Ok, so first, let’s be honest, there’s a lot to take issue with in terms of Ursula the Sea-Witch. She definitely carries on Disney’s longstanding history of portraying evil as black, single, independent women, adding to that list women who are considered “overweight” by Western standards of health and beauty. Oh, and she’s sexually aggressive, in that she flirts with King Triton and likes to move in a way that shows she enjoys her body. So yes, I get that Ursula embodies a lot of the negative stereotypes that women and people of color have had to put up with in media.
But if we can look beyond that, I think Ursula has a lot to say that will help you with your business plan as a private practice therapist, and maybe beyond.
I also must admit that Ariel annoys me, especially at the beginning of the movie, which is where one of my favorite scenes is when she makes a deal with Ursula in “Poor Unfortunate Souls:”
Ariel is reluctant to make a deal, because she’ll risk losing contact with her family forever. And Ursula acknowledges this, and says, “Life’s full of tough choices, innit?”
The number one thing I hear from people who want to have a full-time private practice is, “where do you find the self-pay patients?” There are dozens of posts titled that on the Psychology Today forums, and right next to them are the posts saying how much many therapists hate Managed Care and having to take health insurances, with all the rules and restrictions, and low fees.
Yet, when I talk about building your practice to people, I also hear from many people how much they hate promoting their work, and how critical they are of others when they catch a whiff of self-promotion about them. I can’t tell you how many times my blog posts and book blurbs have been pointed at and I have been “accused” of self-promotion. Accused, as if somehow promoting your work and your business is a bad thing.
Look Ariels of the therapy world, life is full of tough choices. You can have a private practice that relies on insurance only, and that isn’t a bad thing. You’ll get to see a range of people who have worked hard to earn health benefits that they want to use, and you’ll have instant diversity of economic status in your practice, the more plans you accept. And the insurance company will list you for free, and you’ll probably build up your practice more quickly. The downside? You’ll make less money, have more complicated paperwork, and time will be spent doing it. And your income will be capped.
Or you can have a private practice where you focus on self-pay, and that isn’t a bad thing either. You’ll have the ability to set and raise your rates, less paperwork and reviews, and have more time to do other things. You’ll still be able to have a diverse practice, using my PB+5 model, and more independence in many ways. The downside? You’ll need to promote your work. You’ll need to give potential patients and colleagues some good reasons why they should forgo their insurance benefits and pay you more money.
To do this you’ll need to spend time working on networking, generating content for your website, speaking, writing a book or making a DVD. And you’ll need to keep doing it. That’s right, you’ll need to consistently promote yourself and your work. The time I used to spend on billing and reviews I now spend on self-promotion, and I do some of it every single week. Sometimes I like it, sometimes I don’t, but nevertheless I do it. Even though I have a wait-list I still do it. And I have watched as several colleagues, who have been in the field for a long time, have stopped doing it. And their practices have begun to dry up, because the phone doesn’t ring as much any more.
You can also try mixing and matching the above a bit, taking some insurances, and doing less promo. Charging more for some patients, and doing more pro bono. All of that is up to you.
But I’m here to tell you you can’t have it all. That’s right, I’m not going to pitch to the starry-eyed that everything is possible. A lot is possible, but everything is not. That’s right, somebody finally said it, there are limits, and you have to make tough choices.
When people work with me, they end up making those choices, and I don’t judge whichever they choose, because I don’t think there is a right answer to this. But I also am pretty outspoken that they are going to have to fish or cut bait. If you don’t like the idea of tooting your own horn, I’m not going to push you to do it, but then don’t complain to me about having to take health insurance. But if you want a predominantly self-pay practice, don’t get self-righteous about self-promotion. First off, self-promotion takes many forms: blogs, advertisements, peer-reviewed journals, telling someone what you do at a party. Everyone in our field does some of that, at least everyone I have ever met. But you’ll need to get off whatever train trip you’re on about how self-promotion is wrong.
There is absolutely nothing wrong with working in an agency full-time. There is absolutely nothing wrong with having a self-pay practice. There is absolutely nothing wrong with taking or not taking health insurance. There are plenty of therapists who are going to take the options that you don’t. But you need to choose something or you can’t have a business plan. And if you don’t have a business plan, don’t try to be self-employed.
Finally, I’d encourage you to get a clock and keep track of how many hours you spend griping about managed care, criticizing your colleagues who market themselves, or asking how to find those self-pay patients online. Because all of that time is time you could be spending on billing, filling out paperwork, writing a book, promoting a talk, in other words building your practice. Complaining to peers is not networking. Worrying about your business is not the same as effort. Don’t confuse the two.
Life’s full of tough choices, go make one.