When Should I Start Outsourcing in Private Practice?

By L. Gordon Brewer, Jr., MEd, LMFT on June 5, 2019

Most of us want a full caseload. We want a steady stream of referrals and to be able to have as many sessions as we can handle at the times we want to have them. That’s the dream!

But there's this thing that happens: We get busy seeing clients and working our schedules. Our caseload goes up and so do the phone calls, the paperwork, and all the other administrative functions. It’s a great problem to have…

…and it can be totally overwhelming!

That's the point at which we realize something must change. We need to either cut back on the caseload or get some help with all the extra work—in other words, outsource. This is also the point at which automating your processes as much as possible becomes very important.

The Time/Money Dilemma

Most all of us like to save money, and it would be fair to say that most of us also like to save time. Time and money; we always lump those two things together, and no one ever seems to have enough of either.

In the counseling and therapy professions, our livelihood depends on trading our time and expertise for money. It’s simple economics in that people pay us a fee for spending time in conversation with them and offering some sort of expertise and direction. So, when you think about it, your time is very much a commodity. Your time is something you have that is of great value. Your time is what brings you your income.

When deciding when to outsource, it's crucial to understand the value of your time. Think about it in terms of what you get paid for a session. Simply put, if you charge $100 per session, 45-50 minutes of your time is worth $100. It’s simple math. The more time you spend during a week seeing clients, the more money you will make, right? But what about those hours you spend marketing or doing administrative tasks or documenting sessions? What is that time worth?

How you spend your time is important. Being in sessions with clients is, of course, at the core of what we think of when it comes to being in the counseling/therapy business. However, there is also the clinical work that is done outside of sessions and all of the other ancillary things we must do, like billing and dealing with third party payers (insurance). This is where having an EHR system like TherapyNotes becomes crucial. EHRs help you streamline the necessary work you do outside of a session, allowing you to make more efficient use of your time.

The phase of private practice you are in has a lot to do with how you spend your time. In the early stages of starting a private practice, you are going to be spending your time building a client base and referral sources. It is also the phase of practice where “bootstrapping” is needed and sometimes necessary. 

In these beginning phases, bootstrapping makes sense because you have a lot of time to spend but not a lot of money to spend. Spending your time will give you the best return on investment (ROI).

As you grow and spend more time with clients, though, you have less time to spend on all the other things needed for a practice to run. This is the point at which it is a good idea to start outsourcing.

The Case for Outsourcing

If you think about it, you will see most clients more than once. If you see a client for 8 sessions at $100 per session, they are going to bring in $800. If you have 10 clients, their total value is $8,000.

When you think about it this way, your efforts to bring in more clients make your time spent on those things worth something. If you invest 1 hour of time to get one client, essentially that 1 hour of time is worth $800.

Thinking about the value of a client, it makes sense that most of your time should be spent in sessions because that is what you get paid for. Your money, then, should be invested in things that will bring you more clients—in other words, outsource the things that will bring you clients.

Outsourcing frees up your time and can actually be a better ROI than trying to save money by doing it yourself. Some examples of things to outsource:

  • Hiring a virtual assistant to answer and return phone calls
  • Using medical billing services to follow up on claims and other billing
  • Bookkeeping and accounting services
  • Website design, updates, and branding
  • IT help with computer security and such
  • Social media curation and management

So, for example, if you were to hire a virtual assistant for $10-15 an hour to return phone calls and set appointments for you, it would free up your time to see clients. Spending $50 on a task that will bring you a client worth $800 is a great investment. Outsourcing that one thing would help to increase your income.

When to Stop “Bootstrapping” and Switch to Outsourcing

When it comes down to it, one rule of thumb is to invest in “bootstrapping” when your client load is smaller and you have more time. Invest in outsourcing when your client load is higher and you have more money. However you invest, do so with ROI in mind. In other words, will putting your time or money into something give you a return on that investment?

Know for yourself where you are going to get the “biggest bang for your buck,” both in terms of time spent and money invested. Bootstrapping and outsourcing are both ways to optimize your use of time and money. By knowing the value of your time, you will know when to use which strategy.

* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.


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