Hey everybody. This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast episode 5.
Hello. Welcome again to The Testing Psychologist podcast episode number 5. I’m Dr. Jeremy Sharp. Good to be with you today, as always. I hope everyone is doing well. Moving on toward Christmas time. I imagine this episode will be coming out a little after Christmas, but right now we’re headed to Christmas time and that is exciting.
Kids make Christmas a whole different thing, I have found. It’s a lot more exciting. It’s so cool to see them love their Christmases and just get excited about it; listen to Christmas music and be bouncing around the house with a little more energy than usual. Usually, that’s nice. Sometimes not.
Today, we are talking all about time management and scheduling with running a testing practice. So as we’ve gone along here these first few episodes, we started with an overview of things to consider with testing and then dug deep into different aspects of a testing practice over the last few episodes. We first talked about all the financial aspects: billing, how to finance a testing practice, how to market and get testing clients, and now, we’re going to be talking all about time management.
Time management in a testing practice is huge. Here’s how I came to this. I think as I mentioned before, when I started and really began expanding the testing side of my practice, it happened really all at once. I got a whole lot of referrals all at the same time. That was a big jump from previous referrals that I’ve gotten. And so, I had to really figure out how do I manage all this time, because I recognized there was an opportunity to build this testing practice and I had a full therapy practice at the time and had just been really doing testing on the side. So I had a little bit of a panic moment or really panic probably a month or two, where I was like, how do I handle all of this?
I’ve had many weekends, unfortunately, over the years of being in the office, catching up on reports. Oh, I have to work and, oh, I’m behind, that sort of thing. So time management is a really big deal. It took me, gosh, I would say at least a year to completely transition from full-time therapy practice with testing on the side through a hybrid period where I was pairing back my therapy clients and ramping up the testing. And then finally got to the point where at this point I don’t do any testing. My goodness. I keep messing up those words. At this point, I don’t do any therapy and primarily do testing.
So, let’s talk about time management. A big thing here, maybe a no-brainer, but maybe something you haven’t recognized unless you’re doing it day-to-day and week-to-week is it testing takes a lot of time. Depending on the practice model, which we can talk about a little bit, I’m going to assume that most of you are doing the entire evaluation from start to finish, meaning your interview, whatever testing you’re doing, whatever writing you’re doing, and then feedback if you do those.
For me personally, I have a tendency to be really optimistic about getting things done and about how long things will take. So I’m just going to run through and break down different types of evaluations and make it very clear how much time each of these might involve.
Let’s start with very brief evaluations, which I would say are maybe personality evals, substance use evals, some forensic evals where you’re really maybe just doing a personality test or two or a behavior checklist and that’s about it. So even for a brief eval like this, you’re going to probably put in at least three hours: an hour for an interview, an hour for the client taking the test, and if you want to get paid for that at the psychologist testing rate through insurance, you have to be sitting there with them, so that’s an hour of your time as well, and then an hour to write and deliver the report. So there are your three hours already.
Now, if we’re talking about our brief, let’s say cognitive eval, and I think the best example of this is a colleague of mine at The Children’s Hospital in Denver, Amy Connery, has developed and used for many months or years what she calls the one-hour concussion protocol.
So this is a complex eval, very thorough, but also as brief as possible, I think. So that is still going to run you about four hours: an hour for an interview, one hour on a good day with an uncomplicated case for testing- that can range to two hours though, an hour to score and write the report, and then an hour for feedback. So, even a very brief cognitive eval is going to be about four hours.
So from there, maybe we get up to a full evaluation. With a full evaluation, now I’m talking like full neuropsychological battery, maybe full psychoeducation battery. In this case, we’re talking probably seven hours. So again, on the conservative side, so one hour for the initial interview, let’s say four hours for your testing battery, which includes scoring if you’re really good, again, pretty conservative. If you’re really good, I’ll give you an hour for report writing and then an hour for feedback. That’s seven hours for a decently full evaluation.
Now, that brings me to our agency’s model, which is somewhere in the middle. With that, our evaluations are probably 10 to 12 hours. We, I like to think go a little bit beyond minimum requirements so that we can be a little more thorough, but that means more time. So I do a two-hour interview for everyone really because, to be honest, I don’t know how people do an hour interview. I mean, by the time I go over confidentiality, payment policy, that sort of thing, that takes about 10 to 15 minutes. Build a little rapport with the family. Talk about how the interview is going to go and talk about the steps after the interview. That takes another 5 or 10 minutes. So, that’s a half-hour almost of time that’s eaten up just with policies and introductions and get to know you kind of stuff. And so, a half-hour for the remainder of the interview just does not fit for me.
So I moved to a two-hour interview. I do an hour of school observation in many cases where it’s appropriate. We do about 4 to 5 hours of testing- the actual battery. For me, if it’s a good day, it’ll take about two hours to write the report and then, I’ll typically do an hour to an hour and a half for feedback. So, our evaluations here at the clinic end up around 10 to 12 hours.
Now, then you get into what I call mega evaluations, which might be well, certainly the evaluations that I did in grad school. I know different people have different training, but my goodness, we learned this huge breadth of testing and had to write a corresponding report. So, we would spend just hours and hours on these reports, but outside of grad school, in the real world, that would be maybe like a CFI (child, family investigator), or a PRE (parental rights evaluation), maybe forensic evals. And with that point, the sky is the limit. I’ve seen PREs go up to 40 hours. I’m sure some of you have seen more than that. So, it depends on your practice model and what kind of evaluation you’re doing, but you can really get into substantial amount of time to do evaluations.
I am a big fan in general of crafting your practice to fit your life rather than the other way around, but unfortunately, I think I went about it the wrong way- integrating testing into an existing practice. For years, I was fighting to get my time management under control because I was spending so much time on testing and reports.
So, there are a lot of ways that you can streamline your testing and streamline your report writing, we’ll get into those, but I think the takeaway here is just as you’re thinking about either integrating testing in your practice or building a testing practice from the ground up, you got to think that how much time you’re going to dedicate to these things.
So again, I think I talked about last time, this dilemma of how a lot of psychologists can get into the trap of scheduling time for face-to-face appointments. So interviews, testing, feedback, but then don’t have time for writing, and then you fall behind on reports. It takes several weeks or months to get the report back to the client. That’s a situation that we would like to avoid. So, thinking about time management, I think is really, really important and then not to get ahead of yourself and maybe make the mistake that I have in the past, which is being very optimistic about how much time I would be able to spend on my testing and how much I’d be able to get done.
Let’s see. One way that you can streamline your testing process is with outsourcing. I employ a variety of outsourcing methods here in my practice that others do too. This is not original to me by any means. But one thing is that you can adopt a tech model where a psychometrician administers a lot of the tests. That of course frees up your time to do other things.
Now, you still have to train those individuals upfront. I think it takes really good training and a pretty heavy investment in their training to make sure that you can trust someone else to do your testing for you because so much happens in the observations while you’re doing testing. So there is that and that frees up quite a bit of time. And so, my psychometricians that work here administer a lot of the tests and they also do a lot of the test scoring and a lot of what I call the templated writing. So, they put the scores into the tables, which then go in the report.
Now, I also outsource the writing of histories. This is an idea that I got from one of the folks who really taught me a lot when I was building my practice, Arón Bautista at the Austin Center for Therapy and Assessment. Arón talked with me about how they have skilled writers, maybe undergrads with an English major or a psychology major who are good writers who write the clinical histories.
So I found that this has helped. It helps me a lot. It helps the other psychologists in our practice a whole lot because she just finds history writing torturous, and it’s so much nicer to have someone else do it. So, I learned to take really good notes while I’m doing my interview and it’s forced me to structure my interview pretty clearly because then I pass along those notes to someone else to do the history writing. We have an electronic record system where those folks can access the notes online because they’ve been scanned in and they write the history and then plug it into our report template.
Another thing that you can outsource if you have an administrative assistant or again, maybe an undergrad is proofreading. Having someone proofread your reports before they go out, I think is pretty crucial just to avoid any of those errors that might come from using a report template, which we’ll talk about in a bit, and also helps you know and just have some peace of mind that you’re sending out a report that is good. So, that’s another thing that you can outsource and free up a little bit of your time.
Now, another big place for streamlining your time is of course in report writing. You have to have time to write reports. It seems like with everyone I talk to, psychologists who have tried testing but abandoned it, those who stick with it, everybody talks about how report writing is the hardest part of running a testing practice because like I said, I think it’s exciting. I think it’s easy. It’s engaging for most of us to schedule those face-to-face appointments and really get into that and even do the testing.
The testing itself and scoring are pretty enjoyable for me, but then we do get into a little bit of trouble when it comes to report writing because a lot of the time it feels like homework, and homework was like grad school. I don’t think many of us want to go back to grad school. So, report writing is a tough thing for a lot of us.
So what I have done is a few things to create time, to write reports. Initially, I tried just doing it in between therapy clients. That didn’t work at all. What I found about myself and this might vary from person to person, but I really need pretty big blocks of time that I can sit down and really work on a report.
For me, it takes me about two hours to do a report from start to finish: editing, interpretations, recommendations, all that stuff. So I need a good block of at least two hours to sit down and get a report done. Otherwise, I find myself more distracted, checking email, and checking Facebook. It’s just hard. I can’t settle in and get it done. And there is research to support that too, that the more you try to, I’m not trying to multitask, it’s not like I’m trying to be distracted, but the more times you go back and forth between the task you’re working on and some external distractor, the worse your performance gets.
What I have done is many iterations of creating blocks of time. I initially started with taking off just one day a week to write reports and that worked pretty well, but I found that I was not getting as much time as I needed. I would occupy that time with administrative tasks or errands or something. One day did not end up being enough. Then I moved to a model where I took off every 4th week to just write reports. That worked better. It definitely gave me more of a feeling of freedom and a feeling of that.. well, I didn’t have anxiety about writing the reports and didn’t feel like I always had to be writing reports where I was falling behind.
But the place that I’ve gotten to now that has worked the best, and again, this is another example that was inspired by the staff at Austin Center for Therapy and Assessment and James Harrison, who’s the head neuropsychologist down there. He employed a schedule back when I talked with them a few years ago where he does basically two weeks on and two weeks off.
What I mean by that is two weeks on of only seeing clients face-to-face. So interviews, feedback, and testing sessions. And then he would do two weeks off where he would only write reports. So, I have adopted that and changed it to fit my lifestyle where now I do one week on and one week off.
And again, that week on is when I’m doing, it’s basically eight hours of interviews, feedback, and any testing that I’m doing. And then on my week off, that’s my time where I know I have a whole week, I can do some administrative stuff, but really I have full open days to just write reports. And that works really well for me. I find that I can get a lot done when I get in the zone with writing reports. And again, this is supported by research that the more you do something and the more familiar it is, the easier it comes.
So I can get in the zone and really just write reports all day long. I find that my typing and my writing flows better. I’m thinking about things more clearly, I’m conceptualizing better, and that has proven to be a really helpful schedule for me at this point.
Now, you have to think about just for yourself, how much time do you need to write reports? The time that I found varies from 30 minutes, which is basically superhero status in my book to finish the report, all the way up to gosh, maybe four hours or more on more complicated cases. So you can think about it for yourself how much time does it really take to write your reports?
Maybe you’re doing really brief evaluations that you can crank out in 15 to 30 minutes, or maybe you have a computer-generated report that does it for you. That’s going to make a big difference whether you need to dedicate a small amount of time or a large amount of time.
Now, report templates are a huge part of writing reports I think for most of us, especially if you’re doing longer reports. I use templates both for the report in general and for my recommendations. The thing with using templates that you have to be careful of is or things that I hear complaints about maybe from around the community are leaving in other clients’ names, not changing the pronouns, and not personalizing the recommendations for the person that you are working with. So those are just things to be aware of and be extra careful.
Some ways that I have combated that are basically to create a homemade report template that uses form fields in word. So fields like first name, last name, and then the pronoun field. That’s the first thing we do when my staff is putting a report together is to check the client’s name, of course, input the name and the gender, and then we changed the pronouns appropriately and just go through and do, edit, find, replace, and make sure that all the pronouns are appropriate and input are our pronouns set. That’s the first thing that we do. I do not reuse templates from one client to another with actual client information. We start from just a boilerplate template that has a first name, last name, and like I said, the pronouns.
With regard to the recommendations, the approach that I have taken is to basically create separate files for different sets of recommendations based on diagnosis or setting and basically, put any recommendation under the sun into that recommendation file. So then when I’m writing the report, I can go in and I can say, okay, I need recommendations for ADHD.
I write all my reports in word, and so, I will go to the word menu and click on insert, and then there is a file option, and then I insert that recommendation file. And then I personalize it from there. So, adding, or mainly subtracting any recommendations that don’t fit that particular person.
Now, there are some other tricks that can really help if you write your report in a word processing document, which I assume everybody’s doing. One of the big ones that has really helped me is using the auto-correct function in word for common phrases that I use. For example, I write a lot of diagnostic reports where I’m having to put in the DSM-V and ICD-10 codes. So I created little shortcuts for each of the diagnoses.
How you do that is, in the word menu, you can go to tools, then you click on auto-correct, and at least on a Mac, which is what I’m using, there are two windows where you can type it the phrase you want to replace and the phrase you want to replace it with. The replacement phase always starts with a semi-colon and then an abbreviation. For example, I diagnose a lot of reading disorders and dyslexia. So I do ;sldreading, and then I replace that with the DSM-V and ICD 10 code for specific learning disorders with impairment in reading. And so when I type that shortcut ;sldreading, it automatically expands and inputs that full term.
I’ve used that to do longer phrases and templated paragraphs that I’ll use a lot. So you can use that tool for really as much as is appropriate. And if you put some time into it on the front end, you can really save a lot of time later down the road when you’re writing common phrases over and over.
Now, there are a lot of options out there for full templates. We’ll have a lot of links in the show notes. It depends on the type of report you’re writing, of course, and what kind of template you might be looking for, but I would definitely encourage you to do a good search, again, check out our show notes and try to get a sense of what kind of templates are out there that could help you.
Beyond that, there is third-party report writing software. Now, these are aimed mostly at folks doing objective psychological testing with at least behavioral and personality measures. But some of these software programs also try to build out full reports from basically just inputting form fields and checking boxes. I have not personally used any of these, so that’s the disclaimer here, but I can list a few.
PsychWriter is one, DocuNimbus is one, and there’s one called PsychSCREEN. So if those are interesting to you, you can certainly check it out. I found a few colleagues who use those resources with some success. They don’t seem to be super widely adopted at this point, but they are out there and I am sure they’re only going to get better. So those are worth considering as well.
Now, there’s always the test maker or manufacturer scoring software as well. I’m thinking of personality measures. They will give you an interpretive report. Now, of course, you’re not allowed to just copy and paste because that’s infringing on trade secrets and that sort of thing, but it gives you a good idea of what kind of things to be thinking about and how to write your own interpretation.
The intelligence tests and academic tests, at least from Pearson, like the Wechsler scales and many others will do software-based reports that come from their software. A lot of folks use that as well. I find them to be pretty thorough, but I’m also not as personal. So I don’t tend to use those. I try to do my own interpretation based on the client that I’m working with, but that can save quite a bit of time as well.
Now, one thing that I have to mention and have mentioned a little bit, but we’ll go into a little bit more specifically here is the technology available, and this is something that is just more up and coming as we go along. There is significant technology available to help with testing and report writing. Q-interactive is a big one, PARiConnect is another. Most of the publishing companies have some version of online or digital testing and the research is pretty good when you compare to paper and pencil versus digital administration. So these are getting more and more popular.
Like I said, well go into the technology involved in testing and report writing in a future episode in way more detail, but for now, just know that those are out there. We do use Q-interactive here in our clinic for certain measures. I found it to be a little bit, let’s say buggy and clunky with some administrations, but we do use it. For example, with the CVLT. It works really well and is pretty straightforward. So like I said, we’ll talk more in detail about the technology as we go along.
These are just a few ideas and things to think about when you are trying to structure your practice to find the time to write reports, be efficient with writing reports, and make sure that you’re structuring your practice to work for you instead of you working for it.
This is just another example of a time when I think about a phrase that comes to my mind a lot, which is, it seems a lot more difficult to know what to do with all your clients than how to get more clients. Managing the clients and the business you have often ends up harder than actually getting clients in the first place. And I think testing is particularly relevant for that because you have to set boundaries around time and when you’re going to get this done or else you end up with delayed reports and that’s not good.
So thank you again for tuning in to The Testing Psychologist podcast. This is really, really fun and exciting. Like I said, last time, I love putting together these podcasts episodes and talking with you all about building a testing practice.
I haven’t said this in two episodes, but as we are getting started, it’s really important and huge favor if you could go to iTunes or wherever you might be listening and subscribe, rate, or maybe even review the podcast. That will really help me as we are launching and trying to move up those charts in iTunes. And of course, you can go to our website, thetestingpsychologist.com for articles, information, listen to past episodes, all that good stuff.
There is also the opportunity to sign up for my four-week blueprint, which will over the course of a month, send you a weekly email with really concrete action items each time that you can use to build and grow your assessment practice so that at the end of that month, you should be just about ready to go with new testing services. So check that out; thetestingpsychologist.com/fourweekblueprint. And if you want to connect with other psychologists or mental health professionals who are doing testing and assessment, you can always check us out on Facebook at The Testing Psychologist Community.
I look forward to talking with you next time. We’re going to be tackling everything technology and how that is related to testing. This is one of my favorite topics. I’m really looking forward to chatting with y’all. Until then.