Top Ten List for
Beginning a Private Practice
I don't wish to sound presumptuous, but I searched for suggestions when I was beginning my practice, and found very little. So I am making these suggestions for the new guys who may be looking for start-up advice now. I am not going to address the obvious things, like making referral contacts, since those topics will be addressed many times by others. I am attempting to address a few "less than obvious" areas that may be helpful.
(1) Never skimp on office materials. Avoid the temptation to buy inexpensive printers or typewriters, copying machines, etc. Everything leaving your office represents you. Spend the bucks here! When dot matrix printers came out, my reports were printed on them. I got telephone calls from referral sources asking what kind of typewriter I was using to make my reports look so professional (remember, nobody had seen that kind of print back then). Today I use a top level inkjet and/or laser printer. I also prepare an intake sheet that places the client's picture on the form (taken by a fixed camera on the top of the computer screen on my desk). In addition to the tremendous memory aid when in court months or even years later, this technique allows the client's picture to appear just as easily in the report. This is particularly helpful in some evaluations such as security clearances.
(2) Hire a GOOD secretary. Don't rationalize about how you can get along without one. He/She runs the office..... you weren't trained for that. If possible, give the secretary a vested interest in the success of the office. When my wife (a risky idea) became my secretary 13 years ago, she made $10,000 the first month in the office just by going through old files and filing bills and forms that were never completed..... and the money came in! That was money we were certainly entitled to, but would never have gotten from those closed files without her vested interest.
(3) Get comfortable with court work early. Remember, no matter what kind of cross-examination you encounter or fear, you are the only expert on your testimony in the courtroom. Don't be intimidated, learn to say "I don't know" a lot. Only "true experts" can be comfortable with what they don't know, while novices think they have to answer everything. Act like a "true expert" even when you don't feel that way (nobody does for the first many years). Presentation is not everything perhaps, but it is the biggest chunk.
(4) Always send out reports on tinted paper or on paper with printed borders. Your report is going to end up in somebody's folder. You want the readers to get used to yours standing out from all those white papers! You also want them to be neat in appearance, so ....
(5) Send reports unfolded, either in full size envelopes or (even better) in transparent, tinted cover sheets. I send my reports in plastic covers that are held together by a rigid bar. Now I know that as soon as my report gets to whoever it is going, the cover comes off so that the report can go into a folder. Now where does that $.50 cover wind up? With the secretary, of course! She uses it for herself, her kids, other office stuff... but she doesn't throw it away. A subtle reinforcer for the secretary in somebody else's office for using my office. Do psychologist know anything about reinforcers?????
(6) You are the best trained mental health professional produced by the best educational system on earth. If you have a Ph.D. you academically out rank any other professional. The M.D. is academically at the master's level, not the doctorate. Hard to believe? True none the less. Medical colleges never have their graduates share the graduation ceremonies with the rest of the University for this reason.... they don't want to advertise being second to anybody! Remember this, and behave as if you feel the truth of your position! In time you will feel comfortable with this position, but till then, at least act as if you do.
(7) In legal work, always get a retainer before providing services. I know that few beginning psychologists will want to accept this advice, but I strongly urge you to start off doing this. If you don't, you will often not get paid at all. Your office is a business, distasteful for you or not. Fees for depositions or testimony should reflect the higher expense involved as compared to a traditional office hour. This fee should reflect the additional time involved in the preperation of your testimony, the review of records and the disruption of office time for other clients. This should be explained in advance, but should be rigidly held to in practice.
(7a.) Go back and read #7 three more times!
(8) Avoid "Call Waiting" and roll-over telephone lines in your one-secretary office. It creates a better image for a caller to get a busy signal than to be cut off because another call is coming in. And a ringing signal that goes unanswered is terrible. Roll-overs are fine if you have the staff to answer the second line, but otherwise the above holds here also. Answering machines are fine when the office is unmanned, or even when the staff is busy. They are "honest" and people understand their function. An answering service can also be fine, but they can be a problem in that you don't know your remote, live secretary and she certainly doesn't know you or your office practices. I've tried both, and I like the machine.
(9) Telephone conferences with attorneys about clients should be billed! Beware of the "casual" call, since your comments will likely appear in a court order somewhere. Treat all discussions with attorneys about clients as formal. You are accountable either way. Start early with this one. It is appropriate practice, and I promise you that the attorney on the other end of the phone line is billing his client for HIS time talking to you! Good business practice here results in more respect for you!
(10) If you take Managed Care cases at all, at least be picky. Remember, 100% of your office time spent earning 55% of full pay, is no better than 55% of your time earning 100% of full pay.... plus you would have 45% of your time free to plan other practice options! Don't take any program that comes along just because it's there. The last private practitioner I had this argument with was making $200 K per year. He argued that if he didn't fight to get signed up with every MC company he could, it was possible that he would be "shut out" of practice. Two years later his practice failed and he was working with a guidance clinic in another state for a small fraction of his previous income..
Private practice is fun, rewarding and will bring you considerable respect in your community. But it sometimes requires courage, spunk and an ability to resist intimidation. Don't overreact to those frequent lectures by lawyers about the legal difficulties that psychologist may get into. Their advice is usually good, but hear most of the scare stories as "possible" rather than "probable" descriptions of legal outcomes. Remember it is the unusual event that makes a good lecture story.
I hope you enjoyed these suggestions, and that they can help you. They are all serious suggestions. Ignore them at your peril. You will agree with them in the future, if not now. Simply stated, now is better.
Click here to send me your suggestions for additions to this list..... PSWF
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