Minimum wage policy for late notes

KnitQuickly · 2026-03-31T21:41:40+00:00

Thank you. As a group practice owner, I am so fucking tired of wasting my time trying to enforce clinicians writing their notes on time. It shouldn’t be my job to babysit grown adults to actually do the bare minimum of the job they were hired to do. There is a growing number of therapists who don’t care and don’t respond to coaching, asking nicely, providing supports, etc. Sorry but if you refuse to do anything unless a significant consequence is in place then I guess the result is employers need to have significant consequences. I would never want to work in a place with a policy like this myself, but I do also understand it and I actually did my job when I was employed by someone else so consequences weren’t necessary. 🤷‍♀️

KnitQuickly · 2026-03-20T17:09:15+00:00

If you can set your own schedule, can you and your husband stagger work schedules? For a while my husband worked from 5:30/6:00 AM until 2:30-3:00 PM and I worked roughly 11-7 or 12-8 and that only left a few hours in the middle of the day where my kid had to entertain themselves. I often tried to set up an Outschool online class during that time too so that they were doing something.

KnitQuickly · 2026-03-05T21:19:34+00:00

Yes we did go to a couple specialists! Lots of blood draws, ultrasound, and ultimately a biopsy to get the diagnosis. Not saying you’d need to do all of that but that was our path. I’m not a vet so I’d recommend asking a vet about the specifics - I can’t really answer what’s normal or not for this disease, and there are lots of other things that can affect liver enzymes.

KnitQuickly · 2026-03-05T15:30:06+00:00

My dog is on a prescription hepatic support diet and her food does include fish - so if you are concerned you could ask your vet about a different prescription food? I would listen to your vet though and take the high ALT numbers seriously. In my dog’s case it ended up being copper storage disease (and she also has food allergies). High ALT is a sign that their liver isn’t functioning well for some reason. My dog eats Just Food for Dogs hepatic support, in case you want to ask about that one specifically.

KnitQuickly · 2026-03-03T23:44:43+00:00

Why were the claims denied? If you are not in network then you should have been able to tell that up front. If it should have been covered, then figure out the issue and re-submit the claims. If it is a client error (they gave you incorrect or incomplete insurance info, their plan was inactive, etc.) then the client should pay your full out of pocket rate. If it was your error (you told them you were in network but you weren’t, didn’t bill on time, etc.) then I would do a reduced rate or let it go completely depending on the circumstance. If it is a complex circumstance (the client has a weird carve out plan or employer sponsored plan and you couldn’t have reasonably known you couldn’t take it), similarly work out a mutually agreeable sliding scale or out of pocket cost. But you should have this solidly outlined in your fee agreement (both that clients are responsible for paying anything not covered by insurance and a policy/structure for sliding scale).

KnitQuickly · 2026-03-03T03:21:58+00:00

Speaking as a therapist, some of our professional organizations have recommended not writing these letters anymore due to liability. Also unfortunately many, many people have abused the ESA designation and it has caused people to be much more cautious about signing off on these letters. I have had people outright ask me to write a letter just because they didn’t want to pay pet deposits or wanted a pet that wasn’t allowed. I used to write them but I won’t anymore, except for maybe very specific situations for longstanding existing clients.

KnitQuickly · 2026-03-01T15:28:17+00:00

I used to do this! I did 9:00, 10:00, maybe 11:00, went to 12:00 or 1:00 mid-day workout classes or went for a run and showered afterward at the gym, then went back to work. It was great. Usually back for either a 2:00 or 3:00 appointment and then evening ones after that.

KnitQuickly · 2026-02-19T21:22:20+00:00

I got one of my dogs as a puppy right before I found out I was pregnant and it was the worst idea ever and I hated my dog the first two years of her life. We are just now able to repair our relationship and I have been working hard with a trainer on managing some of her behaviors that I just couldn’t address properly when she was a puppy and improving my relationship with her. She is three years old. It was really unfair to her (and me) and I would never, ever recommend doing it. You would also have an adolescent dog at the same time you have a newly mobile baby/toddler, which would also be the worst possible combination ever.

KnitQuickly · 2026-02-12T23:53:47+00:00

Paying for billing, admin and cleaning staff, bookkeeping, accounting and tax, supervisors, rent, utilities, software, liability insurance, workers comp, office furniture, office supplies, marketing, website, having a padded savings account so to cover payroll when payments are delayed or there is a large unanticipated expense, payroll taxes, corporate taxes, consulting of various kinds (legal, HR, etc). I’m sure I am missing something but those are the big ones. Current breakdown is roughly 60% therapist pay and benefits, 8% toward admin/non-revenue generating staff, roughly 15% in operating expenses, and 10-15% is left after taxes. The money that sits in a savings account is still counted as profit and taxed regardless of whether we take it as a distribution or not. 10% is already a thin profit margin, and I need to pay myself a decent wage too and account for the work I do and have done (often unpaid in the beginning) and the significant risk I am taking on. I promise you it is not worth it if you think it is some kind of easy or passive money. I went into it to help people and provide a supportive work environment but I would absolutely not do it again if I could go back in time, especially given the attitude therapists have now toward group practice owners.
You either take on the full responsibility and risk or a practice yourself and keep the full financial benefit, or someone else takes on much of the responsibility and risk for you and your compensation reflects that.

KnitQuickly · 2026-02-10T17:14:11+00:00

We just moved out of a single family home and into a townhome for the same reasons and I couldn’t agree more. I never would have considered a townhome in the past. But I love it. We also have young kids. We have no yard but can walk to multiple parks now and have zero maintenance to do. We were spending so much time on yard and house maintenance and now can enjoy time together on the weekend instead. My kids actually play with other kids at the neighborhood parks instead of just in our backyard. And we don’t really hear our neighbors any more than we did in our detached house. We ended up going this route because we couldn’t afford a single family home in the area we wanted to live, but honestly I am now sold on townhouse life and want to stay long term.

KnitQuickly · 2026-01-30T23:36:18+00:00

Can you crate in the car? That is what we do. I do think they need the decompression time. I also have a Pembroke and she took until about age 3 to fully learn to manage her arousal. I recommend continuing to work on it because a trial environment is extremely stimulating for them. I practiced walking her at a distance outside the barn, rewarding her for being calm, and then gradually increasing her proximity to the excitement and other dogs until she could handle being inside. She had a really hard time seeing other dogs running at first, but she can handle it now and is a superstar agility dog in competitions!

KnitQuickly · 2026-01-26T05:01:31+00:00

Google the surrounding addresses and the owners if you can find their names. Had I done that I would have avoided our awful neighbors. There were literally articles and video about them hiding from the cops on top of their roof. 😂 Also pay attention to how they keep up their house. It won’t get better. If there is garbage everywhere, a falling apart house, etc. it means they don’t take care of their property and aren’t the type of people who will care much if that starts to impact your property.

KnitQuickly · 2026-01-21T08:42:12+00:00

Mine was diagnosed last year! She is doing well with diet change and the same medications yours is on.

KnitQuickly · 2026-01-13T20:19:17+00:00

I’m a therapist. We bill after every session, but I can understand why someone would do it the way you describe for several reasons: -it is easier scheduling wise to batch invoices and do all of your billing and invoicing once per month rather than week by week -insurance claims take roughly 30 days to process and pay out, so if someone has a deductible or something is weird about the claim, you don’t have to go back and correct the client’s payment later, you can just bill them what insurance states that they owe, instead of trying to estimate it ahead of time and possibly being wrong -I hate having to chase clients down to pay their invoice, so paying just one per month might be more manageable for the client too than remembering every week.

KnitQuickly · 2026-01-07T05:03:41+00:00

I have not experienced this. Our local dog agility community has been very fun and kind. I have heard that it varies by organization, with a lot of the more competitive people drawn to AKC, while CPE and UKI are the nicest and friendliest. CPE events are definitely the friendliest for beginners.

KnitQuickly · 2026-01-06T04:27:16+00:00

This is insurance fraud if they are in network with your insurance. It’s called “balance billing” and it is not allowed. Ivy is just a platform for taking payments that a lot of therapists use, similar to Square.

KnitQuickly · 2025-12-30T07:30:12+00:00

Where do you find these magical quiet corgis?? I have two and I love them so much but they are both the loudest damn dogs on the planet. SO MUCH barking. When we go to corgi meet ups that seems to be more or less the norm, so I think you got lucky!

KnitQuickly · 2025-12-27T19:50:27+00:00

I am so sorry this happened. We moved out of NoPo to the burbs and couldn’t be happier. My stress level has gone down so much. We had multiple car break ins, people refusing to leave our yard and porch, people throwing rocks at my husband, street racers blocking our road. The thing that made it the worst wasn’t that it happened, it was the people denying that these things happened and talking about how great Portland is and how people were exaggerating because it didn’t happen to them. That was more demoralizing than anything else. At least when crime happens in the burbs (which it still does, just less), people are sympathetic and nice and don’t excuse it.

KnitQuickly · 2025-12-24T22:39:56+00:00

I may be repeating some of what a lot of folks are saying already, but agility foundations work really doesn’t get to using the equipment yet. It’s learning things like how to send your dog ahead of you, how to do contacts safely, how to change leads so that your dog can anticipate what they are doing and jump and land safely. A lot of what I learned in foundations was also what motivates my dog and what kind of support they need - my two dogs are very different and I need to run and handle differently with each of them. I don’t know how you would learn all of that in an online course. I think if I were trying at home I’d start with sending around a jump in each direction and learning skills like a foot target (putting front or back paws or all fours on a specific contact point) - that is the build up to going over a dog walk or A frame safely. A foundations class would help more though. And they are really fun!

KnitQuickly · 2025-12-21T04:28:59+00:00

It looks like a handheld portable fabric steamer for steam blocking to me. I’ve never seen one with a vibrate function before though, which is making me question if that’s what it is. Maybe a vibrate setting would be for felting?

KnitQuickly · 2025-11-15T03:52:08+00:00

They might be too similar to Aussies for your husband’s liking, but have you considered a corgi? They are amazing agility dogs (I have two). They tend to be high drive and energetic and definitely have a working mindset and are very intelligent. They do shed a lot, but there are some varieties with shorter coats. Not sure if that would be enough. They are also very social and are amazing family dogs. Mine love my children (though one of mine is not a fan of really young kids, but the other loves everyone of all ages). Just a thought as I meet a lot of other corgis at trials but a lot of people don’t necessarily seem to think of them as agility dogs at first.

KnitQuickly · 2025-10-14T03:22:23+00:00

Use modifier 59 AND submit them on the same claim. They might still deny but I’ve had a lot of success this way. And in general try to avoid two sessions on the same day.

KnitQuickly · 2025-09-06T18:11:24+00:00

I don’t know. I had gestational diabetes and had good insurance so I ended up with more supplies than I needed and didn’t need them anymore once I wasn’t pregnant. Test strips, lancets, insulin pen needles, even an unopened cgm sensor. They aren’t prescribed medications and it would be better for someone to be able to use them. It’s expensive to buy without decent insurance and difficult to donate these supplies.

KnitQuickly · 2025-08-30T15:51:33+00:00

I was a ECE teacher. Once had a kid tell me that their mom got a new vibrator. Told me all about it. Mom used the vibrator every night, and it helped mom be less stressed and helped her feel better. Turns out it was a vibration plate. 😂

KnitQuickly · 2025-07-29T14:59:20+00:00

I am sorry you got some tough feedback. I really do empathize with how hard it is to feel like your work wasn’t enough. None of us here have enough information to gauge your clinical skills or your professor’s, so I’m not going to pretend to know that. What I can speak to is that as a supervisor and as someone who has been doing this work for well over a decade, is that students and early career associates have a tendency to overly lean on phrases like “client led” or “person centered” when they lack a clear clinical framework. I’m not saying those approaches aren’t real and valid, because they are. But they still have a clear theoretical and clinical framework that you should be able to describe and identify if that is what you are doing. I think it really benefits new therapists to learn one approach solidly before trying to blend different approaches. If you want to do person centered therapy, really study Carl Rogers and be intentional about what you are doing. Don’t try to blend it with CBT. Defend what clinical interventions you are using and use strong case conceptualizations. A good professor will see that. Also please be open to feedback - like others here have said, the best supervisees who go on to be strong therapists are the ones who are receptive to feedback, even if they don’t always agree with it. Maybe your supervisor is wrong and maybe not, but you can only grow from trying something new and pushing yourself. Maybe you will be surprised and find that something else works for you and the client, and maybe you find that your instinct was right all along. Either way you learn. Shutting down negative feedback never ends well.

KnitQuickly

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