Conscious Entrepreneurship: A Buncha Tips on Private Practice
—by Jim Nolan, Licensed Psychologist, LPCC, LADAC
These are, of course, mostly based on my experience, but I also know a lot of private practitioners, so I can bring in some of their wisdom too.
- You can try to get paneled by insurance companies or not. Your choice, though getting paneled is not quite as easy as it sounds. The insurance companies are not always TAKING new people. You have to work it. The insurance company issue makes a difference, because…
- If you get paneled by insurance, and take Medicaid, you will get clients. That is the dealio. You will. It may take a little while, but a lot of therapists do not WANT to take insurance, especially Medicaid, so those folks who HAVE Medicaid will be looking for a good therapist who will take their Medicaid insurance. I see a ton of these clients. Getting paneled on other commercial insurance panels is cool to…
- This may change somewhat if the current administration repeals Obamacare-let’s wait and see…
- Some therapists complain about insurance companies and Medicaid, and how little they pay, and how much paper work is involved, and so on. I have never been audited, so maybe that experience would change my point of view, but so far, I am not unhappy with what Medicaid pays me, and I am delighted with what New Mexico Health Connections, Blue Cross, and Presbyterian pay me. Let me put numbers to that. As a Psychologist (LPCCs get paid a little less), I get something like $87.12 for a one hour Medicaid session. New Mexico Health Connections pays really close to $130 a session. Blue Cross and Presby somewhere in the vicinity of $110. I GET that as a practitioner that does not take insurance, you can charge a buck thirty, or a buck fifty, but they wonder a lot more than I do where their next client is coming from. I, personally, would be reluctant to pay $150 cash on the barrelhead for therapy. Maybe that’s just me. I would look (and HAVE looked) for someone who takes my insurance first. You will have to decide where you come down on this one.
- Not that I ever finish a session in sixty minutes. I am not made that way. My sessions are almost always at least an hour and 15 minutes. Often an hour and a half. Some fellow professionals might think I have no boundaries, and that I am a sap to work that long for only one hour of pay, but I do not see it that way. My clients love it. You will decide how to see this stuff yourself. I would rather see two clients over three hours, and have a more leisurely time of it. I GET that the guy next door is getting THREE billables for that three-hour block, but I don’t care. That would feel crunched and awful to me. You will have to decide for yourself how you want to work. There is no wrong answer here.
- Your own marketing efforts can make a significant difference in who is drawn to you, and what your clientele ends up looking like…
- My social media advisor told me “You should start your web site two years before you need it.” I think that is pretty smart.
- If you write, then write. If you LOVE writing, then DEFINITELY write. Blogging is one of my own biggest tools, not only for marketing Southwestern College (you cannot imagine how many people come to the College and tell me about reading my blogs, and how that was a big draw for them. I am not tooting my own horn, I am giving you advice. They just do.) In my private practice, it is huge…
- If you accumulate a year or two of blogs about how you view the work you do, people will read it, and will make decisions to come see you based on those. It happens to me all the time. Clients tell me that. I have no reason to doubt them. I am willing to be controversial. I blog about “Harm Reduction” (a polarizing topic) in the addictions realms, I talk about the Law of Attraction (which is also a kind of polarizing topic)–I talk about what I believe in, what resonates for me, about my own practices, and I hope and assume that clients select in or out based on those disclosures, which is EXACTLY what I would hope for….(look at my “Articles” at drjamesmichaelnolan.com)
- Your web site and blogs really, really ought to be about how what you do is going to benefit your clients, NOT about how wondrous you are. Telling your clients in your Psychology Today profile that you do CBT, DBT, EMDR, EFT, Somatic Sensing, and blahbedee blah does not tell them how or why they will feel better for coming to see you. Talk real. Look at it from THEIR point of view.
- A LOT of clients mention that they were drawn to me because I also listed “Life Coaching” as one of the things I do. I have two certificates in Life Coaching, and they both were unimpressive. Life Coaching, for me, is a willingness to focus on the positive, on the client’s strengths, on their goals and strategies for living a better life, without pathologizing everything. People want this. Clients want this. I say that from direct experience. I really strongly suggest you look into Life Coaching and, if it is a fit for you, consider adding it to your list of things you do. (I actually would not even TRUST a therapist who does not do Life Coaching stuff in their practice, but that’s just me…) You can learn a LOT of this on your own. And studying life coaching is a great idea.
- A lot of recent graduates want to start their private practice right away, based on having had 13 individual clients as an intern. That is probably not the optimal plan. I get that a lot of people hate the idea of working for an “agency” for a year or two post-graduation, but really, that is the way to get the most hours toward independent licensure, and a LOT of experience. Does that make sense? I hope so…You DO get better at this with more experience, right?
- You have to be willing and able to keep your own clinical records, in case of an audit. I am not good at this. It makes me nervous. I am not the world’s best “Golden Thread” guy. But I feel I should say this, because it is SO much a part of being a private practitioner these days, especially if you take insurance. You will have have to get good at doing this.
- THIS IS A GREAT FIELD. I am very, very happy to be able to do Private Practice. It is not “easy”, and you have to be really committed, but from my point of view, it is worth it.
- You will make up your own mind. Maybe nothing I said will be true for you. But I hope this is somehow helpful…