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August 24, 2009: Thriving Private Practice
Posted by: Dr Zur9 Comments

How to Build and Market a Thriving Fee-For-Service Private Practice Outside Managed Care

Opening statement by Ofer Zur, Ph.D

For over 20 years I have argued that psychotherapists, when acting strategically and deliberately, can build a thriving fee-for-service private practice outside managed care.

While most therapists in private practice recognize that they need to market their practices, most of them avoid it like the plague.

The most general principle of marketing is that people will pay and do pay for what they value, whether it is health, looks, sex, computers, etc. As a result, they readily pay for cosmetic dentistry, diet programs, clothes, Prozac or Viagra. This means that if people value what we, psychotherapists, have to offer, they will pay for our services. Today’s clients do see themselves as “consumers” and do not want to be viewed as mentally ill or broken.

The Competent Therapist:

  • Is an emotionally healthy and balanced person with a wide range of interests and connection to community and to life of the spirit.
  • “Cleans up” relationships to money, business, and entrepreneurship.
  • “Shows up” and be can be real, self-disclosing, and emotionally present with clients.
  • Is expert in diverse orientations, methods, and techniques.
  • Is flexible with touch, gifts, home-visits, leaving the office, bartering, etc.
  • Uses humor and is neither cold or rigid, nor dogmatic.
  • Manages time, money, billing, etc. very well.
  • Exploits managed-care systems by explaining to clients about the potential risks posed by managed care to their privacy and to health and life insurance.
  • Doesn't pathologize normal and existential concerns, such as grief, life transitions, or spiritual or existential voids.
  • Conducts short-term, intermittent-long-term therapy with individuals and their families throughout their life spans.
  • Becomes an effective consultant for life issues and an expert on developmental, familial, communal, and other existential and spiritual issues.

Marketing 101

  • Present yourself as an expert by
    • Writing articles in local newspapers and giving free lectures and presentations.
    • Mediating conflicts in schools and/or churches or facilitating dialogues and/or forums.
    • Being a visible expert in your community.
  • Be a “helpful expert” not a “beggar of referrals”
    • You can help teachers, ministers, physicians, and education boards.
    • You can be an expert helper to schools, hospitals, and community centers.
  • Develop a Web Site
    • Provide free, helpful, and useful information and resources.
    • Give the readers a sense of who you are as a person beyond your formal CV.
    • Add components, such as blogs, podcasts, videos, chat rooms, etc.
    • If you are low-tech, hire a competent and responsive web site developer.
    • Update your site regularly.
  • Develop your Niche/s
    • Develop a niche/s by becoming an expert on the topic/s.
    • Penetrate your market by writing articles, giving free lectures, helpful podcasts, videos, blogs, etc.
    • Send helpful and professional e-newsletters (not self-promoting.)
    • Learn how to use Internet social networking for marketing.

Private Practice Resources:

Please, share with us your marketing and other private practice development ideas by posting your comment below, (please, no complaining about the economy or “mangled-care”) and please send no more than 250 words, and your comment will be moderated for language and commercialism. Add a Comment Now.

If you have suggestions for more blogs, please email us at info@zurinstitute.com.

James wrote:

Thank you for this good info. Interesting insight you give. http://www.hotfileseek.com
09/05/10 15:34:50

Laurel Milan, Ph.D. wrote:

Great advice. There are people who value therapy and will pay for services. I have been fortunate to have a thriving practice. I did start to do well mainly because I was a provider for manager care companies. This helped me in the beginning. The important thing is to continue to plug along and to continue at it. Anyone can get there if it is what you truly want.
08/05/10 10:01:30

Monica Englander, msw, lcsw wrote:

As a newly licensed clinician starting out in private practice, I am deeply appreciative of the wisdom and knowledge offered on this site. These words on how to start and manage your private practice are a gift to me, and I wanted to say thank you, publicly, to Dr. Zur. Also wanted to say thanks to the other clinicians who have contributed their "take" on things here.
My best to you all,
M. Englander, LCSW
06/02/10 11:25:08

Marie Caterini Choppin, MSW, LCSW-C wrote:

Thanks so much, Dr. Zur, for the insight and thoughts about how to be a competent therapists and have a full fee-for-service practice. I am in the process of doing many of the things suggested, including adding a blog to my website (http://www.counselingforcon...). I'm reminded of the importance of giving to the community and to be a resource, which is always appreciated and a way to get name recognition for your niche.
10/13/09 12:23:58

Jody Jessup, RD, MS, LPC, NCC wrote:

I returned to this site and the fee for services information to give me another boost of confidence in staying away from managed care. As a Registered Dietitian and LPC, I have a small private practice specializing in eating disorders, body image and the non-diet approach to weight loss. When my confidence wobbles, I re-read Dr. Zurs sturdy advice and recommit to a managed care free practice. I find the paper work and the phone time of insurance so incredibly soul depleting and energy consuming I simply needed to find another way to be in this profession. I branched out into food coaching (phone) rather than wrestling with managed care for added clients.
Jody Jessup, RD, MS, LPC, NCC
http://bemyfoodcoach.com
09/28/09 16:52:35

Davina Kotulski, Ph.D. wrote:

Offer Zur's article How to Build and Market a Thriving Fee-For-Service Private Practice Outside Managed Care is right on the money. During this economic downturn clinicians can benefit from thinking outside of the box. Getting out into the community as Dr. Zur mentions, writing articles, and finding new ways to help others. Also, thinking of marketing as an opportunity to serve more people, rather than sell to more people, as I learned from a marketing class for holistic providers. Psychologists seem to be more uncomfortable with marketing directly to clients, hoping instead that if they just had someone their business card, the referrals will eventually trickle in. It's important that we take direct steps to share how we can help others.

With regard to insurance, while I do take some insurance clients. I too have had to call numerous times, accept less money, have more trouble with no shows and collecting money with no shows. When people are directly paying for services they value them more. It would be great if insurance companies would reimburse for missed sessions or approve phone therapy sessions which are more conveniently rescheduled than in person sessions when clients have to miss a session due to an urgent situation.

The good news about the economnic downturn is it gives our profession a chance to rethink our approach and hopefully improve our ability to help others and have thriving practices.
09/24/09 14:25:04

Dr Mary Giuffra wrote:

About 12 years ago I realized that I was spending too much precious time on the phone with representatives from insurance companies. Then the companies began to cut reimbursement rates. That was the final straw. I withdrew from all seven insurance panels, a great decision. It did wonders for my quality of life.

If clients request it, I provide a bill including a DSM IV diagnosis, tax ID number etc but the clients deal with the insurance companies. Many of them get reimbursed for an "out of network provider".

Most of my personal medical practitioners accept managed care for several years following their residency. As they become better known in the community, they stop accepting it. In most professions, we pay more for seasoned practitioners. Managed care is a great way to develop a practice but after years of experience and continuing education it wears thin. Even in countries with socialized medicine such as France and the British Isles, they have specialists and clinics that are "fee for service."
Mary Giuffra, PhD, APRN,LMFT
http://www.drmarygiuffra.com
08/27/09 23:08:48

Samuel Lopez De Victoria, Ph.D. wrote:

I have a private practice where it is 100% non-insurance. All my experiences so far with insurance has been pretty close to hellish. It takes time but it is possible to develop a fee-for-service practice.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
08/27/09 20:18:10

John A. Riolo, PhD wrote:

Just about every clinician dreams about a managed care free practice. Private practice gurus make a fortune in books, CDs lectures etc. encouraging everyone to ditch managed care and charge your patients twice as much or more than a managed care company will pay.

However let’s suppose a substantial number of us did just that. Several questions most be addressed.

First, are there enough patients willing to pay us out of pocket when most now have insurance that covers some mental health services?

Second, why would a patient be willing pay us two times as much or more out of pocket than a managed care company is willing to pay especially since paying out of pocket cuts down on our waiting time and paperwork?

Third, we often speak of usual and customary fees but what does usual and customary actually mean?

Some years ago I wrote a little piece on one of my websites having to do with the meaning of the fee in therapy. It might have bearing on this discussion. See http://www.youradvocateonli...
08/25/09 05:18:24

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