Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing.”
This episode is brought to you by PAR.
PAR offers the SPECTRA – Indices of Psychopathology, a hierarchical dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com/products/spectra.
[00:01:00] Hey everybody. We’re back. Today, we’re talking about an age-old chicken or egg question for a practice. Do you hire first and hope the new clinician gets busy or do you build out a lengthy waitlist before hiring?As usual, the answer is it depends. We’ll talk about when it makes sense to choose one strategy over the other and when to forget about hiring altogether.
Now, if you want to talk through this question or any other question, I would be happy to help you out. Right now, my groups are full and running until the next cohort starts in January, but I’m available for one-on-one strategy sessions or extended relationships for consulting. You can go to thetestingpsychologist.com/consulting and schedule a pre-consulting call to see if it would be a good fit.
All right, let’s talk about hiring.
[00:02:05] Okay, everybody. We are back. Let’s get right to it. I don’t want to bury the lead. So I will tell you right off the bat that I take the more conservative approach and wait to hire until I have proof that we can support that new hire with plenty of referrals. The longer story here is that there are certain situations when you can hire without those booked appointments, and we’ll dive into when that might be appropriate as well.I’ll preface this discussion by saying that this is industry-specific, particularly in startups, software, retail, and many other industries, you have to hire personnel before any business comes through the door. For example, when we started our software company, Reverb, it killed me because we spent a lot of money long before we started selling anything. But in mental health, we have a little bit more of a choice and that’s what we are talking about today.
Let me start first with my [00:03:00] rationale for not taking what I call the field of dreams approach; if you build it, they will come, i. e hiring and then filling the schedule afterward.
Here’s why I like to have a waitlist or a full schedule before hiring.
One thing, it is less risky for both parties. The incoming employee has a sense of stability and the impression that they are joining a thriving business. It’s less of a leap of faith for you. It takes the pressure off to fill someone’s schedule quickly to justify a salary or increased rent. And like I said, it is more secure for the incoming person as well, just from a psychological standpoint.
What else does it help with?
It gives you more confidence from the beginning of the hiring process. If you know that the individual is going to have a full schedule, whatever that looks like, I mean, it could be 10 hours a week, it could be 35 hours a week, I think it leads to more [00:04:00] confidence all the way down the line, all the way back to the beginning of the hiring process. So you presumably will have a better idea of what you can pay them because you have guaranteed “revenue on the books”, which means you can write a clearer job description, you can answer their questions confidently during the interview process, and you know that they will be generating revenue quickly after starting. So confidence all the way down the line.
Another thing is that I think it dangles a carrot for clients because you can schedule folks further out, but let them know that you’re hiring and will likely be able to move them up to an earlier time. Now, you don’t want to make that promise if you’re not fairly certain you’re going to be able to hire someone, but I think it is nice to let clients know, Hey, we’ll get you on the books, but there’s a good chance that you might be able to bump up when we hire a new clinician and need to fill their schedule.
[00:05:00]The last piece of this rationale to have a wait list going before you hire someone is that it saves on marketing dollars. So rather than having to push heavy marketing or invest more to fill someone’s schedule after they start, you simply pull from existing clients and you can move them up on the calendar.Okay. What are the downsides of this conservative approach?
First, it will likely take longer to feel comfortable in hiring. If you’re waiting to build up enough referrals to justify hiring someone else, it’ll push back the hiring date and growth of your practice because you are trying to build a longer waitlist or book further and further out. So it will push back hiring. If you’re in a huge hurry to hire, this may not be the plan for you.
Another downside is that you may lose folks who don’t want to wait on a waitlist or book further out. I know this is an issue in some places or in some [00:06:00] specialty areas, but at least in the area of neurodevelopmental evals for both kids and adults, I think it is pretty standard to be booking 3 to 6 months out. In our practice specifically, we routinely book at least 5 to 7 months out with no problems.
Now, there is some research out there around the longer people have to wait, the more likely they’re going to not fulfill that appointment because they maybe found services elsewhere or decided they didn’t need it, but there is certainly a precedent for booking further and further out still. Important to mention, you may lose folks who don’t want to wait on a waitlist. And that’s the fear that gets a lot of people into this place of wanting to hire quickly is that they don’t want to lose anyone, but you can evaluate your industry and figure out what is reasonable and how long people are willing to wait, and what the standard is. Don’t just operate from that fear-based place.
[00:07:00] Another downside of the conservative approach is that you’ll immediately be thrust into a busier practice if you’re bringing someone on to a full schedule. There’s less time and space to adapt and onboard a new staff member and sort through any problems that might come up after they start because they are just hitting the ground running and seeing a full caseload.Let’s take a break to hear from a featured partner.
Y’all know that I love TherapyNotes, but I am not the only one. They have a 4. 9 out of 5-star rating on trustpilot.com and Google, which makes them the number one rated Electronic Health Record system available for mental health folks today. They make billing, scheduling, note-taking, and telehealth all incredibly easy. They also offer custom forms that you can send through the portal. For all the prescribers out there, TherapyNotes is proudly offering ePrescribe as well. And maybe the most important thing for me is that they have [00:08:00] live telephone support seven days a week so you can actually talk to a real person in a timely manner.
If you’re trying to switch from another EHR, the transition is incredibly easy. They’ll import your demographic data free of charge so you can get going right away. So if you’re curious or you want to switch or you need a new EHR, try TherapyNotes for two months absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code “testing.” Again, totally free. No strings attached. Check it out and see why everyone is switching to TherapyNotes.
The SPECTRA- Indices of Psychopathology provides a hierarchical dimensional look at adult psychopathology. Decades of research into psychiatric disorders have shown that most diagnoses can be integrated into a few broad dimensions. The spectra measures 12 clinically important constructs of depression, anxiety, social anxiety, PTSD, Alcohol Problems, [00:09:00] Severe Aggression, Antisocial Behavior, Drug Problems, Psychosis, Paranoid Ideation, Manic Activation, and Grandiose Ideation. That’s a lot. It organizes them into three higher-order psychopathology spectra of internalizing, externalizing, and reality impairing. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. You can learn more at parinc.com/products/spectra.
All right, let’s get back to the podcast.
In my mind, there are some situations where you can hire without a long wait list or without booking way far out. And here are some of those situations.
One is that you somehow have a guarantee of lots of referrals in the future. Maybe you signed a contract with a local agency and they’re holding onto those referrals until you have a clinician [00:10:00] to see them. Maybe you have a handshake agreement with a local medical practice to send you referrals when You have a clinician. Maybe you deliberately try to hire someone who brings a lot of referrals with them, or you’ve determined they’re responsible for bringing in their own referrals, doing marketing, and so forth. If you somehow have a reasonable guarantee that you’re going to get a lot of referrals when you hire, then that could be a good situation to just go ahead and pull the trigger.
Another situation might be that you hire someone who doesn’t “need to work” and can wait while you build up their caseload. If you go this route, just try to be transparent with folks. I like to give them a worst-case scenario for how long it’ll take to build their caseload so that they’re not waiting around and thinking they’re going to be making money before they do.
Another reason you might be willing to hire without [00:11:00] referrals is you are willing to invest a potentially large amount of money and time into marketing via Google ads, a warm relationship campaign, that kind of thing. So if you just buckle down and you know, like I’m going to be spending a lot of money on advertising and doing whatever I need to do to fill this person, then it could work.
And the last reason I’m going to give is, if you have a financial cushion to float the rent and increased admin cost for a new employee, it might be worth doing it. The biggest concern with a lot of these or with this situation is that you end up upside down because you’re paying someone even if they aren’t bringing in work. This also includes any compensation that you would have to pay for training and onboarding. Of course, we’re not necessarily talking about clinical compensation. Hopefully, you’re not paying them a [00:12:00] salary before they’re seeing clients, but you will have to pay for training and onboarding. And those costs sometimes add up. But if you have a financial cushion to float it, you might feel more confident to hire without those referrals.
So where does this leave us?
As you can tell, I am a big fan of the more conservative approach to hiring where you bank a longer wait list to give some guarantee that you’ll have some appointments to fill your new person’s schedule.
And this is the way that we approach it. We typically will hire someone new and then backfill their schedule with folks who are booked further out. So these are folks who have already booked appointments with us and we will call them and say, Hey, a pleasant surprise. We have a new staff member. You can get in sooner.
Now, this is a little more work on the admin side, but again, this is the process that we have come up with in our practice. You could always hire a staff member and then book [00:13:00] their appointments as the calls come in. I think that is a little tougher because again, it doesn’t let the person start with a full schedule, whereas backfilling before they start from an existing pool of scheduled clients allows them to hit the ground running whenever you would like them to, rather than just waiting for calls to come in and filling their schedule organically. So I like that approach.
Full disclosure though, this is my MO. I trend into slight hoarding behavior to feel a sense of security. This applies to money, booked appointments- our waitlist is a sense of security for me, stocking our pantry and refrigerator, and honestly many other things. So just putting that out there, this is a personality trait or quality for me and that may not be true for you. You could be in a situation or niche where hiring before you technically have people on the books could be a great option. [00:14:00] But it’s just another example of how important it is, I think, to notice how your personality or emotional functioning or viewpoint is going to influence your business. And that’s something that I’m aware of and acknowledging and know that it’s playing a role for me. Either way, make sure that you have the time to train and onboard your new personnel so that they have a successful transition into your practice.
All right, y’all happy hiring.
All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out. If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcast.
[00:15:00] If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice, development, beginner, intermediate, and advanced. We have homework. We have accountability. We have support. We have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.Thanks so much.
The information contained in this podcast and on The Testing Psychologist [00:16:00] website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.
Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and the listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.