How to Know if Your Sliding Scale Is Actually Serving You (Or Slowly Draining You)

If you’re a new PMHNP in private practice, there’s a good chance you set up a sliding scale out of genuine care.

You wanted to be accessible.
You didn’t want money to be a barrier.
You wanted your work to feel inclusive and values-driven.

But now, your schedule is full and your bank account doesn’t reflect it.
You’re feeling stretched.
And a little resentful.
But you’re scared to say that out loud because it feels selfish.

A sliding scale should be intentional, not automatic.
Sustainable, not self-sacrificing.
Aligned, not performative.

Here’s how to check in with your current model and make sure it’s working for you and your clients.

1. Track how many clients are paying your lowest rate

Not in your head. On paper.
How many are paying full fee?
How many are at the low end of your scale?
And is that ratio something you can maintain long-term?

If more than 25–30% of your caseload is at the low end, it’s worth reevaluating. You are running a business, and your time needs to be compensated fairly.

2. Check your pricing boundaries

Do you have a minimum rate you're unwilling to go below?
Or are you adjusting on a case-by-case basis every time someone says they “can’t afford it”?

If there’s no bottom line, you’ll keep shrinking to make things work.
And eventually, you’ll burn out.

Set a floor that feels fair and sustainable. If someone truly can’t meet it, you can still offer referrals or resources without compromising your practice.

3. Ask yourself: am I clear on why I offer a sliding scale?

There’s no right or wrong answer here but there should be an answer.

Is it about access and equity?
Is it because you’re serving a specific community?
Or is it because you felt uncomfortable charging full fee as a new provider?

If it’s coming from guilt or fear, that’s something to pause and unpack.
You don’t need to prove your worth by undercharging.
You don’t need to overextend to be “ethical.”

4. Consider offering a limited number of sliding scale spots

This keeps your model intentional and manageable.
Once those slots are filled, new clients join your full-fee rate or get referred out.
This allows you to offer support without draining your energy or your income.

5. Do your values and your financial goals align?

Because both matter.
You can care deeply about access and care about being paid well.
You can offer help and protect your capacity.
You’re allowed to build a practice that reflects your ethics and meets your needs.
You are not a bad provider for charging your worth.
You’re not unethical for needing stability.
And you can serve with integrity, without self-sacrifice.

If your sliding scale is starting to feel like a burden, it’s time to reassess.
You don’t need to throw it out.
You just need to make sure it’s working for everyone, including you.

If you’re feeling stuck or unsure where to start, come join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.