Folks, welcome back to the podcast. And, um, yeah, I'm really glad you've joined me for this particular episode, and hopefully it'll be helpful for you, particularly those of you that might just be thinking about private practice or just getting started in it. Even for folks that have been in it a while, uh, I think we can always learn from each other as far as different ways to, uh, go about what we do in our practices.
You know, when I started my practice, uh, back in tw- 2006 or 2005, so it's been 20 years, I know, One of the things is, is that there weren't many resources for private practice owners or people wanting to go into private practice. There were a few books out about it, specifically mental health private practices, but really very few resources out there around that.
And of course now today things have changed a whole lot and there's a lot of great resources, a lot of great consultants out there. A lot of them are great friends of mine. And so one of the things I love about that community is, is that there's not really this sense of competition that I perceive, and that we really wanna help people build a practice learn how to do it in a sustainable way and also in a profitable way.
And so, those are... they're out there. But again, I'm a consultant as well and work with people on that. But one of the things that I think a mistake I made early on is I tried to make it more complicated than it really was. You know, there's no exact right way to, to structure your practice or build your practice, but one of the things that I wish I had done was made my systems and processes much simpler.
Today I use TherapyNotes, which you've heard about o- on this podcast a lot, for my practice platform, and, um, my g- particularly the practice platform for the clinical side of things, and I'll distinguish between that in a minute. But yeah, I wish I had done something like that from the get-go rather than trying to bootstrap it and do it all just kinda ad hoc.
Actually when I started private practice, I actually kept paper records from the beginning because there weren't that many, uh, there weren't really any platforms that I remember. There were a few out there, but most of them were geared towards medical practices, and it just seemed like they were much more complicated than, than I wanted to jump into.
So I actually kept paper records with file folders and all that sort of thing in the very beginning. Of course, you figure out pretty quickly that you run out of storage space when you do it that way. I'd filled up two file cabinets when I moved to my new building and, um, yeah, and so it was really, I recognized, okay, this is not a way to do this.
But of course, you know, here we are in 2026, and things have changed a lot in that there's Much more stuff available to us as far as keeping our records, doing our keeping things HIPAA secure, all of those kinds of things. So one of the things is, is I would have, I would have gone ahead and purchased a practice management platform like TherapyNotes, and there's several others out there, but I love Ther- TherapyNotes.
They're a sponsor of the, of this podcast, so I've gotta promote them. But yeah, they're I can really recommend them. I've been very pleased with that. And I had used another system before I started using TherapyNotes, and I'm glad I made the switch. The other system was just not as user-friendly, and I didn't realize it as at the time, but when I switched over to TherapyNotes, it made things much simpler in, in the way that we do our intakes as far as keeping our documentation, um, in check.
Also insurance billing, and I'll talk a little bit about that in a minute. And also, um, just having a, a patient portal where people can come in and, uh, request their own appointments, and it sends out reminders. Also, it handles, um, payment and, uh, patient payments and also files the claims, all of those kinds of things.
When I first started, I had none of that. I had separate systems or different things that I would use to collect payments and, uh, take credit card payments and, and that sort of thing. So it's really nice having it all in one place and things being much simpler by doing it that way. Another thing that I would have done differently is, is that I think it's good to bootstrap in the very beginning when you're starting your practice.
In other words, doing it all is what I mean by bootstrapping as far as, um, answering the phone, uh, uh, set- setting appointments, of, um, doing your marketing, doing your networking, all of those kinds of things. I was doing it all in the very beginning. The advantage to doing it, you're doing it all in the very beginning, when you're building your practice and when your caseload is small, you've got the time to do that, and then you can put the sweat ector- equity, so to speak, into your practice.
And I, I would recommend doing that. That's what I did, so I wouldn't change that part. But one thing I would change is, is that I didn't outsource things soon enough. I waited too long to hire a, uh, an assistant as far as, like, a virtual assistant or a actual person to answer phone calls, set appointments, and do all that front-end stuff.
One, one of the things is, is that I think a lot of people that are new to private practice when they first start is, is that they think, um, "Well, nobody else can do it like I want it done." Well, true, they're not gonna do it exactly the way you wanna do it, but what you might find out is that they could actually do it better, and it frees you up to be able to see clients, and that's where you make money.
Calling clients back, uh, setting appointments, all those administrative tasks don't really bring any income into you directly. Now, I get, I get it in that you're following up people and building your practice, but really, your time is best spent as a practice owner and as a clinician actually seeing clients, and that's where you, where your income comes from.
So outsourcing that is, um, soon- sooner rather than later is a smart thing to do. And now with, um, with AI, there are ways that you can, you can do that, and it's very cost effective. And, um, really, uh, I don't think it replaces humans, but it, it really comes close. I wa- I wanna give a shout-out to my good friend Re- Uriah Gilford at Productive Practice, and he's put together a system an AI system that is just brilliant as far as a good starting place for people when they're first getting started in their practice and want to automate things and have a virtual assistant and that sort of thing.
So it's an AI virtual assistant system that he's developed. And, um, we'll have links here in the show notes and the show summary about that. But yeah, so my point being is, is that with different things like that particularly, like, your intakes and your having someone to answer the phones and set up appointments and that sort of thing, that's something you should that, that's really a low-hanging fruit in the very beginning as far as freeing up your time and being able to make sure that people are being attended to when they g- when they call.
And so that would be one, one particular area that I would outsource pretty quickly. Another, other areas to think about is, um, you know, depending on your, things like bookkeeping and, uh, records management, that kind of thing. Again, you can do use a, um, a platform for that like TherapyNotes or some of the others out there.
There's SimplePractice, there's ... Yeah you can look it up. But, um, not but TherapyNotes I'm really pleased with and I can recommend it. But also being able to outsource things like your marketing and being able to outsource things like the building of your website and putting all those things in place in the beginning are important in maintaining and building your practice.
Again, I bootstrapped all that stuff, and part of it was is I enjoyed learning all that stuff, learning how to build a website, learning how to, uh, do bookkeeping and accounting stuff. All of those things I was just, uh, geeked out on all of those kinds of things. But that might not be for you.
But and so the things that you don't enjoy doing are the things you need to outsource pretty quickly as soon as you can. You know, the other thing in, in speaking about the website, one of the things that I would, uh, and I did this as well, is in the early stages is really put a lot of effort into your website.
Particularly to begin, begin to get your SEO or search engine optimization up and running well. And the best way to do that is to create a lot of content a lot of great content. And so, that can cover the gambit from doing doing YouTube videos, creating a podcast or offering, um, workshops.
Certainly blogging is something that is essential for helping, uh, a website, uh, move up in the rankings so that people can find you. Because when people search you, of course the algorithms are gonna feed the people the things that are most relevant. And so the more that you blog, the more that you put content out there just around different topics like on anxiety or depression or whatever you identify your niche as, it establishes you as an expert in that Particular niche or particular area, and so it will bring it up first in, in your in your s- uh, fr- in people's searches.
Sorry, I got tongue-tied there. But yeah, so I would do, spend a lot of energy on that in the very beginning. The other thing too is, um, I know some folks are built more, like kind of wired more like me, are typically more introverted, which I'm really kind of in the middle when it comes to testing that stuff.
I'm more of what they refer to as an ambivert. I'm kind of right in the middle between being an extrovert and an introvert, but really lean more towards being introverted. But anyway, networking with people and really kind of being out in your community as much as possible helps people to remember you and to refer to you.
I mentioned, um, I think in the intro or that I'm really not seeing that many clients right now 'cause I'm moving into that time where I'm also uh, retirement's on the horizon, and so I'm figuring that out and gonna, you know, work towards that. But one of the things as far as the referrals I get personally, since I've been in, in it so long most of my referrals come as direct referrals from people that I've either seen in the past or people that I've connected with in the community through churches, through doctors, through different connections within the community.
So I would say put a lot of emphasis on that. Get out and get to know people. One, uh, another consultant that's out there and a, a friend of mine is is Allison Puryear. And Allison when she was on this podcast several years ago talked about when she first moved to a new city, she moved to Asheville, North Carolina, one of the things that she did, set a goal for herself, was to network with one person a day for 90 days.
And so, and that was a huge practice builder for her. And so, that, I think that's where you have to start and kinda have the mindset around that of being consis- I like to say being consistent and persistent with those kinds of things are going to pay off in the long run by doing all of those, those different tasks as far as putting your, putting a lot of emphasis on your SEO and building a lot of content on your website.
Also, um, uh, just networking in the community. Um- The other thing that I would do now is, um, and I alluded to this already, is take advantage of AI. This is just a, this is a whole cutting-edge area. We could do a whole episode on that, and I've done a few here in the past. I know a lot of us are concerned about AI taking over the, the counseling and practice, counseling and therapy world.
But the truth is, is that, It's not gonna replace us, I don't think, entirely because people still crave that human-to-human touch, that human-to-human interaction. And so, I don't think our professions are going away anytime soon. But being able to, to use AI to help you come up with a marketing plan, to give you some ideas about your systems and processes, um, ideas about networking or any of those kinds of things, you can just do, plug some stuff in and just, um...
Yeah, and it, it gives you all these idea- ideas, and it's really brilliant when, if you think about it. Also, um, the other thing that I would do, and again, this is something I did do, but I think, uh, a lot of people and a lot of people I've worked with here, here in the past, they really struggle in the beginning in going into private practice.
And part of it is, is that they maybe pulled the trigger too soon. In other words, they jumped into private practice without having a good sense of where their referrals were gonna be coming from. And so they're putting a lot of effort into building their referral base, and it just creates a lot of stress because until you get up to a certain caseload, your income is not gonna be where, where you need it to be.
And so I tell people all the time, "Don't quit your day job too quickly." And I think it's okay to give yourself permission to maybe do some part-time work, and it doesn't necessarily need to be in the same field. Do something that's gonna bring you income in, recognizing that, okay, I'm not gonna do this forever, but do something that brings some income in while you build your practice.
And I would say, too, in your first year, really concentrate on building your reserves. And what I mean by that is, is you want to create a financial buffer for yourself so that when you reach slow times or times when your caseload drops or you're not getting as many referrals for whatever reason, it could be the holidays, it could be, whatever reason, you want to have enough money in reserve to support yourself and pay your bills and that sort of thing to get you through that slump.
And that has been something that I did the first year of going into private practice, was I spent the first year, I still was working. For part of the time I was working for an agency, and then I took on a, a part-time job with, um, some of my church stuff- And it was enough income to live off of, but it allowed me to take pretty much every bit of the profit I made in my practice and sock it away and put it into...
I put it into a money market account at the time just so it could, that money could continue to compound and grow. And really you want to have at least, at the very least, three months of, um, income saved away, income and expenses saved away. Six months is even better, but have that socked away and just protect that money, and only use it when you absolutely have to as far as either paying yourself or paying your expenses and that sort of thing.
And then as soon as you get out of the slump is put that money back. And so, uh, yeah, so that's, that's, uh, I think that's an essential for anybody in private practice or any small business for that matter. You need to be able to have reserves on hand for those slow times, for the slumps that, that come along.
The other, um, I'm jumping around and I apologize for that. I mentioned AI. Again, taking advantage of that and using that those platforms to really be idea generators. They, they can write a blog for you in no time, and again, that adds to your, your content creation, all of that sort of thing.
The work in doing that is so much easier from when I was, I was in it. When I first started, I was, I was spending hours writing blog posts and, um, putting content out there, and ultimately it helped me in my, in my practice in the long term. Yeah, so make use of those platforms.
The other thing that you know, in, in hearing from other people out there in those first months of, first months or the first year of, um, being in private practice People do worry about the income coming in, and I would say, um, look at, um, you know, maybe signing up for some of the existing, uh, um, existing platforms.
Now, I- you have to kind of look at your own, um, kinda moral compass around those and that kinda thing, and certainly you don't want to do anything against your values, but one of the things I would say is, um, make use of some of those things to create some income for yourself. Now, um, any of those platforms, and I'm talking about things like, um, like, um, BetterHelp Grow, um, Seven Cups of Tea or whatever it's called, but any of those, um, platforms that are, um, essentially, um, essentially big investors that have put a lot of money into creating, um, platforms for therapists to do therapy on.
Um, I'd say maybe sign up for one or two of those so that you get, start getting some clients and make use of those platforms to bring some income in for yourself. And again, in the first year, take that money and set it aside and put it away while you're building your practice. And then you don't have to stay on those platforms.
I mean, you're not obligated to do that, and when you get to a place where you can, um, feel like you're sustaining and you got a caseload that can be supported and g- and y- you can get off of those platforms because you will make more money, um, charging your own fees rather than depending on what they dictate.
So again, in the beginning if I had to do it overall again, probably would've taken advantage of one of those to just build my caseload and have clients in the very beginning. Um, the other thing, um, that I would say that I would do differently is, um, really kinda weigh the benefits, cost benefits of either being self-pay or insurance-based.
Ultimately ended up becoming insurance-based, and it's mainly because of the demographics of my area. And the thing that you have to kinda weigh up against is certainly with being insurance-based you, um, kinda have to take whatever fees they set for you. And the same thing with the, with the, um, with the, the platforms that are out there, the, um, the tech companies that have gotten into providing platforms for therapists and that sorta thing where you do online therapy.
And again, I'm referring to things like Better- BetterHelp, Grow Therapy, those kinds of things. Um- the thing is, is that with insurance you kind of have, you have to accept what fees they offer you in your contract, and you, you can't charge any more than that. And so they kinda set your fees for you.
But the payoff is you don't have to do a lot of marketing by doing that. People, um- For better or for worse, people will shop therapists based on what insurance they accept. Now, that's where we have to do a better job with educating people about all of that, because I think really, uh, we need to pick...
A person needs to pick a, a therapist based on their expertise, their niche somebody that's gonna fit well for them. All of those kinds of things are more important than you know, what the insurance is gonna pay for or not. Now, I realize there's a lot of, lot of people out there that do depend on their insurance.
I know I do when I go to my doctor. I, I need to have my health insurance in order to pay for that. And so that system is there. It's not gonna go away, and so you have to kind of think, "Do I want to embrace that or not?" If you decide to go totally cash pay, you're really gonna have to double down on your marketing and, uh, really make sure that you're doing those things that I talked about here at the very beginning of this episode of, of really focusing in on your SEO, your networking, and all of those things to build those refer- referral sources and to...
So that you stand out not only online, but just in your community, and that you become the go-to person for people to refer to. And, um, also it depending on the populations you wanna work with certainly, um, if you have a say a, a calling or a, a pension for working with underserved people, which I think we need people like that you're probably gonna wanna be on insurance panels rather than be self-pay for for your practice.
But a- again it's not a, um, an e- necessarily an easy decision to make, but you can try it. If I were to do it all over again, I would have spent more time doing private pay rather than jumping into insurance, and really spent more time marketing. And then I would probably have later added insurance panels, but been very selective about that, of just picking maybe two or three insurance panels to be on of the comp- of the insurance companies, the, where my community is heavily served by those.
So, you know, whether it's Blue Cross Blue Shield, United Healthcare, Cigna, any of those. Really doing some research on the front end before you do that of which, Which employers use which insurances. Here where I live, there's a big chemical manufacturing company here, and so I've I let that be the first one that I signed up for.
It was, I think at the time it was Cigna, and so I got on the Cigna panel really from the get-go, and it's paid off in that I get a lot of re- referrals, or my practice gets a lot of referrals from all of that. So yeah, pick and choose on that. You can also do a hybrid like I do now. I mean, we accept both cash pay clients and also insurance-based clients, and you can do and not either/or.
But certainly a cash-based practice is easier on the back end, too. You don't have to worry about filing insurance claims or following up with any of that sort of thing. And so, um, yeah, it's just a, y- you can decide. I recently had done some consulting with, uh, some folks that had, had started a new practice, and they were going back and forth on that decision, and ultimately they decided, "Well, we're gonna try to make a go at being self-pay."
And so they're really doubling down on their efforts with their marketing, getting out in their community and leaving flyers and all of that sort of thing, and hopefully that's gonna work for them. But also they have, um, not taken off the table being on insurance panels, but they're gonna do a wait and see on that to see if they want to join any sort of insurance panel.
So there's no right or wrong answer to that. You just have to decide what you're willing to do and what you want to do as far as accepting payments or third-party payments. Um, yeah. So thi- I think you have to think about all of that. Let's see. What else was it I was thinking of, um, with things I would've done differently?
I mentioned having simpler systems, and so let me backtrack a little bit here and let me explain to you kind of the way I think about the different systems and processes. Really, there's two, two kinda ca- categories. There's the business side of your practice, all the business systems and processes you would have in place, and then the clinical side of your practice which is, has to do with pi- clients directly.
Certainly the clinical side of your systems and processes, they need to be HIPAA secure and HIPAA compliant, or however you wanna term that. And so again, with platforms like TherapyNotes, that's all built in. And so- The way I think about it is, is that your clinical side of your, your practice and those systems and processes are very, Very client centered.
In other words, not Carl Rogers client centered, but very much focused on maintaining the records and everything that you need to know about the individual clients that you have including what they've paid you or not paid you and what they owe and their billing and all of that sort of thing. So all of that needs to be a separate system.
And then you have the business side of your practice, and essentially what you do is take the income that your that your clinical side has generated, and then you move it over to the business side, and then you have your business systems and processes in place. So it's things like your accounting software, uh, what you pay yourself, any sort of, if you're a group practice, your employees or your contractors.
All of the business side that most, uh, that any small business would have is a separate system, and I think it's a good idea to keep those separate and not let them overlap too much, number one, for HIPAA compliance, but also it just makes it easier in tracking everything. In other words you want to be able to know, um, you know, where your income is coming in from which patients might or clients might owe you something or have insurance that is owed to you, all of those kinds of things.
So that's a separate system. The other system, the business system, would be your profit and loss, your the income coming into the business. You don't identify specific clients on that side of things. It's just a client income. You keep up with your expenses for running the practice, all of those kinds of things.
You need to have a system in place for that. And again, I would recommend that you find a, um, a software to do that. Kind of the gold standard for accounting is QuickBooks, although there are a bunch of others out there. There's FreshBooks. There's any number of ways to track that side of things. But I would, um, also, again, this would be something you do in the very beginning is get an accountant, uh, that you trust and somebody that you can work for a- and listen to their recommendations on that about how you want to track all of the business side of doing things.
And so that would be something I would, I would really encourage you to do in just thinking about all of that. And so keeping those separate. The other thing that I would do and I'm not even sure if it, uh, if this concept was around when I first started, but I would learn Profit First. Mike Michalowicz, who I've had on this podcast, um, created a system called Profit First, and then my good friend Julie Harris at GreenOak Accounting has written another book specifically for therapists.
So shout out to Julie and her book, Profit First for Therapists. Get that book, learn that system, because when I did that, all of a sudden kind of the light bulb went off and running the business side of the practice became much, much more easy and much simpler by learning that. So in the very beginning, learn that system, and I would, um, I would say I, I didn't necessarily do it this way, but I would say adopt that system with the different bank accounts and all of that sort of thing and really kind of follow it as, as closely as possible.
And it'll make a huge difference for you and your practice in being able to, to making sure that your practice is sustainable, that you're paying yourself enough. And when you bring on other clinicians as employees or, or contractors making sure that you're paying them an amount that's sustainable.
When I first started a group practice, again, a mistake I learned from, is I was paying my people too much, and it was because I, um, just kind of picked a random percentage that I was gonna pay them out of what was coming in, and it was way too high. And so I had to backtrack and, um, I lost a few people in my practice because of that.
But I also once I switched over from a contractor model to an employee model, all of a sudden I became more profitable just because of the, the, uh, different write-offs and all of that sort of thing, which we could do, again, a whole, whole episode on that, and I'm sure I've got some out there already with that.
Being able to adopt the Profit First system and that, uh, that philosophy early on would be something I would do now that I didn't do back then. So I think that's about it on my list for today. I jotted down some things. Just a quick review, um, is, uh, make your system simple. Don't try to create a whole lot of bells and whistles around that.
Outsource as soon as you start getting busy, particularly the having an intake coordinator or having someone that manages your intakes, whether it's an AI assistant, a virtual assistant, or an actual person in your office, I would do that. That would be one of the first systems I would put into place.
Also, just spending a lot of time in the beginning when you've got the time of creating a lot of content to put out there on your website and on the internet so that you're establishing yourself as an expert in our field, and also making the search engines find you just by having a lot of content there.
And focusing on the different SEO things like backlinks and all of that kind of stuff with your website. Also, networking in the community, uh, making those contacts so that you've got a lot of referrals coming in from different, multiple different stor- sources and different ways rather than putting your eggs all in one basket.
Also taking advantage of AI to write your blogs and all of that kind of stuff would, uh, be something I would recommend. Also, um, making use, uh, in the beginning stages of those existing platforms like uh, BetterHelp Seven Cups of Tea Grow Therapy, all of those different ones, Alma Headway, those, those kinds of things.
Make use of those platforms in the very beginning while you're building your practice and particularly building your reserves. Use those platforms to help you build your reserves. So that would be something that I would recommend in the beginning. And, um, again, building those reserves is important in the beginning and concentrating on that and getting three to six months of money saved away so that if you reach a slow period, you've got that saved away.
And then finally learning the, the Profit First system. So hopefully this has been a helpful episode for you and things to think about. Thanks for joining.