Every now and then my in-laws go on a rant about the cost of health care. “The real problem is that these health care providers get paid sooo much money” they say. They then turn to me and look at me like I’m part of the problem. Without fail I say “I don’t know why you’re looking at me, I don’t think therapists get paid enough. Are you saying that therapists should be paid even less?” Usually at that point they just stop talking or change the subject. What we see here is an example of what so many people in America believe: That therapists get paid loads of money to do essentially nothing. And at least amongst my in-laws, there’s also a belief that the health care crisis in America is due to “frivolous” health-care providers like therapists getting paid so much. But is that actually the reality of the situation?
The average mental health therapist in the wealthy State of Massachusetts, in the wealthy city of Boston, gets paid a measly $35,000 a year. Not exactly rollin’ in it are we? I know that’s how much I was being paid prior to going into private practice so I can definitely confirm that’s the reality. My therapist friends who are not in private practice tell me that’s how much they still make and these are seasoned therapists. By the way, most therapists are not in private practice. Back when I worked for an agency, most of my coworkers were collecting food stamps, living in government subsidized housing, and couldn’t afford their own health insurance. In other words, they were collecting welfare. And that sweet $35k I was making? It took more than 40 hours per week to make that happen. I was often working 60 hour weeks because if a client cancelled their appointment you don’t get paid so I had to overbook. Therapists also typically work evenings and weekends. We also have many hours of paperwork that we don’t get paid for. Clients can also be very demanding, wanting us to call and email them in-between sessions, all time that we don’t get paid for. Let’s also add to this our student loans, licensing fees, malpractice insurance, mandatory continuing education we have to pay for, so many unpaid meetings, and association fees. All this and the average therapist only makes $35,000 a year.
You might hear this and think “Why would anyone become a therapist?” We do it because we love the work and people take advantage of that. I also wonder if because there is such a popular belief that therapists are overpaid that some people go into it thinking that it would be an easy lucrative profession only to have their mind blown shortly after graduating. The only way to survive being a therapist is to either marry someone with a good job or go through the rigors of private practice. Meanwhile you have to listen to your in-laws complain about how you’re being overpaid and burdening society. The reality is that therapists are probably one of the most underpaid and under-appreciated professions in this country. I worked with child and family therapists whom decided that the demanding nature of the job as well as the low pay meant that they would never be able to have children of their own. There are child therapists who can’t afford to have children. That’s the reality of the situation.
So how did it get this way? One of the problems is that the insurance companies decide how much we get paid. There is no “negotiating” when it comes to pay. A contract is simply handed to us and we’re told to “take it or leave it”. But how do the insurance companies decide these rates? It’s actually largely influenced by a government committee called RUC and is made up of doctors chosen by the AMA (American Medical Association). This committee gets to decide the going rates for medical procedures, including everything we therapists do and how much we get paid for them. It’s important to note that there’s not a single counselor or therapist on this committee. Since it was formed in 1992, the pay of therapists have decreased 59% and the pay for physicians has increased 63%. In other words, they have taken a bigger piece of the pie for themselves.
How ridiculous is it that the AMA gets to decide how much counselors are paid? It would be like if police officers got to decide how much they got reimbursed along with teachers, meanwhile the teachers had no say. People would say that was a conflict of interest and wouldn’t stand for it. The problem is that now counselors are making so little money, we don’t have the funds to stand up for ourselves. I belong to the ACA (American Counseling Association) but I know that nearly all counselors don’t. That’s because membership is $167 per year and when you’re getting food stamps that’s a luxury you can’t afford. So we have no representation, no ability to fight back, and seemingly it gets worse every year as the public continues to complain that we are being paid far too much.
Can you imagine if you took a job in 1992, a good job that required that you go to college for 8 years and have a professional license, but instead of getting incremental raises you were actually getting decreases in pay to the point where you are now making about 60% less than when you started? Would that not feel very unfair to you? Perhaps even criminal? Who would stay at that job? Who would join that profession? A Masters in Psychology is already listed as the worst Masters degree a person can get, followed close behind by a Masters in Social Work. As far as education goes, it’s the worst return on investment. Young people are seeing this and taking notice. A get calls from would-be therapists and they tell me that they feel a calling to become a therapist but also feel like they’d have to be a complete idiot to enter this profession given the realities of it. They want to know if what they read online about it are true. All I can tell them is that sadly yes it’s true. After a while we’re going to have a real mental health crisis in this country because no one will want to become a therapist. We’re starting to see the effects of it now. Therapists have long wait-lists or have stopped taking on new clients completely. It’s difficult to even get a call back from a therapist because we are so over-loaded. People are having a hard time finding a therapist period, let alone someone “good”.
But what about doctors? Do they deserve to be paid more than us or are they being paid too much? As it so happens, we know that therapists have a higher success rate than medical doctors. That’s right, you are more likely to see a therapist for any reason and have your problem solved than you are to see a doctor for any reason and have that situation solved. This is usually when people say “Yeah but doctors are more likely to deal with life threatening issues”. Not so, doctors mostly deal with issues related to comfort, just like therapists do. But I hate the argument that therapists don’t save lives. Therapists do save lives, everyday. There are many people who have told me they would have killed themselves if not for counseling. Not to mention all of the marriages and families I’ve saved. Therapist do really important work and society greatly benefits from the sacrifices we have made for this career.
I remember that my first year in private practice, I was invited to a dinner party. My neighbor was a medical doctor and she invited us to dinner. My husband and I were the only ones there who were not physicians. At the party were doctors of all types, so there was a great variety of specialties. After the third glass of wine or so, they started talking the truth about their profession. What I heard that night truly shocked me. They each agreed that they were not in the business of curing or even really helping people. They want to keep people alive of course, but only so they can keep billing your insurance. They also want to keep you as sick as possible without dying, also so that they can bill your insurance as much as possible. They all agreed that this was an unwritten hospital policy and something all doctors did. I felt sickened. Although we therapists also need to bill insurance to get paid, our goal for every session is truly to cure people. As little as we get paid, we are always trying to put ourselves out of business. We give it our absolute all and don’t like the idea of our clients suffering.
It made me think back to my father-in-law. He is a very ill man with free government-paid health insurance. It seems like every time I see a commercial on TV for a medication for some obscure illness, it turns out my father-in-law is taking it. He has multiple issues and they are all “lifestyle diseases”. My husband becomes angry because his father’s conditions are all self-made, but where was a doctor encouraging his father to stop smoking, or lose weight, or be more active? He sees doctors seemingly every week but the answer is always another medication or procedure. It would seem he was a living example of the “keep him alive, but never well” philosophy. I know that a therapist would have worked with him to change his lifestyle and would have made all these prescriptions unnecessary. In other words, if people saw therapists more or if doctors were more like therapists, there probably wouldn’t be a health care crisis in this country. And yet, we’re the ones who are being over-paid.