Is Your Allied Health Professional A Money Grubber?

By Chiu Lau for Possibilities Psychological Services
Published for Linkedin: 05/09/2017, Updated: 10.19am AEST, 27/09/2024

Maybe I should stop following NDIS related posts on social media that reference allied health service providers (AHSP) and their fees. Or maybe I should skip some of the comments. But like a scab on my skin, sometimes I can’t help but pick at them. Call me a masochist.

The common theme appears to be that Persons With Disability (PWD) or their carers (parents, relatives, legal guardians) feel extremely frustrated by the hourly fees charged by AHSP.

However, once I calmed down and reflected on why they could be frustrated (and sometimes very, very, very scared, very, very, very exhausted and very, very, very angry), I realised that at one point, before I became a Psychologist working in private practice, before I founded and operated a small to medium enterprise (SME), before I was responsible for ensuring that Possibilities remained commercially viable (pretty term for ‘not shut down’), before I was responsible for my staff’s quality of life in way of respectful remuneration, before I was responsible for making sure clients were placed with the most suitable clinician for their therapeutic and financial needs, before all these, I too, once thought AHSP charged ‘too much’.

I mean, what are they doing with all that money!

(I promise you now, more than likely, not this. Not from the NDIS capped rate anyway.)

But BEFORE, I had NO IDEA how much it costs to run a business. I had noooooo ideaaaaa.

If I could turn back time, I would choose to be the type of psychologist who was able to see clients from a spare room in my home. SO MUCH CHEAPER!

But no. No. I had to be the type of Psychologist who works with children, and their parents, and their whole family, and their teachers, and the Education Department officials, their other allied health professionals, and the paediatricians, the psychiatrists, the GPs. No. I had to be the type of Psychologist to travel off site, to schools, to homes, to other places that is not my office. I had to be the type of Psychologist who wanted to offer group sessions, wanted to work with other AHSP under one roof, who wanted to train undergrads, who wanted to be surrounded by like-minded team mates. No. I had to make things harder for myself.

For some strange reason, Possibilities is attracting other AHSP who also choose not to see clients from a spare room in their home, who choose to work the way I do. Masochists a feather fly together, as a saying goes.

So………operating from a spare room in my home, as a solo practitioner, with minimal work beyond the 1 hour face to face session, is not on the cards for me (at present, anyway).

My point is, I should not get upset when consumers accuse AHSP of being “money grubbers” and/or “selfish”. I should not get frustrated when AHSP are told they only care about money and not the people they have chosen to serve. I should not get defensive when AHSP are told they only want to cheat NDIS consumers (because truth be told, there are easier ways to cheat people without undergoing hundreds and thousands of dollars worth in training. I am thinking it would be more efficient to write emails to strangers, pretending to be a rich prince from a faraway, exotic land).

I should not get angry because at one point, I thought the same way. People who have not started a business and have not tried to keep a business going have no idea how much it costs and therefore, have no idea why their fees are structured the way they are.

There is little point in getting angry at people who don’t know, because they have not had the pleasure (pain? both?) of running a SME.

Until I did, I too, did not know.

So, the FAQ by frustrated consumers is “why does my AHSP charge so much?”

Well, I am not able to speak on behalf of your specific AHSP, but maybe I could help by giving you an idea, based on my own experiences, as a private practice Psychologist and small to medium business owner (we have 10-15 staff).

Before I do this, I will rephrase the FAQ to this instead “What does the hourly fee I pay to see my Psychologist for 50-60 minutes actually cover?” 

Answer: If your psychologist is working for a small to medium private practice, chances are, your hourly fee is covering the following items…..

*the following expenses are based on the expenses of Possibilities Psychological Services and their Principal Psychologist/Business Owner. The registration and operational expenses below are standard for majority of Psychologists in Australia.

**Of course, keep in mind that expenses may vary from business to business, practitioner to practitioner. The list below is only meant to provide mental health consumers with a clearer idea of what happens to the fee you pay after your 50-60 minute face-to-face consultation.

***Should you have concerns with how your practitioner sets their fee schedule, and what they are using their money for, it’s probably best to address these concerns directly with them. Unfortunately, we at Possibilities have no opinion as to how your practitioner affords to live in a ‘big house’ or ‘go on 10-week yoga retreats every year’, or how they ‘afford to drive an Audi’. If you do find out, feel free to let us know. We’re nosy like that.

OK! Here we go!

1. Business expenses. A part of the hourly fee goes into paying for the following:

Rent, water, electricity (working by candle light increases our business insurance premium), general fixing & maintenance, cleaning, lawn/grounds maintenance (TIP: make sure your clinician doesn’t work somewhere where there are trees and bushes because you’ll be paying that bit more), office furniture (Gumtree Freebie section and council clean up days can only take one so far…), soft furnishings, office stationery, printer, toner, ink, cartridge, therapy consumables, computers, computer softwares, clinical tools and resources ($4k for Autism assessment tool. That was painful. Ouch), staff wage (tried to pay our specialists with picture of a spider. They said no), staff annual, sick and carers leave, super payments (ugh), ASIC fees, BAS payments (ugh), income tax payments (ugh), business insurance (ugh), workers compensation (ugh), accountant fees, bookkeeper fees (ugh ugh), website domain name, IT support (ours don’t just tell us to turn desktop off and on, they’re actually quite helpful), phone, internet, secure online client management software, graphic designer (because it’s apparently wrong to steal graphics from other companies, copy right infringement something something), advertising and marketing, indirect client work that are usually not billed but is important part of working in child and family practices (emails and phone calls to clients, email and phone calls to clients’ other service providers, emails and phone calls to client’s health and education professionals, session notes, progress reports to referring doctors, support letters for school, time for session prep, treatment formulation), free / low cost community education events, business development exercises, staff recruitment initiatives (much time goes into making sure we have the right clinicians for our clients), staff development and training, staff operational meetings (to make sure things are running smoothly and everyone knows what the heck they are doing at work and ways we can improve our customer experience), staff supervision (because leaders need to make time for their team, provide support and guidance and encouragement and all that jazz), staff team building events such as ‘Christmas Dinner’ (our business mentor said it’s not polite to make our employees pay for their chicken schnitty, that feeding them a free meal once a year is good for morale), staff amenities eg. coffee, tea, toilet paper (our solicitor said we cannot add a BYO toilet paper clause in employee contract. Apparently we need to supply these?), savings for emergency (because life is filled with sh!t on fan moments, ammirite?), savings for business development (because one day we would like to offer more services and would like to move into premises that would allow us to set up a sensory room), savings for when cash flow disruptions occur (true story: one time, a certain government agency that will remain unnamed transferred $25k to the wrong bank account, that is, not our account. Another true story. A different unnamed government agency delayed payment of $5k by months and months. That was a tough year)

And then, another part of your hourly payment goes into making sure the Psychologist is kosher for practice.

2. Professional registration expenses

Professional Indemnity Insurance, professional association registration, AHPRA registration, minimum 20 hours per year of Continuing Professional Development (CPD) (PS: specialist CPD training costs more), primary supervision fees, peer supervision fees (minimum 10 hours per year), time off work to attend primary supervision and peer supervision (unless your clinician does these things on their days off instead of resting, cleaning their home, spending time with their loved ones, taking care of dependants)

The above is JUST to maintain our registration, BTW.

Below is what we will need to operate on a daily basis…

3. Professional operational expenses 

Motor Vehicle (MV) registration, MV fuel, MV insurance, MV service and maintenance (because being a child and family practice, we do quite a bit of off-site work), income protection, laptop / iPad, session preparation time inside and outside of set work hours, treatment plan formulation time inside and outside of set work hours, research time inside and outside of set work hours..kinda like teachers, we do a lot of stuff inside and outside of set work times.

AND THEN, once all the expenses are deducted from the hourly payment, whatever is left over needs to cover…..

3. Business Owner’s Personal life expenses 

Most business owners’ wages go into paying for private health insurance, home and contents insurance, food, rent, utilities, phone, internet, home furnishings, clothes and shoes and things that we put on our bodies to protect us from elements or for decorative purposes, rest and recreation (because if your person is burnt out, they are useless to you, really), expenses relating to supporting dependants, health and well-being costs, savings for future (because, well, adulting), savings for emergency (see previous).

Look, ideally all AHSP are supported by Sugar Daddies/Mommies or are living off interest from million dollar Lotto winning or are the recipient of a Trust Fund. This would mean that they are literally not working for money. Pay them $50/hour. Pay them this. They will really not care. That would be ideal. Until then….every time you pay for your hour, just know that the above expenses are what it is including. 

Take Home Message.

1. Before I ran a business and worked in private practice, I too, thought AHSP fees should be less.
2. It is not cheap to run and maintain a kosher, ATO and FairWork approved business unless your practitioner books 10 clients back to back, 5-6 days a week to make ends meet.
3. Specialists need to spend a lot of money to maintain their registration AND up-skill to offer up to date, evidence-based suite of services.
4. A lot of stuff happens outside of the 1-hour face to face session to facilitate effective treatment outcomes.
5. Once expenses are deducted from hourly rate, whatever is left is what the AHSP business owner gets to live off.

For the trolls, I am sure you’ll find something to take out of context to rip me a new one but hey, that’s ok, everyone needs a hobby.

To the unhappy NDIS consumers and their loved ones, I am sure there are many mean, nasty, dishonest and toxic people out there, some of whom may be working in the field of allied health. My intention is not to invalidate your experiences.

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Chiu Lau is a Psychologist at Possibilities Psychological Services, an Australia-wide online therapy provider. Since 2003, she has developed expertise in the management of mental health, chronic fatigue, autism & related neurodevelopmental differences, learning & intellectual disabilities, rare genetic conditions, carer & sibling mental health support, and gender questioning & gender diverse presentations.

Recognising the challenges associated with navigating various intervention and mental health provider options, Chiu invites you to book a complimentary 20-minute chat to explore your options and possibilities here.