So you want to start a private practice: some thoughts

So you want to start a So you want to start a private practice: some private practice: some

thoughtsthoughts

Judy Ripsch, Ph.D., L.C.S.W.Judy Ripsch, Ph.D., L.C.S.W.

IntroIntro

►Intro Self (Who made me Intro Self (Who made me the expert?)the expert?)

►Why are you here?Why are you here?►What do you want to know?What do you want to know?►Need to assess market and Need to assess market and assess selfassess self

Assess SelfAssess Self

►AttitudeAttitude►Knowledge Knowledge ►SkillsSkills►Both as a practicing clinician Both as a practicing clinician

and as a business personand as a business person►Let’s talk about the business Let’s talk about the business

personperson

Business Hat ExerciseBusiness Hat Exercise

►Write down all the Write down all the words and phrases that words and phrases that you think of when you you think of when you hear the word hear the word "business”."business”. ►ShareShare

Business Hat ExerciseBusiness Hat Exercise

►Does the word business make Does the word business make you feel uneasy, tense? you feel uneasy, tense?

►Do you think someone may Do you think someone may be taking advantage of you?be taking advantage of you?

►Do you feel that you lack Do you feel that you lack business skills?business skills?

Business Hat Exercise (Cont.)Business Hat Exercise (Cont.)

►Do you believe that Do you believe that business people are:business people are: ruthless, money-hungry, ruthless, money-hungry, without ethics, insensitive without ethics, insensitive to others, a to others, a different different breedbreed from counselors and from counselors and counselor educators, and counselor educators, and from you?from you?

Business Hat Exercise (Cont.)Business Hat Exercise (Cont.)

►If your answer was If your answer was "yes""yes" to to any of these questions, then any of these questions, then you may have roadblocks that you may have roadblocks that hold you back from deciding hold you back from deciding whether to start a private whether to start a private practice.practice.

►Do you want to be a Do you want to be a “business “business person”?person”?

AttitudeAttitude

►Your first step is to put on your Your first step is to put on your business hat! business hat!

►The confidence it takes to put The confidence it takes to put on this hat comes from your on this hat comes from your desire to not only help people, desire to not only help people, but also to but also to make moneymake money..

►Can you bill? Can you collect? Are Can you bill? Can you collect? Are you worth your fee?you worth your fee?

Attitude (Cont.)Attitude (Cont.)► You must be You must be comfortable with your comfortable with your need to make money need to make money and charge directly for and charge directly for your servicesyour services——remember, making a remember, making a living is not unethical!living is not unethical!

Attitude (Cont.)Attitude (Cont.)►You must be willing to take You must be willing to take some some risksrisks financially. financially.

►It often takes at least two It often takes at least two years to build a successful years to build a successful practice; considerably more practice; considerably more if it is planned and if it is planned and managed poorly. managed poorly.

Attitude (Cont.)Attitude (Cont.)

►(after (after 5 yrs IRS5 yrs IRS considers it a hobby!)considers it a hobby!)

►You may You may lose moneylose money initially until a referral initially until a referral network and client base network and client base are established.are established.

KnowledgeKnowledge► You must You must become well acquainted become well acquainted

with with budgets, cash flows and budgets, cash flows and business plansbusiness plans to evaluate the to evaluate the potential and ongoing viability of your potential and ongoing viability of your independent practice.independent practice.

►You must know about You must know about billing, coding, billing, coding, collecting.collecting.

►You must You must be prepared to be prepared to market market your skills your skills to guarantee success.to guarantee success.

SkillsSkills► You must You must be able to attend be able to attend to the to the minutiaeminutiae of running of running an office an office as it is unlikely you as it is unlikely you will be able to afford to hire will be able to afford to hire someone to do this initially.someone to do this initially.

►You must be able to perform You must be able to perform in an in an ethical, competent, ethical, competent, legallegal manner. manner.

What do I need to start?What do I need to start?

► LicenseLicense►Malpractice Ins (1,000,000-3,000,000)Malpractice Ins (1,000,000-3,000,000)► LawyerLawyer

Incorporate? LLC?Incorporate? LLC?

► AccountantAccountant TaxesTaxes

► Business PlanBusiness Plan► Access to clientsAccess to clients► Access to payersAccess to payers

Business PlanBusiness Plan

►A A detailed and sound business detailed and sound business plan plan plots your targetsplots your targets for your for your business and identifies how you business and identifies how you will will achieveachieve them. them.

►Most business plans contain three Most business plans contain three standard elements:standard elements: • • Marketing plan.Marketing plan. • • Operating plan. Operating plan. • • Financial plan.Financial plan.

Marketing PlanMarketing Plan

►Your Your marketing plan marketing plan should should contain a contain a detailed marketing detailed marketing analysis.analysis.

►HowHow will you do this? (e.g. other will you do this? (e.g. other professionals, customer/clients) professionals, customer/clients)

►Needs analysis.Needs analysis. What’s needed in the area?What’s needed in the area? What already exists?What already exists? Wait lists?Wait lists? OtherOther

Marketing Plan (Cont.)Marketing Plan (Cont.)

►Analysis of your Analysis of your competitive competitive strengths and weaknessesstrengths and weaknesses in in ability to fill need. ability to fill need.

►Identify the areas where you know Identify the areas where you know you have an edgeyou have an edge and those and those where you are less qualified.where you are less qualified.

►Finally, identify your Finally, identify your sales sales strategystrategy—the means by which you —the means by which you will make your services known.will make your services known.

Operating PlanOperating Plan►Good business planning also involves the Good business planning also involves the

creation of an creation of an operating planoperating plan——one one that attends to the that attends to the "mechanics""mechanics" of of running a business. running a business.

►You must specify:You must specify: • • The location (building and equipment).The location (building and equipment). • • Management and staffing (as appropriate).Management and staffing (as appropriate). • • Administrative or professional procedures Administrative or professional procedures

that you expect to follow (hours of work, that you expect to follow (hours of work, scheduled services). (P+P manual)scheduled services). (P+P manual)

Financial PlanFinancial Plan

►Lastly, your business plan requires Lastly, your business plan requires a a financial planfinancial plan component. component. Clearly Clearly identify startup costs, identify startup costs, expected sources of funds, cash-expected sources of funds, cash-flow forecasts, operating costs, and flow forecasts, operating costs, and an initial profit/loss forecast.an initial profit/loss forecast.

►Your business plan must emphasize Your business plan must emphasize quantitative data to justify why quantitative data to justify why your business will succeed.your business will succeed.

Financial Plan (Cont.)Financial Plan (Cont.)

►Qualitative data can be used as Qualitative data can be used as well to help in identifying trends well to help in identifying trends associated with the marketplace. associated with the marketplace.

►Using quantitative and qualitative Using quantitative and qualitative data to build your business data to build your business demonstrates that you understand demonstrates that you understand that the market truly requires your that the market truly requires your servicesservices..

Strategic PlanStrategic Plan►For most private For most private

practitioners, the practitioners, the business business and strategic planand strategic plan will be will be one one and the sameand the same..

►Strategic questionsStrategic questions to be to be considered are:considered are: • • What are your long-term What are your long-term

strategies to strategies to market the practice?market the practice? • • What are your long-term client What are your long-term client

and and revenue goalsrevenue goals??

Strategic Plan (Cont.)Strategic Plan (Cont.) • • What are your What are your minimal profitminimal profit

margins/client retention rates margins/client retention rates required to maintain the practice?required to maintain the practice?

• • What associations and networks What associations and networks are planned to are planned to promote practice promote practice growth?growth?

• • What contingency plans have What contingency plans have been created for times of been created for times of illness or illness or slowness inslowness in the marketplace? the marketplace?

Strategic Plan (Cont.)Strategic Plan (Cont.)

►While business and While business and strategic plans are to be strategic plans are to be written, they are not carved written, they are not carved in stone.in stone.

► Each is to be treated as a Each is to be treated as a tool—tool—a fluid documenta fluid document——that you can adjust and that you can adjust and reevaluate as necessary. reevaluate as necessary.

►Think Treatment Planning!Think Treatment Planning!

BudgetingBudgeting►Your Your budgetbudget will be a key will be a key

feature of your business plan feature of your business plan and is updated and is updated annuallyannually..

► A budget outlines expected A budget outlines expected sources of sources of income and income and expensesexpenses and results in a and results in a projected income or lossprojected income or loss for for the year.the year.

Budgeting (Cont.)Budgeting (Cont.)►Your budget for your Your budget for your first yearfirst year

of practice will include of practice will include start-up start-up costscosts in addition to ongoing in addition to ongoing expensesexpenses. .

►When budgeting, it is useful to When budgeting, it is useful to overestimate costs and overestimate costs and underestimate projected underestimate projected incomeincome so as to increase the so as to increase the realistic nature of your realistic nature of your expectations.expectations.

Budgeting (Cont.)Budgeting (Cont.)►Developing a Developing a "worst case""worst case"

scenario will result in more careful scenario will result in more careful planning of budget categories.planning of budget categories.

►Your budget and your Your budget and your financial financial statementstatement—produced at the end —produced at the end of the fiscal year—permit more of the fiscal year—permit more accurate planning of your budget accurate planning of your budget for your second and subsequent for your second and subsequent years of practice.years of practice.

Budgeting (Cont.)Budgeting (Cont.)

► A A financial statement is the financial statement is the summary of actual income and summary of actual income and costs incurred for the fiscal yearcosts incurred for the fiscal year and shows either a profit or a loss and shows either a profit or a loss on the balance sheet. on the balance sheet.

►It uses the same categories as It uses the same categories as those used in your budget and those used in your budget and includes various depreciation includes various depreciation schedules.schedules.

►See Accountant!See Accountant!

ExpenseExpense categories categories► Expense categories in a budget can Expense categories in a budget can varyvary, but , but

common ones common ones might include:might include:

• • Office space—rent, furniture, Office space—rent, furniture, cleaning, upgrades and painting, cleaning, upgrades and painting, utilities, parking.utilities, parking.

• • Telephone—phone lines, Telephone—phone lines, computer access, fax line, long computer access, fax line, long distance charges, cellular phone distance charges, cellular phone service, answering services.service, answering services.

Machine—computer, server, fax, Machine—computer, server, fax, copier, printer, answering machinecopier, printer, answering machine

Expense categories (Cont.)Expense categories (Cont.) • • Office supplies and materials—basic Office supplies and materials—basic

office supplies, ink, paper, stationery, office supplies, ink, paper, stationery, specialized supplies, test materials, specialized supplies, test materials, reference materials, coffee.reference materials, coffee.

• • Postage.Postage. • • Bank charges—for checks, Bank charges—for checks,

accounts, deposits, NSF checks accounts, deposits, NSF checks written by clients, credit card fees.written by clients, credit card fees.

Billing program/service (clearing Billing program/service (clearing house)house)

Business program (Quicken?)Business program (Quicken?)

Expense categories (Cont.)Expense categories (Cont.) interests on loans.interests on loans. • • Insurance—professional liability, Insurance—professional liability,

general office liability, health care, general office liability, health care, disability, office expense (e.g. disability, office expense (e.g. unemployment ins.) , accidental unemployment ins.) , accidental death and dismemberment.death and dismemberment.

• • Salaries and benefits paid to staff Salaries and benefits paid to staff (self).(self).

• • Retirement savingsRetirement savings Pro Bono workPro Bono work

Expense categories (Cont.)Expense categories (Cont.) • • Licenses—professional licenses, Licenses—professional licenses,

business licenses, registration fees, business licenses, registration fees, listing fees.listing fees.

• • Income taxes—payments are Income taxes—payments are computed based on your income or loss computed based on your income or loss for the year and are not a budget for the year and are not a budget category per se. You will however, need category per se. You will however, need to plan on accumulating enough cash to to plan on accumulating enough cash to pay your taxes on a quarterly basis. pay your taxes on a quarterly basis. (Double FICA)(Double FICA)

• • Business and other taxes—as may be Business and other taxes—as may be required locally.required locally.

Expense categories (Cont.)Expense categories (Cont.) • • Bad debts—unpaid invoices that are Bad debts—unpaid invoices that are

written off.written off. • • Bookkeeping and accounting fees.Bookkeeping and accounting fees. • • Legal fees.Legal fees. • • Outside professional services—case Outside professional services—case

consultants, supervision, holiday cover-consultants, supervision, holiday cover-off.off.

• • Professional development—Professional development—conferences and workshops, conferences and workshops, supervision. (CEU’s)supervision. (CEU’s)

• • Professional dues and membership Professional dues and membership fees.fees.

Expense categories (Cont.)Expense categories (Cont.)►- Play therapy materials- Play therapy materials—stocking —stocking

a play therapy room can be very a play therapy room can be very costly. Depending on the complexity costly. Depending on the complexity of the materials offered, costs can of the materials offered, costs can run to several thousand dollars.run to several thousand dollars.

►- Biofeedback materials- Biofeedback materials—again —again this specialized equipment can be this specialized equipment can be very costly. Often a specialized room very costly. Often a specialized room and and chairchair for sessions will further for sessions will further add to cost.add to cost.

Expense categories (Cont.)Expense categories (Cont.)►- Professional journals, reference - Professional journals, reference

materials and membershipsmaterials and memberships—in —in order to keep current with emerging order to keep current with emerging research findings regarding theory and research findings regarding theory and clinical practice, it is convenient to clinical practice, it is convenient to subscribe to various professional subscribe to various professional journals and to buy essential reference journals and to buy essential reference materials. materials.

►- Locked fireproof filing cabinets- Locked fireproof filing cabinets (At lease two locks between files and (At lease two locks between files and intruder)intruder)

Expense categories (Cont.)Expense categories (Cont.) Sales promotion—open house, special Sales promotion—open house, special

mailings, phone book, internet mailings, phone book, internet presence.presence.

• • Vehicle and travel expenses—travel Vehicle and travel expenses—travel logs of business and personal use, logs of business and personal use, vehicle charges, mileage paid, airfares, vehicle charges, mileage paid, airfares, metered parking metered parking

• • Depreciation of furniture, business Depreciation of furniture, business machines and any large purchases.machines and any large purchases.

Collection feesCollection fees Software (client records)Software (client records) OthersOthers

Simple principlesSimple principles can guide can guide early budgetingearly budgeting

►• • Be realistic and estimate Be realistic and estimate costs carefully.costs carefully.

►• • Practice austerity and shop Practice austerity and shop around.around.

►• • Balance cost, durability and Balance cost, durability and quality of materials.quality of materials.

►• • Start basic.Start basic.

Simple principles can guide Simple principles can guide early budgeting (Cont.)early budgeting (Cont.)

►• • Underestimate income and Underestimate income and overestimate costs.overestimate costs.

►• • Accumulate operating capital Accumulate operating capital prior prior to opening your office.to opening your office.

►• • Avoid large loans as you will Avoid large loans as you will need considerable income to need considerable income to service the debt.service the debt.

►• • Expect some payment lag. Expect some payment lag. (Depends a lot on payor)(Depends a lot on payor)

Simple principles can guide Simple principles can guide early budgeting (Cont.)early budgeting (Cont.)

►• • Obtain Obtain partial guaranteed partial guaranteed funding.funding. (part time, consultant, (part time, consultant, services for hosp/court/etc.) services for hosp/court/etc.)

►• • Maintain a block of funds to Maintain a block of funds to cover at least cover at least six months of six months of operatingoperating expenses in case of expenses in case of various emergencies.various emergencies.

►• • Review your budget regularlyReview your budget regularly to to gauge your financial performance.gauge your financial performance.

Accounting and financial Accounting and financial recordsrecords

►As an independent practitioner and As an independent practitioner and business person, you will need to keep business person, you will need to keep accurate and accurate and detailed financial detailed financial records.records.

►Not only does this allow you to track Not only does this allow you to track and manage your finances, but such and manage your finances, but such records are necessary should you ever records are necessary should you ever be be audited by federal tax personnelaudited by federal tax personnel. .

►Consultation with a Consultation with a business business accountant is essentialaccountant is essential in setting your in setting your accounting system and financial accounting system and financial records.records.

Accounting and financial Accounting and financial records (Cont.)records (Cont.)

► Your accountant also may suggest a user-Your accountant also may suggest a user-friendly friendly accounting softwareaccounting software package that package that enables you or your support staff to enter enables you or your support staff to enter basic data and even produce a financial basic data and even produce a financial statement. statement.

► You should consult a licensed accountant to You should consult a licensed accountant to determine the need for a formal determine the need for a formal auditaudit or or financial review of your business. financial review of your business.

► If you incorporate you may require a formal If you incorporate you may require a formal audit—a statement that ensures accuracy and audit—a statement that ensures accuracy and appropriateness of all expenses and income appropriateness of all expenses and income claimed by your business. claimed by your business. Check with lawyer.Check with lawyer.


►If you plan to depend on If you plan to depend on support staff to be responsible support staff to be responsible for record-keeping, ask for record-keeping, ask detailed questions during their detailed questions during their initial interviews about their initial interviews about their experience with financial experience with financial record-keeping, record-keeping, get get references!!!references!!!

►Institute checks and balances.Institute checks and balances.


►Even so, it is very worth your while to Even so, it is very worth your while to be well aware of the income and costs be well aware of the income and costs in your business and review them in your business and review them regularly. regularly.

►You are ultimately responsibleYou are ultimately responsible for the for the success or failure of your business and success or failure of your business and cannot make informed business cannot make informed business decisions unless you are indeed decisions unless you are indeed informed.informed.

What else?What else?

►You are your own You are your own business manager/CEO.business manager/CEO.►You may also be your You may also be your own bookkeeper!own bookkeeper!

Basic necessary financial Basic necessary financial records include:records include:

• • Receipts for all moneyReceipts for all money received from received from direct, uninvoiced payment. (e.g. Co-Pay)direct, uninvoiced payment. (e.g. Co-Pay) Number these sequentially; provide one copy Number these sequentially; provide one copy

to the client and keep one for your records.to the client and keep one for your records. • • Invoices for servicesInvoices for services. .

Number these sequentially; provide two Number these sequentially; provide two copies to the client—one to be returned with copies to the client—one to be returned with payment, one to keep—and keep one for your payment, one to keep—and keep one for your recordsrecords..

► Open a Open a separate accountseparate account solely for solely for your business, record all your business, record all deposits/checks and balance all deposits/checks and balance all statements on a monthly basis.statements on a monthly basis.


►Use of a Use of a separate bank accountseparate bank account assists in assists in the ongoing management of your finances the ongoing management of your finances and saves you time when preparing and saves you time when preparing financial statements and tax returnsfinancial statements and tax returns

►• • Bank deposit slips. These are provided Bank deposit slips. These are provided by your bank; number them sequentially.by your bank; number them sequentially.

►• • Use sequentially numbered, personalized Use sequentially numbered, personalized business checks. business checks.

►Record the Record the name of the payee, the reason name of the payee, the reason for the payment and the amount of the for the payment and the amount of the check on the check stubscheck on the check stubs..


►For services invoiced to you, For services invoiced to you, note the note the check number and the date paid on check number and the date paid on your copy of the invoice.your copy of the invoice.

►• • Always Always check and balance check and balance statementsstatements of credit cards and of credit cards and checking accounts used for your checking accounts used for your business.business.

►• • Maintain a petty cash fund and Maintain a petty cash fund and accurate records accurate records (receipts)(receipts) of of expenses paid with these moneys.expenses paid with these moneys.


► Keep a Keep a log of all mileage drivenlog of all mileage driven for your for your business so that you can either claim business so that you can either claim mileage or a portion of your vehicle mileage or a portion of your vehicle expenses. expenses.

►Consult your accountant on the best Consult your accountant on the best strategy.strategy.

►• • Keep a Keep a log of all pay telephone and log of all pay telephone and parking meter cash paymentsparking meter cash payments for later for later claimsclaims

►My Accountant gave me a book!My Accountant gave me a book!


• • Keep Keep records of payrecords of pay issued to people in issued to people in your employ. If not “contractual”, you your employ. If not “contractual”, you will need to make deductions for them will need to make deductions for them and submit the and submit the Income Tax and FICA.Income Tax and FICA.

Regular monthly remittances reduce Regular monthly remittances reduce penalties. You will also need to decide penalties. You will also need to decide what pay schedule to use to pay what pay schedule to use to pay employees (e.g., monthly, biweekly, employees (e.g., monthly, biweekly, etc.). etc.).

You will need to pay them regularly and to You will need to pay them regularly and to pay them prior to paying your own pay them prior to paying your own salary if cash flow is low.salary if cash flow is low.


►While these records are detailed and While these records are detailed and laborious to keep, they are worth the effort laborious to keep, they are worth the effort as every penny is accounted for and you can as every penny is accounted for and you can see clearly how your business is functioning see clearly how your business is functioning and can then plan accordingly.and can then plan accordingly.

► As an independent practitioner, you will be As an independent practitioner, you will be responsible for responsible for paying and collectingpaying and collecting various taxes. (e.g. Fed + St. Income Tax, various taxes. (e.g. Fed + St. Income Tax, HICFA, Unemployment tax)HICFA, Unemployment tax)

►Electronic billing/banking will Electronic billing/banking will make some of these suggestions make some of these suggestions archaic.archaic.

Office SpaceOffice Space►You will need to find or develop You will need to find or develop

office space. office space. ►One way is to contact One way is to contact existing existing

practitionerspractitioners in your area and in your area and sublet space from them. sublet space from them.

►Most private practitioners have Most private practitioners have open times in their offices where, open times in their offices where, for a fee, you may be able to use for a fee, you may be able to use the office when they do not. the office when they do not.

Office Space (Cont.)Office Space (Cont.)

►The difficulty with this plan is The difficulty with this plan is that you are at the that you are at the mercy of mercy of their schedules.their schedules.

►Another creative way to obtain Another creative way to obtain office space is by contacting office space is by contacting your local pediatricians, your local pediatricians, general practitioners, general practitioners, gynecologists, or other gynecologists, or other doctors.doctors.


► You might offer a You might offer a service to them service to them in exchange for spacein exchange for space in their in their office when they are not using it. office when they are not using it.

►You could offer to do parenting You could offer to do parenting groups, marriage enrichment groups, marriage enrichment groups, weight loss help, divorce groups, weight loss help, divorce recovery, or stress management, recovery, or stress management, all in exchange for office space.all in exchange for office space.

Office Space (Cont.)Office Space (Cont.)►The idea here is that even a The idea here is that even a

busy doctor's office has times busy doctor's office has times where it is not in use. where it is not in use.

►Also, a pediatrician may relish Also, a pediatrician may relish the thought of having a licensed the thought of having a licensed mental health professional in mental health professional in the office, available to see the office, available to see his/her patients.his/her patients.


►There are many There are many options with options with which to negotiatewhich to negotiate. If the doctor . If the doctor or the office manager seems or the office manager seems interested, but suggests some interested, but suggests some payment for office space, and if payment for office space, and if the cost is reasonable, you may the cost is reasonable, you may ask to have your name put on ask to have your name put on the door with the other the door with the other professionals.professionals.

Office Space (Cont.)Office Space (Cont.)►The cost of using the office is The cost of using the office is

offset by the invaluable offset by the invaluable publicity, creditability and publicity, creditability and access to clients.access to clients.

►If you follow this plan, it is If you follow this plan, it is best to best to target a doctor's office target a doctor's office that fits your niche.that fits your niche. (C+A/Pediatrician, Women’s (C+A/Pediatrician, Women’s groups/gynecologist, etc.)groups/gynecologist, etc.)


►If this seems to difficult If this seems to difficult to do, remember that you to do, remember that you are a are a business personbusiness person and that the worst thing and that the worst thing that they could say in that they could say in answer to your offer is answer to your offer is “no”.“no”.

Office Space (Cont.)Office Space (Cont.)►Sharing office spaceSharing office space holds holds

down cost. Another mental down cost. Another mental health professional, a friend, health professional, a friend, may be interested in opening may be interested in opening an office and all expenses an office and all expenses would be shared. would be shared.

►Finally, there's always the Finally, there's always the possibility of finding a small possibility of finding a small office in your target area that office in your target area that may may fit your budget.fit your budget.

Office Space (Cont.)Office Space (Cont.)►Be sure the office is Be sure the office is accessible, accessible,

clean, private, confidential, clean, private, confidential, professional, has a waiting professional, has a waiting area, has accessible bathroom,area, has accessible bathroom, etc.etc.

►Depending on your Depending on your area/nitch/comfort level, you area/nitch/comfort level, you may choose to provide may choose to provide home home visitsvisits. (Not N.H. in IL as yet.) . (Not N.H. in IL as yet.)

►Be creative!Be creative!

FormsForms

► Forms: Forms: ► Clinical records (notes, plan, soc. Hx, diag.)Clinical records (notes, plan, soc. Hx, diag.)► Consent to treat , Confidentiality/HIPPA Consent to treat , Confidentiality/HIPPA

StatementStatement► Consent to billConsent to bill►Demographics, referral sourceDemographics, referral source►Complete, organized and proper Complete, organized and proper

clinical records clinical records enhance service enhance service provision and also serve to protect provision and also serve to protect the practitionerthe practitioner in the event of a in the event of a malpractice allegation or later malpractice allegation or later subpoena to court.subpoena to court.

Core contents of clinical Core contents of clinical filesfiles

►• • Identifying data: name, Identifying data: name, birth date, address, phone birth date, address, phone numbers, gender, numbers, gender, responsible payor.responsible payor.

►• • Intake form identifying Intake form identifying presenting problems.presenting problems.

►• • Record of appointments, Record of appointments, no-shows, cancellations.no-shows, cancellations.

Core contents of clinical files Core contents of clinical files (Cont.)(Cont.)

►• • Any assessments undertaken and Any assessments undertaken and interventions recommended, interventions recommended, formulation and treatment goals.formulation and treatment goals.

►• • Description of the types and dates Description of the types and dates of the services provided, record of of the services provided, record of cancellations and no-shows.cancellations and no-shows.

►• • Periodic description of client Periodic description of client progressprogress. (Justify continuing . (Justify continuing service.)service.)

►• • Copies of any formal service Copies of any formal service agreements.agreements.


►• • Copies of signed releases of Copies of signed releases of information and of the information information and of the information released. released. (Make note on release.)(Make note on release.)

(Needed info is based on State Law. (Needed info is based on State Law. May include: the names of any May include: the names of any persons you expect to be contacting, persons you expect to be contacting, the reason for the contact and the the reason for the contact and the kind of information you will be kind of information you will be discussing, purpose, expiration date discussing, purpose, expiration date of consent, signature, witness, etc.—of consent, signature, witness, etc.—Check your state lawCheck your state law!)!)


►• • Copies of any release Copies of any release forms for taping, training, forms for taping, training, etc.etc.

►• • Copies of any written Copies of any written correspondence and record correspondence and record of phone calls.of phone calls.

Key elementsKey elements to be addressed in to be addressed in effective clinical record-keeping effective clinical record-keeping

include:include:►• • Date all reports only on the day they are Date all reports only on the day they are

completed.completed.►• • Reports are to be signed by the Reports are to be signed by the

practitioner providing service. (Name, practitioner providing service. (Name, License)License)

►• • Notes must be accurate and specific—Notes must be accurate and specific—these are vital to help follow the progress of these are vital to help follow the progress of a client.a client.

► Include a mechanism for regular file review.Include a mechanism for regular file review.

Security of informationSecurity of information

►All records, regardless of All records, regardless of whether they are on paper or whether they are on paper or electronic, must be kept electronic, must be kept securely. securely.

►Must use appropriate Must use appropriate firewalls if firewalls if using electronic submissionsusing electronic submissions..

►Choose Choose fireproof cabinets and fireproof cabinets and locations away from general locations away from general traffic areas.traffic areas.

Security of information Security of information (Cont.)(Cont.)

►• • Keep files and records under lock and Keep files and records under lock and key at all times—secured from public key at all times—secured from public access.access.

►• • Keep public areas of the practice—Keep public areas of the practice—particularly the reception area—free of particularly the reception area—free of personal or financial information. (personal or financial information. (e.g. e.g. Don’t call client by name!)Don’t call client by name!)

►• • Shred all recordings or client Shred all recordings or client documents that are no longer needed.documents that are no longer needed.

►Minimum of two locksMinimum of two locks between file and between file and access..access..

FeesFees

►How do you set a fee schedule?How do you set a fee schedule? (Find out “usual and customary” (Find out “usual and customary”

in area, may check insurance or in area, may check insurance or Medicare payment schedule, Medicare payment schedule, consider your experience and skill consider your experience and skill level…)level…)

►The issue of payments is very The issue of payments is very important.important.

Fees (Cont.)Fees (Cont.)

► Be sure the client Be sure the client (AND YOU)(AND YOU) understand that payment is understand that payment is made at the time of the made at the time of the appointment, and that any appointment, and that any insurance consideration will insurance consideration will be worked out in advance.be worked out in advance.

►Deductables/copays, EOB’sDeductables/copays, EOB’s


►Accepting payment for your Accepting payment for your services may make you services may make you uncomfortable at first. Do not uncomfortable at first. Do not be. be. You are a valuable You are a valuable professionalprofessional who is who is licensed,licensed, and remember: you are solid, and remember: you are solid, knowledgeable, and knowledgeable, and effective.effective.


►If you consider sliding fee, be If you consider sliding fee, be fair to yourself. Remember: fair to yourself. Remember: It It is also a reflection of your vision, is also a reflection of your vision, your self-worth and education. your self-worth and education. Many clients will see your fees as a Many clients will see your fees as a gauge of your value as a gauge of your value as a professional.professional.

►Pro-BonoPro-Bono

MarketingMarketing►Provide Provide good service.good service. No No

network can compare to the one network can compare to the one you create through the you create through the excellence of your work.excellence of your work. Referrals from satisfied clients Referrals from satisfied clients may not generate immediate may not generate immediate referrals, but over time increase referrals, but over time increase your client base. (After 30 years in your client base. (After 30 years in Pontiac, I am seeing 3Pontiac, I am seeing 3rdrd generation, presently WOM and generation, presently WOM and EAP are my client base!)EAP are my client base!)

Building a Client BaseBuilding a Client Base

►• • Provide Provide personal contact personal contact and and immediate responsesimmediate responses to inquiries to inquiries from both referral sources and from both referral sources and potential clients to demonstrate your potential clients to demonstrate your interest in meeting their needs.interest in meeting their needs.

►• • Maintain Maintain goodwill goodwill with potential with potential referralreferral sources and other sources and other professionals in the community.professionals in the community.

Building a Client BaseBuilding a Client Base►Realize that various Realize that various other other

professionalsprofessionals besides psychologists besides psychologists may be valuable referral sources, may be valuable referral sources, including: medical professionals, including: medical professionals, educators, social workers, general educators, social workers, general counselors, employee assistance counselors, employee assistance programs, lawyers and social programs, lawyers and social service personnel, to list a few.service personnel, to list a few.

Building a Client Base (Cont.)Building a Client Base (Cont.)

►••NETWORK, NETWORK, NETWORKNETWORK, NETWORK, NETWORK► Refer clients Refer clients elsewhere if you do elsewhere if you do

not have the not have the specific skillsspecific skills they they require, or provide an option of an require, or provide an option of an alternate referral if your alternate referral if your waiting list is waiting list is very longvery long. Maintain a referral list of . Maintain a referral list of other professionals other professionals whose work you whose work you respectrespect..

Building a Client Base (Cont.)Building a Client Base (Cont.)►• • Distribute your Distribute your business cards business cards

freely.freely. Make them easy to read, Make them easy to read, attractive and professional. Include attractive and professional. Include your name, degrees, license, your name, degrees, license, certificates, address, and phone/fax/e-certificates, address, and phone/fax/e-mail numbers. (e.g. mine)mail numbers. (e.g. mine)

►• • Send a Send a thank you letter thank you letter to the to the referral sourcereferral source once you have seen a once you have seen a client and received their written client and received their written consent to do so.consent to do so.

Building a Client Base (Cont.)Building a Client Base (Cont.)►• • Send an Send an announcement announcement

mailingmailing when you first establish when you first establish your practice, or add another your practice, or add another practitioner to your practice. practitioner to your practice. Realize that this may result in very Realize that this may result in very few referrals, but will still make few referrals, but will still make your availability known.your availability known.

►Contact local business reporter to Contact local business reporter to do a piece on do a piece on something specialsomething special you are offering. (Horse riding you are offering. (Horse riding therapy)therapy)

Building a Client Base (Cont.)Building a Client Base (Cont.)

►• • Hold an Hold an open-houseopen-house to make to make your availability known, thank your availability known, thank the people who have supported the people who have supported you, to establish a practice, and you, to establish a practice, and generally establish goodwill.generally establish goodwill.

►Join the local Join the local Chamber of Chamber of Commerce.Commerce.

Building a Client Base (Cont.)Building a Client Base (Cont.)►Place your name and perhaps an Place your name and perhaps an

advertisement in the advertisement in the Yellow Pages. Yellow Pages. Some people look there firstSome people look there first..

► Realize, however, that some Realize, however, that some people may not select a psychologist people may not select a psychologist through the Yellow Pages. Know that through the Yellow Pages. Know that having your name there indicates having your name there indicates that you are a that you are a bona fide practitioner bona fide practitioner and provides phone numbers and and provides phone numbers and addresses to facilitate contact with addresses to facilitate contact with you.you.

Building a Client Base (Cont.)Building a Client Base (Cont.)►Be willing to accept Be willing to accept interviews interviews

from the mediafrom the media on general topics on general topics in psychology. in psychology.

►Have your name placed on a list Have your name placed on a list for for speakers' bureausspeakers' bureaus indicating indicating your willingness to give your willingness to give presentations and workshops. presentations and workshops. This makes your name known.This makes your name known.

►Volunteer to speakVolunteer to speak at service at service clubs, church groups, women’s clubs, church groups, women’s groups, etc.groups, etc.

Building a Client Base (Cont.)Building a Client Base (Cont.)►• • Give Give your practice ayour practice a name and a name and a

logo. logo. Again, this makes your name Again, this makes your name stand out and is likely to be most stand out and is likely to be most useful if you are in a joint practice useful if you are in a joint practice with several other practitioners.with several other practitioners.

►• • Serve on various Serve on various community community boards boards for either profit or non-profit for either profit or non-profit societies.societies.

►• • Become Become adjunct facultyadjunct faculty for for universities, community colleges, etc.universities, community colleges, etc.

EAPsEAPs►Employee Assistance ProgramsEmployee Assistance Programs (EAPs) (EAPs)

are are employee benefitemployee benefit programs offered by programs offered by many employers, typically in conjunction many employers, typically in conjunction with a with a health insurancehealth insurance plan. plan.

►EAPs are intended to help employees deal EAPs are intended to help employees deal with personal problems that might with personal problems that might adversely impact their work performance, adversely impact their work performance, health, and well-being. health, and well-being.

►EAPs generally include EAPs generally include assessmentassessment, short-, short-term counseling and referral services for term counseling and referral services for employees and their household members.employees and their household members.

EAPs (Cont.)EAPs (Cont.)

►Employees and their household Employees and their household members may use EAPs to help members may use EAPs to help manage issues that could adversely manage issues that could adversely impact their work and personal lives. impact their work and personal lives.

►EAP counselors typically provide EAP counselors typically provide assessment, support, and if needed, assessment, support, and if needed, referrals to additional resources.referrals to additional resources.

The issues for which EAPs The issues for which EAPs provide support vary, but provide support vary, but

examples includeexamples include

► substance abusesubstance abuse ►safe working environmentsafe working environment ►emotional distressemotional distress ►major life events, including births, major life events, including births,

accidents and deaths accidents and deaths ►health carehealth care concerns concerns ►financial or legal concernsfinancial or legal concerns

The issues for which EAPs The issues for which EAPs provide support vary, but provide support vary, but examples include (Cont.)examples include (Cont.)

►family/personal relationship issues family/personal relationship issues ►Partner relationship issuesPartner relationship issues►work relationship issues work relationship issues ►concerns about aging parents concerns about aging parents ►An EAP's services are usually An EAP's services are usually free to free to

the employee or household member, the employee or household member, having been pre-paid by the having been pre-paid by the employeremployer

+/- of working with EAP+/- of working with EAP

►PLUSESPLUSES►Easy to collect from ContractorEasy to collect from Contractor►Less paperworkLess paperwork►Source of referralsSource of referrals►No deductibles/co-pays to collect (no No deductibles/co-pays to collect (no

out-of-pocket for client)out-of-pocket for client)►Does not require “major” Does not require “major”

(reimbursable) diagnosis(reimbursable) diagnosis

+/- of working with EAP +/- of working with EAP (Cont.)(Cont.)►MINUSESMINUSES

►May be required to share client’s info with May be required to share client’s info with employer (with client’s permission)employer (with client’s permission)

► Can not charge a no show feeCan not charge a no show fee►May not be able to self referMay not be able to self refer► Eap company is “Keeper of the Records”Eap company is “Keeper of the Records”►Must be able to function in “brief model”Must be able to function in “brief model”► Some EAP companies have questionable Some EAP companies have questionable

“fee arrangements”“fee arrangements”

InsuranceInsurance

►Some insurances require that you be Some insurances require that you be “on their panel”“on their panel”

►Some will pay at Some will pay at lesser rate if you are lesser rate if you are “out of network”, some not at all.“out of network”, some not at all.

►Can often apply through web site Can often apply through web site (look for (look for “provider relations”)“provider relations”)

►Find out who insures most people in Find out who insures most people in your areayour area

►BC/BS is usually bigBC/BS is usually big

InsuranceInsurance

►May check with other providers May check with other providers (hospital?) to see whom they bill(hospital?) to see whom they bill

►Will need copies of Will need copies of current license, current license, malpractice, certificationsmalpractice, certifications (e.g. CADC) (e.g. CADC)

►Medicare is “special” insurance with Medicare is “special” insurance with own process: see on line, all own process: see on line, all electronic billing (central electronic billing (central management service)management service)

+/-+/-

►PLUSESPLUSES

►Some referrals if persons covered Some referrals if persons covered are seeking someone in networkare seeking someone in network

►Can be reliable source of incomeCan be reliable source of income►You maintain your own recordsYou maintain your own records►Many accept multiple billing Many accept multiple billing

methodsmethods

+/-+/-

►MINUSESMINUSES

►May have to get “preapproval”May have to get “preapproval”►Deal with deductibles each Deal with deductibles each

year and copaysyear and copays►May pay reduced rates to May pay reduced rates to

“covered” therapists“covered” therapists

Coding Info Needed for Coding Info Needed for BillingBilling

►The The CPT is a uniform codingCPT is a uniform coding system consisting of descriptive system consisting of descriptive terms and identifying codes that terms and identifying codes that are used primarily to identify are used primarily to identify medical services and proceduresmedical services and procedures furnished by physicians and furnished by physicians and other health care professionals. other health care professionals.

Coding Info Needed for Billing Coding Info Needed for Billing (Cont.)(Cont.)

►These health care professionals use These health care professionals use the CPT to identify services and the CPT to identify services and procedures for which they procedures for which they bill public bill public or private health insurance or private health insurance programsprograms..

► Decisions regarding the addition, Decisions regarding the addition, deletion, or revision of CPT codes are deletion, or revision of CPT codes are made by the made by the AMA.AMA.

►The CPT codes are republished and The CPT codes are republished and updated annually by the AMA.updated annually by the AMA.

Coding Info Needed for Billing Coding Info Needed for Billing (Cont.)(Cont.)

►Because these particular codes mean so Because these particular codes mean so much income for the AMA, it is difficult to much income for the AMA, it is difficult to find lists of them that are accessible to find lists of them that are accessible to the public. In fact, groups that have tried the public. In fact, groups that have tried to make them public have been cited for to make them public have been cited for violations and fines by the AMA and have violations and fines by the AMA and have been forced to remove them from the been forced to remove them from the Internet. Many groups license the lists of Internet. Many groups license the lists of codes from the AMA, however, and then codes from the AMA, however, and then publish them online or in books. They are publish them online or in books. They are allowed to charge for access since they allowed to charge for access since they are also paying that licensing fee. are also paying that licensing fee.

CPT (Current Procedural CPT (Current Procedural Terminology)Terminology)

►Billing service may have themBilling service may have them►May buy a book from AMAMay buy a book from AMA►May pay for list on lineMay pay for list on line►Most common: 90801-intake, 90806-45 Most common: 90801-intake, 90806-45

to 50 minute session.(90804, 90808)to 50 minute session.(90804, 90808)►Helpful to have the resource for Helpful to have the resource for

parameters of what's includedparameters of what's included►New “Health and Behavior” codes New “Health and Behavior” codes

presently can be used by Psychologistspresently can be used by Psychologists

““Health and Behavior”Health and Behavior”

►CPT Code CPT Code ►(15 min – 1 unit)(1 hr – 4 units)(15 min – 1 unit)(1 hr – 4 units)►96150 Assessment – initial96150 Assessment – initial►*96151 Re-assessment*96151 Re-assessment►96152 Intervention – Individual96152 Intervention – Individual► 96153 Intervention – group 96153 Intervention – group ►96154 Intervention – family w/ patient 96154 Intervention – family w/ patient ►96155 Intervention – family w/o patient96155 Intervention – family w/o patient

ICD-09ICD-09

►What Do the Numbers Mean? ICD-What Do the Numbers Mean? ICD-09, ICD-10 and Others?09, ICD-10 and Others?

► ICD codes were ICD codes were first developed in 1893first developed in 1893 in France by a physician, Jacques in France by a physician, Jacques Bertillion. They were called the Bertillon Bertillion. They were called the Bertillon Classification of Causes of Death. In Classification of Causes of Death. In 1898, they were adopted in the United 1898, they were adopted in the United StatesStates, and were considered, in effect, , and were considered, in effect, ICD-1ICD-1 because that was the first version because that was the first version of code numbers.of code numbers.

ICD-09 (Cont.)ICD-09 (Cont.)► Since then, as medical science has progressed Since then, as medical science has progressed

and new diagnoses have been developed, and new diagnoses have been developed, named and described, the code lists have been named and described, the code lists have been updated. The number designation changes updated. The number designation changes when the updates are so extensive that a when the updates are so extensive that a wholesale change needs to be made. There may wholesale change needs to be made. There may be annual updates, too, but those are be annual updates, too, but those are considered to be relatively minor, and the basic considered to be relatively minor, and the basic code set doesn't change.code set doesn't change.

► For example, the For example, the upgrade in 1949, ICD-upgrade in 1949, ICD-6, was the first time 6, was the first time mental mental disordersdisorders were added to the code were added to the code set. set.

ICD-09 (Cont.)ICD-09 (Cont.)

►Most of the codes we see in the United Most of the codes we see in the United States today are version 9, called ICD-9-States today are version 9, called ICD-9-CM codes.CM codes. With few exceptions, the With few exceptions, the paperwork we receive when we leave a paperwork we receive when we leave a doctors office will contain both doctors office will contain both CPT codesCPT codes (Current Procedural Terminology) to describe (Current Procedural Terminology) to describe the service that was rendered for billing the service that was rendered for billing purposes, and ICD-9-CM codes to describe purposes, and ICD-9-CM codes to describe why that service was provided. Further, most why that service was provided. Further, most death certificates filed since 1977 will have death certificates filed since 1977 will have an ICD-9 code on them.an ICD-9 code on them.

ICD-09 (Cont.)ICD-09 (Cont.)

► The most current list of codes in use is ICD-The most current list of codes in use is ICD-10. This list was first used in the United States 10. This list was first used in the United States in 2007. Minor revisions added to ICD-10 in 2007. Minor revisions added to ICD-10 codes were made available in early 2009 by codes were made available in early 2009 by the NCHS. Globally, most other countries in the NCHS. Globally, most other countries in the world have implemented the ICD-10 the world have implemented the ICD-10 codes. There are some major differences codes. There are some major differences between the two code sets, between the two code sets, the transition is the transition is very expensive, and most American providers very expensive, and most American providers have not yet upgraded to the ICD-10 system.have not yet upgraded to the ICD-10 system.

But I use DSM-IV-TR to But I use DSM-IV-TR to diagnose!diagnose!

►Covered Diagnoses & Covered Diagnoses & Crosswalk of DSMIVCrosswalk of DSMIV

►The crosswalk is a document The crosswalk is a document designed to help you determine designed to help you determine which ICD-9-CM diagnosis code which ICD-9-CM diagnosis code (1977)(1977) corresponds to a particular corresponds to a particular DSM-IV-TR diagnosis code.DSM-IV-TR diagnosis code.

Do I need to use it?Do I need to use it?►YES!YES!►Under the Health Insurance Under the Health Insurance

Portability and Accessibility Act Portability and Accessibility Act (HIPAA), insurance companies (HIPAA), insurance companies who who accept and process accept and process insurance claims electronically insurance claims electronically are only required to accept are only required to accept ICD-9-CMICD-9-CM diagnosis codes. diagnosis codes.

Do I need to use it?Do I need to use it?►Because there is no HIPAA Because there is no HIPAA

requirement that insurance requirement that insurance companies also accept DSM-IV-TR companies also accept DSM-IV-TR codes, codes, insurance companies are insurance companies are likely to only accept electronic likely to only accept electronic claims that use ICD-9-CM diagnosis claims that use ICD-9-CM diagnosis codescodes, and which will require , and which will require psychologists who are only familiar psychologists who are only familiar with DSM-IV-TR to convert their with DSM-IV-TR to convert their DSM-IVTR DSM-IVTR diagnosis codes into ICD-diagnosis codes into ICD-9-CM diagnosis codes.9-CM diagnosis codes.

Where do I find it?Where do I find it?►http://www.apapractice.org/apo/insider/prhttp://www.apapractice.org/apo/insider/pr

actice/pracmanage/practice_managementactice/pracmanage/practice_management/dsm-9/dsm-9..

►GenericArticle.Single.articleLink.GenericArGenericArticle.Single.articleLink.GenericArticle.Single.file.tmp/ticle.Single.file.tmp/Download_the_Covered_Diagnoses_&_CroDownload_the_Covered_Diagnoses_&_Crosswalk%20of_DSM-IV_Codes_to_ICD-9-sswalk%20of_DSM-IV_Codes_to_ICD-9-CM_Codes_chart.pdfCM_Codes_chart.pdf

►Or Google: Or Google: Covered Diagnoses & Covered Diagnoses & Crosswalk of DSMIV Codes to ICD-9-Crosswalk of DSMIV Codes to ICD-9-CM CodesCM Codes

Mentor/supervisionMentor/supervision►If you decide to start a business If you decide to start a business

one of the one of the most important most important components is finding a components is finding a trustworthy reliable trustworthy reliable mentor/supervisor who is mentor/supervisor who is successfulsuccessful. .

►Can supply needed Can supply needed expertiseexpertise in in business and psychotherapy. business and psychotherapy.

►Can provide needed Can provide needed supervision.supervision.

Mentor/supervision (Cont.)Mentor/supervision (Cont.)

►Can provide access to assessing the Can provide access to assessing the current professional standard of carecurrent professional standard of care..

►It is also helpful to: networking with It is also helpful to: networking with other entrepreneurs/therapists, join in-other entrepreneurs/therapists, join in-person and virtual person and virtual entrepreneur/therapist support groups, entrepreneur/therapist support groups, take classes and workshops.take classes and workshops.

Ways to startWays to start

►In the beginning opt for In the beginning opt for full-time full-time work in an agency or work in an agency or institution, institution, but take on a but take on a few few clients privatelyclients privately. .

►This augments income and helps This augments income and helps determine if there is a market for determine if there is a market for your skills.your skills.

►This provides guaranteed income This provides guaranteed income and benefits.and benefits.

Ways to start (Cont.)Ways to start (Cont.)

►Spend time Spend time learning the policies learning the policies and procedures of the entity, and procedures of the entity, including billing.including billing.

► Note: you must be careful to Note: you must be careful to avoid any conflict of interestavoid any conflict of interest, , perhaps best achieved through perhaps best achieved through completely different referral completely different referral sources from those of the agency. sources from those of the agency. It is also important not to use It is also important not to use agency time to build your practice.agency time to build your practice.

Ways to start (Cont.)Ways to start (Cont.)►Another alternative is to Another alternative is to join a join a

functioning professional practice functioning professional practice as an associateas an associate to gain awareness to gain awareness and experience prior to establishing and experience prior to establishing an independent practice. an independent practice.

►This also provides a safety net of This also provides a safety net of sorts. sorts.

►Exercise the same care regarding Exercise the same care regarding conflict of interest as you would if conflict of interest as you would if working working in an agency or in an agency or institution.institution.

Ways to start (Cont.)Ways to start (Cont.)► Opt for Opt for a clearly delineated a clearly delineated

part-time rolepart-time role——working half-working half-time at an agency and half-time in time at an agency and half-time in your own practice. your own practice.

►This is advantageous, as you have This is advantageous, as you have some some guaranteed incomeguaranteed income, but can , but can have more energy available to have more energy available to devote to building your referral devote to building your referral network. Again, take care to network. Again, take care to avoid avoid any conflict of interest.any conflict of interest.

Ways to start (Cont.)Ways to start (Cont.)►Opt for Opt for full-time practicefull-time practice, , while while

understanding the financial risks understanding the financial risks involved. involved.

►Perhaps the Perhaps the best way to ensure best way to ensure viability is to ensure that you have viability is to ensure that you have some guaranteed fundingsome guaranteed funding, such as , such as obtaining a contract for a block of obtaining a contract for a block of service provision, or a part-time service provision, or a part-time teaching position. teaching position.

Ways to start (Cont.)Ways to start (Cont.)►Guaranteed funding ensures that bills Guaranteed funding ensures that bills

will be paid during the time that you will be paid during the time that you are building your referral network and are building your referral network and a steady client base.a steady client base.

► Be creative in developing an option Be creative in developing an option that best suits your skills, strengths, that best suits your skills, strengths, energy, need for security and present energy, need for security and present circumstances. circumstances.

►Have a clear idea of anticipated costs Have a clear idea of anticipated costs and potential income.and potential income.

My AdviceMy Advice

►Don’t quit your day Don’t quit your day job!!!job!!!►A new business can A new business can take up to 5 years to take up to 5 years to turn a good profit!turn a good profit!

My AdviceMy Advice

► Expect to spend a great deal of Expect to spend a great deal of time developing and running a time developing and running a private practice—both in serving private practice—both in serving clients and in marketing and clients and in marketing and running the business.running the business.

►Careful planning and preparation is Careful planning and preparation is crucial and takes time.crucial and takes time.

►Have financial resources available Have financial resources available to your business.to your business.

My AdviceMy Advice►Be prepared to work hard at Be prepared to work hard at

getting started, getting known getting started, getting known and encouraging referrals.and encouraging referrals.

►As your practice enlarges, As your practice enlarges, decrease your other decrease your other commitments.commitments.

►GO FOR IT! YOU CAN GO FOR IT! YOU CAN SUCCEED!!!!!SUCCEED!!!!!

►Q/AQ/A

Documents

So you want to start a private practice: some thoughts