Where Does All the Money Go

[JackD]

I find something to be a bit confusing about the whole private practice thing. In my state, the average masters level clinician that one's their own private practice, makes about $79 per clinical hour and work about 50 hours per week. However, they only make about $40,000 a year. Same problem with psychologists. The average psychologist makes about $110 per hour but only makes about $65,000 per year.

Now if you just do the math, $79 per hour is about $170,000 per year and $110 per hour is about $230,000 per year. However, when all is said and done, the therapists are only make about 1/4 of that. Where is all of that money going?

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[Ollie123]

Rent, malpractice insurance, office staff, the fact that "working hours" will generally far exceed the number of actual face-to-face hours you can bill for (i.e. most people are not scheduling a 50 hour week), even if you schedule 30 hours a week, chances are good a substantial portion will not show up, have to cancel, etc., the fact that thanks to our glorious insurance system you may not be able to collect even when you actually do see clients. That's just a sampling, T4C could probably extend this list for several pages

Overhead shouldn't take 75% of your billable hours unless someone is seriously lacking in business sense, but it will take a substantial chunk of them, and what you can bill for is never going to equal the amount of time you actually spend. I'm not sure what the typical overhead figures are like for psychology, I'm just applying my most-of-an-accounting degree here, but overhead is often more than people expect, and failure to factor in the costs is a MAJOR reason many small businesses struggle early on.

 

[JackD]

So then is it safe to assume that other professionals, such as medical doctors, dentists, optometrists, chiropractors, etc, are making far more per hour/client than a psychologist? I have looked up the average salaries for all of these other professions, and they range between $150,000-$300,000 per year and most of which are private practice. If you look at some examples here, for my area of the world (Chicago), the average private practice general physician makes about $180,000 a year with the bottom 10% making about $120,000 and top top 10% making about $210,000. The average dentist makes about $130,000 a year (100k for the bottom and about 180k top). Hell, the average chiropractor makes about $140,000 a year (top $220,000, bottom $90,000). However, the average clinical psychologist only makes about $70,000 a year (bottom $60,000, top $95,000). And lets not even discuss specialists in other health care areas.


So why are are psychologists making dramatically less per client/patient than most other health care professionals? It seems...unfair.

 

[edieb]

yes, other professionals, incl most master's level, make more. I just got a job offer today (hospital job) and the salary is $19.43/hour + benefits

 

[erg923]

yes, other professionals, incl most master's level, make more. I just got a job offer today (hospital job) and the salary is $19.43/hour + benefits

You've got to be kidding me.......

 

[edieb]

Nope, go to the Louisiana Department of Labor and look up Psychologist 1. Psychologist 2 isn't much better.

LA used to pay well but t said the HR lady since reimbursement rates are falling, the HR person said it makes no sense to pay that much to us because psychologists can't bill enough to warrant a high salary.

This job search is SO depressing. I had a guy today trying to make me feel privileged to be paid $40K by his company. he then said that the hospital has a big incentive to be licensed because I would get a $7K raise and make $47K. I was like WTF? Do you know what I went through for this PhD?

 

[positivepsych]

You're making a classic misassumption. The problem in private practice is not the hourly rate, its the volume. On the other hand, the problem with salaried positions is the rate, and not the volume.

PRIVATE PRACTICE:
Sure, you can make $50-150+ gross per hour of psychotherapy (though will probably net only $25-75 of that after overhead expenses). But unlike a typical 40 hour/week job, you will not see 40 patients per week. Getting that kind of volume is not only logistically difficult (you'd need multiple referral sources, a full time secretary to keep track of scheduling, and probably someone else for billing), but would be incredibly draining, and require probably 50-60+ hours total worked.

Realistically, most practitioners don't see more than 20 patients/week, and handle all the logistics/business stuff on their own, which then adds up to 30-40 hours a week worked. So let's say you net $50 per hour x 20 hours a week = $1,000/week.Assuming you work 50 weeks/year, that's $50,000. That matches a lot more to the salaries you described.

SALARIED JOB:
There is no shortage of patients (especially in community mental health, universities, or VAs). However, there is no shortage of psychologists either, so you will get paid $hit ($20-40/hour). Yes, this is significantly less than other doctoral-level providers. It's even lower than most BA/MA nurses make. The sad reality is that most places can hire MSWs and MFTs, so they're no need to pay us six-figure salaries. And the psychologists they do hire, are often PsyDs or women who only want to work part-time, so they will accept whatever low-ball salary they are offered. That's the pathetic reality of the field.

 

[JackD]

Do you know what I went through for this PhD?

Indeed and this is why i am thinking about moving into something else. I am hardly in this for the money but it seems almost impossible to pay off what might end up being $120,000+ in student loans and years of lost income, on $50,000 a year. Not to mention having to work 50-60 hours a week just to get that. If i was in a fully funded PhD program, I might not care but I'm not, which means several decades in the poor house if I continue. Seems like the risks are starting to greatly outweigh the benefits.

 

[edieb]

I am still in shock that the HR director was trying to make me feel privileged to make less than $45K after licensure. He acted like they were doing me the favor by paying me that much, like I just walked in off the street with no qualifications and was landing a goldmine.

I went to a fully funded PhD clinical program and spent 7 years including internship in school. I pulled so many all nighters in school (preparing manuscripts, studying for tests, finishing reports, doing my own independent reading) and see friends who are physical therapists who spent two years extra in school starting out with 3x more money than I will + recruiters are fighting to hire them.

One thing I believe hurting our field is that people go into psychology for reasons other than money (e.g., they find it interesting, glamorous, whatever) while people go into phys. therapy or speech therapy solley for the money. Thus, when out of school they expect to make the $$$$.

 

[edieb]

Indeed and this is why i am thinking about moving into something else. I am hardly in this for the money but it seems almost impossible to pay off what might end up being $120,000+ in student loans and years of lost income, on $50,000 a year. Not to mention having to work 50-60 hours a week just to get that. If i was in a fully funded PhD program, I might not care but I'm not, which means several decades in the poor house if I continue. Seems like the risks are starting to greatly outweigh the benefits.

Not to be an alarmist, but if I could go back and do all this over, I would have dropped out early. Unfortunately, for psychology, the writing is on the wall. After reading about the lowering of Medicare reimbursements on here I did some research that showed something alarming: while most other professioins are facing cuts, psychology is facing cuts that are a much higher percentage of the amount we make. One thing the APA does not mention about other professions that are facing Medicare cuts is that many of these professions received raises last year. For example, a friend who is ap hysical therapist, said PTs received a 8 percent raise last year and are facing a 2 percent or so cut this year. However, from what I can figure out psychologists have received cuts year after year. Why? Anybody can do our job (though not do it well). You see this attitude on here. I just read a post about someone gong to University of the Rockies, a non-accredited distance learning school, like entering this profession is something you can do in your spare time... I had an internship supervisor (a PHD) say she never hires PhDs because we can't bill much more than LPCs; therefore, there is no point in hiring them.

Some people say they find psych interesting and don't mind the low pay. I found it interesting, too, but one's interest in anything wanes over time and when you want to develop hobbies (travel, etc) outside work, you have no money to do so..............

 

[cara susanna]

This is just what I needed to perk myself up after a stressful day of grad school, ughhhhhhhhhh.

 

[JackD]

Some people say they find psych interesting and don't mind the low pay. I found it interesting, too, but one's interest in anything wanes over time and when you want to develop hobbies (travel, etc) outside work, you have no money to do so..............

Right and one thing I am growing increasingly concerned about is the lifestyle. First, think about all of the work one must put in, in order to get into this field. You need to do exceptionally well as an undergrad, you need letters of recommendation, research experience, clinical experience, and interview at many, many grad schools. None of this is an easy feat and many locked out at some point in this part of the process. Now if you are lucky enough to get in somewhere, you need to do research, teach courses, write articles, attend lectures, get into good practicum sites, conduct assessment and therapy, write a dissertation, and make damn sure that you get into a good internship. Once that is done, you need to obtain a license and spend a few years as a post doc before you can really go out and get into the world of clinical psychology.

But then what awaits you? Working with some of the most difficult people on the planet, in one of the most stressful jobs imaginable, where it is expected that you work 50-60 hours per week but for only $50k, $60k a year? And lets not forget, you are kind of trapped. You can't easily pick up and move across the country or go on vacation. And what do you do if, like someone in my position, you are also sitting on a mountain of debt? Its no wonder psychologists have a lower life expectancy.

The problem is that the system is broken. Many other professions have similar issues to deal with; its not easy being an MD for instance, but at least those other professions, the compensation is there. Its not usual for a medical doctor to work long hours and deal with a lot of stressful situations but then again, many earn $250,000 or $300,000 a year. They deal with a lot of crap but at least they don't have to worry about being poor, as many in this field do. There is at least some upside, no matter how shallow and greedy it may be. The problem is that too much is expected from psychologists and there is too little gratitude for the work they do. Something has to change because for many it is a grueling, hard fought path to get into the profession and once you make it, you get beaten down.

 

[edieb]

whenever asked about the low pay of psychologists in grad school, many of my fellow students would say that they were going into research or had a niche in mind; however, they're all having the same troubles I am. Looking at the recent laws passed in IN and WY and the recent Medicare cuts in psych services, including testing, it looks like neuro is dying, too. As more professions do testing, there will be no need to pay us to do this, either.......

Medication prescribing seems to be sacrosanct while everything we do is given away to everybody else, without even making them gain extra education!!!!!!!!

 

[JackD]

whenever asked about the low pay of psychologists in grad school, many of my fellow students would say that they were going into research or had a niche in mind; however, they're all having the same troubles I am. Looking at the recent laws passed in IN and WY and the recent Medicare cuts in psych services, including testing, it looks like neuro is dying, too. As more professions do testing, there will be no need to pay us to do this, either.......

Medication prescribing seems to be sacrosanct while everything we do is given away to everybody else, without even making them gain extra education!!!!!!!!

Yes and for some people, that works just fine. We have all had professors, obviously, that went to fully funded programs and then locked down cushy, secure research jobs at major universities. But that is only some of the people in the field, not everyone can do that.

To me the future looks like one where there are much fewer psychologists and many more masters level clinicians, under the supervision of psychiatrists. It seems like psychologists are being squeezed out from those on the top and those on the bottom. I might be wrong but I would imagine, in a few decades, the field of mental health is going to look very different and clinical psychologists are not going to be a big part of it.

 

[edieb]

you're thinking is right on target. if you have not already enrolled in grad school, be smart and do something else. if you like mental health, go into psychiatry -- you can do everything a phd can do + actually get paid fore it

 

[medium rare]

Unless something changes in professional psychology (i.e. Rx authority), compensation in salaried positions across all settings will continue to stagnate or get worse. Any of you who are considering doing something different should seriously consider training as a psych NP. As I've said before, this can be done in about two years time. And, if you conceptualize it as post-doctoral training, it's easier to stomach. However, the return on investment is huge. PMHNPs in my area are starting at $130K in CMHCs with full benefits included. Not bad at all for a 2-year master's degree.

That being said, I know many, many private practice psychologists in town who have thriving practices and do very well financially with varying levels of insurance involvement - some take none, some take a lot, some are mixed. None of these folks are hurting for business. The only down side is that they are tied to their private practices and, if they should ever want to relocate, they would essentially be starting over.

 

[erg923]

I know this is a huge derailment...but its bringing up alot of good points. Most notably..what i perceived to be a severe gap between academics/academic advisors and their students regarrding financial issues. My advisor is not like this fortunatley, and we are always told how not to be exploited and how to ensure financial opps for ourselves, both while in grad school and after. However, the intern at my placement was talking to our supervisor just this morning about neuro post-docs. Our supervisor made a casual comment about how if you dont get a formal post-doc in neuro, there is always nonpaid post docs here and else where...so not too worry too much.....

The intern was agast. I mean seriously, to drop this like its just no big deal...i mean how out of touch are some of these people?

Do your guys advisors talk to you about financial issues and the prospects once working? As I said before, mine does, but its my impression that most do not, as it seems they are often out of the loop, or in the case of our intern...My advisor just always said "you're not in this for the money."

I think thats sad. I also think its sad that edieb and his peers spent so much time producing quality research and now have such a hard time finding decent work. Since your lab seemed to be so productive, could these people at least get research jobs if they wanted them...or are they not getting any hits there either?

 

[Buzzwordsoldier]

As a newly minted MA grad, I accepted work paying $5.50/hr -- minimum wage for the state back in 1996. The only way my coworkers and I got our wages up to anything near a living wage was because we fought like hell to get union recognition and ultimately negotiated a binding contract. It was a grueling slog, but it was well worth it. I am constantly amazed that folks in this field turn their noses up at organized labor/union activity, but wonder why/lament that so many others make more than they do . Not that labor activity is the only or best answer. Just saying -- I wonder where the nursing profession would be absent a spirit of solidarity over the course of eons.

And, no offense intended -- It's to say anybody can do our job. The overwhelming majority of nurses, doctors, security, techs, etc., I work with readily/tacitly acknowledge they simply don't have the belly for it and wouldn't do it even if they could maintain their rate of recompense. Of course by dint of inhabiting a warm body, one is entitled to a perspective on best practices when dealing with "the crazies." Should that dictate the state of the industry?

@edieb -- how locked in to your locale are you? As an unlicensed, non-union MA therapist employed by a major hospital system I make in the neighborhood of 55k with full benes. That'll be about the top of the ladder for me, but I know there's better than that out there, all across this great land of ours, for those with a license. Just gots to be aggressive. Be, be aggressive (spare you the clapping smiley).

 

[edieb]

A - Yes, others at my school find research post-docs where we intern. However, even though they are at top places (one is at USF, three or so at Johns Hopkins, Brown, etc.), they are not making much either. I know others have written how much people make at medical schools, but this isn't what I am seeing. I got offered aa [position at the med school I interned at that paid $29K + I paid $100/month for group plann benefits. There is just no way I will work for that.

B - I am not locked in to any locale and have applied all over the place. I am not saying that the only jobs I am finding pay $19/hour but what I am saying, is that there are few jobs outside academe or the federal government, and the ones my friends and I are finding seem to pay little (tops $55K at the V.A.) and have little room for advancement. I think I always knew the fact about low pay, but it is just now hitting me that I am looking for jobs, & is being rubbed in when I see my friends who have degrees that took a fraction of the time making 2x as much. If I had a family where I was the primary breadwinner, I would be even more depressed

 

[Psy01]

Wow. I had heard a bit about the problems in clin psy, but didn't really know much about it. The posts on this forum have been illuminating the issues. Are the problems really of this magnitude? I can't help but wonder how accurate and reflective of the field these anecdotal reports are.

 

[JackD]

Wow. I had heard a bit about the problems in clin psy, but didn't really know much about it. The posts on this forum have been illuminating the issues. Are the problems really of this magnitude? I can't help but wonder how accurate and reflective of the field these anecdotal reports are.

Certainly my take on things is based on anecdotal evidence (as well as averages and pay distributions from bureau of labor statistics) but do keep one thing in mind from my sources on this subject, this comes from full time psychologists. I am not at a major state university. My school uses all adjunct facility, so they work out in the real world and their assessment is quite bleak. This is in sharp contrast from what I saw just last year, at my state school. The professors there, while very component and knowledgeable, are seemingly insulated from the problems that clinical psychologists are facing these days. They have secure jobs, with secure pay, decent hours, and they are still the top dogs with in their corner of the mental health care system. But those who are not full time researchers and don't have that sweet gig at the state school, are painting a much darker picture of what it is like to be a clinical psychologist.

Also keep in mind, this isn't from one or two psychologists, this is from all of the clinical psychology professors I have met this semester, and since I work for the Department of Psychology at my school, I have met a lot of them. Their personal experiences, as well as what they are seeing with their associates in real world practice are problems finding work, getting paid, dealing with other mental health experts trying to squeeze them out of the field, and everything we have discussed thus far. The thing I hear, time and again, is that things aren't what they were. It seems like things changed in the late 80's and early 90's.

Sure this is only anecdotal evidence but there is a lot of it, and all of it is saying the same thing. You wonder if things are really that bad. What I can tell you is that I haven't found a clinical psychologist yet that disputes these claims or says that things aren't really that bad. Without exaggeration, I have yet to meet a clinical psychologist, that isn't a full time professor, that does not have dire assessments of this profession. Obviously there are clinical psychologists are doing just fine but do you really want to bet on being that far above the average? But really, what does it say that when most of the people in the top 1% of this field, aren't even able to make $100,000 a year...in Chicago? That isn't a lot of money. Certainly no one is getting into the field with fantasies about mansions, luxury cars, and 6 month European vacations but when your average PhD, clinical psychologist is making about as much as someone in data entry, something is going horribly wrong and this seems to be the reality of the field these days.

 

[edieb]

You can look at job postings and see for yourself how bad things are. Again, I always knew that things were bad but thought going to a highly-ranked research school would somehow grant me immunity to the woes of the profession. I don't know what the hell I was thinking. Friends who are physical therapy ASSISTANTS (a bachelor's degree) and a brother who is an registered nurse will be making more than I likely will. If you factor in the years I spent in school not making any real money + my student loans, I will be making much, much less than my friends with bachelor's degrees.

I had fantasies about receiving extramural education in cbt at the Beck Institute, but it costs $9K for one year. there is rno way i will be able to afford to enroll nor will i have the enthusiasm to seek extra training because i will not be compensated for it, and paying for it out of my $19/hour will not be a viable option.

I called about training in psychopharmacology so I can prescribe but I first have to get licensed (around $2K with study materials, registration fees, et cetrea) and then have to shell out $13K to take the prescribing courses. That is six months pay for a starting psychologist

I don't know how people from professional schools, let alone professional school students with families, will make ends meet. Like I mentioned a while back, one girl in my internship class owes aroune $300K in student loans, her husband has a poor paying job, and she has 2 children. She is currently making $40K/year and is being laid off in August. As a single person, I will be able to live fairly well on my salary, but what about people who have the audacity to want families?????

The state of the profession is very bad. I really think the only hope is RxP, but at the rate it's going, it may be many years before we even see two more states pass bills. By that time, psychologists will likely be even more marginalized...

 

[erg923]

i think your solution is to get to work dating...

While in grad school, I married my sugar-mama.......a 3rd grade teacher who makes 36k per year..........

 

[Kyle3309]

I was highly considering getting a doctoral degree until I came across this thread. I am about half complete with my MS in Clinical Psych. Once complete I will be elgible to become an LPC... which can independantly practice without any supervision in Texas. I can't justify going through more school and more hoops to only come out making 5 to 8k more a year and acrue a lot more debt. Very sad indeed.

Most psychologists that I know blame managed care for the current state of the profession. I agree that is major factor, but is more at play here? For the profession to radically decomp in the span of a couple of decades is alarming.

 

[medium rare]

Slow down there, cowboy! While the psychology job market is not good, there are opportunities to make a decent living. If you take traditional private practice for example, it is relatively easy to fill a private practice if you are willing to get on insurance panels. Insurance companies are having an increasingly difficult time maintaining functional panels and the government has begun cracking down on "phantom panels" making paneled-providers who are taking new patients in high demand. I personally get calls every day from potential referrals asking if I take such and such insurance. I tell them no and then they typically ask if I know of anyone who takes insurance and has availability as they have called multiple (sometimes 10 or more) providers and can't find anyone.

If I were just starting out as a psychologist, I would find out which panels had high volume in my area and get on some of these. One-5 high volume panels can easily fill a private psychology practice in 6 months; I know several private practice psychologists who routinely see 35-40 patients each week. $70-80 average for a 50-minute session from insurance is pretty decent money, and it is easy to keep overhead low as a psychologist. I have never spent more than $30,000/yr for operating expenses in the last 5 years - this includes all expenses associated with running my practice: rent, utilities, malpractice, secretary, etc.

I'm not as familiar with agency/hospital settings, but I know that the VA in my city tops out at around $110K/yr for clinical psychologists.

Yes, the job market is not great, but no need to panic. There are opportunities out there.

 

[JackD]

Yes, the job market is not great, but no need to panic.

I disagree. A large portion of the clinical psychologists out there are coming from professional schools. For example, if one received their PsyD in clinical psychology from Argosy University, they would need to pay $100,000 in tuition. Its 98 credit hours at $998 per credit. Of course this doesn't include interest, books, living expenses, undergrad loans, etc. What is the likelihood that one of these doctors are going to be able to pay off their student loans and other debt that is probably at least $150,000, if not more, on the salaries we are seeing? You say that the top people in the VA make $110,000 a year. That might allow these people to pay off their loans and get by, but not every psychologist can hold a top position at the VA. And not everyone can open up a booming practice. How's the average clinical psychologist supposed to pay off these astronomically high student loans and still live a life that makes the stress of the profession worth it? The truth is, we wouldn't be seeing these low pay distributions if things were ok or not all that bad. The top wouldn't be making only $100,000 or so a year and the middle 25% wouldn't be making between about $60,000-$70,000 a year. For the bottom 90% of psychologists, the compensation is horrendous and insulting, and for the top 10%, it is mediocre.

I'm not saying people shouldn't get involved in this field. What I am saying is that it is a risky future if you do. You might get lucky and get one of those top VA spots or open that bustling clinic, and live the high life, but if you are coming into the profession, especially from the professional schools, i think people should know there is a high probability of tough times down road. Tough times that might be getting worse.

 

[medium rare]

You say that the top people in the VA make $110,000 a year. That might allow these people to pay off their loans and get by, but not every psychologist can hold a top position at the VA. And not everyone can open up a booming practice.

It's not the TOP people at the VA, for example, who make that much money, it's the average joe psychologist who puts in his or her time over the years and tops out at that range. That salary grade is available to any VA psychologist who puts in their time over the years and gets the standard routine promotions. There's nothing special, per se, about the psychologists or the situation.

And, the insurance-based private practice market is available to any licensed psychologist willing to put the time in to get on panels and do some basic marketing. Is it automatic? No. Is it doable? Definitely.

For example, a new PsyD grad in my area interested in private practice was given my name by an academic early last year. I met with her and gave her the suggestions I've mentioned here. She did the grunt work and within 6 months of getting on 4 high-volume panels, she had enough business to support her practice and within a year, she had a full schedule and was able to quit her part-time CMHC position. She is now at the point where she is turning away referrals - all this in less than 1.5 years. She is a solid clinician with good interpersonal skills but not particularly unique among new graduates.

So, the hypothetical new Argosy grad you mention could pursue either of these routes and be doing reasonably well within a few years or sooner of starting, once he or she is licensed. It does take perseverance and some marketing savvy, but the average new psychologist does have these opportunities available to them.

 

[RGMSU]

So why are are psychologists making dramatically less per client/patient than most other health care professionals? It seems...unfair.

They're not. It's not uncommon for the family physicians you're talking about to bill $750,000 a year and take home the $180,000 you're talking about. Overhead for physicians, malpractice, educational debt level, etc, are higher compared to psychologists - not lower. Of course, physicians are seeing alot more patients, too, and the argument could certainly be made that their work is higher risk (eg, missed appendicitis diagnosis and patient goes home, ruptures, and dies).

 

[Tuff Gong]

Wow. This blows. I've been preparing for applying to ph.d programs since my career prospects were to practice and teach/research at a university. But wow, reading this entire thread I am freakin' depressed (excuse the melodramatic comments) at the job prospects, or lack thereof, for those of us in the counseling/clinical part of the field. I'm sort of lost now. I have 1 child and I'm a single parent. I would have loved to earn my ph.d and do what I really feel I wanted to do but with the new issues brought about through this thread I'm seriously considering passing up my ph.d. (two sad faces represent my feelings more accurately ).

 

[Rick55]

My experience as a clinical psycholoigist has been extremely positive. I wouldn't trade it for anything. I've been out of school less than 10 years and already make over $90,000 with plenty of room to grow (I am a professor in a medical school). As my advisor told me in grad school, "There is always room for the best people." Develop skills that are in demand. I am very strong in quantitative methods and research design and this has paid huge dividends for me. I can get research grants and don't just have to rely on clinical work (although I do about 15 hours per week). I would not go into this field only to be a therapist and I most definitely would not even consider going to a program that charges any tuition at all. The jobs are there and they pay well but you must have the right skills.

 

[OasisStudent]

Just reading these posts have gotten me discouraged. Im a masters/Ed.S student in School Psychology and have made it my goal to obtain my PhD in Counseling or Clinical to "expand my options" right after this program so I can work with college-aged students. I'm also all about leadership in the academic development of disadvantaged adolescents through college. Now I don't know if this "PhD" is at all worth it even if it's in School Psychology. And Im upset that my undergrad professors told me Counseling/Clinical is the way to go and the world would be my oyster! : (

Since Im not really into research, but moreso into assessments and counseling, I'm starting to think it would be more "feasible" to get the PsyD since there are a lot of part time PsyD programs where one can work full time (as an SP for ex.) and pay their way through even if they're paying $30,000 a year. In my mind, this should be a better alternative for someone interested in the psychology field because although they are paying "out of pocket," at least they have some type of job to carry them through and make some extra money so they don't get in debt.. (especially someone single with no family).

So my point is, if the PhD keeps you locked up like a slave and the PsyD gives you freedom(part time programs), why not use that freedom to make some $$$ and pay your way??

Would this be a smart move? Instead of going through a 5-6 year research intensive program, rack up some debt (living expenses) even if it's fully funded and end up working at a school or maybe at a college counseling center making peanuts?

I'd be glad to hear all of your opinions..

 

[edieb]

My experience as a clinical psycholoigist has been extremely positive. I wouldn't trade it for anything. I've been out of school less than 10 years and already make over $90,000 with plenty of room to grow (I am a professor in a medical school). As my advisor told me in grad school, "There is always room for the best people." Develop skills that are in demand. I am very strong in quantitative methods and research design and this has paid huge dividends for me. I can get research grants and don't just have to rely on clinical work (although I do about 15 hours per week). I would not go into this field only to be a therapist and I most definitely would not even consider going to a program that charges any tuition at all. The jobs are there and they pay well but you must have the right skills.[/QUOTE


uuuh, $90k/year after 10 years (after 16 years or so if you count schooling, internship, post-doc), is not good money and you could definiitely not be the breadwinner for a family with that amount of $$.

I could become a social worker and be making the same amount after 10 years in the field. Meanwhile. other doctoral level providers start higher than $90K/year upon graduation. I think a big problem with our field is we expect so little (90K) in return for so much

 

[edieb]

Just reading these posts have gotten me discouraged. Im a masters/Ed.S student in School Psychology and have made it my goal to obtain my PhD in Counseling or Clinical to "expand my options" right after this program so I can work with college-aged students. I'm also all about leadership in the academic development of disadvantaged adolescents through college. Now I don't know if this "PhD" is at all worth it even if it's in School Psychology. And Im upset that my undergrad professors told me Counseling/Clinical is the way to go and the world would be my oyster! : (

Since Im not really into research, but moreso into assessments and counseling, I'm starting to think it would be more "feasible" to get the PsyD since there are a lot of part time PsyD programs where one can work full time (as an SP for ex.) and pay their way through even if they're paying $30,000 a year. In my mind, this should be a better alternative for someone interested in the psychology field because although they are paying "out of pocket," at least they have some type of job to carry them through and make some extra money so they don't get in debt.. (especially someone single with no family).

So my point is, if the PhD keeps you locked up like a slave and the PsyD gives you freedom(part time programs), why not use that freedom to make some $$$ and pay your way??

Would this be a smart move? Instead of going through a 5-6 year research intensive program, rack up some debt (living expenses) even if it's fully funded and end up working at a school or maybe at a college counseling center making peanuts?

I'd be glad to hear all of your opinions..

At least you know the truth now. I have many relatives who are PhDs in clinical psychology who begged me not to pursue this path. My aunt, who is now a professor, saw her income drop from $200K/year in the 1980s (private practice) to $35K/year in the 1990s and beyond. Some of it is due to poor marketing on her part, but most of it is secondary to things like declining reimbursement rates and even moreseo, encroachement of MA-level professions. For instance, she used to consult 15/hours week at a pain clinic doing psychological testing (MMPI, etc). Recently, in texas, LPCs got the right to interpret tests. She now only comes into that clinic for 1 hour/week to sign off on the reports the LPC prepares by cutting and pasting the MMPI-generate report. Welcome to the real world

 

[Evidence Based]

I realize we all have N=1 horror stories. But a look at the data suggests that while we certainly aren't getting paid in the high six figures, most psychologists are doing just fine for themselves.

Take a look at the APA 2007 salary survey: http://research.apa.org/salaries07/table5.pdf

Key figures

Individual Private Practice, 5-9 years:
Median=87,000, Mean=94,000, SD=48,000. (n=43) Huge Standard Deviation, but I'd be just fine starting out with a salary of $94,000.
Those numbers steadily increase with time, with the top 25% of 30 year + veterans making $150,000 or more. This assumes great business skills, but I see nothing too shabby with this. By the 30 year mark, the median salary is 100,00, although again with a large SD.

VA 2-4 years
M=76,800, Median=76,000, SD=6,301

VA 5-9 years
M=89,333, Median=90,000, SD=5,785

It increases after that, with veterans getting paid over 6 figures.

Are we getting paid as much as doctors? No, most psychologists are doing fine. Are most of us poor? No, although some are definitely bad off. We need to keep advocating for ourselves and defend what is ours, but there is no need to panic and despair of ever living anywhere besides a box.

 

[Therapist4Chnge]

Do your guys advisors talk to you about financial issues and the prospects once working? As I said before, mine does, but its my impression that most do not, as it seems they are often out of the loop, or in the case of our intern...My advisor just always said "you're not in this for the money."

Yes.

Before I left my prior career I did a lot of leg work to make sure I can make relatively the same money ($125-$150yr). Unfortunately to get into that range I'll have to do some leg work and patch together a few things.

I'm looking to work at a VA hospital or academic hospital, so that I can get insurance coverage, network, and stay active publishing/presenting. On the side I'm looking to do assessment work (cash only) to pay down some loans, and eventually build up a seperate consulting firm/practice to start building a portfolio. I figure 4-5 years (of 60-70hr/wks) I should have enough business built up to scale back my clinical work. I love psychology, but it is a bad use of my time to only do clinical work....as I don't want to be working until I'm 70.

 

[JackD]

Individual Private Practice, 5-9 years:
Median=87,000, Mean=94,000, SD=48,000. (n=43) Huge Standard Deviation, but I'd be just fine starting out with a salary of $94,000.

First off, I wouldn't say that 5-9 years is just starting out. If i went through, got my PsyD, and everything, then worked for 5-9 years, I would be in my 40's already or rapidly approaching that. I would hardly call it desirable to be making a fairly mediocre amount of money, after years of lost income and massive amounts of debt from student loans. Yes, $94,000 or so is decent money after 10 years on the job but not for someone that went to school until they were almost 30 years old, if not older, and holds a doctorate. If i never went to college and a decade out, i was making that kind of money, it would be great but its not the same situation. And lets not forget, you need to work more than the average person to get that. You would be lukcy to be on a 40 hour work week but you are going to find something more like 50 or even 60 hours a weeks as a psychologist.

Also I don't understand why people think that the VA is some sort of utopia. Yes, you make slightly more money, assuming you can get a job with them, which is not easy but if you do, it is probably going to be one of the toughest jobs to do. It is not easy work at the VA and from what I understand, extremely demanding. My uncle is an MD and he worked at the VA for a few years. He said that he would come home every night and just break down into tears. If you can get a job with the VA and handle it, great, you will be making $4000 more than the average psychologist and you have some pretty good benifits, but I find it interesting that is the only plan suggested by people when very few are actually going to be able to stick with it for 30 years.

People keep bringing these numbers up. You can make $90,000 a year doing this or $95,000 a year doing that, which sounds great. Thats quite a bit above average for this country. But someone holding a PhD or PsyD in clinical psychology is not in an average position. You can't ignore the differences. There is a reason why, traditionally, health care professionals, like medical doctors, dentists, optometrists, etc. make way more money. Its because they have massive debt, they work more hours, they don't start working until later in life, they have skills that most people don't have, and their jobs are more demanding. That is why, as a psychologist, you need to be making more money than this. Its ridiculous to say that after everything a psychologist has been through with schooling and all of the stuff they need to deal with as a clinician, that its ok because it is possible to make $90,000 a year instead of $70,000. Given the circumstances, both practical and in terms of what is fair, its not enough.

 

[Psy01]

From bits and pieces that I've gathered here and there, it seems to me that clinical psy doctoral programs have (in general) been largely shifting in their emphasis toward research. First off, is this true? Second, if it is true, does this seem to be reflective of the issues in the field? In addition to the above, master's level clinicians are increasingly doing therapy. I wonder if the field is turning to its other forte, research, because of these matters. I wonder if clin psy is going to increasingly shift in its collective emphasis to focusing much, much more on research while others do the therapy.

 

[JackD]

From bits and pieces that I've gathered here and there, it seems to me that clinical psy doctoral programs have (in general) been largely shifting in their emphasis toward research. First off, is this true? Second, if it is true, does this seem to be reflective of the issues in the field? In addition to the above, master's level clinicians are increasingly doing therapy. I wonder if the field is turning to its other forte, research, because of these matters. I wonder if clin psy is going to increasingly shift in its collective emphasis to focusing much, much more on research while others do the therapy.

That is something that I have been wondering too. It sounds like we are moving back to the pre-WWII days, with psychiatrists as the main mental health practitioners and psychologists doing all of the research. It is purely speculative on my part but remember when you talk to clinical psychologist, working at a state school as a researcher and occasional teacher, they seem to be rather happy with their position. It is pretty low stress, the hours aren't bad, the pay is decent, and the benifits are there. When you talk to a clinical psychologist out in the real world, things seem more chaotic. If being a researcher becomes far more desirable than working as a clinician, then it is easy to see how clinical psychologists would be drawn to research. Time will tell but if the trends continue, and we do see more masters level clinicans taking over the duties of clinical psychologists, where else are the psychologists going to go? The field certainly won't die off, so they will need to move into something else, for the most part at least.

Again, all speculation but this is the future I see for mental health and there is quite bit of evidence to show that we are trending in that direction.

 

[Psy01]

Indeed. I'm wondering if the field is in, or entering, a state of reorganization (quite possibly as a matter of survival) in order to adapt to these trends.

 

[Therapist4Chnge]

Indeed. I'm wondering if the field is in, or entering, a state of reorganization (quite possibly as a matter of survival) in order to adapt to these trends.

It will be interesting if the APS (?) accreditation attempts gain any ground, as many psychologists believe APA accreditation is not sufficient. I think that movement may very well push psychology back to research, and admit defeat to mid-level providers who are encroaching on the practice of therapy.

I still think doctorally-trained practitioners are the best people to provide therapy, but they aren't the cheapest...and I think that will eventually push us out of the arena, except for niche specialization areas that a small % of people can afford to pay out of pocket.

I know my private practice aspirations are restricted to a small caseload (far from sufficient to be my main source of income), but I think that is probably what will happen for the vast majority who aren't willing to grind out $50-$80 sessions that take 2-3 months to get paid through insurance carriers.

 

[PsyDr]

My .02:


if you teach people you are worthless, they will treat you like you are worthless.


this includes:
-accepting BS salaries
-not billing for every second you are with a patient, be it on the phone or not.
-not sending delinquent accounts to collections
-not making people demonstrate the need for a sliding scale through their tax returns
-engaging in unethical behavior by supervising LPC & LMSWs in assessments, thereby creating a loophole wherein companies can bill for assessments on patients you have not seen.
-not aggressively defending your diagnosis when challenged
-referring down rather than up (e.g., asking for an SLP to clarify the diagnosis as opposed to a behavioral neurologist)
-having crap offices
-dressing unprofessionally
-using jargon
-


If you are not making 100K+, there is something seriously wrong with you as a business person if money is your goal. i think 100-250k is about right for a good return on work to life ratio. 250+ is pretty hard on you. i do know psychologists who make more.

 

[medium rare]

My .02: if you teach people you are worthless, they will treat you like you are worthless. this includes:
-accepting BS salaries
-not billing for every second you are with a patient, be it on the phone or not.
-not sending delinquent accounts to collections
-not making people demonstrate the need for a sliding scale through their tax returns
-engaging in unethical behavior by supervising LPC & LMSWs in assessments, thereby creating a loophole wherein companies can bill for assessments on patients you have not seen.
-not aggressively defending your diagnosis when challenged
-referring down rather than up (e.g., asking for an SLP to clarify the diagnosis as opposed to a behavioral neurologist)
-having crap offices
-dressing unprofessionally
-using jargon

If you are not making 100K+, there is something seriously wrong with you as a business person if money is your goal. i think 100-250k is about right for a good return on work to life ratio. 250+ is pretty hard on you. i do know psychologists who make more.

I agree. I know several private practice psychologists making >150K and they all go about it with sound business sense and skills.

In my group, there are four of us (3 psychologists and myself - psychologist and NP). All 3 of the psychologists are very busy and making well into the 6 figures. The lowest earner nets about 125K and this is because she only works part-time seeing about 25 patients/week. The highest earning psychologist is netting around 240K. These are not unusual numbers in my community for private practice psychology, and I'm not on either coast.

One thing to keep in mind is that salaried positions for psychologists do not generally pay well and the advertised jobs (APA Monitor, etc) are the ones that tend to pay very poorly. Also, the APA salary survey is voluntary and the response rates tend to be low. I personally don't know of one high-earning psychologist who has responded to the survey - none in my group did and they are all doing quite well.

 

[deleted176373]

My .02:


if you teach people you are worthless, they will treat you like you are worthless.


this includes:
-accepting BS salaries
-not billing for every second you are with a patient, be it on the phone or not.
-not sending delinquent accounts to collections
-not making people demonstrate the need for a sliding scale through their tax returns
-engaging in unethical behavior by supervising LPC & LMSWs in assessments, thereby creating a loophole wherein companies can bill for assessments on patients you have not seen.
-not aggressively defending your diagnosis when challenged
-referring down rather than up (e.g., asking for an SLP to clarify the diagnosis as opposed to a behavioral neurologist)
-having crap offices
-dressing unprofessionally
-using jargon
-


If you are not making 100K+, there is something seriously wrong with you as a business person if money is your goal. i think 100-250k is about right for a good return on work to life ratio. 250+ is pretty hard on you. i do know psychologists who make more.

This is an excellent post. Psychologists need to learn how to fight a little better as professionals.

 

[hkusp]

and the argument could certainly be made that their work is higher risk (eg, missed appendicitis diagnosis and patient goes home, ruptures, and dies).

True, physicians often have great risks in their profession.

However, we puke after work for different reasons. You for seeing a gun shot wound to the head (with concordant brain spillage)...me for hearing in excruciating detail and attending to the emotions of working through a horrific sexual assault, and recovering in 5 minutes to see my next patient that was a gunner in Iraq for three tours who can't stop seeing heads explode in his dreams...and then on to the next Patient.

However, the blame for the appendictis issues would be all about a radiologist (and the assigned ER physician) who can't read a CT scan!!

 

[hkusp]

This is an excellent post. Psychologists need to learn how to fight a little better as professionals.

Amen....

If you aren't making 100K a few years out of school you need to learn how to advocate for yourself as a professional and demand what you are worth.

We could learn a lot from the business folks.

If I were to hear someone offer me 40K for a job, I would ask them what Mondays they would like me to work...because I sure won't be there Tuesday through Friday.

 

[erg923]

I agree. I know several private practice psychologists making >150K and they all go about it with sound business sense and skills.

In my group, there are four of us (3 psychologists and myself - psychologist and NP). All 3 of the psychologists are very busy and making well into the 6 figures. The lowest earner nets about 125K and this is because she only works part-time seeing about 25 patients/week. The highest earning psychologist is netting around 240K. These are not unusual numbers in my community for private practice psychology, and I'm not on either coast.

One thing to keep in mind is that salaried positions for psychologists do not generally pay well and the advertised jobs (APA Monitor, etc) are the ones that tend to pay very poorly. Also, the APA salary survey is voluntary and the response rates tend to be low. I personally don't know of one high-earning psychologist who has responded to the survey - none in my group did and they are all doing quite well.

That sound like a great PP, but how much of finding an opp like that is luck? Id love to be one of those that can fall into alreadu succesful group PP, but i suppose the pessimist in me thinks that that really takes luck. That, and feel like I have little skill to build a thriving group PP, therefore i truley would have to find one that is hiring.

So the question is, (besides getting some business skills/savy) what can/should one do to find opps like that?

 

[Kyle3309]

How does pay differ for a psychologist that specializes in forensics? Are there any specialties that pay more? I currently work in a forensics mental health setting that employs psychiatrists and lpcs, from what I see here the pay is slightly better than in general.

 

[RGMSU]

However, the blame for the appendictis issues would be all about a radiologist (and the assigned ER physician) who can't read a CT scan!!

Actually, CT doesn't pick up about 10% of the hot appendices. Sometimes, a very difficult diagnosis to make. Not always obvious. Anyway, the point to getting paid more is emphasizing the importance of your work. I don't think mental healthcare in general has ever been to great at that.

 

[JackD]

That sound like a great PP, but how much of finding an opp like that is luck? Id love to be one of those that can fall into alreadu succesful group PP, but i suppose the pessimist in me thinks that that really takes luck. That, and feel like I have little skill to build a thriving group PP, therefore i truley would have to find one that is hiring.

So the question is, (besides getting some business skills/savy) what can/should one do to find opps like that?

I don't want to come off as sounding harsh or hostile to those that disagree with me on this (i think that is just my writing style ) but it seems to me that the optimists here are basically just telling us that if you aren't making enough money, the solution is easy, just make more money. I'm not really seeing many solutions that individuals can use to make a decent living as a psychologist. Really, as you said, it seems more like luck or being in the right place at the right time or having business skills that not everyone possesses.

And let us not forget, while private practice seems like the only way to make a decent living (although from where i am standing, that seems to be rather difficult), not everyone wants to go out there and open an office. What about those working in community clinics and mental hospitals? Their pay is horrendous.

Look I know it is possible to do well as a psychologist. No one is arguing that 100% of psychologists are living on the streets or making minimum wage. I understand this but it seems to me that the typical situation isn't very good, and the compensation is completely inadequate for a large portion of those in the profession. Really though, what does it say about this profession when we are arguing that making $150,000 a year is amazing and we can all do it if we try? For many other health care professions, that is towards the low end of the scale. If an MD that has been practicing for 15 years went into an interview at a private practice and they were told if they work really hard, maybe someday they can earn $150k a year, they would never take that job. We are arguing whether we can earn a few thousand more a year than the average, when the average is pitiful. Psychologists should be making 3x what the current average is, just to get them on par with other health care professionals.

 

[Therapist4Chnge]

So the question is, (besides getting some business skills/savy) what can/should one do to find opps like that?

Find someone who DOES have those skills. The biggest mistake psychologists make in private practice is treating their PP like everything but a business. A sound business plan with a mediocre clinician will out-earn a poor business plan with a great clinician....EVERY. SINGLE. TIME.

How does pay differ for a psychologist that specializes in forensics? Are there any specialties that pay more? I currently work in a forensics mental health setting that employs psychiatrists and lpcs, from what I see here the pay is slightly better than in general.

In the right communities....both therapy and assessment can be lucrative. Negotiating a contact with a prison to handle assessment work can be lucrative. The same goes for people who do niche work in areas where there are less experts and more need (eating disorders for example).