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Dr. Jeremy Sharp (00:00.568)
Hello everyone and welcome to the testing psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.
Dr. Jeremy Sharp (00:13.516)
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 just 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 slash therapy notes and enter the code testing. This episode is brought to you by PAR.
The new PAR training platform is now available and is the new home for PAR talks, webinars, as well as on-demand learning and product training. Learn more at parinc.com backslash resources backslash par dash training.
Hey everyone, welcome back to the podcast. Thanks for being here. Always glad to be here with you. And today we are talking about, what are we talking about today? We’re talking about one of the biggest decisions that we have to make as private practice owners at some point. And that is when to hire help or if we want to hire help. This has come up a lot recently. I’m not sure if it’s just part of the zeitgeist where everyone is feeling
a little more overwhelmed or maxed out than usual. But if you have found yourself drowning in scheduling, billing, intakes, clinical work, waitlist stretching out, if you’re just feeling totally maxed out, you’re not alone. In this episode, we will talk about both the qualitative and quantitative signs that it’s time to hire, how it feels emotionally when you’re taking on too much and the key financial and operational metrics.
tell you it’s time to bring in help. So I’ll break down the numbers, the workflow challenges and the real opportunity costs of waiting too long to hire. Plus I’ll share strategies to overcome the fears and hesitations that I think a lot of us experience when making that first hire. So if you’re on the fence about expanding your team or just curious about the best way to do it, stick around and we will get into it. Now this and many other topics are just bread and butter for
Dr. Jeremy Sharp (02:25.486)
the consulting work that I do with folks. I’ve been running a practice, a testing focused practice now for about 15 years and have been all around the block in terms of hiring and firing and strategizing finances and all kinds of things. So if you would like some support in your practice, I would love to connect with you. I’ve been doing these strategy sessions here lately over the last several months and
They have been great. think they go really well where we just dive in for an hour and try to answer question or two and then send you on your way with some concrete strategies to, to move through your problem and do something different. So if that is compelling to you, you can book strategy session right from my website, the testing psychologist.com slash consulting. But for now let’s go deep into.
the feelings and the metrics of hiring.
Dr. Jeremy Sharp (03:35.502)
Alright, alright people, we are back. We are back. Okay, let’s talk about hiring. Hiring’s tough. I’ve done a lot of episodes on hiring. The ins and outs of hiring, the finances of hiring, the how, the why, all those things. But it just keeps coming up, you know, this question of how do you know when you’re supposed to hire? And it’s a tough question.
In fact, I did an episode relatively recently that gave a calculator about how to hire. So that’s like very metrics driven, but today I’m talking a little more in depth about kind of the feelings and then pairing that with some of the metrics behind it. So let’s, let’s talk first about the feeling part. Okay. So like the emotional component of, of hiring. So how, how might it feel when it’s time to hire?
administrative or clinical help. These are some signs of what I would call administrative overload. If you are feeling constantly behind on scheduling or billing or writing reports, that is one sign. If you are dreading the administrative task, the administrative side of things more than the clinical work, that’s a good sign that you’re maxing out a little bit.
If you find yourself losing mental bandwidth, if you are someone who typically has pretty good executive functioning, all of a sudden, maybe not all of a sudden, maybe over time, you find that you are missing emails, you’re forgetting to return calls, you are dropping clients in the middle of the eval process and losing track of where they’re at. That’s also a sign that you might be maxing out on the admin side of things. And
That relates to the last potential indicator, which is if you are noticing a decline in the client experience, and that could be like long response times or inefficiencies in your process, or, you know, they’re getting annoyed. They’re not getting their reports on time, things like that. These are also signs that you may be overloaded with administrative tasks. And as I discuss all this, I just want to totally normalize.
Dr. Jeremy Sharp (05:58.338)
being overloaded with administrative tasks because we just like running a business, nobody took a class or multiple classes in grad school on how to handle the administrative tasks of a practice. mean, nobody has had a class on being a project manager or an office manager or anything like that. There are whole degrees that go into, you know, the correspond to this, skillset. We don’t have those. So don’t feel bad if
you feel overwhelmed by the administrative tasks. Now, what about on the clinical side? We’re going to tackle admin and clinical. On the clinical side, these are some signs that you might be overloaded clinically. One, your schedule is consistently booked out, consistently being the keyword here. like year round through all the cycles of the season, your schedule is consistently booked out beyond four to six weeks. You…
are feeling emotionally drained or resent seeing clients. This is an easy one, but also one that we can endure for quite a while. So if you’re getting the Sunday scaries or you think about not wanting to go to work, been there, that is a sign you could be clinically maxed out. You’re turning away cases. That’s a very concrete.
experience, know, you’re turning away cases because you just don’t have the time to see them. And lastly, you know, you, if you find yourself like not having time to keep up with referrals or business development or CEUs, this can also relate back to just, being clinically overloaded and needing some help. So we all know this, right? I don’t need to talk about burnout or anything necessarily, but there is like a real
impact of overworking. If you’re under constant stress, which a lot of especially solo practice owners are, but group practice owners who have not delegated are also under a lot of stress. So constant stress, you know, leads to decision fatigue. To me, decision fatigue is one of the most insidious and detrimental experiences that we can have as practice owners. And maybe you’ve experienced this like,
Dr. Jeremy Sharp (08:21.74)
You work all day, you do everything for your practice, and then you come home and your partner asks what you want for dinner and you melt on the floor. Now, I’m not saying I’ve had that experience or that I’m projecting my own experience onto everyone else. but if you’ve had that experience, you’re not alone by any means. So decision fatigue then makes it really hard to do anything important.
when you actually have an important decision to make, not just dinner, it can really, really affect us. So stress can lead to decision fatigue and burnout. It can also of course lead to struggling to stay present and engaged during your work. So if you are thinking about all those phone calls you have to return or emails you have to return or, my gosh, I forgot to send that person my questionnaires. That’s all part of the deal. It is distracting.
And so not only are you potentially doing yourself a favor, but you’re doing your clients a favor too by hiring some help. And then, you know, your personal relationships might suffer as well. if your work is like creeping into everything. So I think we all know there is a definite impact on overworking or of overworking, but it’s, it’s also easy to, to look past that and just keep putting one foot in front of the other, from day to day when things are not so great.
So those are a lot of the feelings. I’m guessing that some of you resonated with some of those experiences and that’s okay. We’re gonna talk about what to do about it. for those of you who are less feeling oriented and want some metrics, let’s talk about some metrics in terms of knowing when it’s time to hire. So here’s a revenue benchmark. This was interesting. dig, I dig, I I dug into some of the metrics here.
you know, I have opinions about all this, but you know, I actually did some research to figure out when it might make sense from a revenue standpoint. And it seems like if you’re at the point where you are making between 10 and 12,000 a month, it is a little bit of a no brainer to hire admin help. Okay. So where’s that coming from? So 10 to 12 K a month. Um, this is estimating administrative costs to be about
Dr. Jeremy Sharp (10:49.784)
five to 10 % of your revenue. So let’s just say, you know, if you’re at 10,000 a month, that means you’d be spending between 500 and a thousand dollars a month on administrative help. And, know, at that income level, that allows you to maintain a reasonable profit margin and still, you know, spend, you know, relatively small amount on administrative help. So you might say, my gosh, 10 to 12 a month. What in the world? That’s so much money. But
If you’re doing four to six evals a month, two to 3000 a piece, that easily equals 10 to 12,000 or even more. So at that point, like I said, you can set aside 500 to a thousand dollars, maybe a little bit more for administrative help. And that should theoretically buy you anywhere from 20 to 40 hours over the course of the month for administrative help, which is often plenty for
solo practice owners. And if you’re a group practice owner, you should be making a lot more than 10 to 12,000 a month. So if you wait too long to hire admin help, again, those inefficiencies just creep in and you end up costing more in lost revenue than the salary of that administrative person. So if we’re talking 500 to a thousand for many of us, that’s like half of an evaluation. and
the benefit of having an admin person is going to, you know, I assume they’re going to be booking at least one evaluation a month that you would otherwise miss.
Alright.
Dr. Jeremy Sharp (12:32.98)
at, let’s talk about time.
Dr. Jeremy Sharp (12:44.782)
All right, so let’s talk about time a little bit. If you are spending greater than five hours per week, so that’s one hour a day, people, or less than one hour a day if you’re working seven days a week. So if you’re spending greater than five hours per week on administrative tasks, you are 100 % losing money. Okay, so this is just like basic finances. If you charge, let’s just say $200 an hour for clinical work,
and you’re spending five hours a week doing administrative tasks, you are essentially losing a thousand dollars a week in billable hours just for trying to save a little bit of money. Okay. So this is, you know, anchored into plenty of financial data, accounting data, folks, you mental health consultants and, and so forth. So
I would almost argue that if you’re doing any administrative tasks, you’re losing money because you’re not going to pay any administrative person more than $200 an hour, but you are paying yourself that much if you’re choosing to do the admin tasks. But we’ll keep it again, simple, straightforward. If you are spending greater than five hours per week or an hour a day on administrative tasks, like answering phones, sending emails, doing billing, doing scheduling,
then you’re absolutely losing money and shooting yourself in the foot.
Now, what about clinical help? Let’s talk about the metrics behind that. So again, a weeks ago, I released an episode with a little calculator to tell you when you could hire clinical help based on your conversion ratio and inquiries and things like that. But this is a little bit of a different spin. So again, looking into the data, if you have a wait list that is consistently greater than four weeks, you are likely losing
Dr. Jeremy Sharp (14:46.306)
clients. Now we live in a little bit of a bubble in the sense that neuropsych testing is typically booking pretty far out and it’s rare to find someone who is, you know, less than three months booked out. But the data does suggest that if people have to wait greater than four weeks, they will likely go in search of another provider who can, who can book them a lot sooner. So if they’re unable to schedule,
within two to four weeks, they often drop off and try to seek another provider. That’s why just calling back to, I think my episode last week or about 10 days ago, if you are on the phone with someone and they are not converting, perhaps because of the wait time, it might be beneficial to just tell them like, Hey, you can call around, but you aren’t going to find anyone who’s booking fewer than three months out. But again, if you’re booking farther than four weeks out,
This might be when it’s time to hire clinical help because all in all, the sooner that you’re able to get people in, the more your businesses is going to grow. So if you have consistent referrals that exceed your available appointments, it just means that there is likely enough demand to sustain another clinician. So if you are turning away five to 10 clients per month due to lack of availability, that is 10 to 20,000 in lost revenue. And that could easily cover.
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Dr. Jeremy Sharp (17:09.175)
So if you’re curious, or you wanna switch, or you need a new EHR, try TherapyNotes for two months, absolutely free. You can go to thetestingpsychologist.com slash TherapyNotes and enter the code testing. Again, totally free, no strings attached. Check it out and see why everyone is switching to TherapyNotes. I’m excited to tell you about PAR’s all new PAR training platform.
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All right, let’s get back to the podcast.
So where’s this coming from? Many of many folks running, you know, practices would say, again, this four to six week wait list, you know, turning away at least five people a month. That’s, that’s when it’s time to hire some more help. All right. Let’s talk about referral volume a little bit more. If you are getting more than five referrals per week, it’s probably time to expand. Like if you are converting five referrals a week, that is definitely
enough, but if you’re just receiving five new inquiries per week, so that’s 20 per month. I mean, that’s generally enough demand to sustain another provider. I think most of us, if we’re doing comprehensive evals, you’re doing what two, maybe three per week. So you can only, that’s maximum 15 people per month that you’re seeing five week one at three evals a week. So if you’re getting
Dr. Jeremy Sharp (19:06.21)
five increase per week, that’s at least 20 per month or 25 per month. That should be enough demand to start to build a caseload for another provider. So again, these are not hard and fast rules, but they are reasonable thresholds to think about if you just need something quick and dirty to say, okay, it’s a time for me to hire. So if you’re getting greater than five referrals per week or increase per week, so if half of those convert, so that’d be like 10 a month, that’s going to be an additional
20,000 in income. And of course, if you are hitting that demand consistently over three to six months, I think you can be very confident in hiring another clinician to take on those referrals.
So let’s talk about another, another aspect just from a workflow standpoint. I mean, if you’re so busy that you are not getting your reports turned around in three weeks or less, you’re likely running into trouble. So the research I think has shown that the ideal report turnaround time is two to three weeks for a client and referral experience, referral source experience. So if you’re greater than three weeks, which
I’m sure a lot of you are. I’m sure some of you are out there listening like, my gosh, what? yeah, you’re not alone. Plenty of people are taking longer than three weeks. I am just reflecting the research and let me be clear. There have been times in my practice where I am also taking longer than three weeks to get reports back. So I’ve been there. but if your report backlog is exceeding three to four weeks, that is a sign that you need some help with either psychometry or
maybe some AI software or a report writer or an admin, like something to help you get that back under control. So anything that can help delegate those tasks and cut off some time for you can be super helpful.
Dr. Jeremy Sharp (21:10.272)
Okay. So I gave you a bunch of metrics to think about again, just quick and dirty cutoffs from, you know, revenue standpoint, how much time you’re spending on admin tasks, how long your wait list should be and your referral volume and your report turnaround. So if you need, you can go back and relisten to the last five or seven minutes and catch those numbers again. But again, not hard and fast rules, but they will give you an idea of when you want to start.
want to start thinking about hiring.
So let’s transition to actually overcoming some of the fears with hiring and taking the leap. So we are all, I think, hesitant to hire. Okay. There’s the fear of expenses, like this is going to cost too much. I can’t invest it. I can’t, you know, afford it. What I would say to that is, can you see it as an investment in sustainability and profit and long-term health of your business rather than
the fear of the expense. A lot of us have concern about delegation. my gosh. I’m y’all. have so much control that I have to have. I have so many control issues. my poor family, but a lot of us have this concern about delegation, right? So to that, you could start very small. think bringing on a clinician is a really big leap, but you could start small with a virtual assistant or someone a couple hours a week.
and almost like weighed into the pool of delegation. And as you learn that you can trust another person to do things, then that will be very helpful. So that is related certainly to the control issues that many of us have. And to that, I would say the only way to work through those is to walk into the fire. So document your workflows and SOPs, build training resources, shadow that person.
Dr. Jeremy Sharp (23:13.208)
have them shadow you and just trust that there have been a million entrepreneurs and business owners who were scared to death to let anyone do anything in their businesses. And they ultimately got over it and figured out that it could work really well. So you can turn your control into a superpower and look at it more like teaching and mentoring more than anything, if that helps. So let’s
talk a little bit about.
First steps. Okay. if you want to dive deeper, just as an aside, you know, we can talk about money. I’ve done episodes on the money and like how much it costs to hire people and that kind of thing. So I’m not gonna, I’m not gonna do that, but we could talk about that if you wanted to. I think there are other episodes that cover that. So I’m going to skip over the money, but we will talk about, yeah, first steps. Like how do you actually hire smartly and then scale a little bit? So
I think for most solo practitioners, I recommend hiring admin help first. Now I did a podcast episode with, I think it was Jessica Lackey who she advised go straight for your office manager, like someone who can do almost everything and be very reliable and very actionable and responsible. That feels like a big leap for me. But I know it’s worked for several
practitioners for the purpose of this podcast. If we’re just trying to wade into the pool of hiring, I think admin help first makes the most sense. So you can start with a virtual assistant. It’s going to cost you 30 or $40 an hour, maybe a little more. They can help with scheduling. They can help with billing. you can offload your intake calls, your email communication. They can build email templates. If you don’t trust them to answer real, you know, authentically, they can also help you set up.
Dr. Jeremy Sharp (25:15.118)
standard operating procedures based on your, uh, your practices workflow. So I think a virtual assistant can do a lot and is a great way to just step in the hiring. If nothing else, like nothing else, they can send questionnaires because Lord knows it takes so much time, more time than it needs to, to send questionnaires and go to all the different platforms and log in and set up the questionnaires and so forth. So if nothing else, they can send your questionnaires.
They can maybe even enter scores into tables if you have a set up the right way. So you can get a lot out of a virtual assistant. Now on the clinical side, there are some options. So you could hire a psychometrist. So this is maybe best for psychologists who want to see more cases without additional hours. All right. So the psychometrist can step in and do the testing or you can hire a
other clinicians, right? So this gets a little bit more nuanced. Then we’re talking, okay, is this like a postdoc? Is it a licensed person? And then we get into questions of expectations around supervision, caseload, compensation. mean, those, you know, it all gets a little bit more complicated when you hire a clinician, but totally doable. So, you know, if you are pretty risk averse and you want to have a retain a little more control,
In your practice, I think a psychometrist is a great choice because you can supervise them and you can be very clear with them. They’re not a peer necessarily, at least from a licensure standpoint. So it gives you a little bit more agency to, I hate to put it this way, but tell them what to do. think a lot of us don’t feel comfortable giving direction to peers or being a manager of a peer. And so a psychometrist can be an easy way to kind of wade
again, weighed into the pool of hiring on the clinical side and it frees up time immediately. Right. And then you get some breathing room and you get to decide, okay, do I want to use this extra time to see more cases or do I want to catch up on the work I’m behind on or do I want to just use this time to live my life a little bit more? So it can be done folks. it can be done. I this is
Dr. Jeremy Sharp (27:41.07)
kind of short and sweet version of how to hire, but I just want to continue to address the emotional, mainly the emotional concerns around hiring. is tough. It is tough. And I faced these concerns, these problems, you know, when I first started, I waited way too long to hire. And, know, there is something, something called the 80 % rule where if you wait until you until you’re a hundred percent overwhelmed,
It is way too late. If you hire when you’re at 80 % capacity, it’s going to be a lot easier for you because then you’re going to have time to train that person and you’ll have the bandwidth to mentor them, support them, onboard them and all those things. So don’t wait until you’re a hundred percent overwhelmed. Like I was, I was, mean, it was two, three, four years in my practice before I brought on someone to help answer the phones and help with billing. And I wish I’d done it almost from,
from day one, but I’m like a lot of y’all. didn’t want to spend the money. I didn’t know how to train. I didn’t want to give up control, all those things. is legit. Those are legitimate concerns, but totally overcomeable at the same time. So again, hiring could be both a data-driven and an emotional decision. I know it’s hard to marry those two sometimes, but that’s what I’m attempting to do in this episode.
So the one thing you might do is like, just do a quick self assessment. you can run through it. You can look at the transcript and you know, just check for yourself. Are you experiencing any of those emotional components of burnout or being overwhelmed? And are you hitting the metrics that I mentioned for hiring on the clinical admin side? And if you are, then let’s talk about how to hire. Let’s take some next steps and
you’ve got plenty of support either, you know, if you don’t have support with your peers or consultation group, check the testing psychologist community, set up a strategy session. Like I mentioned at the beginning, it is totally doable and hope that you are able to find your way through this process and hire what you need hire. All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here.
Dr. Jeremy Sharp (30:05.41)
I hope that you take away some information that you can implement in your practice and in 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 or Spotify or wherever you listen to your podcasts. And 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, can check out the details at the testingpsychologist.com slash 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.
Dr. Jeremy Sharp (31:23.074)
The information contained in this podcast and on the testing psychologist website are 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
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