The Private Practice Success Podcast

18. How to Reduce your Clinical Hours as the Practice Owner

• Gerda Muller • Episode 18

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In this episode of the Private Practice Success Podcast, Gerda explores the crucial transition of reducing clinical hours as a practice owner in order to focus on business growth and leadership. More specifically it delves into finding the balance between clinical work and the responsibilities of running a group private practice, and doing so in an ethics and values-aligned manner.

In this Episode, you'll learn (amongst others):

  • Why and when practice owners should consider reducing their clinical hours.
  • The importance of balancing clinical duties with leadership responsibilities.
  • Strategies for communicating changes to clients in an ethical and supportive manner.
  • The potential pitfalls of taking on too many clinical hours and how to avoid them.

Who This Episode Is For:

  • Practice owners looking to transition from clinical work to business management.
  • Group practice owners seeking to balance leadership responsibilities with client care.
  • Clinicians interested in understanding the dynamics of reducing clinical hours.

Special Bonus:

Download the first two chapters of Gerda's book, "The 7-Figure Practice," for FREE! 

Don't miss this important episode as Gerda shares personal experiences and practical advice for navigating this important phase of your practice's journey. Whether you are just starting to hire your first clinician or are already managing a growing team, this episode offers valuable guidance to help you succeed.

Connect with Private Practice Success & Gerda here:

Well, hello there, brilliant private practice owner. My name is Gerda Muller, and you are listening to the Private Practice Success podcast. And this is episode number 18. 

Today, I want to talk to you about how to reduce your clinical hours, when you are the practice owner. And how to do it in an ethical and values aligned manner, so that you can rest assured that you have 100 percent looked after the best interest of your clinical clients. 

So, why would a practice owner need to reduce their clinical hours? Generally, this happens when you are building a group private practice.

If you are in solo private practice; you are the person who is doing 100 percent of the clinical work. However, the moment you start to hire your very first clinician, you are going to need to have more time to start working on your business. And even if you've just got that one extra clinician, that might be supporting them with an hour of supervision a week. 

That might be spending more time doing additional marketing to make sure that their diary is also full. Now, initially, if it's only one clinician and maybe they're only working with you two to three days, it's not going to be that much, right? But slowly but surely, as your team gets bigger and bigger, there's going to be more backend work that needs to be done.

Balancing Clinical Work and Leadership

Now obviously there's a lot of ways to manage that. And of course, you're going to hire your support team, whether that is your receptionist, an administrative assistant, maybe even a practice manager and so on and so forth. But when you are hiring clinicians, you 100 percent need to accept that it is your job as the practice owner ,and generally as the principal clinician to be a leader, and to be a manager. 

Whereas previously, when you're a solo practice owner, your only job was to look after your clients. When you start to grow a group private practice, you now need to look after those clients that's still on your caseload, but you now also need to look after your clinicians. You need to make sure that you're available if they need a debriefing after a difficult day or a difficult session. You need to be available if they need some supervision. You need to be there to look after them and support them. And for those  incidental connections happening in the corridor and in the kitchen when you're making a cup of tea or coffee.

Also, when you have a group private practice, you now also need time to look after your admin team.  You are the main person to train them, to support them, to make sure that they know the systems and the processes. So there is a lot of work involved in running a group private practice. Obviously, the better the systems and procedures that support the functioning of that practice - the less time intensive it is going to be.

But I can tell you now, even if you have the best systems in the world, you will still need time to work on your business. Because guess what? The best system is only as good as the people working within it. And systems can't operate just by themselves.  So the time's going to come where you as a group practice owner, whether you like it or not, are probably going to have to drop some clinical hours. Now, of course, when I'm talking about these topics, I'm talking about the general rule.

100 percent there's always going to be outliers. There might be somebody that says, I'm not doing that. I love my clients too much and I am willing and able. That's a very important word - If you've got the budget to straight off the bat say, I'm going to keep doing clinical work and I'm going to trust an external person to come in and run the show for me. I'm going to pay them a great market rate to come and do this work. I'm going to trust them to run my business.  I'm sure there's people out there that do that - but I just wanted to say, there's always going to be outliers. But as a general rule, it's going to be you, the principal clinician, who's made the decision to start a group private practice that is going to be the one to run the show, that is going to have to have time to work on the business in addition to working in it. 

And if you fail to make that transition soon enough, you're going to be in big trouble. I see that all the time. People come to me, especially people interested in coming and working with me in my Private Practice Success Academy, and they tell me they're still doing four, some even five days of clinical work. 

And it's like, no wonder your business is struggling. Because if you are still doing that amount of clinical work and there's a team that you want to look after, no wonder you're working 24/7. No wonder you don't see your kids and your family. No wonder you are on the brink of burnout. The consequences of not making that transition when it is required can be really detrimental.

Now again, the way that you go about that transition can be different for each person. If I think about the way that I did it, when I started my solo practice, I was working five days a week, and then I hired my first two clinicians and I immediately dropped a day. Because I went from being a solo practice owner to hiring a five-day child and adolescent psychologist and employee, and hiring a two day a week adult psychologist. And I hired a practice manager that worked for us five days a week, school hours. 

I immediately dropped a day of clinical work, because I knew that it was now my job to support them. To make sure that I train up the admin and you know, training doesn't happen in one or two days, it takes time. And I also had to train up the team members, my employees that came on board. I had to properly onboard them and support them, make sure they settle in, that they know how to look after the clients. So I was there to answer questions that they might have - and that took time, and I was still seeing my own clinical clients four days a week.

And as I slowly but surely added more and more clinicians, I then dropped down to three, and then I dropped down to two days a week. And then later I dropped down to one day a week.  And my one day a week, by the way, was always Wednesdays. And then I dropped down to Wednesday mornings only. And then I dropped down to every second Wednesday morning only. 

So needless to say, I didn't really want to let go of my clinical work. I think if I could do it over, I wouldn't drag it out the way I did. But I also know why I did it because I love clinical work. I so badly wanted to become a psychologist. And it's hard letting go of that identity piece of that identity piece that says - my primary job is no longer being a clinical psychologist, and when I use the word clinical, I mean, doing clinical work, but it's now actually being a psychology business owner.

The Transition from Clinician to Business Owner

At the time when that was happening, it was back, in 2016.  It was the most recent time that I actually went back to South Africa to visit family. And if you've travelled overseas, you will know that when you come back and you re-enter the country, you've got like a immigration or customs little card that you need to fill out answering various questions, declaring a bunch of things. And one of the arrival cards, I think it's called, I can't remember, it's been so long ago, ask you about your occupation and you need to write down what is your occupation. And it was interesting for me that that was the very first time that I didn't put down clinical psychologist. 

I put down - business owner. I had finally made that transition of going, you know what, most of my day, week, month and year,  is now spent being a psychology business owner. And that was a really interesting feeling, and it took me a really, long time to get there, but we got there. Because essentially that is what happens when you grow a group private practice.

So how do you know when the time is right for you to start dropping your clinical hours as the practice owner? For me, it was when I would arrive at the practice in the morning, and I would feel stressed and worried about the list of things that I had to do for the business. Which was generally things I had to do to support my team, but I knew I couldn't get to it that day because I now had to go into client sessions. And, and the thing is, I don't like letting people down and it felt like I was going to let my team down because I'm not going to get to the stuff that I wanted to do for them.

 And then I would go into my first client that starts at nine, and the moment the client walks in and I would close the door behind me, I was in full psychologist mode. I was there with them in the moment and I would totally forget about that stress, about the worry, about feeling bad, that I'm not going to get to the things that I really wanted to get to and that I'm going to let somebody down.

I would go through the day and I would do quite a lot of clients in one day because that's just how I like to work as a clinician. I could easily see a lot of clients. I didn't like having breaks between appointments, it was like, I'm in the zone. I go in, start at 9am, I'm out at 9:50am. My notes are written. You know, go to the toilet, ready for the 10 o'clock client. And then I would do it one after the other.  And it felt really good for me doing it in that way. To me, that was a really productive day because I could impact a lot of people in a short space of time.

And whilst I was in it, I so enjoyed it, and the day would fly past.  It would be the end of the day and I would have walked the last client out to the front desk, I would walk back into my consulting room and I would sit down and I would always have this thought of - this is why I do what I do. This is why days like today are why I do what I do. Because today I've helped 6, 7, 8 people. Today I've made a difference in the lives of 6, 7, 8 people, and it gave me such a sense of achievement. That's just how I experience being a psychologist. It's an amazing feeling that you are actually able to help another human being. It doesn't mean I never had difficult clients; I treated a lot of trauma, a lot of people with complex PTSD. I did a lot of DID work. So I did not have an easy caseload, but I actually enjoyed that level of work.  That's the stuff that made me feel like I was making a difference. 

It was an amazing motivator for me as the business owner to keep growing my business. Because I would end my day going, this is why I do what I do, and this is why we do what we do as a team. This is why I need to ensure that every consulting room, first and foremost, has a clinician bum-on-seat to see these clients. 

That is why I, secondly, need to do everything in my power to make sure that everybody knows that we exist. Everybody that needs help, that has a mental health condition - or maybe not, maybe they just want somebody to talk to - that they know about The Psych Professionals. Because I now also want clients’ bums in seats here. Because I know what can happen if somebody puts up their hand and asks for help and they come and they see a really amazing psychologist, and of course, I only hire amazing psychologists - I know the impact that that can have. 

And then I was so super motivated to start the next day getting through my list of things to do. So for me, it was like this a little bit of a motivational hit that I would keep getting every week. And I think that was part and parcel of why I hung onto it. It was a bit of a dopamine hit, where I left those days feeling really, really good, totally motivated to do all the harder things, things that were outside of my comfort zone, because we don't get taught how to be a business owner in Uni, only how to be a psychologist. And it allowed me to do those difficult things, uncomfortable things to continue to grow and build the business. And I think for me, that is most certainly why I hung on to client work for a really, really long time. 

Would I do it any differently if I had my time over? Yes, probably. But I don't think you can underestimate the impact that that dopamine has. These days I don't need that anymore to remind me of the impact and of the vision. I get to speak to my principal psychologist, I get to hear success stories from our clinician team, and I get my dopamine hit through third parties in that manner. So I still get to hear really great outcomes that remind me of what we are doing is definitely making a difference.

So let's say you've decided, it is time for me to reduce my clinical hours. Even if it's just half a day or full day, because you now realise and recognise the importance of having that time to work on your business. How do you tell your clients? And I know that this is really hard. I had a number of longer-term clients on my caseload because of the type of work that I did. And I must say, It was really hard for me to have those conversations, but I did. And you know what, not one client took it badly, not one, maybe I was just lucky in that they didn't.  I wouldn't say that I found it easy to hand over clients but the process and the way it played out was way easier than I anticipated in my mind.  

You think you're going to have a consult with a client, you're going to tell them that you can't see clients anymore. And your brain says, Oh, they're going to be so upset, they're going to start crying or they're going to feel like you're abandoning them or they're going to get angry. So you really start to expect the worst. But take it from me - I don't think that happens that often. It doesn't mean it can't, but I've helped a sufficient amount of practice owners now to know that it works out. It works out each and every time. But of course you need to think through the process of how you want to do it. So I do want to give you some tips around that today. 

Preparing Clients for Change

If you're going to have that conversation with clients, you do want to give them advance notice. So you don't want to meet with them today and tell them this is their last appointment. Nope. Which also means that you shouldn't leave this whole process to the last minute, and I've seen that play out where people just go,  I can't do this any longer, I'm done. One appointment and I'm handing them over and I'm done. When you do it in that way - there's no judgment if that's how you did it - that tells me that you were really, really overwhelmed, and overwhelmed is a very difficult emotion to manage. I want you to give yourself grace for that, but we want to try and prevent that from occurring.

So you at least want to have one more appointment after you give notice. So if you're going to speak to them today, you're going to tell them that you are dropping client hours. You want to have one more follow up to make sure that they're 100 percent sure. So advance notice needs to happen.

Second point is if you're going to have that conversation with a client, let's say you're seeing them today and you've decided to have the conversation, have it at the start of the consult. Do not wait for 10 to 15 minutes before the end, because again, you do not know how the client is going to react.

Clients are probably going to be okay, but you need to allow them an opportunity to hear what you're saying - to take it in, to process it, to ask questions, to give you objections, to tell you how they're feeling about it - so that you can use that time to process their feelings. Some clients, you'll tell them at the start, and only after 20 minutes, they'll come back to that information and go, “Hey, can we talk about that?” And if you just drop that bomb at the end, I wouldn't call that an ethical notice to your client. We want to make sure that you put the client first in this conversation, and have it in the start. 

The third important point here is to make sure that you properly position the information that you're going to tell them. Because your clients are going to want to know why. It's just human nature. If I just tell a client - going forward, I'm no longer going to do clinical work.  What's going to be the first thought that pops in their mind? Like why? Why Gerda? What's happening? Are you leaving? What's going on? So you need to know why.

 I believe in being really honest and upfront with our clients. I trust that they can hear the full reason behind why this is happening. 

 When I went through this, what I encouraged my clients to do is to just go, “Hey, I'm not sure whether you realise, but I'm also the business owner.” Do you know how many clients didn't know that when I told them that? And maybe that is because back then people weren’t on social media and on the websites as often as they are now. But some clients actually went, “Really? You're the director?” It's like, Yes, I am, I actually own the business. And then they actually felt really good. They felt like they were special because they got to see the business owner. 

But I would tell them I also owned a business. I’m the principal psychologist at the practice, but I also own the business and the business is growing. We've taken on new team members over the last couple of months, which means that my job has really grown significantly, and my responsibilities outside of client work have really grown. So these days it's my job to look after our clinical team members - so all the other psychologists that you notice here in the practice so that they can look after the clients.

But unfortunately, what that means is that I now need to stop doing clinical work because that's where those extra hours need to come from, it's the only place where I can find them. So what I'm going to be doing in the future is working more on the business to support the team so that they can support the clients. And then I will go from there with that conversation. And you know what? Clients actually take that really well. They, they get that. And if they have questions about it, then you just answer that. 

 The Ethical Approach to Transitioning Clients

Some of the most common questions that you might get is, “Oh, who am I going to go to?”  What I make sure I have done before having this first notice session with the client is to actually determine who the best person at the practice is to see them. 

So I will tell them - What I've done, because I knew I was going to talk to you today, I've looked at our entire history and time together, and I've looked at the team of clinicians we have at the practice. Based on who we have and where you're at in your therapy right now, I'm recommending that you go and see so-and-so at the practice. And then I would tell them why I would tell them a bit about that clinician, about their skills and competency experience - not too much detail, one or two sentences - and say, This is why I believe they are the best person to support you going forward.

And then I will tell them, What I recommend you do is hop onto the website, have a look through their bio between now and when I see you again. If there's any other questions that pop up for you, let me know. 

Another objection that some clients might raise is, “Oh, do I now need to tell a new person my entire history? I really don't think I can do that.” If a client says that - and you can even pre-empt it if you know you've got a very introverted client and they might be taking time to process things, but you think they're going to have this question -  just address this potential unspoken objection, by letting them know how that process is going to work. 

For example, I would say - “I know that a lot of clients are concerned that they might need to repeat their life story to a new person. I want you to rest assured that that is not the case here at the practice. We take really good  clinical case notes, but that aside, I will be having a personal conversation with the new clinician that's going to be in charge of your care, and I'm going to do a full case handover with them. When they meet you for the first appointment, they will not be asking you to rehash your entire life story. We actually have a really clear process for how to do handovers. And they will be handling that new appointment session in a way that's going to be of value to you.” So we address that objection in that way.

So what you're really reassuring the client, is that you, as the person who they trust implicitly, you have matched them with another highly competent, skilled and experienced clinician to look after them. In some instances, if you feel that there's a client that might struggle to adjust to a new clinician, depending on the clients you work with, what you might want to do is get them to have a session with the new clinician between now and your next appointment with them.

However, personally, I've never had to do that, but I do know that some practice owners I've worked with have done that in the past. For me, I really make sure that when I give that notice, I do it well, I do it in a very supportive space, allowing the client to express any thoughts, ask all questions., I answer all of those things whilst giving them those assurances.

And then I do what I said I was going to do, I do a great handover. Our team has a specific way of how they handle a handover session, we use a sheet that we call our Critical Reflection Sheet - which clients absolutely love and they get real value out of that first session with the new clinician and they’re all good.

A final thought on positioning. A lot of clients, particularly the ones that I've worked with and we've had at my trauma centre in the past. A lot of them have often felt very broken. And, you know, if you tell them that you can no longer see them, there's a potential that they could feel abandoned. So I always also make sure that they know that when I hand them over, it's because I 100 percent trust and believe that they can handle that handover. That they are okay enough to see a new person. So, so very important. 

A lot of times our clients need to borrow some belief and trust from us, that we know for certain that they're going to be okay. And also that we know that they are now going to have a fresh pair of eyes looking at their world, looking at their life. And I, for one, know that a lot of times when a client starts seeing a new clinician, they actually improve significantly in that initial three-month period, because a fresh set of eyes is looking at them. A new clinician with a different background, different lived experience, different skills and training is not helping them.

If you conclude the relationship in the way that I've spoken about today already in that real ethical, supported, values aligned manner, having trusted the client - with the reason for why this is happening - getting them to really be there with you, celebrating the fact that the business is doing well, and as a business, you can help more people in better and more effective ways. When you, as the practice owner, step into that space, the client is now part of this thing. The client is part of this movement, but they also get to benefit from it. Because they have now this new person that's going to come up with new strategies that can help them, new ideas, different ways of supporting them. And because of that, at the end of the day, if you do this really well, everybody wins.  

A Word of Caution

I want to end today's conversation with a little warning, because I've seen this happen time and time again. Where a practice owner goes through all these steps, and they actually hand over their clinical clients, and they've got additional time, and they really love this opportunity to build their business. They're really good at it. A lot of practice owners never knew that they were good at running a business until they actually started to focus on it. And they start loving working on the business, and then something happens. 

For example, a clinician might resign, especially when it's somebody that's been working full time - and maybe that practice owner can't find a full-time replacement - maybe they can only find somebody to take on two or three days. And then because they are still that clinician, at heart, they want to make sure that those clients on the caseload are looked after. So what do they do? They pick up additional clinical client hours to look after the overflow of clients.

In a different scenario, if a practice owner has a huge wait list at their practice, they might decide to take on more clinical clients because they're feeling bad about the growing waitlist. They want to help the people that are there. 

Or a third scenario, is when a practice owner becomes cash strapped as a result of a multitude of things that can go wrong in business. What do they do? Their knee jerk reaction is to go the quickest way for me to make money right now so that I can pay my team, pay the bills, and keep the doors open, is for me to take on clinical work again. And then before they know it, they are on the road to burnout again. Because their practice owner duties and responsibilities don't magically disappear, it's still there. And it's probably grown because if you've got cashflow problems, then there's additional stuff you need to do. If you haven't been able to recruit, there's additional recruiting you need to do. And that is a direct line towards burnout.  I see it all the time. 

So please, I'm warning you about this right now. You taking on additional clinical hours when those types of scenarios arise, should be the worst case scenario. And until you've actually reached out for some proper business mentoring, coaching, consulting and support. You might not know what the answer is. It doesn't mean there isn't an answer. You need to remember that sometimes we're just too close to our business to see the solutions.

I've had people tell it to me so many times over the years. Where I would talk to them and I would go, “Hey, have you thought about doing this?” And they went, “Why did I not think of that? It is so simple. Now that you've said it, it is so clear that this is what I need to do.” And it's like, “Because you're human and you're working in your business, and sometimes you just can't see the forest for the trees.” And that's why we need external eyes on our business at times. 

 Finding Your Balance

So today, I want to encourage you to really objectively look at what your working weeks look like.

How many hours are you spending working IN the business as the clinician, and how many hours are you actually spending working ON the business? And is this in balance? Is it one more than it should be? Is the one less than it should be? What is that ideal number for you right now? 

And then start thinking around what are the steps that you might need to take in order to start moving towards a balance in those hours that's going to give you the joy of being a business owner, and that's going to stop you from being on the spiral towards burnout. Because I know you don't want that. Your team and your clients cannot afford you to have that, neither can your family, and I don't want that for you.  

Alrighty, I'm going to love and leave you.  Have an amazing rest of your day and week. And remember, I am here to help you build a practice you can't stop smiling about 😊

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Gerda Muller

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