Episode Transcript
Speaker 0 00:00:00 Hey, hey Shauna, A here licensed clinical mental health counselor, and you're listening to the Business of Therapizing podcast. This is the podcast where I help clinicians build lucrative careers.
Speaker 1 00:00:14 One,
Speaker 0 00:00:22 So we have to talk because it looks like the mental health field is being gentrified and therapists are losing out big time. But you know who else is losing out? The clients. Why is this happening and what can we do about it, is what we're gonna be talking about in this podcast episode. So first things first, what is gentrification? Well, normally when you hear this, you're hearing it in the context of housing, and that's typically when you see the transformation of a community from low value to high value, meaning all of the property prices, all of the taxes and such are going up in a very fast rate. So much so that the original inhabitants of that community are no longer able to live there. And when those original inhabitants begin to leave, this is called displacement. And when they're measuring gentrification, typically they measure that based on how many of the original inhabitants have been displaced, meaning how much of that community looked like, how it originally had looked versus what it looks like now.
Speaker 0 00:01:29 So essentially gentrification is when a community loses its original habitants because the cost has been driven up so high, they can no longer afford or be able to live in that community. The community no longer looks like how it initially looked. So what does this have to do with mental health? Well, I was recently reading a post from back in October, 2021, and there was a therapist from Boston who said that they were leaving the field and never returning ever again. This therapist is now working in the tech industry because they got so overwhelmed and so burned out and they did not want to return to their initial work because of the loss of their work-life balance, that they are no longer a therapist. And it got me to thinking, imagine working for so long towards a degree, spending money on your degree and coming out and being like, Nope, this is no longer for me. I'm too overwhelmed, I'm too frustrated. My work life balance is not where it needs to be. I don't have a social life. I can't leave work where it's at. I have to bring it everywhere I go. Now I'm just not gonna be in the field at all. This is how the therapy field is losing people and they're losing people in droves. And what's alarming about this is that the mental health field already does not have enough clinicians to meet the demand of mental health needs at this point in time. So to lose more people than it gains is a really big deal. That means longer wait list and less access to much needed services. And this therapist isn't alone. Many therapists had as expressed that once the pandemic hit, not only were they navigating the needs of their clients, but also the feelings of being chronically ill and having little to no work-life balance.
Speaker 0 00:03:26 Many therapists face the effects of vicarious trauma being overwhelmed and overworked all the while being underpaid. This often leaves many clinicians with the questions, what else can I do? So here's why this looks like gentrification to me. To understand all of this, we have to look at how the mental health field is built up. You have your private practices and group practices, you have your community mental health agencies, and you also have the online group practices and online therapy companies. So for many clinicians, they went to school dreaming about working independently. They wanted their own private practices. They dreamed about having their own couches where people will tell them about their mothers. And often what has ended up, for many clinicians, they were taught in a way that allowed them to gain the skills necessary to be counselors, to work clinically. However, they had to go out in the field and gain the experiences that they need on their own.
Speaker 0 00:04:29 And sure many of us have internships, but those internships were super general. Then they had to go back out and gain supervision hours. And many state licensing boards say you can't work independently until you become fully licensed. So for some people that can take two-plus years before they're actually working independently or they actually have the ability to work independently. But here's the kicker. Oftentimes when they go to work in the mental health industry for other people, those other people are not mental health providers. They are not clinicians. They didn't have to sit through a clinical ethics class. They're actually somebody who is on the outside. They're a business person, they're a person who said that they didn't have access to services, so they created this fun new way to get access to services. And what's wrong with that is if you don't know mental health ethics, you get to run your business any way you want.
Speaker 0 00:05:31 And off place that to the providers who do know mental health, ethics. These outsiders end up looking at their bottom line and what makes the bottom line, clinicians have to make money. The providers have to make money. So we do these crazy splits where the person who has the skill, the person who can provide the service is making a portion of what they would make if they've credentialed independently, and they have to see so many people in order to meet their productivity clause. I've seen clinicians work 30, 40, 50 client caseloads, some even more and wonder why they're burned out and they're seeing people all underneath the sun. They've got all these different demographics, all of these different things to attend to that is overwhelming. And again, we've seen this not only in community mental health, but in the rising popularity of the online companies. You see companies were started by non-clinician and were backed by venture capitalists.
Speaker 0 00:06:49 And what has transpired is some questionable ethics and low reimbursement rates for clinicians. But when you have a venture capitalist, you have the demand to meet to pay back that investor, and then some, it's to the shareholders. It's not to the mental health providers. So the demand that's placed onto the clinician is so clinicians now become overwhelmed and burned out because they're attempting to meet a demand that's not their own, and they're attempting to meet it in a way that is outside of what is really ethical for a clinician. It's outside of what we should naturally be doing, and it amps up the amount of vicarious trauma a clinician would face on a regular basis. Ultimately, clinicians leave the field, they get so overwhelmed, they get so burned out, they start to ask what else they can do. And people start giving them suggestions like, you should get into real estate, you should be investing, you should do all of these things.
Speaker 0 00:07:52 And none of those things are aligned with what they do. So they leave the industry for better paying opportunities. They leave the industry for less stressful opportunities, leaving the gap and leaving the need still there. But here's the thing, and this is what I've learned. There is value in the mental health industry. Otherwise, you wouldn't have venture capitalists investing into the industry. There is a demand there. Insurances may not be reimbursing us and the outsiders who work at these agencies or who fund these agencies and platforms may not be reimbursing us well either, but they do make a profit. And when they don't, they drive harder onto clinicians to make sure that they do. So they force large caseloads through productivity clauses and low reimbursement. They make you jump through 50 11 hoops and red tape in order to get paid. And what happens with all of that?
Speaker 0 00:08:49 Therapists get tired, burned out, overwhelmed, and eventually, they leave the field. Let me throw some statistics at you. So according to zippia.com, they provide jobs and demographics, statistics and those kinds of things. Their statistics indicate that there is a two year turnover rate for most clinicians where 24% of therapists stay in their job for less than a year, and 35% stay in their jobs between one and two years. And the waiting list continues to grow in 2022. In Massachusetts, there were 14,000 people waiting to see a clinician, and for every 13 people that left their job, only 10 was able to be replaced. Overall, since the pandemic in 2020, 18% of the professionals in the medical field, including therapists, have left it. So we have a huge problem. Clinicians are leaving the field in droves, in droves, and there's a huge turnover rate for clinicians and there's not enough to replace them.
Speaker 0 00:09:55 Obviously, there is no doubt that there is a growing demand for clinicians and not enough supply. However, with all of that, clinicians just don't get paid enough and we're forcing them to work at least twice as hard to make a livable salary. Not to mention the cost of being in the field with dues, CEUs, master level educations and testing fees. The bottom line is the therapists are being displaced out of the field and the public loses. And we're seeing this in so many ways, right? So when there's not enough therapists, those in need have to go on waiting lists. When therapists don't get reimbursed by their insurance therapists, just don't credential with them. And then the cost gets offset to those who are trying to get into services. Those who can afford quality services will pay out of pocket. Those who can't will go without.
Speaker 0 00:10:44 When therapists go to work, for organizations who engage in unethical practices or promote a quantity over quality culture, those in need suffer. Mental health therapists are hurt, but the public suffers the biggest loss in that they miss out on quality necessary care. So how does this get fixed? Well, it's impossible to say that we have to push all of the non-mental health providers out of the industry. That's just not going to happen. And it's been this way for a very long time. It's not just with online therapy. It's also been this way since, well before I entered the field, and it will continue to exist. But therapists can and should look at things differently than they have been taught. You see, clinicians have always been trained behind the mark. Grad schools purposely leave out business information so that therapists enter the field, having to rely on organizations to gain experience and beef up their counseling skills before attempting to go into private practice.
Speaker 0 00:11:44 This sets them up for exploitation. It also puts them further behind. In an ever-changing growing world, not all clinicians have the fund or the privilege to work out of the kindness of their hearts. Many got into the field to actually make a living. So when therapists begin to reframe and reconstruct some of the information that is being thrown out, they're able to carve a lucrative pathway. This goes beyond side hustling and trying to figure out what they can do to make more money. It looks at others in the medical field and begins marrying what they have done to yield more funds. When doctors were exposed to new technology, they, didn't just say, oh, that's taboo. Some of them went out and learned that new technology, and now they're able to utilize it to help them in their practices. Going into my take on this, when you look at doctors, they choose a specialty from when they're in medical school.
Speaker 0 00:12:44 And when you look at infographics, the doctors who specialize make more per year than doctors who are in general practice. Also doctors side hustle, but they do it in ways that is conducive to the work that they are already doing. So they may have a franchise, but it's related to what they do. An example of that would be dermatologists who open their own spa, and they're also selling their own products. This is actually called ancillary products and services. They do this to cut down on unnecessary side hustles, but it also gives them the ability to do more than just see people day in and day out. Doctors also have group practices. So a lot of times when you walk into a doctor's office that is run by another medical person that's not typically run by somebody who's outside of the medical field. Doctors are also really good at networking and working in pods.
Speaker 0 00:13:40 For example, if you were to go see a general practitioner, they may refer you out to a specialist. Now, many times that specialist is someone that they've known. They're familiar with their work and they have met, and so they will refer you to somebody that they know, or multiple people that they may know. What I call all of this is focusing in more than just kneeing down, because we clinicians, we're already in a niche. Our niche is health and wellness. When we start to focus in and focus down, we start to look at particular problems. So we're going beyond health and wellness. We're going beyond saying, we're just working with adults. We're just working with a specific diagnosis, and we're focusing on a specific issue, and we are building off of that. Of course, there's more to it than that, but the answer isn't just a side hustle.
Speaker 0 00:14:37 You need to build something that aligns with those. You help then utilize your network to become the go-to amongst one another. It's more than just coaching. It's more than just increasing your, your prices and writing courses. It's leaning into what you know specifically and providing many channels of help. So, surprise, surprise, my take isn't new, but I haven't seen us clinicians really utilize this in this manner. Generally, I see clinicians working in generalized practice. They're hopping on all of the trends Right now. We're talking a lot about trauma. So there's many trauma clinicians in providing trauma informed care. But what happens when trauma is no longer the trend? What will you do? Are you going to go out and start taking on new courses to appeal to the new trend? Or are you going to carve a place for yourself so that you don't have to keep hopping on every trend that comes up, but you are more so focused in on your field, focused in on what it is that your practice does, and building off of that, building courses, building services, building products, so that your clients, when they come to see you, you are on the forefront of that particular problem.
Speaker 0 00:15:50 Generally, I see clinicians working in generalized practice. Again, they're happening on all the trends, and it's because we're trained in this generalized way. We take the advice of our elders and we allow for our niche to come to us. We allow for that problem that we're looking for to just pop up instead of really trying to find it right when we're getting out of school, really trying to find it right. When we know that this is what we want to do, private practice is the way that we want to go, that is when we need to start focusing in. Then we fear that if we focused, if we knee down, that we'll become so bored that we'll back ourselves in the corner. And the thing of it is, you're already generally trained. So if you become bored or you no longer want to serve in this way or you wanna change things up, you can do that because you already have the skills.
Speaker 0 00:16:43 But when you become the go-to person and you build a network of people around you with an array of products and services that align with what you do, you end up carving out a space to help others. Even when you have a wait list, you carve out of space to make money while you sleep, and you create a space to do more without trading all of your hours for dollars. The reason why displacement is happening to clinicians is because the need is there, and many know it, but not enough of us. Clinicians can see it because of the ways in which we've been trained, plus the information from the older clinicians. The well-intentioned is from yesteryear. If we don't step into changing it, we'll continue to see clinicians leave the field in droves while clients wait for life-changing services. So this is what I have for you.
Speaker 0 00:17:32 You get some homework. I want you to think about how many times you've thought about doing something else, aside from being a clinician. Was that something else aligned with what you already do? Or is it outside of the field completely? If it's outside of of the field, you are already looking at displacement, but you can do something different. This is how you're going to create a lucrative career in the mental health field. You get focused and you build on that. And if you are ready to do so, it's time to journey with me. You've been listening to episode one of the Business of Therapizing podcast. I'm so glad you're here, and I cannot wait for you to tune in for more. Until next time.
