I know you're scared

I've been having a lot of conversations with clinicians lately about money, insurance, and the changing shape of our work.

Underneath so many of these conversations, I hear fear. Fear about insurance clawbacks. About reimbursement rates changing without much explanation. About referrals slowing down. About whether the practice you've spent years building will continue to support you.

Fear about what happens if you can't keep seeing the same number of clients every week.

I know you're scared.

And I want to say something about the industries and systems we're working inside. There are people and companies making money from our confusion.

Insurance companies operate within systems so complicated that even experienced clinicians struggle to understand what they're being paid, why a claim was denied, or whether money they've already earned might be taken back.

Meanwhile, there's a growing industry selling clinicians solutions to the uncertainty. Get off insurance panels. Build a premium practice. Charge more. Create passive income. Start a group. Build a course. Scale.

Some of that advice is useful. Some of it isn't. And some of it is being sold with the same fear that made us vulnerable to the pitch in the first place.

I'm not interested in telling you that everything is fine.

There are real changes happening in healthcare. There are real financial pressures on clinicians. And there are real reasons to reconsider how we work. And here's something else I know:

The traditional model of clinical work had limitations long before this particular moment.

Seeing 25 or 30 clients a week was never going to be a workable plan for everyone, forever.

Our capacity changes. Our lives change. Our interests change. The kinds of work we want to do change.

And yet, so many of us were taught to build a caseload and keep filling it. As though that were the whole career plan.

I've been a clinician for more than 25 years. Along the way, my work has taken all sorts of shapes. Individual therapy, groups, teaching, writing, training, consulting, and building programs with people I love working alongside.

Not all of those changes came from a carefully constructed plan. Some came from curiosity. Some from necessity. Some from recognizing that something wasn't working anymore.

And some came from asking a question I return to again and again:

Why do we do it this way?

I think that's a question worth asking right now.

Not because we need to panic and reinvent ourselves.

Because we deserve to understand our options.

We deserve reliable information about the industries shaping our livelihoods.

We deserve to make decisions about money and work without someone using our fear to sell us the next solution.

And we deserve to imagine that our expertise might have more than one expression.

Maybe you want to continue seeing clients, but fewer of them. Maybe you want to teach or supervise. Maybe you've been thinking about creating a group, developing a training, or consulting with organizations. Maybe you don't know what you want yet. You just know something needs to change.

That's a perfectly reasonable place to begin.

You don't have to make your next move from fear.

You can make it from information, curiosity, experimentation, and a clearer understanding of what you need.

I've been thinking a lot about how to help clinicians do exactly that, and I'll have more to share soon.

In the meantime, I'm curious:

What's one thing about your working life that you're ready to reconsider?

I'd genuinely love to hear.

Hilary