006: Why I decided to quit private practice

October 18, 2023
Joy After Burnout Podcast Cover Art

Hello, wonderful community! 👋 I’ve got a story to share—a tale of a pivotal moment in my career that I think many of you will resonate with. It’s the story of when I decided to bid adieu to my therapy practice, a decision that was laden with insights, discoveries, and unexpected twists. So, grab a cozy spot and a hot cup of your preferred beverage, because I’m about to unveil the journey that led me to change and growth.

The Reality Check that Sparked My Shift

We’ve all come across those tempting ads that promise hefty earnings from private practice, right? However, the truth lurking behind those numbers is far more complex—a tangle of overhead costs, insurance complexities, and the never-ending administrative tasks that can significantly impact your actual earnings. As I delved into my financial records, it became clear that my earnings were not living up to the grand expectations set by those ads. What seemed like a substantial income on paper turned out to be substantially less due to these hidden factors.

The Weight of Emotional Toll and the Struggle for Balance

Ah, the pandemic—a universally challenging time that amplified the emotional demands on everyone. For us therapists, it was particularly intense. Balancing the needs of clients, being there for my family, and effectively managing the practice left me feeling perpetually drained. The reality of burnout hit me hard, and it led me to ponder whether the emotional toll was truly worth the compensation I was receiving. As I reflected on my experiences, the answer became increasingly clear.

Breaking Free from the Sunk Cost Fallacy

Change is intimidating, especially when you feel that you’ve invested so much in a particular path. I was caught in the clutches of the “sunk cost fallacy,” which is the belief that continuing a certain course of action just because you’ve already invested time, effort, or resources into it. But here’s the truth: our identities are fluid, not set in stone. Our desires evolve over time, and embracing that evolution is liberating. Confronting and overcoming the sunk cost fallacy was like opening a door to new opportunities and growth.

(Sunk Cost Fallacy: A psychological trap where individuals continue investing in a decision or project based on the resources they have already committed, even if the decision no longer aligns with their goals or brings benefits. In essence, it’s the difficulty in letting go of something just because you’ve invested significant effort into it.)

Key Takeaways for Navigating Change and Growth

Glimpsing Beyond the Financial Facade: Before making any career move, it’s essential to understand the financial intricacies and how they can affect your earnings. The gap between projected income and the actual take-home pay can be astonishing.

Prioritizing Emotional Resilience: Amidst the daily whirlwind, it’s crucial to find equilibrium between caring for your clients and nurturing your own well-being. Ignoring this balance can lead to emotional exhaustion.

Embracing Change and Shifting Identities: Our identities are not fixed; they evolve with time. Welcoming change and letting go of the fear tied to the sunk cost fallacy allows you to step into uncharted territory with confidence.

In Conclusion: Embracing the Unpredictable

Transitioning from a therapy practice to a new chapter has been enlightening and empowering. It’s a journey about honoring my well-being, welcoming change, and recognizing that my identity extends beyond a single role. If you’re standing at a crossroads or contemplating change, remember that embracing change is a step towards personal growth.

For the complete story, tune in to my latest podcast episode here. I hope my experience sheds light on the significance of finding equilibrium, embracing change, and navigating the uncharted waters of a fulfilling career journey.

Let’s face the future together with courage and curiosity!

Speaker A: Jumping on wanting to talk with you a little bit about why I quit my forever practice. So I was kind of inspired a little bit. So I am probably, at the time of this recording, three months post quitting my practice. So I closed it not even three months, so I closed it in March of 2023. At the time of this recording, it is June, and I’m looking out at some beautiful Rhododendrons in my yard. I live in the state of Maine, and it’s quite green, although rainy this year. Weird weather everywhere, probably. So I have been binge listening to Ramit Sethi’s podcast, I’ll Teach You to Be Rich, and I just binged his Netflix series in like one whole day because I was sick yesterday. You might hear it in my voice. And what I’m getting at is really thinking of our return on our labor. I know this is so nuanced in therapy because our labor takes a lot of resources from us, right? You know, it takes emotional resources. It takes physical resources. It takes all the resources. Going back to thinking about my top earning year in private practice, that was during 2020 or 2021. I think it was 2020, actually, because I booked a lot more sessions than I had previously, and I wasn’t full time in private practice. So I will add that caveat. So I taught online courses in psychology for many years, and that position ended because the school I was working for closed. So I always kind of had two jobs, and I always have liked having two jobs. For some reason, I like to have my hands in things. So why I say all that is to say that at this time, that was my part time job. It wasn’t full time. So I think I was there three days a week, and my top earning year was $80,000. And that sounds like, oh, my gosh, 80K. That’s a lot of money in your private practice. What people don’t tell you is, you’ll see, I’ll see all these different advertisements, and these advertisements tells you things like, make $100,000 in your private practice. Ditch the agency job, girl, you can do it. Sorry, I had to get Advertiser voice on for this because it makes me so mad because they’re not talking about your take home pay. If we’re talking about typical take home pay, you’re thinking about at most 70% of your income. Most people have at least 30% of overhead in a private practice. So if we take that down, we’re just take even numbers, right? So if we’re taking $100,000, then you’re talking about 70K still a good salary. We don’t think about all of those things that add up. So if we have an office, we want to go to supervision, we want to take vacation days, we want to take sick days, all of those things add up. And when I boiled down all my numbers at the end of that year, I took home about $40,000, and that number somehow just stuck in my mind, because that’s close to what I was making on postdoc. So when I was in my postdoctoral residency, I worked full time. Yes, but I was pre licensed. It kind of really struck me that I’m not making more than my pre licensed salary. And the amount of effort, emotional toll that that pandemic year took on me as a therapist affected my whole life. It affected my relationships at home, my mental health, my physical health, all of it. So all of that work came at a cost, and that 40K was not commensurate with the amount of work that I was putting in. And that doesn’t count. Like, all the time that I spend for admin, for example, all the time that I spend calling insurance companies. I did get somebody during 2020 or 2021 to do billing. And I do recommend that if you’re going into your own private practice work to think about outsourcing billing. If you can do that, not everybody can. So how I came into private practice was very much motivated by fear and scarcity. So I had a newborn, and I didn’t feel like I could go back to my job. I didn’t feel like I could leave him. So he had heart surgery at day five, and I had a lot of postpartum anxiety about leaving him, and I was not ready to do that. So I didn’t do that. I didn’t go back working a full time schedule. And I could get all into the nuances of why we don’t have great care for mothers in our society, but we don’t. And that’s part of the burnout of therapists is also many of us are mothers. Many of us are caregivers. Many of us are the people in our families that take care of other people. We fill those roles. So if we fill those roles, then there’s only so much caring that we can give as a human. I believe we just have a quotient of that, and once we’ve expended it, it is gone. And for me, during the pandemic, with caring for my children, caring for my clients, and managing a practice, it was too much. I think the toll of the private practice in the pandemic for me was reasons why I quit, but the big part of it was the financial component. So I thought to myself, I can do a lot of things for $40,000 a year. I can do all kinds of things that aren’t wearing me out, like, this job is wearing me out. And it had to do more with that fit between my life it had to do more with how the job fit into my life versus me fitting into the job. I think another reason why I decided to quit my practice was the overwhelm of being a business owner as well. Technically, I’m still a business owner, yes. But I would argue that being a private practice business owner is a good bit challenging for many reasons. So it’s wearing the hat of being the provider, being the one who’s the caretaker in the role of the therapist or carer. If you’re not a therapist, maybe you’re a helper or maybe you’re someone who is another service provider. For example, at the end of the day, it always felt like something was never done. Whether it be billing or following up on a client or researching something for the next client or emotionally trying to prepare yourself, it never felt done. And one thing I always telled myself, I would actually never go into private practice and I did that and it was good for many years. But I think the administrative part of the job was not my forte at the end. I figured out lots of systems, honestly that really helped me in private practice. But I really came into it very messy and not knowing a lot. I learned a lot, certainly, and I’m very thankful for those things that I learned of being an entrepreneur and being a business owner. But I think if I had to do it over again, I would start way more simply. I think a lot of and I’ve seen a lot of forums about insurance and fighting with insurance companies to get paid. It’s very rare for a business to complete a service and then not get paid for it for someone, the insurance company, because it’s like a middleman saying, yeah, you did that, but we’re not going to pay you for it or file a claim. We don’t know. We don’t think that that’s going to get paid for this certain client’s insurance plan. And that’s a hard pill to swallow. I think one of my key points in that was when I had a client who passed away in the pandemic and I got a call back from an insurance company that said they overpaid me or I needed to send back payment. Just actually opening that letter, seeing the client’s name who had passed away and that I owed money was something that was surreal in some ways. I wanted to do so many things to that piece of paper. I wanted to rip the paper up, I wanted to yell at somebody, I wanted to cry many of the things that I wanted to do because I couldn’t tell anybody. I mean, I could tell my clinician friends, but I really didn’t have someone to really share that burden with and the stress of that was really a lot. So I’d say it’s a lot in the stress of dealing with insurance. I know that works for some people. So I had some insurance payers that actually didn’t cause me a lot of problems. So for example, I’d say like once I was on the Medicare panel for my state, I live in Maine, they paid pretty consistently and some of the top rates, I don’t think I really had to ever fight with them too much. I don’t remember me fighting with them at all. Probably shouldn’t talk about certain panels on the podcast in case people are like, what are you doing? I won’t talk negatively about one, right? In case there’s like big Brother insurance company coming to get me. Because they might because that’s what they make us think. They send us these letters like, we’re going to take you to court and it’s like all this fear mongering and we get scared because people send us really scary correspondence. So for good reason, right, that our nervous systems are like, am I going to do something wrong here? Because we’ve gotten those kind of letters before. So anyway, I would say things never being done and that kind of paperwork, insurance part of things. The paperwork for notes and stuff once I was out of an agency, didn’t bother me too much because I had a pretty good EHR, I used thera Nest for mine and maybe they should sponsor me. We’ll see about that. They’re not paying me to say that right now, but maybe they should because I did think it was pretty easy and a little bit cheaper than some of the other ones unbiased opinion. So I think systems can certainly help you with just the straight paperwork of notes and treatment plans and things like that. Hey therapist. I wanted to let you know about a free resource that I’ve developed for you introducing the Before You Quit guide. This is a free resource I wish I had when I was in the throes of burnout. So it’s going to include focused journal props on areas of struggle and burnout in clinical practice, identification of depleting experiences in your practice and in your life and then we’ll hopefully identify some actionable items for change. If you’re feeling depleted in your role, please give yourself the gift of slowing down and assessing what’s really going on with your career turmoil. As a therapist, I know it can be confusing, isolating and totally overwhelming. So grab your freebie. The link for that is in the show notes. Thanks. I think one other reason why I decided to quit was that I wanted different things that my temperament really didn’t fit. Sitting in a therapy office for 8 hours a day. I always felt that like I mentioned before, I always have had a couple of jobs so I like to do different things. I do like variety in my work and so I’ve consistently sought that out and I wasn’t getting that in a private practice alone. I did try to mix it up in different ways but I think I really just wanted something different and I think the wanting like wanting different things didn’t feel like it was available to me. Making the choice. Actually, I think what happened was when I had an opportunity, a job come available to me for a contracting job with a school locally. When it came, I told myself, oh, I don’t have to do therapy anymore. And it was very telling, I think, because of a number of things that pandemic. So many things that I talked about previously on this podcast led me to feeling like I just needed a way out and that I wanted something else. And I think I will put in the sunk cost fallacy here. So what is the sunk cost fallacy? That’s the thing that keeps you stuck. So it’s the phenomenon whereby a person is reluctant to abandon a strategy or course of action because they have invested in it heavily. If you are a therapist or someone has been to school for a long time to be in your career, then this is you. Even when it’s clear that abandonment would be more beneficial, a lot of us know it would probably be more beneficial for us to leave our agency job or leave our private practice or do a different course of action. But I think for me, starting your own private practice, it feels like a milestone. It feels like, I built this thing from the ground up. I put a lot of blood, sweat, and tears here. And it’s no wonder that many of us feel like we should keep going, that it makes sense to stay in it. But a lot of times, it doesn’t make financial sense. It doesn’t make emotional sense. It doesn’t make sense for us as the person to stay in it. And I’m not telling everybody to quit their role as a therapist. No, we need therapists. I love therapists. But if you feel like you want something else or you want to do anything else, that’s okay too. It’s okay to want something else. And a lot of times for my therapist colleagues, it doesn’t seem available to us. It seems like I made this choice. This is something I was called to do. It was something I was meant to do. For me, I think in my own religious tradition, I felt like, oh, I’m called to this. I’m called to be a therapist. This is my quote unquote ministry. And so that’s hard to leave something that’s a calling, that’s something that’s an identity, something that’s how do I want to put it? Something that becomes part of your identity. Right? For many of us, I’m a therapist just rolls off the tongue. We don’t know how to conceptualize ourselves differently. It takes time. It takes time to realize that you want something else, that you need to do something else in your life. And so I think listening to podcasts like this, for people that have left the field or people that have left and done something differently in the field, so if you’re wanting to stay in the field, for example, maybe it’s taking a different job, taking something that makes more sense for you, something that you can do. For me, that was making that pivot into doing more psychological testing and evaluation. So that doesn’t drain me in the same way that therapy does. It’s a different kind of beast because I’m writing like 20 page reports. So it’s another kind of tired, but it’s not a tired at the end of the day where I have that emotional drain. I can kind of be like, okay, I finished that report onto the next one because I don’t work with that person again. But I have a really important role, so it’s still heavy, and I still get in meetings with people where I’m like, this is dysfunctional. Why are people behaving this way? There’s going to be something wherever you go. So I think I’m trying to figure out a lot of that grass is greener where you water it. Can I water this grass and can I like it and just give a trial? Can I give something like a six month to one year trial? That’s what I’m doing with this podcast. For example, am I going to be able to do this to reach other therapists, to get my message out there, to help people through a new business, to help therapists? That’s what this is for me. It’s an experiment. And a lot of times having that experiment feels really scary. It feels scary to say, all right, I’m going to experiment in my life in the middle of my life, not the beginning, because that’s typically when we make more of our career experiments, right, let’s try an internship or try a different job. Oh, I didn’t like that. So I’ll get another job next week. It’s a little bit harder to do when we’re entrenched in our careers. I know it’s hard. Anyway, I think I’ll add that caveat here that it can be hard because of the sun cost fallacy, but that if we adopt a mindset of, hey, I can want something else, I can do something else, I can try something out. If it doesn’t work, I will lean on my feet. So I’ve kind of been living that and breathing that since I’ve made this shift. So if you’re thinking about doing that, certainly let me know if you need support. So if you need kind of clinical support with your caseload, I can do that on an hourly basis. Or if you want to come into my program, Love It or Leave It, it’s a program just for therapists that I’ve developed that either want to love their therapy practice or the role as a therapist or leave it, do something else, whatever that means for you, it can mean anything. So I really had this for therapists who want to stay in their role as a therapist or want to leave it.

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