(This post was actually another response to someone else’s blog: The Behaviour Analyst. S/he posted about the charges that any BCBA or BCaBA has to charge. I deal with the issue that I myself face as a freelance practitioner in psycho-educational consultancy here in Finland, where the cards are pretty much stacked against the foreigner coming here and trained in any profession that was placed subject to Finland’s protectionist regulatory laws. These laws were enacted in 1994, immediately prior to accession into the European Union. Who says that an open market is that good?)
I’m not a behaviour analyst, and probably never will be. My field is the psychology of teaching, learning and development. But when it comes to what to charge for one’s services… this is probably one of the biggest minefields one encounters in going it alone. I have been a freelancer now for nearly four years, and have not a single clue on what to charge.
The major issue here is that there is a comprehensive education and health system, although I am going to state outright that this does not make these systems necessarily good. And – at least as far as psychology is concerned – it is practically impossible for a person trained outwith the country to get into positions for legalised psychologists. So foreigners with foreign papers have no choice but to either move out of the country or go into private practice as consultants. This means that there is no social insurance institution compensation paid to them per client they see: they have to charge the full fee, and will not see the 75%-of-fee compensation.
This means that – at the point of service dispensation – the client will only have to pay a private-practice legalised psychologist one quarter of that psychologist’s fee. For the private-practice consultant, this means that we have to operate at a fee that will be worth working for, but which will still be competitive with the legalised lot. And this – based on the way the financial aspects of the system work – is practically impossible. The system is set up in such a way that foreign professionals cannot get a realistic share of the private market. Let’s say that a private-practice legalised psychologist can charge 60 euros per hour (which, in Finland, is a 45-minute hour). Of this, on presentation of a KELA card, the client can fill in a form and the psychologist’s legalised status allows him/her an SV-numero (sickness insurance number); and this number, stamped on the form, will reduce that 60 euros to 15 euros (plus a fixed office fee, if s/he operates out of a shared office). The social insurance institution will pay the other 45 euros.
So, even at a service-purchase price of 45 euros per hour, the foreign-born-and-foreign-qualified private-practice consultant is still undercut by a factor of 3 before he or she has opened his/her practice door or even got the shingle hung up!
In this situation, one has to be prepared to specialise very quickly indeed. The health & social care and education systems do not have many specialists in them, and many specialist service providers are now cleaning up. And, in the foundation-type set-ups in which they work, the legal responsibilities are somewhat different from those of their colleagues in the state or municipal services. Would this be a good thing for the foreign professional working in consultancy?
Sadly, the answer is ‘no’. Again, the allowance of the SV number makes it possible for the legalised professional psychologist to charge a fairly high fee for him/herself, with KELA paying the 75% still, whilst the private-practice consultant remains undercut by the same factor of 3, assuming that s/he charges a fee set at 75% of that charged by the legalised psychologist.
I really do not know how a behaviour analyst would fare in this country, and I honestly cannot say how I am going to fare, either. I do not have the luxury of leaving here for a better country with a much more equitable system: I have a child here, and I cannot be expected to abandon her.
I doubt that there are many useful suggestions in my case, but anyone having some ideas is welcome to submit them. Meantime… people in the UK and US who wish to complain about the costs of things like ABA-based teaching for their autistic child… think about what that person has spent on getting prepared to be able to offer you that service, and what they themselves will have to pay out of that fee! And then look at how much they get after those things are paid out… and think about what that leaves them to live on.
And then be grateful that you can get them that cheap!