was kind of weird being in peoples cars on their phones and such. I did find a few clients that benefited and it was a good learning experience. I have a couple patients left and haven’t taken a new one in a couple of months. It was sort of funny how the last several weeks I would do the online gig for three mornings and make less than I do in one session. For a minute I thought I could do it as an adjunct to my private practice but the way they pay higher for more hours just doesn’t lend itself to that. Besides I don’t like what I do being trivialized. What is sad is how many practitioners are so used to being treated that way they wouldn’t even notice.

 

[Sanman]

Would you believe that I actually work for Betterhelp? While I was getting things in place for my private practice and doing a little skiing, I figured I could make a little money at the same time. I filled up unbelievably quickly and just as quickly found out that online is not the same efficacy for a number of reasons. Probably the worst aspect is how trivialized psychotherapy becomes. It was kind of weird being in peoples cars on their phones and such. I did find a few clients that benefited and it was a good learning experience. I have a couple patients left and haven’t taken a new one in a couple of months. It was sort of funny how the last several weeks I would do the online gig for three mornings and make less than I do in one session. For a minute I thought I could do it as an adjunct to my private practice but the way they pay higher for more hours just doesn’t lend itself to that. Besides I don’t like what I do being trivialized. What is sad is how many practitioners are so used to being treated that way they wouldn’t even notice.

I, for one, am very curious about your experiences. As someone that does online therapy, I think how trivialized psychotherapy becomes is less about the medium and more about access. I have patients from my HBPC panel and those that have been waiting months coming from the MHC waitlist. Those on my panel are less serious and those waiting months are usually engaged, have few no-shows, etc. I do wonder if Betterhelp and its play on accessibility are partially to blame for the trivialization. People show up for their expensive personal trainer because they are paying a lot of money. A lot of people have a Planet Fitness membership they forgot to cancel.

 

[smalltownpsych]

I, for one, am very curious about your experiences. As someone that does online therapy, I think how trivialized psychotherapy becomes is less about the medium and more about access. I have patients from my HBPC panel and those that have been waiting months coming from the MHC waitlist. Those on my panel are less serious and those waiting months are usually engaged, have few no-shows, etc. I do wonder if Betterhelp and its play on accessibility are partially to blame for the trivialization. People show up for their expensive personal trainer because they are paying a lot of money. A lot of people have a Planet Fitness membership they forgot to cancel.

i think ease of access and the membership aspect are part of that and that is a great comparison. In my practice I am the expensive personal trainer and on the platform I feel like some guy at Planet Fitness. I definitely had and still have some clients that are using the platform productively. I do think that the online aspect puts a little more on the client or even the psychologist to create a space for the work both in time and effort. Coming to an office designed for that focus does some of that work for us.

My own clinical style and personal dynamic doesn’t lend itself naturally to the online dynamic either. If I was more of a CBT guy that used a lot of structured interventions and homework, the platform would lend itself well to that. I tend to rely on relational factors and helping clients express emotions in healthy and adaptive ways and that works better for me in vivo. Interestingly, I had the opportunity to do a little more executive coaching type of work on the platform and that is not something I had done much of prior and this was kind of fun and relatively effective in online format.

 

[foreverbull]

I, for one, am very curious about your experiences. As someone that does online therapy, I think how trivialized psychotherapy becomes is less about the medium and more about access. I have patients from my HBPC panel and those that have been waiting months coming from the MHC waitlist. Those on my panel are less serious and those waiting months are usually engaged, have few no-shows, etc. I do wonder if Betterhelp and its play on accessibility are partially to blame for the trivialization. People show up for their expensive personal trainer because they are paying a lot of money. A lot of people have a Planet Fitness membership they forgot to cancel.

This is getting a bit off topic perhaps, but certainly what doesn’t help our field is the ton of unregulated people who have “life experience” and/or “intuition” who do counseling as long as they don’t call it psychotherapy or therapy, and no one does anything about it. Thousands of people out there do counseling/coaching/relationship workshops/etc. with zero education or training. I can’t tell you how many people outside of our field consider themselves experts at counseling because “it’s just so easy to give advice and I’m good at it. My friends say I’m a natural counselor.”

Some also seek life coaches and coaches because there’s still stigma around mental health and it sounds less stigmatizing to go to a coach rather than a therapist in some social circles.

In one of the reality shows I watch, a woman who had no prior training or education held a weekend long relationship workshop because she must be an expert if she’s been in a relationship. It was infuriating to watch her host it.

All of this encroachment from people without education and training trivializes our field and makes it seem like you don’t need any training or expertise to do it. It makes it seem like therapy is easy. I don’t think this helps with our image, and I wish that state boards would do more about this problem because it is so widespread.

 

[R. Matey]

Would you believe that I actually work for Betterhelp? While I was getting things in place for my private practice and doing a little skiing, I figured I could make a little money at the same time. I filled up unbelievably quickly and just as quickly found out that online is not the same efficacy for a number of reasons. Probably the worst aspect is how trivialized psychotherapy becomes. It was kind of weird being in peoples cars on their phones and such. I did find a few clients that benefited and it was a good learning experience. I have a couple patients left and haven’t taken a new one in a couple of months. It was sort of funny how the last several weeks I would do the online gig for three mornings and make less than I do in one session. For a minute I thought I could do it as an adjunct to my private practice but the way they pay higher for more hours just doesn’t lend itself to that. Besides I don’t like what I do being trivialized. What is sad is how many practitioners are so used to being treated that way they wouldn’t even notice.

I think some of that can be chalked up to the plethora of poorly trained and desperate midlevels and FPPS grads out there that are socialized to believe that this is what clinical work is always like based on their practica and internship experiences. It is sad for the clinicians and the people they serve, both deserve better.