The Private Practice Success Podcast

29. 30 Clients a Week in School Hours

• Gerda Muller

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In Episode 29 of the Private Practice Success Podcast, Gerda tackles the delicate balance between setting achievable clinical KPIs whilst simultaneously safeguarding your team from burnout. 

Gerda offers practical strategies to help practice owners establish sustainable billable hour targets that support both business success and clinician well-being. This episode is a must-listen for anyone striving to build a thriving practice without compromising on care or team morale.

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

  • Why setting clear and balanced KPIs for your clinical team is essential for business survival.
  • The three critical factors for empowering your team towards achieving their billable KPIs, but without the usual overwhelm.
  • Practical tips for implementing changes gradually to avoid resistance and ensure long-term success.

Who This Episode Is For:

  • Group practice owners looking to balance profitability with team well-being.
  • Clinicians aiming to improve their efficiency and time management in private practice.
  • Practice owners struggling to set and achieve billable hour targets for their team.

Gerda’s candid reflections and actionable advice will inspire you to rethink how you approach KPIs and team management in your practice. Tune in to discover how to create a business that supports your team, your clients, and your long-term success.

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  • Enjoy the calm confidence of having a clear outline and plan.
  • Have productive client sessions. 
  • Finish sessions on time.
  • Kick burnout to the curb. 

Download it HERE.

Want Gerda's Help with your Business?

Gerda helps allied health group practice owners go from overwhelmed, overworked, and underpaid to fully empowered and financially thriving. If this is you, then make today the day you reach out. Complete this super short Triage Form here bit.ly/triageformpps and Gerda will personally reach out to you. 

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Connect with Private Practice Success & Gerda here:

 Well hello there passionate private practice owner.  My name is Gerda Muller, and you are listening to the Private Practice Success Podcast, and this is episode number 29. 

The topic for today's discussion is 30 clients a week in school hours.

I am going to guess that this might prove to be a bit of a triggering title for some people - but I want you to bear with me here. if you've read this title and you thought, “Well - that's just crazy Gerda,” and you immediately pressed play... well then, I'm glad that you have joined me, and therefore the title has done its job. Because today's episode is incredibly important for your business, but also for your team and also for the industry of allied health.

Obviously, I am speaking mostly to group practice owners here. Now, if you are a clinician wanting to go into private practice yourself, you know this is going to stand you in such good stead listening to this podcast as well. But for my group practice owners, for you as a private practice business owner, it is your job to set clear KPIs - Key Performance Indicators - for your clinical team. Yes, for your admin team as well, but today we are talking clinical team. 

The KPI I'm going to talk about specifically here is billable hours. 

It's your job to set clear KPIs - i.e. billable hours - for your team in order to ensure that you can keep the doors open of your business. Simultaneously, you want to make sure that you do that in a way - and as I say this, I want you to see it in your mind in bold, underline it, highlight it in bright pink - without burning your team out. Let me say that again: without burning your team out. Because if your team burns out, the business loses. The clinician loses. The clients lose. The industry loses. It doesn't serve anybody. 

What I often see is that because my group practice owners are aware of burnout and we are wanting to protect our team as much as possible, we step away from having clear KPIs. Instead of going, ‘How do we manage this in a balanced way, where we can still service a sufficient amount of people to actually make a real difference and impact? Because we know the need and demand is so big. But also doing it in a way where we can keep our doors open’  Because take it from me, every week there is a group practice closing its doors. That is not a lie. This is not fear-mongering. And the scary part is that a lot of these businesses are really large group practices. You know those ones that you hear about and you see networking events, and you look at their social media and you're going, “Oh, I'm just a small little group practice owner. I've just got five or six people.”

You're looking at these other people and businesses, and they've got multiple locations, they've got an excess of 20, 30, even 40, 50, even larger clinicians - and those people are also closing down. You know how I know this stuff? Because for me personally in Brisbane, I've hired people that have come from businesses that's closed down. With the practice owners I work with across Australia - they are hiring people; they're doing interviews with people that are looking for jobs because the places where they work are closing down. 

There is a lot of information out there if you know where to look to find this information. So we have a responsibility to make sure that we keep our doors open. But we want to do it in a way that doesn't burn our team out - and that is the purpose of today's discussion, because it doesn't have to be -  this or that. It can be - and - we can have both things - but you need to know how to do it, and that's what I'm going to talk to you about today.

A 30-Client Working Week

So let's talk about this freaking 30 clients a week in school hours. Well, that is actually how I started in solo private practice.  I had my second son back in 2006 in December, and the very next year roundabout February, I registered my ABN, and it was around April that I started doing solo private practice.

Now, obviously I had a very young baby. He went into daycare, his older sister had started prep that year - so I had two young kids. But I also love to work. I love being a psychologist, and I went, “You know what, Gerda, this is the perfect time to start your private practice,” which I then did. Being a new mum now having two young kids, I wanted that time freedom and that flexibility. So what I did was I would drop Heno off at daycare in the morning, I would drop Cassidy off at school (she generally went to before school care), so I could do all of that by eight o'clock. By ten past eight, I would walk into the practice - which was just a one room practice by the way - I would walk into the practice and then as of nine o'clock, I would have six clients back to back. So I saw a client at 9, 10, 11, 12, 1, and 2. That was my six clients. 

I finished just before 3:00 PM and would pack up everything, get in the car and go and collect Cassidy. Her school was out just after three o'clock, like quarter past, and then I would go and get Henno, drive home and be a mum for the rest of the day. And that is how I ran my solo private practice for the rest of the year. And I must say it very, very quickly, you know, obviously when I started I didn't have six clients a day straight off the bat, but it grew so incredibly fast - and before I knew it, that was my week. I would book six clients a day from nine to three. I would be done five days a week. 

Now, obviously everybody didn't attend every day, right? But let's say you would have five cancellations over the course of the week. That was still like 25 clients a week, and I did all of that in school hours, because I was really motivated to have that harmony between staying in my profession and doing the work that I love, but also being able to be there for the kids.  Now, obviously I did have to do some outside of client hours work. This I would normally do on a Friday night because I'm very structured in my thinking like that - I didn’t want to go into the weekend doing that stuff on Saturday and Sunday, so after everybody settled in for Friday after school I would go and spend some time doing any paperwork that I didn't get to during the week. Because obviously if somebody cancels, that's when you do your paperwork: your GP letters, your GP reports, all of that type of stuff. 

The way that I ran that solo practice was really very efficient. I'm so proud of myself when I say that, because I didn't have a reception, I had no reception in 2006. It was only when I moved to a larger location the next year that I actually hired my first receptionist. At that time, there were no VAs. So when I arrived at the practice just after eight o'clock, that is when I would check any voicemails between eight and nine. I didn't have an official landline, I just used my mobile phone - the exact mobile number that I still have today is what I used then.  I have only had one mobile phone number since I arrived in Australia. I used that number for clients for personal use. I still have the exact same mobile number. And you know what? It has never been abused by clients. My clients have been so amazing.  But anyway, I would just have my personal mobile phone. 

Those days, there were no diary management costs. There was no such thing as SMS costs. My clients were all booked into a paper diary. I booked them all like that. It was so low cost, if you think about it, right? My only real expenses were for the room that I had. It was a 19 square meter room, so the room was relatively large. I had a big three-seater sofa, my chair and a beautiful bookcase. I just loved that space. I had a separate area in the same room with my desk and a smaller swivel chair where I could sit and do any paperwork related stuff. I just loved it. 

If you think about it, my clients didn't have a waiting room, but I was seeing clients every hour on the hour. So I had to really manage them and I had to be really clear and say, “Hey, this is where I'm at - when you arrive, if the blinds are closed, just wait outside because I'm still in session. If the blinds are open, you are welcome to come straight in.” 

And the clients followed those instructions, and they would just wait outside. I had a little room on the side of a very small shopping centre, so it was not where all the main shops were. You had to walk almost around to the side, and then you would find my door there and it was just perfect. 

Could you imagine ever running a practice without a waiting room? Without somewhere for your clients to sit? It sounds like, what? But that's exactly how I did it. So I basically started my private practice on a freaking shoestring budget, and I actually earned really good income from it - because my clients attended really, really well. So it was amazing. 

You would think, “But why would you then start a group practice Gerda?”  And that's just because I've always been driven by wanting to help more people in better and more effective ways. And I was getting a lot of child referrals, and I don't see kids. I prefer to see young adults and older people. And I just went, well, somebody needs to look after these referrals and it isn’t going to be me because that's not my niche. So I'm going to hire my first child psychologist. And then I went, well Gerda, if you want to do that, you're going to have to have another room.

And that is when I rented a three room practice just in a building opposite the shopping centre, and that's when I hired my first receptionist. And everything then grew from there -  which was a whirlwind of growth and excitement - but also a lot of blood, sweat and tears. A lot of freaking mistakes, a lot of failures along the way, and all of that type of stuff - but 30 clients a week in school hours. 

For me, private practice has always been the place that I was going to work. So I obviously, (well I say obviously, but you might not know this), I am from South Africa. I studied my psychology undergrad and postgrad and my masters back in South Africa. And in South Africa back then, I don't know whether times might have changed as I've not kept up with the industry in South Africa, but back then you became a psychologist with the notion of going into private practice. There were not really any other jobs for you to do. There was maybe one psychologist job in public or private hospitals. But generally what would happen, is that person would get a job there and they would work there for their entire life. I know that because we were trained by people in psychiatric hospitals back in South Africa, and those were some of the best lecturers I had in psychopathology. But that was their career staying in that hospital, and there were no other opportunities to go there. 

So back in South Africa, that's what you did. You would go into private practice and it would be solo private practice. For me it was always obvious that's what I'm going to do, and that's why I started my solo private practice. Private practice will always be and has always been my first love, but also my only love. There is nothing that can entice me away from private practice. I don't care. They can throw anything at me. I will not work for an NGO. I will never work in public mental health. I just could not deal with the freaking red tape and the bureaucracy, it would frustrate me to no end. I just love the freedom of being able to be creative and do what you want - of course within the law and all of that type of stuff - within private practice.

The thing, however, is that if you want to be successful in private practice, you need to earn every dollar, right? We do not get any funding. We rarely get any grants. You would be very lucky to get a grant in private practice. You will probably only get a grant if you are in some type of consortium with another NGO or stuff like that. That's just not how those things work.  So every dollar needs to be earned and we want to earn that money, as I said earlier, without burning out your team. 

There's a place where we go wrong here, and if I reflect on what made it possible for me to easily book - without getting totally freaked out about it - 30 clients a week in school hours: what allowed me to start at nine, finish that client at 9:50, do my notes, go to the toilet, meet the next one at 10 o'clock, see that client, finish at 10 50 and also take their payment - by the way, because I would take their own payment. I did have an Eftpos machine, so there were merchant fees - that was another expense I had. Take their payment, book the next appointment, do my notes, go to the toilet, get the next person in.

When I sit back and unpack that, I honestly believe it is three things. It is understanding my theoretical foundations - thing number one. Thing number two is being really skilled in caseload management. And thing number three, (I really should get a better word for thing). But thing number three is really great time mastery in clinical practice. So needless to say, my message at the end is going to be: these are the three things that you need to help your clinicians with, and it's your job as the practice owner to make sure they know how to do those three things.

Yes, we would love for the universities to take care of that, but I can tell you I've had a sufficient amount of provisional psychologists and new grads through my practice doors to know that this does not happen, at the level required for sustainable private practice. It just doesn't happen. And I think that's a big failure. And again, I didn't go to university in Australia, I am only commenting on what I see, and what I see people need when they come out of a master's even, and where they are at and what they need through their supervision when they join our practice. 

So let's talk about theoretical frameworks. And yes, we're going to go a bit clinical here, but you know what? All of that clinical stuff is linked to business in private practice. It just is what it is. 

Thing #1: A Clear Theoretical Framework

I find that when people don't have confidence in their theoretical framework, that is when they feel very unprepared going into these sessions. If I think back to when I was doing my Masters - you do your undergrad, then I did my Honors, and then I did my masters - and the first year of Masters back in South Africa was just classes, classes. We had classes Monday to Friday from nine to five, and then you still had to do your clinical client hours. You had a minimum amount of clinical hours even in year one of Masters that you had to do - and you had to fit that around your day classes.

So we would go in normally on Saturdays to see clients at the university clinic. We would also do those after hours - so it was full on. That was year one. And then year two, we had our formal placements, and it was six-month placement. So you would have the first semester placement at one place, and then the second semester you would have a placement at another, and you would still have group supervision, and you would still have intern classes that you still had to attend during that time.

One of the subjects we had in the intern year was called Integrative Psychology. We literally had one or two classes on it, and then we had this big humongous assignment that we had to do. And the assignment was -  During your first year of Masters, we trained you in all these different types of therapies, such as: cognitive behaviour therapy, transactional analysis, and object relations. As you can see, I did a lot of psychodynamic training. So we had this whole list of therapies that we were trained in, person centred therapy, that was another one that we were trained in, all of the things.

So you learned that in year one of masters and now in year two, they said, we want you to now reflect on all the stuff that you've learned, and you now need to come and do a presentation to the entire class and all your lecturers, in terms of presenting to them your choice of theoretical framework, why that is your choice, and how you can apply that in your client work. And that was such a broad and frustrating assignment to get. It's like, what? Now you want me to go through all of the stuff again that I did last year? And I loved all of it. I can see how all of it's going to be useful for different client presentations. Now you are making me choose something? 

I found it incredibly frustrating. I think I have trauma from having to complete that assignment. But you know what, it's normally the stuff that's hardest to do that is the best for you. Because it was an incredibly challenging assignment, but it has stood me in such good stead over the years. I remember when I went in, I had this box, and I was talking about everything I do, how it's all encapsulated with in-person centred therapy, because without that rapport, without the client engagement, without that reflective listening and micro skills that you need, you're not going to get anywhere.  It doesn't matter what type of therapy you want to do with the client, you're not going to get anywhere where you don't have that trust. And then I started to talk about the various theories and the stuff that I love. 

It empowered me with the knowing that I could go from there and into any session with a client fully unprepared. Fully unprepared, and I would know what I'm doing right? And that means that when I started doing a lot of clinical work, I didn't have to go, ‘Oh, what do I need to do for this client? What do I need to do for the next client?’ It's like I knew what I had to do, because it was all encapsulated into my theoretical approach.

It doesn't mean that I couldn't open up my toolbox of skills and take a bit of ACT, take a bit of CBT, take a bit of object relations, take a bit of ego grams out of here and use what the client needed. I could do all that stuff,  I had my toolbox of skills. But because I knew within what framework that was being done, it was easy.

I didn't have that anxious worry that I see a lot of new grads have, where they feel like they need to look at every client with a new, theoretical framework in order to do the best job possible. I love that our clinicians always want to do their best job, but it's really hard work. If you imagine, you know, not 30 clients, even just 20 clients a week and having to go, ‘What's my approach to this client?’ That is draining. So it is really about going - as the human delivering the therapy - I need to know what are my beliefs around human behaviour? What are my beliefs around how change happens and how do I approach that with each and every client? 

I can tell you, I love person-centred therapy. I believe, and, and maybe this is just the standards that I hold for myself as a psychologist - I expect myself to be able to build rapport with any client. When I was doing a lot of clinical work, I would have clients working in corporate space to somebody that would walk into the practice with his overalls on. I clearly remember this one client I had, his hands were dirty,  like he's just stepped out from underneath a motor vehicle. He worked on cars and I would shake his hand, we'd say, “Hey, so great to see you.” And we'd go in and do our session. I would be the same person. I would still dress in exactly the same clothes. I would have the exact same manner, but I could engage, build rapport and trust with any person.  I believe that as a psychologist, that is your job being able to do that. 

I know there's that belief out there that sometimes you're just not a good fit for a client, and the clients have choices. Sometimes they just decide you're not a good fit for them, or you decide you're not a good fit for them. I've got different standards for myself, and that's okay. You can have different standards for yourself. But my standard has always been -  and I took it as a challenge -  that I need to be able to engage each and every client that comes through the door in session one - that's my goal in session one. It's not to get all the answers to my intake form, right? It's not to do a full diagnostic and assessment in case formulation in session one. No, the number one primary goal in session one is building trust, rapport and client engagement. If I do nothing else in that session, I'm fine because that's what session two can be for.

That was so important for me and this is my view on who I am as a psychologist. I can tell you, really embedding the clinical work that I do, and knowing what that is for me, just made seeing clients so freaking easy. So easy. A lot of people ask me, “Gerda, how did you never burn out?” because I did a lot of trauma work. But it's because of that, because that has always been the underpinnings of the work that I do. And when you have really great trust and engagement with clients - therapy is easy.  It becomes easy, and it is incredibly fulfilling work that you can do with your clients when they are engaged - and that's when they get the results. 

So to conclude, thing number one, oh goodness I wish I had thought of a better term for it before I pressed record on this podcast, but we are going to go with thing number one. And needless to say, my kids used to love watching The Cat in the Hat, and I used to watch that with them over and over again. And you will remember thing one and thing two. 

Well, today's podcast has a thing three as well, anyway, I digress. That was thing one. You really want to encourage your team to dig into what is their theoretical approach and their understanding of human behaviour in the work that they do. If they can have that, it's going to make such a big difference already.

Thing #2: Caseload Management Clarity

Thing number two is having a really good understanding of caseload management. And again, I'm talking about a lot of clinical stuff here, but you know what? Getting this clinical stuff right is what allows your team to meet the KPIs, and that's good for your business. So as a business owner, we need to invest in these things for our team.

If a clinician knows how to efficiently manage their caseload, that will allow them to very easily meet the billables that you are setting in private practice. Let me just clarify here, do not ask them to do 30 client hours a week. That is not what I refer to as reasonable. That was the number I did because that was my choice. But I've never asked in all my years of any clinician to meet 30 billable client hours a week. Never have, never will. If they want to, they can, that's up to them. But that would never be a billable that I would sit for any of my team members, irrespective of how experienced they might be. So let me just clarify that. 

Knowing how to manage a caseload, again empowers the clinician. Because if you don't know how to do that, you're just going to be fumbling the whole time, and that is when people get into that place where they just don't stay on top of their work, and their case notes don't get done and their letters don't get done, they don't know where the client is in the process. And before they know it, everything has just snowballed, and all they want to do is run and hide, avoid, procrastinate because everything has become too much and that happens very insidiously.

So you need to ask yourself, how do you do caseload management? How does your clinician do caseload management? Now if you have an employee model, then you can train your employees in your caseload model. If you've got contractors, then they're going to have their own caseload management system, right? So there's a big difference in how we're going to manage employees and contractors. So for the purpose of today's discussion, I'm really focusing on your practice if you have an employee model, because if you've got employees, that is when you're going to have KPIs, right? Totally different operational management style between contracting and employees. 

So your employees need to know: How do we run session one. How do we run session two. What are those anchor sessions? How should all of these things happen? And I think what made it easy for me is that I am skilled in that. When I came over to Australia my very, very first job in Australia was as a personal support coordinator. And an interesting side note, when I started looking for jobs having just arrived off the plane in Australia, nobody wanted to hire me as a psychologist because I did not have permanent residency. My husband and I came over on a work visa, which meant we had the right to work in Australia. It was a four-year visa, but nobody wanted to hire me. 

Although I always wanted to work in private practice, I also knew that I needed to check out the lay of the land. I came to Australia having never even visited, having had no clue how the psychology, allied health or private practice industry worked here. So I knew I had to get myself a job, do my very best in that job, and then do the research - whilst I'm here, boots on the ground, and learn everything - which I did. 

So I got a job with the then PSP program, which was called the Personal Support Program. It was basically people that were on Centrelink, but they were diagnosed with a mental health condition that was preventing them from maintaining a job. They had an opportunity to engage in the PSP program for up to two years, to work through any mental health challenges and to really get them job ready at the end of the day. So that's what I did. I got my first job, the company was called Work Directions and I started working in their Ipswich office. 

I was basically thrown into the deep end, which is perfectly fine. I know how to learn to swim very quickly in any situation. Within three months, I was meeting all my KPIs and my site was the number one site in Queensland. As a result, I was promoted to senior PSP coordinator, which meant that I now also was responsible for supervision, training, performance management of all the other PSP coordinators in the area, all the way from Southport to Maroochydore. Work Directions had PSP offices in various locations within that area, which also meant that I got to travel a lot, drive up and down, and visit all those locations. 

Then after another couple of months with them, I was co-opted into a working group that wrote and then rolled out the Work Directions Caseload Management Model. So we wrote this whole manual, and then we went to all the Work Directions locations and we ran training for all the managers of all the offices. and then we did the training for the team at all the offices. 

So I had a really good foundation, therefore, in caseload management, risk management -  all of that type of stuff. If you are really serious about empowering your team, you want to make sure that they are trained in caseload management. All of that stuff is what empowers a clinician to do their best work - to not burn out, to not get caught up in all this administrative burden. Because the thing is, there is admin in the work we do .

If you are listening to this and you're thinking of becoming a psychologist, which I am, it is not what you see on tv, right? I used to watch Frasier Crane when I was much younger and I thought, ‘Oh, you know, it looks so nice and easy. You just walk in, you see your client, you talk and you help them, they walk out, they feel better.’ It's like, no, there's a shit ton of admin that you need to do. And you know what? It's actually considered part of your work. 

If you look at the most amount of complaints that get sent into AHPRA, which is the Australian Health Practitioner Regulation Agency, which is where you are registered as a psychologist, the majority of complaints are due to communication. You know what communication is: paperwork, lack of record keeping, inadequate record keeping. So you cannot be an allied health provider without the record keeping. That is how, let's be honest, you also cover your ass, because what if something were to happen to your client and then you've neglected it? Why would you do that? 

It is so important to have adequate records of how you've supported someone. You also need to have adequate records if you want to keep seeing certain people as part of Medicare, as part of NDIS, as part of, whatever funding the client might have access to - whether that is DVA, Victims Assist, Work Cover. You cannot go into this work thinking you are just going to do client stuff, and therefore, there's no use getting annoyed at it because it is what it is. The sooner you embrace it, the better. But if you have a system around it, it's going to be so much easier - and that's where the caseload management comes in.

If you are asking yourself, ‘Gerda, that is a really broad concept, caseload management.’ Then I would encourage you to start with those anchor sessions. What is the anchor work that needs to happen at session one, two, and six? To me, that is the anchor sessions in psychology. And if you go, ‘Oh geez, I'm going to have to start this from scratch,’ and you already have a team - make this part of what you're going to do together as a team.. 

You do not have to think of all these things yourself. You can if you want to, but if you've got a team of clinicians go - Hey, let's get this stuff out of everybody's heads. Let's make this our team meetings for the next three, six months and put something together. Maybe start a small little working group within the practice and give people that as a project to come up with what is your caseload management model within your practice. This is going to stand your entire team and business in good stead over many, many years to come okay? That is all about creating an asset within your business, and it's going to enhance the efficiency and effectiveness of everything you do within your practice. And guess what? It's going to stop any burnout and it's going to empower your team to achieve their KPIs.

Thing #3: Clinical Time Mastery

Last but not least is thing number three, and that is being really confident and competent in how you run your session. I refer to this as your session structure. So I've done a lot of training in time mastery in clinical practice, between me and you, I've got a book in the works on that topic as well. but it's on the back burner at the moment, but I'm so super passionate about this.

I would highly encourage you to teach your team how to run a session. I can tell you this is one of the best things I could have done for myself,  because I actually unpacked  - like how was I able to see six clients every hour on the hour? How was I able to stop at the 15-minute mark? How was I able to do that? When I did see trauma? Where I saw a lot of complex clients ,where I had a lot of high-risk clients. How did I do that? And you actually have to stop and unpack stuff like this in order to bring it into conscious awareness. 

When I did that, I put that together in a diagram, and I've been teaching this to my clinicians at my practice for many years now, and it just works. People find it incredibly empowering having this structure. Now, obviously there's going to be times where the structure needs to be thrown out the window. We all know that, but 90% of the time it works.

I am going to gift you a copy of my session structure. If you check out the show notes for today, you will find a link to a PDF download, it's like a clock that says, okay, you're starting at nine o'clock. What do you do in the first five minutes? The next five minutes, the next 20 etc. I'm going to also give you access to a video training where I talk you through how that diagram or that session structure then works, answering some of those frequent questions that I get. So I highly recommend that you download that, and if you don't have a session structure for yourself, test drive it yourself first. And then by all means, feel free to go and teach this to your clinicians. 

Needless to say, having a set session structure that allows you to finish at that 50-minute mark is incredibly important, because you need the next 10 minutes. This is, I believe, one of the biggest reasons why clinicians burn out in private practice - is due to a lack of clinical time mastery. They either don't start their sessions on time, so they're running late straight off the bat, they then don't finish their sessions on time, or even if they did start on time, they don't finish at the allocated time period, and then they don't get to do their notes - and then before you know it, they've got days and days of notes that haven't been done. 

I can tell you, you start to forget. And yes, I know we've got AI these days and all that type of stuff, but you know what? Maybe I'm old school, but I don't want to rely on an AI tool to take my session notes. Even if it takes my session notes, I want to go through it and make sure it's accurate, because AI is not fool proof. If my file gets subpoenaed and if I get called into court to defend the notes, I cannot blame it on AI. That's not going to fly in a court of law. It's still your responsibility to make sure that adequate notes have been kept. 

In all those years, when I did clients one after the other, because that just works for me, I get an immense feeling of productivity. I hate having breaks between appointments. To me, it feels like such a waste of my time. It's like, okay, I'm sitting twiddling my thumbs checking emails. Why would I do that? Why would I break up my day like that? Now, obviously that works for a lot of people, right? It doesn't work for me, and each of us needs to do what works for us. 

But for me, I knew I had those 10 minutes, and I always took handwritten notes because I'm just very tactile, I love handwritten notes. Even today, I take handwritten notes on my iPad. I would take it and I would write a lot of it in session and I would do the final notes after the client has left. By the time I started the next client, that file was done. I didn't have to look at it again.  Do you know how amazing it is to know you leave the practice at the end of the day and all your notes have been written? 

I'm not leaving with that little anchor that says, ‘Oh shit, I haven't done my notes and I need to remember to do it tomorrow, and I've got a full day of clients.’ That's when that pressure starts to build, and I'm going to forget some of the discussions we had. What if I forget the most important thing? Why would you do that to yourself? Don't do that to yourself. You really need to therefore know how to manage the session so that you can have the time to do the notes - whether it's handwritten, whether you type it up, whether it's AI - where you look through it and you go, ‘Yes, I'm happy, I'm putting my digital signature on it,’ and now I can do the next session. 

Do you know how freeing it is getting your notes done on time? It is just the most amazing thing. I think if clinicians can learn how to do that, it's going to make a significant amount of difference in their level of burnout, but also the level of joy they're going to have.

Implement What Matters Most in Your Practice

So to recap, thing number one is really getting clarity on your theoretical framework and foundations via which you are going to be approaching your clinical work. Thing number two is getting really clear on the caseload model that you will be operating within and delivering services within. And then thing number three is really getting clear as to what your session structure is going to look like, and as I said, download mine and amend it accordingly.

Your brain might not work exactly like mine, probably very different. The goal here is to have a structure - that's the goal. A structure that's going to support you, a framework that's going to support you to finish on time so you can get all the paperwork done, so that you can enjoy the work that you are here to do.

Now for my group practice owners, you might be going, “Gerda, I still have this niggling question in the back of my head about billables. So you said you did 30 client hours in a week in school hours. You said never ask your clinicians to do that. So what should I ask them to do? What is a good KPI? This is what I would say -  “For a full-time equivalent, and obviously if people are working part-time, you need to work that backwards - but I think what is really reasonable for a full-time equivalent, a fully registered psychologist, I'm not talking about a provisional psychologist if they're working full time, I would set billable client hours of 24 clients per week. 

So that means that it's more or less, and I'm rounding up here, 64% of their working week, which is 38 hours under our award, will need to be billable hours. It doesn't have to be client facing that could include report writing that gets paid for, but 24 hours of the 38 hours in the week needs to be billable. That means that for a full-time week, this clinician will have 14 hours -  that is a full two days, obviously that is scattered throughout the week -  but they would have a full two days for any non-billable admin, for any prep, for any research, for any in-house supervision, all of those other things that need to happen. I don't know about you, but I think that is pretty reasonable knowing that they will have two full days for all of that stuff.

Now, I also know that a lot of people struggle to get their clinical team to that number, hence today's podcast episode. So honestly, if you go, ‘Yes, Gerda, maybe I've sat 24 as the KPI for my team, but they're just not getting there.’ Maybe they're only getting to 22 or 20 or even 18. I've spoken to practice owners that say, “My team is doing 12 average a week and I can't pay the bills. I struggle to pay their salaries. I am so stressed out because I just don't have the money because the team isn't meeting the billables.” I want you to consider the three things that I mentioned today, and just choose one of those things to go, let's just implement one. 

Do not try to do all of this at the same time. It will not work and you will overwhelm your team. Things will just go further down the drain, okay? That is one of the biggest mistakes I see practice owners make is when they want to try and do all the things all at once. And then they tell me it didn't work. You know why it didn't work? Because you tried to do all the things all at once.

You need to be patient in business. It doesn't mean you just continue to tolerate what is not working. That's also not going to make a difference. You need to change things. Unless you change the way you do stuff, nothing's going to change. And I see this all the time, people reaching out to me and they had reached out to me two, three years ago - and nothing has changed for them, and I find that incredibly sad when that happens. But it does, and I think we're all human and are so stuck on the hamster wheel. So my input to you today is to get off the hamster wheel to stop and go - If my people aren't getting to their KPIs, which of these three things do I need to implement?

I would implement the one that's going to be the easiest to implement, ie: is going to be the fastest to implement. I would do that one first and then make sure that you do it, that it's done really well - review it, tweak it, refine it, and then you can do the next one. And then you can do the next one.

That is how you build a business. If you are a business owner, I would assume that you’re in  this for the long term, so stop trying to do everything at once - but start. If you don't start, you will not build that business that you desire and deserve. At the end of the day, it's our responsibility as a practice owner to have a profitable business. You actually have a legal requirement under Australian law to run a profitable business, otherwise, you are trading whilst insolvent. So stop being ashamed, wanting to have a profitable business. There's no shame in it, but let's do it in a way that we don't burn out our clinicians, because when we do that, nobody wins.

We can empower them and we can share with them skills and strategies so that they can learn to love private practice just as much as we do. Alrighty, I'm going to leave it at that.  Thank you so much for listening to all of my ramblings today. I feel like I've gone off on a lot of different tangents. But go and check out the show notes and download the session structure. 

And as always, thank you so very much for tuning in and 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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