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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

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/therapynotes and enter the code “testing.”

This podcast is brought to you in part by PAR.

The NEO Inventories Normative Update is now available with a new normative sample that is more representative of the current US population. Visit parinc.com/neo.

Hey folks, welcome to the podcast. I’ve got a fantastic guest here today.

[00:01:00] Christine Li is the founder and CEO of Mentaya. Mentaya is a platform that automates out-of-network billing, eliminates the need for superbills, and helps clients and clinicians get paid for out-of-network services. She is driven by a commitment to mental health and a deep belief in empowering therapists. She started Mentaya to tackle the headaches of out-of-network billing, making it easier for therapists to collect their full cash rate, while enabling clients to use insurance to get up to 80% back on private pay services. She believes that mental health clinicians can absolutely build thriving cash-pay practices while playing a key role in expanding access to mental health care.

Before Mentaya, Christine was a Product Manager at Google, where she focused on creating impactful, user-centered products in Google AI and YouTube. So she comes from an extensive background in tech, and as you’ll see during the interview, has a real motivation and commitment to helping providers and [00:02:00] clients in this whole insurance billing mess.

You will also hear during the interview that we have been using Mentaya for several months now, at least the benefits checker, and have found it to be super helpful and increased our conversion ratio for private pay clients because they know what to expect and what they might get back from their insurance company. So, I hope you enjoy this conversation with Christine about Mentaya and making out-of-network billing a little easier.

Like you know, this is the time of the year when I am recruiting for my mastermind groups. New cohorts will start in January 2025, probably mid-January. There are cohorts for beginner, intermediate, and advanced folks, depending on where you’re at in your practice development. These are group coaching experiences with accountability and support aimed at connecting you with other folks doing testing and running businesses and doing the best that you can in that process. You can go to thetestingpsychologist.com/consulting and [00:03:00] get more info.

For now, let’s go to my conversation with Christine Li from Mentaya. As you will hear, if you want to try Mentaya for free for a month, there is a link in the show notes. So make sure and go check that out if you want to take a step toward simplifying out-of-network billing.

Christine. Hey, welcome to the podcast.

Christine: Thank you so much. Got to be here.

Dr. Sharp: I’m glad to have you. This is awesome. I feel like I’m talking to a little bit of a celebrity. You play a big role in our practice here because we use Mentaya ourselves. I feel super grateful to get a little bit of your time and then you’ve got a lot going on. So thanks for being here.

Christine: Thank you for [00:04:00] those kind words. I’ve never been called a celebrity before. So that is an interesting thing to hear.

Dr. Sharp: Here you go. It’s a good way to start the morning. I’ll start the interview the same way I start everyone, which is just asking you why this is important to you. You have an interesting career in tech, I think, that we might get into, but you chose to go in this direction with your experience. So I’d love to hear, why spend your time, energy, and emotional energy on something like Mentaya?

Christine: I have thought about this a lot because you were right. I used to work in tech. I worked as a Product Manager at Google. For me to have left my very cushy job to try something like starting a company like Mentaya was definitely a big decision. And so for me, it definitely started with my interest in mental health. I don’t know how much of my backstory you know, but I unfortunately…

Dr. Sharp: I’m about to hear.

[00:05:00]Christine: Okay. I went to high school that had a lot of mental health issues. This is a trigger warning. We made national news for suicides by school. This was back years ago when mental health wasn’t really talked about. I had just started high school. I’d actually just moved there and I don’t even think I knew what mental health was because no one really talked about it back then. There was definitely a stigma around it. I think we just didn’t really have that many resources or know how to handle something like that.

I wouldn’t say just because of that, I was like, “Oh, I am so big in mental health, this is my passion”, but I do think it’s stuck with me. And I think slowly throughout the years, like in college, I realized that I was naturally interested in it and gravitated towards it. I worked with some therapists in college to try to build something with them, to make it easier for them to run their practices and [00:06:00] with their clients. It was a project. I didn’t turn it into anything.

Around COVID, when I was still at Google, I started thinking more about what I wanted to spend my energy on. Obviously, that was a time where a lot of people started talking about mental health. I started realizing the importance of it more broadly as a society because I think before that, it was the people who knew and were interested in mental health and the people who are like, Oh, I don’t really know too much about it. COVID was definitely, I guess in equalize where everyone dealt with their own things during COVID and therapy became a hot topic.

I was really excited to figure out what I wanted to work on next. It had to be something that I was really passionate about and mental health is one of those things. And so, I really wanted to, for me, build something that helped both the provider side and also the clients, because in healthcare, a [00:07:00] lot of times, incentives are not aligned where things help the patient. And so it’s like, great, let’s make everything really easy and inexpensive, but that’s at the cost of the provider. And so, for me, it was important for me to build something that helped both sides and enabled and helped providers to get paid well and get paid fairly while trying to make mental health care more accessible.

Dr. Sharp: I love that. I love the balance between the two because like you said, I think they are opposed sometimes or it feels like we take from one to give to the other. I’m looking forward to digging more into the software and how that actually happens, but I love that was the objective from the beginning.

As far as the story, let’s continue this theme, I’d love to hear the origin story, like how it came about, and [00:08:00] for some of my own background as somebody who launched a tech or software company two years ago in the mental health space as well, the process of finding the idea and figuring out, is this going to work, who’s this going to help, and how do we do this? That’s a crazy process. I’d love to hear just a little bit more about how you decided to take the leap and go specifically this direction with your idea.

Christine: I think those are actually two different questions.; how did I decide to take the leap and then how did I come up with this idea?

As for how I decided to take the leap, I was at Google for several years doing product. I love thinking about product. I’m always someone who is looking at different products and services and automatically thinking about ways to make it better or simpler, easier for people to use. That’s something that comes natural to me and I really enjoyed that. But I think, for me, after [00:09:00] spending some time there, while it was a great place to grow, I wanted to do something where I could feel more directly the impact I was having in a space that I really cared about.

Google is very big. You’re in a big company and they have a great mission, but you’re one of a bunch of people and you’re not as close to the end customer who’s using your products and you’re maybe not having a level of impact on people’s lives that I wanted to have. I think that combined with COVID happening, I spent a lot of time thinking about what I wanted to do next, and I was like, now’s the best time. I have a lot of energy. I want to pour myself into something, but it has to be something I care about. It can’t just be some random thing.

And so I was not in it to just create a business that would make a lot of money for me. Obviously, that would be great. Who doesn’t want money, But for me, it was more about having an impact on the world in a way that was [00:10:00] meaningful to me. And so for me, that was how I came to wanting to do something in the mental health space.

Dr. Sharp: Very cool. Let’s talk about Mentaya in a little more detail. If people don’t know what it is, I’m sure there are some folks out there who don’t know what it is, give me the elevator speech and then we’ll go into more detail.

Christine: We’re essentially an out-of-network billing platform, you can think of us as that, but that sounds scary because you’re like, ooh, what is out-of-network billing, what do we do, what does that mean for me as a therapist or a psychologist? We basically help and empower therapists and psychologists to make their full cash rate while we help their clients get money back on therapy through out-of-network benefits. A lot of people don’t know that they have insurance plans or insurance benefits that allow them to get money back on services, even if it’s out-of-network. And so, if you’re seeing a gastric [00:11:00] therapist, you can actually get the financial benefits up to 80% back on the services. And so it’s a win for both. Therapists and psychologists get paid whatever their full rate is, and then their clients or patients get a percentage of their session costs covered.

Dr. Sharp: I love that. I don’t know. You jump in and tell me if this is totally off base, but I think of it like you are greasing the wheels or automating to some degree the superbill process. A lot of us know what superbills are, but this is a few steps ahead of that and making that whole process a lot easier for, I think, clients and clinicians. Is that fair?

Christine: Yes, that’s a great way of explaining it. I think a lot of clinicians do think, oh I’ll just provide my clients a superbill, here’s super bill, and then they’ll just deal with it themselves because part of the reason, from what I’ve heard why some [00:12:00] clinicians don’t want to take insurance, they just don’t want to deal with insurance at all. They’re like, I can give you a superbill. You can do it yourself. Good luck. Here are some maybe resources or links you can look into.

But oftentimes, if you think about yourself as you’re a clinician, this is your job, and you don’t even want to deal with insurance. Imagine the average patient. No one knows anything with insurance. No one wants to deal with it. A lot of people don’t even understand what a superbill is or what to do with it. And so we basically take care of all of that so that you and your clients or your patients don’t have to do anything related to insurance. We completely try to shield you from ever having to deal directly with insurance companies. We’ll deal with this. We’ll take care of it for them and they just get their money back.

Dr. Sharp: It sounds so nice. Speaking as a patient, I don’t know if you’ve had this experience, but I’ve been on the patient side of things and tried to get a superbill for out-of-network services and submit a superbill. I have a pretty deep understanding of [00:13:00] insurance and how to do it, and it was not easy. And so, anything that we can do to make that process a little simpler for folks goes a long way, especially for those of us, like we were talking ahead of time, like we have pretty high ticket service items in our practice. We’re charging thousands of dollars for these services. Anything we can do to help people get some of that money back, it makes it a lot easier pill to swallow, I think, from there.

Christine: I know that. Especially with testing, it’s often thousands of dollars. And so, if people are able to get even 50% of that back, that is so much money that they can get back that other…

Dr. Sharp: Do you ever hear… Oh, go ahead.

Christine: I was going to say, that otherwise was just would have been left on the table.

Dr. Sharp: Right. I think that’s the thing. Do you have any statistics on how many [00:14:00] plans out there have some out-of-network benefits? I know it’s hard to get into details as far as how much, but even just a basic question, because people will push back and they’re like, Oh, nobody uses out-of-network benefits. My deductible so high. It’s never going to help. And I’m like, I don’t think that’s true. I think it actually can be helpful if you try it. So do you have any statistics on all that stuff?

Christine: I have statistics from what I’ve read from articles I’ve read online, and then we obviously have our own data on what percent people who use Mentaya or run their benefits through the calculator have out-of-network benefits. Most plans do have out-of-network benefits.

I will say what you’re saying is a real concern. Not every plan with out-of-network benefits is going to be that helpful because there are plans that have like $5,000 or $10,000 deductibles, but there’s also a lot of plans. You would be surprised how many plans we’ve seen that have $500, $1,000, even if $2,000 sounds really [00:15:00] high. Whether you’re doing testing or you’re going to therapy sessions, you hit that pretty quickly and you’re still able to get thousands of dollars back on therapy. I actually looked into this the other day. 

We have helped people get reimbursed. I’ve always known thousands, like people are getting hundreds or thousands of dollars back. I didn’t realize we were in the $10,000s until I looked at the data. We’ve gotten several people more than $10,000 back on therapy sessions, testing, and things like that. That is a lot of money that people don’t realize sometimes they’re eligible for. 

Dr. Sharp: Yeah. I think people forget about out-of-network benefits, at least with the practices that I talk to or people that I maybe do some consulting with. It’s either I go private pay and make a ton of money, screw all of my clients and don’t give anybody access, or I take insurance and screw myself and don’t make any money and everybody is sad. But [00:16:00] this out-of-network benefit thing is a real thing and it can help both parties.

Christine: People definitely think it’s either one or the other. It’s either, I’m private pay, I have nothing to do with insurance, I get paid and that’s it,  or I have to go all the way on the other side, but there is a middle ground where you can still get paid your full fee and your clients or patients can save money on therapy or testing.

People oftentimes don’t even know their in-network insurance benefits, let alone out-of-network. I don’t even think most people understand the concept of out-of-network. There’s some study that was saying the insurance literacy is extremely low in our country. Obviously, insurance companies don’t make it easy to understand, but it was some crazy stat around, I might be butchering this, but it was something like 50% or something of college graduates did not understand insurance. It was something. Don’t quote me on that. 

Dr. Sharp: It’s not surprising.

Christine: I don’t remember the exact stat, but it was something [00:17:00] surprising.

Dr. Sharp: That’s crazy. I think you’re right. There’s so much to dig into there as far as how we can help people understand, but I think talking about the platform might bring it to life a little bit. Maybe now is a good time to talk about what this actually looks like in real life; what Mentaya does, how do we use it, what’s the process? Let’s go there for a little bit.

Christine: I’ll start with an obvious, I know you’re using the platform, but we have basically two core products. The first one we call an instant benefits calculator and the second one we call our claim submission tool or like automated superbill submission tool.

I’ll start with the first one, which is our instant benefits calculator. This is a really nifty widget that you can use, put on your website, send to clients, but essentially, all it asks for [00:18:00] are your client’s name, insurance member ID, and date of birth, and then from that, we can automatically calculate their benefits and estimate how much they might be able to get reimbursed for therapy. We let them know things like their deductible, what they have to pay first on which they can expect to get reimbursed afterwards.

This is a useful tool for therapists who are looking to, or clinicians who are looking to attract more clients because when you’re having that initial call with them and inevitably they ask, Oh, what’s your fee? Then you can say, instead of just being like, Oh I don’t take insurance and this is what it costs, you can say here’s what it costs. You might have these benefits that allow you to get reimbursed for a percentage of the cost of my services. And so, that definitely makes it easier for potential patients or clients to want to start services with you because you’re like, oh, it’s not as expensive as I originally…

[00:19:00] Dr. Sharp: Right. I think I told you before we started that we’re using that benefits checker in our practice. That’s been our main use of Mentaya. It’s great. Just to describe it from a practitioner standpoint. We have it bookmarked on the browser for our scheduling team, and when they’re on a call with somebody and it’s an out-of-network or client who we don’t take their insurance, they just jump on the benefits checker. It’s 10 seconds to put the information in and they can tell them right there, this is what it would cost or this is how much money you might get back from your insurance plan, even though we’re out-of-network. It’s helped us convert a lot more private pay clients that we otherwise would have with just saying, Oh, our fee is, whatever, $3000 and good luck. So, it’s super cool.

Christine: That’s awesome to hear. A lot of practices also, I don’t know if you have it on your website, but…

Dr. Sharp: We don’t have the widget on the website. We’re just doing most scheduling with it 

[00:20:00] Christine: That’s an opportunity as well. A lot of practices will put it. I’ve seen so many creative things done with it. One thing we suggest is putting it on your website so that prospective clients or patients who go to your website can immediately see, especially juxtaposed with where your fee is instead of just Oh, here’s my fee or here’s the fee services, it’s here’s the fee, but here you might have out of network benefits. And so they can check it themselves as well. So you can potentially cap for people who don’t even get to the point where they’re having an intake call.

We’ve also seen people use, we have a link, which it sounds like you bookmarked that you can put anywhere. Some people put at the end of their email signatures, people put it on their Psychology Today profiles, people put it in all these different places where they’re essentially doing marketing for themselves to say, Hey, I know I don’t take insurance, but you might be able to use your insurance to get money, if that makes sense.

Dr. Sharp: Oh, that’s fantastic. Yes, you can put that link everywhere, I suppose. Cool. So that’s the first part of your product. And [00:21:00] then the second part?

Christine: The second part is our actual claim submission tool. If you think about the chronological order, you get some client who’s Oh, great. I didn’t realize I had these benefits. Sure. Let’s start. I would love to do testing or start therapy sessions with you. And it’s like, okay, great. But then the client is okay, cool, I know I have these benefits. How do I actually use them?

Without Mentaya, generally, you’re like, Oh, I can give you a superbill or you can call your insurance company, figure that out yourself. With Mentaya, what a lot of practitioners then say is, Hey, I use Mentaya, fully optional up to you if you want to use it, but they can take care of submitting the superbill or that claim for you such that you don’t have to do anything. It’s also important to know, it’s not just submitting it because sometimes you submit it, it gets rejected, the insurance company is like, oh this doesn’t qualify or you need to [00:22:00] change this and that. And so we take care of all of the follow up process for them so that they don’t have to basically be on the phone with insurance and what does this thing mean? Why did this get rejected? And so we take care of all of that so that your client doesn’t.

Dr. Sharp: Say more. What do you mean when you say we take care of all of that? Is it the claim gets submitted and then does the client hear anything after that point? Or is it all happening in the background? Y’all are just doing it. What’s that experience from the client side?

Christine: That’s really good question. So the way that it generally works on the client side is, I’ll start with the provider side actually. On the provider side, we need to know when the sessions happen. We essentially skip the generating a superbill step and go straight to just verifying a session, submitting a claim. So what that means is, we need to know that the session has happened. We can send you a text. You say, [00:23:00] yes to the compliant text or you can click a button in our platform to be like, yes, the session happened. So then we go ahead and we can submit the claim automatically to the insurance company.

And then what happens is we’ll monitor it and get automatic updates from the insurance company to make sure that it’s going through. Sometimes insurance will come back and say, hey, we actually need this extra paperwork or something. We have a team on our end who will take care of that and resubmit it until it goes through. Sometimes we’ll get on the phone with insurance companies to figure out what’s going on. We do all of that behind the scenes. The client and the provider get notified occasionally when it’s hey, just wanted to let it might be a little bit more delayed because the insurance company requested this additional paperwork that we need to take care of but we’ve taken care of that already. We generally don’t need client or provider input besides just yes, the session has [00:24:00] happened. So we take care of everything after the fact, but we’ll keep you posted and you can see your claim status and your portal after you’ve submitted.

Dr. Sharp: Sure. This might be a nuanced question specific to testing, maybe it happens with therapy as well, so if you’re not sure about this, no worries. Something that we run into specifically with in-network, but I’ve heard stories where it happens without a network too, is the pre-authorization process. Insurance companies will kick claims back because we didn’t have the correct pre-authorization for the services. Have you noticed that coming up through the system or is there anything to say about that from your side? How do you handle that?

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Let’s get back to the podcast.

Christine: I can’t say because I’m not personally monitoring every single claim at this point. 

Dr. Sharp: You’re not doing this work, Christine? You’re not sitting in your C-suite monitoring claims? 

Christine: Oh my gosh. Funny story. I actually quick tangent. I have called so many insurance companies. At the very beginning, I was working with insurance because I wanted to feel and really understand how to do all that. But anyway, back to the question. I can’t say that we’ve never had that. I know I’ve vaguely heard a couple of random instances. I will say [00:27:00] it’s very infrequent from what I’ve heard. In-network is actually quite different from out-of-network. The rules of what happens in-network don’t always apply to out of network.

Here’s an example. For associate therapists, a lot of times insurance companies don’t allow them to bill in-network because they’re not fully licensed, right? Only licensed clinicians can. And so, people assume Oh, you’re pre-licensed, you can’t work with insurance, but a lot of times they’ll approve out-of-network claims. And pre-auth is very common for in-network, but for out-of-network, it’s actually not as much of a thing from what I’ve seen.

Dr. Sharp: Nice. That’s fair. That’s actually a good tip. I did not know explicitly about that pre-licensed issue.

Christine: Glory to Christ!

Dr. Sharp: Yeah, that’s great. So then just to recap from the provider side then, because we don’t use this portion in our practice, just full disclosure, but it [00:28:00] sounds like, the the practice owner or clinician will “submit an out-of-network claim” through Mentaya. It sounds pretty easy. You put in a little info, confirm that it happened, and then it’s off to the races. So the client is not actually doing anything in that process. Is that right?

Christine: Correct. We do have the client at least make an account and put in there transformation just so it’s an acknowledgement of, Hey, I’m creating an account. My provider is going to be doing something with that. I’m aware of that. So the client is involved in that sense. It’s like a one time thing. Generally, we don’t need the client involvement because we basically just asked the practitioner to let us know if the sessions happened and provide a CPT code diagnosis, things like that, so that we can submit a claim.

Dr. Sharp: And then how does the client get paid? Is it a paper check? Is it direct deposit? How does that work?

Christine: It depends on what they have set up with their insurance company. Each insurance [00:29:00] company is a little bit different, but the default is a check in the mail. But if they have direct deposit set up with their insurance, the insurance company generally just deposits.

Dr. Sharp: Nice. We have to talk about the fee structure. I assume you’ll have to make money somehow. So how does the fee work for the client or the practice?

Christine: For the benefits calculator, that is optional. The way that it works, sorry, let me take a sip. It is free to use the platform to submit claims for the practice. Submitting claims, we, by default, charge the client. There is the benefits calculator which is optional. You don’t have to use it, but it is $29 a month per practice, which I feel like for mental health practices…

Dr. Sharp: It’s a steal.

Christine: …they’re so inexpensive. Again, that’s fully optional. So if you are like, I don’t want to spend the $29 a month or I don’t need that, I just want to submit claims. You can do that for free. [00:30:00] We charge the clients 5% and that’s 5% of the session or whatever claim it is. And so if it’s a $200 session, it’s $10. If it’s a $2,000 thing, that is $100. But if you think about how much, and that’s part of why the benefits calculator and claim submission go well together, because you can estimate how much you’re going to get and most times people get back way more than they would pay in the fees, and so it’s generally a no-brainer for clients.

And then I will say, if you want, we don’t say this publicly on our website anywhere, but if you want as the practice, you can actually take on the cost of the 5% fee. The reason we don’t put it online is because we don’t want people to, we don’t want clients to see that there’s an option for the practice to do it in case that reflects poorly on the practice where it’s like, Oh, I see that you have the option to, you decided not to do that. And so we think a lot about wanting to make sure that [00:31:00] we’re navigating these things carefully, but I just, in case you were curious, you have the option to cover the cost as well.

Dr. Sharp: That is interesting. I would guess some practices might want to do that. It’s good to know.

Christine: A lot of practices actually do that. And then we frame it as your practice or your therapist has decided to cover the cost so that it’s completely free for you. And then that’s more like a gift to their clients rather than a standard.

Dr. Sharp: I get where you’re coming from. Just thinking about it from a financial perspective for a practice, gosh, if we, I’m trying to think, a $10 charge on a session, if you were going to spend or pay your admin team, I don’t know, at least even a half hour to argue with insurance over a claim, that’s cheaper than it is to pay the admin team.

Christine: That is the goal. The goal is that it is low enough where we can, obviously we are a business and so we need to make money somehow, but [00:32:00] it didn’t feel like it’s a lot of money. It should be pretty reasonable. Most people are like, this is a no-brainer for me.

Dr. Sharp: Sure. That’s fantastic. It’s been, like I said, super helpful for us. I feel like that $29 for the benefits checker is just a complete steal. It’s so easy. It just works.

Christine: Perfectly said.

Dr. Sharp:  That sounds good. I would love to hear about strategies to help this be effective: how to talk to clients about it, how to get people to buy in, so to speak. Maybe we start there and then we’ll see where that goes.

Christine: Yeah. We know that a lot of clinicians love scripts. We have all of these scripts that you can use with your clients, it’s in our help center, it’s in our product that you can copy and paste. And generally, for the benefits calculator, we talked about this a bit, we [00:33:00] recommend putting it in all the different places in which you do any sort of marketing, even if it’s your website, or your different therapist directed profiles so that people know.

Generally, the way that we encourage you to frame it is, you can call yourself an insurance-friendly practice. A lot of therapists like using that term because you don’t take insurance, you’re insurance-friendly, right? You help people use their insurance benefits. But you explain to clients that, Hey, just because I don’t accept your insurance directly does not mean you can’t use your insurance benefits to get part of the cost covered.

And so that’s really powerful because I think from the consumer or the patient perspective, most people are either like, Oh, I just need to find someone who takes my insurance, or I just have to shell out a ton of money. And most people, again, don’t know that there’s this middle ground of there’s something in between where you can get part of it still covered and still find the best [00:34:00] highest-quality service that you’re able to afford. And so that’s how we encourage clinicians to speak about it with their clients. Just make them understand that it’s not one or the other. It’s not oh, I have to take insurance and you can use your insurance. It could be, I don’t take insurance, but you can still use your insurance. So that’s on the benefits calculator.

On the claim piece, it’s essentially, you worded it perfectly, an automated superbill submission, essentially, plus all the follow ups and not just submission, but actually taking care of that. And so generally, we encourage clinicians to talk to all their clients about it, maybe send out an email blast, bringing it up in a session, but in a very hey, this is helpful for you. I don’t get anything from this, but I just want to help you because I care about you and I want to help you. We don’t generally have clinicians put any pressure on their clients to use it. If it’s help for them, great. [00:35:00] If they’re already, if you’re one of the few that you’re already submitting your superbills and it’s going well, then that’s great for you. But a lot of people need help on that or don’t even understand how it all works. And so just asking and checking in with your clients to see if this might be helpful for them is a great way to start.

Dr. Sharp: Yeah. I have to think it’s a selling point for a lot of private pay practices to do a service for the client and skip that step of them needing to submit a super bill, which can be complicated and challenging. Have you found at least thus far, like particular practices that seem to benefit a lot from Mentaya or any practice profiles or use cases that lend itself more toe being successful with it.

Christine: That’s a really good question. We get a lot of emails about, oh my gosh, I [00:36:00] used the benefits calculator and I filled my practice with a bunch of private pay clients that I was struggling with before. We get a lot of these emails. I’m trying to think about the success stories or a specific type of profile.

I think generally what we tend to see is there’s solo practices and there’s group practices, but the solo practices that seem to do really well with Mentaya try to use it. Actually, the common thing is they try to put it everywhere they can and use it with as many clients as they can. I think those are the practices that see the most success because then you’re getting as many clients to understand. You’re educating as many people on their out-of-network benefits as possible, and hopefully a lot of them end up wanting to start services with you.

And then on the claim submission piece, that helps a lot with retention. So if you’ve ever had this might be more traditional talk therapy, but do you ever [00:37:00] have clients go from, Hey, can we go from weekly sessions to biweekly or monthly? It’s getting expensive. If your things work like that, that’s where we’ve helped the most, where people start realizing, oh, that’s expensive. And so you can say totally, if you want, I just wanted to let you know, you might have these benefits that allow you to get money back on therapy. Have you been submitting your super bills? Because that could actually cut the cost by 50% or 70% or whatever it is and you can continue seeing me every single week. Those are very concrete examples of how it’s helpful. 

Dr. Sharp: I love that. I’m going to backtrack just a little bit and ask another question about the pricing just to clarify it. The 5% number makes sense. The clients pay 5% of the session fee. So just to be super clear, like for us, where we’re submitting, we’ll call it a single claim [00:38:00] that might be, I don’t know, $2,000. I think you used that earlier. So is it priced per claim or like per hour of service? They might be the same thing, but if we submitted a $2,000 bill, essentially, then is it 5% of the $2,000 versus 5% of our hourly rate?

Christine: It’s 5% of the total. It ends up being the same thing because you end up either having a bunch of CPT codes at different rates that all add up, but it’s just 5% of the full bill for the client. For most clients, it’s either, it’s going to be very obvious. You either have these out-of-network benefits, which a lot of people do, and you’re like, this is a no-brainer because I wouldn’t do this otherwise myself, or you’re like, I have a $20,000 deductible and this does not make sense. And so generally it’s pretty obvious.

We also have the pricing on our website. We’re pretty transparent about our pricing and how we make money. It’s like literally one of the tabs on our website. For anyone listening, you [00:39:00] can just go on our website to learn more.

Dr. Sharp: Yeah. I appreciated that one when we are signing up. It’s super clear. Let me see. I was going to jump back to the strategies and the success stories, but maybe on the opposite side. Have you found that there are any practices that are not a good fit or have struggled with it? Any exclusionary factors, if that’s a thing?

Christine: The only thing I can think of, it’s very specific to insurance company, Blue Cross Blue Shield of Texas, does not, you know how before I said that associate therapist actually or pre-licensed clinicians oftentimes are able to get reimbursement, an exception to that is Blue Cross Blue Shield of Texas. And so we’ve seen a couple practices where they have, we’re just like, sorry, we just can’t submit claims for your pre-licensed clinicians because they’re just going to get rejected. They have a policy that they don’t accept [00:40:00] insurance claims out-of-network or probably in-network as well from pre-licensed clinicians. But that’s the only thing I can think of where that was just like, we’re so sorry about that.

In a lot of cases, we try. We do have a risk free… Oh, this is probably important to mention. We have a risk free guarantee where if we submit a claim and we charge you or your client and it doesn’t go through successfully, then we’ll give a full refund of our fees. So we don’t just say, all right, that’s it. We actually make sure that it goes through and if it either doesn’t, or you’ve been waiting for an exorbitant amount of time and then we still can’t figure out how to do it, we’ll just give you a full refund of the fees because we never want to make money for a service that weren’t able to […].

Dr. Sharp: It’s great. It’s good to know. I know there’s some there are some folks listening. I’ve heard so many horror stories about Blue Cross of Texas from the community.

Christine: Really? 

Dr. Sharp: Yeah, it’s a it’s been a whole discussion point [00:41:00] over the last two years in my Facebook group of psychologists. They’re known for being terrible.

Maybe we start to close in talking about how y’all are a little bit different from some of the other options out there on the market. The biggest one I know about is Reimbursify. I think there’s there are two others maybe when I was doing the research, but if people were asking, why should I pick you, of course, that’s a question, what would you say to folks?

Christine: Obviously, I’ve heard of Reimbursify. I think there are two other options out there. A lot of them have actually shut down, I think, from what I’ve seen. But at least the difference between us and Reimbursify, I can’t say that I know enough about them to know exactly how they do things, just anecdotally from what I’ve [00:42:00] heard, the main differences are we actually make sure the claim goes through. I’m scared to say this. I don’t know if this is fully accurate, but from what I’ve heard, they’ll just submit the claim and then they don’t really track. I don’t know if you know what happens to it, things like that. And so that’s the main difference for us where we have this risk-free guarantee where we either get it through or you get a full refund of the fees. 

Another thing is I think they charge the clinician some amount when the clients file claims while for us it’s free. Your client pays for the claims.

Dr. Sharp: Yes.

Christine: And then I think the main thing that I’ve heard, and this is anecdotal from, obviously, it’s a little biased because we hear from the customers who move over to us. They say our customer support is a lot better. A lot of times people, we’ve heard that they’re trying to cancel their account on Reimbursify. They [00:43:00] can’t cancel it because you have to contact them and they just never respond. And so you’re just paying for this thing you can’t cancel it. And so for us, we always make sure that we make it easy to cancel. Even our benefits calculator, we don’t lock you in. It’s month to month. We should probably build an annual subscription at some point, but we genuinely, if it’s useful, subscribe and use it. If it’s not useful, you can pause it. And so, I feel like we’re very provider-friendly and also client-friendly in that way.

If you ever have any questions or issues, you can always email our support team. We have a direct support line. We generally respond within one, if not two business days to your request and we won’t ever do things like lock you in and you can’t cancel your account. Even sometimes people are like, I forgot to cancel my benefits calculator but I didn’t use it last month. Can I get a refund? And we’re like, yeah, sure. If you’re not using it, you can get a refund. I think that’s probably the main differences between us and them.

[00:44:00] Dr. Sharp: That’s fantastic. Customer service goes a long way. I can account for a lot of even like product issues, if you have great customer service, not to say that they’re product issues, but being able to talk to somebody and actually figure it out helps a lot. That’s fantastic.

Christine: That’s something that is very important for us. I think a lot of it is, it’s it’s a space a lot of people don’t really know much about. Out-of-network insurance. It’s scary. And so we really want to make sure that we have everyone with the right resources to be able to use it as effectively as possible.

Dr. Sharp: Nice. I love that. I appreciate you spending so much time with me. Is there anything that I missed, anything that you’d like to highlight about your platform or share with folks as we start to wrap up?

Christine: Oh, I think the one thing we talked about right before is you have an affiliate link, and [00:45:00] this is a gift for all the listeners, anyone who is listening, you can try out the benefits calculator for free for a month using the code, I think it was “testingpsychologist”. 

Dr. Sharp: They’ll figure it out. They know.

Christine: Yeah, testingpsychologist, and that’s the only thing that you would pay for as a therapist or psychologist on the platform. And so essentially if you use the code, you can try everything out for free for a month see how you like it, try it out. Put it everywhere, put it on your website, try using it in your intake calls, and just give it a shot.

Dr. Sharp: That’s awesome. I’ll make sure to put the affiliate link there in the show notes so that folks can access it pretty easily. And if they, let’s just say, are driving, they forget about it, whatever, what’s the easiest way to learn about [00:46:00] Mentaya, check it out once they get to the office?

Christine: You can email our support team. It’s support@mentaya.com. Super straightforward. You can even say, Hey, what was the link on this podcast today I listened to it. We’ll send you all of that.

Dr. Sharp: Oh, nice. 

Christine: Any questions you have we’ll respond to you.

Dr. Sharp: Fantastic. It’s super cool. I’m just so grateful to have gotten the opportunity to chat with you for a little bit. Like I said, we’ve been using this benefits checker. We love it. Our admin team loves it. Clients are liking it. I’m grateful for the time that you decided to spend here with me.

Christine: Thanks for having me on.

Dr. Sharp: 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 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, [00:47:00] I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcast.

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.

[00:48:00] 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 the host or guests of this podcast and that listeners of this podcast. If you need the qualified advice of any mental health upholder practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your needs.

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[00:00:00] Dr. Sharp: Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

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/therapynotes and enter the code “testing”.

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The NEO Inventories Normative Update is now available with a new normative sample that is more representative of the current US population. Visit parinc.com/neo.

Hey folks, welcome back to The Testing Psychologist podcast. Today, I am bringing another episode about [00:01:00] money. I don’t think we can talk enough about money, to be honest. There are so many dimensions of finances and money in private practice, and it is such a fraught, emotional topic for so many of us.

My guest today is Carla Titus. She is the owner and CEO of Wealth and Worth Within which is a Fractional CFO firm that provides financial consulting and advisory services to group practice owners. She’s a finance expert with over 17 years of combined corporate financial planning and analysis as well as business financial consulting experience. Priorities for the clients that she works with range from growing profits to increasing cash reserves, and paying the owner well, so they can build personal wealth.

This is a great conversation. Carla is a really dynamic individual, as you will tell, I think pretty quickly. We really ran the gamut on financial topics. I thought we were going to spend most of our time talking about profit sharing and [00:02:00] different compensation models, but we actually talked about a lot of different things that I think are helpful for practice owners. We get into typical profit percentages for different stages of practice. We talked about how to back out if you started paying people too much and how to reverse that to get to a better place. We do talk about profit sharing- what that actually looks like in real life. And then we close with a discussion about next level strategies for financial health if you have “mastered basics” and you’re thinking about where do I go from here? Great conversation. Lots to take away from this. 

If you are a practice owner, you know how this goes. I would love to have you consider The Testing Psychologist mastermind groups for some coaching and accountability. Got new cohort starting in mid January, 2025 at all levels, beginner, intermediate, advanced. You can go to thetestingpsychologist.com/consulting and schedule a [00:03:00] pre-group call, see if it’d be a good fit. In the meantime, you can get plenty of financial information from this discussion with Carla Titus.

Carla. Hey, welcome to the podcast.

Carla: Thanks so much for having me. Excited about our conversation today.

Dr. Sharp: Me too. I’m going to tell the audience a funny story right off the bat. We talked about doing this podcast several months ago and we ended up scheduling it for whatever date it was. In the meantime, I’m down at the Wise Practice Summit event in Charlotte, North Carolina in October and a woman sits down beside me. I lean over. I was like, “Hey, what what’s going on so far?” [00:04:00] And then you responded. I look at your name tag and I’m like, “Carla, we’re going to be on the podcast in another month or so.” I had no idea that it was actually you in person right beside me. So it’s great to be doing the podcast after we meet in person. Funny.

Carla: Yeah, it was great to put a face to the name and then get to meet my future host for the podcast in person and get to have a great conversation too.

Dr. Sharp: For sure. So it’s funny. It usually goes the other way.

Carla: Yeah.

Dr. Sharp: I’m glad to be here with you. I love talking about financial stuff, money, and money management in private practice, and that is what you do. Always grateful to have skilled folks to talk about money stuff with us.

I’ll start with the question that I always start with, which is why this is important to you. Of all the things you could do with your life, time, and energy, why focus on this?

Carla: I’m a big believer that this [00:05:00] world will be a better place if people had mental health access to services that they need and the support that they’re seeking whether they practically seek that support or they’re just out of a need for the support to exist. I’ve myself had services in the past, even when doing well in my life and I just believe that we all need support and we all need help in many different ways at different stages of life.

Helping other practices thrive means that the services will be available when someone needs them, they can access them ideally at an affordable price, and that they can use their insurance benefits or the private pay sector can access them where they’re located and that it’s not a problem that there’s not enough therapists to people who need one or psychologists available to support people who need some help. I think the world would just be a better place if everyone had access to mental health services.

Dr. Sharp: I like that sentiment. [00:06:00] I’m biased, but I agree with you. But part of access is that folks are running sustainable practices where they are fulfilled and financially secure, right?

Carla: Correct.

Dr. Sharp: That’s not always easy.

Carla: Yeah. The long-term sustainability of a business is important.

Dr. Sharp: Absolutely. I’ve talked about this a lot, but we don’t get a lot of education around the financial components of running a business and certainly running a mental health practice. I would imagine you see a lot of that in your work. Is that fair that folks come into it with little or minimal knowledge?

Carla: Definitely. They’re an expert at what they do, but that doesn’t mean they have to be an expert in every aspect of running a business. They’re not a lawyer. They’re not a marketing expert. They’re not a finance expert for that matter. But the problem comes when not having [00:07:00] enough education or understanding of it so that you can hire people to support you or delegate it out with confidence.

We always say, it starts with just the base education. You don’t need to know everything. You don’t need to be an expert at it, but you need to know enough that you can see when things are not going well. I see often that people just get away from it by saying, Oh, I’m not good at numbers, I’m shy, or they start to judge themselves in the performance of their business, which doesn’t really serve their purpose of staying in business longer, paying themselves well, having the cash to continue to hire people to support the need of their patients and clients coming into the practice.

And so by not looking at it, what’s happening is they’re perpetrating the cycle of consistently struggling or trying to give away more than they can afford to. This community is so giving and so generous that it’s just a tendency to overextend themselves and [00:08:00] not take care of themselves because they’re like, Oh, we take care of everyone else. While that might feel very noble, and I understand where that’s coming from, it doesn’t always serve to you in the financial side of the business because you do want to look at what is affordable, what is sustainable, how do we make sure that we stay in business so we can now help more people, hire more staff to support the needs of the community out there so that we can give more back because we can afford to do. And so, it’s not all about the profits, but we always say, if you want to have the impact, you have to have the profits to be able to do that.

Dr. Sharp: Yeah, that’s such a good way to put it. I think we lose track of that in the day-to-day, and when we’re in those conversations with employees or contractors, like how much are we going to compensate these individuals? It’s very tempting to try to go higher or as high as possible and we lose track of the big picture, which is, if you [00:09:00] don’t stay financially sustainable, nobody gets help and everything shuts down or you end up super stressed as a practice owner and not making any money and then eventually you get to a pretty bad place too.

Carla: Yeah. And you’re comparing your time where maybe you were solo and making good money. You’re like, why am I stressing out with this big staff or this big impact I’m trying to make when it was maybe “easier” but the thing is that you could not have had the impact you wanted unless you hired and grew your practice. And so it’s important that you do it sustainably, profitably, and we’ll talk about how we can get there to make sure you’re looking at the right areas to identify some of the potential issues that you might be having and how to start thinking about solving those problems. But one thing that I always say to my clients is, it doesn’t happen overnight. It’s something that we have to strategically plan and then take actions towards it and be consistent and diligent about focusing on it. It [00:10:00] always starts with looking at the numbers, which could be the hardest step just to get you started.

Dr. Sharp: Absolutely. I’m really curious, as a financial professional, how much of your work is almost therapeutic where you’re helping people face their fears around money or avoidance around money. Is that true?

Carla: Yes, absolutely. I wish I was a licensed professional in your field because I think that would really help a lot of the work we do. But we also understand that a lot of people bring their childhood traumas around money to their business, or they might bring their personal financial management to their business, whether good or bad, we always say we’re not here to judge. We’re here to help. We just want to make sure we meet you where you’re. That’s the first aspect of it, right?

They’re like, “I feel safe to share that I don’t know about this. Fantastic. We can educate you. We can start to share with you how to look at it. We can show you different ways that this would [00:11:00] resonate best for you and then also take that fear out of looking at the numbers by going through it with you, also helping you not judge yourself in the process, but there’s a lot of mindset that comes with it. We understand that it could be very traumatic for someone to even just think about looking at their numbers, let alone doing that work, and so we’re here to support them on that journey. While we are not a licensed clinician to help them through the trauma part of it, and we will definitely refer that out, we do understand where that might be coming from and are able to then help shape the conversation in a way that feels approachable, nonjudgmental, supportive, and empathetic so that we can start to do the work necessary to shift things over.

I think by the time people get to us, they have already struggled with it long enough on their own that they feel enough is enough. I need to try something different and I need help. Just like your clients come to you for therapy, clients come to us to for us to help them define what are some of the problems and help [00:12:00] them create a path forward to solving them.

Dr. Sharp: Yeah. I’m curious what as trigger points or warning signs, I’m not sure what you might call it, those factors that bring people to you or things that we need to watch out for, like, if this is happening in your practice financially, now’s a good time to seek some help.

Carla: You’re probably running up against payroll cycles, very stressed out that you’re not sure you’re going to make it, and you’re just waiting for that last deposit to hit right before you run payroll in order to breathe. That is very stressful. I know that’s a big burden you’re carrying to have to make sure that the livelihoods of your staff and that their paychecks are going to clear. No one wants to be in that position, right?

So we work with that situation to create a cash runway over time. The problems don’t just get solved because [00:13:00] we want them to. There’s a lot of hard work in both and it starts with managing cash flow and starting to provide that cushion needed. But in order to do that, you’ve got to go back to the root cause of the problem, which at times we see often is a wrong compensation structure; the wrong margins on your business that ultimately lead to lack of profit, which means then you can’t put that cash runway in place because you do not have profit. To generate the cash flow, you need to have the runway to then make payroll.

You see how this is all coming back to a root cause problem that a lot of people are not defining correctly? They’re thinking, Oh, I just need to run payroll more often, or maybe I just need to take a loan to cover payroll and then everything will be fine and then I’ll just pay that loan over time and get back on my feet when profits show up and if they show up. That plan does not serve anyone because now we’re even more stressed out because now you have to pay the loan and the payroll again comes to [00:14:00] you a few weeks later and you still don’t have enough because you have not addressed the root cause of your problem, which was something completely different.

Dr. Sharp: Right. Man, just hearing you talk about that cycle of taking a loan to cover payroll, that makes me talk about a trauma response. That is the scariest thing I could ever imagine is being doubly in debt and not sure how it’s going to resolve. But I know that’s how it goes. I worked with a practice owner two years ago who was in that cycle. It’s a tough one to break.

I’ll ask you a question, a lot of people ask me this question, but I’m always curious from the financial professional perspective. When you’re talking about shifting margins or profits, what is a reasonable point of profit or percentage of profit or amount of profit for different practice stages or types? People ask this all the time. I’m curious [00:15:00] how you’d answer.

Carla: The answer is always, it’s a range and it depends on your size of practice and your type of practice, right? Let’s break that down a little further.

If you have a private pay practice, your margins are going to be higher. Therefore, your profitability will be higher because you do not have the whole insurance cycle, you get to charge heftier fees for the work that you do, and you get paid maybe right away. And so that allows you to have a much higher margin and profitability in your private practice than maybe an insurance-based practice that’s beholden to insurance rates that might go up or might not go up.

And so if you’re on the private pay side, you can have really high profit, anywhere from 20%- 30%. Sometimes it’s seen as high as 40%, but again, it depends on the size of the practice, because when you start to add people, what happens is if you were solo, maybe you’re taking home 40% profit because you only have to pay yourself and you [00:16:00] rent a small office. But once you start to add a rented space with five offices and five staff, those profitability is just not possible because you have so much overhead now to cover, right? So you’re going to be on the lower end, like 20%- 30%.

If you’re lower than this, by the way, this are just data points. It just means that there’s room for you to work towards getting and achieving those goals. It doesn’t mean that you’re not doing it right. You might have chosen to compensate people differently, or maybe your area demanded a higher level of salary, or you hire very experienced people that are making six figures each for the type of license or experience that they have. And those are choices you get to make for being able to command those higher prices. Again, it all works together because there’s no one component that says, okay, because you do this now, your profit is that. You have to look at the full picture and then decide what are the levers we’re going to pull to shift the profitability over time.

In private pay, we [00:17:00] just have a little bit more flexibility I’ll say, because sometimes you can increase prices and the market in the area allow it and your clients maybe are not sensitive because they’re on the higher end of the spectrum. So you’re able to leverage that a lot more than an insurance-based practice. 

On the other side, insurance-based, you’re beholden to whatever rates insurance decides on. Sometimes they decrease them. Sometimes they give you an increase. Maybe it’s an increase every 2 years, not every year. You have to decide what is your compensation structure.

What we normally do with that is we try to forecast the revenue based on session count, and then try to do a percentage of that for salary caps so that we know what can we afford to pay and then we slot in our people and their current pay and how that’s going to work. But again, we want to take a step back and always make sure that our compensation structure is accurate because if we first started and hire people randomly, maybe we don’t know what we’re going to pay them. We just say yes to [00:18:00] everything. And then before you know, you have 10 clinicians and you’re like, Oh, I paid everyone differently and I don’t really have a combination structure. So you sometimes just have to take a step back and realize what you’ve created.

And then how you shift going forward is with every new hire, we start to model a different composition structure that it similar or a little bit different that gets you better margins. So over time, we’re able to shift the margins to get more positive so we have more room for profit. And then wherever possible, we’ll look at expenses and make sure we can tackle some of those and reduce them. The margins on that, especially if you’re scaling, you’re investing some of your profits, so your profitability is going to be probably between 10%-15%, on the highest side 20% after everything is paid for, owner’s compensation included in that. The only thing we didn’t include in that would be taxes because you get taxed on the profit.

And so that’s roughly what you can expect on average. If you’re not at that level, [00:19:00] again, it’s about making a plan to get there and have action steps that you take. Profitability fluctuates in practices all the time, year over year. There’s circumstances, there’s churn and turnover sometimes that affect the profits of the business. So keeping an eye on it’s going to be very important.

Dr. Sharp: That’s great. I love the way you’re approaching this. I hope that some folks are feeling validated. It’s like this profit percentage is the measuring stick that we use for success in a lot of cases, and if you’re not at this level, then that means something about you or whatever it may be. It can be it’s fraught. It stirs up some feelings, for sure. So there’s a huge range. Essentially, there’s a huge range and a confluence weight. So it’s just a data point. I really like that.

Carla: Yeah.

Dr. Sharp: I thought you were going to say something about that.

Carla: Go ahead.

Dr. Sharp: Yeah, it’s all right. [00:20:00] We can reset a little bit and go from here. Were you going to say anything else?

Carla: I was going to say, it changes with the size of practice too. So it’s another thing that I think people hear this percentages and they’re like, Oh my God, I’m so off. Or I need to do something very drastically different and it feels impossible. Or feel like you’re stuck with a cost that you already created. But, the size of practice will also dictate what it’s available to you and based on the decisions you make, a lot of that will be impacted as well. So just something for people to consider, and not beat themselves up over it if the profit is not the amount that they want, but work towards that desirable profit percentage that’s attainable for the business.

Dr. Sharp:  Yeah. Well, this might be a good time to talk about the specific process that you actually go through with people. We’ve dipped into it and you’ve said little things here and there about forecasting or talking with people about their profits and so forth, [00:21:00] but it might help just to provide a frame for the rest of the conversation to know, what does working with a financial person like yourself actually look like?

Carla: It starts with a solid foundation where your bookkeeping and financial data is accurate. If that’s not the case, then we’ll be able to see that and provide some recommendations on how to best address that.

Assuming that is in place already, then the first step we’re going to go through is strategically decide what is the direction? What are we trying to achieve in the next year or 2 or 3 depending on what we’re working on? And that’s where the forecasting piece comes in where we’re starting to take the future and shape it intentionally. So despite what you’ve done in the past, that will inform some of maybe what’s possible, but we want to shape a new future or version of your practice going forward. And so we have to intentionally start to craft goals around that.

[00:22:00] It does not start with a number even though that’s what I do for a living. Most people think that a lot of the work is oh, let’s just jump on the spreadsheet and put some numbers together. And it’s no, we need to take a pause, think about the strategy. What are we going to try to hit for a profitability target? How are we going to go about achieving that? There’s a lot of steps to go into how we forecast and frame the conversation or a strategic planning with our business owners.

We want to take into account what the owner wants and needs out of their business first and foremost, because we are so used to taking care of everyone else that the owner is the last thing that gets prioritized. In my world, the owner is, I work for them, so like I want to make sure that they are cared for because no one else is going to watch out for them. So do you need to make sure you can step out of your practice four weeks a year or take two months off and still have things running and providing profit for you and your family to build wealth? Those are the kind of conversations we need to have now because that will tell us, Oh, [00:23:00] we might need to hire a practice manager and a clinical director to run things when you’re not around and make sure that this is owner optional or independent of you showing up in order for it to produce the results we need. We got to put those costs into our plan if we don’t already have them, right?

So then we have to look at what is the admin support you need. As the practice grows, those demands increase. So we need to make sure we have the appropriate staffing for all of that. And then every time we set a goal to grow the business by, let’s say, 20%, we’re not just coming up with a number from thin air. We’re looking at the historical performance of how the business has grown over time and say, is this possible or not? And if we’re going to make it be a goal, we need to now break it down by number of sessions, number of clinicians, average reimbursement rate. We need to actually make it tangible. So now I can tell you, you need this many sessions, this many clinicians at this average rate for that number to actually be reality.

And then when we look at that and the owner goes, whoa, I don’t think we can do that. [00:24:00] Now, we start to test for it. Well then, 20% growth might not be achievable this coming year and then we let dial it back or decide what is the pace of growth we want to have. So this is where all the conversations come together into the plan that we create. It’s not just about putting numbers up on the wall because anyone can do that. It’s the how do we achieve the numbers that makes the transformation of the business possible and then holding the accountability along the way, month over month, adjusting and overcoming objections and problems because guess what? Just because you said you were going to hire 5 new staff doesn’t mean 5 other stuff are not leaving. Now we have to hire 10. And then that churn that happens and then it impacts the business performance.

And then just because you say you want an accountability doesn’t mean your people are hitting their goals every single month. We have to monitor, coach and track that performance to ensure it’s actually happening. You’re going to have those hard conversations and that is not easy at all, but that’s where the profits hide. And so we want to make sure we’re [00:25:00] helping people through, not just creating the plan, but really what are the steps or actions you’re taking to make it a reality? And that’s the more important part of the work that we do is once we create a plan, can we actually stay on track?

Dr. Sharp: I see. It looks like we froze just a little bit.

Carla: Do we catch everything or do I need to go back?

Dr. Sharp: It catches it. I just didn’t hear it. I heard up to this is where the profits hide and we need to do something. That’s where I got to. 

Carla: Take actionable steps.

Dr. Sharp: Take actionable steps. Okay. That sounds good. Let’s see. Let me think.

[00:26:00] I’ll ask you what that looks like when somebody signs up with you or starts to work with you. Is this a rigid meeting schedule or how often do y’all meet?

Carla: [inaudible 00:26:21] 

Dr. Sharp: That sounds good. When I’ve worked with folks on different things around the business, there’s always an initial excitement when you get started and feel some hope and some relief, but then what happens after that? Are you meeting with people pretty regularly or is it a quarterly thing?  What does that actually look like?

Carla: We have different support levels to meet our clients where they’re at and making sure they have just the support they need for the stage of growth they’re at. And so they’ll meet with us either once a month, twice a month, at a cadence that really makes sense for the plan that we’re trying to achieve and helping them stay on track.

The folks that we’re meeting more regularly with, [00:27:00] which is twice a month, we’re doing one finance meeting dedicated to reviewing all the numbers, addressing any issues that we’re encountering. Are we on track, off track? If not, how do we get back on track and coming up with ideas on problem solving our way to reaching the goals because at the day, we need to know they will reach them or not. And then what do we do differently going forward if we haven’t to get back on track, or maybe we’re exceeding our expectations and the goals, and now we’re like, maybe we need more challenging goals going forward? So those are the kinds of conversations we want to have.

And also the hard ones where we’re like, things don’t look good. We need to do something very different if we want to change the direction or course of these results. And that’s where we come in with that perspective from a CFO to really help them shape what are the options? How do we think about this? What else can we do? And since we know the industry, we’re able to bring in some things that we see working in other areas that we can apply to their business and test out.

And then for the second meeting, we normally do a [00:28:00] strategy meeting where we’re again revisiting our strategic plan, looking at is what we forecast is still achievable. Do we still on track for the hiring plan or have we encounter any issues on maybe availability of talent, what we are compensating on maybe being a challenge because sometimes there’s that you can afford this, but the market wants this. And we have to work through both on what do we do about that?

It’s not just Oh, we want to hire at this level and that’s it. We definitely look for the talent at that affordable price point that we can afford to do for the practice, but sometimes that’s not available. So we have to think outside the box. What else can we do? And in a strategic meeting, it’s all about managing margins, having that composition structure conversation, looking at what else came up as an obstacle or problem that we’re trying to address, and sometimes is maybe the owner’s desire to continue to [00:29:00] work at this. Sometimes it’s like the lack of motivation because you’re like, Oh my God, everything is going wrong, that could go wrong, and you’re just like, is this even worth it? And then like having just that conversation very honest and openly, okay how can we make this worth it? And then are you still in it? What’s your energy level? What support do you need? And how can we take things off your plate to ensure that you get back on track?

So a lot of the work is financial and we do a lot of that looking at the numbers, looking at key performance indicators. Is our Lead Generation healthy, is our conversion rate performing well? Are we getting everyone to capacity? How quickly are we getting our new hires to capacity? Those kind of conversations that go into the meeting the goals piece, but it goes even a step further, more detail and deeper on the problems that we might be encountering and the things that are going right. Celebrating that too.

Dr. Sharp: Yeah, I like that. You have to celebrate what’s going right. You used a phrase a little bit ago that caught my ear, which was something like [00:30:00] places where the profits hide. I wanted to ask you about that. Where are some of the common places that profits tend to hide in our practices?

Carla: There’s some areas that are easier and others that are more challenging. I’ll start with the easy ones. Sometimes if you have a practice you’ve been building for a while, you forget that maybe you have people subscribed to software that you were using, but they’re no longer here and you’re still paying for them. Just go to an audit, go revisit, can we take anyone off that’s no longer here that doesn’t need the access? Again, you’re paying per user, so times many users, that can add up, right? And so make sure you’re addressing that.

Sometimes it’s like, we used to pay for this once a year last year and that worked for us, but this year is no longer working. And guess what? Nobody ever thought to challenge that expense, right? So just browsing through what are you spending money on? Is it still giving us the Return On Investment that we expected before, and it continues to [00:31:00] perform on that level going forward, or are we reshaping the strategy and changing the direction and reinvesting differently as we go into the new year, allocating our dollars to work for us better? So that’s one.

Measuring return on investment on everything you spend money on is important, even if it’s time savings and not direct impact to creating revenue or creating some kind of profit. Making sure you’re evaluating that every year is important because the business changes and the needs change. So we should be dynamic in our spending allocation over time. That’s the easy part.

The more complex part where profits hide is when we make bigger decisions such as the size of office you need for your team now versus what you’ll need in the future. What I often see is, we’re like, Oh, we’re going to grow so fast. So let’s just get double the size of office that we actually need. And now we have all this overhead and we don’t know what to do with it. We haven’t filled it with clinicians yet, they’re coming, and we don’t have the [00:32:00] capacity from a lead generation perspective to get those clinicians higher and filled up. So now you’re carrying all this extra office space and maybe you hire a few people, but they’re not full yet, and then it compounds not only on the rent side, because that grows every year by 3% at least on your lease, and you have a 5-year lease, probably, so this is nothing you’re going to get out of overnight either, versus approaching it like, okay, I will get a five office space now, and I have an alternative to rent an additional 5 offices when I need them. That will be a much better approach. Now, I know that’s not always the case or available, but that is a way to think about the problem versus just trying to eat up the whole cost at once.

And then the other piece of this is around the compensation of your clinicians or therapists or psychologists in their practice because if they’re not performing in a given month, your profit is just leaking away because you’re paying them maybe based on salary, maybe it’s based hourly, whatever your model [00:33:00] is. And for every hour, they don’t work, it’s opportunity costs because your practice could have made that extra session or the extra 10 sessions a month that they’re not hitting. And guess what? Your overhead or your fixed costs in the business do not change just because someone is not performing. Now multiply that by 10 people. Now, you’re actually leaking profit out of your business and you don’t even notice because you’re like it’s just one session. It’s just a few weeks of holiday. It’s just this or that.

What we find is that people are not prepared for the holiday season, even though it’s coming and you’re like, Oh, Thanksgiving week, it was a wash and we didn’t get the sessions we needed and therefore, November is just not performing anymore. And you’re like, wait a second. We knew that week was going to be slow. So why didn’t we use the first three weeks in the month to get ahead to get our average up so that by the time the fourth week hit, we’re fine. People can take time off. It’s not going to impact anything.

But that accountability, holding people to the goals and helping them think through that map out, same with [00:34:00] when I take time off or when they go on summer vacation, those are components of the management piece that will help you capture the opportunity on the profits. I know this tends to be a very uncomfortable conversation. Holding accountability is hard, but if you want a profitable business, these are the kind of conversations you have to be addressing over time in order to be able to capture some of that opportunity.

Dr. Sharp: I couldn’t agree more. Those are, I think, the toughest conversations around compensation and accountability. These are things that we really wrestle with in the mental health business and managing other people.

I do want to talk about compensation a little bit because this is another question that comes up all of the time. I know the answer is it depends. That’s always the answer. But just to get our range, people always ask, what should I pay people, employees or 1099s. And then on the flip side, people are like, what should I expect to make in a [00:35:00] practice? It seems rare that those are aligned. I would love to hear about your thoughts on both of those.

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Let’s get back to the podcast.

Carla: I think they can be aligned, but it takes a person thinking through their needs over [00:37:00] maybe what they can go get somewhere else. From the employee perspective, what we always highlight is the amount of flexibility we’re able to provide an employee, the kind of benefits that they’re able to get here, and the kind of support around supervision or licensing that maybe they won’t get somewhere else where they have to pay out of pocket for those type of things.

Those could be a highlight of things that people are looking for in their life. It might be someone who’s totally okay having a flexible hybrid role that is willing to take a little bit less compensation than maybe the market would bear outside of this role because they don’t want to work a full-time caseload of 40 hours a week plus and be burnt out in three years. They rather do the part-time approach or the lower caseload where they can dedicate quality to their clients and patients and make sure they’re paying attention and able to provide them the best quality of care. Maybe that’s important to them and also feel that they have the team environment to be able to thrive in [00:38:00] that way.

Again, that’s just different because some people are going to go for the roles that is all about the money, the full benefits, the full pay, and that’s fine. There’s nothing wrong with that. But I think a lot of the practices are providing this unique opportunity and they need to be able to highlight that.

From the person doing the hiring side of it, we’re looking at market data. We’re analyzing what is the market bear for this type of roles, for this level of experience, looking at what can the practice afford to do. And that’s the key 1 where we have to compare the 2, right? We have to adjust it for also the hours work because most of the roles are not 40 hours. So we have to make sure they’re commensurate with the amount of workload that we’re giving a clinician or psychologist.

What we do is we take that and run it through a gross margin calculation for that particular role before we hire. So we’ll do number of sessions times average reimbursement rate times number of weeks a year that we are open and see patients, and then we’ll take the cost of the [00:39:00] compensation fully with payroll taxes and benefits included and then do the math on what’s left after all of that is paid out, and then see are we on a healthy margin or do we need to offer lower pay because we can’t afford to do that given our standing with insurances and reimbursement rates. And maybe if you’re private, but you have more flexibility to afford higher salaries too. So there’s a give and take there. I’m being very clear in the communication with candidates that this is the kind of role you’re getting into. These are the type of benefits, including the flexibility we can provide you in your life. That maybe is a highlight and something that someone is looking for that they’re not going to get somewhere else,

Dr. Sharp: Right. When you think about compensation, do you approach it in terms of essentially, a percentage of gross revenue can go toward compensation or do you approach it in a different way? People are always like, a 60% [00:40:00] split or a 70% split or whatever. Honestly, I’m not a huge fan of the fee split model. I just want to provide some anchors for folks who are wondering, again, how much should I be paying people if I’m thinking in the split model.

Carla: I’ve seen the split model work well sometimes but it’s more of a 50/50 split more so than the 60 or 70 people are throwing out there because there’s just not enough room for everything else that you need to pay, including profit. Where we’ve seen more success is definitely been with the hourly or salary models, but again, holding that accountability, because you have to have that in place in order to make sure the profits are working.

Sometimes we’ve modeled situations where if we had everyone hitting their goal, even if their goal was lower, but everyone was hitting it, we would be more profitable than if we [00:41:00] didn’t have everyone hitting. And then that means we could do profit sharing with the employees and give them back some of that benefit by paying out a portion of the profits back to them. Again, that has to be very intentionally crafted. You have to have the right margins.

To answer your question around what is the margin? We look at it high level for the practice, across all roles, what is the salary cap that we’re going to set for the practice? And that can be 60%, 70% of revenue and still have room for everything else that’s happening. Again, it depends very much on the size of practice, but that’s where we’re starting to land in full compensation, including the owner, including the admin team, everything that goes into running the business. Or we look at it from the gross margin perspective by clinician and say any given role cannot have a margin of less than 40%. We want to have as high as 50% percent ideally. And then that starts [00:42:00] to shape up the conversation around compensation, around average reimbursement rate.

Now, keep in mind, if your average reimbursement rate goes down, that equation changes. And so we always have to have room for things that are outside of our control. I hope that not nothing like that’s happening in your practice, but it does sometimes. You get decrease letters from insurance paneling and you have to just deal with it. And so that’s where did maybe the split model can save you because then you’re like sorry, guys, everybody’s getting a pay cut. I don’t know how many people will stick around for that, to be honest. So that’s why the split model sometimes can be a little bit worrisome to people because employees want stability and they want to know that you get them, that you’re going to pay them, that they’re going to be compensated fairly for the work that they’re doing and that they’re getting rewarded for that in some way.

By having the split, unless the insurance gives you an increase, then you’re giving everyone an increase based on that, and then they have to wait until insurance pays. And what if you’re billing team is not [00:43:00] collecting on time, then nobody gets paid that month? There’s just a lot of things that the split model doesn’t address. While as an owner, you would have the stress of, if you don’t collect on payments, you still have to pay payroll, which we talked about earlier, and there’s ways to address that outside of getting into that. Preparing for those new hires, having the cash runway available for three months before you hire someone is going to be an important aspect of scaling that I think a lot of people are not talking about beyond the piece around compensation, some margins as well.

Dr. Sharp: Got you. You threw that term profit sharing out there. I would love to hear how you approach profit sharing in a mental health practice. I have seen theoretical models of this, but I want to know how this actually comes into play in practice and what you’ve seen work well.

Carla: I’ll tell you, it takes time because when we set this goals of holding accountability, again, [00:44:00] you’re moving a ship, right? Not everybody’s going to get on board. A lot of people actually going to exit out of your practice when you start to hold accountability. And that is a very real impact to the business. You’re rebuilding with the people that are committed to holding to their goals, and that might be half your people. It might be more than that. Hopefully, it’s not that many that leave, but at times, we have to deal with that, rebuild and rehire the new people within your expectations.

When you start that journey, it’s like a 12-month process to just shift to the new culture of we set expectations and we expect you guys to meet them based on what we’re compensating you because at the end of the day, you have a job and we want you to perform to the job standards. But if you weren’t doing that before, it’s going to be a hard sell for your current people. And then some people will quickly leave. Some will take 6 months to make their own decisions, and that’s fine. But you got to be prepared for that turn and turnover because it’s not easy and most owners at that point want to quit and we’re like, hold on, because on the other side of this, there’s profit sharing and it’s [00:45:00] it’s fantastic but we got to get through that bottom, essentially.

And then as we start to rehire and set those expectations, we’re able to craft into the plan this incentive of, okay, now everybody hits the goals. You all get to participate in profit share. But guess what happens the 1st quarter. Only 1 or 2 people get it. And the way we model is we take the full profit percentage and we break it down by section. So we’ll do sometimes 25% of profit back to the employees that qualify for the profit sharing, 25% for leadership, and 50% for the practice to continue to grow. Because guess what? You can’t grow a practice if you can’t reinvest back. I know a lot of people are like, Oh, let’s just give them 50% of the profit. I’m like so how are you going to grow the practice? Or what are you taking home after your compensation? That’s just not enough, right? So we like the 25%. It’s worked out well and it creates a nice pool as long as you’re getting the profits, right?

Again, managing performance gets you the profits. And then we see [00:46:00] that 1 or 2 people qualify and then checks get cut out of that percentage profit and people are like, wait a second, I’m actually getting extra money now.

I know that a lot of people are not motivated by money, so I don’t know that this will work for every practice out there for every employee. Some people care about other things. Maybe it’s time off, whatever. But assuming this is the kind of reward that resonates with your people, now we have two people that qualify. And then what happens the next quarter, we actually have more people because they notice that we were real about this profit sharing. And now all of a sudden we have five people qualified for the program. The pool is still roughly the same size and we have more people qualify as low as a percentage of salary anyways, because we want to do the math around make sure everybody’s getting roughly the same portion of it and then the pool keeps growing from both the leadership pool that we maybe eventually pay out, the clinical team that get this eligible for it.

And by the way, to be eligible, there’s criteria, right? You have to [00:47:00] meet your goals. You have to submit session notes on time. There’s certain things you have to do in order to qualify. You can’t be on a performance improvement plan. Those kinds of things get defined up front, communicated in a nice way. We try to keep it simple because honestly, people are not paying attention. They’re just like, Oh, you’re paying me more money. Great. What do I do to qualify?

And then what we see is by the time the second half of the year comes or the third quarter comes, all of a sudden people are like, Oh, I could make extra? This sounds great. And then they start to feel like they’re tied to the practice performance. When the practice wins, I win. Now, they can get bought into that by achieving their goals. Not that we need to motivate people to do their job, but it’s nice to be able to share a little bit of the winning with your employees who are here, dedicated to helping you achieve those results and saying, thank you for helping us. Here is your cut of the piece.

Also people are like, Oh, I don’t know if I want to do profit sharing, because maybe [00:48:00] sounds the wrong signal or whatever. That’s totally fine. I think there’s situations where that could work and situations that where we wouldn’t consider doing that, but when we have done it successfully, we’ve noticed improvement in performance because people are bought into that win model.

Dr. Sharp: I like that. So you said take 25% of the entire profit of the practice for the year to dedicate to the profit sharing pool. So if, let’s say a practice, I don’t know, had $100, 000 in profit, just extra leftover at the end of the year, is that before you pay taxes or after you pay taxes on profit?

Carla: That’s the other piece that always comes into play. And what we do is because we have the other 50% we didn’t allocate between the 25% for leadership, 25% for clinical staff, we still have that 50% where we cover the taxes out of that because we’re not want to penalize people over. Oh, you got a bonus, but by the way, it’s going to be reduced by taxes. So we just have the room to cover that. And we know that it’s coming in. It’s [00:49:00] marginal, honestly, out of the grand scheme of things because now we have more profit.

Dr. Sharp: Yeah, that makes sense. So you take $25, 000, let’s say out of that $100, 000, put it into the profit sharing pool, and then just you like to divide it equally between the employees who qualify just however many there are?

Carla: We do it as a percentage salary. So their full-year salary as a percent of total so we can distribute it equitably, because some employees will get paid more, some will be lower level of experience, place of role. You don’t want someone who is junior to get the same amount as someone who has been in the business for 10 years with experience and maybe more licenses and certifications. So we use that percent of salary to total to help manage the fairness or equity in the business on payouts for that. We think that’s worked well because people know they’re more junior associate level. They’re not going to get the same as a PhD who’s been in the business 15 years.

Dr. Sharp: That makes sense. [00:50:00] I like this. I’m guessing, if people were to talk with you in detail or work with you, there’s a charge or something. You provide guidelines for how to determine tenure seniority or eligibility.

Carla: Yeah, we write compensation. We do the full profit sharing outline of communication to the team, the criteria we work with the owner on that to define it because every practice is different. And then we have a rollout plan on how we communicate that, how often it gets paid out. And that’s the choice also from a casual perspective, where you pay a quarterly, we could pay a semi-annually or once a year. And what we find is when we do quarterly, it just rewards the person faster. So then they see the result and they’re like, Oh, next quarter, I get to earn it again if I perform well, so then they’re more motivated, ideally, and they’re not waiting until the end of the year when they’re like, already forgot. Oh, did I hit it or not? Oh, I got this extra money, but it’s not motivating them in the moment, which we’re trying to reward is the current actions that they’re taking to achieve their goals.

[00:51:00] Dr. Sharp: Yeah, that makes sense. I really like that. I like that it’s concrete and you thought about the equity component. I think this is a nice solution to this idea that we, like you said, can’t really pay people for full time because most of our clinicians aren’t working full time. If we’re being honest, for testing, they might be billing, I don’t know, 30, 32 hours a week, maybe a little more, but for therapy, especially people are seeing 20 or 25 clients and that’s the income. It’s hard to pay that additional 10 or 15 hours to bring them up to full time equivalent for comparing compensation with hospitals or community mental health or whatever. So profit sharing is a good way to add a little money to their pocket but it’s based on performance. It only happens if they reach their hours.

Carla: Yeah. It’s an alternative to consider. I [00:52:00] think it could work great for some practices and maybe not so much for others. There’s also a salary type of model compensation. You can evaluate to see if that works for you. Again, big on accountability for that to work. And then there’s other ways people can feel rewarded. It could be through more time off. It could be through other type of rewards. Maybe they care about childcare reimbursement and you want to have a DECAP plan in place.

There’s things you can do that doesn’t honestly always cost a ton of money that meet your team where they’re at. I think we just have to start to think outside the box and profit sharing is just one of them. We use a lot of these tools around benefits to incentivize our workforce and help them feel like they’re getting something, but you’re right, 20 to 25 clients of clinical work a week, that’s a lot, like it’s a lot of effort you guys put into the work and we’re trying to reward it in some way by saying, hey, there’s more for you here just for doing this work that we know it’s already challenging and hard.

Some practices offer [00:53:00] some wellness benefits or contribute to a 401k. There’s ways that we can help our team feel taken care of. And that’s what we’re going for. And also that’s affordable because we got to watch the numbers too.

Dr. Sharp: Sure. Are there any circumstances where profit sharing would not be a good idea for a practice?

Carla: Great point. If you’re struggling with cashflow, probably not a good idea to roll that out yet. We got to get you healthy first. The thing is, in the journey of getting to profit sharing, we build the cash reserves for the business. So first we took care of the health of the business. The first year we had to turn a profit and get back to a healthy profit before we even decided this was a good plan. We had to hire the right people and that costs money. So making sure you have those reserves in place in that every onboarding goes successfully to full capacity first, right?

Once you have a good solid team in place and the profits are consistently showing up in your business and you’re not [00:54:00] concerned about that anymore and you have the cash runway, now we can start to explore things like profit sharing and additional benefits because now we can afford it put it in the plan.

We always say, we just got to run the numbers before we make those decisions and tell the team about it. So we always tell our owners you can make whatever decision you want but just pause for a second, let’s run the analysis and make sure that yields a good outcome that you feel comfortable and confident in and then you can go do all the things you want to do, because we know we can afford it, we know we have the runway for it, and we know that we’re going to be able to maintain this for long term because sometimes when you make a commitment, decommitting from it is 10 times harder, because now the team feels like you’re taking something away from them instead of adding it and staying with it, you’re like adding in and taking it away and then adding something else, taking it away. They don’t want to see that. They want to see you committed long-term to whatever thing you’re going to roll out.

Dr. Sharp: Yes. As we start to wrap up, I want to ask you two closing questions that are different sides of the same coin. [00:55:00] One of the questions is, you just alluded to it, what if we get into a situation where we figure out we are paying people too much. I would love to hear your approach or how you might coach people to back out of compensation that’s too high. And then the second question, the other side of the coin, just to foreshadow a little bit is, strategies for folks who have mastered this. Like we’ve got these things in place. We’re doing profit sharing. We’ve got a 22% profit margin. Things are going pretty well. Is there a next level in terms of financial health or management? 

Carla: For the first one, I’ll say, it starts with a plan. So before you tell anyone anything, we got to go together a plan of action, a strategy around it. What we normally recommend is that we don’t go to people and just say, hey, we’re going to cut your pay because guess what? They’re just going to go find another job, right? That’s the [00:56:00] worst approach in the world because they’re people, right? People want to feel like you care, and you have the responsibility. You made that decision, whether knowing or unknowing. You made the decision to compensate them that way. It’s not their fault, right? They negotiated and you say yes. And again, we’re very given here.

What we want to do is we want to start by defining the roles and responsibilities and then go look in the market, literally Google salaries for that type of role and responsibility in your area. You might find that you’re actually overpaying. You might find you’re actually underpaying. We have to see where we’re at to even start a conversation around it. Then you have to decide if this will have additional responsibilities, maybe the merit that higher compensation, and that is an intentional decision we’re making to keep it that way.

And then you find the pockets of people that need adjustments, right? So identify whatever those roles are. I know sometimes we get hung up on oh, but I really like this person and I don’t want to change their pay. What I say is take the names out for a minute because we understand you have a [00:57:00] team, but let’s look at this objectively through the numbers lens first. Then we say, okay, but for this clinician that’s been with me for eight years, I want to make an exception. Fantastic. You’re the owner. You get to make those decisions. That decision will cost you X percentage of profit. And that’s what you’re trading intentionally, which is totally okay, by the way. We have a lot of these situations where we’re just saying we know, we’re okay with it, and we’re going to stick to it because we want to honor our commitment to that person. Now you can’t do that with every case. Otherwise, nothing changes.

Also, what we find is when we start this exercise where we’re just exploring, we’re just objectively looking at the data, we find that sometimes we get people that give us their notice. Unexpectedly, something happened. They need to move away. Someone got a new job in a new state. It just happens. And so we take those opportunities to start shifting the compensation model. With every new hire, we’re able to reassess, right?

And then also, if you’re gearing up for [00:58:00] growth in our hiring plan, we’re going to shift to the right compensation model with every new hire. So now, we’re not take changing anything for existing team. We’re just going to do with the new people coming in to say, Hey, over time, this is going to shift because we’ll have people come and go and we don’t want to… We know we made this decisions. We want to stick to that and take the hit for it. That’s fine. But with every new hire, we’re going to correct the issue over time. And so, we start to map out that plan to be like, okay, slowly but surely we’ll get there.

And then on the other side of it is, you have that shift in compensation over a year or two, maybe it takes you longer because you’re not willing to make the hard decisions on right scoping and having conversations that are difficult or maybe deal with attrition in the team. And then you do it over time, and that’s where the plan we put in place is okay, how do we shift? When do we ship? How many roles do we need in order to get us back to healthy? And then are we okay dealing with the problem until then?

[00:59:00] So that’s how we approach it. We’ve found a lot of success in doing that. Sometimes even just holding accountability gets a lot of people leaving for whatever reason. Everyone gets to make their choice. We don’t choose for them. And then it gives us a way to bring in some new folks that maybe have the right expectations that run. So that’s on the first one.

On your second question about, okay, what happens next? Okay, you’ve made the profit. Your team is performing and things are good. I think what comes next, it really is defined by the owner. What do you want next? Some folks tell me, I want freedom to spend more time with my family. Let’s hire the right support team in place that can run the show every day for you so you can be owner absentee or owner optional. And that’s when you really start to have that true freedom of wow, I have a highly performing business that’s profitable and I don’t even have to show up for this to run, right? So we work towards that as the next goal maybe is we want to exit. 

[01:00:00] Folks want to consider an offer at some point. So we want to be ready at all times. And this is something that we always prepare clients for us, be exit-ready, because you never know when an opportunity is going to hit. We want to have top dollar for what you’ve created and took you so long to run that if that presented itself, it’s a no-brainer to say yes. We can help them through that process of successfully exit for the right valuation for their business, but that doesn’t happen if you don’t have the financial results in place.

Maybe is, I just want to keep this for a long time. I maybe want to retire in 10 years, 15 years, and this is just producing the profits I need to build wealth. And then we take the money out of the business into their personal wealth-building plan and start to buy properties, buy a building for the practice to run back to it. So then at the end of the day, they actually have an asset that they can sell at retirement or whenever they need to, or continue to rent forever. And this is something that the practice was able to help them achieve, right? So the idea is the profits go to good use in somewhere building that [01:01:00] wealth journey in their personal life.

We don’t keep all the money in the practice. That’s another piece that we talk a lot about with owners. It’s what’s next. What do you want to achieve outside of owning this thing? It varies depending on the person’s goals in life and stage in life too, because some younger owners are like, I want to grow this 10X. Fantastic. Let’s go. And some are like, I’m tired. I just want this to run well and I will retire in three years. Either I’ll sell it to my employee, I’ll sell it to someone, or it’ll just stay to produce the profits I need as I semi-retire or get out of the day-to-day work more and more over time. So there’s options and it’s just up to the owner to decide so we can help them build that plan for what’s next.

Dr. Sharp: Nice. I like this. It sounds great to be at that place and options are always good. There’s lots of things we can do at that point.

Carla: Yeah.

Dr. Sharp: I’m guessing there are folks across the spectrum who are listening and [01:02:00] I’m guessing that there are a lot of folks who’re taking a lot away from this conversation. So I really appreciate you coming on and talking through all this money stuff because it is scary for a lot of us, or just confusing or unknown. So glad that there are folks like you out there who can guide us through it.

Carla: Yeah. I dedicated my whole career to learning about managing business finances. Obviously, we love to educate and share that knowledge. It should be readily available to everyone running a business. We’re a big believer in that because we would have better businesses that are financially healthy out there that are providing jobs and helping impact the community in positive ways. And that’s not possible if we don’t have the profits to be able to do that. So, it’s very important work. I want people to feel confident in reaching out for help or support where needed, or learning about it themselves, too, because I think there’s a lot of power in that, too.

Dr. Sharp: Absolutely. If people do want to reach out to you, or find you, or start to [01:03:00] work with you, what does that look like? How do they do that?

Carla: They can reach us on our website at wealthworthwithin.com. There’s that Let’s Get Started button you can push to book a call for free. We love to just talk about where you’re at, support needs you might have, and how we might be able to help you through our fractional CFO services. We also offer bookkeeping services in case you’ve outgrown your current team and you’re looking for an alternative that understand this industry. I see a lot of that especially this time of year. And if you want to follow along, we put a lot of educational content for free on our newsletter. You can sign up on our website and follow us on social media. We put two videos once a week to help people just get better at money managing, different topics and things that they need to be thinking about and get better on, and that’s @wealthworthwithin on Facebook, Instagram, and LinkedIn.

Dr. Sharp: Awesome. It’s been great to have an extended conversation with you. Thanks again, Carla, for spending the time with [01:04:00] me. I really appreciate it.

Carla: Happy to be here. Thanks for having me, Jeremy.

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 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, Spotify, or wherever you listen to your podcasts.

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 [01:05:00] 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 website will 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 the host or guests of this podcast [01:06:00] and 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 an expertise that fits your needs.

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[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

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.

The new PAR training platform is now available and is the new home for PARtalks, Webinars, as well as on-demand learning, and product training. Learn more at parinc.com\resources\par-training.

Hey, everyone. Welcome back to The Testing [00:01:00] Psychologist podcast. I am thrilled to have two guests here with me today. I’ve got Dr. Karen Pavlidis and Fran Schopick, who’s an attorney. They are co-founders of the Working Alliance, which is an education resource devoted to helping mental health providers build awareness of risk management and protect their practices.

We’re going to talk all about the Working Alliance and what it entails, but it’s essentially like how we’re always looking for paperwork packets, disclosures, and informed consents, that kind of thing. So it’s all of that with the added benefit of being co-authored by an actual attorney, that’s Fran.

It’s also a wraparound support system where they offer webinars and add-on modules, office hours consultation to assist practice owners and psychologists in risk management. Fantastic resource and you’ll hear all about it during the [00:02:00] episode.

Fran is an attorney in Washington State with a unique background in psychiatric research and social work. She was a social worker before she became an attorney. She devotes most of her time representing mental health care providers facing Licensing Board complaints. She is a speaker on ethics and risk management, and focuses on strategies for providers to avoid or navigate through Licensing Board investigations.

Karen Pavlidis, PhD, is a psychologist with over 25 years of experience, licensed to practice in Washington State. She is the founder of Child and Teen Solutions in Seattle, a group practice that offers both assessment and evaluations for children and teens. Karen also serves as a Clinical Instructor at the University of Washington’s Department of Psychology.

So like I said, we had a fantastic conversation around risk management and everything that entails. I love getting Fran and Karen’s perspective and seeing how they come at things differently as an attorney and a [00:03:00] psychologist. As always, I think there’s a lot to take away from this episode.

It is that time of year though, folks, if you’re a practice owner or hopeful practice owner, and you’d like to join a coaching group with some accountability and support. My Testing Psychologist mastermind cohorts are starting again in January. So there’s a beginner, an intermediate, and advanced cohort. So wherever you’re at in your practice journey, you can possibly join a group and get some support with that. You can go to thetestingpsychologist.com/consulting and set up a pre-group call if you’re interested.

For now, let’s get to my conversation with Fran Schopick and Dr. Karen Pavlidis.

[00:04:00] Karen and Fran, welcome to the podcast.

Dr. Karen: Thanks, Jeremy.

Fran: I’m happy to be here.

Fran: Big fan. I’m excited to be here.

Dr. Sharp: Oh, stop. I am excited to have the two of you. Karen, I’ve known you for years now. My gosh, I think we met in Chicago, maybe at the …

Dr. Karen: 2019.

Dr. Sharp: Yeah. My gosh, it feels like a long time ago. I’m glad we did. We’ve had a lot of cool interactions over the years and now excited to talk with you about this project and of course, have you here as well, Fran. I know y’all have teamed up and created something pretty awesome for psychologists and we’re going to talk all about it.

We can start with some brief introductions. I’d love to give people a chance to get to know you and orient to your voice a little bit. So Fran, do you want to go first?

Fran: Sure. My name is Fran Schopick. I have a background as an MSW. For many years, I worked as [00:05:00] an MSW, social worker, therapist and also a psychiatric researcher. This was on the East Coast at Mount Sinai School of Medicine and Harvard Medical School.

Then I went to law school. And so now what I do is I represent health care providers who have problems with the Department of Health. I also help people with disclosure forms, because I find that it’s a very important part of their practice, to have a good disclosure form. And that’s turned into this project with Karen, where we are presenting to you today with the Working Alliance.

Dr. Sharp: Nice. How about you, Karen?

Dr. Karen: I’m Karen Pavlidis. I’m a licensed psychologist in Washington State. I was in solo practice for about 20 years and then 4 years ago started a group practice called Child and Teen Solutions in Seattle, and then also have teamed up with [00:06:00] Fran in the last few years to work on this new project.

Dr. Sharp: Nice. Which we will get into all the details. I’ll start though, with this question that I always start with, which is, why is this important? You can answer separately, of course, but why spend your time on this? Why dedicate so much energy to this topic or this project?

Fran: That’s a good question. It’s very interesting, most counselors grapple with the issue of having a disclosure form, what’s also called an informed consent. And for the most part, what they seem to focus on is what’s required. What does the state require that they put in their informed consent?

What I’ve found is that, of course you want to have what is required, but I have found that counselors have certain choices because it’s important to know how they work and what are the [00:07:00] decisions that they make in their practice. If you can put that into your disclosure form, then you’re putting clients on notice about how you work.

You can explore their ambivalence around whatever it is you might do. You can explore your own ambivalence about whether a client seems like a good fit for you. If you put it all in the disclosure form, it’s there to be referenced, to be reminded and to be stated from the very start. It creates a huge advantage in terms of the work that you do and the client services that you can provide.

Dr. Karen: I agree with all of that, what Fran said. And then I would add, I came at this from a different story, and of course I had a disclosure informed consent as a solo practitioner, but it wasn’t until I started the group practice that I had to wake up and discover how important it [00:08:00] is both in terms of having the clinic run smoothly and our clinical work as smoothly as possible.

As I was opening my eyes to that with the group practice, I could look back and see how we all have certain challenges that pop up in our practices. I’m glad we’re talking to probably a lot of your listeners are people who do evaluations, and that’s a big focus of my practice and always has been, and I work with kids and families.

So I think when you bring that combination kids, families evaluation, in Washington State, we have this added complication. I would call it a complication for this conversation, that adolescents ages 13 to 17 can consent to their own care. So there’s just a [00:09:00] lot of nuance when we’re doing services and evaluations.

In these initial months, years of the group practice, I realized retrospectively that there were sections that had I included in the disclosure form in my longer career as a solo provider, it would have really helped smooth out some of the bumps that can come up for us in doing evaluations with kids.

Dr. Sharp: It sounds like it was born in part from just personal experience, which I think is true for a lot of things that we work on. This area is pretty fraught. I think a lot of folks struggle with just documentation and what needs to be in the disclosure form, how much to put in there and what the nuances should look like. I [00:10:00] think there’s going to be a lot to take from this conversation, but y’all, it sounds like you turned your personal experience into a little bit of a springboard to help other clinicians.

Dr. Karen: Very much.

Dr. Sharp: Can you tell me a little bit of the origin story? It sounds like, Karen, were going through some things in your practice and maybe learned a lot through that, but I’m curious how the two of you connected and decided to launch this venture.

Dr. Karen: Awesome question. Fran, do you want to start this one?

Fran: First as a social worker, I spent many years doing individual one-on-one practice. My first job was at an agency in Brooklyn, New York that worked with families, but every permutation of the family. I worked with individual clients who were 2 years old or 3 years old and also who were adults and [00:11:00] teens. And then I worked with sibships; with groups of siblings. I worked with groups of unrelated people. I worked with couples, families. It was a great experience.

I found that the grounding to that work was informed consent, was having people understand what the goals were. Who was the client? Was it the child? Was it the whole family? Was it the couple? The work that we got done was enhanced by that.

Then when I started to do psychiatric research, I noticed that the other people in the project at the school of medicine, they said that they took 2 minutes or 5 minutes to do the informed consent just to get the signature. I realized I was spending 15, 20, 25, sometimes longer with clients, just going through the informed consent because I wanted to give them a chance to ask questions.

Often people would say no, I don’t have any questions, let me [00:12:00] just sign. And I would say, no, for me, then I need to know that you’re aware of this and I want to know how you feel about it because it’s important.

Sometimes I would joke and I’d say there’s going to be a pop quiz at the end where I’m going to ask you questions. I found that process was very helpful. Some people felt that the retention rate was higher when we spent more time with the clients.

So then fast forward and now I’m a lawyer and now I’m helping people put together their informed consent, and I’m just realizing how important it is to have a conversation and to be able to refer back because people, when they come to you for an evaluation or for therapy, they’re not really thinking about what you’re telling them; they’re thinking, I’ve got a problem and I can’t solve it myself and I need your help, can we just get to that?

And so on the part of the therapist or evaluator, there’s an art to it on the one hand, addressing their [00:13:00] concerns, but on the other hand, also wanting to weave in their concerns with the ground rules. I came to realize that informed consent was a two-way street. That it was the client understanding what is involved, but it’s also the therapist or the evaluator understanding whether what they have is what the client needs.

If it’s not what the client needs, then they have an ethical duty as well as a self-protective duty or if it’s not a duty, it’s a hope that everybody can come through this in the best way possible. So I just began to put that together.

And then when I met Karen, Karen has this very interesting practice and very interesting background. And so the two of us, I’m thinking about all these things and she’s like, that’s a really good idea. She found that it was helping her clients. It helped her give better client care and better clarity to the [00:14:00] evaluation process.

So we just realized, wow, this is a really interesting combination and it would be great to put together this product so that we could help people have a better experience with the informed consent and disclosure. The two terms, in Washington, they call it a disclosure, meaning it’s what you disclose to the client so that they can make an informed decision about how to work. Some states call it an informed consent, but it’s basically the same process.

Dr. Sharp: Got you. The way you describe it, it’s almost like, I think it may have been Jordan Wright, who said something like consent is a process, not a document. And this reminds me a lot of that statement, it overlaps quite a bit. That’s fantastic.

From the business aspect, I don’t want to spend a ton of time on this, but a lot of people out there probably [00:15:00] think about selling something, paperwork or who knows, a course or something like that. What convinced you that there was a gap in the market here or what did you see that compelled you to really take the leap and create a business out of all of this versus just hey, we’re friends, you’re an attorney. I’m a psychologist. This is cool. Thanks for the documents. I’ll see you later. How did you take it to the next level?

Fran: Do you want to answer that, Karen or should I?

Dr. Karen: Sure, I can get that one to go. We spent a fair amount of time researching what was out there and that was a really interesting project, and there are a lot of good materials out there. What we were finding was that, at least what we saw was out there, the focus was on requirements. Whereas [00:16:00] a big part of the story of the Working Alliance is realizing the importance of going beyond just what’s our state requirements in the disclosure form.

What I can appreciate is that it really is a tool that helps us work clinically. I could go in all different directions here but in the first months of the group practice, things were bumpy. Just going from solo to several employees and just when you increase the numbers, puts a spotlight on where the vulnerabilities are in the onboarding process when taking new clients. And so each hiccup, I learned to use really productively [00:17:00] because 99.9% of these hiccups are systems problems or a gap in our onboarding process.

And it wasn’t a gap in that we missed something that was required, it was that, you know what, we need to give our prospective clients the chance to understand what to expect from us clinically and so really learning to use the disclosure form clinically, what are the expectations for parent involvement? What can they expect risks and benefits, we can come back to that one if you want, potential risks and benefits when you do an evaluation with us? What do people really need to know?

And it’s that setting the expectations and being super transparent, it empowers the [00:18:00] prospective clients as consumers to make an informed decision, and it also creates consistency within a clinic. We all have our different styles and ways of working but those fundamental processes that make us who we are in terms of the quality that we deliver has a lot to do with the structure and processes. And so there was just so much that happened in that first year.

And to this day, I’d say every week, I’m tweaking and adding things to our form. So back to the question about the business, as far as we know, this is the first project, our document package that really addresses the more clinical nuance and the ways to customize the documents to fit someone’s own practice.

[00:19:00] And so what we have is this add-on bank that goes beyond the core. Anything, Fran, that you would add?

Fran: We’re always saying it’s important to add that this product is educational and informational. When Karen talks about something that’s clinical or referring to her practice, it’s informational about that. We’re not giving clinical advice and I’m not giving legal advice. We’re not creating legal or clinical relationships.

As a social worker, I was aware that the focus of the duty of care is to the client. As a lawyer, my responsibility is to my client, who now would be the counselor because I’m working that way. So in conceiving these products, I’m thinking about protecting the counselor and the counselor’s thinking about protecting the client. And so there’s this kind of [00:20:00] spectrum that we try to cover because I want the counselors to be safe.

And so there was this discovery about what does the counselor need? Or do you need two signatures of parents to go ahead and do an evaluation? Do the clients understand what the confidentiality limits are? Can we really make that clear? It’d be better to make it clear at the beginning rather than say, oh, by the way while you’re $2,000 into the process?

I also realized from my point of view as an attorney helping people with their disclosure forms is that it’s very important for the disclosure form to have the counselor’s voice and that it’s personal to the practice. So people would come to me with their disclosure forms and I would help them with their disclosure forms. It was always from the ground up.

I still enjoy doing that if that’s [00:21:00] what people want, but people would also say, don’t you have some language? Could you just use it? Could we just pop it in? There are pros and cons to that. And then I thought, maybe I could put together some language and have it work but I still want people to speak to a lawyer in their jurisdiction to make sure that they are following the rules of their state.

So it grew into this project where as I became more and more aware, largely through Karen, that this work was helping her give better services and that the work that I was doing, as I was trying to think in terms of the counselors, was actually giving better services down to the clients. So it was a really wonderful progression of awareness.

And then we thought, if we could put together a project, what about the education piece? So then we wrote up this huge piece. [00:22:00] Each section has an explanation as to why this is important and how it can help you protect yourself as well as give better care to your clients so that you don’t make promises that you can’t keep, for instance, or that you don’t overstate confidentiality.

When people say, everything you say here is confidential, that’s not really true. So many exceptions that from the client’s point of view, it does not feel as if it’s as solid as they are under the impression that it is, that everything is confidential because there’s so many exceptions. So it evolved into thinking if we could have a project and a product that was available, and then we can also explain the things, maybe that could help improve the services all around.

Dr. Sharp: I like that frame, looking through [00:23:00] this lens of the consent or disclosure document as a process, as almost like a rapport builder or an alliance builder. It’s all going to flow through to better service and a better experience for everyone.

Fran: And also more people throughout the country as an educational piece, informational, and we’re not practicing, I’m not practicing law, Karen’s not practicing psychology. There are people throughout the entire country who can benefit from this. So we’re hoping that if people find it interesting and useful that they can also access this product.

Dr. Karen: Can I expand on something important that Fran said? Fran, thanks for clarifying that I’m talking about clinical self-referencing how things work at my clinic. [00:24:00] As Fran said, each section, each add-on, each module, each supplemental form has an educational discussion. We went through great pains when we wrote these to make sure that nobody would experience it that we were suggesting that you should handle this this way or that this way. We acknowledge that everybody works different clinically, everybody has different comfort levels with different specialties and subspecialties.

So those discussions about how to apply this clinically are more about, we highlight questions to ask ourselves, to consider this or that, and we give examples and samples, but it’s not meant to be like, oh, you’re supposed to handle it such and such way. It’s just to bring that awareness to that we have [00:25:00] choices and options, and just trying to address some of the blind spots that I think a lot of us clinicians can have.

Dr. Sharp: I think that’s a nice segway, people for better or for worse, love stories of hardship, mistakes and that kind of thing. I know that from what y’all said before we started to record that there are some personal experiences that drove the creation of the Working Alliance.

I wonder if we could spend a little bit of time there maybe framing it. Fran, from your perspective, you could certainly talk about some of the horror stories or things you’ve seen that were not so great and Karen, you can obviously talk about little missteps in your practice or like you said, the bumpy parts that catalyzed some of the work here. So whoever would like to start, like I said, for better or for worse, [00:26:00] people always like to hear how we might be messing up, and of course, we’ll talk about what to do about it.

Fran: The first incipient piece of it was when as a social worker, I was working in New York City. I was based in New York City. I was working in the Bronx at the time and I was on jury duty. Jury duties is very mixed bag so everybody hates it, but then sometimes you develop these little clicks as you’re waiting around to see if you’re going to be called.

We went to lunch and then came back. Somebody said that one of our group of this pod of people that we were hanging out with, she had been hit by a bus. She wasn’t killed, thankfully, but she was hit by a bus. I thought to myself, if I were hit by a bus, would my notes stand up to scrutiny?

I was actually thinking about this, if somebody had to take care of my notes, would they be horrified when they looked at it? Was I up to date? Were they written well? [00:27:00] What would be my legacy for my notes?

And so that really stuck with me. I began to think, it really doesn’t take that much time to write a note as long as you know what you want to do, and it’s actually much easier if I write the note within the 10-minute break that I had between ending and starting another session.

I could do this very quickly if I just put my mind to it. And so I developed this efficiency around doing the notes, which was really very self-protective. I really was thinking if I were hit by a bus, what would my notes show.

And so that was the start of it. And then I began to see that if something were included, I’m trying to think if there was anything you could call a disaster, sorry. I began to find as a lawyer that some people were giving me stories [00:28:00] that were better addressed early. Like someone said, psychologically, I’m so upset, I can’t do what you’re asking. They’d have to write a response to the Department of Health and they’re telling me they can’t write it or they can’t talk to me on the phone about it.

And so I put in my disclosure form, I understand that this is upsetting, I understand that it’s traumatic, but you have to be able to talk to me. If you can’t talk to me, then I can’t work with you. And so I just began to put together these things. Karen, why don’t you go and I’ll try to think of something.

Dr. Karen: Okay. I’m going to knock on wood. I am very superstitious. I haven’t had horror stories. I’d say they definitely fall into the category of hiccups, bumps. I’m a ruminator, lost sleep. I like people to be happy but really it’s around communication.

I think any of us who work with [00:29:00] kids and families know that you have to be really aware when we’re working with divorced families. I’d say just the sheer numbers, you start to see patterns and it puts a spotlight on where the vulnerabilities are. I realized we needed to tighten how we onboard families where the household has gone through a divorce and to educate the parents about how we communicate.

Again, this is not to say what anybody should do, but we found it important to educate families that if we were communicating with parents in a divorce household, we wanted both parents on all of the emails. We didn’t want conflictual emails forwarded to us. We weren’t going to have side conversations with one parent behind the other [00:30:00] parent’s back.

We had to get really clear on payment policies and how payments would be processed for sessions. We also learned to ask certain questions in our screening process with new inquiries, like just wanting to know if the family had been through a high conflict divorce, and we would define that for people who, as part of that question, that’s been really important.

And also learning the importance of inquiring has anyone in the household had legal involvement. Another really important question that’s been important is, are both parents on board with the services that they are seeking? That’s been very key.

Also where we got really [00:31:00] clear, when I say clear, what feels like overcommunicating to us is actually just right for a lot of the people we work with because there’s so much information that we put in front of new or prospective clients. In Washington, with this nuance of 13 to 17 being able to consent to their care, going over the importance of like we can’t have side conversations without the 13 to 17-year-old in the loop or being assumed that they’ll be looped in.

I can pause there, but I can also talk a little bit about evaluations and some considerations there. Should I go on?

Dr. Sharp: I can just validate. I feel like this experience of working with separated or divorced parents is a pretty common one. I feel like of all the issues that I’ve [00:32:00] consulted our practice attorney about in the last 5 years, it’s probably 90% something related to separated or divorced parents, medical decision making, who has access to records and who can do this or that.

We also have that situation where in Colorado, I think it’s 12 where kids can consent to their own services and what circumstances, is that appropriate or not, when can parents be, just to validate all of that.

Fran: And also putting the providers in the middle, putting them in the position of accusing the provider of having violated the parenting plan because they’re not in a position to interpret somebody else’s parenting plan and yet they’re placed in that position or characterized that way by the families. It’s very upsetting. You are triangulated in this power.

[00:33:00] Dr. Sharp: For the payment issue, that would come up a lot in years past. We fixed that by now but it took a few go rounds where we had to be like, look, we are not mediating your payment dispute. One person is going to pay for this and y’all go figure it out. Otherwise, we’re not going to be taking multiple payments from people and deciding who pays what.

Dr. Karen: It takes going through it to realize, oh, we need to be clear.

Dr. Sharp: Absolutely.

Dr. Karen: There were also things that weren’t new to group practice, but more in retrospect, realizing, oh, this would have been really helpful over my career if I had included this and emphasized this for my evaluations.

Often, in my clinical practice, hiccups come up with evaluations, particularly around autism, [00:34:00] whether the diagnosis is given or it’s expected but not given, or test scores maybe being not what was expected. I have found it really important, it’s probably one of my favorite sections of my disclosure form is the potential risks and benefits of evaluation.

So every intake, I start with that. I go over, in quite a bit of detail, what the potential benefits are in validating what the family is looking for. I’m working with mostly kids here that I’m evaluating, and then also just walking through the risk that a diagnosis might be given that’s not wanted, or a diagnosis may not be given that is wanted, or that [00:35:00] there might be some scores.

And also talking about as part of that, not just, okay, here’s the risks, here we go, but also talking about the steps that I take to mitigate those risks and create transparency in the evaluation process. I’d say more recently, seeing that families really need to benefit from education about the reports that we write are, a part of the health care record. And so it’s not a collaborative document where we can just drop diagnoses or drop scores or drop descriptions of scores.

That awareness too, for us as providers, makes us really mindful of what we write and thinking about the importance of sensitivity and who our audience is, which is the client, their parents [00:36:00] and schools often. And then we also talk a lot about gifted testing too, because we see a lot of that in Seattle.

Dr. Sharp: Oh, absolutely. I can imagine. Could we take a little detour here? I would love to hear a piece of how you are tackling this diagnosis expected but not given situation because I think that comes up a lot and that is a frequent topic of conversation in the Facebook community and consultation groups. This is pretty common these days, and then we can pivot. I definitely want to get into the details of the Working Alliance.

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Alright, let’s get back to the podcast.

Dr. Karen: So you’re talking specifically about wanted often like autism, is that what we’re talking about?

Dr. Sharp: Yeah, ADHD comes up frequently, but autism is a big one.

Dr. Karen: Sure. That seems to be a more [00:39:00] current, this wasn’t something that I was grappling with 5 or 10 years ago, this has been in the last two years more and more. What I’m finding is that it’s that open discussion in the intake. I haven’t had a situation like this recently, but I think if I were to realize that someone was coming into this invested, I probably would really talk a lot in the intake about how do they feel about if the diagnosis is not given, and do they still want to go forward?

It’s a big investment of time, emotions, often money, knowing that that might not be the outcome and maybe give them a chance and also us as providers, a chance to decide [00:40:00] whether or not it makes sense to even move forward with the evaluation if it seems there’s discomfort with that risk. I don’t have an easy answer to that. I think it’s new. We’re figuring this out. It’s a good question.

Dr. Sharp: It sounds like just talking about it explicitly and introducing the idea that the outcome may not match the expectations.

Fran: That’s why it’s important to make the distinction between reading the words on the page and having a discussion because the words on the page, they’re a great start. That’s a good start but in terms of getting a sense of what the concerns might be or what the fears of the person or anticipation might be on that person’s part, you have to have a conversation. That’s the way that those issues [00:41:00] can surface so that you can handle them or you can address them.

It’s really important to address them. Sometimes the laws in the state are not clear or there might not be any particular laws about that. It’s really up to you to engage a person in that discussion to find out if you feel that this is a safe place to have this testing done.

I think often people are just focused on getting that signature and move on to the real stuff. My feeling is that that is the real stuff. I’m often saying that having a well-administered disclosure form is the single important risk management tool you have at your disposal.

Well-administered meaning you have these discussions; you allow for questions. If people don’t ask questions, you provide the questions like if I were in your position, here’s what I might be asking or a lot of people ask me this [00:42:00] question and it might be good to go over it.

People might not want to talk about what their anticipated diagnosis would be for their child. And sometimes you even think that the parent will be happy that they might not have the diagnosis, but they’re not happy about it because they really want it in terms of maybe entitlements that they can get from their community or services at a school that they were hoping to get. And so it’s important to explore that early on rather than later.

Dr. Karen: And this idea of conversation is worth lingering over because when I was talking about going over that section of the disclosure of the evaluation intakes, it really is a dialogue and that is where it is an invitation for parents or caregivers to share their thoughts and perspectives on diagnosis. [00:43:00] They bring up some sensitive areas that I don’t think would have been brought up if I hadn’t started that conversation. So sometimes that can take 20, 30 minutes and it’s well worth it.

Dr. Sharp: It makes me think too, about the work that Stephanie Nelson does. I don’t know how much you have seen her stuff but she talks about this idea of secret questions and I see this whole thing as, there’s a lot of overlap there where maybe we start in this place of a sterile disclosure conversation or informed consent, but that pretty quickly moves into getting at people’s motivations for seeking the evaluation and what are their fears around the outcome or their hopes around the outcome and deeper concerns that may not otherwise come up. It’s just another entry point, I suppose.

Dr. Karen: Yeah. I think a common referral is, [00:44:00] hey, can you test my kid for ADHD? And it’s like, just give my kid that test. It’s our job to educate and onboard families about, this is a very complex process where we have to look at the whole picture and it’s not just a matter of giving a test. We have a responsibility, I feel like, to really inform families about that.

Dr. Sharp: I agree. I’m guilty of not doing that. It’s being crunched for time and especially, taking insurance, there’s a lot of, hey, we just need to be as efficient as possible and move to the, like you said, the good stuff, but there’s a lot to be done.

Fran: That’s where that balance comes in. It’s an art to be able to do it in a way that you can tolerate and that you can still get what you need to get done.

Dr. Sharp: I wonder, [00:45:00] I know I keep putting this off. We will talk about the actual product that y’all put together, but this is a rich discussion. I am curious if y’all have strategies; when you say it’s an art, are there ways that you found, either of you, to be helpful in navigating these conversations beyond just hey, do you have any questions about our paperwork? Or, hey, do you have any questions about our policies? How’s this actually getting woven into the appointment?

Fran: One of the disasters that can happen, to give you an example, is where you start to talk to somebody and then they tell you something that requires mandatory reporting. They’ll say something about let’s just say abuse of a child, but you haven’t yet had a chance to get into the disclosure form, so you haven’t formally told them that there’s mandatory reporting.

[00:46:00] What can be helpful is to have in all your materials, like on your emails or on your website, on your call waiting, if there’s a recording as a person waits to get through on the phone to say something about that there’s mandatory reporting, that if there’s information about abuse of a child or abuse of a vulnerable disabled or dependent person, that that you’d have to report so that, at least, that’s out there.

You want to go over it again with the disclosure form, but it’s out there so that if you’re hit with that information before you have a chance, you can at least feel that they’ve been informed. That’s one thing.

So then a person comes to your office and they want what they want, let’s say testing or if it’s therapy, and you’ve got this thing to handle, which is that they need some services from you. By definition, they’ve come to you because they have a problem that they’re not able to solve on their own. They come to you [00:47:00] because you’re a person who’s informed and maybe even an expert in the problem. And so they want your help.

As you’re talking to them, you have no idea of what they’re actually hearing because on some level, they’re probably focused on whatever it is that they’ve come to you for. So if you start in on a consent form, they’re not going to listen to you because they’re like, why can’t we talk about why I’m here?

So in general, it can be helpful to talk to the person about what brings them there. How can I help? What is it that you need? But at some point before you end that session, you’re going to need to go over the disclosure form.

Some people would say that they should sign it before they even walk into your office. The problem with that is that they won’t have had a chance to ask questions, and they won’t have had a chance to be able to say that they have no questions, or that they’re satisfied, that they understand what the whole process is, because you can’t be sure of that.

So it’s a choice that you make. And in general, one way to do it can be to talk to them about why they’ve come to see you and spend time on that. [00:48:00] And you know what the disclosure form says, so you can begin to weave in some of those concepts as they’re telling you about their problem.

So they get the satisfaction of telling you about their problem, you’re listening and hearing why they’ve come to you, but you’re also planting the seeds of the disclosure. And then at some point, you’re going to say, the intake process might take more than one session, but I need to look at this disclosure form with you and I need to be sure that you understand what’s in it.

Hopefully, they will have read it so that they have some chance to ask questions. They’re usually likely to say, oh, no, I have no questions. Let me just sign it. Let’s just get onto the real work. And then that’s the moment where you can say, for my benefit, I want to be sure that you understand certain things. I need to know that I’ve communicated certain things to you clearly.

And you can also say, as I said before, you can say that these are some questions that a lot of people ask, or if I were in your position, here’s what I’d want to know. And so you’re constantly [00:49:00] balancing their needs with yours or characterizing the needs to go through the disclosure form as a need of theirs because it is a need of theirs.

They do need to be put on notice of these things. They do need to understand certain things. It’s just that that’s not the need that they want to address first. So you’re always engaging in this balance of administering the disclosure form, but at the same time addressing why they’re there and how you can help.

Do you see what I mean? It’s an art, I don’t mean artful in the sense of manipulative or complicated or wrongly based, the art in the idea that it’s that art is taking the human need and being aware of how it fits into the whole picture but it’s a very complicated balance when you think about it.

And then also the fact [00:50:00] that you are engaging a person and depending if it’s therapy or evaluation, how you see your role, if it’s a compassionate role or if it’s a client-based role or humanistic role or whatever that might be, but also you’re in authority. Even if it’s something you work with client determination, that doesn’t mean that you give over the authority. You’re always balancing your own role so that you can provide the best services possible. It’s very complicated.

Dr. Sharp: It is complicated.

Dr. Karen: I have some other angles too, today. One of the harder things of what we’re talking about as far as communicating the information and the disclosure is that it’s so much language and it’s so much reading and I think it’s a lot to put on our clientele.

I haven’t found a [00:51:00] solution for this but one of the things we do, we find that at first inquiry, there are scripts or email scripts for responding to initial inquiries have critical information about how we work, specifically around the role of parents and a little bit about how we work with families where there’s been divorce.

And so at that first inquiry, we’re giving people a chance to self-select already a little bit. So then the people who want to go on to the next phase then, again, with each journey, I recently was realizing I mapped out the client journey before they even see a clinician.

There’s six phases for the client journey and in most of those phases, we’re [00:52:00] doing some of that onboarding and educating about how we work. So it’s some content that’s in the disclosure form or in these email communications.

There was a time I experimented with, I didn’t continue this, but I literally had a PowerPoint video for families as a way to lessen the reading load, to go over some of the really key areas for people to understand. I had a lot of positive feedback about that. What was hard was that it’s hard to keep up to date but I might go back to that.

Another thing that we’ve done is for teens. We have a teen handbook. It’s an online document, but now that we’re doing a lot more in person, they get this physical handbook that talks [00:53:00] about cancellation policy, but also how we handle confidentiality, how we handle disclosures about self-harm or suicidality. It’s got these lovely graphics, and it’s engaging, and so it’s also a way for the clinician that supplements the onboarding.

And then we also, within the first month or so, this is something that I’ve more recently discovered is really helpful, is having a formal treatment planning meeting with the families and seeing are we all on board with why we’re here? Not only like why we’re here, but how we’re going to get from here to there and what kind of alignment do we have? And that has been really powerful as well.

And so even though that doesn’t look like the [00:54:00] disclosure, it is related to that process because it’s orienting people and giving another chance to have this discussion maybe several weeks into starting.

Fran: And also always being clear about who’s the client and who’s a collateral because parents might approach you for services for their child, but if the child is the client, that’s where the focus is and the duty of care.

Especially when you have a 13-year-old, or as you say, in Colorado, a 12-year-old in charge of the process, there’s a real departure from the normal or the usual power balance within the family. Usually it’s the parents who tell the kid what to do, but in this case, for the parents to even talk to you, they might need a signed release of information from the child. So that’s a big adjustment and it’s important for the evaluator to be clear, and you’d be surprised how many times people are not clear about who’s the [00:55:00] client.

So it sounds like a simple question, but it’s not a simple question, and that’s a really important piece of the care, is making that clear, because you might be clear about it but the clients, whatever that means, whoever those people are, the people in the room might have a different understanding of it.

That’s why Karen was talking about overcommunicating. One example of it is that you think it’s clear because you said it once, but it’s not necessarily clear. It’s important to reiterate it every time so that it’s reinforced and everybody’s in agreement about it.

Dr. Sharp: That’s such a good point. In a profession that’s based so much on trust, this is a huge part of the process in doing our best to ensure that we’re transparent and communicating everything as clearly as we can. It’s easy to miss things.

[00:56:00] Let’s talk about what y’all have going on. This has been a long buildup, but give me just big picture, what is the Working Alliance?

Fran: Karen.

Dr. Karen: Okay. We were excited when we came up with the name, the Working Alliance. A bit of a play on words. What Fran and I have discovered is that together we have a synergy in ideas, and we write really well together, and so we’ve created this working alliance to help providers with the alliances that they have in their work.

In the last 2 years, we’ve done a [00:57:00] number of continuing education talks more locally, like to the Washington State Psychological Association, UWO, Seattle Children’s and then some other early career psychologists in Washington State and some other areas of our mental health community.

Fran, for years, has been presenting nationally for continuing education on law and ethics. I think where our synergy, where we focused a lot in Washington is working with the nuances of working with children and families as well as considerations for reducing risk of board complaints.

Our primary emphasis when we formed the Working Alliance was on these educational webinars. And then as we moved forward with the project, we got more fine-grained in the products, and so we have [00:58:00] a core form that aims to cover core requirements, at least, in Washington state.

And then also we have a bank of add-ons. And like we were talking about before, each add-on has an educational discussion. So it’s not just a template. And then we also have supplemental forms. The nice thing is that we’re always building our bank and so this is a plug, but anybody who purchases the document package will have access to a dashboard, so any sort of revisions or add-ons to the bank of document modules, they would have access to that as well.

We were also going to talk about the M&M Review, but I’ll pause there.

Dr. Sharp: I think that’s a good start. I [00:59:00] just want to make it really clear for folks what they might see when they go to the website and what the product is here, so to speak. It’s pretty full-featured. Y’all have put together a lot of pretty amazing materials, and I want to make sure folks know what all is out there.

Dr. Karen: Yes, we have a solo document package, and then we have group practice. We have two different price points, depending on the size of the group practice. And then we also have, for larger group practices, the option to have us customized because we figured the larger the practice, the more need there’s going to be for customization, but the solo and group are basically the same, it’s just different wording, instead of my policies, it’s our policies.

And then we also have, for the group [01:00:00] practices, a provider addendum so that each provider has a document with their own education history. Examples of some of the add-ons we have are modules that we would consider of general interest like adolescence and confidentiality, LGBTQ+ affirmative mental health care.

We have sections on role clarity, multiple roles, a lot about communication, so how providers might think about electronic communications, questions to consider about a “No Secrets” policy. We also include discussions about respectful communication and how that’s a value in the workplace. Again, for providers who are interested in this, who want to also communicate to [01:01:00] clientele that there’s parameters around respectful communication.

And also we thought it was really important to include a section that addresses domestic violence. For testing and evaluations, we talk about that all important topic of risks and benefits of evaluations, working with psychometrists, issues that come up with gifted testing.

We also have templates for release of information, collateral consents, provider addendum for group practices. And then we have a child assent not as a form, but as a guide, just questions for providers to consider when having discussions around child assent.

We have a long list of ideas, we just realized we wanted to launch with at least a subset of our ideas but [01:02:00] our intention is to keep adding to that bank. And also we want to hear from people, what they think is missing and what they would like to see, because we will write those add-ons as well. So that’s the document. And then let us know when you want to talk about the M&M review.

Dr. Sharp: We can transition to that, but I want to highlight on y’all’s behalf that yes, you have this really comprehensive document package that you can tailor for different types of practitioners or groups. And like you said earlier, it goes beyond the documents. It’s these modules, these webinars, you mentioned office hours, it’s a, I don’t know if wraparound support is the right term, but it’s a pretty comprehensive, almost like risk management option for folks if they want to take advantage of some of those resources that y’all have built into the site, [01:03:00] which is super cool and distinct from some of the other similar offerings out there.

Dr. Karen: Thanks, Jeremy. We wanted to provide people with a dialogue with us, and so we’ve already held some office hours, some webinars and plan to schedule more in the new year. And then we do have this, I guess I would call it a specialty service that is also on the site that we call the M&M Review.

This is for anybody who wants to have a consult, their own hour devoted to a conversation with Fran and I either about something difficult that happened that they want to debrief on and we’re very clear that it’s not legal [01:04:00] advice, it’s not clinical advice that we’re there.

We would never want to have these conversations about an adverse event when someone’s in the midst of an adverse event. We always think people need to hire an in-state attorney and consult with their risk management services through their insurance if they have that available, but it could be really helpful after the fact to debrief and do a review of the practice and risk management just in general to see where maybe some systems can be strengthened.

The idea of M&M Review truly came out of just a casual almost joking frame that I came up with early on in that first year at CATS, my group practice clinic, where, as I mentioned earlier, every bump, every hiccup, we [01:05:00] analyzed in a way that was incredibly productive.

And so the term M&M stands for morbidity and mortality, as some listeners may know. I heard about that on Grey’s Anatomy. I would serve M&M’s and it was just a way to warm up difficult topics. We still have M&M Review and it’s always followed by happy hours. That’s very key part.

Dr. Sharp: That always happens.

Dr. Karen: It’s Friday.

Fran: You can […] it with happy hour, and then people will talk more freely.

Dr. Karen: There’s an happy hour after we’re through the hard stuff but when I looked up, where did this idea, I know it didn’t start in Grey’S Anatomy, where did it come from? So reading a little bit about it, I learned, okay, this has been around for at least 100 years.

The [01:06:00] idea has always been to take mishaps that happen in a medical practice and look at how those can be prevented moving forward. The intention is always for it to be psychologically safe, non-blaming. That is not what I saw in Grey’s Anatomy, but it is how we practice the M&M Review is that that sense of psychological safety is so crucial and that most of these things that happen are not a people issue, they truly are a systems issue.

And that has been the number one most, I’d say, powerful source of how we’ve improved our systems and our communications with our clientele, and I love it. So we thought, oh, this would be really cool to offer [01:07:00] people as well.

Dr. Sharp: I love that, like a debrief, a post-mortem.

Dr. Karen: Exactly.

Fran: Which I heard you once say, Karen, that a crisis is a terrible thing to waste.

Dr. Karen: Yeah.

Fran: And I thought that was a great way to put it, that it’s really a learning opportunity when you’re both intellectually and emotionally invested in wanting to make it better the next time.

Dr. Karen: Absolutely. I think that’s a Winston Churchill. Every crisis, it’s like, ooh, we lost sleep. It was stressful, but let’s sink our teeth into this and make great use of it and it can be incredibly productive.

Fran: I agree with Karen’s point about how there can be these systems issues, but I’ve also seen that when I asked people, did you see this coming or just to ask, did you have a sense of this [01:08:00] family or this person or this situation being fraught? Usually, they do because counselors and evaluators, one of their strengths is that they see these things coming. They understand when people are upset before the person knows that they’re upset or that the people are angry before they know they’re angry.

So they do see these things coming, but the other side of the work is that you don’t want to be judgmental. There’s this feeling that you should be neutral, that you should give the person the benefit of the doubt. So what can end up happening is that you give the other person the benefit of the doubt to your own detriment.

And this is another way in which we’re trying to help people do these debriefs, the M&M debrief or just in general to call a situation for what it is when you’re trying to decide if you’re the right person, if what you have to offer is what these people need or bringing together those matches.

It’s an encompassing a 360 approach to this work and [01:09:00] using the disclosure form in order to help you do that, and then process. That’s the overall of what we’re trying to offer here so that people can protect themselves before they enter into these situations, but also in the situations, how you can make the best of it and afterward, how you can debrief.

Dr. Sharp: That’s the thing that I love about this approach is that it’s a 360-degree perspective where you’re trying to support clinicians at every step of the process. I love the idea of the debrief because that’s, I feel like we never get that. Maybe we do it with our friends or colleagues or spouses or whatever, but to actually sit down and have a little bit more formal informed debrief and think, what do we learn here? What would we do different? And have some real input from professionals is [01:10:00] super helpful.

Fran: Right. A lot of these forms that we’ve seen are, this combination of my being a lawyer with being with the social work background and Karen’s being a psychologist, we bring a lot of experience to it and a lot of thought over the years, I think that they’re unique in that way too.

Dr. Sharp: Sure. I appreciate y’all coming on. I know we’re pushing time a little bit and just talking through all of this with me, the more you share about it, it just seems clear that you’ve put together a pretty stellar thing here for folks to check out. And Lord knows, risk management is something that we have to deal with on a pretty regular basis. So I hope that folks will go check out the website and see what’s out there, and reach out.

Fran: Yeah. Thank you for having us. This has been great.

[01:11:00] Karen: Yeah.

Dr. Sharp: Good. I’m happy to have you. Thanks for coming on. I’m very grateful.

Fran: Okay, thank you.

Dr. Karen: Jeremy, we are going to give a code to your listeners for 10% off the documents. We will share that with you, but this has been really fun. Thank you, Jeremy.

Dr. Sharp: Of course. I’ll put all that information in the show notes for anybody listening to make sure you go grab that code and check out the Working Alliance. Thanks y’all.

Fran: Thank you.

Dr. Karen: Thank you.

Dr. Sharp: 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 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.

If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing [01:12:00] 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 website are intended for informational and educational purposes only. Nothing in this podcast [01:13:00] 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 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.

Click here to listen instead!

[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at the 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 podcast is brought to you by PAR.

Use the Feifer Diagnostic Achievement Test to hone in on specific reading, writing, and math learning disabilities and figure out why academic issues are occurring. Learn more at parinc.com\feifer.

Hey folks, welcome back to The Testing Psychologist podcast. Today is a [00:01:00] business episode; the second episode in an annual series that I started last year. It’s called Business Topics I’m Thinking About for the following year. I really enjoyed putting together this episode last year for topics that I was thinking about in 2024 and so I am going to chat a little bit about business topics I’m thinking about for 2025, because part of my job as the visionary for our practice is to dive deep into trends that could influence our practice and generate ideas for improvement and generally keep my finger on the pulse of the industry, so to speak. So I’ll be sharing some things that I’ll be thinking about for 2025.

It’s interesting to reflect back and see that there’s a fair amount of overlap between last year’s episode and this year’s episode which maybe speaks to the idea that things don’t develop as quickly as I would think and trends tend to extend on a longer timeframe but we [00:02:00] will see how these things play out.

Now, not all of the ideas directly impact our practice, of course, but I think it’s valuable to brainstorm and identify potential areas to be working on and thinking about over the next 6 to 12 months, as we continue to try to run the best practices that we can. 

Speaking of which, I promise I didn’t plan that transition, but this is the time of the year when my mastermind cohorts start up again. So in January 2025, there will be cohorts for beginner, intermediate, and advanced practice owners with testing as the main focus of the practice. These are group coaching experiences where you can expect support and accountability to work on your practice and do the best that you can and make it the best that it can be. So if that’s interesting to you, you can get more info at thetestingpsychologist.com/consulting.

All right y’all, let’s talk a little bit about trends [00:03:00] for 2025.

Okay, everybody, here we are talking about business trends in the mental health and neuropsychology industry for 2025. I’m going to jump right into it without further ado.

Topic 1. Now, these are in no particular order in terms of importance or urgency or anything like that. So you can sort through these and decide for yourself what feels most important, but I’ll start at the top, increased testing fees. This was an item from the list last year as well and here we are again. I think that most of us have probably gotten those emails from the test publishers talking about raising rates again in 2025.

This is not a popular stance, [00:04:00] but I’m going to try to split the difference here and see both sides. We talk all the time about raising our own rates to match inflation and standard of living and so forth. I get it from a business standpoint that these companies are doing what they have to do to cover the costs for employees and other expenses in their businesses. That said, it’s really unfortunate that we are the ones that bear the brunt of that.

I’m not enough of an economist to know if this is how things should work but it seems like this is how things go. Businesses and other goods producers raise the cost of their services or goods to cover expenses, and then we just pass that expense along to our clients in the form of raising our rates, and [00:05:00] then there’s pressure on businesses to raise wages to cover the cost of goods and services. I don’t know what the right solution is but it seems like this is how it goes. If anybody out there is an economist or can tell me how this should work, please reach out. But this is the reality. Testing publisher companies are raising their fees for testing materials. 

Last year, we implemented a testing materials fee to offset some of the cost of the rising materials cost. Some people can do this. Some people can’t. I certainly advise checking with all of your insurance panels if you’re an insurance-based practice, which we are. I had to check with the panels to make sure that these fees are legal under our insurance contracts. Some of them said no. Some of them said yes. So we are charging materials fees for the [00:06:00] panels where it’s acceptable and we rolled the materials fee into our private pay rate for clients who are private pay. So if you’re a private pay practice, I think it’s definitely worth raising your fees at least enough to cover testing materials.

I may have mentioned on the episode last year or on other episodes that the cost of testing materials is now somewhere in the neighborhood of $100 to 150 $per comprehensive pediatric evaluation. For adults, it’s a little bit less, but not much. That’s a substantial expense.

One thing that I actually found effective was with our insurance panels, bringing this to their attention and using that as a negotiating point for increasing reimbursement rates, it actually did work in the case of one panel. So you may be able to document these increasing materials fees, take that to panels, [00:07:00] and use that to justify a raise in rates. Lots to think about here, but the reality again is that testing materials fees are going up and insurance reimbursement is generally not keeping pace. So I think it’s up to us to take these fees and these costs to the insurance panels and try to make an argument to raise our rates. Private pay practices will certainly have an advantage because you can just raise your rates to cover the materials cost as you would like. Either way, consider a testing materials fee and check it out to see if that is an acceptable way to cover some of these costs.

Now, the next topic is AI, of course. AI is continuing to grow. I actually had some thoughts and have heard on various business podcasts that the AI boom might be plateauing a little bit. I don’t think that’s necessarily [00:08:00] true. I did some research in preparation for this episode and the projections say that the AI market share is going to quadruple or quintuple within the next 5 to 6 years. It doesn’t seem like there’s any indication that AI is slowing down.

I think the initial rush to AI and that initial round of every business incorporating AI in some form or fashion, like just getting some basic implementation out there, has died down and now we are maybe in the one-and-a-half or second phase of AI implementation where the tools are getting more sophisticated. It’s going beyond chatbots or wrappers around chatGPT and that kind of thing. So if you’re not using AI in some form or fashion, I would say, prepare to get left behind essentially. [00:09:00] You have to at least have some understanding of AI, how it’s being utilized, where it’s showing up in the different industries.

I think about it in terms of direct and indirect effects. And so let’s say you’re not ready to implement AI in your clinical work, which is fine, lots of feelings around that and fears, I think, and some resistance. So let’s say you don’t want to use it in your clinical work. You still might want to leverage it for scheduling tools, writing emails, or using it in Canva to generate images or graphics.

It’s just getting implemented everywhere. I think relatively soon, we’re going to see some major differences emerge between folks or businesses who are successfully utilizing AI and those who aren’t. [00:10:00] I’m going to take a maybe radical position and say it’s going to be a car versus horse-drawn carriage situation sooner than we think as AI frees up our brain power to do the most important parts of our work instead of spending time on the minutia.

What does this actually mean?

There’s AI solutions in almost every software that you’re using. A lot of our EHRs are starting to build in AI, especially for therapy note summaries and things like that. If you’re not doing therapy, that’s fine. Google Workspace has AI built in to summarize emails and generate documents. Microsoft, of course, has Co-pilot who is their major investor in open AI, which is the parent company of chat GPT. So it’s integrated in pretty much everywhere. And like [00:11:00] I said, I see AI as a tool and not as a threat. And if you are not willing to learn how to utilize AI in some form in your business, you’re probably going to get left behind as other folks do.

Like I said, I think the cool thing about AI is that it frees up our brainpower to do the more important parts of our work so that we don’t have to focus on little details and mundane work. In the context of evaluations, that means you can leverage some AI solutions to write your background and history, generate your tables, or write those parts of the report that are a little more scripted or templated so that you can focus your brain power where I think we should be spending our time, which is the conceptualization or summary and writing really good recommendations. You can even use AI to help with that.

[00:12:00] Full disclosure, I’m a co-founder of an AI-driven report-writing program. It’s called Reverb for those of you who have not heard of it. But there are many other ideas or software solutions out there. So even experimenting with various large language models or using something like Bastion can give you a leg up.

In conclusion, AI is going to continue to grow. I think it’s really up to all of us to learn how to use it. I don’t think AI is going to take our jobs, but I think folks who know how to use AI are going to slowly grab more business than folks who don’t know how to use AI simply because they’ll have more time and brainpower at their disposal.

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 [00:13:00] 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 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.

[00:14:00] The Feifer Diagnostic Achievement Tests are comprehensive tools that help you help struggling students. Use the FAR, FAM, and FAW to hone in on specific reading, writing, and math learning disabilities, and figure out why academic issues are occurring. Instant online scoring is available via PARiConnect, and in-person e-stimulus books allow for more convenient and hygienic administration via tablet. Learn more at parinc.com\feifer.

All right, let’s get back to the podcast.

All right, the next topic is, I’m calling it reality sets in as far as practice ownership post-COVID. I talked about this a little bit last year, but I think we’re continuing to come off of the COVID boom. COVID was huge for a lot of mental health practice owners. Practices grew very [00:15:00] rapidly. Group practices got bigger and bigger. Hiring was relatively easy. The referrals were like a fire hose for most practices. We couldn’t hire people fast enough to meet the demand and even solo practitioners felt more confident to take the leap from agencies and so forth. 

But in the last year, I think things have changed. Some insurance panels are maintaining or expanding telehealth access, but others are reducing reimbursement for telehealth. So we’re starting to see some of that demand go away. On the venture capital side, I’m definitely seeing venture capital lose interest in telehealth-only practices. Folks seem to really value in-person work more and more. So if you’re in that phase where you’re thinking about selling your practice or building something to sell, just know, it seems like the VC money [00:16:00] is drying up a little bit for telehealth-only.

What else are we noticing in this area?

Referrals are slowing down for many people as we, I think there are many factors with that. We went through a period of inflation, that’s largely come down, but we did go through that period and potential clients are watching their budgets a little more closely. I noticed it started probably around this time last year, maybe September 2023, people started to talk more about I’m not getting as many referrals as I used to. I am paying for advertising for the first time in forever. So, like I said, referrals are slowing down a bit and we’re coming back to a little bit of equilibrium, I think following the post-COVID boom.

Now, within the last several months, I’ve also noticed a lot of group practice owners becoming disillusioned with practice ownership and either shutting down [00:17:00] entirely, enduring practice ownership with slim profit margins and frequent people problems that seem somewhat intractable or see going back to solo practice. This is a common theme in the Facebook groups, listservs, and circles that I’m in as far as group practice owners. And this applies to folks who are relatively small and relatively large.

I think a lot of group practices grew pretty quickly and did seem to do well at least through COVID and for the years after, but now it’s coming back full circle where the ones who are surviving and actually thriving are the group practice owners who’ve put in the work to become good leaders, have a great handle on finances, and are willing to actually make those hard decisions around running a business versus [00:18:00] supporting employees and paying them relatively high rates and things like that. I think this is more of an issue with therapy-centric practices because groups like Alma, Headway, and so forth are providing a lot of competition for those groups.

So what do you do about this? If you’re a thriving group and you love what you’re doing, now might be the time to look to acquire those smaller practices that are on the verge of shutting down or even some of the larger practices that are on the verge of shutting down. There are also a lot of folks who are “aging out of practice” as the baby boomer generation gets older and those folks might want to sell and maintain a legacy. If you’re a growing practice, there’s a great opportunity, I think, to look for some of those practices.

Now, if you are not happy or otherwise struggling as a practice owner, you are not alone. I personally made a huge shift early in [00:19:00] 2024 to scale our practice down. I talked about that in a podcast several episodes ago. So don’t think that you have to endure it just because you’ve sunk a few years and a lot of money into your practice. Get real with yourself about options for increasing the joy in your practice and in your life, right? Life is short.

Otherwise, in this realm, I’m thinking about continuing to nurture my team, both clinically and personally. And if you’re a group practice owner, I think your job is making sure your team is totally on point. You cannot ignore your people. This is one of the advantages that we offer over solo practices; the collaboration, the team environment, the support, and all the things that come with being a group.

All right. What else? Next topic? Master’s level testing. This is interesting. I think this is an emerging trend. There’s a lot of [00:20:00] discussion around this in the last few months as APA is considering master’s level licensure for psychologists.

I don’t know what to say about this other than having a lot of mixed feelings. On one hand, I think we do have a shortage of neuropsychologists or testing folks, on the other, I absolutely do not want to dilute the practice of assessment. I imagine that this is probably a similar dynamic that happened for psychiatrists when psychologists and others started doing therapy or, as it stands now, prescribing medication. I know that there are many masters level folks out there who can develop the expertise just like all of us with the time and the training to do so, but I’m curious how that will play out in real life, and if we’re going to find that there are programs out there that offer shortcuts or subpar training and assessment.

So what do you do? If you’re concerned about masters’ level folks taking your job, I would encourage you to spend that energy into [00:21:00] honing your own expertise, figuring out how to stand out from the crowd, and figuring out how to market yourself or your practice. Spoiler, the general public is not going to know or care about qualifications when they’re looking for someone to do testing. If there’s a master’s level person out there with a great website, great copy, and willingness to present themselves confidently, the general public is not going to know that they need a psychologist or maybe even want a psychologist. So, rather than complain about it, I think we’re going to need to spend our energy, like I said, figuring out how to stand out, communicate your expertise, and distinguish yourself from the crowd.

If history is any indication though, it’s very unlikely that we’ll reach a point of true saturation in the market. I think there are enough clients for everyone if you’re doing good work and being a good person. Building relationships in your community, like I said, doing good work, [00:22:00] and focusing on presenting yourself in a way that’s attractive to potential clients.

The last thing that I want to talk about is the trend of being in person again. This is another post-COVID trend, but worth highlighting, I think. And this cropped up for me around two personal experiences. Over the last two years, I have hosted this Crafted Practice event, which is a business retreat for testing psychologists. The past two summers, I’ve done this event and people are enjoying the connection and energy that comes from being in person again, at least in my data point of one.

But then I also saw this when I attended the NAN conference in November, just a few weeks ago. This is the first neuropsychological conference that I’ve attended in person in years and it was so much better than sitting on a computer [00:23:00] all day watching virtual presentations. I recognize there’s some personal preference at play here. Some people would prefer virtual, and some people want to be in person, but just for me, I think we are built for relationships and connecting with people, being around people. There’s a collective energy that’s so much greater than the sum of the parts. The data would say this as well. Trends are pointing in the direction of saying that the vast majority of people prefer in-person events.

There is still a market for virtual events, but in-person events are making a resurgence, and like I said, the research is certainly saying that people prefer in-person events, but the good news is that you will likely have your pick. Lots of events are doing a hot bird model where you can come in person if you would like, or you can attend virtually as well. So you might be able to choose [00:24:00] which option you would prefer.

All right, folks. These are just a few topics, like I said, that I’m going to be thinking about for 2025. I did not get into different service lines and things like that, that you might offer in your practice. Last year, I talked about coaching, financial therapy, and sober curious therapy things like that. That stuff just isn’t top of mind for me these days because we are not offering therapeutic services in our practice anymore, we’re solely testing-focused at this point, but I hope that some of these topics stood out to you.

I’m really curious, if you’re thinking about anything in particular, if there are other trends that you’re seeing, make some comments on this post or shoot me an email, at jeremy@thetestingpsychologist.com. Perhaps it can turn into another podcast conversation.

I wish all of you well and I’m looking forward to what [00:25:00] 2025 brings.

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 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.

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 [00:26:00] 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 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 listeners of this podcast. [00:27:00] 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.

Click here to listen instead!

[00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years. 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/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/spectra.

[00:01:00] Hello everyone. Welcome to The Testing Psychologist podcast. I am talking today about another business question; this is a question that came from one of my mastermind groups, which is often where I get content for the podcast- lots of good questions in those groups, and sometimes a little more discussion is needed and it’s worth sharing with the broader audience. The question in the group that I would like to talk about today is when do you know that you need to hire another clinician? This is aimed at anyone who’s considering hiring.

So you could be in solo practice. You could be a group practice. It’s going to be applicable across the board. It’s a deceptively simple question that most of us, myself included “feel into”, as my wife would say, without paying attention to the metrics that are right in front of us to help guide that decision. So stay tuned to learn what I think is a pretty easy equation that will help if [00:02:00] and when you need to hire and how many folks you can bring on.

Speaking of mastermind groups, y’all know I am promoting my groups heavily right now because new cohorts start in January 2025 for beginner, intermediate, and advanced group practice owners. If you’re a testing practice owner and you want some accountability and support from other folks who get it and know what you’re going through, check out the groups. You can go to thetestingpsychologist.com/consulting, get more info, and schedule a pre-group call.

All right. Let’s talk about the equation that will tell you when you need to hire.

Okay, everyone, we are talking about the equation that’s going to tell you when you need to hire and how many [00:03:00] people to hire. For my practice ownership journey, a good part of my practice ownership journey, I basically just hired people when I could find them and when I thought that it would be a good idea. Typically it went something like this, Oh shit, we’re really busy and booked far out. I should probably hire somebody. Or someone would email me asking for a job and I’d say, sure, come on in for an interview. Or I would think, wow, we have two open offices. I should probably hire people to go in them.

I don’t know if any of that sounds familiar, but this is the process of hiring for me for a long time. I will call that reactive. It’s very reactive. We’re seeing what’s going on in the practice and haphazardly deciding to bring people on. So if that sounds familiar to you, you are not alone. This is typically how it goes.

But lately, I have been turning to a more data-driven approach to hiring that I suspect is very common in “real [00:04:00] businesses.” I did some research on this very problem and found that large corporations and hospitals have full-time positions dedicated to, what they call capacity planning and infrastructure. They utilize sophisticated data on patient or customer volume. They do some forecasting. It’s essentially a science of figuring out when you need to hire, how many people, what positions and so forth.

For those of you who’ve listened to the podcast for a while, I’m a big fan of approaching our practices as if they are real businesses because they are, but we don’t get that. It’s easy to forget that and easy to not step into that role of actually running a real business, but we can borrow some of these strategies from real businesses and utilize them in our practices.

The good news though, is that you don’t have [00:05:00] to employ a complex model to figure out when you need to hire. I think there’s a pretty simple equation that can help you know when you’re ready to hire and how many folks you need to hire. The only prerequisite here is that you are tracking your booked appointments.

If you didn’t catch the episode on metrics earlier in the month, definitely go check it out for more info on which statistics and numbers to track in your practice. One of them I did talk about was how many intakes are you booking each week. That’s the one that I’m going to focus on here for the sake of this discussion. I want to keep it very simple and just boil it down to one single number essentially, and that is how many intakes are you booking each week. 

I want to be very clear. We’re not talking about how many intake spots are open each week. That’s more like your capacity. We’re talking about how many intakes are you booking in a given calendar [00:06:00] week.

Just to bring this to life, let’s just say that our capacity here in our practice is two intakes a week. That’s what my clinicians handle. Our full-time folks do two intakes a week, but in any given week, our schedulers will receive, we’ll call it, I don’t know, six phone calls for intakes and we’ll book five of them. So we’re booking five intakes further out down the road and that’s the number that I’m talking about; how many calls are you getting and how many of those calls are we booking into intakes further down the road? So this requires that you are booking further down the road and you’re not doing a wait list model or something like that, though I think you could adapt it to that. I’m operating on the assumption that you’re getting calls each week. Those calls are more than you can handle and you are essentially [00:07:00] booking more appointments further and further out that you don’t have the capacity for.

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 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. [00:08:00] 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, with no strings attached, check it out and see why everyone is switching to TherapyNotes.

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All right, let’s get back to the podcast.

That number is important because it just tells you how many real clients you are booking in intakes that will likely follow through.

Another caveat, I’m going to assume that all these folks are showing up for their appointments. You can add a show rate into the equation if you would like, but I’m going to keep it pretty simple.

So what is this equation?

It’s taking current demand; this is the average number of intakes booked per week that I was just talking about, and subtracting your current capacity; which is the available intake slots per week, and then [00:10:00] dividing by clinician caseload. I’ll say that one more time, but then I’ll walk through an example to try to bring it to life a little bit.

So again, you take your current demand; this is the average number of intakes booked per week, subtract the current capacity; which is your available intake slots per week, and then divide by the clinician caseload.

Let’s do an example. Again, this is straight from our practice. I know from tracking our KPIs that we are booking 23 intakes per week on average. Every week we are adding an additional 23 intakes somewhere down the road. Typically it’s 4 to 6 months down the road, we’re booking these intakes. So 23 intakes per week are getting booked. I also know that we have the capacity to do 20 intakes per week at this point based on our staff.

Let’s go back to our equation. Current demand [00:11:00] is 23 intakes per week on average. The current capacity is 20. So 23 -20 = 3. I also know that our clinician caseload is two intakes per week for a full-time clinic. So then we have the bottom number. 3/2=1. 5, which tells me I can either hire one clinician and not quite meet demand and we’ll continue to book further and further out or I can hire two clinicians and run the risk of the second clinician not being totally full. Though this honestly has never happened. The demand has always exceeded the capacity in my 15 years as a practice owner. It’s like the highway problem. The more lanes you add, the more traffic it generates and that seems to be true in our practice as well, at least up to this point.

Okay. So go through it [00:12:00] one more time. You have your current demand, which is the number of intakes you’re booking a week. For me, that’s 23. You subtract the current capacity; which is the available intake slots per week. For me, that’s 20. So that gives us a 3. And then you divide that by the clinician caseload. And for us, that’s two intakes per week. So 3/2=1. 5. That is the number of folks you need to hire.

Now, you can also use this equation for admin staff or schedulers. If you know that you’re getting 60 calls per week on average, and your current scheduler capacity is 40 calls per week, all you need to know is the average “caseload” for a scheduler. So let’s call it 20 calls per week. So 60 minus 40 divided by 20 equals 1. So you theoretically need 1 more scheduler.

All right. So as is the case, whenever I talk about math on an audio podcast, I know this is tough sometimes maybe to follow. [00:13:00] All you need to know is how many intakes you’re booking in a given week, what your current capacity is, and what the average caseload looks like. So it’s an easy three-part equation. You can check the show notes for a simple written version of the equation. As always, I think I said a couple of episodes ago, I’m now doing the strategy sessions where you can book a one-off a la carte hour just to talk through some of these questions. We can work through the numbers, we could do the equation, and hopefully get you to a better place and help you feel confident that you are hiring appropriately to meet the demand that your practice is seeing.

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 [00:14:00] listen to your podcasts.

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 [00:15:00] podcast and on The Testing Psychologist 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 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.

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