Building a private practice through caseload management
Building a private practice involves several steps. You need to create the foundation for your practice. You need to select your niche. You have created an online marketing presence with social media and a website. You have selected and implemented your electronic health record system. The referrals are coming in and your schedule is filling with client appointments. You are also starting to feel overwhelmed and not sure how to manage this caseload and balance your time. Where to begin?
What is an ideal caseload?
Many therapists, whether new to building a private practice or private practice veterans, struggle with this question. How many clients should I see each week? There is no universal answer to this question. Some therapists run a full-time practice with fifteen sessions per week and some therapists would consider fifteen sessions closer to a part-time practice.
A better question to ask is what kind of a schedule would I like to create? Building a private practice schedule is a very personal and individualized answer based on many factors in your life. One of the nice benefits of building a private practice is taking charge of your schedule based on what works best for your life.
The answer begins with thinking about your ideal schedule.
Some questions to ask yourself:
- Am I running a full-time or part-time private practice?
- How many days a week do I want to work seeing clients?
- What kind of hours do I want to work seeing clients?
- Do I want to see clients in the evenings? On the weekends?
- Do I want to see clients every day?
- Do I have other work or business activities? Teaching? Agency? Coursework?
- What other activities do I want to incorporate into my life?
- What other needs do I have that I need to address in building a private practice schedule? Health issues? Children? Volunteer commitments?
- Are there any regular meetings or classes that I need to fit into my schedule?
There are no right or wrong answers to these questions. They are personal answers based on your needs, wants, and preferences. The answers are very important because you do not want to continue seeing clients when it’s not reasonable to see them. It is important to consider how you want to approach building a private schedule and set those boundaries when scheduling. If you are building a private practice schedule to see clients when you do not want to work, feel too tired to work, or cancel other obligations, then you may begin to feel resentful or distracted, and not provide the best therapy for your clients. Ultimately, you help your clients the most by adhering to the schedule that you want and need.
You can tailor the hours while building your private practice to your needs and wants. As you answer the questions, start building a private practice schedule accordingly. From the beginning of establishing your schedule, it is important to adhere to the boundaries that you establish with client appointment slots.
As you gain a more solid and clear understanding of how you want to begin building your private practice schedule, then you can work to determine how many client slots to create. While building a private practice, you likely established a salary that you want to earn. You can use this salary range and your average reimbursement rate to figure out how many sessions you need each week to meet this salary.
If the number of sessions is too high, then consider adding in alternate forms of income such as supervision, teachings, or workshops. You may also need to consider your reimbursement rate. If you have a private pay practice, then you might need to raise the rate. If you accept insurance, then you can work to negotiate your contracted rate with insurance companies or stop accepting some of the lower-paying plans.
Other factors to consider when building a private practice
When building a private practice, there are other factors to consider besides therapy and time for documentation.
Because you run a business, you have tasks to accomplish related to business operations. You need to consider the amount of time you want to spend on these tasks when building your private practice. Otherwise, they might not get completed or you will end up working on them when you do not want to be working. Determine if there are any functions you can outsource or hire an assistant to help complete.
Those types of tasks include:
- Cleaning and organizing the office
- Returning phone calls
- Supervision on consultation
- Session preparation
- Marketing work
There are also business-related tasks that EMR software like TheraPlatform can help automate some of these tasks such as:
Also, keep in mind how you will advance and excel as a therapist. Do you need to make time for clinical learning, reading workshops or continuing education?
One of the benefits of building a private practice is designing a work schedule that fits your lifestyle wants and needs. You do not have to work traditional office hours. If you are a morning person, you can start your day early. Many people would like to have an early morning therapy session before work or school commitments. If you like to sleep in, you can start your day later and work into the evening hours seeing clients. Again, building the private practice schedule that works best for you is what helps your clients the most. If you feel too tired at 7 p.m. to effectively provide therapy, then do not create evening hours.
Other personal considerations might include:
- Family time (children, significant others, extended family)
- Health issues that may impact your availability
- Healthcare appointments
Don’t forget to eat!
Too often therapists book themselves through lunch and eat a very fast and unhealthy meal in between sessions. Make sure to build in a lunch break as well as time to rest your mind from the clinical work. You will provide much more effective therapy with a full stomach and fresh mind.
Holidays and vacation time are important too. You do not have an employer to schedule paid holidays, office closings, or vacation time. When building a private practice, you have the freedom to plan ahead and block off your calendar for these times or to add the time off work as it develops. But remember, you deserve and need time off work.
Finding balance with your schedule and caseload
So now you have this list of all the things to consider when building a private practice and scheduling and planning for your caseload. How many clients to see. Time for business tasks. Breaks. Lunch. A personal life. Sound overwhelming? The secret is to find the balance that works for you. Again, there are no right or wrong ways to continue building your private practice schedule but finding balance is important.
Once you have figured out how many client sessions you need, and can handle to earn the salary you desire, block off regular appointment slots each week in your calendar. If the magic number is 20 sessions, then create 20 weekly appointments for the times of day that work best for you. Build in breaks, lunch, and time for business tasks. Some therapists might spread those 20 sessions throughout the week, and some may prefer to see clients on fewer days but have more appointments on those days.
To find the balance, you need to set the boundaries and limits for your availability and adhere to them.
Most likely a client will call and ask for you to squeeze them in for an appointment. Or, a client will cancel and want to reschedule for a different time that week. If you have an available slot in your planned schedule, then go right ahead.
However, if you do not have availability for their requested time, then do not squeeze them into your appointment calendar. Remember, you are building a private practice intentionally with a planned purpose. Your favorite grocery store does not open up when it is closed so that you can shop … even in an emergency. If you’d like to streamline the scheduling process, EMRs like TheraPlatform provide embeddable scheduling widgets that empower clients to self-serve when scheduling appointments based on availability you enter.
The important thing is to block out time for sessions only. If you begin seeing clients outside of your appointed slots, your schedule can quickly get out of your control and the balance is lost. Setting limits and telling a client that you do not have availability at their requested time will help you to keep balance in your practice. The doctor, dentist, hairdresser, and dog groomer all do it. If the client truly wants to make an appointment with you for counseling, they will adapt to your schedule just as they do with other service providers.
As a therapist, it is common to feel that you need to meet the requests of the client to help them. Be cautious about developing a habit of overscheduling or showing your clients that you will accommodate your schedule to their needs. When you break your schedule boundaries, you not only model this behavior for your clients, but you are not treating yourself fairly. You lose the balance if you work through your lunch, wake up too early for an appointment, see clients too late, or schedule through that planned business task hour. Keeping your other commitments, business and personal, are essential to finding balance in your life.
Watch the below video on common pain points in private practice and TheraPlatform’s solutions.
Impact of a specialty on scheduling
As you build a private practice, your specialty area or the niche you address can impact your scheduling needs and the number of sessions you have per day. For example, if you have a more distressing or disturbing session, you should allow yourself more time for a break before the next session or task for some self-care. Treating issues like suicidal thoughts, severe trauma, first responder trauma, or child abuse can take an emotional toll on a therapist during the session. If you have a practice full of these types of issues, then it can help to routinely schedule more time in between sessions to attend to your emotional well-being.
Other specialty issues can impact your scheduling needs:
- Certain treatment modalities that require more than the typical 45- to 60-minute session
- Home, school, or community-based services that require travel in between sessions
- Art, play, or other modalities that may require clean-up time in between sessions
Managing your time
Learning to manage your time will help you to run a more successful practice and lead to less stress and disruptions in your life. Managing your time begins with finding the best system for you. There are many digital time management tools as well as traditional paper planners.
Automated practice management tools can also help to manage your time. Electronic health records (EHRs) offer automated tools to assist with time management such as calendars, automated appointment reminders, and electronic intakes. These EHR components can not only save you time but help you to remain more organized in your practice.
As you see clients, there are other cautions to keep in mind that can interfere with your time management such as adhering to the time allotted for the session. If the appointment was scheduled for 50 minutes, then keep to the 50-minute slot. Running over session time puts you behind schedule for the next appointment. You can also lose your break time in between sessions or not have time for documentation. Very easily, you can find yourself working later hours than planned or running at a more hectic pace than you desire. Consider placing a clock where you and your client can see it and practice winding down sessions before the time runs out on the session.
Encouraging your clients to use the EHR to process any client copays or charges for the session, can also save time before or after the session. Most EHRs should safely store the client’s credit card information and allow you to quickly charge their card or allow the client to pay prior to the appointment.
You have many options when building a private practice schedule. Some therapists may prefer to see clients every day with fewer sessions a day. While other therapists may prefer to have an entire day or two during the week with no sessions and time allotted for other things.
This example is based on a therapist caseload of 20 clients with a therapist who sees clients 5 days per week.
Monday: Business hours of 9 a.m. to 5 p.m.
9 a.m. to noon
Weekly prep, social media, bill payments and bookkeeping
Noon to 12:30 p.m.
Return phone calls/emails
12:30 p.m. to 1:15 p.m.
1:15 p.m. to 1:30 p.m.
1:30 p.m. to 2:15 p.m.
2:15 p.m. to 2:30 p.m.
2:30 p.m. to 3:15 p.m.
3:15 p.m. to 3:30 p.m.
3:30 p.m. to 4:15 p.m.
4:15 p.m to 4:30 p.m.
Tuesday and Thursday: Business hours of 11 a.m. to 7:30 p.m.
11 a.m. to 1 p.m.
Daily prep, emails, phone calls
1 p.m. to 1:45 p.m.
1:45 p.m. to 2 p.m.
2 p.m. to 2:45 p.m.
2:45 to 3 p.m.
3 p.m. to 4 p.m.
Break to include lunch and admin tasks
4 p.m. to 4:45 p.m.
4:45 p.m. to 5 p.m.
5:15 p.m. to 6 p.m.
6 p.m. to 6:15 p.m.
6:15 p.m. to 7 p.m.
Wednesday and Friday: Business hours of 9 a.m. to 1 p.m.
9 a.m. to 10 a.m.
Private practice management and session prep
10 a.m. to 10:45 a.m.
10:45 a.m. to 11 a.m.
11 a.m. to 11:45 a.m.
11:45 a.m. to noon
Noon to 12:45 p.m.
12:45 p.m. to 1 p.m.
Errands, doctors’ appointments, networking, researching therapy trends
Building a private practice along with your schedule and caseload may take some time and require adjustments from time to time. Your income requirements may change. You may feel burned out and want to decrease your caseload. Or you may decide to finally write that book and need to dedicate time to write. Always keep in mind that you can adjust and make changes to your schedule and communicate these changes to your clients.
Therapists can save time on building a private practices and managing operations by using EMRs like TheraPlatform. Schedule, take notes and file claims and offer teletherapy with their platform. They offer a 30-day free trial. No credit card required and you can cancel at any time.