Notes From a Newbie: Inching My Way Toward Starting a Small-town Practice
Dr. Debbie Klingender
I wake up most mornings thinking about money. Not about making scads of money and getting rich, but about all the money in my savings and investment portfolio that is fast disappearing – poof! – and will continue to vanish well into the foreseeable future.
Okay, so maybe “thinking” isn’t the most accurate term for what I’m doing when I awaken to feelings of sheer, out-and-out, gut-grabbing worry. Some of you may recognize this syndrome although it’s only obscurely listed in the DSM. Yes, that’s right: it’s 309.24/81 (Posttraumatic Stress Adjustment Disorder with Anxiety Due to Fear of Starting a Private Practice).
As a form of narrative exposure therapy to treat my PTSADADFSPP, I thought I ought to write a series of blog-like articles to chronicle the ups and downs of launching an independent practice. I figured that it might be of help or amusement to my fellow early career folks and others – perhaps even to seasoned pros who haven’t focused much attention on the oft-dreaded business and marketing-related aspects of running a psychotherapy practice in today’s harsh climate.
Back to my story. Two years ago, I moved to a very small town (pop. 6,000 or so) in the mountains of western North Carolina. (I’ll fast-forward through the part where I heroically finished writing and successfully defended my dissertation amid the chaos of workers hammering and sawing as they completed our new house.) After rewarding myself with some time off for very good behavior, I spent the next several months studying for the state and national licensure exams. I passed both with wide margins (and consequently gave myself more time off, naturally).
NC offers a provisional license that will convert to permanent after you’ve documented 1500 hours of postdoc supervised practice – something for newbies to investigate when making decisions about where to settle after graduate school. My adoptive state also is flexible about the setting in which one may undertake the postdoc hours. With a neophyte’s optimism, I decided I’d do so in my own practice, given the absence of jobs in my rural area.
So far, so good, eh? (Did I mention that I’m a transplanted Canadian?) With a flourish, I scratched off “graduate” and “get licensed” from my to-do list and began looking for office space. Here the saga comes to a grinding halt. Honestly, there was nothing available that I considered even close to appropriate for a psychotherapy practice. There were one or two spaces for lease in quaint buildings downtown, but they were second-floor offices, with no access for disabled or other people who could not climb stairs. Morally, I felt I just couldn’t set up shop in a place that wasn’t fully accessible.
Many months passed. I kept busy with volunteer work and other fun stuff (aka avoidance techniques). I also did lots of reading and planning regarding the business aspects of practice. Now some of you may fantasize that you can simply find a cozy little place and hang out a shingle and people will line up to see you. Not true. It will take lots of careful preparation to learn about and handle the non-clinical elements of a therapy business (yes, I used that term deliberately). Moreover, it will take considerable effort – perhaps in ways you’re not accustomed to – to make yourself known among potential referral sources and prospective patients in your community. More on that in a future article.
A fundamental step is deciding what your business structure will be (sole proprietorship, LLC, limited partnership, S-corporation, etc.; see the following section on resources). The default choice (meaning, in my opinion, that no real choice was made) for many clinicians tends to be to go the sole proprietor route, but that may not be the best decision for you and your circumstances. Having explored the various options, I determined that I would organize as a professional limited liability company (PLLC), for protection of my husband’s and my personal assets.
Because people tend to stumble over pronouncing my last name, I realized that I’d need to come up with a catchy business name for my PLLC. I decided on Wellspring Psychological Services, PLLC, and reserved that name through the NC Secretary of State’s office for a small fee (money OUT – ca-ching!). Later I completed the PLLC application form (ca-ching!), wrote an operating agreement to accompany it (using inexpensive software [ca-ching!] that walked me through it in easy steps), and got the green light to do business under that name from the NC Psychology Board (ca-ching!). Everyone gets a piece of the pie.
An important aside: I just discovered, in the process of filling out a city business license application, that I must also apply for a state privilege license (another fifty-dollar ca-ching! annually – see what I mean about all this money going OUT long before any money will begin coming IN?).
Okay, so business name and legal status in hand, I still had nowhere to go. Finally, two pieces of serendipity occurred. I met Linda, a licensed professional counselor who also was looking for office space, and a former medical office was advertised for lease. Deciding to join forces for better bargaining power, Linda and I looked at the space. The building is located next to our community hospital and the medical park where most MDs in town have their offices. It was my dream come true.
Linda and I quickly realized that we only were interested in the front portion of the building – the former waiting room and receptionist area, along with one of the bathrooms and a small storage room – which would give both of us nice, sunny therapy offices. To our surprise, the landlord agreed to our build-out proposal, even though we were asking for the most rentable part of the building. Then began the hardball negotiations. After about a week of lobbing offers and counteroffers over the net, we ended up agreeing to pay his too-high rent, and he agreed to be responsible for all maintenance and repairs and to let us have the space rent-free for two months while the remodeling is being done.
The celebratory feelings were fleeting, I must report, dampened as they were by the hard reality of my new three-year financial and legal obligation. You’ll recall my self-diagnosed 309.24/81.
Watch for the next installment of Notes From a Newbie in the fall issue of IP.
A Few Things I’ve Learned: A Sampling of Tips and Info
Licensure
- Get accurate information about requirements and procedures from the psychology licensing body in the state(s) where you intend to practice. It’s readily available online (just use Dogpile or Google to search for the appropriate state website).
- Buy study materials for the EPPP. Used ones are fine, as long as the practice tests are unmarked. I passed handily using a PsychPrep package that came with good karma from its previous owner, then sold the materials to recoup some of the costs.
- Join an EPPP online support group. I liked one on Yahoo Groups (go to http://groups.yahoo.com and search for EPPP; you’ll see a number of choices and can get instructions on how to join).
- Enjoy the studying process! I mean it! Rather than complaining and feeling resentful about having to jump through more hoops, go into it with a sense of excitement about learning new things (e.g., industrial/organizational psych, memory and cognition, psychopharm, etc.) and brushing up on the basic clinical stiff. Try to make it fun for yourself.
Basics of Private Practice
Some very helpful resources for both newbies and seasoned practitioners who want to build busier and/or managed care-free practices include:
- “The Business of Private Practice” workshop DVDs and manual by Jason Seidel, Psy.D. (available at www.businessofprivatepractice.com).
- How to Build a Thriving Fee-for-Service Practice, by Laurie Kolt, Ph.D.
- How to Survive and Thrive as a Therapist, by Ken Pope, Ph.D., and Melba Vasquez, Ph.D.
- Saying Good-bye to Managed Care, by Sandra Haber, Ph.D., Elaine Rodino, Ph.D., and Iris Lipner, CSW.
- Our own Division 42 and the APA Practice websites also offer a wealth of very useful information, such as tips on practice development, marketing, professional development, and continuing education opportunities. Find them at www.division42.org and www.apapractice.org. Division 42 recently hosted a wonderful FREE marketing course delivered via downloadable articles and four live teleconference sessions.
- A good legal advice website for dummies is www.nolo.com. It offers many terrific articles related to small business issues. Among the most relevant are what to look out for when negotiating a commercial lease, and explanations of the various types of business legal status and their pros and cons. This is where I purchased downloadable software for writing an LLC operating agreement to send with my PLLC application to the NC Secretary of State’s office. The software also includes various contract forms and IRS tax forms.
Connect with Colleagues
Everyone has heard about “networking” as a vehicle for self-promotion, but there’s another facet of networking that will prove invaluable to newbies. If you’re in a place where you can meet with colleagues in person, by all means take advantage of it. Introduce yourself to fellow psychologists and other mental health care folks by offering to take them out for coffee or lunch. Make it clear that not only do you want to let them know about your own practice, but are eager to learn about their clinical interests and specialties so that you can make appropriate referrals.
You can also make virtual connections with great colleagues by participating in the various APA lists and other lists online. The DIV42 list is perhaps the most colorful. I’ve developed nice backchannel relationships with quite a number of members, and find the support and encouragement of this cyber community indispensable. I also belong to APA’s EARLYCAREER, NEWPSYCH, and MENTORS lists, as well as the Yahoo NEWPSYCH list. Check them out at http://listserve.apa.org, where you’ll click on the Subscriber’s Corner link.
