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Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

Hey, y’all, welcome back to the beginner practice launch series, this informal series that is taking shape over time as the episodes are released. Today, I am talking about the biggest hurdles when you’re starting your testing practice. These hurdles are born from, well, not born from, these hurdles and questions come from the topics that come up most in the Facebook group, The Testing Psychologist Community, and my consulting with individual clients and my group clients. I hear the same things over and over, and I want to compile them here and try to address some of these hurdles.

Now, if you are a beginner practice owner or a hopeful beginner practice owner, you can check out The Testing Psychologist Beginner Practice Mastermind group which is enrolling for the next cohort. Stay here with me now in April and May 2022. You can go to thetestingpsychologist.com/beginner and get more information.

All right, let’s talk about these hurdles.

Okay. Here we are diving into some of the biggest questions that come up among my consulting clients and in the Facebook group when we’re talking about starting a practice. This episode is multi-layered. One layer, of course, is providing some normalization or validation if you find[00:02:00] asking these questions, but two, I would like to try to address some of these hurdles and give you some things to think about in solving these problems.

The first one that comes up is more just a general hurdle for making decisions, and that’s the analysis paralysis paradigm. More than anything, I run into folks who just have trouble making decisions about each of the aspects of launching their testing practices because there are so many options. As we know decision fatigue is a real thing. And when you’re launching your practice, there are any number of decisions that you have to make and fractals that you can go down. I think of fractal shapes when it comes to decision-making. Once you go down one rabbit hole, it just spins and spins and gets more complex. And then before you know it, you’re pretty deep in deciding on some very granular aspect of an EHR when you should be looking at the big picture. So analysis paralysis is a big hurdle.

There are two things that I think about when just making decisions. One is that good is certainly better than perfect. A lot of you have heard that phrase, don’t let perfection be the enemy of good enough, something like that. And I think there’s a lot of truth to that because most of the decisions that we make when we launch our practices can be changed later. It might take a little bit. It’s a little bit like steering the Titanic to make some changes in your practice, like with your schedule, for example, or fees perhaps, or paperwork, but for the most part, many of the decisions we make are reversible.

The second layer to that is [00:04:00] a phrase that I use often, which is this idea that mood follows action. So, if you’re feeling confused and overwhelmed in the decision-making process, sometimes it just helps to do. Just make the decision and go with it rather than analyzing it forever.

With that in mind as a theme for the rest of the items we’re going to talk about, let’s go a little deeper into some of these questions.

One of the main hurdles that I hear a lot is just simply the “business stuff”. People ask a lot of questions about, how do I establish a business?

What do I do with my finances? Do I need an accountant? Do I need a financial planner? Do I need an attorney? People get quite bogged down in the business aspects. And so, one of the things just to cut through is to register your business. An easy step is just to register your business as a single-member LLC or PLLC with your secretary of state. Choose a business name and be done with it. That will take care of a lot on the legal and tax side. And then from there, you can decide which professionals you need to help you.

I will say from personal experience that doing taxes was pretty easy early on. If things are relatively simple, you can do that. You don’t necessarily need an accountant, but I think it is helpful to have a bookkeeper, especially as your practice gets more complex. However, there are some layers to that too. Bookkeeping can be very easy if you are an accountable individual who will do your bookkeeping every month, and if you have a relatively small number of accounts and transactions. Most of the bookkeeping software you use will learn the rules for how to classify transactions and [00:06:00] it can be automated pretty easily when you’re small. Where it gets more complicated is when you bring in payroll and more complex accounts or multiple accounts or multiple businesses. But in the beginning, it can be easy.

That said if you’re not a person who will sit down and do it every month, just be honest with yourself and hire someone to do it. It will cost you probably anywhere between $100 and $300 a month to have a bookkeeper. It’s so nice.  And it’ll save you so much time when it comes time to do your taxes.

So business stuff. If you have any concerns about establishing your business in the right way, you can consult an attorney. It shouldn’t take more than an hour of their time, which of course varies depending on your geography, but somewhere around $200 to $500 for an hour, just to have some peace of mind around your business entity and make sure that you’re registering it the right way. So that’s one question I get a lot just like, what do I do with the business stuff? If you get into hiring folks down the road, that adds some complexity, of course, but we are talking about beginner practice issues. So let’s stick there.

Another question I get a lot is private pay versus insurance. Do I need to take insurance or can I do private pay? So there are so many layers to this that there is no way to solve this question in a 20-minute podcast. What I will say though is that private pay is infinitely easier. It’s infinitely easier in terms of collecting payment, doing your accounting, it reduces the amount of support staff that you might need, it is a lot less time on the practitioner and admin staff. So if you can go private pay, I am a big fan of going private pay.

[00:08:00] If you didn’t catch my episode with Dr. Annie VanSkiver from several months ago about going private pay and still providing access to folks, I would highly recommend that you go check that out. That is the biggest concern that I hear from people is, well, if I take private pay, I’m not going to be able to provide access to those who need an evaluation. And Annie talks through how she made that transition and is thriving in a private pay practice but also is providing access to the folks who need it. So there are ways to do that. I’m also a big fan of going private at pay if you can, and then just charging enough that you could truly provide sliding scale or pro bono evaluations for those who need it if that is a value for you.

So, should you take private payer insurance? I think private pay is way easier. In some geographic areas, genuinely, I don’t know that a practice can be sustained in a private pay model. So then you need to think about taking insurance. And even with that, it doesn’t mean you have to take every insurance. It doesn’t mean you have to take Medicaid. It doesn’t mean you have to take the lowest-paying insurances. There are layers as always. So you can decide, you can do some research and figure out selectively which insurance panels are biggest, easiest to work with, and pay the most. Hopefully, at least 2 of those 3 circles will overlap. And you can use that to make a decision about taking private pay versus insurance.

Let’s see. It is safer and something that a lot of folks do where they start taking insurance, and then once they get a large number of referrals and build up a reputation in the community, they will transition off and go private pay. So that’s an option as well.

Another question that I get a lot is what [00:10:00] measures do I need? This is a very difficult question to answer, but, of course, it’s going to map to the presenting concerns that you have, the referrals that you’re getting, and the complexity of eval that you’re doing, but generally speaking, we all need an intelligence test. Most of us need an academic measure. A lot of us need social-emotional rating scales and checklists, and so forth. So you can’t go wrong just getting some core measures that will satisfy those needs.

There are some situations where you might need multiple tests that get at the same thing, like a KTEA and a WJ or a WIAT or a WISC and a RIAS, but for the most part, an IQ measure, an academic measure, and a social-emotional checklist. And then you can build from there depending on your presenting concerns.

The place where I see people getting stuck is like really getting in the weeds as far as what measure assesses the specific constructs “the best.” The truth of the matter is that there’s a lot of research to be done if you really want to dive into what assessments do the “best job.” I would not go with the ones that are the most popular necessarily, but you can look at certainly technical manuals, consult with colleagues who are familiar with this kind of evaluation or assessment of measures efficacy. And you can also look at the gosh, the name is escaping me now, but I will link it in the show notes, the guide, there’s a compendium of test reviews that can be quite helpful as well. And I will again, link that in the show notes [00:12:00] when I find it.

So again, the issue is not picking the perfect measures. You can always add measures. You can sell measures, right? People buy and sell measures all the time. So, getting a core battery, knowing that you’ll be able to address 90% of the referrals that come through your door, that’s where you want to spend your time and energy. Otherwise, you really can get bogged down in buying too many tests or tests that you don’t need, things like that.

Related to that, people ask a lot, should I do Q-interactive or should paper administration? The pros and cons here are, I think relatively clear.

Q-interactive is more efficient. It can be more cost-effective at the lower end of the volume. So if you’re doing fewer assessments, it is cheaper than buying paper kits. It’s easy to get started with Q-interactive without the high startup cost of buying paper kits. The trade-off though is that research I think is still emerging with a lot of measures that are on Q interactive. They certainly weren’t normed on Q interactive. They were compared, but not normed or developed necessarily.

The downside is the more volume you do, the more expensive Q-interactive gets. So again, personal decision. A lot of folks like Q-interactive. It is pretty efficient, pretty easy. The library of measures is ever-expanding. And I think that’s the direction that we are headed as a field in general.

Things are moving online. Things are moving digital. So I would really start, especially as you are launching your practice, start from a place of why wouldn’t Q-interactive work for me and look at the details there and see if the research and the efficacy are [00:14:00] strong enough for the measures that you need to assess the referral concerns that you have.

The last question that I hear a lot is, what EHR should I use? Again, there are so many layers through this question. I did a whole review series on 5 or 6 of the most common EHRs that are out there. I will link that in the show notes. You can go watch those videos. They’re YouTube videos where I do a screen recording of walking through these EHRs. There are certainly some that rose to the top. I’ve been using TherapyNotes forever. IntakeQ has grown significantly in popularity over the years. A lot of folks use SimplePractice. I would say those are the top three.

There are a number of EHRs that are emerging onto the scene and getting more attention. So, this is one of those discussions that may not be evergreen necessarily. If you’re listening in 2023 or 2024, this may not be accurate, but right now, just limit your options to of the top three: TherapyNotes, SimplePractice, IntakeQ. Those seem to be the ones that folks use the most and like the most. There are many others out there, but I would just limit your search.

What I advise folks to do is do a free trial for a month, a couple of months, walk through the workflows, see which ones you like best. I think that they each have strengths and weaknesses, and it really just depends on your particular needs for your practice. I will say that those are the three that I found that were probably the most testing-friendly right out of the box compared to some of the other major players in the EHR community, but your mileage may vary. So, take some time and test [00:16:00] out each of those EHRs, go through the same process with each one, and see what you like.

All right. That’s a quick crash course into the biggest hurdles that I hear when people are starting a testing practice. Hopefully, some of that resonated with you. There are many other episodes to branch off onto. If you wanna go deeper into any of those topics, those are linked in the show notes. And like I said, of course, if you are interested in getting formal support, you can go to thetestingpsychologist.com/beginner. Learn more about the Beginner Practice Mastermind that’s starting later in the spring and schedule a pre-group call to see if it’d be a good fit.

Okay, y’all. That’s it. For next time, I think we are going to continue this beginner practice launch series in the next business episode. So, I will catch you then.

The information contained in this podcast and on The Testing Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with [00:18:00] expertise that fits your needs.

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