You’re Not a Bad Clinician for Wanting a Better Contract

There’s a moment in almost every psychologist’s private practice career when a familiar feeling sets in—not burnout, exactly, and not quite anger, but something quieter and harder to name. It shows up late in the evening after the last client has left. Or when you finally look at the reimbursement line on the Explanation of Benefits and feel your stomach sink. Or when you try, once again, to reconcile the monthly income with the hours you’ve worked and find that the math, no matter how you spin it, just doesn’t add up.

And then comes the thought—half-formed but weighted with meaning: Maybe I shouldn’t be doing this. Maybe I’m asking for too much.

It’s a thought that carries shame disguised as humility. It frames the desire for a better contract as a personal failing, an ethical lapse, a departure from the selfless spirit of the field. It doesn’t say, this system is broken. It says, you should be able to live with this.

This, right here, is the psychological trap that keeps so many clinicians underpaid, overextended, and quietly complicit in their own exhaustion. It’s not just the contract that needs renegotiating.

It’s the story we’ve told ourselves about what it means to be a “good” psychologist.

The Quiet Collusion Between Professionalism and Self-Denial

The field of psychology, in its current cultural form, was built on an ethic of service. A noble one, but also a burdened one. Psychologists are trained, implicitly and explicitly, to locate value in sacrifice: in showing up no matter what, in holding the frame even when it’s crumbling, in prioritizing the therapeutic relationship over their own economic stability.

There is real power in that ethic. But it has also created a kind of quiet collusion between professionalism and self-denial. We don’t just absorb underpayment—we interpret it as a sign of our virtue. We don’t just tolerate administrative neglect—we wear it like a badge of how dedicated we are. We let ourselves believe that staying in a low-paying contract is somehow more ethical than leaving it.

And so, when the desire to leave arises—when we start to ask for something better—our first instinct isn’t agency. It’s guilt.

The System Is Dysfunctional—Not Your Expectations

Here’s what’s true: Most insurance reimbursement rates have remained stagnant for over a decade. Many are still based on outdated cost-of-living models that no longer reflect the financial realities of running a clinical practice in 2025. Therapists are routinely expected to navigate increasingly complex authorization processes, absorb rising overhead, provide culturally attuned and legally compliant care—and do it all for a rate that, after taxes and expenses, barely covers the cost of showing up.

This is not a result of individual failure. It is the predictable outcome of a system that counts on your hesitation to walk away. A system that leverages your training, your empathy, your sense of duty, and uses it to negotiate against you.

So when you begin to want more—when you notice that a panel isn’t paying what it should, or that your practice is sustaining the system more than it’s sustaining you—that’s not greed or fragility or poor boundaries.

That’s clarity.

It’s your internal compass reorienting.

“But What About the Clients?”

This is the question that traps nearly every psychologist on the edge of exiting a plan: If I leave, what will happen to the clients?

It’s a fair and loving question. It’s also a deeply manipulative one—because it’s the very question the system wants you to ask. It makes you responsible for the access gap. It frames your exhaustion as a failure of generosity. It casts systemic inadequacy as a personal dilemma.

But here’s the truth: You cannot fix access by sacrificing yourself. You cannot subsidize a broken infrastructure with your own financial depletion. The longer you stay in a contract that undermines your ability to practice sustainably, the more you erode your capacity to show up at all.

Leaving a plan doesn’t make you a bad clinician.

It makes you a finite one. A person who knows the limits of what they can carry. A professional who understands that ethical care cannot exist without structural support.

You are not abandoning your clients.

You are refusing to be abandoned by the system that is supposed to support your work.

Reclaiming Professional Disappointment

It’s okay to feel disappointed. Disappointed that the rates are low. Disappointed that negotiations don’t yield more. Disappointed that so many colleagues are still told to be grateful for being included at all. That disappointment is not bitterness. It’s not burnout. It’s not entitlement.

It’s grief.

Grief for the career you imagined when you started. Grief for the values you thought the field would honor. Grief for how hard you’ve worked to build something ethical and sound, only to be told that your sustainability is optional.

Naming that grief matters. Because if you don’t name it, it becomes shame. And shame is what keeps you stuck.

Good Clinicians Ask for More

Let’s be clear: You are not less ethical because you ask for a higher rate. You are not less caring because you turn down a panel that pays below breakeven. You are not less committed to equity because you can’t afford to subsidize a for-profit system.

You are still a good clinician.

Maybe even a better one—for knowing what it takes to practice responsibly, and for insisting on a structure that allows you to keep showing up over time.

The best clinicians do not just offer containment. They model it. And modeling it sometimes means saying: This contract does not honor the work I do. I am stepping away.

Not out of defiance. But out of integrity.

Building a Practice You Can Stay In

Every time you say yes to a contract that doesn’t meet your needs, you chip away at your ability to stay in the field. You increase the likelihood that you’ll leave the profession early, burnt out and disillusioned. And when that happens, the field doesn’t thank you for your sacrifice. It replaces you—quietly, without ceremony.

Wanting a better contract is not a betrayal of your values. It is a way of honoring them over the long arc of your career. It’s how you build a practice you can stay in—not just this year, but next year, and the one after that.

A practice that doesn’t just meet the needs of your clients, but yours too.

Because you matter in this equation.

You always have. Even when the system pretends you don’t.

About the Editor
Cody Thomas Rounds is a Clinical Psychologist-Master based in Burlington, Vermont, specializing in psychological assessment and collaborative care. He serves as Editor-in-Chief of PsycheAtWork Magazine, founder of the Learn.Do.Grow educational platform and the PsycheAtWork YouTube channel. In addition to publishing, he offers consultation and supervision for psychologists and creates practical therapist resources designed to support ethical, sustainable practice.

The Loneliness of Ethical Boundaries in a Dysfunctional System

There’s a particular kind of silence that follows an ethical decision. Not the kind born of indecision or doubt, but the silence that settles after the choice is made—after the contract is declined, after the underpaying panel is exited, after the long overdue rate increase is issued. It is not a triumphant quiet. It is not relief. It is something heavier: the strange, aching stillness of doing the right thing alone.

Most psychologists do not speak of this silence. It doesn’t fit into peer consultation or ethics trainings or practice management seminars. Yet it exists—and for many clinicians, it is one of the most disorienting parts of private practice. Because while ethics are taught as a shield, they often function as a wedge: separating you from the flow of what others seem willing to tolerate. And the moment you draw a line, even privately, you become aware of how few others are standing on that side with you.

Not because they don’t care.

Because the system makes it so hard to.

The Illusion of Ethical Consensus

In graduate training, ethics are often presented as a kind of professional glue. We are taught that the APA Code of Ethics, state laws, and best practices will guide us—and, by implication, unify us. The idea is that ethics are shared: that we will more or less agree on what they require, and that they will be easy to uphold when they matter most.

But in practice, ethical clarity rarely produces communal support. When a psychologist refuses to participate in a plan that underpays them, or decides not to provide a service outside of scope, or chooses to leave a job that violates their values, they do not receive applause. They do not receive solidarity. More often, they receive silence—or worse, subtle pressure to compromise. They are reminded, often gently, of how much the clients need them. How difficult the system is. How no one else seems to mind.

The message is clear: Don’t make things harder than they already are.

But ethics are, by nature, hard.

If they weren’t, they wouldn’t require codes or courage.

When Boundaries Look Like Betrayal

The ethical boundaries that most commonly trigger professional isolation are not about client care. They are about economics. Systems. Contracts. Money. The most painful boundary decisions are the ones that look, from the outside, like self-interest.

When a psychologist drops a contract because the rate no longer covers overhead, the backlash is often unspoken but real: You’re abandoning access. You’re choosing income over equity. You’re giving up.

When a therapist declines to take on another client in crisis because they are already over-capacity, they risk appearing cold or unavailable.

When a practice chooses not to enroll with Medicaid, or raises fees, or limits sliding scale to a small number of slots, the ethical calculus becomes suspect in the eyes of others—no matter how principled, thoughtful, or necessary those choices were.

There is a kind of loneliness that comes not from doing harm, but from refusing to be harmed further.

And that loneliness is rarely named.

The Internal Cost of Holding the Line

Most psychologists do not lack ethical insight. They lack ethical stamina.

It is exhausting to hold a boundary no one else seems to recognize. To keep refusing what everyone else has normalized. To repeatedly explain why something isn’t sustainable—and to watch others nod sympathetically while continuing to do it.

Over time, this dissonance wears on you. It becomes harder to trust your reasoning. Harder to maintain the conviction that you’re not just being rigid, difficult, or precious.

It doesn’t help that ethical strength is often mistaken for inflexibility. Or that principled dissent can be interpreted as moral posturing. Or that, in the era of burnout, saying “no” is often seen as a luxury rather than a necessity.

You begin to question whether it’s worth it.

You begin to wonder if it’s your standards—or your isolation—that’s the problem.

The Ethical Boundary as a Mirror

One of the hidden functions of ethical boundaries is that they show you who you are when no one is watching. They reveal what you’re willing to endure, what you refuse to normalize, what you believe care should cost—not just financially, but emotionally.

They are not declarations. They are mirrors.

And what makes them so destabilizing in a dysfunctional system is that they rarely reflect anything back. You hold the line. The system doesn’t change. The gap remains. You stand at the edge of what you can tolerate—and discover that almost no one will meet you there.

That’s when you must choose.

Not whether the boundary was right.

But whether you can keep holding it without company.

Reframing the Pain

The pain of ethical boundaries is not a sign you’re wrong. It’s a sign you’re intact.

Discomfort is not always a signal to revisit your choice. Sometimes it’s just the echo of having made one in a field that doesn’t reward it.

Staying on the panel would have been easier. Accepting the rate would have created less friction. Saying yes would have allowed you to feel momentarily useful, seen, good.

But none of those feelings would have lasted. And none of them would have spared you the deeper cost of betraying your own limit.

Pain is not always evidence of error.

Sometimes it’s evidence of integrity.

You Are Not the Only One

If it feels like you are the only one saying no, the only one renegotiating, the only one asking to be paid fairly, you are not.

There are others—quietly making similar decisions, quietly grappling with the same fatigue. They may not be loud. They may not be in your circle. But they exist.

And as more psychologists speak up, connect, and name these patterns publicly, the weight begins to redistribute. The story begins to change. The silence becomes less oppressive.

But even if no one else stands with you—right now, in this moment—you are not wrong to stand where you do.

Your boundary is not a rupture in the system.

It is a repair attempt.

Why It Still Matters

You do not have to hold every line. You do not have to be heroic. But you do have to be honest—with yourself, with your needs, with your limits.

Because every time you compromise a principle to avoid discomfort, the cost is cumulative.

And every time you hold the line, even quietly, you send a message: that the work has value, that the provider has value, that the system—however flawed—must not be allowed to erase either one.

It is lonely. But it is also leadership.

And it is how change, however slow, begins.

About the Editor
Cody Thomas Rounds is a Clinical Psychologist-Master based in Burlington, Vermont, specializing in psychological assessment and collaborative care. He serves as Editor-in-Chief of PsycheAtWork Magazine, founder of the Learn.Do.Grow educational platform and the PsycheAtWork YouTube channel. In addition to publishing, he offers consultation and supervision for psychologists and creates practical therapist resources designed to support ethical, sustainable practice.