March 19, 2026
9 min read
By Albert Wong, PhD · Clinical Psychologist
You're doing real clinical work with real clients who have real problems. You're carrying real liability. And you're paying for the privilege. Let's talk about the math nobody does.
Here's a number: $0.
That's what most practicum students get paid. Zero dollars. For seeing clients. Real clients. People with depression and suicidal ideation and trauma histories and substance use disorders. People who don't know or don't care that the person across from them is still in school. People who show up every week and trust you with the hardest parts of their life.
Zero dollars.
But it's worse than zero. Because zero implies you're just not getting paid. The reality is you're losing money. Every week. And nobody ever sits you down and makes you do the math.
So let's do the math.
Start with the obvious ones. Gas to your practicum site. Or bus fare, or train fare, or the wear on your car that you're pretending not to notice. Most practicum sites aren't down the street. You're commuting. Two, three, four days a week. That's $50 to $150 a month in transportation alone, depending on where you live and how far you drive.
Parking. If your site is at a hospital or a university clinic, you're paying for parking. Maybe $5 a day. Maybe $10. That adds up. $60 to $120 a month.
Supervision fees. If your practicum includes on-site supervision, you might be covered. But a lot of pre-licensed clinicians pay for individual supervision out of pocket. The going rate is $75 to $150 an hour. You need it weekly or biweekly. That's $150 to $600 a month.
Malpractice insurance. Yes, you need it. Even as a student. Even as an intern. Your program might require it. Your site definitely should. Student policies run $35 to $100 a year. Pre-licensed policies run $100 to $300 a year. It's not the biggest expense, but it's one more.
Background check. Your site requires one. Your program might require a separate one. $30 to $75 each. Drug screening sometimes too. Another $30 to $50.
Required textbooks and training materials. Your site uses a specific treatment manual. Your supervisor recommends three books. Your CE requirements for pre-licensure supervision mean you're buying workshops and webinars. Another $100 to $300 a year.
And then there's the EHR.
Some sites provide one. Some don't. Some give you access to theirs but it's terrible — a system built in 2008 that crashes twice a week and requires you to click through seventeen screens to write a note. Some sites tell you to figure it out yourself. Get your own system. The ones that work cost $39 to $79 a month. Per clinician.
Add it up. A conservative estimate: $300 to $500 a month. To do your practicum. To see clients for free. To do the clinical work that your site bills insurance for — because they do bill for it, under a supervisor's credentials — while you see none of that revenue.
A more realistic estimate, if you're paying for supervision: $500 to $1,000 a month.
For free labor.
Doctors do residency. It's hard. The hours are brutal. Nobody's saying medical training is easy. But residents get paid. Not a lot — maybe $55,000 to $65,000 a year — but they get paid. They have health insurance through their program. They're not paying out of pocket for the privilege of treating patients.
Lawyers work as associates. First-year associates at big firms make $215,000. First-year associates at small firms make $60,000 to $80,000. Either way, they make money. From day one. While they learn.
Accountants get paid while they study for the CPA. Engineers get paid while they work toward their PE license. Nurses get paid from their first shift. Electricians and plumbers get paid as apprentices.
Therapists? Therapists pay to train. Therapists pay to accumulate hours. Therapists pay for supervision and insurance and background checks and software and gas and parking so they can see clients who generate revenue they never touch.
Name another profession where this is true. I'll wait.
Because it always has. That's the honest answer. That's the whole answer.
The training model for therapists was built decades ago, when the assumption was that you could live on a single income while your spouse worked, or that you'd come from a family that could support you through graduate school, or that the cost of living was low enough that "unpaid" didn't mean "unsustainable." None of those assumptions hold anymore. But the model persists.
It persists because the people who could change it — licensing boards, graduate programs, established practitioners — have already gotten through it. They survived training. They built their practices. The system worked for them, or at least it didn't break them, and so they assume it works. Survivorship bias in a field that should know better.
It persists because the people who are most harmed by it — students, interns, pre-licensed associates — are the people with the least power to change it. You're not going to boycott your practicum. You need the hours. You need the degree. You'll eat the cost because the alternative is not becoming a therapist, and you've already invested six figures in a graduate education to get here.
And it persists because of a quiet, ugly assumption that runs underneath everything in this field: that helping people should be its own reward. That if you're in it for the money, you're in it for the wrong reasons. That real clinicians don't think about compensation. This is nonsense. Caring about your clients and caring about paying your rent are not contradictory positions. But the field treats them like they are, and the training model reflects that.
Let me be honest about this. Some of these costs aren't going anywhere.
You need malpractice insurance. You should have it. Supervision costs money because your supervisor's time has value and their expertise matters. Licensing boards aren't going to lower their hour requirements because a blog post pointed out the math. The structural problems with therapist training are real, and they require systemic change, and systemic change is slow and hard and nobody's holding their breath.
But some of the costs are just... unnecessary. They exist because nobody bothered to question them. Because the companies selling products to clinicians don't distinguish between someone making $200 an hour and someone making $0 an hour. Because "per-seat pricing" treats a trainee and a practice owner as the same customer.
The EHR is one of those costs.
There is no reason a pre-licensed clinician should pay $50 or $60 or $79 a month for practice management software. None. The software doesn't cost more to run for a trainee than for a licensed clinician. The server doesn't care about your credentials. The AI doesn't charge extra because you're still accumulating hours.
We can't fix the whole system. We can fix that one thing.
Practice Harbor is free for pre-licensed clinicians. Not discounted. Not "affordable." Free. The full product. AI notes, telehealth, scheduling, intake forms, treatment plans, client portal, billing. Everything the licensed clinician gets, you get.
We're not solving the unpaid labor problem. We know that. We can't pay you for your practicum hours. We can't reduce your supervision fees. We can't make the licensing board move faster or the hour requirements smaller. Those fights are bigger than us.
But we can take one line item off your monthly budget. One bill you don't have to pay. One cost you don't have to absorb for the privilege of doing work that somebody else is getting paid for.
It's not enough. We know it's not enough.
But it's something. And right now, nobody else is offering you even that.
Full EHR. Unlimited AI notes. No credit card. No trial. No catch.
Your data is always yours. Always exportable. Always encrypted.