James J. De Santis, Ph.D.
Post Office Box 894, Glendora, CA 91740-0894
(818) 551-1714

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Your Private Practice is a Business

Like it or not, your private practice is a business. Unfortunately, small
businesses fail at a phenomenal rate every year. If you don't think of
private practice as a business, then your private practice may be likely to
fail as a business.

Contrary to popular belief, most people in business for themselves are not
entrepreneurs--they are technical experts in a craft or discipline who
believed they could do better on their own. Often mental health
professionals in solo private practice fit this description.

Time was when you could hang out a shingle, and the phone would begin to
ring. Today's mental health professional is faced with the challenges of an
increasingly competitive marketplace. Many have witnessed erosion of their
practices as a result of fundamental changes in the health care delivery
system. Others who are new to the field have encountered barriers to entry
into the private sector. We may find ourselves competing not only with our
colleagues, but also with client fear of stigma, client denial of problems,
referrer preconceptions, and payor indifference, as well as competing with
client dollars for the luxury car, the vacation cruise, and the plasma TV.
However, we are now entering the post-managed-care era. New hope is
developing among many.

Historically, we were prohibited by the traditional canon of professional
ethics from advertising, soliciting, and other forms of self-promotion. Today,
many more methods of business development are available to the mental
health professional that are not only ethical but also cultivate collegial
respect, preserve clinical autonomy, and increase patient access to quality

It's probably fairly easy to do better at marketing than most of your
colleagues. Too frequently, our graduate education did not address how to
develop a private practice at all. We may launch into business efforts
haphazardly. The isolation of solo private practice can feed inertia about
business development. We may experience a kind of drift, where our
practice is less guided by what we enjoy doing and are best skilled at than
by whomever calls for an appointment. Career satisfaction can plummet as
a result.

Clinically, we already know that applying techniques without a clear
rationale can result in wasted time, effort, and expense. Similarly, actual
success in business depends on the application of tested principles in a
strategic way with consistency over time. The old adage still applies: "Work
smarter, not harder."

What is an "Entrepreneur"?

The term "entrepreneur" may evoke cynical images in the clinician's mind.
Marketing does not mean "pushing" or "soliciting" or, least of all,

My own definition of an entrepreneur is not inconsistent with the idea of a
mentally healthy, ethical, community-spirited individual. The entrepreneur is
motivated by a strong desire to succeed in life. The entrepreneur gravitates
toward taking personal control and responsibility, welcomes challenge yet
competes primarily with himself, readily accepts the risks for both success
and failure, and does not quit easily. While continually striving for
autonomy, he can equally be a good leader and team player. The
entrepreneur understands how to delegate and teach skills to others.

The entrepreneur enjoys work, organizing and managing business ventures
applying natural and logical principles, making intelligent decisions, and
engaging in conscious, persistent, goal-directed activity. Understanding
that a thriving business is not static, she capitalizes on creativity and
innovation to identify opportunities, to learn from mistakes, to orchestrate
efficiencies, and to channel existing resources in ways that multiply
resources. The entrepreneur cultivates a mind-set of abundance rather
than scarcity.

The true entrepreneur doesn't mind selling, which at its core involves
introducing goods and services to those who need them. Yet the
entrepreneur is guided by core ethical standards to satisfy real human
needs through delivering genuine value to others. At the same time, the
entrepreneur enjoys maximizing his potential not only for profit and financial
security but also for personal fulfillment, balance in life, and a sense of

The One-Minute Self-Assessment

Take just 60 seconds right now to evaluate yourself. You are in a position
to consider more about marketing if you are recently licensed and wanting
to enter practice, relocating to a new geographic area, re-entering private
practice after time away, shifting from the public sector to private practice,
wanting to expand from part-time to full-time, wanting to increase your net
practice income, wanting to change your client mix, or wanting to reduce
your dependence on managed care. All these circumstances warrant careful
thought about marketing.

Formulate Your Business Goals First

The place to begin in marketing is to do some conceptualization first, to
clarify and prioritize your long-term business goals based on your core
values and beliefs and generate consistent intermediate objectives. An
example of a goal may be a dollar amount of income you wish to achieve in
five years from now or a number of client-hours per week in your caseload
to achieve in the next six months.

Inventory your unique pool of existing personal and professional
resources--including expertise, interests, aptitudes, and support systems to
guide your professional development. One cannot overestimate the
importance of accounting for personal satisfaction in goal-setting; too many
clinicians begin marketing efforts thinking to themselves, "Well, this is what
I CAN do, therefore I must compromise and do this." Forgetting to consider
what brings us personal satisfaction will only result in emotional drain and a
long-term career burnout. Do what kind of work brings you joy and results
are apt to follow.

Research Your Marketplace

Define existing profit centers in your practice. In principle, often as much as
80% of your total time and money are spent in activities, both in marketing
as well as actual product production and distribution, that yield as little as
20% of your total revenue, while 20% of your resources are spent in
activities that yield 80% of your revenue. An "80-20 analysis" may help
focus your efforts on those activities that are the most efficient and
eliminate or reduce those activities that are a drain on your resources. Look
at the profit you make in terms of the products and services that you sell,
in terms of who refers business to you, and in terms of what kinds of
customers you serve. More often than not, your optimal customer is not the
end-user or client, but a handful of key referrers. Analyze the expectations
and needs of this optimal customer and what you can deliver. Bear in mind
that the true hallmark of customer satisfaction is not to meet but to exceed

What's a good referral for you? Brainstorm a list of your ideal, optimal, or
preferred customers. "Customer" can refer to a referral source (such as a
physician or attorney), payor source (such as a managed care company or
a parent), or end-user (such as a client by demographics, diagnosis, or
treatment modality). Ask yourself how the potential customer–whether
referrer, payor, or client--would be able to recognize the need for your
services and to know when to call you.

Examples of classic referral sources include physicians and other health
professionals, alternative health practitioners, attorneys by specialty,
religious organizations, mental health colleagues, schools and teachers,
family and friends, active or inactive clients, websites, clinics and hospitals,
and referral directories.

Forecast societal macro-trends and future markets. Brainstorm a list of
future changes you see potentially coming either to healthcare or to our
general society. Consider sources such as the media, historical analysis,
personal observations, etc. Consider such data as sociological, cultural,
political, and economic developments. First identify the current trend, then
project this trend to its broadest conclusion (macrotrend), and finally focus
it down to your own practice. Visualize what new potential customers may
emerge and what they will want. Consider what current customers might
also enter into decline as a result and what they will now want. Then
determine how you might best address customer needs while keeping in
mind your own professional and business objectives. What current trends in
our society predict important new client bases in the future? The browning
of America, vicarious traumatization, rising rates of obesity, etc. What will
tomorrow's clients need that psychology can deliver? Planning ahead now
may give you sufficient time to obtain additional appropriate training,
supervision, and experience.

Implement Strategy Only After Careful Design

Too many clinicians think about implementation before design. Colleagues
will talk about writing a brochure or a flier without considering the format's
suitability to the audience, the message, or the service. Select ethical and
effective selling methods only after developing a clear rationale. Public
speaking may be best for certain audiences, written articles may be best for
others, direct mail for yet others. Always, always look for your optimal type
of customer where they are apt to look for the services that you are

Marketing is primarily about commanding market share. Design begins by
assessing your competitors and position relative to them. Identify all those
professionals in the community who are similar to you in what they offer.
Examples may include people with similar professional specializations or
expertise, but also those with professional community visibility or networking
leadership, similar geographic location, similar or greater entrepreneurial skill,
greater experience, those with exclusive referral sources, those who may
undercut pricing, those who are extraordinarily productive. Consider both
specific individuals as well as categories of competitors. Consider also
clinics, organizations, and hospitals that may impinge on your uniqueness.
Identify how they market themselves. Lastly, identify your key
strengths--how you are different or better than they. Examples include
credentials, special competencies, personal characteristics, quality of
service, convenience, length of professional experience, features, special
equipment, range of services or staff, and pricing.

The business of private practice is not a zero-sum game. We do not have
to compete directly with each other for all of us to be successful. Each of
us offers something unique in what we do, in our attitudes, our
temperament, in our individual life experience, etc. Potential clients will
recognize this.

Marketing Need Not Be Difficult or Complicated

Marketing is quite accessible to those who not only need specific knowledge
in order to be successful in private practice but also who don't know where
to begin, often procrastinate or get overwhelmed, are haphazard, start
projects, then give up, get busy with clients and forget about marketing, or
are shy and hate having to "sell" themselves.

You probably do some form of marketing already, although you may not
recognize it or give yourself credit for it. Marketing is, firstly, not
necessarily advertising. There are many activities that the successful
clinician engages in routinely that they might not think of as marketing but
in fact function effectively as marketing: going to lunch with a colleague,
giving a client a reprint of an article, making a referral, telling one's family
and friends what kind of work one does.

The first and foremost marketing strategy is to do good, sound, ethical,
effective, quality work. The professional, clinical reasons are obvious, but
from the marketing perspective perhaps not so obvious. Word of mouth is
one of the most powerful and resilient marketing strategies. One happy
client may tell a friend, but one unhappy client will tell ten friends.

The second fundamental marketing strategy is to stay in one location or
community for a long period of time, and to keep the same phone number. A
private practice is built-up slowly over time. Not only effort but also time is
what you invest in your practice. If you move, much of that investment is
lost forever.

A third fundamental is to keep in the stream of consciousness of your
optimal customers. Stay visible in the community. Tell people what you do.
Ask them for what you want. The longer I am in clinical practice, the more I
think it is a hallmark of mental health to know what makes you happy and to
ask the universe for it.

Identify for yourself what constitute the biggest frustrations and obstacles
to success and happiness in your professional life, where it comes from, and
alternative solutions to eliminate them. Some examples are: unpaid claims,
specializations that you don't enjoy, unkept appointments, pagers, billing
problems, working late hours, commuting, etc. Strive to eliminate them from
your business. "Work is what you are doing when you are not doing what
you want."

Most clinicians are overly reticent about the issue of money and operate
covertly on lots of myths. Too often we treat the money-side of private
practice as if it were painful and difficult. What are your personal
sensitivities and core beliefs about money that may interfere with the
profitability of your business? We may believe any of a number of myths
about money: "I am not worth what I charge. Asking for money is scary.
Taking money from people I agree to help is taking advantage of them. I
can't prosper doing what I love."

In fact, our professional fee is necessary for us to take care of our own
needs sufficiently in order to reserve the time, space, and energy to
properly focus our attention on the client's needs in the professional service

Articulate Your Basic Message

What do you want your client or referrer to know about you? Articulate
your basic marketing message thoughtfully. Focusing on your audience,
identify the elements of the message you want to convey. The elements
should be based on benefits & advantages. No one wants to buy individual
psychotherapy. Why? Firstly, from a clinical standpoint, this is because
therapy can be costly, difficult, and lengthy. Secondly, from a marketing
standpoint, this is because the customer is usually disinterested in
"features," (or "methodology" in our jargon). What people are truly
interested in are benefits and advantages (i.e. results): such as adjusted
children, a successful career, a satisfying relationship–not that we ever
guarantee results, but we should be focused in our professional efforts on

I will often recommend to a clinician writing one paragraph on each of the
following topics, at lengths of 50, 100, and 500 words each. Keep your
descriptions short and free of clinical jargon. This exercise is designed to
help you synopsize your services so you can explain to someone what you
do in 60 seconds or less.

Write a professional biography describing your educational background,
internship training, work experience, licensure and certifications, present
and past positions held, organizational affiliations, and current professional
activities. You may describe how long you have been in business, your
personal motivations and how your work evolved. You may include some
discretionary personal information as relevant.

Write a description of your areas of expertise or specializations for each of
your optimal niches. Write a description of the problem you are addressing
from the patient's point of view, report what the research shows and what
treatment options are available. Write a narrative paragraph of your
treatment philosophy for each treatment or specialty you offer. Discuss
your theoretical orientation from a practical standpoint in terms of your
understanding of human nature, what people really want, why they have
the difficulties they have, and why your methods are appropriate. Write a
statement discussing the value of your services to the patient, include any
information about how your approach may differ from other treatments.
Consider any ethical limitations to those services or their potential

Write a statement describing practical matters for new patients, including
such information as your fees, how you handle insurance, your office hours
and availability for a first appointment, access to your office, and how to
schedule a first appointment.

Niche Marketing Suits the Private Practice Model

Niche marketing is a method of marketing that identifies you to either a
limited audience, or identifies you to a more general audience as a specialist
in a particular domain. You may have several specialties each of which is it's
own niche.

Some key criteria for evaluating a niche or practice specialty are the
following. The more of these items your specialty achieves, the more likely
it will be successful: The customer has money to spend and may pay a
premium for quality. Large number of customers are in your catchment area.
Competition for your customer is low. The ease of reaching your customer is
high. Your credibility with this customer is high. Your experience with this
customer is high. The customer has a high need for your service. The
customer knows they need what you offer.

Identify ways in which you can overlap niches that work together in ways
that multiply opportunities for profit while reducing redundant effort and
costs. Within each niche, identify synergistic profit centers, either referral
sources or customers, products and services, or marketing activities, which
you either already have or can develop that are associated with each

Two Marketing Strategies That Fit the Solo Practice Model Well

Two marketing approaches well-match the solo private practice
psychologist. Both are elegant strategies that avoid directly competing with

The first approach is to launch a new product or service into an
uncontested market. This essentially creates a new category, niche, or
segment in the market, although you need not be entirely new. Focus your
marketing resources to achieve a local uniqueness with a single product. A
sustained marketing effort to get out the message may be as critical as the
launch itself. Expand laterally into other specializations only after you
achieve a breakthrough. The best clinical example launching a special-topic
psychotherapy group. If you provide a service that people need that is not
available elsewhere easily, people will seek you out.

A second approach is to pick a market segment small enough so you can
become a leader in it. Consider entering markets being abandoned by
leaders. Examples of a small segment are geographic catchment area,
special demographics, clients in specific industries, one-of-a-kind products,
or high-end quality. Be quick and flexible to respond to changes in the
marketplace itself. Abandon failures; don't let your ego hang on to
something people do not want.

Draw on your Marketing Competencies

Inventory your existing strengths in marketing and lead with your strengths.
Design promotional strategy which maximizes your personal aptitudes and
interests, whether you are best at public speaking, writing for the lay
reader, or mingling with colleagues.

Identify a list of those marketing competencies you will need in order to
effectively implement your broad marketing strategy. Some examples include
assertiveness, confidence, writing ability, speaking ability, self-esteem,
ability to negotiate, decisiveness, or selling technique. Brainstorm all the
ways in which you are comfortable and skillful as well as uncomfortable and
not skilled at each marketing competency. If your target market doesn't
typically look for mental health services where you are promoting yourself,
then you may have to develop other competencies.

Marketing Implementation

At last, after you've clarified your business goals, identified your optimal
customer, constructed your marketing message, and inventoried your
marketing competencies, it is time for action. Many methods of selling are
available and should not be selected haphazardly.

Internet, direct mail, writing books, public speaking, teaching, networking,
classified advertising, client reactivation letters, fliers & brochures,
newsletters, public seminars are some familiar examples.

The choice of method should be guided by consideration of a number of
questions. Is this method consistent with the way my customer shops? Is
this method optimal for conveying my marketing message in a way the
customer will grasp? Does this method retain or add to my credibility with
my optimal customer? Will this method reach the largest concentration of
customers in my catchment area? Using this method, what percentage of
likely recipients is my target market? What is the dollar cost of this method
per unit? Per cycle? What is the expected return on investment? How easy
or expedient is this method for me to implement? Does this method
capitalize on my strengths? What potential synergies does this method offer
for other products and services of mine? Is this method ethical in all
possible respects?

Maintain Persistence and Consistency over Time

Persistence and consistency are essential to the marketing agenda.
Marketing should be an essential element built into a private practice
clinician's typical work-week. Too many clinicians seem to don their market
suit only when their caseloads get low and then forget about marketing
when they get busy. This irregular approach is apt to contribute to business
instability by amplifying peaks and valleys.

"Anything measured improves." Quantify and actively track your marketing
results, evaluate progress, and modify goals and methods accordingly.
Marketing is largely learning through experimentation. Obviously, keep
repeating successful tactics. But what people often overlook is the fact
that failures and other negative results of marketing campaigns are valuable
outcome data. Just because a marketing effort fails does necessarily mean
to abandon the goal or the approach. What you may have is extremely
valuable proprietary information on how to improve your strategy the next
time around.
How to Market A Successful