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.
When I officially opened the doors to my private practice on August 1, 2016 I didn’t have one paying client.
Yes, you read that right. Not. One. Paying. Client.
You might be reading this and saying “Is she out of her naive mind, she opened a practice without one client on board?” Believe me, I agree with you! But here is what I did have: a shared office space in a central location (so I was only responsible for 1/2 the rent), a website and presence on four social media channels (Facebook, Instagram, Twitter and LinkedIn), a marketing plan, great experience and a whole lot of hope, fear and determination. My eyes were completely focused on the prize, and for me, that prize was having a successful practice. I was going to make it happen.
I set a goal right away to have at least one meeting a week (it was usually more) with people in my industry because, as a former marketing executive, I know the power of network marketing. And let’s face it, I obviously had way more time on my hands than I did clients!
So began my meetings. I met with fellow students from grad school at their private practices. I toured substance use and abuse facilities and hospital behavioral health departments. I attended local (free) CEUs at agency venues and handed out my cards. I called former colleagues that I worked with at various agencies to meet up for coffee, and invited them to see my office space. I joined a network marketing group of local business women. I met with doctors, physical therapists and other health-care providers. I partnered up with other people and developed some education and training courses. I volunteered to run groups at a treatment facility. I cold-called and emailed other counselors that I knew in the area, and met with them over pizza, salads and sandwiches to pick their brains about their private or group practices, and to let them know I was ready for referrals.
My very first client came from one of those meetings. And then my next. And then my next. And while I do rely on paid advertising to market my business, some of my best and long-term clients have come, and continue to come, from these word-of-mouth referrals.
I have also received other gigs from these meetings to diversify my practice, including writing and training opportunities, contracting positions (I currently have three outside contracts) and have been offered a position to sit on the board of a large local agency.
As my client base and practice grows, I still make time for at least one meeting a week. Again, it’s usually more, but as my clinic hours fill (and that’s how I pay myself), I stick to my rule of at least one. These weekly meetings have benefitted me in many ways, and not only business-wise. It gets me out in the community and keeps me on top of new resources for my clients, as well as gets me in touch with other people in the business – something that is crucial for this sole practitioner. In fact, I’m writing this after reaching out and meeting a counselor for coffee that I sat next to at a networking event this past summer. Next week I’m touring a substance-use treatment center in the Texas Hill Country and being hosted as a guest for a paid CEU course. The week after that I’m speaking at a middle school on the South Side of San Antonio for their Career Day. My meetings will continue into 2018 and beyond.
When and where is your next meeting?
So you’re thinking about therapy. For most people, that’s a really huge step forward….and a great one, in my opinion. (‘Cause obviously any therapist would be totally stupid to say anything else otherwise.) No, but all jokes aside. I think therapy is one of the best gifts you can give to yourself and your mental well-being.
But here’s the thing. Therapy isn’t the answer to all your problems. It’s part of the solution to your problems, but it’s not the be-all-end-all answer to everything.
I can’t tell you how many people walk into my office for their first appointment and expect to have life’s answers figured out and solved in a 60-minute timeframe. When they realize this is simply not the case, I can tell by the look on their face that they are not coming back. And they don’t. And that’s really too bad, because mostly these are the people that need therapy and would benefit greatly from it.
Or, I’ve had clients tell me they were in therapy previously but nothing was changing so they stopped going. One client recently told me this and I asked him how long he had seen the therapist. His answer? Two appointments.
Sorry people. Therapy is not a magic-bullet, quick-fix solution. It just doesn’t work like that. I wish it didn’t, but it doesn’t. Therapy is a process. Sometimes, issues can be resolved in a few appointments. Other times, longer-term, regular and consistent therapy is needed for a few months. It all depends on one thing: how much work a person is willing to put in. And how dedicated they are to making changes.
And here’s another thing. As a client, it’s your job to apply the techniques and work on the goals mutually agreed upon in session; the work is not all on the therapist. Oftentimes I assign clients “homework” of sorts. The ones who do it seem to have the most success and make progress. Others stay stagnant and frustrated. I tell them it’s because they have to be willing to put in the work outside of session. Behaviors don’t change because we want them to change. We have to constantly work to change them.
The other day a woman called me around 10 in the morning. She asked if I had an appointment at noon…that same day….on her work lunch break. I’m always leery of people that need an appointment RIGHT AWAY. Why? Because I know they expect it to solve something and have an instantaneous result. Of course, I assessed for crisis and suicide risk due to her sense of immediacy and quickly got to the root of the problem: her boyfriend had told her she needed to see a therapist or he would leave her. I knew if that was her motivation for coming in, she most likely would think that one therapy session would change everything.
Changes aren’t going to happen in one therapy appointment. Changes and progress can be made with steady, consistent attendance of therapy…and applying the techniques and suggestions that are worked on in session – out of session. I tell all of my clients this: therapy is the foundation. But it’s also work. The real work is done in between appointments. I’ve seen people make positive changes, get out of ruts, recommit to failing relationships, stop using substances and get out of jobs they hated – all due to self-discovery and changes they were willing to make in their lives. It wasn’t the therapy alone: it was the combination of them willing to show up, do the work and make the changes they wanted to make.
Therapy is a commitment and one that is worth it. It’s just not a quick and easy answer. It’s one piece of a puzzle that you have to work – with your therapist – to solve.
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