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Posted by Kaye Frankcom, July 10th, 2020

What defines a leader? Leaders in psychology like in many areas of human endeavor hold various offices in our professional organisations or related entities. Being a leader in your private practice (even if you are a solo practitioner and therefore a leader of one) is often an unsung role. It requires the ability to deal with complexity, to tolerate ambiguity, to have reserves of self-reflection and self soothing capabilities and the capacity to take on a bigger perspective.

You must think bigger to grow the paradigm to move from being a practitioner to a director of a practice. Coaching psychology ideas (Keegan, 2009) suggests that we need to be at a stage of being “self-authoring” whereby we have established our own values and beliefs which could be typified by the well-known song “I did it my way”. But where does wisdom sit in this approach and how do continue to adapt to increasing complexity in your workspace/practice and move to the stage of being “self-transforming”? Sounds good but where is the path and who is driving us? How well situated are we to be the leaders we need to be in the challenging world of private psychology practice? Should we be led by business coaches, social media experts, business advisors or clinical supervisors? All these people play a role but a complex problem such as how to make your practice successful, effective and sustainable requires a higher level of thinking than the one that created it. We need to draw our systems boundaries wider, consider longer temporal frames for our goals, focus on process and interconnectedness and notice tensions and paradoxes as this is where we can learn and grow. The reality is that systems are nested within each other.

Many practice directors have been successful clinicians, and this has led them in turn to establish a group practice and to induct practitioners into their practice, give them referrals, mentor them and generally grow a business via this expansion. But practice development and expansion doesn’t happen in a bubble and there are many business and practice decisions to be made and these occur often on the basis of the individual personal characteristics and capacities of the practice director and their experience of being a successful clinician but not so much on the basis of a rigorous understanding of how to be a successful practice director.

The system that a successful clinician set up for themselves may not adapt to the expansion because of a lack of understanding of the differences between their way of experiencing change and that of the clinicians they seek to join their practice. There is a need to understand the impact of systems on clinicians and the complexity of team dynamics, for example.

As an example of how a bigger perspective changes our understanding:

Contracting in psychology private practice is common. The splits vary in terms of the amount a practice director may keep of the fee earned as part of a providing the services (e.g. referrals, intake services, office administration, bookkeeping etc). So, the clinician who offered the service may get between 50-70% of the fee a client paid depending on the agreed split. What is the basis of determining the split? Practice directors report that they look at what is the common approach across the market, they look at their expenses, they consider what is “fair”, they talk to accountants and other advisors and then they determine the split. They communicate it to the clinicians who accept it or otherwise.

What’s wrong with that process? There is often limited investigation as to theories/frameworks and models that the advice is situated in and how a certain status quo in terms of splitting/contracting came to be the accepted norm. Can the practice director describe what their philosophy is and how it drove their decisions in terms of managing a practice and what would a fly on the wall see if they watched them working as a practice director for a day or two in regards this splitting fee policy and how it is nested within other policies and ways the practice as a whole functions?

This reflection process is not navel gazing for its own sake. Once these types of decisions are made, often with little examination of the values and beliefs that drive them, you are then stuck with them. If you want to change from a contracting model to a room rental model or to an employee model or some other hybrid of these choices, how do you persuade your contractors to change and accept the new approach? Practices who have been established for some years are currently considering these questions considering the nested systems they are operating in that include community demands, government responses to various reports and commissions.

Another example is the decisions that needed to be made in March 2020 with the declaration of the COVID-19 pandemic by the WHO. Can you look back at how you decided on service provision under COVID-19 and recognize a strategy? What was your mindset at the time? Were you complacent? Were you panicked? Did you have multiple plans for multiple scenarios but wondered which one to chose when? Did you have the right infrastructure and business arrangements in place to be informed and able to go to practitioners that work with you, clients, banks, landlords, the ATO, accountants etc.?

Some choices that practices considered included:

  • Cease all face-to-face consultations and move to on-line immediately.
  • Continue to offer both face-to-face consultations and telehealth
  • Communicating fees regarding service provision

All our operating assumptions were up for examination. Which practitioners pulled with you and which ones were focused on themselves and their fears? Was your business structure robust or did the problems with cash flow, lack of contingency planning, sustainability of your P& L all create extra pressures and stressors.

An interesting exercise is to list all of the assumptions you have made about your practice/business and how it operates and then go through them searching for the assumptions that will assist you with the changes we are experiencing. Think about the constraining assumptions in your practice/business that prevent innovation and challenge them. There are going to be pain points in our economy soon with high unemployment being predicted and purchasing power severely compromised. How will your fee policy, your practitioner’s capabilities and overall approach to your community and referrers respond to these shifting sands? There will potentially be high demand for mental health services and difficulties with co-payments on top of Medicare reimbursement. Is your business strategy and (growth) mindset nimble enough to adapt, focus on the outcomes of the clients and manage the other stakeholders (staff, referrers etc.)? Do you need to source other work for your practice? Speaking anecdotally, Medicare Australia funds (in part) up to 75% of clients that seek private psychology services. Should other opportunities be sought out that provide solutions to this reliance as a medium-longer term plan? These are the kind of questions that often get shelved due to the demands of everyday life and keeping the doors open.

The pandemic may make us re-consider the notions of “the growth mindset” (have a look at Carol Dweck’s book Mindset and her presentation on TED)  in the face of a crisis, the need to interrogate data that addresses the performance of the practice on a regular basis and the importance of learning in order to improve.

Ref:  Dweck Carol, (2017) Mindset-updated Edition: Changing the way you think to fulfil your potential, Robinson, England UK.

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Kaye Frankcom

GAICD, B.A, B.S.W, Grad Dip. Counselling. Psych., Master Clinical Psychology, Master of Science in Medicine (Pain Management)

Kaye is a highly accomplished businesswoman, and leader in the health sector. She is an endorsed clinical and counselling psychologist, consultant and business coach to psychologists, in-demand speaker and trainer and has held national roles in psychology regulation and professional standards. She built a successful group psychology practice in Williamstown, Victoria which she sold in 2018. She is the lead author of Fit for Practice: Everything you wanted to know about starting your own psychology practice in Australia but were afraid to ask (co-authors Professor Bruce Stevens and Dr Phil Watts. Published November 2016). She consults and offers training in clinical governance to the health sector. She provides (business and clinical) coaching, mentoring and clinical supervision to practices across Australia.

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