The Private Practice Success Podcast

20. Waitlists: To Have or Have Not...?

• Gerda Muller • Episode 20

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In today's episode of The Private Practice Success Podcast, Gerda tackles the age-old question that every private practice owner will wrestle with at some point in time and that is whether to have or not have a waitlist.

Join Gerda as she dives into the pros and cons of maintaining a waitlist, drawing from her extensive experience as a group practice owner and business consultant to allied health professionals.

In this Episode, you will learn (among others):

  • When, how & why to have a waitlist, as it applies to both solo and group practice owners.
  • How to implement a proactive and ethical waitlist management process.
  • Strategies to balance client demand and availability.
  • Insights into aligning your waitlist with your business vision.
  • How to support waitlisted clients through value-add strategies.

Who This Episode Is For:

  • Solo practitioners looking to manage client demand effectively.
  • Group practice owners wanting to optimise their waitlist strategy.
  • Clinicians interested in ethical client management.

Gerda shares practical advice and personal insights to help practice owners navigate the complexities of waitlist management. This episode is essential for anyone looking to enhance their practice's efficiency and client satisfaction.

Connect with Private Practice Success & Gerda here:

Well, hello there, spectacular private practice owner. My name is Gerda Muller and you are listening to the Private Practice Success Podcast. And this is episode number 20. 

Today we're going to answer a question that has probably been around for as long as private practice has been around. And that is the question of - Waitlists. To have or have not. Let's get into it.

 If you are a practice owner, whether you are a solo practitioner or a group private practice owner, I'm pretty sure that at some point in time, this question has popped into your head and you have probably spent a lot of time considering this. There are a lot of arguments for and against having a waitlist in your private practice. People have very, very strong opinions, both ways.

I consider myself a very reasonable and rational person, which means that I 100% understand, accept, and respect the opinions on both sides of this argument.  Both the yes you should have it. And the no, you should not have it argument. But today what I want to do, because this is the Private Practice Success Podcast, I'm going to share with you my opinion on this question.I'm basing my opinion on now having had my very own group private practice for almost two freaking decades. I can't believe it. That makes me feel so darn old, but yeah, it's been 18 years of having The Psych Professionals, which is my practice. And I've been doing this thing called being a business consultant to other allied health, particularly psychology group practice owners, for more than a decade. 

So I started back in 2014. So it's like we're in our 11th year already now of me working with group practice owners who want to grow and scale their business. So needless to say, I think that there's a lot of evidence, experience, and history behind my opinion. Still doesn't mean that you need to accept it, but this is just me sharing my opinion based on my experience that I've just shared with you.

Proactive and Ethical Waitlist Management

So my opinion is that you 100% should have a wait list at your private practice. No questions about it. And I am applying that answer - yes, to group practice owners, as you might expect - but you might not expect that I'm also applying that answer to solo practice owners. You know why? Because if you as a solo practice owner don't work, you don't get paid. So it's a really important part of making sure that you have ongoing business. 

That's just the short of it. Just so that I don't lose my solo practice owners in this discussion. And you go, I'm going to tune out or skip to another episode or listen to a different podcast because this is more for group practice owners. No, it's not. It includes you as well as a solo practice owner.

But there's a really important disclaimer here. I'm very confident in that, yes, you should have a waitlist, but, and this is the disclaimer, you should only have a waitlist if you also have a proactive and ethical wait list management process, that's going to support that wait list. If you don't have that, you've got no business having a wait list.

If the extent of your wait list management is having a list of names on a piece of paper or on an Excel spreadsheet, or even in your diary software that you can call on when there's holes in your diary, then you've got no business having a waitlist. That's not how we do it. It's not ethical in my personal opinion, and it's also not proactive. That is just about going, this is for my own peace of mind, having those people there, and when I need them, I'm going to book them into my diary. No, that's not how we roll. That's not how we do it. Okay. So let that sink in for a second and maybe take a moment to just reflect on how you've been managing your waitlist.

And please, there's no judgment because sometimes we just don't know what we don't know. We might think that this is just how people do it out there in the industry. And if you've been really isolated in trying to build and run and grow your business, you won't know what other people are doing. And yes, you might be in Facebook groups where people share every now and then. 

I can tell you 100% of people don't share everything. You just can't share all the details in a Facebook post. It's just not possible. You can't share the context of what happens behind the scene. So although I myself give input to people in Facebook groups, I'm very aware that we're giving people like this little, little, little piece of information that's one tiny piece, of a thousand piece puzzle. And yes, it's going to make a little difference, but they're trying to build a puzzle and they don't even know what the image is that they're trying to build. That is what happens when you try and run a business based on random people that's trying to be helpful in Facebook groups, including myself.

So you need to be aware of it. There's no judgment. And that's why I'm glad that you are listening to this podcast, because I'm going to share with you my thoughts on this topic.

The Gap Between Demand and Availability

So let's consider some arguments against having a waitlist, because like I said at the start, people have got very strong opinions either way. And I would say the biggest and most probably most meaningful and understandable argument, is the fact that when you are running a waitlist, there are people sitting and waiting for a service.

In the case of my practice, The Psych Professionals, and probably a lot of your practices -  if you are psychologists - that is people with mental health challenges and they need our help, probably sooner rather than later, but similarly for other allied health disciplines. These people that need our help and support as helping professionals and when they are sitting on a waitlist, they can't access that support. They're just sitting there and nothing's happening, and that is why a lot of people don't like having waitlists because those wait lists keep you up at night. You worry about them. That is if you are a really passionate helping professional, that's what will happen for you.  I'm going to err on the side of caution and go with everybody I'm speaking to today. If you're listening to this podcast, you are a helping professional and your heart is in helping people.

So it's going to be a really heavy burden on your shoulders, knowing that there are 10, 20, 100. I once spoke to a practice owner that had an excess - like a group practice owner - I will preface this, they had an excess of 900 people on their wait list. Let that sink in. 900 people on their wait list. I had to check and triple check. I probably asked that question three times and they confirmed - yes, I heard that correctly. 

That is people not getting the help they need and deserve. And I'm not saying you should have that amount of people on your wait list. I'm just painting the picture for you of what I have seen and heard. I've spoken to lots of practice owners over the years, and this is the honest truth. These are the numbers they share with me. And I can tell you if I had 900 people on my wait list, I wouldn't be able to sleep even though I had a proactive ethical wait list management process.  Well, that being said, I think it would be really hard to manage that type of waitlist. I wouldn't want that. I will most certainly put a ceiling on waitlist numbers, but I'm jumping ahead. 

So let's get back to - yes, we want people to get the help that they need sooner rather than later. But we also need to remember the following  - that right now, and for a very long time in our industry, demand has exceeded the supply of helping professionals. There are way more people needing to see a psychologist than they are psychologists, and with available hours to see those people. So not having a wait list, it's not going to solve that problem, right? So even if we have public health and NGOs that could also pick up a segment of the market that needs mental health support, there is a very large segment of the market, and I'm going to call that the private market that just doesn't qualify for services within public health, who doesn't qualify for services with NGOs. So they have no option but to access the private providers, which is us in private practice. 

And there are not enough psychologists, particularly because that's my industry - but I would actually venture to say allied health in general, because I work with a range of disciplines. We just don't have enough service providers to service the private market.  It's just what it is. So to some extent, are you just going to let those people out into the wild and just leave them by themselves, or are you going to put them on a wait list with an ethical proactive management process attached to it. So that they get some level of contact and interaction and support from your business whilst waiting. I would say that is better than just letting them out into the wild and letting them fend for themselves. 

For me, what helps me sleep at night is knowing that they are on our waitlist. They know they're on our waitlist. I know we've got a process to support them, but you know what's the other thing I know as well, and that is that people aren't locked in to come to us. Our clients are actually way more savvy than we give them credit for.

They've got a choice and they've got options. And they can go out there and they can call 10 other practices to see if they can get in earlier. I can tell you now if you've got 300 people on your wait list, when you start calling that wait list to book them in, 200, two thirds of them will already have accessed services elsewhere. So when you look at the people on your wait list and you go, okay, that's good. You really should only go, one third of those people will probably convert into actual appointments in our diary. Because our clients are clever. They are savvy. They are way more educated when it comes to looking after their mental health.

In 2025, which is the year that I'm recording this in, people will continue to be more educated around their mental health. And they've got that choice and control. So it's really a balance between all these things. And I can tell you, I've spoken to practice owners when they come on board and start to work with me - we obviously speak about all the challenges, their roadblocks, what they're struggling with. 

And some of the stuff that often comes up with regards to wait list management is that the practice owner would go, “ I had all these people on my waitlist, and based on that waitlist I hired one full time equivalent, sometimes even more, let's say psychologists. And  because of the waitlist, I employed this person permanently full time because I wanted to service that waitlist because I'm passionate about helping people. And then when we started calling people to get them booked in, people weren't booking in because they were already elsewhere. Clients don't come back to you to say, “Hey Can you take me off the waitlist”, and they don't have to, because this is a waitlist. They're not your client. They've got no duty to tell you that they've got in somewhere else. 

They can stay on 20 waitlists if that's what they choose to do, and then you've got a practice owner, they've now just employed somebody full time and they can't fill their caseload because they've been relying on a waitlist. But it's because they didn't have a proactive and ethical waitlist management process. It was a set and forget list. It was a list that made them feel like there would be business, but because clients are savvy, they have moved on elsewhere. 

The Seesaw Effect

Another factor to consider in answering this question and making your own decision around having a waitlist, is what I like to refer to as the seesaw effect within private practice. I see this play out so very often. This is where Practice owners, solo and group, but also clinicians working within group practice - particularly contractors more so than employees -  are on this consistent seesaw of worrying that they have too many clients versus too little clients. Too many bookings in the diary, versus too little bookings in the diary.

And it's the seesaw effect being that it's up and down, up and down. They find it really hard to get to that place of balance, and as a result, there's constant worry.  If they aren't worried and therefore stressed and anxious about not having enough clients -  they are worried, stressed, and anxious about having too many.

For the practice owner, this is because they are paying maybe employees that are there, they're paying overheads. And that amount of expenses doesn't decrease when there's less clients, is exactly the same. For contractors, if there are no clients, they don't get paid, right? For the solo practitioner, if they don't have clients, they don't get paid.

And it's this constant seesaw and people are finding it really hard to get to that place of balance. So once again, having a waitlist, but managing it proactively and ethically allows you to get to a place of balance where you can actually go -  what is my ideal number of client appointments that I want every week. And then how do I need to set parameters around my waitlist management, that's going to help me maintain that equilibrium. Because if you can achieve that, you'll take so much stress out of your world. It's just not true. The amount of energy  that goes into stress and worry about caseload numbers is just crazy, but totally understandable.

And from my perspective, having a waitlist helps you address that so that waitlist really serves you, as an individual and a group practice owner, as a clinician, as a contractor, as a solo practitioner, but it also serves the clients. Because you can look after them whilst they're on the waitlist. You're going to call them when something becomes available. And they might go, “Thank you so much, I would love to book in.” Or they might go, “Thank you so much for ringing, but I've already booked somewhere else.” And that is perfectly okay. Because that's their choice and their right to do that. But you'll still have a waitlist to make sure that you maintain that equilibrium.

So that is really important, because if you do not have a waitlist, you are relying on consistent marketing efforts, which should be there anyway,  but particularly if you are a solo practitioner, that's going to add stress to your world. So we want to make sure that there's that balance between our marketing efforts and our waitlist.

Aligning Your Waitlist with Your Business Vision 

So let's answer this question then - What is this proactive ethical waitlist management process you speak of Gerda?   Now for each of us, it's going to look slightly different. But, you know, the words in it say it all. You need to be proactive and it has to meet our ethical guidelines. 

For me personally, it has to pass my can I sleep at night test.  Can I sleep at night with what it is that I have put in place? And that starts with not having that set and forget waitlist. That is the worst thing that you can do. Yes, it's still a waitlist, but in my opinion, that's not ethical and it's not proactive. So I think a lot of times when I hear arguments against waitlists, it's because a lot of people have a set and forget waitlist. So I am also against that type of waitlist. 

Ultimately for you to determine what's going to be proactive and ethical in your world at your practice, with your discipline, with your team that you have, it's going to depend on the size of your business, the number of clinicians you have. But you also need to look at the type of clients that you service. Do you work with children and adolescents that have NDIS referrals, because generally they stay on your caseload much longer. Do you work with complex PTSD? Do you work with eating disorders? Or do you work with your bread and butter depression, anxiety, stress within private practice. As the business owner, especially of group practice owners, but also solo, you would have an idea of what your retention rates at the practice.

In general, how many sessions does one client attend? Which means that you would know when do you expect more spaces to potentially become available? Also, what are the booking guidelines within your practice? Do you book one session in advance? Two? Three? Six? Do you book a whole term in advance? Do you book a whole year in advance? Yes, people do a range of things, right? From one appointment to a whole year in advance. How do you book your clients? All of that is going to give you really vital information around what your ethical and proactive waitlist management processes need to look like. Because if your whole practice calendar is booked out for the next 12 months, because that's how you book, then I would venture to say that you will not have a lot of people on your wait list.

There's always going to be people that move out of the area or, you know, something like that, that's going to open up spaces, but you're not going to want 300 people on a wait list. That is not going to be ethical in my point of view. Unless of course you're going to open up a second location and you're going to be able to duplicate your clinician availability and hence capacity to take on more work. Can you see how this waitlist can also lead to business growth? That is a very much related, but different discussion. I'm not going to go down that pathway, but that could be an option. 

My point that I'm trying to make is that as the business owner, you need to have sufficient time in your world to sit as we like to refer to in my Private Practice Success Academy at the top of the mountain. We have this view of the surrounding landscape where you can see what is happening down there? What is coming there in the distance? What is happening over there in the distance?  

And then you collate that information and then you can go, we are going in this direction. That's the goal that we are working towards. How do all these things inform me what we are doing? And you do the same with your waitlist. How are your future plans for your business informing your waitlist management. How does your plans for the next 6 to 12 months inform it? What do you want to do? Are you just consolidating so there's not going to be growth of team members that's going to inform a certain proactive management process? Or are you super excited, you're ready, you've got your systems, your processes, foundations in place, and you're going to start another location or you're going to start outreach or you're going to duplicate what you're doing somewhere else. All of that needs to inform what it is that you're going to do within your business.

Solo Practitioners: Reducing Waitlist Overwhelm

Now let's take a step deeper and I'm first going to speak to solo practitioners, and then I'm going to speak to my group practice owners. So if you're a solo practitioner listening to this and you're going - Okay, Gerda, I think you've got a point. I'm going to start compiling a wait list.

This is my input to you. I realise that as a solo practitioner, a wait list is an even more heavy burden to bear because it's only on your shoulders. You've got nobody else to send those clients to, right? Because it's just you in your business. So the first thing I would encourage you to do is to be very clear as to who is your ideal client.

Who is your niche? What is that client that you love working with, that is easy for you to work with? I find that when you niche down into a certain presenting problem, which for me as a clinician was trauma. And  when you get really good at treating, let's say, trauma versus then also taking on clients with other types of mental health disorders, you don't have to think as much. Because you know, your stuff, you know, your theoretical framework, you know, your approach, you know, what works and you just go in and you do your thing.

I actually am a true believer in having a niche as a psychologist, particularly because that's what I am, that's what my business is predominantly - It prevents burnout. I think if you want to be everything to everyone, it's hard to work. There's more energy. There's more thinking. Now, if you are a provisional psychologist or you're doing your endorsement supervision, then unfortunately you can't niche because part of your training is learning to deal with a range of presentations, you need to deal with a range of age groups. And that is really important because doing that and going through that process helps you to determine - what do I love working in? What am I really passionate about? Who are those clients that when I get ready in the morning to go to the practice, like I can't wait to see them.

And who are those clients where I go, Oh, that's going to be really hard. Or, you know, I don't enjoy having those conversations. And it's okay to have certain clients that you love working with and others that you don't love working with because there will be somebody else out there that loves working with those clients you don't like working with, right?

So when we're doing our training and we're doing our provisional and also our endorsement supervision in our chosen area of endorsement, that way when people start calling up and they're not your ideal client, you can refer them on. And I would encourage you to decide who you are going to refer them to? 

And that brings me to my second point,  you want to make sure that you establish some very clear and strategic referral relationships within your local area. 

So just to come back to my niche.  You want to build a wait list of people that is your ideal client, because if you do that, you can also build a caseload that's not going to burn you out, but that's going to light you up. Also, if you have a niche caseload, guess what? Just on an extra little point that I'm going to throw in here. When you have a niche practice, you can charge more money. Because you have a niche. But we're not going to speak about fees today. 

So let's say now you have people calling in and they're not your ideal client. You want to refer them on. So what you want to do is you want to have a look at who else is in your area that you can support, maybe it's another solo practice owner. Maybe it's a group practice that you can send people to. And I know that might be scary because you're going, what if they take all my clients? No, they won't. Not if you've got a niche. They might even refer to you. We at my group, private practice, we've been referring to solo practitioners for many, many years. Especially if I've met them at a networking event or they've reached out and they have a niche. 

So have a think around who in your area could you refer people to, even if it's just one other practitioner, and then they will refer to you. Maybe when you've got spaces available, or you can just flag to them and say, “Hey, I've got some space available. If you've got anybody on your waitlist or anybody reaching out that has this type of presentation, I'm here. I'm available.”   Don't be scared to establish strategic referral relationships. That's going to help you sleep at night by knowing that even though you're a solo practitioner, you do have other people in your peer network that you trust and who you can refer to.

For a lot of people, of course, when they are in solo private practice and they start to develop a wait list, for a lot of people, that is that little flag, or maybe that helpful trigger in this instance to say - Hmm, maybe this is a sign that you should start a group private practice, and a lot of people will then start a group private practice

I mean, that's how I started my group private practice.  I was a solo practitioner for six months, at which point I realized that I had so much demand, and then I gave myself some time to think about it. And then I pulled the trigger and within nine months I had hired my first full time child and lesson psychologist and my first part time two day a week adult psychologist, and that's how my group private practice started. But you know, if you don't have any plans for group private practice, then it's about referring those clients out, or setting parameters around how many people do I want on my waitlist. You might just want five or ten. 

Always remembering that two thirds of them would already have gone elsewhere by the time you call to book them in. But that's not the only thing. You need to have a proactive way of managing them. I'm going to come back to that bit. 

Group Practice Owners: Communication Clarity and Cadence

Now, moving over to our group practice owners, you're going to keep everything in mind that I've just mentioned to our solo practitioners. You are going to have an even greater responsibility to proactively and ethically manage your waitlist because there's going to be more people on your list that are impacted by how you manage it. So how do we then ethically and proactively manage the waitlist? I'm going to give you just a few pointers.  

The first thing, and I've said this probably twice now already, is that this should not be a set and forget list. So what do you do instead? So if it's not set and forgot, you need to engage in regular communication with your waitlist.

You want people to know that you are not just a number on our list. We know that you are there. We care that you are there.  So you need to think about what that is going to look like for your practice. It could be as simple as sending them an email each fortnight. Not your regular practice newsletter. I'm talking about specific communication to your waitlist to say - Hey, we're very aware that you're still on our waitlist. This is what is happening. We note that your reason for wanting to come in is for depression or for generalized anxiety disorder or for stress or for anxiety. What we recommend is for you to maybe check out this article, read this blog and consider getting a copy of this book.

So I would actually encourage you to give people access to resources that they can use whilst on the wait list.  Free resources are always good. The purpose of that communication is really to remind people that you've not forgotten about them. I would also encourage them , please reply to this email, let us know if anything has changed for you. That way they can also, if they want to, let you know that they got in somewhere else, so you can take them off the waitlist, and then you reply back and you say, “Thank you so much for letting us know. We are so happy that you are receiving the support that you need. We wish you all the best. We're always here if you need us at any point in the future.”  So clear, open, supportive communication with your waitlist is really important.

Just because these people on the waitlist aren't paying clients as yet, doesn't mean they don't matter.  I know you don't think that they don't matter, but I'm just saying it because sometimes unconsciously we go, I'm so busy. I don't have time for that.  I need to deal with the clients that are already paying us money. But these clients on the waitlist, even when they go somewhere else, they might find their way back to you. And we have seen this played out so many times where clients have gone to other providers, had three sessions, and then they call us back up and say, “No, that service wasn't the right fit. We want to get back onto the waitlist.”

And because we engage in proactive communication with our waitlist, they feel happy and comfortable to do that and then they are way less likely to go elsewhere because they've already gone elsewhere. They noted that the grass wasn't greener over there, and they're happy to wait for our service. Because obviously, you build up reputation, all that type of thing.

So what I'm saying is that with the waitlist, you're also playing the long game. Just because somebody's not a NOW client now doesn't mean they're not going to be a LATER client. And this is particularly important for my group practice owners because you've got more clinician diaries to fill, and unless you're planning to sell your practice in the next six months, you are playing the long game. So you have to proactively manage that waitlist in this manner, and you need to look after that waitlist for the potential that it has both in terms of you doing the work that you're here to do, like help people, but also that waitlist equals future business.

Supporting Your Waitlist Clients While They Wait

Now speaking to both my solo and group practice owners, if you are very industrious, what you can also do is potentially put together a self study program for clients on your waitlist. Now this will be way easier to do If you've established that niche, where you know that 90 percent of our clients are this age and have this presenting problem.

Or if you do serve a variety of presenting problems, over time, you can create what I like to refer to as assets within your business, which are basically resources. Such as a three module self study course for people to listen to that you can then roll out over time. Remember, we're playing the long game. You can start with, for example, psyche education on anxiety. Just talking about what anxiety is. You can do a three part video series, each video is like 10 minutes, send it out to the clients. That is a proactive, ethical, wait list management strategy.

We are helping whilst people are waiting. You can do that for free and you can have some paid options as well. I would probably start by doing something for free because when people get something from you, they actually watch it, and it was free, so it's easy to access. It's easy to say yes, but it shouldn't be too long. That's why I said 10 minutes. 

Then they might go, you know, that was really, really helpful. Then they might be more inclined to pay for something a bit more in depth. If you record these things in a way where it doesn't date, then you can keep on using it over and over again. And that is when you create resources that become assets within your business, and that can then start to service your wait list. 

And again, it doesn't have to be a recording. That for me is like the ideal outcome. It can be an article. It can be a recommended reading for them. It could be a free YouTube clip of somebody else's work that you are sharing. But it's about going  - We know you here. We haven't forgotten about you and we want to support you whilst you're waiting and it's perfectly fine if you decide to come and work with us when the spot becomes available or not.

A Recap and Final Thoughts

So to recap, waitlist, to have or have not.  100% I think you should have a waitlist. But you need to have a proactive and ethical waitlist management process that will serve not only your business, not only your clinicians, but most importantly, the clients that are sitting on that waitlist wanting to access a service. Because that is why we all went into allied health - to help. So we need to help the people on our waitlist, but we want to do it in a way that 's ethical, proactive, and helps us pass our sleep at night test. 

So please, my encouragement to you would be not to avoid a waitlist because you are scared of how it makes you feel. Because you are scared of that pressure of going -  oh my goodness, there's people sitting there, not getting the help they need. I can't be responsible for it. Been there, done that. I know how that feels.  Instead, we want to flip the script and say, we are here to help. So how can we help in a way that is ethical and proactive and is in service of the clients and our business. We're going to leave it at that. 

Thank you so very much for tuning in. And as always, remember that 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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