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Ten steps to take when starting out in practice

Starting out in practice is challenging; especially if your training did not include much of an emphasis on practice development. Most training programs don’t as they have very tight curriculums and focus on teaching the core knowledge and skills needed to prepare one to be a competent and effective clinician. Leaving out the core business of practice skills needed to create a sustainable practice environment can make the transition into private practice quite challenging and anxiety provoking.

We share ten basic steps to take if you are thinking about getting into practice or have just begun. It doesn’t replace reading all you can and getting professional consultation, but it can help get you started.

Create your vision: Before doing a lot of planning and making major business decisions, create the vision for your practice. Why are you in practice? Go further than simply saying “to help people” or “to earn a living”. Those are outcomes that you are hoping to achieve. What is the deeper purpose? Being clear about this can help you align the many decisions ahead with your core vision.

Carefully choose your practice, clinical mentors, and consultants: Private practice is not a do-it-yourself venture. Even if you are going into solo practice, it is important to get input and support to avoid the many pitfalls that you may not even know exist. You can stumble through it, or you can respect the great investment you have made in time, energy, and money, and other sacrifices you have made, to be sure you have your advisors and their expertise and support in place to in order for you to make the most of your career. While many clinicians think of working with an accountant and an attorney, we often recommend seeking out mentors who can help you with clinical issues while also having a practice management consultant to help with set up, marketing, and operational issues.

Build your clinical expertise: Many mental health professionals are generalists. They don’t have unique skills compared to their colleagues, and are not seen as offering unique services in the community (or marketplace). Keeping in mind your vision, develop a niche as part of your practice and offer something that is new and of benefit to members of your community.

“Keeping in mind your vision, develop a niche as part of your practice and offer something that is new and of benefit to members of your community.”

Determine the structure of your practice: Are you going to go into solo practice? Are you going to have a partner or form a group practice? If so, be sure to specifically address such things as how decisions will be made (especially if you disagree), what your responsibilities will be, how each of you will be compensated, and even how you will terminate your relationship down the road if one of you desires to do so.

Develop a well thought out business plan: Decide on the specific strategies you’ll take to build a successful practice. How will you be different from the competition? What will your “brand” be? How will you market the practice and to whom? Also focus on how your practice will operate financially during the startup phase and beyond. How much greater will projected revenues be compared to your expenses based on how you are structuring your practice? Will that net provide enough compensation for you to make ends meet in your personal life? Do the math to make sure the decisions you are making also are sensible financially. Meeting your personal financial needs is crucial to building a sustainable practice.

Get it in writing: Whether you are signing a lease, setting up a partnership agreement, or renting equipment, be sure to have your agreements in writing. Be sure that you and your attorney read, fully understand, and agree to all the fine print in advance of signing the document. Contracts that are presented to you are generally not written to protect your interests. What you allege is said by a corporate representative (e.g., in provider relations at a managed care company) is not what will prevail if there is a written agreement that says something else.

Carefully plan your office administration policies and procedures: Be attentive to such things as how you will process new cases, how you will assure regulatory compliance, how you will track key business metrics, how will you make the administrative tasks run efficiently and in a cost-effective manner, and how you will protect against fraud and loss. Having written policies and procedures in place will be helpful both to prevent problems and to ensure you and others who work in your practice respond appropriately when difficulties arise over time.

Let’s shake on this by rawpixel.com. CC0 public domain via Unsplash.

Take your time: Practices grow like plants. They have different stages of development. Too often practice owners want to go too fast and make bold decisions in advance of being ready and in advance of having thought out the prerequisites for such a decision (as well as the pros and cons). The adage “first things first” certainly applies. For example, taking on associates before you have established a strong referral base can lead to major problems. Having unhappy associates because they don’t have enough work and aren’t making enough income can lead to turnover and a community image that you have an unstable practice. Similarly, not handling the flow of referrals because you don’t have an associate can lead to a sense that your practice is never available. Take the time and care needed to build a strong base to your practice before making decisions that you are not fully prepared to implement.

Prepare for things to change: As excited as you may be to start your practice, or to take it to the next level, always consider how you will shift from what you are planning to your next stage of development. Make sure you have an “exit strategy” to help you with the transitions that are down the road and out of sight. For example, how might you leave the practice if your life partner gets a different job in another state, or the practice partnership does not work out? Thinking this through at the start can help you structure your practice in a way that allows room for things to change.

Build your relationships: While most mental health clinical activities are done in private, your practice is both its own system and also part of the other systems in the community. What is your relationship with your community? Are you visible in your community, actively engaged in it, and do you regularly contribute to its welfare? Be attuned to how you are coming across to others and interacting with your colleagues. In essence you are always marketing, as virtually everyone you come in contact with can be a potential referral source when they are asked by a loved one or friend, “Do you know someone who is a good mental health professional?” Your relationships will be impacted by how you function in them, and so will your practice.

Featured image credit: Calculator by Alexander Stein. CC0 Public Domain via Pixabay.

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