You have decided to take the plunge, leave your agency and hang your own private practice shingle. Congrats! One of the biggest and most important decisions you now need to make is figuring out where to office your new practice.
Office space, my fellow therapists, is where you will be spending the majority of your time as well as your gross income. It is be the biggest piece of your expense pie, so you need to choose it carefully. Most important, it’s the space where your clients come for sessions – and you want (and need!) them to keep coming back!
My first office was shared 50/50 with another clinician. It had no window, as the inside offices in the building were way cheaper. As my practice grew, so did my space (yay for windows and my own office!) and the need to have an office 100% of the time for myself.
The hunt for office space is both exciting and overwhelming. Here are a few things to consider before picking your space and signing your name on the dotted lease line:
- Know your Market – I was a cash-pay only clinician going after cash-pay clients. I knew my clients would want – and expect – a nice office building with plenty of parking and amenities. My office provides that and more. Think of it this way: your office space is the first impression your clients will have of you, so make sure it’s a good one
- Location, Location, Location – This, of course, is the golden rule of real estate. I searched a lot of office spaces and settled on a location that had easy access from major highways, plus a Starbucks right across the street that many of my clients frequent en route to their appointment. My office also has a bus line outside – an important factor if you live in a metropolitan area or serve clients with transportation barriers. Plus, as a personal bonus, my office is a 10-minute drive from my home. If I have a break in between sessions, I can run home and let my dog out and I’m right around the corner from my daughter’s high school.
- Don’t Scrimp – One of the worst financial decisions I ever made was buying a cheap used car. I was downgrading from a nicer one with lots of amenities to save a little bit of money. I decided to forego leather seats and Sirius xm radio. One week later, driving my hour commute downtown and missing the channels I could no longer access, then spilling a coffee that soaked into my cloth seats, I knew I made a horrible mistake. My buyer’s remorse was instant and real. Same goes for your office space. Don’t cut an important corner to save a little bit of money; as your practice grows, you will certainly regret it. Get the best space you can get, and one where both you – and your clients – will thrive.
- Read the Fine Print about Amenities – Make sure you know exactly what amenities are included in your lease terms, and what are extra (and their costs). Are copies, faxing and wi-fi included? Coffee service? One month I was surprised with a rather large copy bill that I wasn’t expecting, because I didn’t realize X amount of copies were included, and I went over. An amenity I really enjoy with my space is a shared receptionist that announces when my clients arrive. I also have a back elevator for high-profile clients that don’t want to be recognized in the lobby.
- Lease Terms – I currently re-upped my lease in my building, which offers one or two-year lease terms. Starting out, I didn’t want to lock myself into a long lease in case one – I hated private practice; or two – my practice didn’t survive. I recently considered switching offices, but the lease terms were too long for my comfort (three to five years in some cases) and they didn’t offer the same level of amenities.
- Neighbors – Take a good look at the current tenants in the building and the types of businesses that are there. If you work with addiction, it’s probably best to stay away from a liquor store or vaping shop nearby. You also want to sit in the space for some time during the day to see how the noise level is through the walls. Does sound carry? Are the walls thin? Are people coming in and out of other offices constantly slamming doors? If the window faces a parking lot, can you hear cars coming and going? These are things that can’t be changed once you sign and move in, so make sure you do throrough research.
- Sub-leasing – I sub-lease my office to another clinician during the hours I don’t use it. It helps me offset my rent cost. See if your landlord will allow you to do that (some do, some don’t); it’s a great way to subsidize your rent.
- Expect Some Unexpected – I had to learn to put a sign on my door during my night sessions as the cleaning service would come and open and unlock the door and surprise the heck out of both me and my clients. Also, things will happen that are competely out of your control. The A/C went out recently and I had to reschedule my clients – you definitely need A/C in the 100 degree Texas summer heat!
I hope this helped you think about some things to consider for your office. Best of luck that you find the right fit for you and your practice!
2019 has been an incredible year of professional growth. My practice has grown exponentially – a good, no make that – great problem to have – but when you are a sole practitioner, too much growth too fast can bring some pretty big growing pains.
This year I was finding myself more and more drowning in the weeds. As a sole practitioner, I’m the one scheduling, re-scheduling, following-up on emails, answering the phone and doing consults, marketing, networking, working odd and crazy hours and doing all the things that keep my practice up and running.
But did I mention the errors I was making? Like, having the receptionist text me saying “Your 4:00 is here.” And then: “Oh, and your other 4:00 is here.” Or telling a client I’d email them something and then completely forgetting to do it until three days later I’d get an email saying, “sorry to bug you, but can you send me that thing we talked about in session?”
Yikes.
Full disclosure: last month, I made a huge appointment screw-up and lost a great new client – she was super-mad and I don’t blame her one bit. But instead of beating myself up (which I admittedly did for a full afternoon), I knew something had to change. And fast.
After whining and crying about my life to a trusty mentor, she suggested I hire a business coach.
I’m in a women’s entrepreneurial networking group that meets monthly here in San Antonio, and a woman in that group recently launched her own coaching business. Her name is Robin and since we already had an established relationship, I knew that she’d be up for the task of looking at my business practices and helping me tweak where needed.
And to help me get my business shit together.
Off the bat, she told me this: you’ve got to get your calendar under control. It has to be automated. No more excuses, just get it done. I use Google calendar, but it only sent appointment reminders to me, so if I was off (or if my client input a wrong date), there was no check or balance system in place. I’m currently in the process of using a new calendar system through www.therapynotes.com and it’s already a game-changer, sending automated appointment reminders and confirmations (which yours truly was doing, sporadically at best, and obviously not doing it well). Eventually a link will be added to my website so clients can schedule or re-schedule themselves 24/7 without my direct involvement.
Another problem was my crazy schedule. Most days I work 8-8 with a few breaks in the day but my schedule was killing me. I also began adding 7:00 a.m. appointments to accommodate my busy business executives. I was never home to eat dinner with my family and when I was walking through the door at 8:30 or 9:00, I was certainly not my best self. Robin told me to allocate, at most, one or two nights a week for late appointments for my “grandfathered” clients, but offer only daytime hours to any new clients.
Robin is coaching me on other aspects of my business and helping me plan and strategize for future goals (stay tuned!!) that I’ve been too overwhelmed to think about, much less implement. She is helping me narrow my focus as well as develop a timeline/schedule of action-steps and realistic deadlines (which this procrastinator desperately needs).
So my advice to any fellow practitioners, or small business owners struggling with either growing your business or simply keeping up with your current pace is this: getchu a business coach, and getchu one now. It is an invaluable investment in your business and yourself. My only wish is that I’d done it sooner!
I started writing this “Private Practice Chronicles” series two years ago when I opened my practice. It was a way for me to write about the ups, downs and everything in-between. My chronicles of PP have been some of my most-read blogs, and it’s been fun for me to re-read them to see how far I’ve come in a relatively short period of time.
I’ve written about my mistakes here and here. Looking back over the last two years, though….well, I know I’ve made mistakes but, dang, I’ve also done a lot of things right. So today, I’m sharing six things I feel I’ve done well:
- I don’t try to solve everyone’s problems – When I first started out, I felt immense pressure to fix everyone and everything that walked through the door. That’s what a good counselor does, right? WRONG. I know here are some things that are simply not fixable. The only thing that can change is the level of acceptance in the client, and my job is to help them get there anyway I can.
- I set boundaries – Of course, I’m admittedly still a work in progress on this one, but I’m getting much, much better. I’m not answering every email or phone call or text that comes through on the weekends (or all hours, for that matter), and I end my last appointment of the day at 7:00 p.m. (I used to take 9:00 pm appointments, even on a Friday)!
- I keep the hustle up – Just because your practice starts taking off doesn’t mean you can sit back and rest on your laurels. I am constantly marketing myself and thinking of new ways to get new business in the door.
- I screw up – and own it. Double-booked clients? Been there. Called a client by another client’s name? Done that. Completely forgot about a business meeting I set up with someone I admire who squeezed me into his busy schedule? Yup, that’s me. I’m a human being. I’m imperfect. I never make excuses for my mistakes, I can only own them, apologize, then do my damndest not to repeat them.
- I stick to my guns – People told me to take insurance (I don’t). People told me to see everyone that walks through me door to grow my business (I don’t). People told me to take on a partner (I haven’t). People advised me to take on business contracts that, while lucrative…..would be the only reason why I was doing it. People told me to do lots of thing that, in my gut, I knew weren’t right for me or my business. It’s your practice, to run your way – not anyone else’s.
- Listen to others – Contrary to my previous point, there have been times where I have sought out advice from older and more experienced clinicians in private practice. Something a colleague said to me has resonated with me since my early days. We were talking about marketing and he told me he doesn’t spend a lot of time or money on it. Why not? I asked him, almost incredulous at his answer. He said this: “I spend my time reading and learning and just trying to be the best therapist I can be for my clients, and when I do that, I find that my business grows itself.” He has a successful practice, and this statement of his is true on many levels.
So there you have it, the six things I’ve done well. I’d love to hear from you and what you do well in your practice. Keep going and keep growing.
It’s usually the first question I am asked when a potential client calls or emails me. Do you take United/Aetna/Humana/BCBS/Tricare?
No, no, no, no and no. And here’s why:
Before opening my doors of my practice back in July of 2016, I struggled with this choice. Being a cash-pay only clinician is not for everyone. The advantage of paneling with insurance companies is that there is a built-in referral network and a relatively full clinic in a short amount of time.
But here’s the deal with insurance: if you come to me even once or twice needing to sort out a work problem or a relationship problem or just trying to figure out a general struggle or issue, I have to slap a mental health diagnosis, or ICD-10 code on you so I get paid. And that stays on your permanent medical record. And I’m just not okay with that.
Oftentimes, insurance companies limit the number of sessions for a client (depending on diagnosis). So eventually, if you wanted to continue with me for a longer term (and I have many long-term clients), you’d max out your benefit and have to pay cash anyway. I’ve heard a few horror stories from some of my clinician friends who were audited by the insurance companies (and one who had to refund payment!) and see messages on many of the social media business groups I am in griping about delayed payment or submitted billing that was kicked back or questioned.
No thanks.
When I opened my clinic, I didn’t have one paying client (Read more about that craziness here). I knew I’d have to hustle and grind and market myself hard to fill my clinic with cash-pay clients. The funny thing is that my clinic filled relatively quickly, with many clients that called originally asking what insurance I took and hearing my answer of “none.” In 2017, my sales increased by 526% over my opening year. So far as of this writing in 2018, my sales are up 74%.
It’s risky being cash-pay. I meet with many other clinicians and physicians that are in the insurance game, and there is a love/hate relationship. They battle the insurance companies and spend lots of time and money billing – but their clinics are full. And oftentimes, their clinics have waiting lists.
The advantages of seeing a cash-pay only clinician? There are many. I’m not bound by the limitations set by insurance companies, and especially ones I don’t agree with for the treatment path of my clients. I also spend my time reading and educating myself on the latest news, trends and counseling techniques instead of billing and battling. Another advantage is that if my client’s insurance changes and I’m not on that panel, it doesn’t affect them in the least. They can continue their care with me instead of making a switch.
I have recently been afforded some opportunities that continue to help me circumvent taking insurance. These include two EAP contracts – one with a Fortune 500 company, and one with – ahem, an insurance company – as well as a contract with a state agency for substance use and abuse assessments and various writing assignments. How do I get paid for all of those?
In cash.
As the insurance companies get bigger and their mental health benefits shrink or change, it has zero bearing on how I run my business or serve my clients. And in the end, that’s all I care about.
I’m a year-and-a-half into owning my private practice (woot, woot!!). I wrote a blog back in June about my first set of Rookie Mistakes, and now I’m back to share Part Two of a few things I’ve learned the hard way.
I know in retrospect when I read these they seem so obvious…like, DUH-obvious……but the fact of the matter is these things are easy to overlook when you’re flying solo.
So here are five more Rookie Mistakes for you to avoid if/when you are thinking of opening your own private practice:
1) Keep your Forms Updated – Then Update some More – I had an emergency contact space on my original form…..oh wait, no I didn’t!!! I mean, can you believe I did that? How did I discover this huge oversight? When I had a client in a really bad situation contact me and I needed to get in touch with a family member. Only when I pulled his file did I realize this horrible mistake. I now get at LEAST one emergency contact name and number per client. And I’m constantly updating my forms to add other crucial info (pregnancies, miscarriages, etc.)
2) RUN the Credit Card your Clients give you to Keep on File – One of my business practices includes keeping a client’s credit card on file to charge future appointments (or no-shows and less than 24-hour’s notice of cancellation). I have a form where clients voluntarily fill in their Credit Card info, then I manually run them at the end of the day. Oh, how naive I was to think they were writing down the correct number!!!! This is especially crucial for a cash-pay only business. Run that card with them in the office first to ensure it is a valid card.
3) Don’t Scrimp on Office Space – My first office space didn’t have a window, because, quite frankly, I didn’t have any clients and a window seemed like an unneccessary luxury. My practice grew quickly, and soon my tiny windowless office just wasn’t adequate for my clients – or myself. Upgrading to an office with a window makes all the difference in the world. So get the best office space you can (even if it means you have to hustle extra). I chose a secure building in a nice area with a shared receptionist and coffee/tea service included. It’s a nice space for my clients, who are spending their hard-earned money to come and see me. And now they have a window!!!
4) Wasting Precious Advertising Dollars – When you start out, everyone and their brother is going to call you (and call on you) to advertise with them. I have a marketing background, so I know the value of advertising and I needed to grow my business. One of the worst investments I made was buying a very expensive print ad in a local paper. I didn’t receive one call or email from that ad, and I think I’m the only person that saw it. My dollars would have been better spent on online advertising, where I receive the most return on my investment.
5) Not Setting Personal Boundaries – Starting a business is a 24/7 venture. It’s not a 9-5, Monday through Friday job. You must feed it constantly, or it simply won’t grow. But here was my problem: You want a 7:00 a.m. slot? Yes. You want an 8:00 Saturday morning slot? Yes. You need to text me at 10:00 at night? Yes. You need an 8:00 pm slot? Yes. Answer my business line at 10:00 a.m or 10:00 p.m. on Sunday? Yes. Pretty soon all of these “Yeses” were taking a personal toll, on both myself and my family. I’m still working hard on this one, but I’m setting more limits starting with phone and email activity, and I have a hard and fast last 7:00 p.m. appointment during the week.
My mistakes are and have been an amazing way for me to learn and grow, both personally and professionally. What are your (if any) rookie mistakes? I’d love to hear about them, how you discovered them, and how you handled them.
The holidays are approaching, and maybe you’re thinking of gifts to get yourself or your small business.
While I found I didn’t need much to get my practice up and running, these are some things that I have found invaluable for keeping my business running smoothly and efficiently :
Line2 – When I was setting up my practice, I was going to buy a completely separate phone, and didn’t want the a huge expense. When asked a few other clinicians how they handled their business line, a trusted mentor told me about the Line2 app. It costs 9.99 a month (10.81 with tax), and completely interfaces with my iPhone. It has the calling and texting features I need, and when it rings it comes through the app so I know it’s a work-related call. The only drawback is that sometimes it “acts up” and there is a delay in texts. Other than that, it’s easy to use and I love love love it. So I have one phone but it functions as two.
Bluehost – My website is hosted there. They are reasonable for hosting fees ($12.00 per month) and customer support is available 24/7 if there are problems.
Gmail – It’s just the best email system out there. Nothing else to say here.
Google Calendar – I keep all appointments in a Google calendar. It took a little time for me to get used to using it, but now I – and my business – couldn’t survive without it. I also sublease my office for a few hours a week, and my calendar is shared so my officemate and I can book appointments around each other’s schedule.
Quickbooks – My CPA will be so happy with me at tax time! I love the ease of Quickbooks for tracking all of my income and expenses. They have a cool mileage feature as well as an easy way to upload any business-related receipts.
Square – I use this for my credit card )processing. There are admittedly a lot of features I don’t use (like appointment reminders but the reports are awesome and it’s really user-friendly. I did have to order another chip reader this year (mine conked out , of course, just after the 1-year warranty) and since I’m cash-pay, most of my transactions are done through credit card.
Vsee – This is a HIPPA-compliant platform that I use for distance counseling. It can be used for both calls or for video conferencing. I currently am utilizing this more frequently with clients that don’t live in San Antonio. It’s a great option for people that have transportation issues, or feel more comfortable in their own home. Best of all….it’s free!!!
I’m always seeking ways to improve and be more efficient at work. What are your Favorite Business things? I’d love to hear.
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