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Friday 27 January 2012

Private Practice: The Repulsions

This post is part of a series on private practice issues that will be appearing on Fridays for the next month or two, on the leadup to a series of workshops (based on my book Private Practice Made Simple) taking place in Calgary, Toronto, Ottawa, Vancouver, and Edmonton in March (information here).
Not even an apple to offer us.

Last week I covered some of the hopes for private practice reported by people who have attended my workshops. This week, let's consider some of their fears.

1.  I'll never get clients.

This is hands-down the most frequent fear that people express. They've often been working in large, well-known organizations where the clients are covered by insurers and are referred to the service, not to the person working within it. "If I'm not part of that organization, and if on top of that I'm charging for what I do, how will people ever come to see me?"

This is an entirely valid concern. Most clinicians are, to be frank, lousy at making their services known and have few ideas about how to do it. Fortunately, such things can be learned, and eventually most private practitioners figure at least some of them out. It's a major topic in my book and others in the area.

2. I want a reliable income!

Another dead-on concern. People get used to having a very clear idea about how much money will be in every paycheque. In private practice you never really know how much you're going to make each month. This makes personal budgeting more difficult, especially if you live anywhere close to the edge of your income. Furthermore, there is no way of ensuring that the business takes in a stable amount: it always fluctuates.

Private practitioners have to learn to deal with this uncertainty. One of the best ways is to live with more of a margin than you would if you earned about the same amount in a large organization. You save more, you keep more in savings, you go into debt less. You can also pay yourself a set amount each month from the business, then issue yourself bonuses if the business account begins to build up beyond any reserve that you need.

3.  I know nothing about running a business.

At the workshops I love asking how many people took a small-business management course as a part of their professional training. No one ever puts up their hand. Despite the fact that many of their graduates will be running a business, professional schools almost never devote any time to it. Furthermore, most therapists don't get the experience or training anywhere else - they generally haven't run anything bigger than a lemonade stand.

Fortunately, lots of people have to run businesses, so many of the seemingly-threatening details (How do I do payroll? Book keeping? Tax payments?) aren't actually as difficult as they might seem. Governments actually want people to pay their taxes, so they don't generally make it too difficult to do so. 

4.  I won't have any benefits package.

This is almost certainly valid. As an employee of a large organization, a professional will usually get extended health coverage, sick leave, short-term disability, long-term disability, government pension plan, private pension plan, and vacation pay. The value of these extras amounts to a significant percentage of a person's pay package (it varies, but can be up to 20%). All of this evaporates when you move into full-time private practice. 

Consequently, it's worth contemplating whether one really wants to give up all those benefits. If not, then maybe part-time private practice is an option, or none at all. There are also organizations that offer purchasable benefits packages for private practitioners.

5.  I don't know enough to work on my own!

I applaud the people who say this, because they're right. They don't know enough, and they never will. None of us is an expert on every concern that might appear in a therapist's office. Therefore, if and when they go into private practice they need to have a good consultation network so they can talk over challenges with colleagues. They'll also have to have good boundaries and know when a concern is outside their area of expertise, so they can refer people onward. 

It's the ones who think they know enough to practice independently that I worry about.

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So there are a few of the many concerns people have raised about the prospect of private practice. I review more of them in Private Practice Made Simple, and go into more detail about the ones above.

Coming up: More posts on the nuts and bolts of operating a practice.

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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple.  It contains information on starting a practice, creating a space, designing a website, getting referrals, managing finances, avoiding burnout, and much more.

The book is available at bookstores, from the Changeways Clinic website, and through Amazon here.

Vancouver Workshop November 29 2013

Click here for information and registration for the one-day workshop Private Practice Made Simple being held in Vancouver Canada Friday November 29. 

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