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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[WisNeuro]

1) Not the average or median outcome with a master's, but possible.
2) Depends on how good of a businessperson you are and how saturated your market is at the moment.

 

[chicandtoughness]

I’m a masters level therapist. I see 20 patients a week (this is “part time” for me and I also hold a salaried day job) and take in $120-180 per patient (depending on if insurance or not). You do the math.

PhD is not really worth it from a purely $$$ perspective (lots of other great reasons to pursue though!) Very rarely are patients willing to cash pay much more for a doctorate. Insurance pays a laughably small amount more (like $25 more per session). If all you want to do is private practice, get your masters and get out there working. With a PhD you’re losing out on 5-6 years of earning potential, compared with 2-3 for masters.

 

[WisNeuro]

I’m a masters level therapist. I see 20 patients a week (this is “part time” for me and I also hold a salaried day job) and take in $120-180 per patient (depending on if insurance or not). You do the math.

PhD is not really worth it from a purely $$$ perspective (lots of other great reasons to pursue though!) Very rarely are patients willing to cash pay much more for a doctorate. Insurance pays a laughably small amount more (like $25 more per session). If all you want to do is private practice, get your masters and get out there working. With a PhD you’re losing out on 5-6 years of earning potential, compared with 2-3 for masters.

If OP only wants to do therapy, I agree, PhD not worth it. If they were interested in assessment, where people will definitely cash pay for sooner availability, particularly with peds, then it can be more than worth it. Also opens up the door for IME/legal work, where you will out earn many physicians. Though, for that latter kind of work, you have to have the stomach for it.

 

[mindfulany]

If you don’t mind me asking, why do you only do it part-time? That sounds like great pay and gives me some inspiration as the license I’m getting is LMHC as well! Also is this in your own private practice or at a group practice? Thanks for your help, haven’t met a lot of LMHC’s so to talk to one who is successful makes me optimistic!

 

[chicandtoughness]

If you don’t mind me asking, why do you only do it part-time? That sounds like great pay and gives me some inspiration as the license I’m getting is LMHC as well! Also is this in your own private practice or at a group practice? Thanks for your help, haven’t met a lot of LMHC’s so to talk to one who is successful makes me optimistic!

Group practice. Don’t have time for all that billing and admin stuff (I say this partially in jest, I used to be an office manager/biller for a psych clinic so I know what it’s like).

I get burnt out on 1:1 therapy very fast and I work solely with ED patients (typically adolescents) so the workload leaks outside of the face to face sessions quite often. I also have a day job that I love, pays well, has flexible hours. I’m basically double-jobbing to pay off debt faster. I do not plan to do private practice long term.

 

[Lukewarm Counselor]

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

I believe this was discussed elsewhere in a recent thread. But people should understand that counseling and clinical psychology are two entirely separate professions. It is not a natural progression (at all) to move from a master's in counseling to a doctorate in clinical psychology. At best, the master's in counseling degree may help shave off a few months of the doctorate degree in SOME cases. Just understand that if you enroll in a clinical psyche doctorate program, you can expect to spend another 4-6+ years in school and also expect whatever debt is associated with the program. I do not say this to discourage anyone. It is just important for people to understand that making the jump from counseling to clinical psychology pretty much means flushing the counseling (master's) degree, and all the money invested into it, down the drain. It makes zero sense to get a master's in counseling degree first if one's end goal is to practice psychology. (Unless time and money are no object to them.)

So, for other students/future clinicians out there: the moral of this story is that you need to choose which route you take before enrolling in a graduate program.

The natural trajectory for counselors is the doctorate degree in counselor education and supervision (CES) via CACREP. But this degree does not qualify providers to bill higher rates. (We remain licensed at the master's level.) This degree mostly focuses on preparing experienced counselors to teach the next generation in academic settings. Depending on the specific program and its area of emphasis, it may also include significant training in advanced clinical techniques and theories of counselor supervision. (i.e., it can be useful for clinical directors.)

I strongly encourage newer counselors to embrace their new careers as mid-level practitioners. Get a few years of experience under your belt. Seek out great supervision in your area and find a niche area of true passion in which to specialize. Look for fellowship opportunities (if you are able to relocate). There are plenty of fantastic mid-level providers out there making good money. In the world of PP, cash-paying clients expect superior services and content knowledge. They could care less about the provider's title(s) or where they went to school.

 

[WisNeuro]

I believe this was discussed elsewhere in a recent thread. But people should understand that counseling and clinical psychology are two entirely separate professions. It is not a natural progression (at all) to move from a master's in counseling to a doctorate in clinical psychology. At best, the master's in counseling degree may help shave off a few months of the doctorate degree in SOME cases. Just understand that if you enroll in a clinical psyche doctorate program, you can expect to spend another 4-6+ years in school and also expect whatever debt is associated with the program. I do not say this to discourage anyone. It is just important for people to understand that making the jump from counseling to clinical psychology pretty much means flushing the counseling (master's) degree, and all the money invested into it, down the drain. It makes zero sense to get a master's in counseling degree first if one's end goal is to practice psychology. (Unless time and money are no object to them.)

Just be careful with wording here, as there are counseling psychology doctoral programs that operate very similarly, and ins some cases indistinguishable from clinical psych doctoral programs.

And, as for debt, largely depends on the funding level of the program as well as the CoL of the area. At least according to the last comprehensive salary/debt survey, about a third of clinical/counseling psych grads had zero debt related to their graduate work.

Otherwise, I definitely agree that prospective students need to crunch the numbers and do some digging into what they actually want to do before embarking down a particular path.

 

[foreverbull]

This seems to be double-posted in the mental health and psychology forums. It was discussed at length in the psychology forum:

Private Practice Income- Masters Vs Doctorate

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...

forums.studentdoctor.net

 

[R. Matey]

Just be careful with wording here, as there are counseling psychology doctoral programs that operate very similarly, and ins some cases indistinguishable from clinical psych doctoral programs.

Additionally, some Ph.D. programs in counseling psychology assume a master's degree in counseling upon entry. These are becoming fewer in number as the years go on given the one-sided infighting between the orgs that govern counseling and psychology, but they do exist.

The natural trajectory for counselors is the doctorate degree in counselor education and supervision (CES) via CACREP. But this degree does not qualify providers to bill higher rates. (We remain licensed at the master's level.) This degree mostly focuses on preparing experienced counselors to teach the next generation in academic settings. Depending on the specific program and its area of emphasis, it may also include significant training in advanced clinical techniques and theories of counselor supervision. (i.e., it can be useful for clinical directors.)

I wouldn't call it a natural progression, but more of a requirement if you want to teach in a CACREP program. I think the "natural" progression from a master's in counseling is to be licensed as an LPC and see people for psychotherapy. That's what is meant by terminal master's degree.

 

[biomom]

I’m a master’s level clinician in my own private pay private practice. My goal is 20 clients a week. I’m halfway there. I charge $75/hr. I won’t make that unless I get paneled with more insurance companies, raise my rates, or see more clients. I teach social skills 4 evenings a week, so I’ll leave it at 20. It is great fun. I once thought of getting a PhD, but am happy now.

 

[chicandtoughness]

I’m a master’s level clinician in my own private pay private practice. My goal is 20 clients a week. I’m halfway there. I charge $75/hr. I won’t make that unless I get paneled with more insurance companies, raise my rates, or see more clients. I teach social skills 4 evenings a week, so I’ll leave it at 20. It is great fun. I once thought of getting a PhD, but am happy now.

Are you fully licensed? $75/hr is pretty low, don't sell yourself short!

 

[biomom]

Are you fully licensed? $75/hr is pretty low, don't sell yourself short!

I’m fully licensed. I had a hard time getting clients in the beginning. So far, I’m only paneled with one insurance company. I was turned down by the top 3 for doing telehealth only. Very frustrating.

 

[lily_pad]

Group practice. Don’t have time for all that billing and admin stuff (I say this partially in jest, I used to be an office manager/biller for a psych clinic so I know what it’s like).

I get burnt out on 1:1 therapy very fast and I work solely with ED patients (typically adolescents) so the workload leaks outside of the face to face sessions quite often. I also have a day job that I love, pays well, has flexible hours. I’m basically double-jobbing to pay off debt faster. I do not plan to do private practice long term.

Do you mind if I ask you what your other part-time job is? I'm still in grad school but starting to think about options for when I'm building my private practice and will probably need to work another job until I get enough clients.

 

[chicandtoughness]

Do you mind if I ask you what your other part-time job is? I'm still in grad school but starting to think about options for when I'm building my private practice and will probably need to work another job until I get enough clients.

My other job is full time. I do utilization review for a nationally known chain of behavioral health facilities.

 

[foreverbull]

My other job is full time. I do utilization review for a nationally known chain of behavioral health facilities.

This is like a unicorn job in our field! There are probably only hundreds of these jobs nationally at most. It's quite a hard niche to get into, it seems.

 

[WisNeuro]

This is like a unicorn job in our field! There are probably only hundreds of these jobs nationally at most. It's quite a hard niche to get into, it seems.

This jobs are quite variable. Some of these jobs are good, some pay pretty meh rates. I did this for a while for a national carrier, but have since moved on to more lucrative work in terms of hourly compensation.

 

[lily_pad]

This is like a unicorn job in our field! There are probably only hundreds of these jobs nationally at most. It's quite a hard niche to get into, it seems.

What is utilization review exactly?

 

[R. Matey]

What is utilization review exactly?

URs are internal audits done by clinicians employed by insurance companies to ensure that providers are only billing for services that are medically necessary.

 

[MAClinician]

URs are internal audits done by clinicians employed by insurance companies to ensure that providers are only billing for services that are medically necessary.

I’ve also seen UR occur to authorize higher level of care (inpatient facilities, detox, diversion care etc) and those positions have been filled by licensed masters providers in my state at least.

 

[R. Matey]

I’ve also seen UR occur to authorize higher level of care (inpatient facilities, detox, diversion care etc) and those positions have been filled by licensed masters providers in my state at least.

Yeah, in the larger systems where I've worked, the team that is responsible for the audits are also responsible for authorizing specialty services.

 

[chicandtoughness]

I work on the facility side, not the payor side, which means life is much more cushy and not a call center environment. I used to do UR with UHC/Optum and it sucked. You were on the clock (literally, there was a timer on your computer) and monitored with everything you did to meet productivity standards. Nowadays I work with the facility to request pre-auths and conduct concurrent reviews, and most days I’m putting in 4-5 hours of work but getting paid for a full 8 (it’s salaried). Not sky high compensation, but for the effort put in, it is niiiiiice.

 

[orion.x]

I’m a masters level therapist. I see 20 patients a week (this is “part time” for me and I also hold a salaried day job) and take in $120-180 per patient (depending on if insurance or not). You do the math.

PhD is not really worth it from a purely $$$ perspective (lots of other great reasons to pursue though!) Very rarely are patients willing to cash pay much more for a doctorate. Insurance pays a laughably small amount more (like $25 more per session). If all you want to do is private practice, get your masters and get out there working. With a PhD you’re losing out on 5-6 years of earning potential, compared with 2-3 for masters.

Do you take all of the income or do you work for a practice and split?

 

[chicandtoughness]

Do you take all of the income or do you work for a practice and split?

I run my own practice and take home everything as income after business expenses.
Working for a practice is only worth it if you don't think you can get enough referrals on your own (and even then, anything lower than 70/30 split is something you should RUN from, and fast). In this current landscape, I wouldn't worry about not getting enough referrals. I get at least 10 Psychology Today requests a week. I do specialize in two niches (eating disorders and OCD) that help my referrals a lot.

 

[psychma]

I have my MA and make $125 private pay. I work about 30-35 hours a week right now.