Focus on practice management

Reducing In-the-trench Psychotherapy To Focus On Practice Management

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As a therapist/owner, it is difficult to know when to reduce one’s in-the-trench psychotherapy to focus on practice management. After all, you were the first producer of your primary service, psychotherapy. Furthermore, you are a central figure in your practice’s brand. 

And yet, if you continue to be the top producer, your practice will become starved of the administrative attention it needs to thrive. Think of it this way. Your practice is your child, and it needs your care. Once your child has been born, you as the parent must transform the way you do everything. You have to change.

Let’s step back and think about the whole process, i.e., the critical ingredients of success.

How you got into this predicament

When you first started your practice, you were rightly concerned about building a large enough caseload to support yourself. Inevitably, you worked more hours than you should. However, you knew it was temporary. Fortunately, it was. 

Doubtless, as time went on, you got more balanced. You delegated some tasks and hired out others. Non-essentials got dropped, especially the one-and-done sort. In short, your practice became more efficient. 

On the other hand, as you hired people and they got busy, the demand for your productivity never went away. In truth, the demands on your time only increased. Consequently, tension grew over what the practice needed from you. It demanded you be both a productive clinician and an attentive manager

How do you do an excellent job at both? Short answer? You can’t. You have to choose.

Of course, you worry that if you neglect productivity, you may struggle financially. And if you fail in your role as manager, you will struggle to retain clinicians. They will leave as the administrative headaches mount. 

Why we must reduce clinical work in favor of managerial

The solution to this challenge? Reduce your clinical activity, as you can, to become the manager your business requires and focus on practice management. Why?

Firstly, you can hire clinicians to create the volume of clinical activity you need to survive. But only you can be the owner. Ownership is a unique position, and no one else can do it but the owner. In fact, I would argue that the owner is the central figure setting the tone for the whole organization. Furthermore, I believe it is a mistake to depend on others to provide the organizational glue.  

Secondly, no matter how you compensate managers, they will inevitably wonder why they should stay to work for you. If they perceive that the owner is not adding much value to the leadership process, why should they stay? Why should they not build a practice for themselves?

So summing up, the best resolution to the tension between the clinical and administrative roles is for the owner to reduce the time given to clinical work to make space for the administration and leadership. 

So how do we know it is time for a shift in duties?

Your first job–productivity

When launching a practice, the obvious priority is to develop a large enough caseload to make a living. And at first, the owner is typically the primary producer. But as staff are added and become productive, we start focusing on practice management, probably for the first time. Eventually, there will be enough income to cover expenses and for the owner to go on a salary. This is a big transition and the first step in creating an asset that has monetary value. (For more on how practices become an asset, see: Selling a practice: How practices become assets.)

When facing these transitions, the owner must continuously monitor the productivity and financial health of the organization. That task never goes away.

Your next job–growth

Once there is enough demand for your services, then hiring and managing the growth becomes central. In addition, practice owners grow in their attention to focusing on practice management. I have written many posts on the challenges of growing a practice. This article is an overview that will help direct you to more posts: The ultimate guide to managing the demands of growth.

And finally–managing 

Building demand and then growing and managing the staff and systems round out the owner’s significant tasks. Now we are clearly focusing on practice management as a central and essential job.

The challenges of these aspects of practice never end. But the way the owner spends time does. 

The transition to focusing on practice management

My role shifted in several transitional steps, from a productive clinician into an attentive manager with a minor caseload.

First, I needed to believe in our business model, that it was robust enough to weather all storms. My early reluctance to trust in the productivity of others got in the way. As part of this transition, I had to live through some fearful times. Especially difficult was when a significant producer left the practice. I needed to experience that loss and get comfortable with the solutions I found. More precisely, I needed to get proficient at recruiting the next generation of therapists to keep productivity rolling. For more, see: 

While developing trust in the business model, I needed to catch a vision for sustaining all three critical activities–productivity, growth, and management–without exhausting myself.

Second, I stopped trying to be the top producer. There were even times when I did not get paid as much as some of my employees. But I was building something more significant than my salary. I was creating a saleable asset. (For more on how owners make money, see: Financial rewards for owners of private practices.)

Third, I eventually relaxed into seeing my primary role as a leader and administrator. I gave up viewing myself as the fireman, ready to rush into any burning building to douse any flames with the hose of my productivity. Yes, growth is often the answer to many crises, but I needed to delegate productivity. For more on managing problems, see: 

And at retirement

At my retirement, after 39 years of practice, I had not had a new client in five years, and my caseload was down to ten client hours per week. 

Instead of seeing clients, I spent most of my time focused on practice management. That meant supervising staff, preparing and leading meetings, and planning and implementing the next organizational changes we faced. Additionally, I focused on technology, processes for how we do things, and our recruitment and training systems. 

These adjustments allowed me to create, own, and manage a practice with 40 clinicians and ten support staff working in three communities–an asset that still grows and produces income for the current staff and the new owner.

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