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Survey May 2005

 

Practice, Heart and - Money - Can They Really Go Together?
Or, Everything You Always Wanted to Know about Fees but Were Afraid to Ask


Introduction

First of all I wish to thank the 36 people who took the time to give us their information and feedback that made this survey worthwhile. It was particularly helpful that there were those contributors who took still more time to write out additional comments which proved to be both informative and enlightening in answering the questions.

There were a divergence of opinions which are thought provoking and point out once again that there are a number of values involved in running a practice some of which values can conflict with each other. This is the true dilemma, when there is a conflict between values rather than a conflict between right and wrong. There is a challenge to run a practice that can both be a means of providing a solid livelihood and a practice that is of service to others. This was one of the interests I had in putting this survey together.

My hope was in the end to have a sense of how our local practices are being managed and to share this information in a way that will be of help to each of us.


Considerations and Questions

If there had been sufficient time, it would have been valuable to have run a test survey to work out some of the bugs:

  • clarified what is full time and part time work
  • clarified whether hours worked meant client hours or total hours worked
  • on questions asking to indicate your comfort level, the range was from 10 (easy) to 0 (hard); on review this seems counterintuitive and I would reverse this to 0 (easy) to 10 (hard)
  • Also, after the survey was published, further questions came to mind as well as those suggested by the contributors:

  • Are you running any groups?
  • If you work with managed care, what % of your practice and of your income is it? What insurance plans are you a provider for?
  • What % of clients pay full fee (only 5% can afford this in my practice)?
  • Wish gender was asked for, I suspect there is a difference.
  • Websites - are they helpful for your practice?
  • Were this survey ever run again, these revisions would be important and helpful.


    The Survey

    To download the original survey, click here!


    The Results

    (written responses for questions 9, 13, 22, 26, 28 will follow after question 28)

    Abbreviations:  R = range     Av = average

    1. What is your normal fee?     R: $110 to $55     Av: $88

    2. Do you offer a sliding scale?     Yes: 32     No: 4

    3. If so, what is the range for your fees? *     Min: $20 - 80     Av: 52;               Max: $70 - 110      Av: 88

    4. Do you limit the number of low-fee clients?     Yes: 23     No: 13

    5. Do you accept insurance/managed care?     Yes: 28     No: 8

    6. Do you charge for late cancellations?     Yes: 33     No: 3

    7. If yes, what do you charge?     Full fee: 31     Other: 2 charge ½ fee

    8. Again if yes, do you charge:     always: 8     sometimes: 25

    9. If sometimes, please explain: (see below)

    10. Do you need to earn an income?     Yes: 32     No: 4

    11. What is your comfort level in charging your full fee? (On 10 point scale, 10=easy, 0=hard)
    R: 0 - 10     Av: 8.0

    12. What is your comfort level in charging for late cancellations or no shows?
    R: 0 - 10     Av: 6.4

    13. If you use a sliding scale, how do you determine what to charge?
    (see below)

    14. What is your last year’s (2004) gross salary for your practice?
    R: $3,000 - 100,000     Av: $41,111

    15. In your practice, do you work:     Part-time: 22     Full time: 12

    16. Do you have more that 1 office location?     Yes: 9      No: 26

    17. If you work part-time, do you wish to work full time?     Yes: 5     No: 19

    18. Approximately how many hours per week do you work in your practice?
    R: 5 - 50     Av: 18.9

    19. How many hours per week would you like to be working in your practice?
    R: 7.5 - 42     Av: 20.9

    20. Do you have non-practice income/work?     Yes: 20     No: 16

    21. If so, do you wish to continue both kinds of work?     Yes: 14     No: 3

    22. If so, would you explain why? (e.g. stable income, etc.) (see below)

    23. How long have you been licensed?     R: 2 - 30     Av: 14.0

    24. How long have you had a practice?     R: .5 - 32     Av: 13.3

    25. Are you a member of your local Chamber of Commerce?  Yes: 1   No: 34

    26. Honestly, on a gut level, does it feel like charging fees and providing therapy seem like a conflict of values?     Yes: 8     No: 25     Both: 3

    27. How comfortable are you "marketing" yourself and your practice? (10 to 0 scale)
    R: 0 - 10     Av: 6.1

    28. Do you have any questions or thoughts along these lines that you would like to have brought up at May’s meeting for discussion?

    * MediCal base rate = $33.64 / Child Protective Services base rate = $30


    Written Responses (questions 9, 13, 22, 26, 28)

    9. If you do sometimes charge for late cancellations, please explain:

    Responses:

    Don’t charge for:

  • Emergencies; hospitalization; car breakdown; illness; accident; unexpected crisis; birth; death; jury duty; if due to something unavoidable; if good excuse, won’t charge first time;
  • If I can fill the time
  • If no shows several times; if repetitive no shows or repetitive late cancels
  • when not a clinical issue
  • Comments:

  • First session free, make sure they understand policy, always charge afterwards unless true emergency
  • "Things happen. Mistakes. Misunderstandings. Emergencies. It’s never been a problem. If it were, I would charge. (I can make mistakes, too. Forget. Double book)"
  • 13. If you use a sliding scale, how do you determine what to charge?

    Responses:

    Client determines based on ability to pay; what person says they can afford

    Negotiate with client

  • I ask for my full fee. If that is a problem I may ask them to pick a fee that will allow them to be consistently in therapy without the financial stress.
  • "My fee is $90. Is that OK?" Then we bargain.
  • I ask the client how much they feel they can pay.
  • Ask about ability to pay - honor system - I don’t ask for proof of income
  • We discuss their situation, income, other resources, expenses and priorities, then I propose an amount.
  • What I can afford; I do not offer if I have too many on scale.
  • Full fee for non-insurance clients

    Comments:

  • Not charging full fee & not charging for cancellations effects not just ourselves but each other. Accepting cancellations with only 24 hours notice is not taking care of ourselves or our profession.
  • I hate managed care & do not think we should participate in it
  • 22. If you have non-practice income/work and wish to continue both kinds of work would you explain why? (e.g. stable income, etc.)

    Responses:

  • Stable income, retirement, sick leave, vacation, investments
  • Community involvement
  • Variety, new interests, all related to main field
  • Appreciate collaborative work (schools)
  • Balance of exercise and activity

  • It was with question 26 that I had hoped to explore the potential conflicts and dilemmas of managing a practice. The responses that follow give a wonderful perspective of the values involved!

    26. Honestly, on a gut level, does it feel like charging fees and providing therapy seem like a conflict of values?

    Responses:

  • Yes: 5
  • Yes with explanation: 3
  • No: 21
  • No with explanation: 4
  • Both: 2
  • both with explanation: 2
  • Comments:

    • Mostly no except for clients on disability or homeless
    • No - Sometimes
    • No - once in a while
    • Yes in some ways
    • No - absolutely not
    • No - keeps boundaries clear
    • Yes - when I was very codependent, that has changed
    • No - the conflict is in the high amount of fee - out of range for so many people
    • Since I work with many adults abused as children, who were not taken care of by the community (teachers, doctors, social workers, police) I believe the government (if not their perpetrators) should be paying. I’m fine charging people with good incomes. Often a person’s low income relates to their early abuse.
    • I’m a child therapist working with financially struggling families, half of whom are on MediCal. My goal is to help these children, not to make money. I only make about $36,000 - $40,000 a year (gross). I’m blessed with an aged father who respects my values and helps out with my family’s expenses.
    • Yes - seems like the dilemma is:
      1) either see in-need clients with difficult and persistent problems / disorders (who usually are low fee), or
      2) see high-functioning clients with more neurotic / milder problems at higher fees.

    And finally the last question:

    28. Do you have any questions or thoughts along these lines that you would like to have brought up at May’s meeting for discussion?

    Fees

  • Where can we find good sliding scale guidelines?
  • I finally have a billing person (1-1-05) and since January have made more money than any of the 17 years I’ve been in practice. Fear is why I didn’t do it sooner. And I wasn’t important enough.
  • Coaching

  • What if financially successful therapists coach those wanting support and direction to be balanced and abundant
  • Survey results

  • Hope they will be published in the Therapist (here it is!)
  • Other issues that would like to be addressed:

    • Paying private practice interns
    • Marketing ideas that don’t take much work
    • How to avoid burnout, where to market in print, how to say what we do in a few sentences or less
    • Ideas on getting referrals, getting started, subletting
    • Good use of office help or billing system to lessen paperwork morass

    Summary:

    Most of the respondents use a sliding scale and charge for late cancellations so sharing their comments can be helpful to us all in having a sense about what others are doing and use to guide us in our own practices.

    One recommendation I would make from this is that we each consider having a written policy that clearly states what our expectations are for our clients and ourselves.

    So hopefully by comparing our fees to those charged by others and making use of ideas that may prove helpful to us we may be able to expand our practices as we are wanting so that we can have that balance between truly providing for a living for ourselves as well as serving our clients.

    My hope is that this survey will be helpful toward this end.

    F. Michael Montgomery, LCSW, MFT
    1209 College Avenue, Santa Rosa, CA 95404
    (707) 578-9385    
    fmm@inner-healing.com     www.inner-healing.com

     

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