Today is the day Blue Cross Blue Shield cuts my reimbursement rates by 11%. Yesterday I got another “FYI” (yes, that is the official name *smirk*) from Blue Cross telling me that they will no longer reimburse out of network providers directly and “are working to encourage our members to use in-network providers to contain costs.”

This is not-so-subtle code for, “Screw all of you who signed off the panel in protest of our cuts last month, now we’re making it even harder for you to get paid.”

I stayed on the panel, but my colleagues who resigned as of 9/1 are miserable right now. They are angry, frustrated and worst of all going to feel the hurt financially very soon.

If you are a regular reader here, you know I offer ideas and solutions for these kinds of business issues.  Most of the information is free, or super low cost. People acknowledge how helpful this information is. Which is nice to hear.

But then they say (actual quotes)………

“I don’t have the time to do your marketing program.”

“I’ve been writing a book for 2 years and just can’t seem to finish it.”

“I’m in your Marketing Your Private Practice program, but never listen to the audio or watch the video, please unsubscribe me.”

“I know I need to add another income stream, but just can’t seem to motivate myself to get started.”

Hm. When your income is set to be cut for years to come, it is so hard for me to accept that no one has the time or energy to DO SOMETHING to change that reality.

The irony here is that Blue Cross (and the other managed care companies) seem to have plenty of time to change their policies every 30 days.

More irony, they are people, just like you, and they have the same 24/7 that you do. No one gives anyone an extra hour or two in the day to do more, create opportunities and change their future. (And dream up ways to move their business forward at the expense of yours).

I don’t buy that no one but me and a few other biz savvy therapists has the time to innovate, market and escape the downward spiral of their main income stream.

What Does Time Have to Do With It?

When someone claims “I have no time,” or “I’ll get to it later,” it either means:

• They don’t want change bad enough (and aren’t in enough pain to get up and do something)
• They are afraid (Legitimate. However, Do you know what I’m afraid of? Getting paid 11% less every hour. Starting today.)

or

• They’re lazy and want someone else to rescue them.

I hope most of my colleagues are suffering from the first two bullet points and not the third (though if you were to ask me, many are looking for a rescue, though they would never define themselves as lazy.)

So how do you find the time and the motivation? Here are some ideas you can use today.

Motivation

Imagine that the managed care companies will cut your rates and allowed authorized hours for your services every year for the next 10 years. (Wait! I don’t need to imagine that. It’s happening TODAY!)

Picture a weak economy for the foreseeable future with more and more people needing your services, but no means to pay your full fee.

Believe the reality that costs will continue to rise and your income decreases.

Motivated yet? And don’t be the frog in the pot of water slowly heating up to boiling. You know, being slightly aware that change is happening, but not feeling it badly enough yet to do anything about it. That approach will only burn thought the resources you have now, leaving you with no equity to invest in new ways of growing, healing  and making a living.

Time Sources

Look at your daily schedule. Where are you productive and where are you frittering away time? Examine the time you watch TV, surf the internet, waste time being anxious about things you can’t control (like an 11% salary decrease!). You waste time.  We all do. Find an hour of this unproductive time and dedicate it to developing a new program or marketing. [And TV is the worst, worst time waster. Pick the few shows you really love and watch them, but don't stare at the tube when the content on there is not worth your time.]

Get up earlier. Many entrepreneurs I know work early in the morning. It’s quiet and they are alert. If you feel you really need that extra hour in the morning, work later in the evening. Or go to bed earlier to wake up earlier — you get the idea. I’m writing this post a 6:30 AM.

Stop using your time fighting to hold on to the old ways of doing thing. I see so many of my colleagues in a frenzy about these cuts in managed care. OK, I get it. It’s discouraging and shocking and hurts the bottom line. But you aren’t going to change a damn thing with your complaints and surveys and meetings with your senators. Health care reform is about CUTTING COSTS. Hello…that means providers make less money. The President of the United States wants costs cut. Your survey does not trump the power of the POTUS. [Sorry for the rant, I just get so frustrated when I see time invested in "solutions" when there is no realistic hope that all those efforts will change anything back to the way things used to be. ]

Take the energy that you would use to try to regain the ground you lost and shift it to create something new.

Trust me, you will feel so much better. Letting go is the first step to moving forward. The old models are dying. Really. I know it’s sad and scary. But what are your options? Make time to change.

When you do carve out an hour to do creative work, turn off all distractions and focus. Often when we have a “free” hour we find all sorts of ways to fritter it away. We reply to old emails, make a cup of coffee and check out the newspaper or pick up a book, plan a vacation. It’s very easy to do anything but the thing we are a bit nervous about doing. Try to stop that.

Take little steps. Many people who I meet through Biz Savvy Therapist admit that all of this innovation is “intimidating.” That’s normal. It’s new and you have no idea how it all works. In so many ways, I’m right there with you. Want to know how I handle that fear of doing it wrong or being a failure? I set a goal I think I can reach and do one thing a day to get me there. Then I”m not overwhelmed and scared because writing one blog post or recording one audio is no big deal, right?

Group like tasks in time blocks. Clump together your client hours on several days and your creative/innovative work on others. I see clients 3 days a week and do my creating the other days. It’s much easier to focus when I have a stretch of 4-6 hours to do this work, rather than try to fit it in here and there between other time demands.

Use the weekends. There are 48 hours on the weekend that are available to you! Even if you used 2 of those, you’d be well on your way to completing that book, writing blog posts or figuring out Twitter.

Avoid the excuse of “no time.” When you hear yourself saying there’s “no time,” stop and think about what you can do to make time. There IS time. There’s always time.

How I Do It

You know I work the way I do so I can be home with my child as much as possible. Since his birth I have worked after he goes to bed, early mornings and several hours every weekend.  (I get 7-8 hours a sleep a night, too). Anytime my son has been in daycare or had other caregivers has been the time I see clients and I’ve never been to my office more than 3 days a week in the last 7 years. Now I”m dialing down to 2 days a week, but my income will increase this year.

I watch minimal TV (never before 9 PM), never go to the mall, my house could be better organized and I could always do more laundry. I choose to prioritize time with my family and creating an innovative practice that helps lots of people through multiple services.

Honestly, I’m not special and am certainly not super organized. I just want to make it happen. Does that make sense? How about you?

Photo credit: Alexkerhead via Flikr

I just heard from a colleague that she is signing off of all managed care panels effective September 1. She says she can’t grow a practice with her reimbursement rates declining and is ready to go with a managed care free practice.

While I applaud her biz savvy-ness for knowing that she needs to change her business model, I want to ask her.

“Now what?”

What else is she changing? Why should I refer assessment cases to her, rather than the 3 other psychologists in town who do take insurance?

If I were completely eliminating all dependence in managed care starting tomorrow, this is what I would do.

1. Niche, niche, niche, (but you know that).

2. Offer unique, specialized services.

3. Work hard to offer remarkable, outstanding, amazing services that people rave about.

4. Be better than my colleagues who do take insurance. Better services, better office decor, better amenities.

5. Cut my rates. I know, that sounds like heresy. However, taking insurance is expensive. With all the time, paperwork, preauthorization, you need to charge higher rates to make up for all the time you don’t see clients to deal with the red tape. But, if you eliminate all that wasted time, you can charge less per service and still make a bigger profit.

6. Offer services in packages, programs and “bundled” formats at a discount.  How about 6 sessions for the price of 5 or a free parent education course that you offer when a child participates in a course of treatment.

7. Market my awesome, unique,bundled services  to all of my referral sources, telling them that to offer such amazingness I need to cut ties with managed care.

8. Be present online so people can find me and check out my practice and services on their own time, compare and contrast what I offer to what the guy who takes insurance offers and come to clearly understand that it is worth their hard earned money to invest in my services, rather than take what they can get for a co-pay.

9. Have a detailed plan for all of the above. A change in business plan and income stream should NEVER be undertaken on a whim or haphazardly.

Going forward I predict more and more health care professionals will opt out of accepting managed care.  How will that change the quality and types of services we offer?

Photo credit: Captain Camera via Flikr

As our population gets more and more “plugged in” how do we treat their mental health?

With millions of people meeting romantic partners online, how do we help them sort out issues of meeting a partner, courtship, cultural differences and possible separation?

When someone who is happily married can find their high school sweetheart and re-connect via Facebook, how do we explore the concepts of virtual infidelity?

How should we address cyber bullying – the bullies and the bullied?

When a child sees her father only via Skype because he is working for our country in Afghanistan, how do we help her connect with “the daddy on the computer”?

When a teen only comes down from his bedroom to dinner when his mom sends him a text, should we worry about their relationship or view it as a normal part of modern life?

When a child loses a friend because of comments she put on her Facebook wall, how do we support her in her confusion and sadness?

When you work with divorcing couples and one sees the other in a picture on a dating site with their kids, how do you help them understand online boundaries?

When a client of yours tells you her daughter is studying abroad, doesn’t speak the language of the country she’s living in and is depressed, could you help with a referral to someone who could help?

Our world of relationships is changing. We need to be able to treat a plugged in population. Rather than check technology at the door of our offices, maybe it’s time to invite it in and work with it in ways to benefit our clients.

Photo credit: Project Macfrica via Flikr

Why is this important?

You know I love marketing and I sing the praises of how marketing will bring your clients! and money! and free time you never knew you had!

All true.

There also seem to be about 100 other people out there also telling you how to market your practice. I know some of these folks personally and they know their stuff.

But most of them won’t tell you the nitty gritty ,down and dirty insider secrets that I’m about to tell you now because they have filters and are appropriate in polite company and I just say stuff that comes to mind (because it’s my blog and I can do that).

The truth is, there are more than 5 things people aren’t telling you about marketing, but I’m going to share 5 here because I don’t want to scare you. I share because I care and don’t want you to make some of the same mistakes I’ve made along the way that have cost me time and money. Let my experience be a warning educate you about how to do the marketing right.

It’s Not Simple

The first thing no one will tell you is marketing is more complicated than people are telling you.

A lot of marketers sell “formulas” to market a practice. They offer templates and forms, strategies that you can cut and paste to market your practice. The problem with those approaches is that YOUR practice is unique. What works for them with their ideal clients, in their geographical location and within their specialty won’t necessarily work for you.

It is, however, easy to sell formulas with titles like, “The Marketing Magic Kit,” because people want an easy button, and no one will buy something called, “5 Ways to Do the Market Research Necessary to Fill Your Practice.”

Being Online is Great, but Not the “Answer”

The second marketing trap is the idea that being online is awesome and will be a magical path to success.  Honestly, it’s not enough to have a web site, a Twitter account and a Facebook business page. You need to customize these to speak to your ideal client.

People often read this blog and go forth to engage in social media. Once they get set up with a website, Twitter and Facebook they come back to me and say, “Hey, this online stuff doesn’t work!”  So, I go check out their online office and see all sorts of reasons why it doesn’t work for them.

If you’re website’s confusing, too wordy, all about you, has no call to action, or just looks amateurish, you won’t get as many clients if it is clean, clear, about the client, and has a strong call to action. (Pssst…if you think your site is awesome, but it isn’t bringing you clients you need to rethink the awesomeness. It’s only good if it brings results).

And if you tweet like you’re advertising, over and over again promoting yourself, your practice, or your products no one will do business with you. You need to converse, be real, promote others, share resources, be approachable and friendly, then people will want to work with you.

Just showing up online doesn’t guarantee you anything. Having a sophisticated, professional presence online gives you a much better chance of a health return on investment.

Marketing is Work (dang it!)

Third, you will get out of marketing what you put in to it. Often I hear this from therapists,

“I want to write a blog and out out a free report or e-book,Tweet and network but I can’t seem to find the energy/time/mojo to do it. But I really need more clients and I don’t want to take insurance. Do you have any ideas of how I can do that?”

No.  I have no idea how to answer that question.  I have all my clients because I write, post, Tweet, network, and publish.

The truth is, if you manage to put out only 2 blog posts, a few Tweets and occassionally get coffee with a colleague you will get very few (if any) clients from your efforts. But if you kick it into gear and consistently put your stuff out there, over time people notice and you stand out and eventually they want to do business with you.

You’ve Got to DO Stuff!

The fourth thing no one is telling you is that doing is more important than learning. At a certain point you will get diminishing returns from learning how to market and you just need to get out there and do it.

The other day someone asked me how to Tweet. Again, no answer here….just write 140 characters or less about a topic of interest. Read the 1 million other tweets on Twitter and get a feel for what people are doing.

Write. Send. Repeat Often.

Don’t waste your money on a book about how to tweet. Figure out the basics and take action.

The First Try Doesn’t Always Work

Finally, no one really wants to tell you that sometimes your marketing will fail. If we’re being really honest, often your marketing will fail until you get good at it. Getting good at it requires knowing your target audience, speaking to their pain, offering the support they want (not what you think they need), and doing it all while looking professional and polished.

When your marketing doesn’t get you the results you want, you have two choices.

1) Give up, or

2) Tweak and try again.

Good marketers are always tweaking and trying again. They know this isn’t an exact science. They understand that giving people what they want and need isn’t always easy.

I admire good marketing and a website that pulls me in and copy that speaks to me so clearly I want to buy what their selling, even if I have no logical reason to do so.

It’s a Process

Good marketing is an art. It takes time and thought to hit the “sweet spot” with your marketing message, but if you invest in the process it pays off in a major way.

And the real truth is, therapists have a much easier marketing journey than the guys that sell juice, tires or dry cleaning because our work inherently solves a pain. People want to invest in things that solve pain and offer solutions to problems. That’s what we do!!

But don’t let anyone tell you their marketing program will solve all your problems. That’s great marketing, but knowing what works and doing what works are two different things.

Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on.

Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, I suppose. But is that what you want for your career? Do you want to work for someone else for a Relative Value Unit (whatever those are)?

How about your patients and clients? Do you think they would prefer to receive care in a small practice where they are known by the staff and cared for with dignity?

Despite the commoditization of health care, small private practices can still thrive, but you’ll need to be willing to move into what I call a “next generation practice.” The old ways of doing things sucks doesn’t work any more. Here are four steps to you new, profitable practice.

1. Develop a well-defined specialty.  Yes, even a primary care practice can specialize (families, elder care, fitness freaks, people with weight issues, families with autistic kids, etc.). If you want to be a generalist, join a group practice. If you want your own small business to thrive, niche up. Why? People will find that very unique and attractive. When they find the practice that speaks to their needs, they’ll be more likely to be loyal to the practice and pay for extra services.

2. Offer services specifically tailored to your target patient. This can include typical therapy appointments and assessments with added support groups, coaching services, information nights with professionals who also serve your population.

For example, a practice focused on helping people with weight loss could have a support group that meets once a week and a monthly info night for new and continuing patients where a nutritionist, massage therapist, fitness expert and yoga instructor come to talk about how their services can support weight loss. This would be great for networking, PR and patient satisfaction.

3. Embrace technology. And I mean give it a big hug. There are lots of HIPAA compliant scheduling programs, electronic medical records platforms and email encryption services. Set up systems so you can answer patient queries by email a few times a day (or have an assistant do it for you), do as much scheduling as possible online, start referring your patients to relevant smart phone apps and encourage them to stay connected with your practice via social media.

Why get all plugged in? First, it’s cool and many patients will be excited to work with a networked health care provider (those that are intimidated by technology will be able to get care with a more traditional practice). Second, it sets you a part from your colleagues and is good marketing, third, it will be much easier to be profitable when you leverage technology to make your practice more efficient and streamlined.

4. Stay flexible. Change is going to be the norm, not the exception during this generation of health care. New technologies will be coming out at an increasingly fast pace. Health insurance will be adapting and adjusting to new laws affecting reimbursement rates over and over and over again.  Plan for change. Stay flexible. Don’t invest in anything that will take 10 years to pay off.  Keep alert to new trends, regulations and service possibilties. When you see trends or changes, be ready to adjust and take action. Practices that can turn on a dime will be consistently profitable. Those that can’t adjust without months of evaluation and debate will be burdened with lag time between what used to generate income and what works now.

The next generation health care practice will be innovative, cutting edge and meaningful to patients and clients. It will appeal to a generation of people who are plugged in, educated and informed. A practice that wisely integrates technology, specializes and is ready to adapt to change will be positioned to help more people and be exceptionally profitable.

The new opportunities the future will bring us are exciting to me. How do you feel about the concept of “next generation” practices?

I just spend an hour reading a professional association list serve and now I feel like I need a stiff drink (or a large ice cream sundae–pick your poison).

I’ve talked about the reimbursement cuts we are facing here in Massachusetts. For some psychologists they are a  massive income slash. We’re looking at 12-28% cuts. This is very, very bad news. But that is not what has me feeling overwhelmed and anxious.

It’s the desperation of my colleagues. Understandably most are angry, many are scared. This is health care reform in real time. This is our future and it looks bad.

Worse, most are stuck. Stuck in one business model, stuck in one mindset and stuck in their negative affect.  To me, it feels like watching someone drown and you have no means to help them. Honestly, reading those posts made me feel ill. Because there is a wild-eyed panic about their reaction, not a calm, deliberate problem solving mindset. And when your livelihood is at stake, calm, logical problem solving will trump panic and desperation every time.

And make no mistake, many of us are seeing our very careers at stake. This health care reform is going to be life changing and is being referred to as a “generational shift.”

Are You Ready?

This is the question I pose here most often.

Are you ready for major change?

Are you ready to innovate?

Are you ready to do the work required to maintain your standard of living?

Are you ready to stop begging outsiders for a viable income stream?

Those who are ready to take on these challenges will come out on top,with solid careers and an income stream to be proud of. Those who sit back and wait for someone to fix the problem are in trouble. No matter how desperate, wild-eyed and panicked you become, you will not turn the tide of health care reform.

You Want Me to Sign a What?

Over the last few days, I’ve been asked to sign petitions, support political candidates (not even in my district) who psychologists feel have some power to change our situation.

I will not sign your political petition to reinstate reimbursement fees, nor will I spend money to support your candidate.  It won’t do any good. It’s like drug addiction. If you rely on managed care for your fix of income and managed care jacks up the ante for how you get paid and how much, you have no power. None. They can ask you to do a song and dance routine for your income fix and if you have no other options, you have to do the song and the dance.

[And if you want to disagree you can, but that political approach you're taking in August--realistically, how soon will you see a benefit? But I can take the $500 you want me to spend on your candidate's re-election, redesign my website and produce a product that I can sell and make $1500 in a weekend. And I have a plan to actually do that by end of August].

I’m putting my energy toward innovation. I literally want to change the way health care providers do business.

Amazon changed the way we bought books, now publishing companies are dying.

Bloggers changed the way we get news and now newspapers are dying.

The internet changed the way we market everything from cars to colleges and since ad money is flowing into the internet, now magazines are dying.

E-mail, Facebook, and Twitter are changing the way we communicate and now postal mail is dying.

You need to decide if you want to be on the side of Amazon, bloggers, the internet, email, Facebook and Twitter or hang on to the alternative. The writing is on the wall. You make the choice.

Now I need to ask a favor. If you agree with anything I say above, please share it with colleagues, friends, association executive directors, your networking groups, etc.

These really are potentially devastating times. Truly. I’m not saying this to be dramatic, it’s bad here in Massachusetts and we are the bell weather state. To share this you can forward the link, retweet, post it to your Facebook page, post it to LinkedIn, start a discussion about it on an online group. I don’t care how it’s shared, but please be  a part of the solution, not a passive consumer of ideas. We need to start a movement in mental health and I can’t do it alone. Here’s the shortlink to share: http://bizsavvytherapist.com/?p=1525

Don’t feel overwhelmed and stressed. You truly CAN do the work you love and make a good living!

photo credit: programwitch

Psychotherapists often feel the “holy grail” of practice success is a caseload full of people who are willing to pay their full fee out of pocket. This would be ideal, since we wouldn’t need to hassle with insurance companies and could make more money, getting paid at time of service, rather than waiting for reimbursement, hassling for authorizations and accepting low reimbursement fees.

However, most practices won’t ever achieve that milestone and its not because people don’t need or want to pay for quality mental health services. The public understands that mental health insurance coverage sucks and are probably willing to invest a bit more in their emotional health. However, if you do the following 5 things, you’ll never get anyone to pay your full fee.

And before we begin, I must tell you this is a very honest post. Which means it isn’t all positive affirmations and rose-colored, glass half full schlock. If you want people to pay you the cash, you need to get beyond platitudes and jump in with both feet. So if you’re ready to take an honest look at yourself and dig in to the reasons why people may not be paying you, read on….

The 5 Reasons No One Will Pay Your Full Fee

1. You think you’re great and assume everyone should recognize you for such. Psychotherapists can be a narcissistic bunch. There’s a lot of talk in our inner circles about how we have so much education and training and why-doesn’t-anyone-understand- how-valuable-we-are? The fact is nobody does know how awesome you are, and no one cares unless you educate them and show them some results. That’s what you would expect from your physician, lawyer and accountant and the public should expect from us.

How do you educate your public? Marketing, networking and being an all-around positive community member. We talk too much in our inner circles. Time to branch out and talk to others and show them what we are doing and why its valuable.

2. You won’t pay anyone else’s full fee (or even the equivalent of your own fee). When you start to stress over the fact that no one pays you “what you’re worth,” take a considerable amount of time to ponder if you are paying others what they are worth. Do you pay for high-end personalized services (such as hair style, personal shoppers, or your own medical procedures or psychotherapy)? Or are YOU also looking for the least expensive way to get your needs met?

True story. A few weeks ago I offered a “pay your own fee” coaching special to over 500 people. Do you know how many took me up on the offer? The number is WAY lower than you think. If you were one of them, you’re a smart cookie and on your way to attracting full fee clients. If you thought about it and then didn’t follow through, didn’t even consider it at all, or if you said something like, “I appreciate all that you do, but I won’t pay for it”  time to give up any fantasy that anyone will invest in your services. Call it karma, law of attraction, money mindset…you pick the term.

If you won’t invest in you at your own declared rate, why should anyone else?

Think about this. Money and expense is the #1 objection I get form people who are interested in coaching and express a desire to get full-fee clients, but these same people won’t pay me their own rate. Not to be rude, but what’s up with that??  I could see the resistance if my rate was higher than your hourly rate, but the SAME rate??   I made this offer as an experiment and the results were telling.

I have a few theories about why therapists are loathe to invest in their business development. It seems like part ambivalence about money, part misunderstandings about how business works and part of living in a “lack and scarcity” mindset. No matter what the reason, if you won’t pay your own fee to a professional colleague, you’ll never move beyond your current reality.

3. You feel entitled to something no one promised you. This is going to sound harsh, but if I hear one more therapist complain about an insurance company giving them the run around for authorization or payment, I may just scream (As it is now, you should know that when I encounter the “insurance wailers” in my social media space, I unfollow them.)

Insurance companies are not required to make your life easy or give you a comfortable living. If they want to put you on hold or drag you through a 20 minute authorization interview, they can. Is it nice? No, it’s rude. But you have a choice (and so do your clients, but that is a topic for another post).

If you want a self sufficient private practice, this must be your mantra: “No one owes me a living.” Not the insurance companies, not your clients.  You have full responsibility to tweak your business model to maximize your income.

This can be scary and intimidating, but if I can figure it out, you can , too. But please, please , please stop telling us that insurance companies make your life miserable. We know. Grinding your teeth about the unfairness of it all is a waste of time and will lead to predictable failure.  Do you really think you’re going to change health care in the US?  (Maybe you do and maybe you have a master plan to do it, if so let me know.)

The system is what it is. The focus of your energy should be how to you maximize your income and minimize your pain in this reality, rather than try to change the reality.

We’ve talked about developing multiple services and multiple price points so clients can access your expertise and pay you directly.  Are you exploring those options and putting them into your business plan?

4. You’re clinical work isn’t awesome. People pay for outcomes, plain and simple. Yes, we know therapy is a process, but if someone is shelling out hundreds or thousands of dollars on a service, they better see some kind of outcome. If you’re clinical work lacks in the ability to offer people some positive return on their investment, they will not invest in you.

5. You want the best stuff for free. Everyone likes free, myself included.  And now with the internet, there is a lot of great free information out there to access, learn and utilize to improve your business skills. But the best information, the personalized information, customized for you and your business will never be free.  If you remember Psych 101, you’ll recall that research shows people place a higher value on things they pay for, rather than what is free. Which means when you pay for it, you’ll take it me seriously, act on it and improve your chances of success.

The fact is, you can only go so far with the information you can garner from free reports and blog posts.  But if you aren’t willing to invest in yourself, why should others give you a lot of free information? Would you give away your best stuff for free? Think about it.

Over the years, I’ve paid my coaches close to $20,000 to learn to be biz savvy. I’ve made every cent back and much more.

Why this post?

Reading the above, you may be thinking, “Gee, what’s up with Susan? Bad day?” The truth is I’m not having a bad day at all. I just see the above themes repeating over and over again in the interactions I’m having with the readers of this blog. I can see many of you starting to use the tips I describe, and I can hear some of your frustration that it’s not working as well as I explain it.

You need to  know that just doing those basic things isn’t going to grow your practice substantially.

There’s more behind the post, as they say.

For example, simply using Twitter isn’t going to get you clients. There is a way to use it to maximize your return on investment of time and energy to tweet. The same goes for writing a blog, starting an e-zine, adding coaching to your practice, or promoting a tele-class. There’s finesse that goes along with all of it that can’t be explained in a blog post or in a free report.

And the important piece of the details is that they are different for everyone. Your marketing campaign won’t succeed if you simply copy and paste another person’s web copy or add a new tool to your box of strategies. Why?  Because you have a different target audience, a different personality and unique goals for your practice.  Realistically, I can’t give you any information that is going to skyrocket your practice until I know lots more about you and your goals.

It starts with a mindset

The success mindset is this, “I will do whatever it takes to learn how to make this work. I’ll invest in myself, my learning and my service to my clients. Failure is not an option.”

The want-to-be-successful-but-not-really mindset is this: “I want to make more money and it shouldn’t be this hard. I don’t understand why people aren’t calling me. Since I have very little money coming in, I can’t pay for any help. I’m afraid to fail, but don’t feel empowered enough to do anything about it.”

The result of the second mindset is perpetual anxiety, lack of success and eventual failure.

I call this the “learned helplessness of therapists.”

As a profession we are masters of this. We are always looking to external reasons (no one understands the value of psychotherapy) or external entities (managed care) for our professional woes. With that mindset, we are never responsible for our own success. But we also never empower ourselves to do any more than accept what outsiders give to us.

Reject helplessness

I really want you to be successful, but I also want you to be aware that the excuses we make as a collective profession are what keep us under-earning.

You are one of the most highly educated people in the world (really). You have the skills to help people live better lives. Your hourly income (even with insurance) is higher than 75% of Americans. Chances are you have the ability to do more than you are currently doing to improve your business and your bottom line.

I urge you to not let helplessness get in your way. Don’t give your power to create the life you want to someone else.

People want your help and will pay for quality care. You just need to give them a reason to do so and prove that you are worth the investment.

For more information on how to grow a thriving private practice business (including working with clients ready and willing to pay your fees), register for my free e-course: 7 Ways to Grow Your Practice this Summer! Or to have these articles mainlined directly to your email box, sign up for the feed here.

Photo credit: Johnr71

Health care professionals are starting to feel the sting of health care reform and the weak economy.   I’ve said it before and I’ll say it again, more people will be insured and you will get paid less.  Yesterday, I read an interview with the CEO of Blue Cross Blue Shield who said, we are in a “generational shift” in how health care is delivered and paid for.  I agree with him 100%.  A generational shift is a big deal.  And you and I are smack in the middle of it.

I’m hearing some of you are feeling overwhelmed and scared that you don’t have enough clients to pay the bills, never mind make a profit or take a salary.  I know how awful that can feel. I was there the first few weeks in June when I thought I office mate (who pays half of our expenses) had disappeared and my client bookings were waaaay down. Several sleepless nights later, the office mate paid some of the bills (not her whole amount, however) and clients started coming in from their vacations and getting re-organized after the end of school chaos.  I’m back in the black, I’m happy to say.

I want to let you in on my “behind the scenes” process to getting and keeping clients, even during the slow summer season and this sluggish economy.

The steps aren’t fancy and require some compromise, but it works for me.

1. Be prepared to work hard. More specifically be prepared to work odd hours and manage your time like crazy.  If those two sentences make you shudder, stop reading now and go back to work for your employer.  Building your own business is fun, exhilerating, and time consuming.

How I do it:  The day I have the most clients is Saturday. Yes, I work Saturdays. I also work Tuesday and Friday evenings  (I don’t work Sunday,  Monday, Wednesday, Thursday).  I have not achieved a profitable practice by insisting I work a week day 9-5 schedule.  No successful entrepreneur I know works a Monday through Friday 9-5 schedule. Not one. We get time off and we make our own schedule, but we work at the times we can make the most money.  For me that is evenings and Saturdays.  Those are the times my clients are available. If I didn’t work Saturdays, I’d have 6-7 fewer clients each week. That, my friends, is a lot of money.

2.  Master the art of multitasking. To make a private practice business profitable, you need to be working on many things at once: clinical work, marketing, and product development(the Big Three) take up most of my time. The rest of the time is the administrative work required to make the Big Three  move smoothly.

3. Keep your day job. If you have not achieved profitability in your practice, do not stop working for you employer unless you have 6-12 months of living expenses saved up (stop laughing, someone somewhere must have that saved. Why else would financial planners keep recommending it? ).

How I did it:  I gradually moved from working full time in a public school to my private practice.  First I dialed down my full time job to part -time (to get used to less disposable income), then I moved to a group practice.  While at the group practice, I sublet a small office locally and started seeing a few clients privately.  I dialed up my marketing and once I had enough clients to match my group practice income, I resigned from the group and moved into my private practice exclusively. This whole process took about 2 years.

Have a plan and a safety net.  This takes time.

4.  Accept some insurance. People are going to want to use insurance.  I know it doesn’t pay well, I know it is a pain in the ass to work with, I know the whole thing is distasteful.  Some people make no-insurance practices work.  They live in metropolitan areas where there are enough people who have large incomes to pay their fees.  Many live in New York or LA where therapy is a part of people’s monthly budget, along with food and rent.  If you are not in that situation, make peace with at least one insurance company.

How I do it:  I accept exactly ONE insurance.  They pay me adequately and don’t hassle me for my money.  They will reduce my reimbursement rate in September 2010.. But less money is more than no money.  I’ve toyed with the idea of a sliding scale, but it’s a lot of work to keep it all legal and above board, so this is the compromise I make. Successful business is an exercise in compromise.

5.  Learn to be a better communicator. A business is only as successful as its ability to communicate its value and worth.  You may build it, but if you muddle the communication, they will not come.  Improve your writing, study the art of copywriting, join Toastmasters…do what it takes to improve your ability to communicate your worth.

Oh and get your website looking professional and easy for people to navigate.  Any old website is not going to bring you clients. People don’t buy cars with a plain steel frame and they won’t work with you if your site looks like the high school kid down the street slapped it together while he was texting his friends and checking out girls on Facebook.

If you don’t want to learn how to do  all this yourself, then partner or hire  with someone who will do this work for you, while you focus on the clinical side of things.

6.  Ask for feedback. If no one is referring to you or your clients aren’t booking appointments, it makes sense to ask them what would help them to utilize your services. You can do this with a survey or a simple phone call.  This works especially well if you have previous relationships with these folks and they will be willing to be honest with you.

When you want to offer a new program or service, do a survey of current clients to assess their needs,what they will pay for  and how much they are willing to pay.

How I did it: When I launched my coaching program two years ago, I put a 3 page annonymous survey in my waiting area asking people what additional services they would like to see, if they would pay and how much.  The results allowed me to tailor my offerings to their needs and offer it at a price point they were willing to pay. Needless to say, it worked out well.

7. Listen to feedback. You are getting feedback from your clients and potential clients all day long. If the phone is ringing and they are scheduling appointments, you are doing something right. If not, something’s not working for them.

I discontinued my personal business coaching program a few months ago which met my needs for about 2 years and then stopped being relevant.  The coach sent me several emails trying to enlist me to rejoin the group. His last email had the subject line: “It’s all my fault” and the subject of the email was that he must not be doing something right if I was resigning the program (don’t feel bad for the guy, he has 80,000 people paying him $57/month to learn from him –yeah, you do the math).

But his attitude is right on. People will call, schedule and pay you if you are meeting their needs.  Money can be an objection and you may need to tweak that formula, but people find the money for all sorts of trivia if they really want it.  Therapy is NOT trivia, but there is some disconnect if people don’t see the value and would rather spend $80 on a trip to Chuck E Cheese than pay you.

So, back to listening.  When you ask for feedback, LISTEN to it.  Don’t get defensive, don’t dismiss it as demanding, unrealistic clients, HEAR what they are saying.

Just today a Biz Savvy client of mine said she was having hard time getting clients. They are telling her they need to use their insurance. Her response, “But I don’t want to take insurance. I shouldn’t have to. They just don’t get it.”

My feedback is this, “What is their objection telling you?  It tells me either you haven’t communicated your value well enough, the price to access you is  too high or they really need to use their insurance. Take that and adjust accordingly.”

8. Take action and implement. Success comes to those who “do.” Ideas are great, conversation is lovely, but if you don’t take action and implement new approaches to your practice, you won’t see any results.

This can be particularly true when you go through a phase of massive action and it doesn’t work out. People don’t buy what you put together. This feels awful. I’ve been there and I’m not embarrassed to admit, I’ve cried over it.

But when you are self-employed there is no “mental health day” that you can call in to the boss so you can go to the beach and get paid to rejuvinate. Oh no. So you keep going. It’s ok to lick your wounds, vent to a friend and eat ice cream, but then you need to get back to the drawing board and figure out your next move.

The truth is businesses fail all the time.  Why? A million reasons and one is putting a lot of time, effort and money into a service or product that can’t be sold in large enough numbers to make a profit.

Your business does not have to fail if you do #s 6, 7, and 8 above.  Your clients will TELL you what they want. You just have to find a way to give it to them.

How I do it: (for BizSavvyTherapist.com)- I have a blog, I use Twitter, I keep my ear to the ground listening to you. Then I create products and workshops to meet your needs. It works very, very well. You’re happy someone is offering a solution to your problems and I’m happy to teach people something I love AND make money doing it. Win-win.

The bottom line: You CAN have a wildly successful private practice in uncertain times.  There’s lots of freedom and fun that comes with owning your practice and there are down days, too (like life, really).  The trick to making it all work is an ability to be flexible and provide what your target client wants, not only what you want to offer. Make sense?

I love summer camp.  Lake swimming, boat rowing, craft building, doing things you’ve never done before (rope climbing, canoe tipping, wearing 100 Silly Bandz at one time).

Summer camp is fun, helps kids tackle new challenges and learn new things.

We mental  health care professionals need a Social Media Summer Camp.

Why? We need to try something new in a fun way, get out of our comfort zone and play.

Everything we hear about social media is so SERIOUS. ” Is it ethical? Is it safe? Will it ruin your career?”

I know those questions are important, but why don’t we play with the new stuff a bit before we make it hard work, shall we?

And play you must because you know that half a billion people use social media and two thirds of them (how many is that? Math and I are not friends) are looking for health care information online.

If you chose a career in mental health to help people, social media will help you do that with thousands of folks a day.

And if you chose a health career to work flexible hours and make good money, social media is really good at helping you build that life, too.

Social media rocks

But can I be honest?  Most health care people are really bad at using it, leveraging it and embracing this new way of doing business.

Thank goodness for Social Media Summer Camp because we will learn all the fun, useful ways to use Facebook, Twitter and blogs to change the world (your world, your client’s world, people you never met, but can use your expertise–their world, too).

This will be a course for beginners. We’ll talk about what all the “RTs, “DM”s and “@” are in Twitter, how , why, how often to use them. Etiquette issues will be addressed as well as what to post, how often, who to friend and follow. And, yes, we’ll talk privacy – yours, your clients’, your children’s.

We’ll use webinars and screen casts, ’cause it will all make more sense if you can see how it all works.

Good times.

Interested?

If you want to learn more about Social Media Summer Camp, sign up below.  No obligation. I want to get a sense if there are enough people interested before I go all wild and crazy putting together an awesome camp and only have 2 people show up (very disappointing when that happens). If there isn’t enough interest, I’ll shelve this for next summer because we can’t do summer camp in winter, now can we?

When you sign up, I’ll send you 1-2 more updates on the program and we’ll get going in August.  This won’t be a major time obligation, either. I know it’s summer and while social media is fun, it’s not as fun as trips to the beach/lake/mountains and I want you to have time for those things, too.

Sign up here to learn how to use social media this summer!