Episode 5: Do You Have To Offer A Sliding Scale In Your Private Practice?

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Hello there, and welcome back to the Mountain Practice Journeys podcast! I’m your host, Cindy Norton. Here in Episode 5 I’m going to talk a bit about sliding scales in private practice, and answer the question “Do you have to offer a sliding scale in private practice?”

Let’s get started.

Have you been wanting to start your private practice, but you can’t seem to take that first step? Maybe you’re afraid of failure or lack confidence, or maybe the idea of running your own practice is overwhelming. I’m Cindy Norton, owner of Mountain Practice Journeys and I help therapists and counselors to love the business side of private practice. I’ll share with you practical skills and advice along with a healthy dose of inspiration so that you can be on your way to the practice of your dreams. Put on your hiking boots, and let’s get going.

If you haven’t yet listened to Episode 4, I urge you to do that. I chat with Patrick Casale about how to know when it’s time to leave your agency job for private practice. We both share our experiences working at an agency and provide inspiration and encouragement to those who want to take the leap into private practice.

Now let’s get to today’s episode – Do you have to offer a sliding scale in your private practice?

The short answer is “no, you don’t have to.” The decisions that you face in your private practice are yours (and yours alone) to make. After all, you are the one who is left to work in your business, and you want your practice to work for you.

You are going to run across colleagues, whether in person or in the therapist facebook groups, who have very strong opinions about many topics including fees, cancellation policies, and really just about anything else you can think of – including sliding scale.

As with any of these topics I advise you to ignore what other people say that you should do – pause – and check in with yourself, what you really want, and what’s going to be best for your practice – because only you will know this.

That’s not to say that you shouldn’t take into consideration what others have to offer. Being able to see what others are doing and taking their suggestions – when they resonate – can be very beneficial as you build your practice.

With that being said let’s talk about all things sliding scale: why you may decide to offer it, why you may decide not to offer it, and why you may decide to delay it for a bit.

Let’s start with why you may decide to offer a sliding scale…

A sliding scale is a great way to give back to your community, to offer lower fee spots to those who otherwise couldn’t afford it, and to have the opportunity to work with the populations that you love supporting.

A sliding scale has many benefits to the therapist, the client, and the community. In fact, there are no real disadvantages to offering a sliding scale. I have only seen it become an issue when therapists have too many sliding scale spots, have not taken their finances into account, and are struggling to keep their practice open – but this situation is rare.

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One thing I want to add here in this section is the option of an alternative to sliding scale. Many of you have probably heard of Open Path Psychotherapy Collective, created by Asheville therapist Paul Fugelsang.

Open Path is free for therapists to join. You can create a profile and be listed on the directory to be matched up with clients who are looking for affordable therapy. Clients pay a one-time membership fee to become part of the collective which allows them to have lifetime access to all the member therapists.

Open Path only asks that therapists see at least one Open Path client at a time (although you can see more). Within your profile you are able to update your availability to reflect if you have space for an Open Path client. Currently, you can set your Open Path rates between $30-$60 for individuals, and between $30-$80 for couples and families.

I offer my low fee spots through Open Path as a way of managing my sliding scale. It makes having a sliding scale really simple and easy to manage. Open Path does the advertising for me, and all I have to do is ensure that my availability is updated and current. I’ve been using Open Path for a while now and I have had a great experience. My Open Path clients have been amazing, and when I open up my availability on the directory I’m able to get a prompt referral.

If you’re not a member therapist already, I encourage you to join. If every therapist signed up and offered only one Open Path slot, a multitude of clients in need of affordable therapy would be served.

Please check the show notes for a link to join Open Path. You can find the show notes for this episode at mountainpracticejourneys.com/episode5/

~

Next let’s talk about why you may decide not to offer a sliding scale…

Just because you have a private practice does not mean that you have to offer sliding scale spots. Not many people think of it this way, but not all therapists are financially able to offer sliding scale spots in their practice. Especially when just starting out and they have bills to pay and families to support.

Owning a business is not always easy, and it can be really tough financially as well. We do not know the circumstances of our colleagues. Some may have financial support from a partner or other family members – and can easily offer a few lower fee spots on their schedule. Some may be single parents trying to build their private practice on their own – and need all their spots to be full-fee in order to make ends meet.

It really saddens me when therapists are so judgmental and try to shame their colleagues because they do not offer sliding scale spots. You don’t always know someone else’s situation, and it’s not up to you to decide what someone else should be doing in their own business.

Many therapists who do not offer sliding scale spots are giving back in other ways to their families and communities. I know of some therapists who are donating several hours a week to help out their communities and to volunteer. And, because they do this, they are not able to have a sliding scale.

Remember: Just because you’re a therapist doesn’t mean that you have to give back through your business.

And finally, let’s talk about why you may decide to delay offering a sliding scale…

Starting a business can be tough, and you’re probably not going to be rolling in the dough in the very beginning. It may be a hardship on you to be offering low fee spots in your practice when you are trying to get established.

I’m sure you’ve heard the statistic about half of all businesses failing within the first five years (and 30% within the first year). If you’re able to get full fee clients in the beginning, it may make sense to get your practice established first before offering your sliding scale. When you feel like your practice is in a good spot financially, you can make room for sliding scale spots or give back in other ways (or not – you do you).

In the end, I want you to be empowered to make the best decisions for your business, regardless of what anyone else thinks you should do (including me).

I also want to mention that some new therapists will offer several Open Path spots when beginning their practice in order to fill space in their calendar. Just be aware of how many low fee spots you are taking on and manage them so that they do not negatively impact your financial situation.

During each episode I’ll be giving you one small take away, action step, or mindset shift. I call these acorns. Listen to episode 0 to get the scoop on what the acorns are all about.

The acorn from this episode is that just by being a therapist you are doing enough. Let me say that again: Just by being a therapist you are doing enough. You sit with people in their darkest moments. You provide your experience, presence, and expertise. And sometimes you get overwhelmed and weighed down by all that you hold for others. You need to take care of yourself first, or you will be of no use to your clients.

Offer a sliding scale, or don’t offer a sliding scale. I don’t care. What I do care about is you and your well-being. If you are opening up several sliding scale spots in your schedule (when you really can’t afford to do so in the first place) because you were shamed or guilted by a colleague for being selfish or uncaring – please reconsider why you are making this change. If it is going to cause you to become resentful, burnt-out, or financially burdened – think about how this will not only affect your health and well-being, but the experience of your clients.

On the other hand, if you are opening up one (or several) sliding scale spots on your calendar because you are excited about it, feel good about it, and it makes financial sense for your business, then that is wonderful!

And remember, no matter what you decide, you are doing enough – and YOU ARE ENOUGH. PERIOD.

As I outlined in episode 0, I’ll be alternating between a fun fact and ‘what I’m digging’ segment with each new episode. Open Path is what I’m digging for this episode. I mentioned it earlier, but I can’t say enough good things about it. The Open Path Psychotherapy Collective was created by Paul Fugelsang, a therapist here in Asheville, North Carolina, and at the time of this recording has matched over 50,000 clients to affordable psychotherapeutic care. I personally use Open Path to manage my sliding scale spots and it has worked wonderfully. It’s free for therapists to join, so you have nothing to lose. Check the show notes page at mountainpracticejourneys.com/episode5/ to find my referral link to join the Open Path collective.

Thank you so much for joining me today on your private practice journey.

For episode 6 I’m going to help therapists who are overwhelmed with client inquiries successfully manage the process through an understanding of the importance of systems and automation.

There’s no way you can know how much it means to me that you choose to join me here as I share all things related to private practice. Please subscribe so you don’t miss a step. For more information about this episode, please visit the show notes page at mountainpracticejourneys.com/podcast I truly appreciate you Trailblazers. Your mountain is within reach. Journey on.