When I meet with clinicians and we speak about aspects of the therapeutic journey the conversation of their bio often comes up. Clinicians often reference that they provide a safe and supportive environment. When I ask for the clinician to describe what they do to ensure the client feels safe clinicians will tell me that a part of safety is ensuring that the client feels connected, understood, heard. Another aspect of "safe" comes from explaining the boundaries and rules around confidentiality, consent and processes, like the cancellation policy.
If you agree with this last statement, then I'd like to encourage you to take a step further toward thinking outside of the box and lean into the understanding of some other aspects of the processes and policies that can be discussed with clients. The aim is to help mesh the aspect of business with the language of the clinical world.
When you review reasons why clients who say they are going to attend, don't, you'll find some surprising information hidden in your cancellation and reschedule notes.
Write a list of your client appointments for the past three months. Understand the reason for the non-attendance. Did the client provide the failed to attend notice within the period of your cancellation policy? What themes or patterns do you see?
Appointment: Attended/ Rescheduled/ Cancelled/ No Show
Reason for Rescheduled/ Cancelled/ No Show
By understanding this information you may find ways to adjust your practice and/or conversations with clients to assist with solutions to their cancellations or work with clients to increase their engagement.
You can take the exercise above to the next step (if you'd like) and understand if the cancelled or rescheduled appointment happened within your cancellation policy.
Understand if from there, you've charged your fee. If you haven't then ask yourself "Why do I have this policy?"
Look back at your clients from the last two years and understand how many of them dropped out of therapy due to you charging this fee to them.
By tracking and understanding the data that we have at our fingertips, we are able to adjust our practice accordingly. Adjust it to what works for you. If you're not comfortable charging a cancellation fee, don't. If the fee is rupturing the therapeutic alliance, adjust what you're doing.
By fully understanding the impact of this business process (yes, it is a business process although we are actively working toward changing that mindset) we can provide better clinical outcomes to clients. We shouldn't build a practice (aka business) based on the notion that, "Someone, somewhere at one time did this, so must I."
Average Session Fee
Is your practice sustainable? Are you working long hours? Do you have more clients on your caseload than you can remember their names?
When you understand your average session fee, you can adjust your books according to what allows you to put food on your table. If you're bulk billing and paying any overheads, how long can you survive like that?
When you break down the details (business details) of what your average session fee is, you can adjust your caseload to open and close your lower fees.
Yes, you want to provide a service to those who can't afford it. Yes, you should always (when possible) keep your books open to bulk bill clients. However, we have to be reasonable. You have to earn a living too.
I know you don't want to think about the business side of private practice, but the reality is that they are one and the same. Regardless of your arrangement with the principal (or what you tell yourself), they are interchangeable. Instead of sweeping the business side under the rug, embrace ways to weave the analytics into your practice. How can the analytics translate to better clinical outcomes? How can you grasp the numbers side of what you do? The dark side. Bring it to light.