Would you advise someone to go into psych today?

[Sanman]

Maybe not mutually exclusive? I can't tell you how many folks feel relief at the idea that there is an evidenced-based treatment for their problem.

ETA: I truly appreciate the feedback, folks.

I'm not saying it is mutually exclusive. Good treatment is certainly a good thing and I am all for it. However, there is no measurement of quality in MH care reimbursement. Medicare states that supportive psychotherapy is covered the same as CBT, DBT, etc. and all are reimbursed at the same rate. Doesn't matter to them if you are a widow with a mild adjustment disorder or a borderline with suicidal tendencies. The workload, however is very different in reality.

As has been said before, I would put money on a mediocre (not bad but mediocre) therapist with good marketing and business skills outearning an excellent clinician with poor business and marketing skills. If you are taking insurance, then it really does not matter how skilled you are given the shortage of clinicians vs public demand. Insurance does not offer you more money for better treatment as stated above. If you are cash only then the business and marketing skills come into play much more significantly. So does being able to afford an office in a nice part of town. Look at the life coaches charging exorbitant fees with no credentials. You can't tell me that they are highly skilled.

It is similar to folks going to the mechanic. Finding a good honest one is not easy and most people have no idea where to look. There is a belief that car dealerships have the best mechanics when the truth is that this is often where novices cut their teeth (same as with major medical centers).

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[smalltownpsych]

Clinical expertise does pay when you are only cash pay. I have several midlevels working for me and they charge 50 and hour less and sometimes even less because of a sliding scale and they still struggle with being able to build a caseload whereas I tend to have a full schedule most weeks. When it comes to insurance though, everyone in my area who accepts their weaker reimbursement is slammed with patients so quality and reputation doesn’t really matter. My postdoc is doing a lot of testing that is cash pay and we were just taking about potentially increasing what we charge for him so that he can generate above 200 an hour.

I worked in a couple of industries for quite a few years before I went back to school with a dream to be a psychologist at age 30 and I have absolutely no regrets because psychology is my passion and almost like a calling. If you’re born to do this, it’s just not that much of a choice. 😁

My biggest challenge is currently and has been throughout my pursuit of this career is to select what I want to do and how I want to do it because I love almost all of it and there are limitations. One way I am satisfying my love for all the aspects of the field is to hire people to do parts of it that they might be better suited for and have more time to pursue and then I still get to be involved.

 

[R. Matey]

Clinical expertise does pay when you are only cash pay. I have several midlevels working for me and they charge 50 and hour less and sometimes even less because of a sliding scale and they still struggle with being able to build a caseload whereas I tend to have a full schedule most weeks.

This rings true for me. Mids that I know in my area are billing $50/hr. less than psychologists I know and also having trouble keeping their caseloads full. What the actual reimbursement is though, I don't know.

 

[Sanman]

This rings true for me. Mids that I know in my area are billing $50/hr. less than psychologists I know and also having trouble keeping their caseloads full. What the actual reimbursement is though, I don't know.

I have seen midlevels all over the map. Anywhere from $150-240/hr depending on the area. None of the ones I know are struggling for work. That said, a big part of that is the clientele in your area. Remind me, is Treasure Island on the west coast?

 

[R. Matey]

I have seen midlevels all over the map. Anywhere from $150-240/hr depending on the area. None of the ones I know are struggling for work. That said, a big part of that is the clientele in your area. Remind me, is Treasure Island on the west coast?

Lol, yes, we pirates like to scour the best coast.

 

[Sanman]

Lol, yes, we pirates like to scour the best coast.

Let's not bring that up. I'm still a bit salty about the world series.

 

[AcronymAllergy]

This rings true for me. Mids that I know in my area are billing $50/hr. less than psychologists I know and also having trouble keeping their caseloads full. What the actual reimbursement is though, I don't know.

Yeah, I suspect a lot will depend on the area. Although with increased access to telehealth, I wonder about its effects on the marketplace (and am just thinking out loud)--now that essentially anywhere could be saturated with providers (assuming the patient is open to telehealth), will patients then begin looking at credentials to differentiate? And/or with increased exposure to psychotherapy, will patients seeking psychotherapy then have more of an idea of what they want, and what type of provider they want to work with? And/or will people become burned out with telehealth? I've already been hearing similar sentiments from my older patients, but not sure if it's also happening in younger people.

All that said, psychology definitely offers a varied skillset. I think going forward, it'll be more important for psychologists to take advantage of those varied skills. For example, I could see how conducting clinical research in your private practice/clinic could be a beneficial marketing tool.

 

[R. Matey]

And/or with increased exposure to psychotherapy, will patients seeking psychotherapy then have more of an idea of what they want, and what type of provider they want to work with? And/or will people become burned out with telehealth? I've already been hearing similar sentiments from my older patients, but not sure if it's also happening in younger people.

Some friends of mine (at both training levels, tbh) have joked that telehealth therapy companies have been great for business due to the sheer incompetence of many of their providers motivating patients to seek out 'actual therapy.' But I do agree that we should be looking to innovate in clinical work using skills that mid-levels do not possess.

Related, I will not miss this occasion to drudge up this beaut:

15-Year-Old Finds Summer Job As BetterHelp Therapist

FORT MILL, SC—Hoping to make some extra cash before the start of a new school year, local 15-year-old Evan Solis confirmed Monday that he had landed a summer job as a therapist at the online mental health services provider BetterHelp. “It’s fine, I guess; I mowed lawns last summer, and that...

theonion.com

 

[Sanman]

Some friends of mine (at both training levels, tbh) have joked that telehealth therapy companies have been great for business due to the sheer incompetence of many of their providers motivating patients to seek out 'actual therapy.' But I do agree that we should be looking to innovate in clinical work using skills that mid-levels do not possess.

Related, I will not miss this occasion to drudge up this beaut:

15-Year-Old Finds Summer Job As BetterHelp Therapist

FORT MILL, SC—Hoping to make some extra cash before the start of a new school year, local 15-year-old Evan Solis confirmed Monday that he had landed a summer job as a therapist at the online mental health services provider BetterHelp. “It’s fine, I guess; I mowed lawns last summer, and that...

theonion.com

I am not sure that Betterhelp is the issue so much as PsyPact. Now that does not affect NY or CA, but many other states are accepting this and it opens up patients to a much larger group of clinicians. I believe that midlevels are not far behind in that area.

 

[R. Matey]

I am not sure that Betterhelp is the issue so much as PsyPact. Now that does not affect NY or CA, but many other states are accepting this and it opens up patients to a much larger group of clinicians. I believe that midlevels are not far behind in that area.

We don't have PsyPact here so that might be part of it. I'm licensed in a state that does have PsyPact where admittedly I have less data, but it does seems that psychologists there are still pretty busy (lurkers, if you are, feel free to chime in). My counselor friends tell me that the roll out of their equivalent (COMPACT?) has been somewhat of a disaster so it's not imposing an immediate threat, but I don't doubt they'll eventually figure it out.

It does not really concern me too much. As I said, demand for services seems high as people continue to write articles about therapists shortages. There's even a greater shortage of people who know what they're doing. So do I think midlevels will busy competing with each other and AI before they're too much of an existential threat provided that we continue to demonstrate our expertise, market effectively, and be innovative.

 

[Sanman]

We don't have PsyPact here so that might be part of it. I'm licensed in a state that does have PsyPact where admittedly I have less data, but it does seems that psychologists there are still pretty busy (lurkers, if you are, feel free to chime in). My counselor friends tell me that the roll out of their equivalent (COMPACT?) has been somewhat of a disaster so it's not imposing an immediate threat, but I don't doubt they'll eventually figure it out.

It does not really concern me too much. As I said, demand for services seems high as people continue to write articles about therapists shortages. There's even a greater shortage of people who know what they're doing. So do I think midlevels will busy competing with each other and AI before they're too much of an existential threat provided that we continue to demonstrate our expertise, market effectively, and be innovative.

Am I super concerned? Not really as a current mid-career psychologist that will be slowing down my practice by the time the chickens come home to roost and the owner of a home already. As a young person coming into the field now with the cost of many programs and current home prices? I would be less sure. Personally, an NP program seems like the best bang for the financial buck currently with failsafe's if you stop along the way. Not sure how I will advise my own kid.