[PretzelJudge]

A PhD in psychology takes 6 years to complete plus another year for licensing. A PsyD is a little bit less, but typically you pay high tuition during that time, whereas most PhD programs are free (with a small stipend). So, you make little to no money (or pay money) for a long period of time and then you are presented with a choice to take or not take insurance. If you choose the former, you:

- Get paid half as much

- Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you.

- Get your money later instead of now.

- Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards.

- Have to lose patients when their coverage runs out

Meanwhile, there's overwhelming demand for therapists in many cities and plenty of people who will pay cash. I truly believe that many therapists are not in it for the money... but if they are going to make less money, let's at least figure out a way to handle the bureaucracy so that their jobs are more enjoyable.

[jdgoesmarching]

LPCs, MSWs, LCPCs, LMHCs make up a much larger portion of therapists over PhDs and PsyDs. All take much less schooling.

[pas]

for anyone else wondering WTF is going on :P

LPC - Licensed Professional Counselor, 24 states + DC

LMHC - Licensed Mental Health Counselor, 7 states (NY)

LCPC - Licensed Clinical Professional Counselor, 7 states (IL)

LPCC - Licensed Professional Clinical Counselor, 6 states (CA)

...

MSW is likely Master of Social Work

( https://www.psychotherapynotes.com/decoding-counselor-alphab... )

[timr]

I know someone who is in training to be a therapist. It still takes an absurdly long time and a lot of money to get any of those degrees. In New York, for example, there's a mandatory multi-thousand-hour internship that essentially treats you as indentured labor for several years -- and this is after getting a masters, which you usually pay for. The average case ends up substantially in debt, for a field where private practice pays mediocre salaries.

(Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)

[notepad0x90]

if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue.

[mnky9800n]

No this doesn't work. In Norway there is typically a minimum 6 month wait. Or you can see a private person who takes money today. Same in Germany, and the Netherlands, and basically everywhere else I lived that has subsidized healthcare. It's one of the things that falls through the cracks in my experience.

[lolinder]

I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid?

The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally.

And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.

[nanoxide]

The issue is similar in Germany, where the vast majority has mandatory insurance: Too few therapists for too many people. Even in large cities you might wait months, if they even have waiting lists. It's much easier if you pay by yourself.

[JumpCrisscross]

> if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue

Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.

[nradov]

It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.

[victorbjorklund]

in sweden it is almost impossible to find a psycologist. Many years of waiting and that is only if you are an extreme case. If you are just average depressed you can just dream about getting one in your lifetime.

[BeetleB]

You don't need a PhD to get a license...

[nothercastle]

But very few non phd therapists practice evidence based medicine

[miki123211]

Okay, here's one thing I really don't get.

There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?

[PretzelJudge]

Sure, if you just want someone to talk to. But most clinical psychologists are dealing with more severe cases. Would you want your suicidal teenager talking to a licensed therapist trained to deal with their case, or to someone overseas whose qualification is that they speak English?

[rafram]

Because people want therapists who’ll connect with them and understand their life experiences.

I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.

[Suppafly]

The problem with this, and we see this in the US already with medical providers, is that even if they are 'native' speakers in their own country, they miss a lot of important nuance and conversational skills to work with US native patients. And that's before you even consider the cultural stuff that they just don't have a frame of reference to understand. Someone from a country where women don't have rights, or where normal things like divorce or abortion are illegal, isn't going to be able to offer useful therapy to someone from the US.