The Private Practice Success Podcast

52. 3 Reasons Why Your Diary is Still Not Full

• Gerda Muller • Episode 52

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In Episode 52, Gerda unpacks the three core reasons why your diary is still not full and why “just do more marketing” is almost never the whole answer. 

Whether you run a solo practice or a growing group practice, empty appointment slots create stress, cash flow pressure, and, over time, burnout. This episode is all about diagnosing the real problems, so you can finally fix them.

More specifically, Gerda walks you through the full client journey - from enquiries, to front desk conversations, to clinical engagement - and shows you exactly where the “leaks” usually are. You’ll learn how to think like a business owner (not just a clinician), use your data, and put practical systems in place so your diary can stay consistently full in an ethical, values-aligned way.

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

  • The three core reasons your diary isn’t full.
  • How to empower your front desk to convert with compassion so more enquiries become bookings.
  • The key clinical metrics to track and what they reveal about client engagement.

Who This Episode Is For:

  • Allied health practice owners who are tired of staring at gappy diaries and guessing what’s going wrong.
  • Group practice owners who want to protect cash flow, support their team, and reduce the risk of burnout.
  • Solo practitioners who need a clear, practical roadmap to consistently filling their books.

Tune in for a practical, eye-opening breakdown of why your diary is still not full and walk away with clear next steps to build a practice you can’t stop smiling about.

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Connect with Private Practice Success & Gerda here:

 Well, hello there fabulous private practice owner. My name is Gerda Muller, and you are listening to the Private Practice Success Podcast, and this is episode number 52. 

Today I'm going to talk to you about the three reasons, the three core reasons why your diary is still not fully booked. But let's start by talking about why this is a problem, because irrespective of your model of private practice, this is going to be a problem for you. And  irrespective of whether you are a group practice owner or a solo practice owner, this is going to be a problem. 

And this is why - If you've got an employee model and you've got employees potentially even working full time, you are paying them whether their diary is full or not. That's a problem, right?  Because how do we make money in private practice to pay our team, by having clients coming through our doors and paying, okay. We are not NGOs, we're not public health. We don't have government funding, okay. We need to make every dollar so that we can pay our team. So that is a big problem when you've got an employee team, because you most certainly have to pay them, okay, no getting around that. Whether they've got one client or full diary. 

If you've got a contractor model where you have independent contractors coming in and seeing your clients, then that is still a problem. When you have a contractor model, you are not obliged to give them ongoing work. But contractors are probably contracting with you because they want supplemental income to the other work that they're already doing - and if they're not going to get it at your practice, they're probably going to start looking for it elsewhere. So it is in your best interest to also give them work. So that's the risk that you take if there's no clients coming through the doors. 

If you've got a hybrid model where you've got employees and contractors, it becomes even more tricky because you generally need to fill up the books of your clinicians first and foremost, which then also means that your contractors aren’t going to get the work that they would like in order to stay engaged with your business.

If you've got a services or facilities model where clinicians, let's call them your business associates, are paying your business for services and those services include marketing so that there's clients in their diary. They're going to be looking at you and going, ‘Hey, where's the clients? I'm paying you a service fee to make sure my books are full. You're not doing your job, so now I want to pay you less, and potentially I'm going to go elsewhere and they're going to be unhappy.’ So it doesn't work. 

And if you are a solo practitioner, it just means that you can't pay your bills, your personal bills, because you're not making any money if clients aren't coming through the doors and paying you. It just is what it is. So when you are in a service business, which each and every allied health professional is in, we are not product based, we are service based. We get paid for our service, which means that we need to have a diary that is fully booked. Yes, I said fully booked. 

Depending on the cancellation rates at your practice, you might need to - and don't freak out when I say this word, do not freak out, brace yourselves - you might need to overbook. So you need to know what these numbers are, and cancellation rates are going to be different per clinician. Have you actually looked at that? It's actually a very interesting exercise, especially when you've got a group of clinicians to go: What is each of their individual cancellation rates? Because some people's rates are much higher than others. And then you want to start having those discussions about what is this telling me? What are the variables for this person, the way they work, the clients they see, all of that type of variables that you want to consider. And then you want to take that information and go, okay, what does this mean?

If I know what the number is so that I can pay the bills, break even and have additional contributions to OPEX and make some profit. What should that number be? And now when I look at the cancellation rates, what should the diary look like? Okay, but I'm not going to go down that rabbit hole today - that's a whole different podcast episode. Gerda make a mental note to probably talk about that at some point or another - But if somebody has a high cancellation rate, you might need to even overbook them. Because we know people cancel, they reschedule, they might even no show. And yes, you might be thinking, well Gerda, that's what no show fees are for.

Let's be honest, the majority of people out there waive more no show and late cancellation fees than what they charge. It just is what it is, the majority of us are very soft hearted. And maybe you get to that point where you're just like over it, and then you decide no more. But you might not even be there yet.

So it's really, really important that you have a fully booked diary, in order to ensure that your business keeps running. Because if you don't, if I had to summarize the consequences of not having a fully booked diary in allied health private practice - number one: stress. Stress mostly for you as the practice owner. To a lesser extent, employees, if you've got an employee model. If you've got really great employees that have some good commercial understanding and business acumen, they will know that it's an issue. They will know that we can't continue just seeing two to three clients a day because this business is going to have to shut its freaking doors if that's the case. 

And if your employees start to worry about stuff like that, that's when they're going to start jumping ship. Because at the end of the day, they need to know that they've got a set wage, they need to have that security, because they need to look after their family, right. So it's stress all round. But a lot of stress for you as the practice owner, because what happens - number two: cash flow.

Cashflow issues is so stressful and anxiety provoking. It's that I can't sleep at night situation. It's the waking at 2:00 AM not being able to fall back to sleep because in your brain, you're just going around and around in circles because you can't pay your bills. You're concerned about what payments are going to go out of my bank account tomorrow, and when is the next payment dropping in because I don't have the money. If you know, you know. And all of this at the end of the day leads to practice owner burnout. I've seen it way too often.

If you've not seen it, don't think that it doesn't happen. If you are a practice owner listening to this, you've probably felt it. But unfortunately, there's a lot of shame attached to burning out as the business owner. Because we go, we are not allowed to burn out, I'm not allowed to. It's my job to stay in control, to just keep going. I've made all these commitments to team members, both clinical and admin, and I've made commitments to my family. I've taken this humongous risk, I need to make this work. And what do you do? You just work harder and harder and harder. You take on additional clinical client work just so that you can bring more money in. You are working 12, 15, 18-hour days. I know, because guess what? I've been there. Yes, it's been quite some time, but I've been there. I know what it's like. Burnout is not fun, okay, so we want to avoid that. 

So let's talk about the three reasons why your diary is still not full, because we need to change this. Before we do, let's just address the elephant in the room. Because 9 out of 10 times, possibly even 10 out of 10 times, when you look at your diary and you go, ‘oh, look at all those open appointment slots this week. What's going on? What do I need to do?’ Your brain immediately goes to one thing - marketing, marketing, marketing. 

I need to do more marketing.  But the thing is, this marketing might not be the only solution here. A lack of marketing and a lack of the right marketing might not be the only problem here. The thing is before we can decide what the answer is, what the solution is to a problem, we first need to go and diagnose the actual problem, okay? Don't just look at the surface level. I'm seeing that there are empty appointment slots, so that means immediately I need to do more marketing. It might mean that, but it might not. 

And if you've had open appointment slots in your diary for the last six to nine months and your brain's been thinking, marketing, marketing, marketing, and you've been focusing on marketing and it still looks like that, guess what? That's probably not the only problem, it might be part of the problem, but it's probably not the only problem. So today we are going to look at three core reasons why you might still have this exact same problem that you had six, nine, even 12 months ago, because I want to help you fix it. 

Core Reason #1: Not Enough Client Enquiries

The first core reason why your diary is still not full, is probably the one you are going to guess anyway, and that is that you don't have enough client enquiries. So a client enquiry is people reaching out, calling, emailing, completing your contact form on your website because they are interested in your service.

It also includes client enquiries via third parties. So that might be a referral from a GP, from a support coordinator, a paediatrician, psychiatrist, school  guidance counsellor, a lawyer, another allied health professional, work cover - all of the third-party referrals that we can get in private practice. So not enough enquiries.

You might be thinking, ‘Well, Gerda, as you said earlier, it's probably a marketing problem, right?’ Hmm, let's talk about it. Let's talk about why this is happening. If you think about this in marketing terms, this is a top of funnel problem, we don't have enough client enquiries. And there's a number of reasons why this could be happening.

First is yes, you might be doing marketing, but you're not using the right strategies. Instead, you are using the wrong marketing strategies for your level of private practice development. And I see this all the time. Level two startup and step up practices that have two to three clinicians, trying to implement marketing strategies that people at level five and above should be using.

If you think about it, if you've got 2, 3, 4 team members versus a practice that has 20 plus team members, it's a different business. There are different marketing strategies that you need to use. And when you are trying to market like somebody at level four and five, you're going to get stuck. It just is what it is.

And if you are a large practice and you're trying to market like somebody that's at level two that only has two or three people, you are also going to get stuck. So you as a practice owner need to ensure that you've got clarity as to what is the right strategy for your level of private practice development.

The second reason why this is happening is because you are not having the patience required to implement, evaluate, review, tweak. And again, evaluate, review and tweak the marketing strategies that you are using. You do something, you implement it, you go, ‘Gerda I've done this thing. I've done a meet and greet, or I’ve dropped off this pack, or I've sent this email, I've sent this fax, I've done this, that, and the other thing, and it's been a whole freaking week and nothing. Nothing. It's not working.’  And I'm thinking to myself, well, no shit, Sherlock, of course it's not working yet. This is not how business works. 

Do you think just because you go and talk to a GP, now all of a sudden they should be sending you referrals. They don't owe you a referral, and they don't have to drop everything they're doing and now send somebody your way, it doesn't work like that. You are actually being really unrealistic expecting that to happen. But for some reason you think it's going to happen. It's almost like magical thinking that if I take this action automatically there's going to be clients in my diary. No, this is business, okay. And I'm not trying to be condescending here, but I really want you to realise how unhelpful that type of thinking is for you.  Because sometimes when we are in this situation, we just think this way without even realising it. 

And then what do you do when your marketing strategy isn't working? You go down that rabbit hole of, I'm not cut out for this, I'm not good at running a business, I'm a bad business owner. What am I thinking? When it's not you. Marketing strategies take time. Yes, there might be this exception to the ruling, you might be doing a GP meet and greet this morning, and by this afternoon one of the doctors has referred to you. That might happen. It does happen. But it is the exception, it is not the rule. 

Marketing strategies can take 1, 2, 3, or even more months to actually pay off. So it is the practice owner that's going to have the patience that is going to win the long game here. So you need to go into this with your eyes wide open, in terms of how this works in the world of business. And then, when you realise, Ah, this is the strategy that is working, what do people do? They stop using it. That is such a big thing that I see happening, because you get bored. You go, Oh, I've been doing that specific strategy for the last 12 months, I'm going to try something else, instead of implementing it consistently. If something works - don't stop doing it. That's the worst thing that you can do. So really be mindful of you potentially getting bored with the marketing that you're doing in your business. And you might be listening to this and going, ‘Gerda that's never going to happen.’ It does. It happens all the time. And that's how people break their businesses.

So it's going to be really important also, therefore, that you track where your clients are coming from. Because you need to know which of my marketing strategies are working. And often people try to do too many strategies all at the same time, and all of a sudden the diary fills up. But it's like, which of these five things I've actually brought these clients in? It might be one of the five. It might be a combination of two or three. I, I don't know. You don't know. So you need to find out, which means that every freaking client that comes through your doors needs to answer the question, how did you hear about us? So that you can actually track which strategies are working for your business.

So maybe pause and reflect on what I've just shared with you, because this is one of the three core reasons why there's probably still gaps in your practice diary.

Core Reason #2: Ineffective Conversion Conversations at the Front Desk

The second core reason why your diary is still not full, is if you haven't trained your front desk team in having ethical conversion conversations. So think about it like this: 

Phase one is those client enquiries, and we've just spoken about that, we need client enquiries coming in. Phase two now, is the front desk picking up the phone and talking to that person, or if they've done an email enquiry, calling them and having a conversation. So conversion conversation just means that what we are doing during this conversation is that we are converting an enquiry into a booking. So it's taking the client from enquiry to saying, ‘Yes, I'm going to come in and I'm going to see this clinician at your practice.’

The thing is this, not all people are ready to book in when they reach out, that's just how it is, right? Not all people are chomping at the bit to make that very first appointment, so we have to train our front desk team - and how to talk to people, how to meet them where they are at. So that intake and triage process that happens on that phone call, requires a really delicate balance between advocating for this person's mental health, and them saying yes to get the help that they need and deserve, and also having compassion for how hard it is for them to actually book in. 

So the way that your front desk team therefore communicates with the caller, will have a really big impact on whether they actually say yes to having that help, not only whether they say yes at your practice, but also whether they say yes for anywhere. Because this might be their first time that they've actually been brave enough to make that phone call to say, Yes, I need help and I'm going to speak to somebody.

It is incredibly important for me as a practice owner and as a psychologist, first and foremost, that each and every person that has an interaction at my practice with my business, has a good experience. I don't want them walking away and going, ‘I knew it. I should never have done it. Psychologists are shit. They're not with the money you pay for it. They don't know how to help me,’ or insert whatever other statement they want to make about our profession.  So I want to be able to feel good about that. And that is, as I said, a really delicate balance. We need to be mindful that therapy can be a big source of pain for people. It's not easy to say yes, so we need to keep that reality in mind, it's a really, really delicate balance. 

This means that you've got a really important responsibility as the business owner, to make sure that your friend desk team - from your most junior reception to your practice manager - they have to know and therefore be empowered and fully trained in how to have those conversations. How to convert enquiries into bookings, but in a manner that is compassionate. At my practice, we call it converting with compassion. We don't shy away from the fact that this is actually a sales conversation for us as a business, but we will never lose sight of the fact that at the core of this, we need to be compassionate, because I know how hard it is for people to say yes to come in and see a psychologist. It's very scary, especially if it's your first time. And even just as scary if it's your second or third time, because you now know how painful it can be to come and do the hard work that is often involved in seeking help.

So really reflect on - Have I trained my front desk team in having these conversations? If I had to unpack it, what would those conversations look like? When we train our front desk team, and, and what I share with my PPS Academy and Founders Club, is when you want to convert with compassion, there are six steps that you need to follow. You need to do all six, and it needs to happen in a specific sequence in order for this to work. If you are missing any of these steps, if your front desk team skips over any of it, because you might have a fully trained front desk team, but if they are going, ‘I'm too busy today, I'm just going to skip over this front bit or this last section,’ they're not going to convert in the way that they should.

If we take, again, a business perspective as a business owner, you are investing a lot of time, money, and energy into getting these enquiries. Every client coming through your doors, there's what we refer to as a cost of client acquisition. It costs you money. It's not free, okay? Those phone calls aren’t free. You have put money into your marketing strategies to get that call. So why not train up your front desk to convert as many of those calls as possible? And it's not just - I trained them today and I go, ‘done and dusted, now I'm moving on.’ That's a big mistake practice owners make, like, ‘okay, what's the next, what's the next fire I need to put out? What's the next problem I need to solve?’ And what happens two months later, you go, ‘Why are there all these gaps in the diary,’ because your front desk has dropped the ball. They're human, they get busy. 

You need to check, you need to keep them accountable. And if it's not you, a practice manager might need to do that, but it's, somebody needs to have the job of ensuring that, and this applies actually for any process in your business = that the system is being followed. That the process is being followed, that the policy is being implemented. Otherwise, you can look at your diary and you're going to go, I don't understand it. I've spent five grand last month on marketing. Where's the clients? Maybe it's your front desk not converting with compassion, not having conversion conversations, not following the required steps and process to do that successfully, in a compassionate and ethical manner. 

So go and have a look at your front desk's conversion rates. Do you even know what those numbers are? Are you tracking it? If not, you should be doing it because you don't want to guess, okay. Data is your friend when you are running your business. Yes, there's a lot of touchy, feeling stuff for us as allied health businesses, but there's still a huge amount of data that needs to inform the decisions that you make. So if you don’t know what your conversion rates are, that's probably the first thing that I would start tracking at the front desk. So that was reason number two.

Core Reason #3: Lack of Clinical Client Engagement

Let's say that you've addressed core reason number one, and core reason number two that I've just taken you through. Now the third one, and these things are actually a bit sequential, the third core reason why your diary is possibly still not full, is because your clinical team isn't actively engaging the clients into treatment.

You've done the marketing, you're doing the right marketing for your level of private practice development, you're getting all these client enquiries in, you've trained your front desk team - they're empowered, you're keeping them accountable, and they are having conversion conversations in an ethical and compassionate way - people are booking in, but then your clinicians aren't actively engaging clients in treatment. How do you know this is happening? There are three red flags. Which are three numbers, remember I've just spoken about how important data is, there are three numbers that you need to look at.

First is your dropout rates. What are the dropout rates for each and every clinician at your practice? You need to be tracking this on a monthly basis. When you look at the research, and I'm specifically talking about psychology here, because I'm a psychologist and that's the discipline that my practice is, but I'm going to venture a guess that this might be pretty universal across allied health. I would actually venture a guess that it should really be less for other disciplines because I don't know, but I think psychology is a really painful part of our industry in terms of its emotionally really hard for clients to go through therapy as a general rule. Maybe I'm just speaking as a trauma psychologist, because that's the area that I always worked in and one of my practices is a trauma centre, my other practice is a child and adolescent centre, for some context. 

That being said, I work with practice owners from right around Australia, from all locations, in all disciplines, all allied health disciplines, and I've seen these numbers to be pretty universal. The research tells us that around about 27% of people will drop out after one, two, or three sessions. I would say ballpark, if the dropout rates for a clinician on your team is 30% or above, then there's an issue that you need to address. That 27% dropout rate could be for any and all reasons, whether the person had an issue that we solved in two sessions, or the person moved away, or the person decided, I can no longer afford sessions, I'm going to spend my money elsewhere. 

It doesn't matter what the reason is. You know all those reasons that you might be making up in your own head. Your clinicians might be making up in their own head reasons, AKA excuses, and I'm not saying that in a negative way, but generally when people have a high dropout rate, they come up with excuses. Now what I'm saying is, yeah, whatever that excuse or reason is, that only gets you to 27%. Anything above it, we've got a problem, and we need to address it. The numbers are helpful here, and we all can learn, we all can learn how to better engage clients. Because if you think about it, if somebody drops out of treatment, it means that that person's not getting the help that they need. 

For me as a clinician, I always need to ask myself, ‘Okay, what could I have done better?’ When I've got a client that drops out after one, two, or three sessions, as a clinician, I have always sat with that client file and gone, okay, I need to reflect on what happened here. Maybe we did solve the problem in only two sessions.  You know, what are all those valid and legitimate reasons why they only needed three sessions?  But then I'm going to look at the others and I'm going to go, ‘Okay, what happened? What can I recall from that intake?’

When I was new in private practice, I clearly remembered one of the big learnings I had as a clinician, was that I was putting a lot of pressure on myself to do a proper intake session asking all the questions, because I wanted to get to case formulation diagnosis, be able to come up with a treatment plan at the end of session one. Because I was going, people are now paying me money to see me, right? I'm now in private practice, I'm charging money and I need to do a good job. I need to give them value straight off the bat. And then I realised that I was so stuck in getting through all my questions, that I didn't do good, reflective listening, especially as a trauma psychologist. Geez, Gerda, that was so bad. Luckily, I'm talking like 2007 now, I've learned quite a lot since then. But it really stood out for me. 

Then the penny dropped, and I went, okay, you just need to throw out this intake questionnaire, and I actually stopped using an intake questionnaire. I changed my intake session to literally have one question, and that was: What made you decide to come and see me today. And I would just take it from there. I would just take it from there. It literally changed how I did therapy. It took so much pressure off my shoulders for session one, and it meant that my clients did not drop out. So what I encourage you to do is really go look at the dropout rates for your team.

The other number is retention rates. So, retention rates are the average number of sessions that the client attends at your practice. The way that we run it at my practice is that we look at that number on a monthly basis, and it looks at the entire caseload. Now, if a clinician is very new, you can't do much of this number because they're building up a caseload, right? So dropout rates, you can start looking at that within the first two to three months of having a clinician on board. When it comes to retention rates, because the majority of clients in my world of psychology attends fortnightly, we look at it, but the data only becomes powerful after about four to six months, okay? Where we can really start to go, okay, what does this number tell us right now?  It doesn't mean that we are not talking to our clinical team about client engagement. We do that as part of onboarding already, because we want to set them up for success, right? Then we also start to look at the numbers. 

Then the third red flag is the inactive client list. Generally, if somebody's sitting on your clinician's inactive client list, it means that they are at high risk of dropout, okay, so those are the three numbers that you want to look at. Maybe what I would say is just to give you some numbers or parameters around inactive client lists, the policy that I have always had is that a clinician can have one inactive client on the inactive client list for every day that they consult at the practice. Which means that if they work at the practice full-time five days a week, they can have five people on that list. And so I'm a very reasonable person, right. But I feel like having a number is very clear, and I like to set clear expectations of my team. Having this number also reflects the priority that we give to making sure that people are in therapy. Or if they've made that decision not to continue, we've done the necessary discharge paperwork, because compliance is incredibly important.

If you aren't staying on top of your paperwork and your discharge paperwork, AKA, everything that makes sure that you are compliant, it'll snowball and get totally out of control, and that causes huge problems down the track, and you don't want that. So it's in everybody's best interest that we know what our inactive client list looks like.

As a whole, dropout rates, retention rates, and an inactive client list, you know why those things become problems? If I had to summarise it all in one sentence, it is because clinicians take a passive approach to their client engagement - instead of an active approach. I hear that all the time, people going, ‘Oh, I leave it up to the client to decide whether they want to book another appointment, or I just leave the ball in the client's hand so that they can decide.’ No,  I'm all for client choice and control, let me just say that. But I also feel like I've got a professional, ethical and moral responsibility to tell somebody when I can help them. Why would I not tell them? And, to tell them what I think that help should look like, and then it's up to them to decide.

Final Reflection

That was the three core reasons of why I suspect your practice diary isn't fully booked as yet. It is incredibly important for you as a responsible business owner, to ensure that you address all three of these reasons. Because if you only do the one, you will continue to struggle, and chase your tail and wonder what's happening. You have to address all three of them. 

If you are a really established group practice, I would actually recommend starting with reason number three, then go into two, and then go into one. If you are a relatively new group practice, I would start with reason one, then two, and then three. That's just a little bit of guidance from my side. What you must absolutely do is review this within your own business. And as always, if you need help, you know where to find me.

Thank you so much for listening, 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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