The Mentor's Corner - Spring 2003
Miriam Adler asks:
I am just getting started in practice (6 weeks ago) and have one client. Obviously, I would like more. I was thinking of sending a letter of introduction outlining my specialties to doctors and other mental health professionals that might refer. I have already spoken to a few professionals I know who said they will keep me in mind (and indeed I got a few referrals that fell through due to my not being on panels and client not wanting to pay put of network). I feel very shy to cold call doctors on the phone, but would send a mailing if anyone has a positive experience with it. (As a side point, I have decided to join one panel- Magellan- because I just can’t afford to be without clients for a prolonged period, but that won’t come through for 3-6 months from what I understand). Does anyone have any feedback on sending mailings to acquaintances and strangers in appropriate fields to generate referrals or any other marketing ideas to assist me in starting my practice?
Esther Lerman Freeman responds:
This is an issue near and dear to my heart. I had a thriving practice in Virginia and after 20 years moved to Oregon. I can give you information and support both in what helped me to grow my practice in Virginia and how challenging it is to do that again. Working in many areas at once really helps. Too often we put all of our energy in one big endeavor (a mailing, a talk, a meeting with an important person, a contact, etc.). We have great success and then expect that to be followed in short order by the referrals.
As I start over again I have the benefit of knowing just how long and how much effort went in to developing my practice. No endeavor was the “magic bullet” and none were fruitless. No results were linear. This is what I found to be helpful:
- Always be working on more than one thing at a time so that when one dead ends you are not caught feeling hopeless or in a state of inertia.
- Being friendly in all settings and always carrying your business card is very important. The veterinarian who tells me about her friend’s depression secondary to breast cancer is glad to know my specialty in that area and get a card. People you meet at a party and ask for your card for “a friend”. I have received referrals from many unexpected sources. Most recently a gentleman next to me on a cross country flight asked me about finding a coach and, voila, I gave him my card.
- Giving your time freely and for free is always good. Even if you don’t get referrals you are building your confidence, your resume, getting your name out and if no referrals come of it you still have the GREAT feeling of having done something good for others. As always the better you feel the better you will be able to sell yourself and your practice.
- Call organizations that provide services to the groups you are interested in serving. If you are volunteering to give talks for free, serve on their board etc, you don’t have to feel funny about “cold calling” because you’re offering to give something not asking for anything.
- Be the first one to volunteer to give talks to the PTAs at the local schools. They are always looking for speakers. If you specialize in kids, talk on kid issues, if you specialize in adults do one on the working mom, stress in the dual career family, single parenting, blended families, discipline for adolescents, etc.
- See if your local schools need a professional volunteer to work on their guidance committee.You get the idea. Working for free is very valuable. Giving away time is MUCH better than sitting around hoping your last effort is going to bring someone to your door.
- Hospitals have to fill spaces for grand rounds speakers and are frequently grateful for fresh ideas. Family practice, pediatrics and internal medicine are usually very receptive to talks on treating depression, screening for suicide, working with somaticizers, chronic pain, coping with hostile and manipulative patients etc. To make the talk a success spend some time with the physician coordinating the grand rounds and get an idea about what they already know, what the perceived needs are and what the most recent mental health talks have been. They like things clear, quick and non-theoretical. They want to know what they can DO. I recently gave my CV to someone interested in having me talk to her organization. She said “do you charge for this” and I said “I don’t now, but I will again later.” That is, it is a talk I was paid to do when I lived in VA and was very busy. My job now is to get known again, not to stand on ceremony and say “my services are valuable and I should get paid”. While that is true, I could wait a very long time to get paid and be feeling useless and frustrated in the meanwhile.
I hope these ideas are helpful. I also want to emphasize how important networking is. Everyone who knows you and likes you will be happy to share you with others as a resource.
Beverly Celotta adds:
Miriam, when I started out, I sent mailings to the immediate world. I went through the Yellow Pages, looked at each category, and composed a letter that offered something that I thought might be useful (e.g. offering vets grief counseling sessions for pet owners, a workshop on homework hassles for PTAs, a stress management group for local high schools). At first, I offered the services for free. I also did many lunchtime workshops for big firms in my area. This way, the participants and the human resources people could get to know me. I received many referrals this way. After a while, I charged a fair fee for the services - although now I occasionally give free ones as part of my pro bono work to agencies and other worthy groups that can’t afford to pay.
Heather Wassarman asks:
I am happy to report that I just finished passing both licensing exams in California. Now, I am ready to begin the job search and wondered if others out there might have some advice.
My interests focus primarily on doing CBT-based clinical work with adults in health psychology/behavioral medicine, addictive behaviors, and coping with depression/anxiety/stress. I am interested in starting up a private-pay practice, yet also initially getting a PT or FT job in a clinic to pay the bills. I’m located in San Francisco and would very much appreciate hearing others’ perspectives (especially those in the Bay Area) about how to get started. I have read “Saying Good-bye to Managed Care” and “How to Build a Thriving Fee-for-Service Practice”, both of which were very helpful, but I still have some questions. Specifically:
- Where does one find out about sub-letting office space from other mental health providers for a few days per week?
- Does it make more sense to first join a pre-existing group practice and learn some of the ropes of working in the private sector before embarking on one’s own private practice?
- Re: finding a PT job aside from traditional clinic settings, where would one find information on working for an EAP?
- If I develop my niche area of health psychology and approach physician practices to become a consultant/member of their clinical team, how is one able to do that and get referrals from the physicians without also being on insurance panels versus private pay? This coordinating of care with the medical field is a growing area, yet it seems hard for psychologists to function there outside the bounds of managed care. Any ideas?
Miriam Adler responds:
Heather, congratulations on passing your licensing exams. I have many of the same questions and am interested in reading the responses you receive as well.
I did recently find office space. I found it through the office space classifieds. While most were for full time use, I answered one that was for part time use and had specified in the add that it was for an office that was part of a mental health practice’s suite. I also made cold calls to mental health professionals in the phone book to see if they had space available. I received a call back that was very appealing, though I did not end up taking it. In New Jersey, the New Jersey Psychological Association almost always has classifieds on its website that include office space; many of which are part-time with other psychologists or social workers. Additionally, a friend of mine recently found space by calling mental health professionals she new and asking if there was space in their suites or buildings.
Elaine Rodino adds:
Regarding the issue of working with physicians and not being on insurance panels, here in L.A. more and more physicians are not on any panel and in fact are not even doing direct billing to insurance companies even for those on PPO’s of Blue Cross or Blue Shield. They will give patients a superbill and expect direct pay. Then, the patient can submit the superbill to get their reimbursement. I suggest that if you don’t want to be on a managed care panel look to connect with a physician(s) who also are not on managed care panels. Their clientele will be the clientele you will also deal with.
Marc Oster contributes:
I’d like to echo Elaine’s comments and add a small piece. Probably 7-8 years ago I resigned from any managed care panels I was on. Since that time I’ve worked on a cash or Medicare basis only. Recently I’ve added Blue Cross PPO as they are quite active in the Chicago area and reliable.
I also work one day per week in a physician’s practice. In making this arrangement I agreed to see any patients he would normally see, with one exception; no HMO patients. Interestingly, the physician I work with takes no HMO or typically managed care patients anyway (takes PPOs).
When I switched to no insurance (except Medicare) friends were concerned I’d have no business. In fact over the next 6 years my income returned to and exceeded my pre-managed care era in spite of my raising my fee, and I worked fewer hours and with far fewer headaches.
Steve Walfish adds:
I have made this offer before but if you, or anyone else on the list would like a complimentary e-mail copy of my 2001 APA presentation titled, “Clinical Practice Strategies Outside The Realm Of Managed Care” please e-mail me directly at psychpubs@aol.com. To date I have sent out 1,684 copies. I guess you can say that it is “a topic of significant interest.”
This was a survey of a sample of Division 42 members regarding their practice activities that fell outside the boundaries of managed care. A total of 180 specific activities were identified and rationally grouped into ten separate categories. These include: (a) Business Psychology; (b) Consultation To Organizations; (c) Fee-for-Service; (d) Forensic Psychology; (e) Group Therapy; (f) Health Psychology; (g) Psychoeducational Services; (h) Services to Government; (i) Teaching and Supervision, and (j) Miscellaneous. Implications of these data for psychologists in their own practices were discussed.
Elaine Rodino shares:
The book written by Sandy Haber and me, both past presidents of Division 42. Saying Good-bye to Managed Care: Building Your Independent Psychotherapy Practice, is focused both on leaving a managed care practice and for building a new practice, available at www.springerpub.com
Also, you will find many ideas, materials and products to help you begin your practice on this website.
Anne Israeli suggests:
Zuckerman’s book The Paper Office 3rd edition is great. It comes with a CD that includes the various forms you need to use with clients, a chapter on how to market yourself, a chapter on finances and bookkeeping, chapters on ethics confidentiality and legal issues, and a whole plethora of other useful info. I purchased many books on setting up a private practice and marketing it and I feel this one is the best I’ve seen and used. Saying Goodbye to Managed Care by Haber and Rodino is good to help you get into the mindset of feeling your personal worth and not being afraid to ask for payment that you think you deserve and it includes useful tips for marketing.