Psychology and salary: the payment of health plans

While the CFP table says that the minimum value of a psychotherapy should be 80 reais, health plans pay less than 20 reais.

Hello friends!

A while ago I wrote the text – Why do psychologists earn so poorly? – and a dear reader addressed the issue of health plans, which had not been addressed in the text. In order to open the discussion, I will then put some points so that professionals who wish to can agree or disagree in the comments and for those who, by chance, want to study psychology, also know about one of the facets of our current reality.

Minimum wage

In our area, in psychology, there is no salary floor. For the area of ​​clinical psychology, even if there were a floor, it would be a little pointless, since the psychological care service is generally a service to the final consumer (what, in English, is called b2c – business to consumer) and not a service to a company (b2b, business to business).

Therefore, as the patients or clients are the individuals who are going to contract the service, the payment received will not be in full, all at once, like a paycheck when we work in a company. That’s why I say that for clinical psychology, generally speaking, the question of the minimum salary would be practically irrelevant.

Table of fees (2013)

What a lot of people don’t know is that there is a table of fees created by the CFP (Federal Council of Psychology). In this table, there is a minimum amount, an average amount and a maximum amount to be charged for each service.

For individual psychotherapy, which is the most common work of clinical psychology in the office, we have:

Minimum amount: BRL 81.62

Average value: BRL 118.18

Maximum amount: BRL 139.93

Curious how the market does not follow this table. On the one hand, it’s very easy to see that the lower bound is not followed, but neither is the upper bound. Many professionals charge much more for a single consultation.

Health plans and psychology

My argument in the other text – Why do psychologists earn so poorly? – is that psychology is not outside the economic system in which we live. It is not a meaningless argument, as it seems to me… so, if it is true that psychology is inserted in our capitalist system, professional practice will be the offering of a product (such as a book, a psychological test, a course or a lecture on dvd, etc) or a service (a psychological assessment, application of a test, recruitment, selection, clinic, etc).

And, by simple rules of economics, of the most basic economy, we can understand how prices vary according to the demand of people wanting the product or service and of professionals offering the product or service.

Some examples:

The book Verbal Behavior, by BF Skinner is out of print. Therefore, there is a low supply of this product. Result: whoever is selling in used bookstores is selling for three times the price of a new book! After all, the demand exists, but the supply practically does not.

Another Skinner book that isn’t out of print won’t sell for such a high price, of course. In fact, the standard is for it to be sold at about half the price of new.

A nationally known speaker can charge, for example, 15 thousand reais for a lecture. For him, there is a lot of demand, that is, many colleges, courses, companies looking for his service. And since he is only one, his time will be limited. Therefore, the supply will be limited. With that, the value goes up and he may even refuse the offer of 15 thousand to receive a higher value.

The same simple equation can be applied to the issue of health plans. A health plan, in theory, would benefit everyone:

– users (who pay a monthly fee and have access to several professionals);

– professionals (who increase their patient base – clients);

– health plan (which, by uniting users and professionals, makes the difference).

However, this intermediary, which is the health plan, will do everything to reduce costs and increase profits. Obvious because every company aims at profit. To reduce costs, you will pay low amounts to professionals and to increase profits, increase the user’s monthly payment.

With this, the user complains about the monthly amount he pays and the professional about the amount he receives for his work.

Taking the CFP fee schedule as a basis, it is easy to see how health plans (even government ones, such as the Military Police health plan, for example) are far from the suggested minimum. If the suggested minimum is 81.62 reais, what the professional receives is between 15 and 25 reais. I’ve heard that some plans in São Paulo pay health professionals – not just psychologists – something like 8 reais per service.

Advantages and disadvantages of health insurance for professionals

Then the question arises whether it is an advantage or not to be linked to a health plan. And to say about the value of something, of course, we have to make a value judgment. And, as each person has a value and a perspective, each one will end up evaluating whether or not it is worth having patients or clients coming from health plans.

The advantage, in theory, would be to have access to a larger number of patients or clients. That is, having a full office and thus earning “in quantity”.

Let’s say that the amount offered by a certain health plan is 20 reais per session (after discounts and taxes have been deducted). If the session lasts 1 hour, we would have that in one day, with 10 patients, the professional would earn 200 reais. In 20 days worked, I would earn 4,000 reais.

These numbers are hypothetical, to be clear.

But what seems to bring dissatisfaction is the difficulty of seeing 10 patients a day. It is certainly not an undemanding job. You have to study a lot and, in addition, have enough balance to deal with all cases.

Dissatisfaction also comes from comparison with other salary ranges, in psychology and other areas.

Conclusion

Well, as I said at the beginning, I would like to open the discussion. I put some specific data and some opinions of my own.

In my professional life, I’ve worked with health plans that paid 25 reais per session (15 reais at the end with discounts). The question that arises is about the objective of the professional. I, particularly, think that the health area involves something more than money. Better saying, we don’t work only for the money.

In some texts here, I mentioned how brilliant teachers I had paid social prices (10 reais per session) to those who could not afford it. Lacan, for example, went so far as not to charge those who could not, but really wanted to do analysis. Afterwards, when they were able to afford it again, they paid a symbolic amount.

But, of course, the professional needs to pay his bills and have his life. Therefore, the question remains open. There is not much hope in the short term that the law of a wage floor for our category will pass (it would be around 4 thousand reais the floor, the minimum). On the other hand, for clinical psychology, as I said, having a floor would not be a guarantee of earning the floor, because the payment is made individually.

Another question is about the fee schedule not working in practice. And it doesn’t work because professionals who need it will accept the amounts offered by health plans that are lower, either because they need it or because they want to help patients.

Anyway, there seems to be a mismatch and a distance between psychologists and their Board, as well as between the Board and the reality of the market.

Questions, suggestions, comments, please write below!

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