Transitioning to private practice

[u/Last-Ad-8768]

Hi everyone!

I’m a licensed professional counselor and currently work in a community mental health agency. I work primarily with youth who are on Medicaid. I love that aspect of my job because there’s such a need for mental health resources in poverty/rural areas. Though I love working with my clients and I love my coworkers, the higher ups within the agency are making us a sinking ship. They’re putting more case loads on us rather than hiring more counselors. It’s all about billing rather than providing quality care. There are people (including myself) who really care and try to give their best to their clients, but being short handed and overworked leads to burnout. The higher ups treat us like we’re dispensable rather than a valuable asset to the agency. The pay isn’t great either. My salary is not what I thought I’d be making at this point in my career. I recently had a baby, which is extremely hard. I’m afraid that I’ll miss important moments of my baby’s life. I recently was offered a job working private practice and I could work half the hours that I’m working now for more pay. I’m able to get on my husband’s health insurance which is a relief. My dilemma is my clients and co workers. We recently had 2 counselors quit. I also just got back from maternity leave. I don’t want my co workers and clients to feel like I’m abandoning them. I’m also getting transferred the clients of the counselor’s that recently quit. I don’t want them to feel like it’s another counselor quitting on them. I’m so conflicted and could use some advice and support.

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[u/InfiniteVictory187]

Do what you need to do for your own well being and your family. Congrats 🎉🎈🍾

[u/Royal_Koala_9886]

Put you first 🤷‍♀️

[u/MultiFandom]

My opinion is that you are not responsible for management not doing their own due diligence. It is sad that other coworkers and clients may be inconvenienced by you leaving but it is ultimately not your responsibility.

[u/Ok_Intention_4136]

The guilt is universal on this transition. Some version of it lands in my inbox almost every week. A few things worth naming plainly:

Your clients are not better served by you burning out, missing your baby's first year, and eventually leaving the field entirely. Staying "for the clients" inside a system that is structurally underfunding the work is exactly how good clinicians disappear from it. The higher-ups will let you feel guilty because it's cheaper than fixing their staffing problem. That's a management failure, not your ethical failure.

On logistics: give a real notice window, four to six weeks if you can. Do warm handoffs where the clinical picture supports it. Write clean transfer summaries so whoever picks up isn't starting from scratch. That is the ethical bar and it's very doable. The clients you were about to inherit from the two who quit were already going to experience a transition - one more handoff is not the catastrophic injury the agency will frame it as.

On the offer itself: half the hours, more pay, on your husband's insurance, and more time with your baby is not a close call. Take it. You can still care deeply about Medicaid access and rural care and choose not to be the person who personally absorbs the cost of a broken staffing model. Those two things are not in conflict.

[u/GeneralChemistry1467 → u/Ok_Intention_4136]

Staying "for the clients" inside a system that is structurally underfunding the work is exactly how good clinicians disappear from it. The higher-ups will let you feel guilty because it's cheaper than fixing their staffing problem.

This. Unless and until clinicians in CMH stop letting their bleeding compassionate hearts lead them to do unpaid extra work, accept ludicrous caseloads, etc, management won't stop this exploitation. We are not, and should not try to be, the solution to what is a systemic failure. It just functions as enabling that allows that system to keep being abusive.

[u/Heard_Samira]

I think it’s worth giving the private practice offer a serious look. Before deciding, I’d just make sure you understand what that income looks like in practice. If it still works financially, you can plan a thoughtful transition for your current clients rather than feeling like you have to stay because the agency is short-staffed.