Getting Better at Private Practice

Chris E. Stout

• Publisher: Wiley
• Year: 2012
• ISBN:
  9781118235058
• Edition: 1
• Topic: Psychology
• Subtopic: Research & Methodology in Psychology
• Index: Psychology

Expert advice for building your private practice

The "business" of practice as a mental health professional is a skill that is seldom taught in school and requires thoughtful guidance and professional mentorship from those who have already succeeded.

Containing the collective wisdom and secrets of many expert practitioners, this helpful resource provides useful insights for setting up, managing, and marketing your practice, including timely advice on being a successful provider in the digital age—from Internet marketing to building your online presence.

Designed for private practices of any size and at any stage of development, this practical guide looks at:

• Creating your dream niche practice
• Choosing the right technological tools and resources to simplify and streamline your job
• Leveraging the Internet to market your practice
• Developing a practice outside of managed care
• Transitioning to executive coaching
• Ethical and legal aspects of private practice

Full of action-oriented ideas, tips, and techniques, Getting Better at Private Practice provides both early career and seasoned mental health professionals with the knowledge and tools they need to establish, develop, and position their practice so that it is financially successful and life-enriching over the long term.

Section III

The Dream Niche Practice: Successful Stories of Specialization

Chapter 16

Starting and Growing Concierge Psychotherapy and Psychiatric Practices

William R. Lynch

Introduction

I am about to tell you how to start up a new practice or transform your existing one into what ClearLifePath.org clinicians call concierge psychiatry. Its essence is extraordinary customer service paired with outstanding clinical competence untethered from managed care constraints. I use the term concierge psychiatry, but everything here can be applied to the business of all related disciplines—psychology, social work, counseling, or, frankly, any small business.

Pay close attention. Implement all I recommend and you will develop a gratifying practice like mine. This is hard work. It will take a large investment of time and energy, but you’ve come this far already, so why not go all the way? All the information you need to succeed is included. The most important ingredient is nowhere to be found in this or any other book; it is your dedication, determination, and persistence in the face of challenge—in short, your character. Your steady labor coupled with these tips and guidance from your chosen advisors can help you create the thriving practice you have always wanted.

Who Am I?

I learned my earliest business lessons in starting my first practice in Dallas, Texas, in 1982. Back then I was haunted by fears of failure. I was anxious and uncertain about my competence as a newly minted psychiatrist. I continued my education by enrolling in the local psychoanalytic institute. As my education and experience grew, so did my confidence.

Marketing in Dallas was more aggressive than that of my colleagues. I was driven by a terrifying conviction of failure. I was also hampered by a peculiar shame in promoting my business. A narcissistically determined defensive grandiosity made marketing myself feel like a constant, agonizing admission of inferiority. Secretly, I was a redneck from East Texas masquerading as an urbane psychiatrist/psychoanalyst. That was a strain.

Practice promotion consisted of attending meetings of the local psychiatric and psychoanalytic societies, socializing with colleagues, directly communicating with other clinicians of all types in the community, making it clear that I was available to see patients. I also instinctively understood the importance of prompt follow-up when someone did send work my way. Over time, my anxiety-driven outreach transformed into a calm realization of the excellent quality of my work and eagerness to sustain my practice.

I developed a love of psychiatry. Early in my career, I began teaching psychiatric residents in individual psychotherapy supervision and in a continuous case conference for more senior residents. As I gained experience in these settings I came to appreciate my teaching skills, validated when I received several teaching awards from the residents. Along with growing confidence in my clinical skills, I became a respected member of my professional community, eventually serving on the officer tracks of both the local psychiatric and psychoanalytic organizations, almost, but not quite completely, eliminating my dense sense of lack. I kept at it.

With my move to Chicago in 2004, I faced the challenges of starting over from scratch, this time completely confident in my clinical skills. I also had the evidence of having built and grown a successful solo, cash-based practice. I was sure that I could do it again. This confidence allowed me to stay focused on the particular needs of reestablishing myself in a new city. I was able to immediately roll up my sleeves and get down to work.

The first few years in Chicago were full of new things, including developing a new marketing style and forming a corporation for the first time. I quickly established a profitable Chicago clinical practice. These experiences, along with years of psychotherapy, have taught me tremendous lessons. What I have learned in this journey I will now share with you.

What Is Concierge Psychiatry?

We borrowed the term concierge from the concierge medical practices that began to appear a few years ago. These practices typically charge an annual membership fee, which in return provides patients a more exclusive relationship with their physician. After considerable debate, I decided the annual membership plan didn’t feel right for our kind of practice. I opted instead to focus on delivering an extraordinary level of availability and responsiveness—paired, naturally, with excellent psychiatric care. I deliberately set my fees high. I planned to shape my practice into a relatively small group of highly motivated patients.

Declining to work directly with insurance companies is the first pillar of my business model. The other is the high fee. Both elements serve as filters for my clientele: I spell out these details clearly on my Web site, when speaking on the phone with potential patients, and especially in the “new patient packet”—a set of forms that every new patient reads through and completes before our first meeting. We also review the Treatment Agreement when face to face in the initial meeting with the potential patient, to make sure they understand how we operate.

Before developing these business foundations, I would spend a lot of time on the phone with potential clients—often to discover that they wanted to use a clinician in their insurance plan. Now my practice is filled with clients who really want to make use of my services. It is not unusual for people who initially decide against using me to return after experiencing less-satisfying service elsewhere. Remarkable, prompt professionalism gets noticed.

I devote myself to being easily accessible and remarkably responsive to my clientele. This premium service is my unique selling position. My practice is busy enough to provide an excellent living, but small enough to allow for scheduling new patients promptly or for fitting in crisis sessions as needed—a tremendous value for patients. This is what I mean by “concierge.”

There are many pieces to this puzzle, but the most important one is your pluck and determination. To succeed you must become as entrepreneurial as I am. Take my hard-learned lessons on customer relations, referral-source relations, core business practices, and basic self-care, and build your own brand of business devoted to delivering your own “flavor” of psychiatric and/or psychotherapeutic services. Do it in a way that is fun, fulfilling, and profitable.

Are you a recently trained clinician ready to embark on a career of learning and improvement, or a seasoned pro still learning and fine-tuning your business skills? Either way, you have a core competency in performing the basics—conducting an evaluation, arriving at a working hypothesis, and engaging your patient in a treatment process. With these basic professional skills—along with my tips—it is absolutely possible to run a thriving, cash-based practice. Work hard implementing everything I show you. Before you know it, you will be enjoying a practice just like mine.

The Customer

A Prospective Client

How do potential customers find you? Once they find you, how do they reach you? Telephone? E-mail? Via your Web site or through aggregator sites like PsychologyToday.com or Therapy Tribe? The bulk of my new business still comes the old-fashioned way: a personal referral, either from a trusted referral source or from a current or previous patient. However, there are increasing numbers arriving directly from the Web site and a few other Internet sites.

Early in my career, I wanted to remove all barriers to scheduling new patients. I wanted traffic, phone inquiries, the more the better. I wanted people packed in my waiting room and in lines out the door. Not anymore. Back then, I thought it was my duty to “take all comers.” I actually accepted anyone into my practice. You already know about my early insecurities. I failed to realize that my business was not a good fit for many people. After many years, I realized that this made little sense for me or for my patients and resolved to do something about it.

ClearLifePath’s innovative practice in this regard is to provide enough information about the business model to allow for a high degree of self-selection. It is a waste of time for me and the prospective client. Set the bar high for entrance into your practice and you’ll be glad you did. There is a very clear and simple method for doing this.

I publish my rates on the Web site and readily quote them to prospective clients. If I return a telephone inquiry and get the person’s voicemail, I give them a thumbnail summary of fees, location, and available times and direct them to the Web site. If we are speaking directly, I am friendly and interested but try my best to limit the amount of time on the phone. I want to quickly “sell” an evaluation session.

At least two things will flow from this:

1. You will find yourself working with highly motivated people—people interested in investing time and money to optimize their development and functioning.

2. You will have open time in your practice. The people you want as clientele appreciate the value of being able to be seen quickly. The open time will also allow you to take better care of your current patients. Earlier in my career, having open time was distressing. Now I value it and encourage you to as well.

A New Patient Evaluation

I suggest that new clients arrive a bit early for our first meeting, allowing time to read and complete the New Patient Packet. This includes the treatment agreement, a form for basic identifying information, and a form for credit card information. These documents set out explicitly the parameters of our working relationship.

In the one-and-a-half-page agreement, I articulate the guiding principles of the treatment situation—everything from my fee structure, the expectation of payment for missed sessions, and my version of confidentiality. I make the business relationship explicit, in writing, to facilitate a mutual understanding before any specific treatment is recommended. At times this raises questions. For the most part people read it, sign it, and we begin.

It is my intent—within the 90 minutes I set aside for an initial evaluation—to be able to generate an initial hypothesis regarding the troubles presented and recommend, if not get started on, a course of treatment. This process is the product of years of trial and error.

Patients in Treatment

I start appointments promptly. My time as well as my patient’s is valuable and not to be wasted. I make sure I finish a meeting soon enough to wrap up and prepare for my next appointment. This punctuality is another facet of ClearLifePath’s service. It could be argued that it is only ordinary civility, but I fear this is not community standard.

From our first contact, I am actively engaged with my client. This is another aspect of my brand of psychiatry. I am truly interested in bringing value to my customers. I am convinced that the most effective mode of providing service is by way of active and optimal interaction. I want my patients to experience this. I tell them in no uncertain terms that I want this sort of active engagement and that their improvement hinges on us both struggling for it.

I want my patients to get better and leave my practice, becoming walking billboards for my business. I tell them that. I want you to want your patients to leave yours as satisfied customers who say without hesitation that they got what they came into your practice to get, as this spouse of a patient recently wrote:

Dear Dr. Lynch,

I just want to express my deepest gratitude to you for bringing my husband back to us. When he first came to you, he was a completely different person than the one I had known for almost 30 years. Your quick assessment of his situation and appropriate treatment, both drug therapy and counseling, made for a quick turn around. In fact, he responded better after just a couple of visits to you than he had during ...

Table of contents

• Cover
• Contents
• Title
• Copyright
• Dedication
• Preface
• Acknowledgments
• About the Editor
• About the Contributors
• Section I: Setting Up, Managing, and Marketing your Practice
• Section II: Building, Marketing, and Practicing in the Digital Age
• Section III: The Dream Niche Practice: Successful Stories of Specialization
• Section IV: Final Thoughts
• Index