Creating a solid policy around sliding scale appointments in private practice can be easier than you think. You can save a select portion of your appointments for sliding scale as long as the boundaries around your policy are created with purpose, are aligned with your way of being, and can be sustained long-term. I see two different ways to hold this piece:
1) Set aside a certain number of slots. Meaning…pick a number of spaces each week where you feel comfortable donating your time either through pro bono appointments or sliding scale (I’ve read several times that 10% is some standard of measure). This way, you can manage the number of sliding scale appointments and you won’t regret offering them to clients.
Lets say you are seeing 25 clients per week and you decide 3 of those spaces could be reserved for sliding scale and 22 spaces for full fee. When you reach the 3 sliding scale, don’t offer any more until one of those spaces becomes available. The 23 remaining full fee spaces need to hit your target of revenue needed to fund your life. So…the amount of sliding scale you can offer may be correlated to your target income.
2) Calculate your average fees. Determine the amount of revenue you need to generate weekly. Calculate the number of clients seen/fees per client to come up with an average fee. As long as your average fees match the amount of revenue you need to generate, you are on target. If you offer too many sliding scale appointments and your average fee per session dips below your needed revenue then you are overextending yourself and need to stop offering sliding scale.
So lets say your target income after business expenses is $100,000 and accounting for vacations and slow weeks, you have 45 weeks to generate $100,000. That would mean you need to collect about $2,230/week. If you average 25 clients/week you would need an average fee of $90. Track your average fees weekly to make sure you are on target.
Determine a method that is aligned with your value system so you feel solid and grounded in establishing these appointments.
Put your target income first and work from there.
Value every client the same, regardless of fee.
Think long-term: Don’t accept a low-fee client if you can’t sustain long-term treatment with this client.
Keep a listing of low-fee referral sources so you can refer out a client needing service if your sliding scale slots are full.
Trust that there are more than enough clients out there who can afford your full fee.
Renegotiate the fee at certain intervals, maybe every quarter. A clients financial situation may improve after treatment starts. If not, then the reduced fee can be kept in place.
Don’t devalue your service.
Don’t flip-flop based on client. It feels messy to have a loose policy and charge clients based on what they can afford, especially when they are getting the same service (you).
Don’t reduce fees out of your own financial anxiety. It can taint the treatment.
For more on this topic:
I found a great article in Counseling Today, The Complications of Sliding Fee Scales.
And… here is a great article on the deeper issues behind offering sliding scale appointment. From Joseph Burgo PhD on his ‘After Psychotherapy’ website.
What does everyone else do? If you are aligned with your sliding scale policy, and it has worked for you, please share!!