The decline of the field is accelerating!

[edieb]

---

Members don't see this ad.

I hate to be negative but I also think it is so important to post objective data on the field as a cautionary tale to people considering the field or at least to give them objective data. The latest Optum insurance fee schedule was released recently and the difference between a Ph.D. and an LMFT/LCSW is LESS than $5 per half hour for therapy and LESS than $21 for an assessment.

If you are an employer, there is really no reason to pay a PhD psychologist now because PhDs can't generate the revenue.

On the other hand, the difference between a psychiatrist > prescribing psychologist > nurse practitioner is huge as you can see on here.

Here is the schedule:

https://www.optumhealthnewmexico.co..._FFS_MCO_Practitioner_Fee_Schedule_1-1-13.pdf

 

[PHD12]

We need data that shows that PhD level providers reduce long-term MH utilization costs, including repeat hospitalizations, long-term intensive treatment. Someone needs to do this type of research.

 

[bcliff]

I hate to be negative but I also think it is so important to post objective data on the field as a cautionary tale to people considering the field or at least to give them objective data. The latest Optum insurance fee schedule was released recently and the difference between a Ph.D. and an LMFT/LCSW is LESS than $5 per half hour for therapy and LESS than $21 for an assessment.

If you are an employer, there is really no reason to pay a PhD psychologist now because PhDs can't generate the revenue.

On the other hand, the difference between a psychiatrist > prescribing psychologist > nurse practitioner is huge as you can see on here.

Here is the schedule:

https://www.optumhealthnewmexico.co..._FFS_MCO_Practitioner_Fee_Schedule_1-1-13.pdf

It seems like the only areas where PhD's are competitive as compared to MD's compensation wise, is when it comes to assessment. In my own experience, assessment is really the only clinical practice that psychologists have been able to protect from encroachment, and this data begs the question of whether we should try and save ourselves across the board, or fight specifically for psych assessment and become more of a first responser who evaluates and refers either to an LPC or LCSW for therapy or MD or NP for medication management. Obviously, clinical psychologists have more than enough training to evaluate, determine treatment, and provide treatment in one swift motion, but with dwindling reimbursement rates, I don't see how psychologists can remain this 'all in one' provider.

 

[Member6523]

So is neuropsychology to be the last buoy bobbing across an ocean of failure?

 

[AcronymAllergy]

So is neuropsychology to be the last buoy bobbing across an ocean of failure?

I know people who seem to be having success in various other specialty areas (e.g., health/med psych, forensics, rehab, eating disorders, trauma). I think what might be going by the wayside is the idea of just doing "general adult clinical psychology," though. The small private practice setup also sounds like it could become unsustainable, although I think that's an across-the-board situation.

As for reimbursement rates, yeah, we're getting slammed. I'm really not sure what will end up stemming that tide unless we start doing a much better job of advocating and legislating for our profession.

 

[edieb]

we need to get added to the physician medicare definition asap. also, a PhD earns around $19 more for assessment than an LPC. I would hardly call us "competitive" with counselors in regards to this area....? When these codes were issued last year, psychologists earned $11 more/hour for therapy and $30 more for assessments, so it has been cut again.

 

[Sanman]

There are other reasons to keep psychologists around as well (legal ones) in some settings. I do agree that the small general private practice is in danger. However, I have never seen that as a sustainable model. I do see psychologists as gaining supervisory positions over masters level clinicians similar to the physician/nurse model. However, the private practice psychologist-therapist will continue to decline with the exception of private pay clients.

 

[KillerDiller]

I'm not a fan of the idea of abandoning the provision of therapy to masters-level folks. I have a lot of respect for the MSW, specifically because it often includes a lot of advocacy training that we do not get in clinical psych programs. However, my experiences have made me dubious about how much preparation any masters program can provide students when it comes to doing therapy for SMI or even clinical populations in general. I think they can do and do do great supportive therapy. I also think they can do very well at leading psycho education groups. That being said, doctoral training in psychology involves a lot more than that--we are trained to select evidence-based approaches and deliver them in a theory-consistent manner while still being flexible to individualized client needs. This involves a lot of time in training. So, I think we should continue to fight for higher reimbursement for therapy and maybe for distinctions in pay grade between supportive/adjuct therapy and therapy as a primary treatment method that is called for given the client's dx.

 

[Therapist4Chnge]

So is neuropsychology to be the last buoy bobbing across an ocean of failure?

No. Neuropsychology is under siege from the insurance side (more and more exclusions and slashed reimbursement rates) as well as from lesser trained providers (neurologists buying a computer program and calling the canned report a neuropsych report, generalists attempting to do neuropsych assessmnet "on the side", midlevel providers trying to encroach on assessment work, etc). The "average" neuropsychologist is still having to fight w. insurance companies to scratch out a decent living.

Most assessment-based work is in a better position than most/all therapist-based work, though it is far from a solid plan. Forensic assessment (NGRI/psych, child custody), neuro assessment, and pain/transplant/med-based assessment are all decent options. However, they all carry higher risks for things like malpractice and stress. They also all require more years of training (typically a fellowship) to be viewed as competitive. There are still some areas of therapy worth considering (from a financial perspective), but they almost all require a "cash only" model that limits you to the small segment of the population that can afford it...and the work is typically in areas that most people actively avoid (e.g. eating disorders).

 

[edieb]

I was really floored when I saw the new fee schedules. The difference in reimbursement between PhDs and LPCs/LCSWs has shrunk even more in the last year or so. I am predicting by next year, there will be no difference in therapy rates between psychologists and master-level clinicians. I am very lucky to have RxP because these rate changes don't affect me and I actually received a sizable raise as far as insurance reimbursement goes, and I was already billing approximately $230 an hour. However, I would like to see the whole profession, not only the prescribing side, doing well!

 

[voyeurofthemind]

I'm not a fan of the idea of abandoning the provision of therapy to masters-level folks. I have a lot of respect for the MSW, specifically because it often includes a lot of advocacy training that we do not get in clinical psych programs. However, my experiences have made me dubious about how much preparation any masters program can provide students when it comes to doing therapy for SMI or even clinical populations in general. I think they can do and do do great supportive therapy. I also think they can do very well at leading psycho education groups. That being said, doctoral training in psychology involves a lot more than that--we are trained to select evidence-based approaches and deliver them in a theory-consistent manner while still being flexible to individualized client needs. This involves a lot of time in training. So, I think we should continue to fight for higher reimbursement for therapy and maybe for distinctions in pay grade between supportive/adjuct therapy therapy as a primary treatment method that is called for given the client's dx.

This sums it all up 👍

I have often found most master's level clinicians in their own works just want to to "help people" and find research "icky". When asked about what journals they read on a regular basis to stay informed and abreast I get blank looks and crickets. I continued on with a doctorate despite having a master's where I could practice because I realized I still had no idea what I was doing.

 

[docma]

I agree with the posters who are pointing to competencies in professional psychology that are not emphasized enough in training--but are where PhD/PsyD credentials can be applied and where jobs continue to exisit: program evaluation, management and administration, implementation of EBP, outcomes-based research on effectiveness of treatments, consultation, etc. The degree has versatility--but the hyper-focus on individual treatment/private practice--has skewed training programs and what students think they want when they enter academic programs. The skills needed when they exit are not necessarily where the emphasis has been in coursework--and plenty of other degrees teach basic counseling/therapy skills for direct service positions.

 

[Rivi]

I'm not a fan of the idea of abandoning the provision of therapy to masters-level folks. I have a lot of respect for the MSW, specifically because it often includes a lot of advocacy training that we do not get in clinical psych programs. However, my experiences have made me dubious about how much preparation any masters program can provide students when it comes to doing therapy for SMI or even clinical populations in general. I think they can do and do do great supportive therapy. I also think they can do very well at leading psycho education groups. That being said, doctoral training in psychology involves a lot more than that--we are trained to select evidence-based approaches and deliver them in a theory-consistent manner while still being flexible to individualized client needs. This involves a lot of time in training. So, I think we should continue to fight for higher reimbursement for therapy and maybe for distinctions in pay grade between supportive/adjuct therapy and therapy as a primary treatment method that is called for given the client's dx.

Agree 100%

As for edieb's post, what is interesting is how much more MD providers make as compared to Ph.D. providers when doing psychotherapy. I am unaware of any research that suggests that MD/DO providers produce better outcomes. My point is, the insurance companies don't seem to compensate based on outcomes, but by some other criteria?

 

[KillerDiller]

The skills needed when they exit are not necessarily where the emphasis has been in coursework--and plenty of other degrees teach basic counseling/therapy skills for direct service positions.

Doesn't this suggest that students in doctoral programs only learn basic counseling/therapy skills, and that we actually don't have more training than masters-level folks when it comes to providing this treatment? Based on my contact with the two fields, I don't see this as the case.

Basically, we have evidence that therapy is the first-line treatment for plenty of disorders--OCD, phobia, PTSD, etc. We have also demonstrated that it is a major part of effective treatment for other disorders--e.g. depression and eating disorders. I don't think we should cede this territory as being something that masters-level folks are just as competent at providing. I'd really like to see psychologists advocate for therapy to be compensated as a primary treatment for the things it really should be the primary treatment for.

 

[edieb]

I agree with the posters who are pointing to competencies in professional psychology that are not emphasized enough in training--but are where PhD/PsyD credentials can be applied and where jobs continue to exisit: program evaluation, management and administration, implementation of EBP, outcomes-based research on effectiveness of treatments, consultation, etc. The degree has versatility--but the hyper-focus on individual treatment/private practice--has skewed training programs and what students think they want when they enter academic programs. The skills needed when they exit are not necessarily where the emphasis has been in coursework--and plenty of other degrees teach basic counseling/therapy skills for direct service positions.

I cannot imagine that there are enough supervisor-level jobs to employee the 5000 psychologists being minted a year and the ones already out in the field. Additionally, many agencies will hire master-level cliniciansas deparment heads. When I was working at the V.A., a LCSW was the head. Point being: unless there is some adverse consequence, employers will hire the labor they can make the most from to fill any position. They hire prescribers and push meds as the first line treatment because prescribing generates more revenue than therapy, etc. A psychologist as a department head will not generate any more revenue for the department than a LCSW so I think the writing is on the wall there, too.

 

[WisNeuro]

Agree 100%

As for edieb's post, what is interesting is how much more MD providers make as compared to Ph.D. providers when doing psychotherapy. I am unaware of any research that suggests that MD/DO providers produce better outcomes. My point is, the insurance companies don't seem to compensate based on outcomes, but by some other criteria?

Relative to other medical/mental health fields, the AMA has substantially more lobbying power. Money talks. AMA pays off politicians, and they make sure that MD's are the least affected when cuts come around.

 

[Ollie123]

I think the key is (and always will be) in what you can offer that is different from everyone else. That difference can be in quality (i.e. provide higher-quality therapy) or in the nature of service (i.e. better equipped to track/analyze outcomes). This is why specialists are still somewhat able to survive while generalists seem to be getting hit particularly hard. Of course, you also need to be able to prove what you offer is both useful and economically worthwhile. We can yell and scream all we want about how we're better than MA level folks at therapy but until we can prove we're better AND better by a wide enough margin for it to be worth paying us more...we'll be constantly fighting a losing battle against market forces. When psychology itself is continuing to blur the lines between us and mid-levels by continuing to drive down standards with regards to the things that DO differentiate us...declining salaries seem inevitable as not only are we unable to earn more through patient-care, we're less able to argue we bring other skills beyond direct care to the table. Of course, add to this the fact that the whole model of healthcare in the US is a completely unsustainable mess and things get more complicated - billing for (non-mental-health) medical care is laughably over-inflated and I'm sure this "bubble" will be popping sometime in the not-too-distant future as well. What that will mean for us, I have no idea.

As for what to do about it - I think we need some more dramatic re-invention of what being a psychologist means. I think we've been too caught up in "psychologist=therapist" forgetting that therapy isn't really "ours" (it actually came from us encroaching on psychiatrists and they essentially abandoned it as psych meds came about) and it shouldn't be how we define our profession. Yes, we absolutely should learn it but it shouldn't be the central end-all be-all it seems to have become in psychology training. Anything short of dramatic re-invention seems the proverbial band-aid on the broken limb that might get us another decade (at best) before we're back in the same boat. For better or worse, PCSAS and the Delaware project seem to be thinking in that direction (though are certainly not without flaws) - I think in the long-run that's going to lead to more success and better sustained success for psychologists (at least from that type of program) than anything else.

 

[PHD12]

I tOWe can yell and scream all we want about how we're better than MA level folks at therapy but until we can prove we're better AND better by a wide enough margin for it to be worth paying us more...we'll be constantly fighting a losing battle against market forces. .

As others have mentioned, I don't think we need to give up on being experts at therapy. We have all seen HUGE differences between MA and PhD level providers in terms of their ability to utilize EBT in a flexible manner, conceptualize cases in complex ways, manage the most difficult cases/group situations, lead treatment teams, be up to date on the latest research etc. I have seen very few MA level providers who actually know how to use CBT and other evidence-based treatments and get good results with patients. From my experience, they are also not as adept at managing the most complex cases because very few have good training and expertise in DBT, motivational interviewing etc. The more difficult the case, the more helpful it is to have extensive training and expertise, which psychologists are more likely to have. Obviously there are exceptions to this so i don't want to generalize. It would be easy to demonstrate differences in patient outcomes (including drop out rates) if someone was willing to do the research and had the resources. There are differences and it makes sense because most MA level providers are not actually trained as therapists (e.g., many social work programs focus on case management/policy not therapy), and our length of training is easily double what they go through. This is all anecdotal so until we have data I can't prove anything.

Anecdotally, i have inherited many patients from MA level providers and more often than not the patients seem to think that it was normal for the therapist to talk about himself, give advice, tell the patient what to do or just listen most of the session. This was also my experience in co-leading "CBT" groups with MA providers. Most of the time they were giving advice and many seemed to break down during the most difficult patient situations (e.g., kicking patients out of group or getting really silent/uncomfortable). On the other hand, the psychologist supervisors i've had seem to be able to manage very complicated situations in groups. They are not perfect and can make mistakes, but seem to have developed much more flexible clinical skills to weather these types of situations. As killer diller mentioned, they should be providing the supportive therapy while the psychologists should be billing more for the specialized treatments (e.g., CBT, DBT, exposure). I am not trying to put any other profession down, but MD's and nurses have different scopes of practice and are paid on a different scale as well.

I realize that what i'm saying is going to be unpopular and controversial, but I am speaking honestly based on my own experiences and have met many colleagues who have observed these differences as well.

 

[Ollie123]

Oh I'm not advocating we give up on it. I'm just making the point that saying "We should be paid more" isn't going to get us much traction unless we can provide tangible reasons why we should be paid more for the "same job" (in the eyes of a businessman). More training isn't sufficient unless we can show we use that training for something. I'm not questioning that we do, I'm questioning our methods of advocacy. I don't think I'm alone in believing we generally do a piss-poor job of making our case for higher pay even when we can get our collective acts together enough to advocate for something.

I realize my note that "Psychologist = therapist" was somewhat unclear. To clarify - I'm not suggesting we should not be therapists. I am suggesting that broadly, our training model has moved in the direction of counselor-level training. Anyone leaving grad school with no skills beyond therapy (even if they're very good at it) should be ashamed. I'm trying to dance around the FSPS issue to avoid rehashing that discussion here too, but I think its related. We're pushing people into the field with no understanding of science, no respect for (or knowledge of) EBP. The training model (nationally) is increasingly moving towards psychologists as "therapy technicians" rather than engineers. Our training is (or at least once was) pretty darn unique in the healthcare field. Rather than capitalizing on that, we seem to be moving towards becoming just like everyone else while relying on brand-name (i.e. profession-name) recognition to justify a higher salary. I promise you right now, that strategy ain't gonna work. We might win a battle here and there but we'll lose the war.

 

[KillerDiller]

Oh I'm not advocating we give up on it. I'm just making the point that saying "We should be paid more" isn't going to get us much traction unless we can provide tangible reasons why we should be paid more for the "same job" (in the eyes of a businessman). More training isn't sufficient unless we can show we use that training for something. I'm not questioning that we do, I'm questioning our methods of advocacy. I don't think I'm alone in believing we generally do a piss-poor job of making our case for higher pay even when we can get our collective acts together enough to advocate for something.

PhD12's post above closely matches my own experiences and impressions of the differences between the training models when it comes to therapy. (Again, I have great respect for the MSW, but think it equips graduates to perform a different role in treatment than the PhD does.) I also agree with Ollie on this point. Clearly, we need a better lobbying arm for the profession and we need research to back up some of the anecdotal points about our comparative skills. I think, too, psychologists as individuals need to be better about stepping up and talking about our skill set in a confident manner. Business people are great at this, but my experience is that psychologists tend to defer to the expertise of other doctoral-level providers and give non-committal answers even when there is research to back up what they're saying. Nobody is going to believe we do competent work unless we act like we do within our treatment settings.

 

[xXIDaShizIXx]

PhD12's post above closely matches my own experiences and impressions of the differences between the training models when it comes to therapy. (Again, I have great respect for the MSW, but think it equips graduates to perform a different role in treatment than the PhD does.) I also agree with Ollie on this point. Clearly, we need a better lobbying arm for the profession and we need research to back up some of the anecdotal points about our comparative skills. I think, too, psychologists as individuals need to be better about stepping up and talking about our skill set in a confident manner. Business people are great at this, but my experience is that psychologists tend to defer to the expertise of other doctoral-level providers and give non-committal answers even when there is research to back up what they're saying. Nobody is going to believe we do competent work unless we act like we do within our treatment settings.

Honestly though, just like the NPs in the medical profession, why hire someone with a doctorate when you can hire someone that that "seems" to do the same job? The bottom line will always be money especially with no oversight. Regardless of the effects on the patient/client.

 

[Therapist4Chnge]

I think, too, psychologists as individuals need to be better about stepping up and talking about our skill set in a confident manner. Business people are great at this, but my experience is that psychologists tend to defer to the expertise of other doctoral-level providers and give non-committal answers even when there is research to back up what they're saying.

As a profession we need to educate and actively promote our expertise because most people have no idea what we do. In regard to deferring to other providers or giving a "wishy-washy" answer....this is the #1 complaint I hear from my physician referrals about our field. I work with a neurosurgeon who literally wants 1-3 sentences in my summary statement that clearly states my professional opinion about whether he should operate on the patient. He told me that he is the expert in his OR and I am the expert in my office. Too many psychologists shrink when they should shine, especially when we have SOLID RESEARCH to inform our diagnosis/recommendations/interventions.

Honestly though, just like the NPs in the medical profession, why hire someone with a doctorate when you can hire someone that that "seems" to do the same job? The bottom line will always be money especially with no oversight. Regardless of the effects on the patient/client.

At a complete minimum every psychologist needs to know their gross billing, net billing, and overhead cost. If you do not know these numbers then you are taking a knife to a gun fight.

 

[AcronymAllergy]

As a profession we need to educate and actively promote our expertise because most people have no idea what we do. In regard to deferring to other providers or giving a "wishy-washy" answer....this is the #1 complaint I hear from my physician referrals about our field. I work with a neurosurgeon who literally wants 1-3 sentences in my summary statement that clearly states my professional opinion about whether he should operate on the patient. He told me that he is the expert in his OR and I am the expert in my office. Too many psychologists shrink when they should shine, especially when we have SOLID RESEARCH to inform our diagnosis/recommendations/interventions.

I would agree, although also I'd caution it by saying that sometimes, we need to inform the referral source as to A) what constitutes an appropriate referral, and B) what sorts of answers we can actually provide. Sometimes, providers/referrers want something from us that we aren't able to give, and so it falls to us to inform these folks when that's the case. Conversely, it also falls to us to tailor our answers so that they're actually of use to the referral source and patient alike.

 

[socaldeb]

I hate to be negative but I also think it is so important to post objective data on the field as a cautionary tale to people considering the field or at least to give them objective data. The latest Optum insurance fee schedule was released recently and the difference between a Ph.D. and an LMFT/LCSW is LESS than $5 per half hour for therapy and LESS than $21 for an assessment.

If you are an employer, there is really no reason to pay a PhD psychologist now because PhDs can't generate the revenue.

On the other hand, the difference between a psychiatrist > prescribing psychologist > nurse practitioner is huge as you can see on here.

Here is the schedule:

https://www.optumhealthnewmexico.co..._FFS_MCO_Practitioner_Fee_Schedule_1-1-13.pdf

That is a Medicaide fee schedule which in most states is the lowest form of reimbursement. Private ins. carriers pay more- Medicare likely pays more

 

[Doctor Eliza]

That is a Medicaide fee schedule which in most states is the lowest form of reimbursement. Private ins. carriers pay more- Medicare likely pays more

That isn't my experience. It looks similar to many insurance payments that I receive (high $60's to low $70's.) Additionally, private insurers take their cues from Medicaid and Medicare. They reduce reimbursement, so does everyone else.

Dr. E

 

[paramour]

I'm not a fan of the idea of abandoning the provision of therapy to masters-level folks. I have a lot of respect for the MSW, specifically because it often includes a lot of advocacy training that we do not get in clinical psych programs. However, my experiences have made me dubious about how much preparation any masters program can provide students when it comes to doing therapy for SMI or even clinical populations in general. I think they can do and do do great supportive therapy. I also think they can do very well at leading psycho education groups. That being said, doctoral training in psychology involves a lot more than that--we are trained to select evidence-based approaches and deliver them in a theory-consistent manner while still being flexible to individualized client needs. This involves a lot of time in training. So, I think we should continue to fight for higher reimbursement for therapy and maybe for distinctions in pay grade between supportive/adjuct therapy and therapy as a primary treatment method that is called for given the client's dx.

The last place I worked relied solely on MA (and even BA) level folks to provide therapy services. There was a "special team" for the SPMI population that I was asked to start meeting with on a regular basis--to consult with re: the most appropriate treatment/assessment services, revise rehabilitation and recovery goals, etc. I eventually was asked to consider presenting a workshop/seminar on diagnosing clients. Why? Because their MASTER's LEVEL clinicians felt uncomfortable diagnosing anyone. And the ones who did feel comfortable were often blatantly wrong. Everyone who had a hallucination was schizophrenic. Hell, the number of children who were referred to me with schizophrenia was absolutely amazing... particularly when you started listening to what they considered "hallucinations." 🙄 Person had a traumatic experience. Perhaps we should consider PTSD? Nope. They have ... <drumroll> ... depression disorder NOS, ADHD, or a LD. Um, say, what? Clinicians would only consider one symptom and immediately diagnose someone. Or they would diagnose someone with oooh, half a dozen diagnoses. Even when presented with evidence that a client did not meet diagnosis for oh, say mental ******ation, or autism, or fill in whatever random diagnosis they pulled out of their arse, they refused to believe it, kept in the chart, and continued referring to it. It was absolutely ridiculous.

There were a few WONDERFUL therapists there. They were FEW and far between (not that it did their clients any good when you often couldn't be seen but once every three months, if you were lucky). The decent therapists were way the hell overworked, underpaid, and looking to get out as soon as possible due to being overwhelmed with everything that was being thrown at them. I really don't blame them.

 

[KillerDiller]

I eventually was asked to consider presenting a workshop/seminar on diagnosing clients. Why? Because their MASTER's LEVEL clinicians felt uncomfortable diagnosing anyone.

Yeah, I'm not surprised. I'm actually glad they owned up to their discomfort. It should be uncomfortable. I haven't come across a masters program that has required any more than a one-semester course in psychopathology. Depending on the quality of instruction, I'm sure it's possible to graduate without exposure to the nuances of diagnosis such as cultural considerations and the importance of psych testing.

So yeah, psychologists need to paint themselves as experts in diagnosis too. I had a client this year who came for a 90 minute intake interview and, at the beginning, asked for a referral to a psychiatrist so she could get a "thorough evaluation and diagnosis." I was glad to have the opportunity to explain to her that she was already sitting in the right chair for that. If psychiatrists can come off as experts after a medication evaluation, we should be able to come off as experts following an intake interview.

As a complete aside, I find it telling that I feel compelled to add "of course, I consulted with my supervisor" to this post. I did, obviously, but it just goes to show that the culture of psychology isn't conducive to being confident in the role of expert.

 

[Therapist4Chnge]

As a complete aside, I find it telling that I feel compelled to add "of course, I consulted with my supervisor" to this post. I did, obviously, but it just goes to show that the culture of psychology isn't conducive to being confident in the role of expert.

Keep in mind that being confident doesn't equal being an expert, let alone being competent to render a professional opinion. If you are still in training you SHOULD be consulting with your supervisor, as you are practicing under their license and they are tasked with ensuring that you are practicing within your scope of practice and within the bounds of our ethical code. Misguided confidence can do more damage than deference in most cases. I'm glad that you felt compelled to add what you did because it demonstrates you understand the importance of the above tenets. 👍

 

[Sanman]

That isn't my experience. It looks similar to many insurance payments that I receive (high $60's to low $70's.) Additionally, private insurers take their cues from Medicaid and Medicare. They reduce reimbursement, so does everyone else.

Dr. E

The national average rate for medicare is $81 for a 90834 according to APA and seems in line with what I have seen. The average insurance payout in my area seems to be $80-85 plus copay (usually $20). At least from what I have seen.

http://www.apapracticecentral.org/update/2012/11-29/medicare-payment.aspx

 

[Doctor Eliza]

The national average rate for medicare is $81 for a 90834 according to APA and seems in line with what I have seen. The average insurance payout in my area seems to be $80-85 plus copay (usually $20). At least from what I have seen.

http://www.apapracticecentral.org/update/2012/11-29/medicare-payment.aspx

Wow! $100 per session! I need to move. Cost of living here isn't that high, but it isn't that cheap either.

Dr. E

 

[psych844]

After reading this, I'm glad that that in Canada I can register as a Psychologist with a Masters. (in some provinces) That is my goal. There is indications that there may be changes in the near future..and all the provinces might switch to the Phd. But do to the situation in Canada, the fact that I can become a Psychologist with a Masters is hardly a problem for Phd's.

The difference in Canada is that we don't really have for-profit/private schools. Almost every University is publically funded. So the government controls how many Universities there are. The clinical programs let in very few students. You are guranteed a job. Same with Canadian medical schools. There is no such thing as a Canadian med student not matching unless they have no flexibility at all. They allow a certain number of students based on need...what a concept.

On the other hand, Counselling programs tend to allow quite a bit more students. The thing is, even provinces that allow Masters Psychologists mostly hire Clinical Psychologists for hospital settings. The same with Universities. As a Masters Psychologist you can't teach at a University, only college.

While Phd's in some instances get paid similar to Masters level (especially in community settings), I don't feel that there are too many unqualified people out there, I don't feel there are too many Psychologists, and I feel they do different jobs for most part.

 

[psych844]

Just to add.

One province that allows Masters Psychologists (Saskatchewan) has restrictions on who can actually give a diagnosis. Many Masters Psychologists don't have this right.

 

[PHD12]

The difference in Canada is that we don't really have for-profit/private schools. Almost every University is publically funded. So the government controls how many Universities there are. The clinical programs let in very few students. You are guranteed a job. Same with Canadian medical schools. There is no such thing as a Canadian med student not matching unless they have no flexibility at all. They allow a certain number of students based on need...what a concept.

Awesome. I bet psychologists make a liveable wage too and you don't have unpaid postdoctoral fellowships like we do out here. Corporations/for profit schools rule out here. Screw the students. Let them take out 250K in loans with no good job prospects. I know some folks who went to Canada for internship. It was less competitive and the stipend was significantly higher.

 

[Sanman]

Awesome. I bet psychologists make a liveable wage too and you don't have unpaid postdoctoral fellowships like we do out here. Corporations/for profit schools rule out here. Screw the students. Let them take out 250K in loans with no good job prospects. I know some folks who went to Canada for internship. It was less competitive and the stipend was significantly higher.

That is because we have Capitalism here in America. Not democracy, but Capitialism. Anything can be bought here (including political office) and committing crimes is only illegal as long as you can't become wealthy enough to change the law. Government attempting protect young naive students from corporations would be socialism and socialism sounds like communism. Are you a Commi? Yeah, that is what you are.

 

[PHD12]

That is because we have Capitalism here in America. Not democracy, but Capitialism. Anything can be bought here (including political office) and committing crimes is only illegal as long as you can't become wealthy enough to change the law. Government attempting protect young naive students from corporations would be socialism and socialism sounds like communism. Are you a Commi? Yeah, that is what you are.

I don't know if it's only due to capitalism. We just have an extreme form of corporate hegemony in this country. Corporations and politicians are the only ones who seem to pay low/no taxes and can do whatever they want without consequences.

 

[psych844]

That is because we have Capitalism here in America. Not democracy, but Capitialism. Anything can be bought here (including political office) and committing crimes is only illegal as long as you can't become wealthy enough to change the law. Government attempting protect young naive students from corporations would be socialism and socialism sounds like communism. Are you a Commi? Yeah, that is what you are.

Regulation is also not a bad word here. While provincial jurisdiction is respected people are not at all against having national standards. They want national standards. Universal healthcare here is by far the most popular program we have and people take pride in it. It has about 80-85% support.

Yeah I agree the economy should not be planned for most part. But what Canada understands is that you need to regulate to make sure that demand/supply is close.

In America everything seems to come down to freedom. Freedom for anyone to do whatever they want even though that might negativley affect others. In the process, standards are forgotten.

 

[erg923]

I am already heading into nontraditional work (well, maybe that a little strong...but I'm not doing alot of direct service myself and I am no longer in academia) and am planning on continuing to play up the admin and consultation part of this field. Anything to get out the hole that is relying on insurance and seeing patients all day everyday.

At least to me. And its still and 8-4:30 gig (score 🙂) which means I can do cash only practice on the side in the coming years.

 

[Therapist4Chnge]

After reading this, I'm glad that that in Canada I can register as a Psychologist with a Masters. (in some provinces) That is my goal. There is indications that there may be changes in the near future..and all the provinces might switch to the Phd. But do to the situation in Canada, the fact that I can become a Psychologist with a Masters is hardly a problem for Phd's.

Same title but far less training...I'm not sure about that assertion.

 

[psych844]

Same title but far less training...I'm not sure about that assertion.

Technically same title but you can put Dr. infront of your name and I can't.

As I said, in at least one province that allows Masters Psychologists you must meet extra standards to prove you are capable of diagnosing. As a result, many Masters level Psychologists don't have that right. (even some Phd's) That is pretty huge. Masters level Psychologists also can't teach in Universities. If you want to work at a hospital or university you usually need a clinical masters/phd (which is very hard to get in to all across Canada) Since we don't have for-profit schools, and we only have a certain amount of Uni's that provide clinical programs (with few slots available each year), only those that deserve it get the higher paying/better jobs. Another province that allows Master level does not allow the program to be online.


Still, there are people that want to increase the standards even more (and heck, I have no issue with that) All I'm saying is that currently we are in a pretty good place. First, we don't have a supply/demand issue. The people who got accepted into the clinical programs (which are really hard to get into) are working at more prestiges places (and getting paid more as a result). And even the places that allow Masters Psychologists have certain rules that keep their standards high. Ie Masters can't teach at Uni's. You must get extra training, pass exams, to be able to diagnose. And others don't allow your Masters to be mostly online.

 

[Sanman]

I am already heading into nontraditional work (well, maybe that a little strong...but I'm not doing alot of direct service myself and I am no longer in academia) and am planning on continuing to play up the admin and consultation part of this field. Anything to get out the hole that is relying on insurance and seeing patients all day everyday.

At least to me. And its still and 8-4:30 gig (score 🙂) which means I can do cash only practice on the side in the coming years.

I've been meaning to ask you about the new position as I know we talked when you were looking around about the geropsych companies and I was curious about the position you ended up taking. We can always PM if you don't want to share everything with the world. I have been looking at certain admin track positions as well.

 

[erg923]

I'll PM you, but probably tomorrow. Wild night here. Dinner with friends, 2 glasses of bourbon and time for bed at 9;30. Getting up to study for the EPPP at the crack of dawn, which my future employer seems to care little about, but is a necessary evil, really takes it out of ya. 4 more weeks to go. Big fart noise goes here...

I do wonder about some of the students (in a graduate program) that I have taught and supervised (doubtlessly unskillfully) during the past year and how they are being trained. Primarily as first-line clinicians/psychotherapists. sure, you can make the switch/transformation later as you go, but it doesn't seem like we can keep this up in good faith for another 30 years. Where the hell are they all gonna work?! What differentiates you in the eyes of employers/the larger healthcare field? Trust me, they could give less than a **** that you have 2 years more of 500-hour practica doing X with Y clients at Z place than the LPC/MSW they saw before you. And do you really want to fight the fight with the insurance companies for 60/hour psychotherapy sessions. Not me. Not me.

 

[cara susanna]

I dunno, my program (which is more clinical-focused or at least balanced) seems to have an easy time placing graduates. However, we're also in an area with a high need for mental health services.