What If Your Sliding Scale Is Slowly Draining You?
You created a sliding scale because you care.
Because you believe therapy should be accessible.
Because you didn’t want to be the provider who turns people away over money.
And honestly? That matters.
But here’s the part that doesn’t get said enough:
Caring deeply doesn’t mean you should be running your practice on fumes.
Because lately, the math isn’t mathing, right?
You’re squeezing in one more $75 session.
Skipping lunch again.
Staring at your calendar and bracing yourself for the emotional labor ahead.
And then you do the mental math on how many more of these sessions it’ll take to cover rent… or childcare… or groceries.
You wanted to build a practice rooted in equity.
But instead, it feels like you’re subsidizing your sliding scale with your health.
That’s not what you signed up for.
And no, you’re not a bad person because it’s not working anymore.
You’re just a provider with a human nervous system and real bills.
Let’s Name the Red Flags
I can’t tell you how many PMHNPs and therapists I’ve mentored who say this in hushed voices: “I thought I’d feel good about this, but honestly? I’m burnt out and low-key resentful.”
If you’re seeing yourself in that, you’re not alone. Here are some patterns I see all the time:
You never defined clear criteria, so now everyone who asks gets a discount… and you’re left navigating it on gut feelings and guilt.
You haven’t raised your scale since opening, even though your skills and cost of living have both increased.
You’re offering reduced fees from your survival budget, not from overflow.
You dread certain names on your calendar—the ones who pay the least and often need the most.
And yes, that last one is hard to admit. But let’s be honest: you’re carrying a lot.
And it’s okay to acknowledge when the math (and the emotional labor) stops adding up.
Ask Yourself Two Questions
If you’re starting to feel the weight, it’s time to pause and ask:
1. Is this financially sustainable?
Can you pay your bills? Are you building savings? Do your rates reflect your expertise—or are they stuck where you priced yourself when you still felt like a newbie?
2. Is this clinically sustainable?
Can you show up fully for the people you serve? Or are you dissociating during sessions, running on empty, and wondering how long you can keep this up?
If the answer to either is no, it’s time to shift something.
Because access shouldn’t come at the cost of your well-being.
A Sliding Scale Can Still Be Ethical and Sustainable
Audit your caseload. How many sliding scale spots can you afford per month—not in theory, but in reality?
Define your eligibility. Use income, systemic barriers, lived experience—whatever fits your mission. Just make it clear.
Set a reassessment schedule. No more indefinite sliding spots. Revisit them every 6 or 12 months.
Anchor your scale to your full rate. If your baseline is too low, your “discount” is a donation.
But the most important piece?
Stop trying to prove your values through undercharging.
Your values show up in your clinical work. In the way you listen. In how you advocate for your patients. You don’t need to financially bleed out to prove you’re a good provider.
You’re allowed to build a business that’s both value-driven and sustainable.
One that doesn’t require you to burn out to be generous.
If you’re ready to rework your sliding scale—or your whole practice model—Strong Roots Mentorship is here for you. We’ll walk you through how to build structure around your values, so you can show up for your clients and yourself.
You don’t have to choose between access and survival.
You get to build something that holds both.
Let’s build the practice your nervous system—and your mission—deserves. Come join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.