If you are fortunate enough to be successful in growing, you will soon discover an additional challenge–having too many referrals to manage. While this may be a welcome relief from earlier struggles, it becomes a serious problem. You will be forced to choose between two unattractive alternatives. You can stretching yourself so thin as to risk burnout. Or you can elect to disappoint your referral sources and see referrer look elsewhere. Can we really expect referral people to keep referring if my consistent response is “I’m sorry, but I have no room for your referral”?
What to do?
One solution: Stay small and build a resource group
Many solo practitioners facing this issue will actively choose to stay small. They choose to not grow beyond the caseload that they can service. One way to do that is to develop a niche that works and then to refer all others out to other clinicians. This especially works well if you can develop a diverse list of equally-skilled therapists. The goal is to develop a list of therapist friends who do other types of things. Find someone to do couples, someone else to do eating disorders, someone to do adolescents, etc. That way we do not have to take every case the referrer sends. This is an excellent way to solve the dilemma.
Yet there remains one challenging aspect of this approach. Not all clinical resources are equal. These imbalances in both skill and in how referrals get distributed can create some jealousies and resentments. But if one’s resource group can keep its competitive juices under control, this system can work very well.
Another solution: Delegate and manage
Another way, the way I chose to go, was to hire skilled clinicians to handle the demand beyond my skill or availability. I was fortunate enough to hire some extremely skilled colleagues. At first I hired on a part-time basis and eventually full-time. But it did not take me too long to realize that while hiring and delegating did solve some issues, it created others.
It added the new challenge of learning how to manage the work that I was delegating. And I had to do that in a manner that did not offend those who actually did the tasks assigned them. Learning how to manage transformed what I was doing each day. In addition to doing therapy and marketing I was managing staff and building the infrastructure that supports the practice’s growth. (See more details on this at “The training we never had–Part 1: Hiring and firing” and then “The training we never had–Part 2: Managing.”)
I came to enjoy all these tasks. I enjoyed seeing the impact we could have as a group. We were able to go far beyond anything I could do as an individual alone. I found a new mission for my work–the multiplication of our collective impact on the communities we serve.
More on becoming a manager
In the beginning I did a lot of floundering as a manager. I did not know how to do most of the required tasks. What I did know was that I had to find a way to show my caring to my employees while we built an institution. Obviously institutions do always show much caring for their members. The interests of employer and employee do not always align. But I decided it is worth the effort to try. I came to understand that to work together multiplies the effects we can have in our corner of the world. I liked that.
Bottomline, to hire and delegate, I was going to need to learn how to manage. Did I want to do that? I eventually found it a very enjoyable. The business demanded it. And I needed to get good at it if I was going to do more than work in a solo practice.
What about the stuff that cannot be delegated?
No matter how good I became at delegating and then managing, some things just could not be delegated. Facing this challenge meant I was back to working on myself again.
I have written about those efforts in this post: “Getting myself under control: Solving my self-imposed roller coaster”