Hey, y’all. Welcome to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Good to be back with you again.
Today is going to be a little bit of a different episode than expected. I’ll be doing a solo episode today about when and how to expand your testing practice and think about hiring folks to help you out.
I originally thought that I was going to be interviewing Dr. Karen Postal, like I’ve talked about in the past two episodes, but we had to reschedule, which happens. I’ll look for her in two weeks. In the meantime, you’ve got me and [00:01:00] we’ll be talking about when and how to expand your testing practice.
I’ve told this story before about how I transitioned from Solo practice to hiring my first, at that time, independent contractor to help out with testing. This happened, I don’t know, at this point, probably 6 or 7 years ago, but this was after I’d been in practice for a year or two.
What happened was that our local university changed their policy for prescribing ADHD medication such that anyone requesting ADHD medication had to complete a full psychological evaluation before they could get that prescription. Prior to that, I had evaluated two college students over there and sent the reports over like I usually do. And so, when they changed this policy and [00:02:00] needed evaluations for all these students, they ended up sending them my direction, fortunately.
What happened though was that I found myself with probably 15 to 20 evaluation referrals almost overnight. Prior to that, I’d been doing maybe 1 or 2 a month. Maybe a little bit more than that, but certainly nowhere near the 15 to 20.
At that point, I panicked a little bit, of course, and then sat down, got my wits about me, and started to plan. One of the first decisions I made was to figure out how to hire someone and bring someone on to help me with the testing. So, I guess I would say, stumbled into hiring and technically becoming a group practice at that point. Thankfully, it turned out well and I’ve learned a lot along the way. I did what I had to do [00:03:00] back then but I think there are certainly more of a structure to it and things to consider. I’ll be talking about a number of those factors here over the course of the episode today.
When I think about when it is appropriate to bring someone on, like I said, you have situations like mine, which I think are probably unique. Maybe not. Maybe a lot of you are having that kind of situation, but in any case, I think what you’re looking for is when you’ve reached your, what I would call upper limit for testing and are just getting more referrals than you can handle.
There are a number of ways to gauge that. There’s the, I would say informal way, which is if you just feel too busy; if you’re working at night, if you’re working on the weekend or if you feel overwhelmed with the work that you have, that’s maybe a good time to [00:04:00] say, Hey, I need to consider bringing somebody else on and to get some help here.
Now, if you want to do more of a numbers-based metric, then I would think about the number of referrals. As far as I’m concerned, a full-time testing schedule, if you are doing all of the testing, report writing, and everything from start to finish, if you’re doing pretty full evaluations, then you can maybe fit in 2 to 3 cases a week. If you put in, let’s just say 10 hours per evaluation, you can maybe squeeze in three. If you’re more like in our practice, we do more around 12 to 15 hours. So that’s more in the two-cases-a-week range. So that’s another way to think about when would it make sense to start to hire someone if you are getting more referrals than [00:05:00] you can handle.
You can track your referrals. I would certainly say, try to track them for about six months. And if you’re consistently getting more than 10 or 12 evaluation referrals a month or if you’re getting burned out, then, that’s a good time to consider hiring someone.
I would say, a key thing when you’re gauging your referrals is to make sure that you have an accurate sense of the timeframe and the consistency. I always look at referrals outside the school year. For us, we’ve tested a lot of kids, so things are busier certainly at the beginning of the year and the end of the year. Things slow down a little bit over the summer. So depending on the population you work with, make sure that you’re gauging your referral stream across the year and not just at a particular time of year when things might be a little [00:06:00] more busy.
As I continue to hire folks and look at testing folks, when I look to hire another full testing clinician, that happened when I was consistently booked out for about 10 to 12 weeks for the initial appointment. I think that I should have done that a lot sooner, but I think a lot of it depends on your community as well. Around here we have, I’d say a fair number of agencies that provide testing, and we also have a children’s hospital within an hour and a half of our community. So, you can call around the community and get a sense of what other folks and other clinics’ wait lists look like.
If you’re thinking from a business standpoint, I think it makes a lot of sense to try to have a shorter [00:07:00] waitlist than the shortest one you can find. So it doesn’t have to be a lot, but I think that does make a big difference. When people are calling around looking for an evaluation, if you can get them in six weeks versus having to wait, let’s say, 12 weeks for the local children’s hospital or another agency, then that makes a really big difference.
When I did the math and figured out, hey, I could transfer over two cases a week to another psychologist and we would still be booked out longer than I hoped, which is two months, that’s when I started looking for another full psychologist to bring on in addition to the graduate students. It talks about the when you might think of expanding and hiring other clinicians in your practice.
The other piece of that though is thinking about when you [00:08:00] might bring on additional staff like support staff, like an admin assistant or a billing support, and those kinds of folks.
I would say, looking back, I waited way too long to bring on those services. I think I’ve joked around on here before about being a control freak. And so I, for a long time did everything myself with regard to answering the phone, doing the billing, checking insurance, following up on insurance. Honestly, it was a complete nightmare and probably contributed to being booked so far out because I wasn’t being as efficient in moving folks through the practice as quickly as I could. If I could go back, I would definitely hire a little bit of support way earlier in my practice.
Two things to consider there:
1. If you take insurance, I would hire a billing service or at least an insurance verification service [00:09:00] almost immediately. That’s a service that can call and check your clients’ insurance coverage for testing prior to them coming in. It typically does not cost a lot. It might be $4 to $5 per patient. The reason that I think that’s so important is because once I started doing that, then that allowed me to: One, it freed up a ton of time. It also led to a lot less confusion on the client side with billing throughout the evaluation process.
When you have an estimate of their coverage ahead of time, then you can communicate that to the client before they come in. So it cuts down on no-shows that might happen or cancellations that might happen when they find out that it’s going to be more expensive than they thought.
It also allows you to put a policy in place for collecting. In our clinic, we collect half of the estimated total [00:10:00] at the testing appointment. That helps with cash flow, aging reports, balance, and that kind of thing.
It also increases client relationships because you’re being upfront about the cost. If it’s going to be a little more expensive than maybe they anticipated, you can communicate that immediately. That builds trust and gives you an opportunity to devise a payment plan if you need to, that kind of thing. So, if you take insurance, I would definitely consider that service pretty quickly.
Now, in terms of office support and an admin assistant, again, I wish that I’d done this a lot quicker. I’m a big advocate of hiring an admin assistant at least on a limited basis, almost from the beginning. There are services out there that are… It can basically be answering services and also do scheduling for you if you want to do a virtual service. I use [00:11:00] Conversational right now as a backup service for our in-house person. If he can’t answer the phone for whatever reason, it goes to Conversational. But I would really think about admin support pretty quickly as well.
Here are just a few tasks that an admin person can take off your plate, even part-time. So this could be someone who’s in two hours a day. They can answer the phone, return messages, and explain the testing process.
This is super important for us because, at least for me, when someone was calling for an evaluation, that phone call would take anywhere from 10 to 20, maybe even longer than that, 10 or 20 minutes of phone call. Now, if you are getting, let’s just go back to that number. If you get three of those a week, it may not seem like a lot, but you’re spending an hour on the phone per week.[00:12:00] That’s a lot of time. You can be doing some other things.
One thing that I struggled with with that was this thought that nobody’s going to be able to explain testing like I can. It’s too complex. They can’t answer all the questions and that’s really important. Well, I figured out that that was not true. So what that forced me to do was write up a really nice, thorough script of what our testing process looked like from start to finish. I included a Frequently Asked Question section.
Of course, there was some training that happened at the beginning. There’s pretty extensive training to, be honest, of our admin assistant, but after that, I have never looked back. He’s gotten really good at describing the testing process and it has not made any difference in terms of folks following through or not. I’ve had a lot more conversion, so to speak from phone calls because [00:13:00] someone is answering the phone and returning messages on time as opposed to me putting it off cause I didn’t have the time that I needed to talk with them. So that’s just one thing.
They can answer questions about insurance if that’s part of your practice. They can follow up on billing issues if that’s the way you have the role set up. They can do scheduling activities. Our admin person schedules all the feedback sessions and schedules all my interviews. So that’s a big task off of my plate.
But I think one of the more important things that our admin assistant does is what you might call case management. After every interview that I do, I have a post-interview form that I fill out. It has a few different fields that has a send a thank you fax to the referral source. We send a fax to every referral source that we get [00:14:00] just to maintain that connection. So sending that fax. Let’s see, asking for any records from any previous providers, like any evaluations, any records from schools any medical records that might be relevant.
It also has a box for scheduling collateral interviews. Often, I will interview kids’ teachers, daycare providers, if parents are divorced, making sure to make contact with both parents, with adults that might involve interviewing a spouse or a provider, you get the idea. So I’m scheduling collateral interviews, requesting records from other folks, and scanning the file in. We’ve gone to a paperless record system using Google Drive, so he takes that file, scans everything in right after the interview, and then that file is [00:15:00] ready to go for the electronic records system. So I think the case management piece has probably been one of the biggest pieces because that it makes things go smoother.
In the past, I would find myself playing phone tag with other providers. I couldn’t get interviews scheduled in a timely manner. And so then that would delay the evaluation. If I was missing paperwork or needed to follow up on materials that needed to come back from parents or something like that, I would just put those tasks off and not get them done in a timely manner. And so our admin assistant really helps with those kinds of tasks.
Again, I’m a big advocate for really considering administrative support pretty early on in the process. Even if you’re a solo practitioner, I think it you can benefit greatly from administrative support.
Once you move on to [00:16:00] deciding to hire other practitioners in your practice to help with testing, I think you get to a decision point. So the question becomes, do you want to hire psychometricians who can help you do the testing but not do any interpretation or, I don’t know what the word is… Sorry. Had a little brain malfunction. ..any interpretation or guiding the evaluation or leading the eval. Or do you want to hire another licensed clinician who might be able to do the full evaluation and take on the whole evaluation themselves?
There are different considerations with both. If you’re a solo practitioner and you don’t feel like you have enough referrals to fully support another clinician, I think there’s something to be said for really considering that because you could hire someone part [00:17:00] time even at the rate of one evaluation a week. That’s 10 to 15 billed hours. And that’s a part-time position for a lot of people. So, you could consider that and see if it fits with your practice. But if you’re a solo practitioner and you don’t feel like you can support another clinician, but you would like some extra time, I think the psychometrician route makes a lot of sense.
So then it gets to the question of, where do you find good psychometricians.
Well, thus far in our practice, I have exclusively employed advanced graduate students as psychometricians. These graduate students are advanced doctoral students. They’re all getting their doctoral degrees in either clinical psychology, counseling psychology, or school psychology. At the point that I hire them, those graduate students have had at least a solid year of testing [00:18:00] experience., not just taking appropriate classes, they have practical experience administering and interpreting test results under supervision. So I think that’s pretty important.
If you are going that route, I think the graduate student route is great. If you enjoy training, if you hire grad students, you do have to provide supervision. So if you don’t like that, then I would discourage the graduate student route. In that case, I might consider more of an independent psychometrician. Those folks are certainly out there. And like we talked about a few episodes ago, there is a board of certified psychometrists that’s starting to standardize that training a little bit more. So there are folks out there who are “only psychometricians” and are not necessarily graduate students. So, that option is out there as well.
In my case, I [00:19:00] really do like training. I think having students in the practice certainly brings freshness, and a different perspective, and keeps us all plugged into updated learning and making sure that we’re on top of the research and that kind of thing. So I love training and I’ve really enjoyed having grad students in the practice.
But again, another aspect of the training piece is that you have to put time into standardization. So, writing up a good training manual. The training process is pretty important. I think I talked about that two episodes ago where we have