Careers & Employment Opportunities for Psychologists & Therapists

More often, clinicians are choosing to start their careers in mental health in private practice.

And with so much information online, going into private practice has never been easier.

But the question remains: Should you go solo or join a group practice?

Everyone you know in solo practice says they make more on their own but does the math support the claims? Plus, when you see those solo practice owners, they look tired and haggard (kinda like Bert, the one-man-band in Mary Poppins). They’ll nervously tell you they can’t afford to take a day off or get sick. You can see they’re obviously working hard… harder it seems than when they were at the agency. And that’s probably the case because everything – clinical work, clinical admin, billing, marketing, accounting, claim appeals – rests on their shoulders in solo private practice. Here’s the harsh reality about solo practice:

The MORE you work, the LESS you make.

Skeptical? Check out the numbers below and let them do the talking. Below is a very lean budget based on actual amounts as of this writing (June 2021) for 4 solo practice scenarios: in (INN) vs. out of network (OON) and a traditional office setting vs. telehealth only setting. Each scenario is based on:

• 20% cancelation rate (5) = 20 sessions completed out of 25 possible slots
• $125 per session based on average insurance reimbursement rates for licensed Masters and Doctoral level clinicians in Miami, FL
• 2 weeks for vacation & 2 weeks for illness
• Averaged out expenses for variations between Masters and Doctoral level clinicians
• Averaged out expenses for variations across Miami-Dade, Broward, and Palm Beach counties
• Annual Membership to a national group for referrals, credentialing, and/or billing (e.g. Alma, Headway, My Wellbeing, etc.)
• No more than 40 hours weekly worked in your business (including clinical, admin, marketing, content creation, billing, etc.)

You’re in a no-win situation. 

Here’s the reality: solo clinicians spend way more than 20 hours per week seeing clients and doing things for their business. This means the only way to earn more is to raise fees and/or see more clients.  If you take insurance, that isn’t an option because you don’t have control over reimbursement rates and worse yet, you’re vulnerable to any changes to those rates. (BCBS cut rates by 33% in Florida with 2 months’ notice a few years ago!) If you raise your fee, you further limit access to needed care. And finally, increasing your caseload will require more billing and admin work to handle claim appeals and QA requests which means now you’re working even more hours.

That’s a recipe for clinical and entrepreneurial burnout. 

National groups like Alma, Headway, etc. promise to get you consistent referrals, credentialed with insurance companies, handle the billing, negotiate higher reimbursement rates, and pay at regular intervals.  While these groups seem to solve the missing puzzle pieces to making solo practice viable, there are some drawbacks like:

• You’re still a 1099/independent contractor and responsible for self-employment taxes.
• You “own” the client, which means you’re on the hook for QA requests and retroactive claim denials (i.e. “clawbacks”).
• You’re vulnerable to changes to reimbursement rates.
• You’re vulnerable to changes to the policies that govern Headway, Alma, etc, and the insurance companies.
• Even if you joined all of them, they may not provide enough referrals to keep a practice full (i.e. ~3 new clients each week).

The MORE you work, the MORE you SHOULD make.

At Envision Wellness, we understand that. Careers at our practice are designed to provide our clinicians with streamlined support and autonomy while catering to their ambitions. Our pay scale offers a clear path for financial growth and longevity for careers in the mental health field. 

That’s a sobering reality, huh?

As you can see from the chart above, an EWCo clinician’s compensation entirely depends on the number of clinical hours (inclusive of clinical admin time) they chose to work. Across the board, they’re taking home approximately 45-48% of total revenue, which is still more than most of the scenarios above. Here’s why that’s a big deal:

• The average income for Master’s level psychotherapists in Miami, FL, is $63, 455, ranging from $44,671 – $78,691.
• The average income for Clinical Psychologists in Miami, FL, is $93,156, ranging from $65,580 – $115,524.
• It’s comparable to being in solo telehealth-only practice and accepting insurance (INN).
• It’s comparable to the traditional 60%-40% split for 1099/Independent Contractors across South Florida and most of the US.

In fact, the only scenario that financially outperforms our model is the solo private pay, telehealth-only practice which leads to taking home 49% of total revenue. That’s only a 4% difference from our model for newly licensed clinicians BUT you’re doing it all – clinically, administratively, technologically, and entrepreneurially – and carrying all the risk. The difference decreases to 1% for experienced licensed clinicians.

For these nominal differences, you can eliminate all the time wasted on the administrative, technological, and entrepreneurial headaches that come with owning, operating, and working in a business. Using the example above, it’s equal to $5,760 yearly, $480 monthly, or $120 weekly depending on how you look at it. For less than the cost of a session, you’d gain back more than 1 hour of your time each week to spend on the people and things that matter most to you.