Uncommon Practice: Our Private Practice Growth Story
We want to let you know why we started this business and what it stands for. You can learn more about our personal stories at Our Personal Stories, but this page is about why Uncommon Practices exists and how we can help you reach your private practice goals.
We are committed
to doing everything we can
to help you succeed
in creating your Ideal Practice.
If you're like us - and most clinicians - you learned little or nothing about business or marketing in graduate school. In contrast to the confidence you probably feel about your clinical skills, you may feel inadequate or uncomfortable in knowing what to do or how to proceed in promoting, marketing and growing your practice. Or you may know what to do, but just really dislike doing it. We were just like you, when we embarked on a relentless study of business and marketing.
Uncommon Practices, helping mental health professionals with private practice marketing and growth, was founded by Joe Bavonese, PhD and Melhim Restum, PhD in 2005. Joe and Mel first met in 1976 as doctoral graduate students in psychology. Later in our careers, we worked as Directors of separate Outpatient Mental Health and Substance Abuse clinics in the same organization. What follows below is the story of how we both entered private practice, and how we learned - the long, hard, expensive way - what it takes to create a very successful private practice.
In 1992 I started my private practice in psychotherapy. I was told by five colleagues not to start a practice, because private practice was a dinosaur and no one could make money in private practice anymore. I decided to do it anyway, with an office in a run-down office building, three clients, a beat-up old couch, and a box of tissues. I had another full-time job, so I started part-time to see if I could make it on my own.
To no one's great surprise, people did not come running to my door. Despite having good clinical skills, I struggled to maintain a consistent caseload. I liked the freedom of my practice, but it was up and down. I averaged about six referrals a month, mostly by referrals from other therapists and past clients.
I survived, but my practice was certainly not anywhere close to where I wanted it. I'd have some great weeks following by lots of empty spaces in my schedule I tried a number of different things, but I was guessing at what to do, I had no real theory or knowledge guiding my marketing decisions. But I was willing to experiment and try new ideas, some of which were working out well.
In 1996, my wife and I wanted to have a second child and unexpectedly got a bonus: we had twin boys in 1997. I now had three children and no longer had the option of a mediocre practice: I had to do better financially. But what to do?
I started reading some small business marketing books, which helped a little (see Resources). I hired local marketing consultants, which was almost totally worthless and a complete waste of time and money.
I was frustrated. Nobody seemed to really understand what we did, how unique it was, and I couldn't find any marketing consultants specializing in psychological practices.
So I looked elsewhere. I decided that if I was really serious about this, I should find the best small business training available anywhere. So I sought out nationally known marketing training and consultation for small business, with some of the biggest (and most expensive) names in the business.
(You can read more details about my journey into the business world in my July 2007 article in Psychotherapy Networker, entitled Developing a Money Mindset ).
What follows is a summary of my greatest marketing and business development mentors. I encourage you to visit their web sites, download their free information, and consider signing up for their services (if you can afford them). But when you read their material, keep two things in mind: all of these consultants are VERY expensive from the average psychotherapist's mindset; and 25-75% of what they teach will have no relevance for you (which is actually okay and still valuable, if you understand Return on Educational Investment).
While you may not have heard of some or all of these small business consultants, I assure you they are all superb at what they do. In my summary, I'll include what I spent on my training. This is not for any reason other than for you to see how expensive really top-notch marketing consultants are in the real world of business.
I started with Jay Abraham who, according to Fortune magazine, is the most expensive marketing consultant in the country at $5,000 per hour.
I didn't have $5,000 to spend, so I started with a book of Jay's that cost $350. I had never paid that much for a book, and I was very ambivalent about buying it. But I finally bought it and was immediately impressed by his ideas. I quickly made some changes in my practice that resulted in a twenty-fold return on my $350 investment. I was hooked, and I wanted more knowledge.
So I attended a 3 day seminar with Jay Abraham in Los Angeles. There were 400 people there, and I was the only mental health professional in attendance. The seminar cost $3500. All my friends told me I was insane to pay that much for a 3 day seminar. But I went because I was beginning to understand Return on Educational Investment. I came back from the seminar and using what I had learned, I made changes in my practice that increased my referrals by 40% in just six months.
Inspired by these results, I applied and was accepted in an Incubator program with Jay Abraham, where he personally worked with 10 small businesses. It was great having Jay's personal input into what I was doing.
I also studied with a master of implementation, Scott Hallman. Scott has an uncanny ability to help businesses optimize and then systematize what they're doing, and thereby create a powerful improvement in your bottom line.
I also studied with super salesman Chet Holmes. Chet is the guy who could sell the proverbial ice cubes to the Eskimos. He taught me that we're all in the business of selling, even in mental health services, and how to do it most skillfully. Chet is also the mastermind behind the art of Setting the Buying Criterion in any sales situation
Neither Scott or Chet had ever had a mental health professional study with them.
I also studied with a fascinating and brilliant business teacher Toby Hecht, founder of the Aji Network, in his nationally known Business Professionals Course. Toby teaches people how to create more powerful results in the marketplace by understanding some of the unconscious cultural forces that effect all of our thinking and actions as a business professional, and by learning how to design the best possible offer. I was the first mental health professional to take the course in the 18 years he has been doing it.
The cumulative effect of all of this learning was that I developed a new mindset - a business, marketing mindset - that allows me to view business challenges and opportunities in a new way. I consider this mindset no less significant than the clinical mindset I developed in graduate school and beyond. And surprisingly to me, this mindset is not unethical as I had always assumed business people to be. Some of the people I have met in my business trainings have been exceptional human beings, living lives of great integrity and service to others.
In the past 10 years, I have spent over $52,000 in consulting and training fees to acquire this mindset. To many psychotherapists, this is an absurd amount of money to invest in marketing and business education. In my mind, it was money well spent! I have come a long way from my original reluctance to spend a mere $350 when first starting out. I have already made back multiples of all of the money I spent, and I will continue to benefit massively from this knowledge for the rest of my career.
My solo practice filled up so completely years ago that I never have a concern at all about having a full caseload. The thought 'how can I fill up my caseload' hasn't entered my mind in several years. A full caseload is just a given - a fact which I attibute to my business acumen, not my clinical skills. There are many excellent clinicians in my geographic area - I realize that my advantage lies elsewhere.
In fact, I created so many referrals that I have taken the next step in leveraging my work: my practice has evolved into a group practice with 24 therapists and 3 offices, and we now average 125 referrals a month. In sum, my original six referrals a month has increased twenty-fold; my annual income has risen every single year I've been in practice; and I've been in the top 1% of all psychologist's income since 2002.
My approaches to private practice growth began to attract attention. I have been featured in the Psychotherapy Finances newsletter on three different occasions since 1996. I began doing marketing consultations with psychotherapists around the phone in 1997 and have always been pleased to find out that what I have to tell them has been a new, fresh perspective that they had never been exposed to before.
As I said earlier, I encourage you to do as I have done: study with great marketing masters. It is well worth the time and effort.
But if you'd like to streamline the process, what we're offering you is to benefit from our having sorted out the wheat from the chaff, in the time-tested practical applicaton of an ongoing group psychotherapy practice, for a fraction of what it would cost you to hire these consultants and teachers. Our program The Business of Psychotherapy: Creating Your Ideal Practice will teach you all of the best and most useful things that I have learned in all of these marketing trainings and consultations.
To read about all of our services to help clinicians grow their practices, please go to: Uncommon Practices Programs and Services. Or give us a call at 800 940 0185, or shoot us an email at email@example.com
I began this journey towards building a successful career – I now refer to it as a business to remind myself of how seriously I need to take that concept – along fairly traditional pathways. However, the path that I ultimately took changed significantly because the institutional structures I counted on could no longer support the ideals and the promises they suggested. I am thankful for my ability to adapt to the changes the field has undergone in the thirty years I have been doing this work and I am equally thankful for the mentors who pointed the way. Most notable among them is Joe Bavonese, a remarkably generous, gifted and cherished friend.
My first job after receiving a Masters degree in Clinical Psychology was as a houseparent/clinician running a home for retarded, emotionally disturbed youngsters. University undergrads and foster grandparents made up our staff with consultation from my university professor and agency professionals readily available. It was a difficult yet rewarding experience and confirmed for me that human services work was right for me.
My next job was in a child guidance center. You have to be a certain age to understand that term fully, but suffice it to say that this represented a movement aimed at raising awareness of the mental health needs of children and families and providing appropriate services. Again I was doing “good work” and the staff who trained and cultivated me professionally were wonderful teachers and colleagues. My initial salary was about $12,500.00. This position confirmed a notion I was unconsciously carrying around; namely, that the important rewards of this work were helping others in need and the collegial relationships. The money I earned seemed secondary.
After a year or so I decided to pursue a doctorate. I think my reasoning was that since I would be doing this work for the rest of my life, I’d rather be doing it as a doctor. I’m sure status was a consideration. And the increased income such a degree could bring over my professional lifetime was a factor. I learned a number of things in graduate school, though how to develop a business after graduation was not one of them. I’ve since learned that this is the norm for graduate programs rather than the exception. I also again learned how to live a spartan existence and while I considered this a virtue, it may have added another layer of resistance to earning money.
I met Joe in graduate school and his fascination with statistics which included batting averages, earned run averages and later games of chance (i.e. craps) seemed a quirky and charming quality. Little did I know that this interest would lead to the development of sound business practices years later. But mostly I realized Joe was one of those once in a lifetime friends that I should hold onto. So when he suggested we audiotape to keep in touch after he transferred to a university in California, I gladly agreed. And later when he finished his doctoral training, I helped to facilitate his return to Michigan by setting up an interview with my then employer. This culminated in Joe becoming a Clinical Director at a sister outpatient clinic to the one I was directing.
Prior to that I worked in a psychiatry department of a local hospital. Here I was exposed to the innovative ideas of a really bright psychologist and had first hand opportunities to work with students and educators in an educational milieu with therapeutic classrooms. I also formulated another “business” idea at this time; financial security lies in working for (powerful) others. In this instance, a big hospital which was part of a large national hospital system. However, I didn’t anticipate the precipitous and abrupt changes healthcare and especially managed care would have on my program and similar ones across the country. Length of stay figures in our setting tumbled from months to weeks to days. In addition, staff cuts further compromised the integrity of the program until I was directing (after being promoted) a program that was sadly a mere shell of its once glorious self.
Luckily, there was another opportunity available to me in the aforementioned outpatient psychiatric program. The company had landed a large managed care contract and it was growing explosively before our eyes. My job was to set up and run a large clinic that would serve a large managed care population along with other prospective patients. It was a heady time and after finding out what some early staff were being paid, I was able to renegotiate a great contract. When a pension plan was later added I was once again sure that my career was secure.
However, this “security” was again relatively short lived as the Clinical Director positions in this organization were eliminated when revenues couldn’t keep up with spending. From this experience, I learned that managed care contracts didn’t always live up to financial expectations, that placing too much faith in others was not necessarily prudent and foremost that security did not lie in seemingly well positioned, even well funded business entities.
While keeping a contractual position with this group it became more obvious that I should test the private practice waters. The words of one colleague/friend (“I did it, you can too”) helped me to get over my apprehensions which nonetheless surfaced often during the first year or so. He indeed had built a solid private practice in the years since he left the hospital program where we worked together. I applied to managed care panels with my new office address and new tax ID number and suggested to my friend that we meet with physicians in the under serviced area where we set up our new office. My plan was to build mutual referring relationships with some of these people and generate a caseload that way. Given my background in pediatric psychology, I followed the same plan with counselors and other professionals in local school districts.
I learned from my colleague how to run a practice while keeping expenses to a minimum. This was a good strategy at the time but I believe this orientation also limited my growth in later years. I tried to forge relationships with other groups in the community like the local Big Brothers – Big Sisters and daycare centers. Most of these contacts didn’t bear fruit despite my expending lots of time and effort. However, valuable relationships sometimes came about almost coincidentally.
I realized around this time that it would help if I knew more about business so I began to explore this in an admittedly haphazard manner. I joined the National Federal of Independent Business (NFIB), in part to obtain family health insurance at a group rate. I started reading selectively from the Wall Street Journal, purchased books and tapes on growing a mental health practice and began subscribing to Psychotherapy Finances. I also studied business experts like Brian Tracey and Anthony Robbins. I read Think and Grow Rich by Napoleon Hill and discovered In Search of Excellence by Tom Peters.
I realized as a byproduct of this work that I had high aspirations, but also inhibitions, even fears that I would need to overcome. Also, since a number of these experts devoted considerable attention to overcoming fears associated with change and finances, I knew I wasn’t alone in this regard.
As valuable as these materials were, I ran into two problems that kept me from using this information to its fullest. First, I struggled to translate these ideas into my own practice. I have always considered a mental health practice unique given the sensitive nature of the problems addressed and the core principle of confidentiality. Was it even reasonable to use the term business when discussing it? Secondly, when I did find ideas that I thought suitable to pursue, I was having trouble following through on implementing them. Where did I find the time? How should I organize my efforts? How do I get myself to push beyond my apprehensions? I was finding myself frustrated despite the solid growth my business was undergoing.
It was around this time that Joe and I began seriously talking about business. I had lots of questions and Joe was starting to find answers through business study programs he was pursuing. Joe was spending a lot of money on this training and on advertising his business. He was getting supervision via phone and e-mail from some of the people I had listened to on tape and he was developing business plans and collecting data as naturally as writing treatment plans and doing research in graduate school. When I asked him how he could speak so casually about spending so much money on his business he explained the concept of return on educational investment. In short, he was earning back every dollar he spent, and more.
While he acknowledged that not all of the plans he and his mentors developed were successful, the results were clear: his business was growing rapidly, he could be far more selective in the kind of work he was doing, command higher fees and develop a client base that was eager to avail itself of the services he and his growing group of professionals were offering. It was obvious Joe was on the right track and that these ideas were compatible with those that I was using. Furthermore, I could incorporate these ideas into my business practices often at little cost.
With time our business talks became more collaborative exchanges where I was contributing useful ideas from my studies and experiences, as well. These talks spurred me on to create a separate subspecialty practice (ADHD) by conducting free seminars for hundreds of parents and I have been joined by a group of professionals who conduct evaluations and offer psychoeducation or skill development programs. In addition, other clinicians have joined me in treating patients and families in more traditional psychotherapy, allowing me to grow beyond the one clinician, one person model so many private practitioners seem to be stuck in. And this growth has occurred while avoiding the regulatory headaches and paperwork nightmares associated with many outpatient group practices.
I still believe that I’ve just scratched the surface of my professional and business growth, despite reaching the 99th percentile of earned income among psychologists. I’ve also discovered that teaching is both a great way to learn and to get myself to follow-up on ideas that will enhance my business further. Therefore, I look forward to sharing these ideas and practices with many more professionals so we can share in the synergy this type of learning, implementation and growth creates.
I encourage you to look around our site. Read the free articles and learn about our services. Most of all, check out our program The Business of Psychotherapy: Creating Your Ideal Practice. I honestly believe this is the best program available for psychotherapists and counselors to learn what Joe and I have learned the hard way: how to develop a successful private practice. We're committed to teaching you the very best of what we've learned, and helping you in any way we can to achieve a very successful practice.
To read about all of our services to help clinicians grow their practices, please go to: Uncommon Practices Programs and Services.
For more information, email us at: firstname.lastname@example.org or call us at (800) 940-0185.