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The slippery slope of the sliding fee scale



As health care professionals, standards demand we provide our clients with the highest level of service possible. But while those rigorous standards ensure high-quality care for our clients, we also maintain another responsibility: to set standards for our business that reflect what we are worth.

In building a health care business, one thing is clear: Insurance and "sliding scale fees" don't add up to a thriving, growing health care business. According to dictionary.com a sliding scale is defined as "a scale of fees, taxes, wages, etc., that varies in accordance with variation of some standard." But I wonder: Who sets these standards?  

The term sliding scale is tossed around in the health care field as if it is a form of client entitlement and many providers consider the sliding scale fee an avenue for giving back to the community. I view the sliding scale as additional weight placed upon providers' shoulders that inevitably builds blockage in running and building a seamless business. Moreover, the sliding scale perpetuates the misconception that profitability is not an option within the helping field, even as our expertise and education establishes our credibility, knowledge, professional acumen and eventual reputation within the field.  

Somewhere along the line, it became routine to expect professional health care services to depend upon and ride the rocky slopes of our client's economic mountains. 

Ironically, the term "sliding scale" is never applied to most other professions. Consumers, for example, don't ask the grocery clerk for a sliding scale. Imagine the look on your mechanic's face if you requested a sliding scale rate. Sounds preposterous, right?  

In "helping fields," however, it is a way of life. Dr. Larry Waldman author of the book The Graduate Course You Never Had, speaks out about how helping professionals have trained consumers to respond to the sliding scale by allowing it to happen. The essence of truth stings deeper than any other wound and as a result, clients anticipate receiving sliding scales, discounts and freebies.  

Our higher education in the helping field has trained us to provide remedies and cures for the vices that ail our clients, but it is our duty as providers to value our own self worth as well as our business. If we do not value our time, our training or our investments we have placed into our practice, how can we expect anyone else to?

Don't get me wrong; I believe sowing seeds within the community is important to promote everlasting growth. However, there are a myriad of other avenues for contribution besides short-changing your business. There's volunteering, choosing pro bono cases and a host of philanthropic endeavors all of which serve to enrich the community as well as your soul.

The key to success in private practice is knowing when to give back and, at times refusing to give in when growing a flourishing private practice. Along your journey to finding balance, you will discover why some people make it in the world of private practice and others don't. Keep in mind that once you step away from the security blanket of an agency and stand on your own two feet, the game changes and you are always it.

While in the midst of finding your personal Zen, here are some steps to help nudge you towards the direction of inner peace between the conflicts of business while lending a helping hand within your profession.

 Begin by setting clear-cut goals for your business. A business plan will enhance your vision, as well as provide guidance during long and short periods of time. Next, seek supervision to address how these goals impact your role as a helper. Supervision can come by way of mentors, or groups comprised of individuals who share the common goal of spearheading a strong private practice.  

Never underestimate your own self worth. This is accomplished by not only determining the monetary value for your services but also refusing to waver. Find ways to support your community - while supporting yourself and your business.

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Teri Karjala

Teri Karjala is owner of the Creative Counseling Center, LLC, as well as Talking With Teri, LLC. Teri’s passion for the business aspects of owning and maintaining a business has made her a sought out coach by others in the helping fields. She is a regular columnist for ColoradoBiz Magazine and speaks to therapists across the nation in building their thriving practice. Recently she has released her “How to Live Deliciously” Creative Journal Series to help inspire and empower adults, teens, and children. These are available in print at www.talkingwithteri.com.

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