Multiple Income Streams Success Story #1: Supervision

In the past, I've written about increasing revenue using multiple forms of income (income not related to direct client hours). I offered five key questions to find areas where you might be able to enjoy adding some extra income to your private practice. In this series, I want to share the successes of private practitioners who have used these concepts to find areas that not only increase their income, but help reach their ideal clients and also fuel their passions. Amy Tatsumi, MA, LPC, found that she could garner additional income and give back to the psychotherapy community by providing supervision to others training in her field. Amy estimates that 25-30% of her income comes from supervision and consultation services.

“I believe that supervision and consultation are the biggest ways that I can give back as a therapist. Supporting clinicians in their journey to become sound, connected, and grounded psychotherapists has a powerful ripple effect. The supervisee, as well as all of their future clients, are impacted by the supervision process in their growth and development. In my private practice, I offer both individual and group clinical supervision and consultation for post graduate candidates and post license and seasoned practitioners in art therapy, counseling, and psychotherapy.”

To learn more about Amy and her services, visit amytatsumi.com 

You might find that the fee you can charge for supervision is similar to your hourly clinical rate. I recommend researching what the standard rates are for supervisors in your area. Be sure that you are meeting all the qualifications for supervising a particular discipline as requirements differ depending on the field (social work, professional counseling, psychology, marriage & family therapy) and on in which state you practice. It is common that supervisors meet requirements for a minimum number of years of licensure or have specialized training as a supervisor. It's also important to research and understand which groups of trainees you should or should not supervise.

Income from supervision can be accomplished in a few ways. I have found in my own practice that hiring interns to meet with clients has been a successful way of creating additional income for the practice. It allows your practice to see more clients than only having one provider. You can also provide direct supervision to clinicians from other agencies. There are many times when clinicians may not have access to the type  of supervisor necessary to meet the licensing requirements. They must then seek someone who can provide that. You can also provide supervision for other agencies themselves. Agencies may find that they have a need for someone to supervise employees for similar reasons that clinicians may seed outside supervision. Creating a relationship with an agency for supervision could be a consistent income stream. Consider all your options, then implement the style that works best for you.

If supervision isn't the income source you're looking for, don't worry; I'll be sharing other success stories and ideas for multiple avenues for revenue. I'd love to hear from you about areas where you have found the opportunity to generate income and, hopefully, some excitement for you.

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3 Ways Managed Care is Hurting Your Practice

3 Ways Managed Care is hurting your

This is not the first time you've heard me share my perspective on the problems of building private practice based on managed care. The original intent of these third-party companies was to ensure equity for those who receive treatment, but the actual results have been far from successful and have caused a myriad of problems. Some have even described managed care as the cause of the mental health care crisis. And while managed care wreaks havoc on the field as a whole, this system is also problematic for private therapy practices. As a clinician, I can certainly attest to this. My guess is that you can too. Here are the 3 main ways that using managed care panels may be hurting your practice:

1) Micromanagement of Treatment

Managed care panels have a way of micromanaging you in a supposed attempt to make you accountable. This means that a therapist often has less say and control in the type, length, and modality of treatment provided to the client, who has also has less input in the process. Think about it: an outside, commercial middle-man is dictating how you, the professional, help your client. It's easy to see how such a system lends itself to inadequacy and substandard care.

The mandatory diagnosing of clients is arguably the most deplorable part of using managing care panels. You are often required to provide a diagnosis, even if you do not believe your client has one. Even worse, some companies only accept certain kinds of diagnoses, which only further restricts your ability to provide ethical and accurate information and care.

2) Business Inefficiency

Communicating with managed care companies is a nightmare. There's excessive paperwork to fill out and phone calls to make. The hassle is never-ending, and it takes away from what you want to do: use your professional skills to serve your clients. Not only is your business inefficient and time-consuming to operate, but by looking at the math, you'll discover that your overall costs are increased as well. Even analyzing things solely from a business perspective, it's evident that using managed care is not a desirable model.

3) Payment Problems

When working with managed care their contracted rates were 40-60% of my full fee. Not only was there a low fee, but there was also the frustration of denied or delayed payments. There would sometimes be problems with the paperwork, or things would get lost in the tedious communication, and I wouldn't get paid for weeks or even months. I wasn't being sufficiently compensated for my work, and I wasn't always being paid in a timely manner. It was disheartening to say the least. It is emotionally and financially draining, and we deserve better.

These are three of the major ways managed care can hurt your practice (although there are certainly more). Thankfully, there's a better way. A way you can work less and earn more. I'm excited to share you with in upcoming posts about how transitioning to a fee-for-service model helped me build a thriving practice.

Click here to access my webinar, "Breaking Up With Managed Care" to learn even more tips and strategies.

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Top 10 Websites for Building Your Private Practice

Top 10 Websites

Like any worthwhile endeavor, building a successful private practice takes a lot of work, time, and know-how. So why not consult the experts? Here's a list of 10 of the best websites (listed in no particular order) to help you do just that:

1) Zur Institute

Drawing from his 20+ years of experience, Dr. Ofer Zur gives insight on virtually all aspects of the field of psychotherapy and the mental health profession, including practice building and continuing education. He offers practical resources on such topics as using a newsletter for marketing and how to deal with collections agencies. Many of Dr. Zur's publications and packages have a set price, but he does give some free articles and videos.

2) Private Practice From the Inside Out

Tamara G. Suttle, M.Ed., LPC has run a private clinical practice since 1991 and wants to share her secrets to success. She includes tips on blogging, how to build your website, and marketing your practice. Her site is very interactive, as you can submit your own questions and also have the potential to contribute a guest post.

3) Practice of the Practice

Joe Sanock, MA, LLP, LPC, NCC, is committed to making counselors awesome by sharing the business and social media info that he's acquired in his years of private practice. He covers a wide variety of topics, such as how to use Wordpress and Bluehost to build your own site, finding your niche as a therapist, and how to use Google Keyword Planner to rank higher in search engines. Joe also runs a very successful podcast where he discusses even more tricks of the trade. He even discloses his monthly income report and shows exactly how he has managed to increase his earnings through his side professional activities.

4) Zynny Me

Miranda Palmer, LMFT and Kelly Higdon, LMFT are no-nonsense experts in all things private practice! Become part of their Business Bootcamp, where a community of clinicians offer their experience and support to help each other (re)examine beliefs concerning money and private ownership, create a business vision, and build a sturdy foundation to grow into a thriving psychotherapy practice!

5) Get Down to Business Consulting

Cathy Hanville, LCSW knows that being a great psychotherapist is not enough, and she offers consulting to help you take your business to the next level. By reviewing your social media campaign, helping you streamline your billing procedures to make them more efficient, and helping you get started with blogging, Cathy can guide you on how to market and manage your practice to expand your outreach and create a robust practice.

6) The Counselor Entrepreneur

When Camille McDaniel, LPC, CPCS first started out in private practice, she worked long hours without a clear vision of her own. Once she educated herself on marketing, business skills, and how to develop multiple income streams, she was able to have more creative control of her practice and find more fulfillment in her work. Her goal with "The Counselor Entrepreneur" is to help other counselors tap into their own creativity and use it to help others.

7) Be a Wealthy Therapist

Building upon the principles she gives in her book, Casey Truffo spills the beans on all things related to becoming financially well-off as a therapist. She tells how to attract full-fee clients, how to change a negative or inaccurate mindset that hurts your practice, and how to increase your income when you're already capped out with clients.

8) Perfected Practice

Samara Stone, LCSW and founder of The Stone Foundation built her own practice from the ground up. Wanting to help others replicate the success that she herself has had, Samara shares valuable information and tips about the importance of networking with other professionals in the field, how to work hard in building your practice without burning out, and best practices for selecting administrative staff.

9) Heart of Business

Founder Mark Silva understands the dilemma of wanting to make a difference in people's lives but also realistically needing to earn a living. Though not specific to the mental health profession, Heart of Business seeks to help entrepreneurs run their businesses in such a way that they can serve their clients while still meeting their own needs. You can receive small-group coaching for personalized attention and support, or you can subscribe to a free newsletter to get tips and strategies delivered to your inbox.

10) Private Practice Toolbox

This list would be incomplete without the very website you are reading right now! I love the opportunity to share with my tribe the lessons that I have learned since founding my own practice in 2002, but I think the real strength of Private Practice Toolbox is that it's all about you! We crowd-source through social media to generate inquiries, ideas, and input about all things related to private practice. We also highlight and celebrate those who've found success, who then share their secrets with the rest of us.

What blogs/ sites have helped YOU

learn and grow your practice?

(Click herefor a list of top 10 book resources!)

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How Media Exposure Can Grow Your Practice: Podcast Interview

I thought you'd you enjoy this lively interview with Joe Sanok of Practice of the Practice Podcast about my private practice journey from a solo practitioner to a clinic with 3 locations and 20 employees. We cover a lot of ground during this podcast!  In addition to tips about gaining media exposure you'll also find: Tips to land high profile media interviews.

The biggest lesson I learned when resigning from managed care.

The book that helped transform my practice.

Tips for finding blog topics to write about.

How to find quality therapist to expand your practice.

How to encourage to see my colleagues when you don't have openings.

The role of social media and building an online presence.

How I became a private practice consultant.

Listen to the podcast interview here

..and here's a fun graphic specifically about how to add top-notch clinicians...

Find out more about the MostAwesomeConference.com with fellow PsychCentral Bloggers Kelly Higdon, Miranda Palmer, and Joe Sanok.

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4 Ways a Private Pay Practice Model Benefits Clients

The value of using a private pay model (instead of a managed care system) for your therapy practice is clear: less stress about additional paperwork requirements, greater autonomy to provide the services you deem are in the client's best interest, and immediate payment of your full fee are some of the main advantages. But some therapists are understandably hesitant about how to make the switch because of the potential impact this choice it might have on their clients. Some common fears are “Clients might stop getting the therapy they need because they can’t afford me” or “charging a higher fee is selfish and means I care more about money than helping people.” When I was considering making the switch, I too had thoughts like these cross my mind. But I discovered that the opposite was true; breaking up with managed care and embracing the new way of structuring my practice actually benefited clients who received services. Here are 4 ways that a private pay model benefits clients:

1) No Mandatory Diagnosis

Many managed care systems require that you diagnose a client's specific mental health condition condition prior to paying you for your services. In some cases, insurance companies will only pay for certain diagnoses. Often, relationship issues are not covered. However, this can turn in to serious ethical problems.

I remember years ago I was referred an urgent client - a child who was sexually assaulted. I determined that she had no clear-cut symptoms and didn't meet a diagnosis that her insurance benefits would cover. I was in a terrible dilemma: do I give an inaccurate diagnosis to satisfy the requirements of managed care, or do I get paid for the initial? No therapist should ever have to find him/herself in this kind of a situation, and no client should be subject to this either.

One of the best parts of employing a private pay model is that there is obviously no such requirement. Diagnosis can be used as a tool, but you are not obligated to provide one. By eliminating the need to diagnosis a condition that may or may not fully exist, you can ensure that your clients receive ethical, honest, and accurate care.

2) Higher Quality of Service

Back when I used a managed care system, I was receiving approximately 40-70% of my stated fee. This meant I was in survival mode, seeing more and more clients just to try to get by and meet my own financial needs. And all the while, I still had the stressful task of running the business side of things. It’s not surprising then that I wasn’t able to give as much to my clients. As much as I tried, unfortunately the standard of care I could provide was compromised. That was unfair to me and unfair to the people who were paying me to help them.

By changing to a private pay model, I was able to see fewer clients and, which reduced my stress, which allowed me to be more present for my clients. I also no longer spending hours per week on phone calls and paperwork that came with using a managed care system, which freed up my energy to give to those I served.

3) Better Therapist/Client Match

A private pay model also lends itself to a better fit between the therapist and the client. If you have fewer clients, you can be selective about the ones you see. The opposite is also true; if someone is willing to pay more for professional therapy, it’s likely that he/ she has done his/ her research and sought you out because of your specialty and the expertise you provide. To put it simply, you want them, and they want you.

I’ve found that using this financial model attracts highly-motivated clients. Although they are required to pay more, they place high value on therapy and budget accordingly.

4) More Clients Reached

A private pay therapy model allows you to have a greater outreach and help more clients. This may initially seem counter-intuitive; how does seeing less clients serve more people? The answer is that if you have a surplus of potential clients or have people come to you with needs that are different that the expertise of your practice, you can refer them to trusted outside resources. You’re helping other therapists while simultaneously ensuring that clients receive the best care specifically for them.

The other thing I have found is that the income stability provided by a private pay model allows my colleagues and me to do more pro bono work. Paradoxically, because we earn more, we can provide more volunteer service when we choose.

All in all, switching to a private pay model was one of the best business decisions I made to benefit not only myself, not only my practice, but the clients and the community we serve. Charging a higher fee does not mean you are inconsiderate or selfish; it means you are valuing yourself and providing the best quality care to your clients.

*If you find that finances are legitimately a concern for some of your clients, you may decide to provide alternative choices, such as reduced fee sessions with Masters’ student interns. My practice Wasatch Family Therapy does this, and it works well for those looking for a more affordable option.

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