What to do when your practice is full

A full practice does not sound like a problem to those clinicians just starting out or to those struggling to get clients.

But if you stay the course, become known online and in your community, and keep doing great work – there will come a day when your practice is full.

Then what? What will you do when a new, ideal client requests a session?

There are 3 ways to handle it.

1. Refer the client to a trusted colleague.

This may be someone you’ve known for years, gotten to know recently or even someone who rents space from you.

Advantage: Clients get a great therapist.

Disadvantage: No additional income for you.

2. Quote a new (and higher fee) for those inquiring and start a waiting list.

As your existing clients graduate, your caseload will begin to fill with higher fee clients.

Advantage: More income for you if the people wait for you.

Disadvantage: Can be complicated to manage a list.

3. Add clinicians to your practice to handle the overflow.

Advantage: You increase your income without adding more client hours.

Disadvantage: Requires systems and managing people.

While it is not for everyone, let’s talk about adding clinicians to your practice.

If your phone is ringing, it means you have created a reputable brand and your community respects you. Your marketing is working. And that says a lot about who you are and what you do – both as a clinician and as a business owner.

Now, imagine, if you hired a therapist you respected – someone who didn’t want to market their practice – and were able to refer your overflow to that provider. And imagine you received 40% of each session fee for providing the space and the marketing. This could mean an extra few hundred or even thousands of dollars for you.

It can be a win-win-win. You get to expand your business, serve more people, stretch your entrepreneurial muscles and increase your income. The new clinician in your practice gets clients without the worry about being a business owner. And your prospective clients get more choice since there is now more availability in your practice.

This is not for everyone. But if you have a full practice, enjoy being a therapy business owner, and love serving your community, this just may be the hot ticket for you!

Something to consider anyway…

Love and blessings,

PS I am preparing a new learning series on this topic: Things to Know when Adding Clinicians to Your Practice.

What is YOUR most important question on this topic? Comment and share below! I look forward to learning what is on your mind!

31 Responses to What to do when your practice is full

  1. Alicia says:

    Hi. Great post. I am preparing to add two associates working toward their license (and under my supervision) to my private practice. They will be paying me for supervision and office space on a monthly basis. Thoughts about me paying them as independent contractors to see my overflow? Seems like the money back and forth can get confusing. Thanks!

  2. Terri Haley says:

    Love this series! Thank you!!
    Couple of questions-
    1. Can you talk about the differences of an Independent contractor vs. employee
    2. What is a fair amount to keep per session % if they are a MFT and have their own practice but just need extra business.
    3. How is this in conflict with taking a referral fee?
    4. what are the systems needed specifically for an employee.
    I’ve been waiting for this to all be addressed.
    So excited you are teaching us this!
    Thanks so so much!

    • Casey and the Team says:

      Hi Terri!!

      Such great questions and #4 will be addresses in the next free video (systems.) The difference between employee and contractor will be covered in the full course that Joe and I do next month. As far as the conflict of ‘referral fee’ – I think I have addressed that in other comments here as that is a common (and GREAT!) question. You aren’t taking a referral fee. You are charging a fee in return for marketing, administration and space. Finally, on your second question – I personally think someone who has a practice and just wants ‘extra business’ is not the ideal person for you to bring on.If their goal is to get ‘extra business’ and they already have a practice, there can ultimately be problems with that person resenting you taking such a hefty %. Again, more on this in the course but for now – think about it. What if that person’s practice gets busier – what happens to their commitment to you? This is what I meant in the video about ‘hire well’ and make sure their goals are in line with yours. Your job is to build your business with people who want to be there = not to help someone else get extra business. Well, that is my two cents anyway. LOL

  3. Lisa I. Volk says:

    This has given me an idea . I don’t know if it will work or not, but I’d sur like to. Know what you think! I have been a licensed, seasoned therapist for almost 17 years now, until felled by illness (chronic). Because of the complicated restrictions of disability, and my own ongoing health issues I am having a rough time marketing myself, but can see all sorts of ways to promote my colleagues (most of whom are dying to make the leap to private practice but are afraid of all the things at which I excel (paperwork/organizational stuff).
    Having built a reputation here in Colorado after years in public mental health, would it not be possible to head something like this up without necessarily having any clients of my own?
    Also, wouldn’t the percentages collected from individual therapists have to vary based on their skill and experience level?

    • Casey and the Team says:

      Hi Lisa!

      Interesting idea and the bottom line is = you would just need to test it. I will tell you that if you aren’t seeing clients, the profit will be less of course. And to your second question, it is tricky and you want to incentivize your best people to keep them and yet still make a profit.Some private practice owners are MUCH too generous with the payment to their associates in that they end up not really making a profit – so if you start them lower there is room to increase their percentage as time goes on. We will be covering this in more detail later in the full course we will do.

      I like the way you think!

  4. Deb says:

    Hi Casey,

    I have been thinking of just this…adding clinicians to my practice..but don’t I need to have the supervision course completed first and what additional time and money will it take to get that person set up.
    I recently bought software to run my practice and it has been a great time saver in billing and keeping track of client income.
    I have learned a lot over the past 2 yrs and now my practice is full and I have had to turn a few clients away…that was sad. Trying to find a clinician that I trust will treat clients the way I do…not that easy.

  5. Shawntay Dixon says:

    As you are discussing adding more clinicians, this is where we are at our private practice. Our main therapist is full and he is seeing clients back to back almost every day. You speak on the importance of management and systems when adding another clinician who does not want to operate as a business, but want to practice. The main therapist is already booked back to back and probably prefer seeing clients than managing; therefore, what systems need to be in place if we add as an independent contractor and not an employee. Some insight of what you have done will be greatly appreciated.

    • Casey and the Team says:

      Shawntay, Great questions and great position to be in! You need systems for the client journey (how do they get from phone call to sitting in the office and then paying for the session.) You need systems for the associate (meaning additional) clinician journey (how they get paid, how they keep records, how they schedule their time and time off) and you need admin systems (billing, scheduling) and finally you need to have systems that help you evaluate how well your center is doing – revenue tracking, quality control on the therapists and admin staff. I know it is a lot but you probably have a lot of it already.

  6. I am in the position of having a full practice. I am approximately 31/2 weeks booked out and am getting about 5 more new calls a week. My question is – “How do you know when to stop taking new patients?” I read Casey’s information about having a full practice and about taking a waiting list and increasing fees. My problem here is that I take insurance and I am not allowed to charge people with insurance a FFS price. I think it is time for me to stop taking new patients but it just kills me to turn them away. Any feedback? Thanks.

  7. James Lamper says:

    Hi Casey,

    I have grown my London practice over the last 7 years – we now have 5 psychotherapists, doctor, dietitian, 4 body therapists – and I am just about to take on 4 more psychotherapists!

    I am interested in the margins you have mentioned. You give 55% to start with – then 70% based on number of clients per week and length of service. How do you determine the right number of sessions per week and length of service that works for your practice? Say we have a £100 fee – 8 client hours @ 50% = £400 margin – 10 client hours @ 30% = £300 margin. How does this benefit my business?

    Can you offer some guidance and inspiration?

    Thanks – James

    • Casey and the Team says:

      Hi James,
      Great questions and congrats on your success. The numbers vary and I don’t recommend those — they are just the ones I am testing. The % depends on a lot of things including your expenses and your desired profit. My point is if a clinician does 0-10 sessions per week, they may be at 55%. If they do 11-20, they may be at 60% … and they may go up in % the longer they stay. It benefits your business because you have someone who wants to stay, clearly does good work and keeps the clients, and often become very easy to manage since they know your procedures. This means you might have less turnover which always benefits you – plus you have the opportunity to build an even better reputation because you end up with happy, effective people representing you. But again – those were just my numbers – not meant to be everyone’s.

  8. Jean says:

    Also I may add that clients are not able to get re-reimbursements from health insurance companies here for a certainty. I am considering life- coaching to my practice when I start one.

  9. Jean says:

    Tell you the honest truth. I live in Jamaica West Indies. I have worked as a counsellor in two educational institutions for several years. The problem is that people are scared to ask for counselling and psychotherapy services since they thing they can get help through friends and family Or if they are good Christians they should only speak to their pastors or elders. Anyway, I am thinking of offering other services soon so I will need to do some marketing which could be unique to this culture. I think what you do for marketing also helps Casey. I think you are an inspiration.

    • Casey and the Team says:

      Hugs to you Jean! I get it and I wonder if there are pockets of people who are scared to talk to their pastors or elders and might enjoy a fresh perspective?? xoxox

      • Shawntay Dixon says:

        You’re right Casey. I am in ministry and you’d be surprised how many Christians are going through life challenges and do not want to reveal to their church leadership, due to shame, due to fear of the word spreading around, especially in a smaller congregation. We start going to the churches and speaking with ministers for our counseling center and we have been amazed at how the ministers welcome experienced and trained professionals to address some of their congregants issues. Especially issues such as mental health and substance abuse issues. That frees the ministers up to work on the spiritual matters of the church.

  10. Casey,
    So great to see you are writing on this topic. Your help six years ago helped me to make a sucessful transistion from activy duty military psychologist to private practice business owner (Do you remember me?). We now have 3 psychologists, a social worker, an office manager, and an intern (and have also had three doctoral candidate interns, and two previous psychologists, and a training analyst). What I really want is to recruite is a medication manager. Spoken to a few psychiatrists, but have not found the right fit. Considering a psychiatric NP. I’d love to hear you write more on this subtopic for recruiting for medication management. This is the area where we send patients (and their business) out the door to providers with have limited access to and little knowledge of when what our customers really want is “one stop shopping” services.

    • Casey and the Team says:

      Elizabeth! I think of you often and see you online sometimes too! Congrats on your success. It is soooo great to hear from you!! We start our licensed clinicians at my center at 55% of the fee and move them up to 70% based on how many sessions they do per week and how long they have been with the center. Because you are right – my business expenses (in my own practice) were 50% – so if those individuals wanted to open their own practice , they wouldn’t be keeping 60 to 70% of their income as profit. Nice reminder – thanks! And HUGS to you!! xox

  11. Treona, LCSW says:

    This post is perfect timing as I am considering supervising someone as a way to work towards offering more services. I am concerned about some logistics of fee split versus him just paying for rent of the office and supervision time. I am feeling concerned about other logistics, which were mentioned in the post by Ken, and the time needed to supervise and oversee other logistics with an employee.

    • Casey and the Team says:

      Treona, great questions and we will be addressing these. Quick question: have you considered hiring a fully licensed person?

      • Treona, LCSW says:

        My interest in working with this particular person, who I would need to supervise because he has just graduated from an MFT program, is primarily to offer co-therapy groups and couples counseling. I have not found other licensed male therapists who are interested in this type of work in my area. So, my interest in bringing someone in with me is not because I have too many potential clients to refer out nor am I focused on increasing my incomeby having an employee (my income will increase by offering the groups) – my interest is really just in working with a male therapist to offer co-therapy services and I really like the potential that this particular male therapist seems to have.

  12. Pat says:

    I have a few colleagues who joined group practices, then left because a) monthly meetings meant having to keep a clear spot in their schedule every week (few clients sign up for 3x/month); and b) if the client became long term, they didn’t feel it was fair to lose 30% of the fee for 6 months or longer just for not having to market (fee range $150 – 30% = $105). So maybe part of the strategy would be to use your #2 (use waiting list to set higher fees) first, and then try #3?

    • Casey and the Team says:

      HI Pat!

      Interesting points you bring up. Thanks for sharing. I think there is a difference between joining a group practice and hiring people on contract to be clinicians in a for-profit practice – exactly for the points you mentioned. When hiring someone as a contractor, I thinking hiring anyone who is willing to go out and market their own practice is a bad idea because you are right – they will resent paying a % of the fee for marketing. But people who hate marketing are delighted to get $105 (or less) for having the clients handed to them – sure beats agency wages!

    • Their 30% or more should be going to everything, marketing, rent on the space, a/c, office manager, website maintanance. Most people cannot say that if they go it alone they can keep 60-70% after covering all that overhead. being in a group can be more profitable for the independent contractor if the group is really coveringall that. Monthly meetings are a waste of time, most information can be convayed by emails.

    • Pat, I love the video on your website. How did you do that (i.e., how did you get help for that, where did you start?) Casey? Anyone?

      • Casey and the Team says:

        Elizabeth, Great question on video. You can do your own with a high def phone camera and microphone – and edit it. Or you can hire someone to create one. At our live event More Income for YOU this year (October 23-25) we will have someone talking about video.

  13. I find that when adding clinicians to your practice, particularly California Associate Clinical Social Workers (ASW) or Marriage and Family Therapist Interns (IMF), it’s VERY important to have a good payroll service to handle their reported earnings, calculate the tax withholdings, and even file the quarterly payroll taxes for you. There are many, but I do all this through Development Consulting, a branch of Morfin Financial Services in Kensington, California. That is key, since these associate clinicians need to be supervised, sure, but they must be EMPLOYEES of you, and all that entails. That service makes all the difference, so you can focus on the clinical supervision. I do a 50/50 fee split, but this varies in the community. I work with these associate clinicians to build my brand, which is GayTherapyLA.com. They also do speaking, organizational consulting, and conference work with me. I recommend what Casey says about expanding your practice with others.

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