The long term trend is not good; why become a psychiatrist when you can earn more as almost any other specialist? (With exception of pediatry). Jails are collectively America's largest mental health service providers. If there was money in psych work you'd see even private equity pump it up like urgent care chains.
Even with single payer or heavily regulated universal insurance schemes there's often a mental health services gap.
I think that is more a supply/demand issue.
I am not sure why people aren't rushing to become psychologists, it seems like it'd be a profitable field, but there is certainly a huge shortage, at least in major metro areas.
I'd really like to read a proper analysis of the situation...
As I understood it, she was saying basically this:
1. therapists typically just want to work freelance, make their own hours, and don’t mind having very few clients / taking extended breaks from working many hours.
2. therapists don’t want to deal with “challenging” clients (who generally are the most in need of therapy in the first place). “Ability to pay out of pocket” is a good filter to implicitly reject “undesirable” clients.
3. therapists want to externalize the labor burden of coordinating with insurance onto the patient
4. None of this has any connection to charging higher prices - that’s a separate supply & demand phenomenon based on the talent of the therapist, population & demographics of the area, and specializations that deal with issues more correlated with wealthy clients.
My impression from all this has been a massive negative opinion of “working class” therapists and counselors, to the point where I believe they should be required to accept insurance and they should be required to manage the paperwork process of insurance claims as a regulated condition of practicing therapy - it’s a matter of public health that’s in all our collective best interest to enforce with regulation.
Try to find a psychologist, not therapist (there are many paths to get qualifications to become a therapist, and not all of them are exactly HQ), in the pacific NW some time.
The wait time is in months.
This is the way it works for a lot of therapy and mental health services and it’s horrible. Prices are absolutely insane, practitioners are not accommodating to patient schedules, and patients have absolutely zero bargaining power.
In some ways doing it through insurance is kind of like a union. You all agree to accept certain inefficiencies, bureaucracy, etc., (and associated cost) in order for better collective bargaining terms.
Of course people with great jobs usually don’t care about unions. They don’t need the collective bargaining power and thus figure the bureaucracy cost is just a loss they don’t need.
Same thing with very healthy people and insurance. If you’re healthy you just figure, give me cheap catastrophe insurance, what do I care? But if you’re in the depths of the medical industrial complex because you need frequent treatment for chronic conditions, you quickly learn that papering everything over with lots of bureaucracy to adhere it to better collective bargaining for patients is way better, and I’d rather take the nasty, churning quagmire of price inflating insurance than deal with spartan libertarian mini-insurance that essentially just results in rich-get-richer (i.e. genetically lucky healthy people just get to save money while everyone else suffers).