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By Adrienne Loker, LCSW, EMDR, SE Therapist
Recently, I was perusing Indeed for outpatient therapy positions to ensure that our compensation package remains competitive. This is always a tedious process because it’s comparing apples to oranges.
At face value, there are some incredible opportunities for therapists to be high earners, but out of 22 companies that I looked at, only two disclosed the caseload expectation - and one of those companies was mine!
These two companies, along with a posting from a CSB, were the only salaried positions I saw as well. It’s common practice in the therapy field to reimburse clinicians for client-facing hours only, or to compensate them at an administrative rate for non-client facing hours. This means that if a clinician plans to make $125,000 per year (assuming there are two weeks of PTO, and they’re reimbursed close to 70% of a session at roughly $65 per hour), they must see 38.5 clients per week. That means scheduling about 45 clients a week to accommodate for a 15% cancellation rate. (Please note, these numbers are estimates - each insurance company reimburses something different, and it’s a breach of contract for companies to disclose their reimbursement rates - which is an issue in and of itself.)
Most agencies only reimburse clinicians 60% of the session, with the other 40% paying for the overhead of rent, administrative salaries, electronic medical records, email, website, utilities, marketing budget, etc. The companies who offer 70% often do this with high caseload expectations that must be met weekly for the percentage to apply.
Could you imagine holding the emotional space of 38.5 hours per week? Or, what’s just as important, can you imagine being one of those 38.5 clients? I’ve certainly had that experience - my provider was falling asleep during our time together, nodding their head at inappropriate times, or hearing one word I said and expounding upon it in an irrelevant way that only highlighted how absent from the room they were.
The biggest reason that I offer a salary is because of this. I think clinicians have worked their asses off to get where they are, and they shouldn’t have to hustle at their client’s expense! (or at their own expense or their family’s expense). Of course, what this means is that I’m shouldering a huge risk for employees when their caseloads inevitably dip, during cold and flu season, and during the vacations of the summer months. During our early start up phase, there were many paychecks that I didn’t receive in order to protect my team.
This is where the analogy of apples to oranges comes in. While my clinicians could make a lot more money if I adopted the fee-for-service model, they would have to step back into hustle culture to sustain their high numbers. Inevitably though, caseloads just naturally fall, and during those times, clinicians would be paid less. Having a salary model gives clinicians the peace of mind knowing that they have a consistent paycheck whether their caseload is full or not.
For some clinicians, money is the most important, which is absolutely respectable - but those clinicians aren’t a fit for my practice. At Seeking Depth to Recovery, we value anti-oppressive and trauma-sensitive workplace culture. This includes policies that radically oppose hustle culture, such as a consistent salary, realistic caseload expectations, and paid time off that’s given rather than earned.
Adrienne Loker, LCSW is an EMDRIA Certified Therapist, EMDR Consultant in Training, and Somatic Experiencing Therapist. She owns and operates a trauma-sensitive therapy practice, Seeking Depth to Recovery, that specializes in the treatment of complex and non-verbal trauma, using experiential modalities in an intensive format. In as little as one 90-minute intensive therapy session, participants report marked insight into their anxiety, panic, depression, and trauma compared to their previous experience with traditional talk therapy.
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