Show Notes

Kayla: Welcome back to the Designer Practice Podcast and I’m your host Kayla Das.

When it comes to private practice, one of the struggles that new therapists face is setting their private practice fee. In today’s episode, our guest Roxanne Francis, social worker and group practice owner, is going to break down the process for setting your private practice fee.

Hi Roxanne. Welcome to the show.

Roxanne: Thank you so much for having me, Kayla. It’s my pleasure.

Kayla: So, Roxanne, I want to share with our listeners how we met. In May, Roxanne and I met at a Jane event in Vancouver because we’re both Jane Ambassadors, and we just love Jane, and we use it in our own businesses. And we hit it off instantly. I would say, like, instant friends.

Roxanne: Definitely, definitely.

Kayla: And after the main event, I think it was probably on the Friday, we spent at least an hour or so talking about private practice start-up, marketing, passive income streams. And we both learned how much we love the same things. We love helping therapists starting their practices, growing their practices, putting passive income streams, just so that people can have that financial freedom in their own business.

Roxanne: It was such a great conversation. We really dove into some of the similarities, that we have in our businesses. And I really, really do enjoy working with other mental health practitioners. And, yeah, we came across the idea that, or the thing that I noticed a lot with some of the therapists that I work with is the issue around setting fees. So, yeah, I’m really looking forward to this conversation.

Kayla: Yeah, me too. And something I’m going to throw it out in the world. I know we’re only in the very baby steps, but I believe putting things out in the world so that they actually happen. So, Roxanne and I are actually considering starting the very first, or at least the very first that we know anyway, conference for therapists here in Canada. Now, there’s nowhere to sign up for this yet. We’re literally at the baby stages and seeing how that might work and what that might be. We’re thinking in 2025.

But what we’ve noticed is that there really isn’t that many conferences, actually, if any, for specifically therapists here in Canada, regarding business, start-up, therapeutic modalities, just ways to get our continuing education credits. And of course, networking and meeting other therapists.

Roxanne: Exactly. It’s absolutely crucial. And there really is nothing like that here. And I think it’s really, really important. The networking is important. Learning about modalities is important. Learning about the business side of running a practice is important. It’s one of the things that very few therapists know about. They don’t teach us this in grad school.

Kayla: No.

Roxanne: And so, I think it’s going to be really good for us to put this together.

Kayla: Yeah. And there’s so many opportunities, say down in the States. But like here in Canada, again, I don’t know of any conference that happens regularly, specifically for therapists. From time to time there’s different conferences for specific professions, like social workers and so forth. But even then, I find they’re far and few between, and especially for all Canadians to be able to access. So, I’m super excited. I’m putting that out in the world because I believe if we record it today, it means we’re going to do it at some point. So, stay tuned. Hopefully in the next couple of years, we’ll have that up and running.

Introduction

But Roxanne, before we dive into today’s topics of setting fees, can you introduce yourself, where you’re from and a little bit about your own journey as a social worker and a group practice owner?

Roxanne: Yeah, so my name is Roxanne Francis and I’m a social worker and I run a group practice in Ontario. We support clients all over the province of Ontario. I’m also a wellness and DEI consultant for many companies and organizations and I also mentor other therapists and provide clinical supervision. I often provide supports around the business side of running a practice as well.

I kind of fell into the practice of social work. I actually went to school for the very first time for biochemistry and in the process of moving countries. I’m originally from the Caribbean. The process of moving countries. I really recognize that I really wanted to actually support people throughout their mental health journey. So, I went back to school and now I’m a therapist and I absolutely love it.

While I enjoy working with my clients. One of my greatest joys is also supporting therapists who are coming up or in the field who are struggling with the business side of their practice because there are not many people to turn to when you have questions about running your business.

Kayla: No, I agree completely. That’s something I’ve noticed too, especially as social workers we’re taught therapeutic modalities, we’re taught the concepts of social work, but we’re not necessarily taught the concepts of business, yet many social workers and therapists in general, go into private practice, yet not necessarily familiar with the business side. And, of course, today’s topic, how to set fee.

Roxanne: Exactly, exactly.

Considerations for Setting Your Private Practice Fee

Kayla: So, when therapists are deciding on a rate to charge for their one-to-one services in their private practice, what are some considerations they should think about when doing so?

Roxanne: So, I often tell clinicians, do you know how much it costs to live your life per month? The temptation is to really go to a therapist directory and see what everybody else is charging and just pick that number. But the truth of the matter is that everyone has a different life. Some people may have children. Some people may have other financial obligations. Some people may live a lifestyle that requires a lot of financing. And so, you really have to think, how much does it cost to be me, right? And when you think about your housing costs, your transportation costs, your communication costs, your utilities, maybe costs for your children, maybe you’re caring for an older parent or so on, figure out how much your life costs.

Then you need to think about how many days per week am I going to work? What are my hours of work going to be? Then you need to think about what’s my capacity in terms of how many clients can I see per day? Some people can see five clients per day. Some people can only see three. So based on your capacity, based on how many client days you’re going to work per week, and then you need to figure out what does that work out for me per month.

And then you need to figure out, does that match with how much my life costs? So, if you just go to a therapist directory and you say, “Okay, I like a nice round figure, like $100.” And you say, “Well, that’s what’s going to be my fee.” And then at the end of the month, you are struggling because you’ve run out of money. That’s because the cost of your life is more than the revenue that you are bringing in. So, you either now need to extend your client hours, work more client days, or you need to increase your fee.

So, figure out how much your life costs. Then work backwards in terms of the math, figure out how many days per week you’re going to work, how many client hours, how many clients you’re going to see and then you can figure out how much each hourly session is going to cost me, or what the rate is. Then you’ll have to figure out what the rate is per client session.

Shifting Mindset from Employee to Business Owner

Kayla: That’s a really good point. And something that I’ve noticed working with therapists is that as many of us are familiar with working as an employee. And as an employee, we tend to get paid anywhere between, say, $25 to maybe $40 an hour, depending on where you work. But when we go into private practice, sometimes even charging $100 sounds so out there because that is just not the, I guess, financial language as an employee that we’re familiar with.

So, if someone is thinking about setting their fee and they think, $75 or $100 or $120 just seems so out there. Do you have any advice or anything for therapists who might be struggling with that?

Roxanne: Yes, I would say, first of all, as a business owner, you’re going to have expenses. So, if you charge, let’s say you decide that you’re going to charge $100, all of that $100 is not going into your pocket, right? We have business expenses. If you are working as a virtual therapist, you have to pay the cost for your equipment. You have to pay for the internet. You have to pay for your electricity. You have to pay for the roof over your head in the building that you’re sitting in.

You also want to consider that some people have student loans, we have registration dues and professional dues that we have to pay to our associations and our colleges, these are business expenses, we have liability insurance, all of these things that have to get paid and all of that has to get paid out of the fee that you are collecting, if this is your sole source of income. So do not let that large number scare you, because you have things outside of you getting paid. There are other things that require that money. You have to save for taxes because that is a given in the world that we live.

And also, I want you to think that you’re a professional, you have expert knowledge, you deserve to be compensated for the time. The clients that come to you are not just paying for that 50 minutes or 60 minutes that you’re sitting in front of you for. They’re paying for the expertise that you’ve accumulated over years of education, over years of expertise that needs to be paid for.

And the other thing that I say to therapists is that society somehow thinks that we should give our services away for free because everyone needs mental health supports. The truth of the matter is, if you go to the dentist, and no shit to dentists because they do really great work. But if you go to the dentist, for yourself, for your partner, for your child, on your way out the door, whether or not you have benefits to cover the cost, and they say to you, it’s $250, it’s $350, it’s $400 because you had an x ray. We pay it without any question and we leave. But somehow for mental health clinicians, we hem and we haw. Should we charge this much? Is it too expensive? Do we deserve that? We actually do deserve it. We’re professionals too. Set your fee and charge it.

Kayla: That’s actually a really good point. It’s something that I was thinking as you were speaking is, and this is obviously my opinion. And, some listeners might disagree with this, but I also think as employees were underpaid, right? Many of us. And as a result, if you were to look at, say, a dentist or even let’s use a doctor, because they’re in the public sector here in Canada. They are often paid to a larger amount. And maybe a doctor is not the greatest example because they’re probably one of the most paid. But when we think of other professions, they are often paid at a higher rate than mental health professionals. So, in many ways, we are underpaid as employees. And we normalize that into “This is okay, right? This is the starting rate.”

And I know when I first started as a social worker, my first job, I got paid $16. $16 an hour. Now minimum wage at that point, and I was in Newfoundland at that point, was probably $10. So, it wasn’t minimum wage, but it still wasn’t the greatest. And I had a bachelor’s at the time. I didn’t have my master’s at that point. But I just graduated and getting $16 an hour and it was really hard work in my opinion.

So, going back to that, sometimes I think we normalize the rates that we get paid as employees and for all of those reasons you’ve mentioned. There’s more than just paying us when it comes to private practice, but it’s also understanding that we might actually be underpaid as an employee as well if we were to look at other allied health professionals in the field.

Roxanne: I agree. I think as a society in general, we need to really take a look at the pay that our social workers or our mental health workers or psychotherapists are receiving, because we do, in my opinion, lifesaving work, right? If you are not feeling safe with yourself. If you are inflicting self-harm. If you are unable to get out of bed and care for your children. If you’re unable to get out of bed and go to work, then those are things that impact your life quite significantly. And these are things that our mental health practitioners help people work through and become the best versions of themselves. And we need to get paid in a way that reflects that.

Steps for Increasing Your Practice Rate with Confidence

Kayla: Agree 100%. So, let’s say that a therapist has set a private practice fee and they want to increase it because they feel that maybe they aren’t able to cover their expenses, or maybe they just feel at this point they want to have a raise, but they don’t know how to go about doing so. What are some of the steps, they can take in order to increase their rate with confidence?

Roxanne: I would say, again, going back to the math, what is the number that you need to live your life? And often times, again, because we discount ourselves, we only look at our expenses or the cost to keep the lights on. But you also need to factor in your rest. You need to factor in your sick time. Time that you will need to maybe close your service while you are going on vacation. Taking care of family members and so on.

If you know you need to raise your rates. I would not jump from $100 to $200 immediately. That’s a bit of a big jump. It will be a bit of a shock to the system for your clients. I would raise it incrementally, maybe by $10, $20. And I would definitely give the clients as much notice as possible. You know that you will be raising your rates in the new year, and it’s September. Start dropping hints. Send a newsletter. Send a note to all of your clients to say, “As of January 1st, 2024, my rates are going to be X.” To give them enough time to make the adjustments necessary. And set your rate and stick to it. Sometimes we set a rate and think that we’re going to stick to it, but one client might say, I can’t afford that $10 increase. Another client will say, I can only afford a $5 increase. And then before you know it, 15 of your clients all have different rates. That isn’t fair to you. And that isn’t fair to the clients who are paying full fee.

It’s one thing to have a sliding scale, but in terms of increasing your fee, you want to increase it across the board so that everything is streamlined and there is no confusion for yourself or for the client. Because if your client is confused about any part of your service, they might choose to work with another therapist instead.

Kayla: I agree 100% and something that you touched on but I’d like to elaborate on is where you mentioned giving the client as much time as possible for the notice of the increase. It’s important to give as much notice as possible, because what happens is that not only can people may not be able to afford it, or they just need that notice and so forth. I always say marketing is about how we make people feel. And if someone walks into the therapy room, whether virtual or otherwise, or even maybe a day before their session and they’re met with a, “Oh, just FYI, your session has increased by even $10 bucks.” You’re like, “Wouldn’t I have known this in advance?” And it may not feel so great for the person who’s now being told. Now, if they were given a month’s notice, and then they have the choice to cancel, but as we know, many therapists even have a 24, 48-hour cancellation. So, if you’re telling the client 24 hours before the appointment that there’s an increase, it’s “Do I cancel and lose it all” or whatnot? So really just thinking about how would you feel? Or how much time would you want if you were a client and a practitioner was increasing their rates for you?

Roxanne: Exactly. I agree 100%. It really is about the client feeling valued, right? And if clients are not being told ahead of time, they do not feel valued. And when people don’t feel valued, they’re unlikely to spend money with you. And so, you want to preserve that relationship as much as possible by treating your clients how you would like to be treated if you were a client.

How to Include Pro Bono or Sliding Scales without Sacrificing Your Income

Kayla: 100%. So, sometimes therapists have a vision to provide either pro bono or sliding scale spots inside their private practices. Are there ways that a therapist can manage providing such services without sacrificing their time or income?

Roxanne: Yes. I would say if you are considering having a sliding scale in your practice or pro bono spots, you need to figure out, again, it goes back to the math. How much money do I need to make in order to live my life? Once you have figured that number out, you need to ask yourself, how far can I slide that scale and still meet that number? How many sliding scale spots can I have? If I slide that scale as low as I can slide it to, let’s say your rate is $100 and you want to have a sliding scale that varies between $100 and $50. Let’s say all of your sliding scale clients were at that 50 mark. Would you still be able to afford your life? That math needs to be worked out.

Also, you need to give yourself a set number of sliding scale or pro bono clients that you are willing or able to see per month, per quarter, per six months or per year and cap it. So, let’s say you have agreed to have 10 sliding scale clients per six months. If client number 11 comes in and says, I can’t afford your full rate. Can you see me at $50? You need to say, I will either have to put you on a wait list or I will need to refer you. Because if you keep offering everyone a sliding scale, you will slide yourself right out of your practice. You will not be able to afford it. And so, you want to have a thriving practice. You want to be able to afford your life so you can be present with your clients. You cannot be present and providing good work and helping your clients be the best version of themselves, if you are frustrated and worried about money and you are not the best version of yourself. So, think about whether or not the numbers add up decide how many sliding scale or pro bono clients you’re going to have and stick to it.

Kayla: I love that. Sometimes we think it depends on how we look at sliding scales or pro bonos, but sometimes in practices, we think, “Well, this is really great marketing if I offer sliding scales” and so forth. But what often happens is that if we’re offering everyone that sliding scale, it goes back into that math, we’re eventually not going to be able to cover the bills. And what often happens for therapists is that they end up having to go out of business and/or they burn out as a result. Because now they have to make up all of these extra sessions to be able to cover the pro bono and sliding scale spots. It doesn’t mean though that you can’t have these, but really what I’m hearing you say is, there needs to be some strategy behind it. There needs to be thought behind, how many can I take?

Because if you can only do three or four sessions a day and that drains you. And you’re already at max capacity, and now you’re saying, okay, I want to take on three sliding scales or pro bonos a week. Those three, that’s almost a full day if you’re only taking three a day. So, it’s really balancing out what is your vision, and if your vision is to incorporate these into your practice. How do you do that with that strategy that you just outlined?

Roxanne: 100% and you know another strategy that I’ve seen some of my colleagues implementing is having students in their practice or registered psychotherapists who are still qualifying and then having low cost or maybe even no cost services through these students that they are supervising closely. But even then, that still requires a cap because those students, because they’re students, have limited capacity and you will still have to supervise them. So that takes effort from you as well. So, you will want to say, “Okay, these students are seeing clients at low cost, but they can only take three per week or three per month because they are still learning.” You are having to supervise them. It’s extra work. And so, then the clients can decide whether they want to come and see the student who’s being supervised by you at a lower cost or no cost. Or do they want to see you, the experienced clinician, at the full rate?

Kayla: Yeah, that’s really important consideration, too, because some clients coming in may actually appreciate the decreased rate, whereas others may say, no, I want to work with someone that’s fully registered or licensed. And it’s good to have options because then other people can have that access.

The other piece to consider is insurance. If people are using insurance, they’re unlikely able to have a student cover that, but if they’re paying out of pocket, they may appreciate that lesser rate.

Roxanne: Exactly, exactly.

Additional Insights

Kayla: So, when it comes to setting private practice fees, do you have any additional advice or insights to provide listeners with respect to that?

Roxanne: I would say, be confident in your price. Also be confident in your skills. And do not be dissuaded by people who would say you should charge less. Recognize your worth, recognize your experience, your education, understand that people need our services, set your fee, don’t flip flop on that fee. And the last thing that you want to do is just go to a therapist directory and just pick a random number or pick the most popular number. Because that might not work for you.

And also understand as you were talking about earlier, Kayla, about raising your fees. Understand that if you choose one rates today, it may not work for you in six months. It may not work for you in a year. And you might need to increase that because life changes. People have children, people get married, or they separate, or they buy property, or inflation happens. I mean, have you seen the price of eggs? Things happen, and so, from time to time, we will need to increase our prices, and it does not mean that you’re a bad person for it.

Kayla: No, I want to go back to our example earlier, if you go to a dentist today and you go next year, even if you go to the same dentist. They may or may not have the same rate. At least for myself, as a consumer, I’m not expecting the same rate today that I am next week. The only thing that’s a bit different with mental health professionals is that we tend to see our clients more regularly, so the rate increase is very observable. Whereas if I go to a dentist today and I go in six months or a year. And I won’t even remember what I paid last year, so that’s the only difference. But the truth is other professionals are also increasing their rates as they need to as well. So going off of your point, yeah, increasing your rates as long as it, again, has that strategy. And I think that that’s the theme. If I was to create a theme out of today. It’s do the math and have a strategy.

Roxanne: 100% We can’t just pick a number out of the air and think that it’s going to work for us. Otherwise, as you mentioned, we might end up losing our businesses. And that’s the last thing we want. And one of the reasons why I’m so passionate about this conversation is because mental health services are really, really important. And there are people who cannot afford out-of-pocket services, and they access community-based services at low cost or no cost. But those waitlists are a year, 18 months long for services.

And when someone finally comes to the end of themselves and they decide that they need services, the last thing they want to be doing is languishing on a waitlist for 16, 18, 20 months. But if we do not set strategy, if we do not figure out what we’re doing with our fees, and we go out of business, then those waitlists get even longer. And so, we are really doing society a great service by strategizing and being really firm and confident with our pricing structure.

Kayla: Yeah, and I’d like to also add in too, is your business is meant to be long term. So whatever rate you set or whether you put in pro bono or sliding scale, it’s to really think of that sustainability and what you can sustain long term. Now I know some of us are doing private practice part time, and it is kind of a side hustle, and that’s totally okay if that is you. But if you’re looking to go into it full time, or you are in a full time, this is about the long game, this is about the sustainability. Which also means that at this point, you might not be at a place to do sliding scale, but you might want to do it later on. And these are the shifts you can do in your private practice. And that’s what’s so great about owning your own business is that you can change things whenever you want. Of course, a strategy is always helpful, but in saying that, you’re not stuck with your current fee, you’re not stuck with your current business model, you’re not stuck with any of those things.

But what you can do moving forward is really think about what is sustainable for me today? And it might pivot. I’ll give an example. When I first started, and this was not sustainable, by the way, I was doing six and seven sessions a day. One time I even did eight and I will tell you that I was glad that I didn’t actually have any sessions the following day because I had to sleep in, my brain was just mush. So now my ideal is four and I do four now because I have passive income streams. But at first, I was doing five and that seemed to be okay, right? But now I actually do four a day and that’s because I have additional income streams into my business. It actually is sustainable for me that way, but it doesn’t mean that you can’t shift, right?

If you start taking six, seven a day and you’re like, “Oh, I just can’t do this long term,” you don’t have to. You can slowly decrease because some of your clients will just the natural flow of when they start feeling better, they’re not necessarily going to want therapy anymore. And as a result, you can, at that point, even create your waitlist or just refer out depending on what it is that your business says. So, you can really think about that sustainability and that you can pivot and you can shift.

Roxanne: You’re absolutely right. I couldn’t agree with you more. When I speak to therapists about their practice, when they’re new to this, or when they’re launching from part time to full time, one of the things that they express relief about is being in control because when someone else is in charge, you are stuck. You can’t raise rates. You can’t change how many clients you see. You can’t change the days that you see your clients. You have to do what other people tell you to do. So as a practice owner, you have the autonomy to have the business model that you want to see. As many clients as you want to see. The kinds of clients that you want. And to charge the rate that you want. And so, we really have to step into that autonomy and select the fee that works best for us.

Roxanne’s Course for Starting a Private Practice

Kayla: Fabulous. So, Roxanne, you have a course that teaches therapists the steps for starting a private practice, including setting private practice fees. So, can you tell us a little bit about this course and how it can help therapists?

Roxanne: Yeah, so my program is called Jump Start VIP Day. And what that means is we get together either in person or virtually. And I go through all the steps and questions around starting your own private practice that goes from registering your business, setting your fees, how to manage your calendar, managing slow seasons, how to market and get clients, how to connect with other people so that you can get more clients, things like navigating liability insurance, association dues, all those pieces, h ow to save for going on vacation. And if you already have a part time practice and you are wanting to launch full time, we talk about how to know when it’s time to go full time. When do you know it’s time to hire an assistant? Should I bring on associates? What’s the best business model? We go through all of those pieces. I share some of the best business books that I have used. And at the end of the day, I give everyone access to one of my folders on my Google drive, which has all kinds of tools and forms and templates that they can use. And they can just plug and play, put in their own business name and take that as they go along. I share with them my own business lawyer, my accountant, my marketing person, all the people who have helped me because it’s definitely really intimidating to start this all on your own, not knowing who to ask. And, it’s my joy to share this information with others.

Kayla: So, to sign up for Roxanne’s Jumpstart VIP Day Course. Head to kayladas.com/roxannefranciscourse.

That’s kayladas.com/roxannefranciscourse.

Or you can simply scroll down to the show notes and click on the link.

Kayla: Thank you, Roxanne, for sharing your wisdom with us and teaching us how to confidently set or even raise our private practice fees.

Roxanne: Thank you so much for having me, Kayla. It’s been great.

Kayla: Thank you, everyone, for tuning into today’s episode, and I hope you join me again soon on the Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

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