74 Transcript

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[00:00:00] Dr. Sharp: Hey, this is The Testing Psychologist podcast episode 74. I’m Dr. Jeremy Sharp. Welcome back y’all.

We’ve had a little break over the month of November primarily and yeah, I don’t know that I meant to take a break for that whole month but that’s how it happened. I went on a trip, the beginning of November out to LA, which is my favorite get-out-of-town spot. I’ve got some friends over there and it’s always warm, which is awesome.

Went to LA for a few days just to clear my mind, get a little break from the practice, and have some time to do some visioning, planning, and getting some clarity on where I’m headed and it was awesome. I got to connect with my friend Kelly Higdon, who’s on the podcast long time ago, and y’all may have seen her out in the coaching world, but she’s fantastic.

I got to chat with her and just relax, walked all over the place, listened to some great podcasts, and chilled out, but developed [00:01:00] some cool ideas. I’ve been working on some projects that were born from that time away and we’ll be announcing those very soon, I think.

But in the meantime, we had a break from our podcast. Hope y’all have been doing well. Today we’re going to jump right back into it. This is the first of just a two-part series on private pay private practice. Today I’m talking with Dr. Rebecca Resnik.

Rebecca has a PsyD from George Washington University. She has a long history of testing, extensive training in psychological testing and neuropsychological assessment. She also has a Master’s degree in Special Education with a focus in learning disabilities, so she gets things from that side as well.

But the place that Rebecca shares her knowledge with us is building a private pay testing practice. So we dive into that. She’s the owner and a licensed psychologist at Rebecca Resnik and Associates in Bethesda, Maryland.

So we [00:02:00] talk all about private pay testing practices and what that looks like, how to build it, how to maintain it, how to get referrals, how to handle the financial aspects. So this is a great one. I hope that you enjoy it.

And without further ado, we will go to our conversation with Dr. Rebecca Resnik.

Hey y’all, welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Hope y’all are doing well. Today, I’m super excited to be talking with Dr. Rebecca Resnik. She is a licensed psychologist in Maryland. She’s also the founder of Rebecca Resnik and Associates Psychological Care.

Rebecca is going to be talking all about building a private [00:03:00] pay testing practice with us today. This is something that comes up a lot in the Facebook group. I am really excited to be dedicating a whole episode to building a private pay practice.

So Rebecca, welcome to the podcast.

Dr. Rebecca: Thank you. It’s so fun to be here. I listen to you when I run. I listen to you when I walk the dogs and I love how much you’re sharing. Not only experts from all over the country, but the fact that you’re talking about the nuts and bolts of how do you actually profit enough to survive on a testing practice, that’s a huge gift to all of us out there.

Dr. Sharp: Oh, my gosh, thanks so much. Thank you. It’s really cool to hear that. I think I talked last time too, about how it’s such a mutually beneficial thing. I have the good fortune to just be able to call up all these folks who are doing really cool things and say, hey, let me ask you questions about all these components that I’m interested in and people just do it and I’m like, [00:04:00] wow, this is the best job ever. So it is mutual. I really appreciate it. I feel really fortunate to have you on today.

Dr. Rebecca: Thank you.

Dr. Sharp: So like we usually do, we can dive in and I would love to just hear a little about your training and how you got to private practice and what your practice looks like today.

Dr. Rebecca: Okay. I want to get one thing off my chest, which is, with respect to this topic, not taking insurance bothers me a little bit in terms of like a social justice/comic sense because it’s not my intention in not taking insurance to propagate the inequity and access to care. I’ve always been interested in serving the underserved, that was like the whole first half of my career.

[00:05:00] What’s really got me in this zone of not taking insurance is much more about having burned out on having to cut corners and not do things right for people and not feel like I could give them the really good quality ethical care. And that it’s wicked expensive to do business where I live and practice, and you can’t keep and attract really good people unless you can pay them well, because it’s so expensive to live here.

And so I guess I’m being self-conscious here. I don’t want everyone to think that I’m all about making a practice that’s only for the wealthy. That’s not it but here we are.

So I started out in special education because I always wanted to work with people with disabilities. That’s all I’ve ever wanted to do. And so I started out as a special education teacher, got my bachelor’s, got my [00:06:00] masters, concentrated in learning disabilities, and then burned out right on schedule.

Everybody burns out in like three to five years, I lasted five years and then I was realizing that that wasn’t for me and went back to school, I got my Doctor of Psychology at George Washington, did my postdoc in a private practice. After having my second kid, that’s when things get real. I realize, oh, my gosh, you know how it goes. It’s like the first kid, you feel like you’re exhausted. The second kid, you know you’re really exhausted.

When I had a one-year-old, that was when I started this practice with some partners at first, and then after a while, I realized that I really could do this if I was just willing to work really hard, which I know you understand as well. And so the practice has grown to have a mix of [00:07:00] employees, contractors and an admin, which I think is really important.

Your podcast on having an admin is a great service to people. Get an admin. It’s about half testing, half therapy, and it’s absolutely wonderful. I feel very privileged to come to work everyday.

Dr. Sharp: Oh, that’s fantastic. It sounds like we actually have a really similar practice in terms of the makeup. So we have about half testing, half therapy. That’s really cool.

I want to go back to what you started with and just acknowledge and express some appreciation for putting that on the table. I think that’s a myth maybe, if that’s what you want to call it, that if you only do private pay; that it’s excluding certain populations and it’s all about money. I don’t know that that’s necessarily true, but I think it is something that a lot of us wrestle with in this insurance versus private pay debate. So [00:08:00] thanks for putting it on the table.

Dr. Rebecca: Yeah, absolutely. It’s awful to have to turn people away. I would rather do some IEE’s, independent educational evaluations in some reduced fee/pro bono work than I would take insurance. So that’s how I manage to feel good about things. I also really love being able to give people high quality care. At age 45, I’m so burned out on always, there for a while, always not feeling like I was really doing right by people. It’s as much about that as anything else.

Dr. Sharp: I hear you. Not to totally belabor this point, my good friend, Kelly Higdon, who’s a private practice coach, I was talking about this with her, and when you run the math, you can actually provide truly pro bono services by taking private pay. Like if your issue is [00:09:00] providing access to folks, you can do four evaluations at $2,500 a pop and then do one for free. Then if you were doing five evaluations at $1,200 or $1,500, you make more and get to actually provide a free service to someone who really needs it.

Dr. Rebecca: I’d rather do that than add some corporate executive wallet or buy them another yacht or whatever. I’m a little cynical with respect to that but yeah, I’d rather just help a family out directly.

Dr. Sharp: Yeah, absolutely. Well, we have a lot to talk about. We’re going to be diving all in on how to build and maintain and grow a thriving private pay testing practice. I think one of those main things really is how did you decide to go that route in the first place? And it may be part of that, just to set the stage is, is your practice 100% private pay or do you do any insurance or [00:10:00] how is that working?

Dr. Rebecca: Practice is fully private pay. Most of the psychology practices in my area are practiced in Bethesda, Maryland. I have an office in Bethesda and Rockville, and this is what we call a thick market, which basically means there’s a lot of people here that do what I do. The cost of business is so high that most of the people who are doing testing, unless you’re talking about being at a hospital, they’re all private pay.

And as is the case with many things in psychology, I really didn’t decide, the opportunities came. When I was looking for a postdoc, there were very few opportunities in my area for people who wanted to do pediatrics. By the time I was going for a postdoc, it was like second career, so living on $15,000 a year or basically leaving my husband and stepson and moving out of state [00:11:00] to try and exist on $15,000 a year for what postdocs were paying at the time wasn’t a great option. So I ended up in a private pay clinic where I got extra neuropsychological training, which was terrific.

I learned a lot about the business model from the two women who I found at the practice. So that’s what I got used to and when it was time to think about making a change, I knew how to do this and I felt like, you know what, that’s the path and let’s see if we can make it work. What’s the worst that can happen? You go broke and bankrupt. So why not?

Dr. Sharp: That’s all. No big deal. Nice. So it’s what you were used to; you grew up with it and then that was on the table when you went out on your own. I think it’s helpful. Have you ever thought about taking insurance at all? And if not, why not? [00:12:00] What led you away from taking any insurance?

Dr. Rebecca: I did think about taking insurance and honestly, what led me away from it was really math because I spoke with some people who are in business about it and what it would entail, and when I sat down and did the math and thought about how much it would cost me to do all of the billing, pay a staff member, like a contractor. At the time, I would have thought about a contractor. Now I’m all about employees. What you would actually take home for what they would reimburse for testing, it was pretty terrible.

Remember in your first podcast that you talked about how you looked and you had $90,000 worth of debt, it’s super expensive to do testing. I spend about $500 to $700 a month on testing supplies. It’s very hard to make that [00:13:00] happen with insurance companies. Sometimes they’re going to pay you and then sometimes they’re not, as you know. Sometimes they’ll preapprove things and you’ll think, okay, great and then they’ll say like, oh, yeah, but you diagnosed a reading disability here. So basically we’re not paying for the whole half of this psychological evaluation.

And I just can’t run a business if I don’t know when money’s coming in and if I’m going to get paid for my services and how much of my administrative assistance’s time is going to be spent on the phone arguing with these people. It’s really hard.

Dr. Sharp: Yeah, absolutely. One part that I want to highlight from all that is that it sounds like you actually did do the math to figure out if it was viable or not. I don’t know how many people do that. So this is just a plug for actually doing the math before you go one direction or the other [00:14:00] if you’re starting.

Dr. Rebecca: My state psychological association, I’m a huge fan of state psychological associations. We had a speaker come up and he did a whole chart where he showed you if you tried to be all assessment and take insurance, how long it would take you to go broke in this part of the country.

Dr. Sharp: Oh, jeez.

Dr. Rebecca: I know. That’s pretty inspiring as a young professional. And you know how it is, is once you have kids, a lot of years you’re pretty much making just barely enough to cover the childcare. Not having enough to cover all the things that your kids need is really hard. It’s one thing not to have enough money when it’s just you but as you’ve said, it gets real once you have kids.

Dr. Sharp: It’s a whole another layer, I know.

Dr. Rebecca: A whole another layer of expense.

Dr. Sharp: I know that, for us, and this varies across the country, but there is a pretty big disparity between what insurance [00:15:00] reimburses and what the out-of-pocket fee for testing might be. Is that the case in your area too?

Dr. Rebecca: I don’t know as much about that because I’ve never taken insurance, but I do know that people vary a lot in terms of what they’re able to negotiate. I think Maureen, two podcasts ago, was talking about how she renegotiates pretty aggressively, and that’s fantastic.

In my neck of the woods, there’s so many psychologists that insurance, it’s very hard to convince an insurance company that you’re the only 10-mile radius that could serve a particular child. So that doesn’t work quite as well here.

Dr. Sharp: Got you. I see what you mean. One of the questions on people’s minds just speaking from experience, I’m going to guess that other people are in this boat is, can I really do this? How do people pay out-of-pocket for testing when it’s so expensive? Do you have thoughts on that question?

[00:16:00] Dr. Rebecca: Many thoughts on that question. The first thing you have to think about is that when you sign up for an insurance panel, it’s a transaction. So you’re signing up for them, what you’re getting out of it is a steady flow of clients and you’re agreeing to accept a reduced fee in exchange for that steady flow of clients.

So the great thing is that, if you’re taking insurance, you don’t have to go hustle like I do in the market space to generate referrals and leads and conversions. That’s done for you, and that’s worth a lot particularly like if you got a baby at home or something like that, and you don’t have time to go to all those networking lunches and such, that can be a great deal.

One of the things that’s important to remember though is that people pay for stuff out-of-pocket all the time and we’re treated a [00:17:00] little bit differently than say a lot of other people who provide professional services because people often expect us to take insurance and yet there’s many professional services you pay for, like a lawyer, for example. You and I’ve spent a lot on lawyer fees. You know when you call your lawyer, whatever you contract with that person to do for you, you’re going to pay out-of-pocket.

People get their kitchens redone. People buy expensive cars. Many of the things that we could do for ourselves, people will pay professionals to do, like we could do our taxes for ourselves. We can ride the bus instead of getting a car. Many people, if something’s important to them, will make it work.

I’ve seen many people who it was really a stretch for them, and I’ll try to do a payment plan or give them a reduced fee to make it work for them. I’ll tell you [00:18:00] honestly that the people who haven’t paid me are almost never the people for whom it’s a real stretch. It’s almost always people who are very comfortable.

When I went on a network for my son’s testing and I’m going to guess you probably did too because you really wanted to have a great experience and get something that you couldn’t get if you went with someone who was on a panel. What I usually talk with people about is that people will pay for something if you can offer them something that has a lot of value for them, and they will feel like it’s worth paying for it. So the question becomes, what kind of value are you able to offer that somebody on a panel might not be able to?

Dr. Sharp: I guess you have some ideas too.

Dr. Rebecca: Yeah. I usually encourage people to think about what do people hate [00:19:00] about psychology and going for psychological testing and we would call this pain point.

Dr. Sharp: Yeah.

Dr. Rebecca: There’s a lot of things people hate about psychological testing, right?

Dr. Sharp: Sure. Let’s talk about that a little bit.

Dr. Rebecca: Yes, exactly. Long waitlist, not getting the kind of experience you want. A lot of times the report might not be something that really fits what you were hoping to get. For example, if you have a kid on the autism spectrum and you get testing done through the school, you may get some things about educational placement but you won’t get the whole piece about what do I do for therapy? What do I do for taking care of behavior issues? What kind of speech pathologist should I get?

You also can offer a very different quality of experience to them. So what they’re getting in exchange for paying out of pocket, [00:20:00] maybe like you’re going to see them faster. You’re going to get them the report faster. It may be a very personalized report that addresses their specific question.

If they’re going out to network, they may be able to get someone who has a really great level of expertise that they weren’t able to get if they say, waited for six months and got their testing done at a hospital or three months and got their testing done through the school.

So anytime you can address one of those pain points, one of those things that make the whole process terrible or awkward or stressful for people, you’ve created a lot of value and people will often pay for that if they can manage it.

Dr. Sharp: Yeah. It sounds like maybe step one, so to speak, is identify what kind of value you add above and beyond a provider who’s on an insurance panel and how you can address some of those pain points that might come up if someone tries to see someone on the insurance panel.

Dr. Rebecca: The [00:21:00] wait list is a huge deal. For the people who take insurance, their wait list is so long. And if you have a kid who’s really crashing and burning and things are getting desperate, it might be well worth it to you to go to someone who can get you in in maybe a month as opposed to waiting like for the Kennedy Krieger Institute where the wait list is six months to a year. So that’s one easy way to create value is just plain old speed.

Dr. Sharp: Absolutely. Well, so let me ask, how do you highlight these value ads? Is that on website? Is that part of your initial phone script? How do you communicate to clients that they’re getting something more for the private pay rate?

Dr. Rebecca: Sure. It is in the website, but most of the time, by the time they’re coming to the website, they’ve already heard about me from somebody else because I do business-to-business marketing primarily. [00:22:00] But it starts right from the minute they call.

So we have an administrative assistant who manages the phones. I manage the phone. My director of clinical services answers the phone and they immediately get somebody who’s really nice and kind and interested in them and is going to take the time to listen to them, they’re going to get in as quickly as they can.

As quickly as we can, we’re going to match them up with the right person. If we can’t match them up with someone in our practice, we’ll match them up at a friend’s practice. So it starts off like immediately. They have to feel, if you remember when a Cotswold expression, the holding environment, I think about my practice like that. The website’s got to be a holding environment, the waiting room, even the parking lot.

If my parking lot’s a terrible place where they, if they can’t push their strollers and handle the diaper bag and the toddler and all of that, that’s not good. So [00:23:00] every step of the experience I think through in advance. They’re also purchasing a lot more of my time so when they’ve purchased a lot of my time, I have the luxury of doing things like spending an hour reviewing a 2-inch thick binder of notes and previous testings.

I have the time to talk with their special education lawyer, their tutor, their teacher, their therapist. I have the time to work at the kid’s pace unlike when I worked at a hospital. I don’t have to push a kid through because I only have this little chunk of time with him. I can let a kid ease in.

I think in one of your podcasts, you talk about walking the kids around the office and taking them to check the mail. We’ll sometimes walk around out back and look for bunnies. And with a really anxious kid, that’s a huge value add as opposed to, all right, you can have a sticker if you finish this assessment right now. [00:24:00] I don’t want to have to do that anymore.

We don’t pay a lot of experience, I think, in psychology to the experience of what it’s going to be like for our clients, but if you’re going to go private pay and people are going to pay for it, they’re going to expect you to create a really wonderful experience that feels therapeutic and empowering as opposed to what it’s like back when people used to have to come see me at the hospital. It was clinical, very impersonal, it wasn’t a pleasant place for kids to be. A lot of times they would wait ages to get the report back from me but it was free. So it’s all about the kind of experience you want.

Dr. Sharp: Yeah, absolutely. I’m glad you mentioned that just crafting the whole experience to provide a holding environment for the client and help them feel comfortable and welcome, it’s all super important in the whole process. I think [00:25:00] there is an association with I should get what I pay for. And when people pay a lot of money, then they expect a certain level of care.

Dr. Rebecca: Yes. And if they don’t get it, they’re not coming here.

Dr. Sharp: So you got to up your game a little bit, in the end.

Dr. Rebecca: Oh, no, I really got up my game. If you’re thinking of going off of insurance panels, you have to make a conscious decision that you’re going to practice differently because they are paying for a lot of your time, your expertise, your energy. If clients email me or call on the weekend, I’m going to call them back probably Sunday morning because that’s the level that they can expect from me.

If their kid has a meltdown in the first part of testing and we need to book an extra day, that’s the level of care that they’re paying for and they deserve.

Dr. Sharp: Right.

Dr. Rebecca: Everybody deserves it, not just the private pay people. [00:26:00] So I hope that didn’t come across in a way I didn’t intend it to.

Dr. Sharp: Oh, sure. No, that’s totally true. Ideally we’d be able to provide all of that to everyone who comes in.

Dr. Rebecca: Yeah, ideally. Absolutely. I would love it if insurance companies would make it easier for me to take insurance. I would love to be able to take insurance. It’d be great not to have to turn people away and give everyone that Mercedes level of care.

Dr. Sharp: Yeah, I know what you mean. One thing that you mentioned a little bit earlier is, it sounds like a big part of this process is that people already know about you and know what to expect and know something of your reputation. And you mentioned business-to-business marketing, can you talk more about what that is? It almost sounds like other people are prepping your clients for a private pay experience. How’s that working?

Dr. Rebecca: It works really well. I started reading [00:27:00] business books a while ago and listening to business podcasts like you do. I came across this term B2B. It’s called business-to-business marketing.

So basically what that means is that I don’t send out mailers to potential clients. I don’t advertise in the local magazines that are on the radio station or anything like that. The type of marketing I enjoy doing and you can enjoy marketing, I promise. I love just meeting great people. It’s so much cheaper to do business-to-business marketing.

When you’re marketing as a big blast to all the parents or people in a geographic area, most of those people are not looking for psychological services. We’re not the kind of thing like pizza where you want pizza on a fairly regular basis. I [00:28:00] want it constantly.

So I have to find people when they actually need me and they don’t know how to shop for me. Nobody knows how to shop for a good psychologist. People go on to something like Psychology Today and they look maybe and they say like, oh, this person sees kids and they look nice and they’re close to me but what I’m doing is meeting with the professionals for whom I can solve problems and who can solve problems for me because that’s what a business relationship, aside from the fact that it can be a lot of fun, that’s what it’s all about.

So I spend a lot of time just going out and meeting people. If you can meet with somebody, even for just a half an hour, it can mean thousands of dollars in referrals for you and for them. If the two of you see the same client base, so say I meet with someone who does really great [00:29:00] evidence-based tutoring for kids with dyslexia and she needs clients and I need clients, the two of us can sit down and have coffee together.

In this area is a seven-dollar cup of coffee probably, half an hour of my time but if we create a relationship that lasts, we could be sending clients to each other for the next 20 years. I’m in it for the long game. And especially with younger clinicians coming in, if you can meet with the other young people who are starting up practices or professional services, those people are going to be a lot more interested in you and a lot more likely to start referring.

When I first started out, I would try to do business-to-business marketing with a pediatrics practice that had like 15 doctors. And I thought, oh, that’s great. That’s going to be efficient. I’ll have 15 doctors referring to me. No, that did not [00:30:00] happen. What happened is I would sit in the break room next to a tray of sandwiches being totally ignored.

Dr. Sharp: Oh geez.

Dr. Rebecca: All the drug reps are competing with you. And trust me, they’re a lot hotter than I am. So the pediatricians are inundated with people marketing to them all the time. What I learned really quickly is that people who’ve been out there for like 20 years, they were not interested in me. They had all of their buddies. They had all of their Rolodex with full. They didn’t care what I did.

A lot of them didn’t even answer my calls and when they did, they just talked to me about themselves the whole time. That’s alright but I got better things to do. So I started looking for the other younger people, back when I qualified as a younger person, the other up-and-comers who seemed to be hungry and who seemed to be active and interested and really good. Those people were interested.

And so now I have people that I’ve been referring to for the last 10 years who [00:31:00] are not only business relationship people, but good friends. And so there’s business to business connections. If you can then be friend as the saying goes, instead of try to defeat and compete with the other people in your market space, you get a lot more of a robust practice that people will refer to instead of seeing you as competition in the market space.

Dr. Sharp: I so appreciate that you are saying that. That’s something that I’ve talked about for a long time that if you’re trying to start a practice, it doesn’t do anyone any good to have that competition mindset. It doesn’t help clients. It doesn’t help clinicians.

And it seems counterintuitive but I talk a lot about reaching out to folks who do what you do because eventually you’re all going to get full and you’re going to need places to refer and need quality [00:32:00] providers.

Dr. Rebecca: Yeah, look what you’re doing. Look how much time you’re giving up to help other people who are technically your competition. When I was a girl, I remember that scene from Miracle on 34th Street, you remember the scene where the kid’s sitting on Santa’s lap and he says, I want this fire truck and the mom says, no, don’t tell him he can have the fire truck because Macy’s ain’t got him. You remember that?

Dr. Sharp: Mm-hmm.

Dr. Rebecca: Maybe, and Santa Claus immediately says like oh, no, don’t worry about it. Gimbal’s has them. So he was referring to the competition. That really inspired me, even though I was just a little kid when I saw that movie.

I will refer to my competition, the good ones, I don’t refer to the bad ones, obviously, but if somebody is really great with, say, trichotillomania, we don’t have anyone in my practice who does trichotillomania, I want to have a good relationship with that person, and I’ll refer to them [00:33:00] because I would so much rather that that client have a good experience with me as like, oh, that nice lady who helped them find Dr. so and so than, oh yeah, they took our money and didn’t solve the problem.

So it’s a long-term growth strategy to think about giving the clients the best care possible as opposed to a short-sighted; I’m going to get as much profit as I possibly can.

Dr. Sharp: Yeah, absolutely. So within the business-to-business marketing, are there other folks you’re networking with aside from clinicians or other businesses we might want to think about in terms of private pay clients?

Dr. Rebecca: Yeah. So one of the things I’m really active in is my state psychological association. Again, I can’t encourage you enough to get involved there. I’m involved with the local different kinds of special education advocacy groups like LDA, CHAD, there’s [00:34:00] a GT/LD network around.

I definitely want to connect up with tutors and speech pathologists. I spend a lot of time out talking to the learning specialists at independent schools.

The independent schools, the speech pathologists, everyone who could refer to me, I treat them with the same level of respect and care they treat clients because they are my clients too. They refer someone over to me. They want me to solve a problem or make things better for a kid and so I need to deliver good service not only to the client but to them.

So I spend a lot of time out in the school explicitly talking with them about what’s your culture like? What are your learning support programs like? What do you want to see in a report? What kinds of recommendations work for you? What doesn’t work for you? And providing that client care to the referral sources as well as to the patients.

Dr. Sharp: Yeah, that’s a good point [00:35:00] too. Don’t just take the referral and run, you got to stay in touch and take care of them and hopefully same too.

Dr. Rebecca: Those connections are what really matters. A lot of people get very nervous about networking. Networking when you first start out is pretty terrible for most of us, I think. I was a lot like Marvin the Android from Hitchhiker’s Guide to the Galaxy when I first started marketing. I just felt like, oh, God, I hate this. I’m terrible at this. I dreaded doing it.

And so you have to think about networking as like, we’re just as bad as our clients with anxiety because we get avoidant about networking and we have that self-fulfilling prophecy that I’m not going to be good at it. I’m always going to be terrible.

At one point, my therapist, [00:36:00] he actually yelled at me a little bit because I was whining about networking and he goes, no, you used to be bad at that. You’re getting better at that all the time. Wow. Okay. I will try but it’s like anything else. It’s like exposure therapy for people. The more you do it, the better you will get at doing it. And after a while, once it becomes like old hat, you can then start to have fun. It’s just you have to get through that really awkward period before it can become fun.

But if you’re not up for networking with a whole bunch of strangers are going to one of those big terrible Cattle Call Luncheon, you can just start out by calling up a speech pathologist who’s worked with one of your clients or go over to that really great Montessori school in the neighborhood and just sit down with the learning specialist. You can do it in really little, non-threatening ways and then [00:37:00] build up to the more intimidating types of events.

Dr. Sharp: Yeah. Let me ask you just a very nuanced detailed question. What do you say in that first contact with people when you’re trying to reach out and meet with them? Is that an email? Is that a phone call? And what do you actually say?

Dr. Rebecca: Usually the first encounter that they’ll have had is that someone they trust will tell them to call me because I put in a lot of time to build those relationships and get known in the community. And then I give out my cell phone. They’re welcome to call me. Most of the time I want them talking to my admin because if I’m working with a kid for like a four hour testing session, I’m not answering phone calls.

But every single piece of that process has to feel like a good experience for them. It has to feel warm and kind and [00:38:00] supportive. So what I actually do is a lot more listening than talking. And yeah, I end up spending too much time on the phone. That’s a problem but at the same time, I learn a lot about what it is that’s on people’s mind, and where they’re coming from, and how they found my name, too.

The very first thing after I call and introduce myself is I just let the parent roll. Just let them talk for a while because we don’t generally listen to people all that much. We usually just wait for our turn to talk. But we as psychologists are one of the few people who got out of that habit because we learned how to listen.

And often they’re so happy. I think you’ve mentioned this too, when you return their phone call and you listen to them a little bit, they are so happy. It’s such a huge gift to give to people. It’s just that little bit of time so they can talk about why they’re worried about their kid.

Dr. Sharp: [00:39:00] Yeah. That’s so true. It sounds like a lot of your marketing is, like you said, business to business or person to person. Do you employ other marketing methods at all? Do you do AdWords, Facebook, Google digital stuff, anything else that helps drive referrals for your practice?

Dr. Rebecca: Occasionally I’ll do a Facebook Blast if I’m giving a talk somewhere but in general, I know it’s much more personal. I find that conversion rate is much higher. I haven’t done Google AdWords in ages. I don’t really want the people who find me randomly so much as I want the people who’ve heard call Rebecca, you can trust her.

Those people are much more likely to convert. And so when I’m spending my time with somebody who’s like, say, pediatrician recommended them to me, I’m much more likely to actually have that case convert and be a good fit for me.

[00:40:00] Like when I had a Psychology Today ad, nothing against Psychology Today, you get really good… their search engine optimization is fantastic so nothing can compete with Psychology Today in terms of getting your page up there; front and center but I found a lot of people were calling me and a whole bunch of other people and they had no specific interest in me. And then I got two pervs when I was younger calling through […]

Dr. Sharp: I’ve heard that happens.

Dr. Rebecca: Yeah, back before I was an old mom. I cut it off after a while because what I wanted was clients who were much more invested and had that personal recommendation. Another thing that I do a lot of is talk. I know a lot of people are intimidated about giving talks. Again, it’s one of those things where if you force yourself to keep doing [00:41:00] it, you’ll get in the groove and it will not be as scary.

So I’ll do talks. I’ve done talks at like national big conferences and stuff. And it’s fine. It’s just for fun, honestly, but when I give talks locally, that’s where my name gets out there because if I do a talk for a PTA, I may have like 40 parents in the library of a school and I’ll give like a 30-minute talk on anxiety or grit or something like that.

And yeah, 30, 40 people, maybe 50 if it’s a big library, those people will see me, but the great thing is that the schools in our area are huge. And so for every talk I give, my name gets passed out on the school’s listserv and about 1500 people will see it. I read in a business book somewhere that if people, maybe it might’ve been Cialdini’s [00:42:00] Influence, I don’t know if you’ve ever read that one. That’s a fun one.

Dr. Sharp: I haven’t read it. I know it’s so famous though.

Dr. Rebecca: It’s so good. It actually is a really fun read. You can buy it at any airport. What I learned from that is that the more people have heard your name and are familiar with your brand, the better impression they have of it. So apparently it takes about six times of people hearing your name for them to think you’re good. And then even if you suck, they think you’re good because that familiarity is what really drives us. We like to go with stuff that feels comfortable and trustworthy.

So the more I can get my name out there in a framework of this is a trustworthy person, the better for me. So it’s well worth my time to do a little half-hour talk at a PTA because enough parents will have heard that, that then when their pediatrician gives them three names of people to call, [00:43:00] if they recognize mine, it’s going to convert for me, odds are.

Dr. Sharp: Absolutely. I can probably wrap it into a little bit of marketing there as well, I think anybody should have a nicely done logo and header on their reports and so forth, but especially if you’re private pay, I think that really wraps into brand recognition and is one of those six touches that you’re talking about where even if people see that report, like they see the logo, they see your name, then they see it on your website, then they get the name from the pediatrician, then maybe a teacher at school, all those things tied together to create this brand recognition and familiarity. And that’s really important.

Dr. Rebecca: And it’s very deliberate, like your website’s gorgeous. One of the great things about your website is that I could get all the information I need to contact you within about three seconds.

Dr. Sharp: It’s huge.

Dr. Rebecca: It’s huge investing in a decent [00:44:00] website. What I read is that if people have to search for the information they’re looking for, for more than five seconds, they will leave your website. You have five seconds to draw them in and make sure that they can contact you. That’s not a lot of time. It’s got to be really user-friendly.

And you want a website that shows that you care because there’s a lot of generic psychology websites, there’ll be a picture of a plant, maybe some bamboo at the top or a flower. It’ll be like get a professional headshot done. 45 years old, trust me, I wanted that photo retouching on my website. My headshot, I’m too old to go with like the computer camera picture. It shows that you care and that you’ve invested in the business.

Dr. Sharp: That’s so true.

Dr. Rebecca: I was also given the recommendation to name your practice [00:45:00] after yourself, which you didn’t do. And so I’m talking with this business consultant and I’m saying, yeah, I think I want to name it like Bethesda Psychology Care or something like that. And he goes, oh, so you mean you want to disappear from the internet? I said, but no, I can’t name it after myself. He said, well, you’re the brand.

And think about it this way, if they’re searching on Bethesda or psychology, they’re not going to find you. They’re going to find hair salons and dentists and anything that’s in Bethesda; restaurants, your competition. So I’m still mildly embarrassed about the fact that the practice is named after me but it’s all about the brand recognition at this point and trying to have a brand that conveys trust and integrity.

Dr. Sharp: Sure. No, I think that’s true. We’ve definitely gotten away, at least from a Google standpoint of trying to name your business in NCEO friendly name like [00:46:00] location plus psychology term. You can create a personal brand.

At least for me, it’s funny, I started as myself and then rebranded as an agency and I think there’s some work to do either way. When you’re the face of the brand, then you maybe have to sell your clinicians a little bit more in this and that side, but it’s totally doable.

Dr. Rebecca: That’s totally true.

Dr. Sharp: But that’s also kind of the attorney model where it’s like one or two people’s names and then, of course, there are associates and you might meet with whomever at the practice. It’s all in the branding. It all comes back to branding as far as I concerned.

Dr. Rebecca: It is hard because people assume that just because your name is on the door that you’re the best one there. What I honestly tell people is what means is that when the toilet clogs, I’m the one that’s going to unclog it. That’s really what that means. I’m the one who will change the [00:47:00] toner or go out and buy fans when the AC goes down. It doesn’t mean I’m any better than any of my staff and may not at all be the best fit for you. So it’s all about you.

Dr. Sharp: Right. Well, so let’s get into maybe some nuts and bolts here before our time runs out. Just very basic, how do you structure the payment for your evaluations? Is it all upfront? Do they pay in two installments? Do you take credit cards? Give me some information about how that runs.

Dr. Rebecca: So if I’m going to have people doing private pay, then I’ve got to make it really easy for them. So I have an electronic medical record system. We bill through that. It’s not optimal with respect to the credit card rate that we’re getting, but it’s very convenient. For them, they can upload a credit card.

Dr. Sharp: Which system do you use?

Dr. Rebecca: We have TheraNest.

Dr. Sharp: Oh, sure.

Dr. Rebecca: It is wicked expensive, to be honest with you, but it [00:48:00] has all the bells and whistles that a large practice needs. I had to have something that… I’ve got 13 people, 13 people have to be able to use it and bill through it. It does things like appointment reminders if they agree to opt in for that. So the convenience factor is huge.

For people, especially in this area, you have people who work like 50, 60-hour work weeks, so like corporate lawyers and that kind of thing. They do not have a lot of time, so you got to make it easy for them. The first thing they have to do, we’ve learned this the hard way, they have to pay in advance for their intake.

Dr. Sharp: Okay. How much is that, would you be willing to share?

Dr. Rebecca: Yeah, sure. Ethically, we’re not supposed to do price fixing, so I don’t really care about… you can call me up if you want to find out, but I don’t want to cross that ethical line into price fixing, actually, now that I think [00:49:00] about it.

Dr. Sharp: Yeah. Can I ask you like as a percentage of the total fee; how much is that that you’re asking them to prepay?

Dr. Rebecca: The intake fee is just our hourly rate. So we do a 90-minute intake just at the hourly rate because I don’t know that testing is going to be necessarily the right thing for them. We might sit down and halfway through, I might realize that they need to be seen by a neurologist first or that maybe this is actually more of a therapy case. We try to screen for that.

Or it’s like they’re 16 years old and they have a learning support plan and they think they need to get retested for the SAT, ACT, I may say to them, honestly, you don’t need this, which I’ll do. So we do charge for that. They have to pay in advance. That really protects my staff because what people would do is, a lot of them, they’re so stressed, they’ll [00:50:00] forget, or maybe they’ll hedge their bets and schedule at a different practice, or maybe they’ll change their mind. It really hurts the staff for people to cancel last minute.

With testing, I generally have them, if they can manage it, they generally do 50% the first day and then the rest at our feedback meeting. We actually give them the report. We do it all in one thing. They get a report draft. They meet with us. And then if there’s any changes that they have questions about or if we misspelled the little sister’s name or something like that, they have the opportunity to ask us to change those things in the draft. And then once it’s done, it’s done.

But it’s really important for private pay that you consider giving people some kind of a payment plan. We don’t check their credit. I feel like [00:51:00] that’s just more intrusive than I want to get. I don’t really want people pinging my credit. If it would be hard for them, then… I’ve done three months payment plans. In some rare cases, I’ve done a whole year.

It is hard because people’s motivation to pay you does go down the longer out they are and so we won’t do it anymore without a credit card. They have to have a working card up because we found out that it can be hard and ugly and ruin the quality of the relationship if you’re having to nag them to pay.

Dr. Sharp: Absolutely.

Dr. Rebecca: I don’t want to get into that.

Dr. Sharp: Yeah, I don’t know…

Dr. Rebecca: For independent… go on.

Dr. Sharp: I was just going to say, I don’t know which system y’all use for payment plans, but we have it set up as a subscription plan through PayPal. There’s an option to just relay payments where they input their payment method, whatever that is, bank [00:52:00] account or credit card. And then you can set the parameters to bill it every month for three months or whatever, every two weeks for six months, whatever you want to do. And then it just automatically does it and they only have to sign that.

Dr. Rebecca: I like that a lot. I’ll have to see if we can get our EMR to do that because if PayPal is able to do it, the technology is out there.

Dr. Sharp: Right. Yeah.

Dr. Rebecca: That’s a great idea. And then you don’t have to nag and it can all stay positive. That last experience that they have with you is what colors the whole flavor of the interaction, so you got to make sure that that last touches is a positive one.

Dr. Sharp: Sure. Let’s see, I’m trying to think what else. I know that we are getting to the end of the time that we have so I will say that, for anybody listening, we’ve touched on a lot of the aspects of building a private pay practice and how to make that [00:53:00] work and the marketing and so forth but Rebecca, you put together this incredible information sheet or white paper or something, I’m not sure what to call it, but it’s really awesome. I’ll have that linked in the show notes and it goes into a lot of detail about each of these pieces that we’ve talked about. So there is that.

Maybe I could just ask you, other things that we have not touched on or you feel like deserve more attention before we wrap up in terms of key points of having a private pay practice, how to keep it running, how to keep the referrals coming, really anything.

Dr. Rebecca: I think before moving into treading to develop a private pay aspect of the practice or trying to have a private pay practice, really sitting down and thinking strategically about what you’re going to do. Most of us learn by rolling along and making mistakes. So meeting with a business consultant, we [00:54:00] met with two different business consultants to get different kinds of perspectives.

For goodness sake, meet with an attorney. It’s wicked expensive and many times they’ll disappoint you. Meet with a CPA, meet with an attorney and sit down and have those people talk to you about employees versus contractors and how do you fill and how do you make sure that your paperwork is structured in such a way that if you had go to collections, you could do that.

Talk with somebody about marketing, you can try and do it yourself. I’ve spent a lot of time researching this on my own. But just like you wouldn’t encourage your patients to get their psychological information from like one of those mom’s chat rooms; Moms and Dads, where everybody just says all sorts of ill-informed, biased information, you’re meeting with an expert.

It [00:55:00] seems like oh my gosh, I can’t justify that expense but if it gets your practice on the right track and helps you avoid any kind of lawsuit or complaint against you, it’s so worth it to sit down with those people and get them looking over your books, running projections, telling you what you can afford to do, what you can’t afford to do.

Like Maureen said on her podcast two months ago when she was interviewed by you, she talked about how important it is to consult experts instead of just like putting up on Facebook like, hey, should I be an escort? It’s like, no, you need to talk to an actual attorney about that. It’s worth it in the long run.

Dr. Sharp: That’s a great point. Yeah, I think we’re hesitant to spend money. I’m always hesitant to spend money maybe appropriately so but there are a few things that are really worth it, and those are two…

Dr. Rebecca: Yeah, and protecting yourself from any kind of [00:56:00] ethical problems or problems with the IRS is well worth doing.

Dr. Sharp: Yes. It’s so funny, we were in, this is a tangent, but we were in our staff meeting yesterday and we’re doing a big overhaul of our device security, like technology and HIPAA compliance and computers and all that kind of stuff, and so many times it’s tedious and it’s hard to change patterns or behavior but one of our psychologists, her father is an attorney and she just kept saying, but it’s a lot easier than going to court, and that’s what you got to keep in mind. Like most of these things we’re talking about are a lot easier than going to court. It’s better to pay $1000 now than whatever, $10,000 later.

Dr. Rebecca: Right. Have the trust increase the charges for your malpractice, that would be bad. [00:57:00] I did write up a lot of things for the writeup, including a list of books, podcasts, resources, if you’re interested in learning more. You can always get Jeremy’s consulting too.

Dr. Sharp: Oh my gosh. Thank you. I’m going to have you on again. When do you want to come? Well, no, I really appreciate it. If people have questions or want to learn more about how you’re running your practice, what’s the best way to get in touch with you?

Dr. Rebecca: They’re welcome to email. I’m on my email way more than is healthy. People are welcome to email me. They can contact me through the website as well. Totally fine. I try to return all emails and phone calls within 24 hours.

Dr. Sharp: Nice. I’ll have links to all of that information in the show notes too; how to find you. Well, this is fantastic. I know that in some ways we’re just scratching the surface, [00:58:00] but I think it’s important to talk about. So I really appreciate the time and I will see you in the Facebook group and I hope others will.

Dr. Rebecca: Bye, Jeremy. It was so nice talking with you. I love the fact that you’re providing information for people about the business side. It’s sorely needed and graduate schools aren’t doing it. Most of our professional organizations are not doing it. So we really desperately need it. So thanks.

Dr. Sharp: That’s so good to hear. Happy to do it. Well, take care, Rebecca. Talk soon.

All right, y’all. There we have it. Dr. Rebecca Resnik talking all about private pay testing practices. And as she mentioned in the interview, there’s a great handout. Hopefully you caught that while you were listening. There’s a great handout in the show notes that really goes into a ton of detail. To be honest, I was really impressed when Rebecca sent me that handout to include in the show notes.

So definitely check that out and I hope you took away some positive [00:59:00] information from this. I know that we wrestle with insurance versus private pay. Hopefully, the message here is that it’s totally possible if you want to go that route and hopefully you learn some things to make that a little more possible.

I’ll be talking with you next time about private practice as well. Next time, I’m chatting with Tiffany McLain, all about money mindset. And this one was a barn burner. So definitely tune in. If you haven’t subscribed, please do that. You’ll definitely get those podcasts downloaded right when they come out. You don’t want to miss this one with Tiffany. I think it pairs really well with Rebecca and I’s interview. So hopefully you’ll catch that one.

All right, until next time, y’all, take care. [01:00:00]

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