Getting referrals, where am I off?

[deleted1129370]

Hi folks, I have a group private practice that operates 100% via tele-health. We accept most major PPO insurance plans, and see folks across 44+ states since all of us have PSYPACT credential. In the past year, I have literally sent out over 800 emails to various physician practices ranging from psychiatry, family medicine, internal medicine, neurology, PM&R, addiction/SUD facilities, and even chiropractors. I've even cold called probably 20-30 different hospitals in the Houston area, most of whom don't respond or have confusing automated set ups, and the ones that have picked up are very convoluted answers from various staff members. I've gone door to door at this local medical complex and handed out about 100 fliers with my card. I've also gone to a face to face meet and greet at a local SUD treatment program. Now, I have my assistant send out 20-30 emails a day to various practices and hospitals, make social media posts across all 6 of our social media platforms, and respond to "in search of" posts on Facebook each day.

My practice accepts most major insurances, we are tele-health which helps increase access to care, we offer evening times (up till 9PM), open on Saturdays from 11AM to 4PM, we offer services in Spanish. We do both therapy and assessments.

You would think with the mental health crisis people keep talking about, that we have hit most of the major hot topic buttons to help assuage people's concerns to get them in the door. We don't really have a referral source with a heavy and steady volume, which is ideally what I am looking for. We get a few recommendations and referrals from some folks who've responded to our marketing efforts.

What am I missing? How can we get more steady, and high volume referrals?

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[littlefred]

Are you psychotherapy only?

 

[deleted1129370]

Are you psychotherapy only?

No, we do therapy and assessments.

 

[Egg122]

How selective are you in screening out patients? Also, what kind of therapy do you offer? I find the availabilty for more specialized therapy is almost non-existent but there is are an abundance of therapists looking to pick off worried well or more simple issues in my area- particularly with telemedicine only.

 

[comp1]

Wouldn't most referrals come from insurance companies? I can't imagine cold calling does much good. PsychologyToday?

 

[deleted1129370]

How selective are you in screening out patients? Also, what kind of therapy do you offer? I find the availabilty for more specialized therapy is almost non-existent but there is are an abundance of therapists looking to pick off worried well or more simple issues in my area- particularly with telemedicine only.

We aren't very selective because we see a wide range of presenting concerns. There are certainly some things we don't see or work with, but that tends to be in the minority. I do not like the whole "stick with a niche" model at all. So we are varied. I see folks for depression (uni or bi), anxiety, panic, phobias, PTSD, chronic pain, OCD, SUD, and LGBT issues. My other providers have similar backgrounds.

 

[deleted1129370]

Wouldn't most referrals come from insurance companies? I can't imagine cold calling does much good.

Nope....we get like a few here and there, typically from Optum. Nothing from BCBS, and maybe a few from Cigna. Nothing from Aetna, and nothing from TRICARE.

 

[calvnandhobbs68]

So most people on here are going to be psychiatry, so unsure how applicable our advice is to your psychotherapy pratice.

I guess I'm slightly confused as to the question....are you looking for one major referral source to provide you with a steady stream of patients or do you just not have enough patients in general?

I'm not surprised you cold calling hospital systems/practices hasn't been very fruitful, you're unlikely to get the right person in a big hospital system. Your emails are probably going right in the trash at a lot of doctors offices.
I think it's going to be very difficult if you're not part of the system to get referrals from outpatient practices in a large health system unless they've had several patients go to you before or had a good experience with you, they'll just refer people in-system (so for instance a doc in a cleveland clinic owned FM clinic is typically just gonna take the path of least resistance and give a patient a number for the CCF behavioral health intake line cause Epic probably pulls that up for them automatically).

I think you're at a disadvantage being 100% virtual for therapy and you're probably in a much more saturated market nationally. Even for very specialized options (eating d/o, OCD) I have plenty of patients balk at virtual only therapy. For more general stuff, what exactly is differentiating you from BetterHelp, Cerebral, Talkspace? Because all your referral sources can just hand patients those websites too. I'm sure you're actually better than them, but how do those referral sources know that?

 

[Jules A]

In my area medication management seems to be the key. Do you have a psychiatrist or are you selling therapy services only?

 

[Sushirolls]

To piggy back of @calvnandhobbs68 ; your aren't as big or cringy as the 'talkspace' type places, but not small or local enough to get a true local referral. When people see all online, it lowers their impression as a referral source. People still want the local brick and motor person. I have one local psychologist who called and talked with me and sends me business cards when I ask, who I've likely filled up with referrals. But this person lives local, despite being 100% telemedicine, so that aids in local rapport building. The local market for me in middle of nowhere is hard to get in for therapy. But as far as me directly add a 100% telemedicine firm to my usual referral list, I likely won't. I will preference local players, and leave patients to stumble into a telemedicine only firm themselves. Also because of the larger cringe worthy telemedecine firms not having the best experience for patients, this impression carries over for most other tele specific spamming I get.

Conversely, I moved my office, and over a 2 year period I lost like 75% of my panel from that original location because the patients wanted someone local. Despite my access and quality and hours didn't change. Currently 60-70% of my patients after the first visit opt for telemedicine.

So you might want to have a brick and mortar location, that then builds up to be telemedicine over time. This will get more traction from local entities.

Also as others pointed out Big Box Shops will likely keep referrals internal - even when their own entities are backlogged... So you are looking at small independent PCP groups or psychiatry groups to refer to. Psychology today will be the better marketing source - but again, if everything screams 100% telemedicine, its hard to differentiate your group from every other person trying to do 100% telemedicine. Most patients want in person for therapy. And that's what they are looking for even on Psychology Today.

*Now If I got spammed, DBT only. Or got spammed with CBT only purist. I would bite. I would definitely refer to a CBT pure therapist or DBT work book focused therapist.

 

[deleted1129370]

I also need to mention we have presence on Psychology Today and Mental Health Match. I also tried ZocDoc which was terrible. I also run Google Ads, and I have a marketing company that since re-designed my website to enhance SEO. It was very much worth it. I actually have a solid background in web design, but they are professionals, and it was worth the $2600 I paid. These efforts have led to more referrals, but not at the frequency I would like. Ideally I should be able to get about 5-8 calls for each provider (I have 3 other psychologists) per week to fill up their schedules and to account for attrition.

To answer some questions others have posed, I have structured my practice to operate very different from other large venture capital backed sites because it's owned by me, not venture capitalists. Rather than spend 10-15 minutes going through an interrogation to possibly be matched to a provider, who then may or may not reach out promptly, patients go to our site, they literally click "book now" and in 1-2 minutes they would have already booked their appointment with any of our providers. Also, they can just call our office and I have an admin assistant whose sole job is to just answer the phones to get folks scheduled and to verify their insurance benefits. Unlike those other websites, we aren't restricted in who we can see across state lines.

I have no desire to have a physical office space as a big reason for designing my practice the way I have was for flexibility. I don't want to trek into an office space anymore, I did that for years at several VA systems in Ohio and here in Houston. I like operating from the comfort of my home. It also tends to correlate with markedly reduced no shows and late cancellations since most of them then can make their appointments even if they are just getting off of work and don't need to fight traffic to show up to the office 10-15 minutes late (at which point makes me get backed up in my day).

Like I said earlier, I have sent out so many emails to various practices and hospitals, most of them local, especially more mom and pop type of family medicine practices and psychiatry practices. I have one psychiatrist here in Houston who does send me semi-frequent referrals since I am one of very few in the Houston area that accepts insurance.

Another thins that distinguishes our practice from others, is that it's comprised of all psychologists, not master's level providers. We also have a clinical pharmacist who does medication therapy management services as needed.

Basically, I have an extremely streamlined practice that operates like a well oiled machine. I earn about $17-18K a month from my income alone. I am wanting to grow this 3x, 5,x, etc. with filling up my other providers' schedules. In the end, I need a high volume referral source.

 

[KaiBuzz]

Have you confirmed with all the health plans that you’re listed as an in network provider and accepting new patients? You can easily check their online directories.

 

[deleted1129370]

Have you confirmed with all the health plans that you’re listed as an in network provider and accepting new patients? You can easily check their online directories.

Absolutely. That was one of the very first things I did.

 

[Sushirolls]

Well, that's good news you are making money and paying yourself. That's a win.

I don't know why you have a pharmacist. That's a waste of money. They know nothing of psychopharm and real world applicability, and seldom offer more than an epocrates drug interaction check for value. Save your self some money there and get rid of the pharmacist - that's a high dollar expense for no gain. If I see a psychology group has a pharmacist on their list of service, that's a red flag right there to not refer. Its a sign of a lack of understanding of pharmacotherapy and what psychiatry is and who has the knowledge base to do it.

In summary, your real issue really is matching the desired growth to actual growth; but not the realm of solvency for the practice. So that's good news.

You state you're not interested in brick and mortar; and you've listed most everything for advertising strategies, I don't see how else you can change or optimize. You may simply be up against a brick wall for growth rate that won't change - unless you turn this into another venture capital / private equity beast. So if you can't force more patients in, you might need to force therapists out, until the demand is actually there...

Matching up growth to demand is a struggle for many industries, and even clinical practices. Sorry this may be an issue for you. It sucks.

 

[TexasPhysician]

Your biggest hurdle is being 100% telehealth. Your 100% telehealth competitors are spending tons of $$$$ on advertising. As a local psychiatrist, I only refer to psychologists and therapists with an in-person location that I’ve met in-person. Doing in-person and tele psychiatry optional, I 100% believe that psychiatric diagnoses are more accurate when made in-person. My consents even state that online appointments have greater risks of errors, and they must sign acknowledging this. I have tons of patients that tell me that in-person is higher quality than online. It also gets patients out of their house which can be therapeutic in itself.

I type all this not to convince you to change your model, but it does highlight your roadblocks to success. Do you market to many other tele only clinicians? Online-only is a niche in itself.

Clinical pharmacist? Pharmacists can be helpful with sourcing medications, but their pharmacology is not good.

 

[Sushirolls]

I almost married a PharmD. Topped their massive class and at a top 5 pharmd school. Did a very competitive 2 year pharmD residency. I too am intimately aware of what they know and don't know. And the superb intellect of this person, still its questionable what they have to offer. And simply because large health systems have leaned into using "residencies" to select for whom they hire for the coveted inpatient jobs [i.e. gets them out of retail] doesn't mean its a proof of concept that they should. The sporadic deficiencies of some physicians (and PAs ARNPs) not catching their drug interactions is a fault of the clinician not the field of physicians as a whole. They just aren't medicine experts. There was little to no benefits in the degree creep of RPh to PharmD, if anything it was loss as the number of programs decreasing the exposure to compounding.

Every time I rounded on non-psych services in residency that had a rotating pharmd, it was a waste of resources.

It truly is our job to know the meds. To know the reactions. To get trained not just in outpatient psychiatry but do IP, State hospitals, community mental health, transplant services, bariatric, eating disorder, the list goes on, and the conflicts of meds/conditions/age/social ramifications etc and their interface with meds. Being armed with an epocrates drug checker is just not sufficient. The calls I get from retail pharmacist, who typically weren't competitive enough to get pharmd residencies are just mind boggling. 'Yes, pharmacist colleague, that is the prescription, it is indicated and it is appropriate, I'm sorry you don't know the everything of how/why meds are used.'

You've come here asking for feedback. Others and even I have given you excellent feedback. Doesn't mean you like it. Or have to enact it.
@TexasPhysician is seasoned, legit with a sizeable group practice. He walks the walk. But accept the feedback you are getting is the valuable harsh truth you wanted when you first posted. We have offered the fresh eyes from a different angle of a problem that you've been coming at from one direction. I wonder now if the other valuable more experienced Psychiatrists on here are going to further contribute. Perhaps just say thank you and flush the ideas you don't like later?

Here is a similar, comparable practice [but is cash only], also psypact, mailing that I got in the mail. w w w dot V e r i t a s P P dot c o m
In essence competition to the mailings that offices might receive, when yours arrives. Might be informative.

 

[deleted1129370]

While I can appreciate your feedback, it doesn't mean I have to blindly accept it. Especially if some folks just blurt out some generalized comments that people may disagree with. I am also free to express some pushback. that's fine if others wouldn't want to respond, I usually am hesitant to post on here as folks really don't know each other and make very generalized statements. Again, while I can see some points made, I don't necessarily agree with some of them. I'm allowed to express that. Conversations go both ways - if someone says something that is a bit offensive, I may be inclined to point that out. I receive the same treatment by my fellow psychologists if I might say something they may not agree with. We can sit here all day recounting our unique experiences, and I doubt you, me or others are going to fundamentally change our minds here. I am looking for other explanations or suggestions. We've already gone through some people's thoughts on this, let's move on.

 

[calvnandhobbs68]

I also need to mention we have presence on Psychology Today and Mental Health Match. I also tried ZocDoc which was terrible. I also run Google Ads, and I have a marketing company that since re-designed my website to enhance SEO. It was very much worth it. I actually have a solid background in web design, but they are professionals, and it was worth the $2600 I paid. These efforts have led to more referrals, but not at the frequency I would like. Ideally I should be able to get about 5-8 calls for each provider (I have 3 other psychologists) per week to fill up their schedules and to account for attrition.

To answer some questions others have posed, I have structured my practice to operate very different from other large venture capital backed sites because it's owned by me, not venture capitalists. Rather than spend 10-15 minutes going through an interrogation to possibly be matched to a provider, who then may or may not reach out promptly, patients go to our site, they literally click "book now" and in 1-2 minutes they would have already booked their appointment with any of our providers. Also, they can just call our office and I have an admin assistant whose sole job is to just answer the phones to get folks scheduled and to verify their insurance benefits. Unlike those other websites, we aren't restricted in who we can see across state lines.

I have no desire to have a physical office space as a big reason for designing my practice the way I have was for flexibility. I don't want to trek into an office space anymore, I did that for years at several VA systems in Ohio and here in Houston. I like operating from the comfort of my home. It also tends to correlate with markedly reduced no shows and late cancellations since most of them then can make their appointments even if they are just getting off of work and don't need to fight traffic to show up to the office 10-15 minutes late (at which point makes me get backed up in my day).

Like I said earlier, I have sent out so many emails to various practices and hospitals, most of them local, especially more mom and pop type of family medicine practices and psychiatry practices. I have one psychiatrist here in Houston who does send me semi-frequent referrals since I am one of very few in the Houston area that accepts insurance.

Another thins that distinguishes our practice from others, is that it's comprised of all psychologists, not master's level providers. We also have a clinical pharmacist who does medication therapy management services as needed.

Basically, I have an extremely streamlined practice that operates like a well oiled machine. I earn about $17-18K a month from my income alone. I am wanting to grow this 3x, 5,x, etc. with filling up my other providers' schedules. In the end, I need a high volume referral source.

Hey you don't need to convince us, you need to convince your referral sources and patients. You're trying to give the impression in this post you've got it all figured out but if that was the case you wouldn't be saying stuff like "You would think with the mental health crisis people keep talking about, that we have hit most of the major hot topic buttons to help assuage people's concerns to get them in the door" or not even realizing who you'd need to talk to in a large hospital system.

Cool you and all your other co-workers like to sit in your home office and do tele, that's fine just realize it can put you at a competitive disadvantage. We also all do telemed in some way or another...you don't need to convince us that it's easier to sit in your PJ bottoms and a polo than get dressed and drive into the office.

Emails are gonna get you nowhere. If I got an email from some random therapy group I never met I'd delete it. There are way too many terrible therapists out there and I'm gonna assume the ones who are mass emailing aren't full for a reason.
How are you even sending emails to "hospitals"...like do you even know who specifically in the hospital you should be sending it to? If the information never gets to the social worker who does discharge planning from the hospitals PHP for instance, it's basically useless.
You're describing a bunch of stuff that happens on your website AFTER someone actually gets to that website for an intake. That's not helpful if the patient never gets to your website in the first place.

Anyway, I don't know if you're going to find some kind of singular referral source that gives you 15-24 calls a week for therapy.
The people you're onboarding are probably going to scale at the same rate you initially scaled unless you already have a waitlist or you're particularly well known in the area and people were just waiting for you to open up availability.

 

[deleted1129370]

Hey you don't need to convince us, you need to convince your referral sources and patients. You're trying to give the impression in this post you've got it all figured out but if that was the case you wouldn't be saying stuff like "You would think with the mental health crisis people keep talking about, that we have hit most of the major hot topic buttons to help assuage people's concerns to get them in the door" or not even realizing who you'd need to talk to in a large hospital system.

Cool you and all your other co-workers like to sit in your home office and do tele, that's fine just realize it can put you at a competitive disadvantage. We also all do telemed in some way or another...you don't need to convince us that it's easier to sit in your PJ bottoms and a polo than get dressed and drive into the office.

Emails are gonna get you nowhere. If I got an email from some random therapy group I never met I'd delete it. There are way too many terrible therapists out there and I'm gonna assume the ones who are mass emailing aren't full for a reason.
How are you even sending emails to "hospitals"...like do you even know who specifically in the hospital you should be sending it to? If the information never gets to the social worker who does discharge planning from the hospitals PHP for instance, it's basically useless.
You're describing a bunch of stuff that happens on your website AFTER someone actually gets to that website for an intake. That's not helpful if the patient never gets to your website in the first place.

Anyway, I don't know if you're going to find some kind of singular referral source that gives you 15-24 calls a week for therapy.
The people you're onboarding are probably going to scale at the same rate you initially scaled unless you already have a waitlist or you're particularly well known in the area and people were just waiting for you to open up availability.

This makes sense. I think there were a few times where I did try to reach the discharging SW, but I think I spoke to one person, so perhaps emphasizing that would be ideal. I've suspected the email campaigns were a waste, but we've had maybe one or two recent referrals where the folks referring to us were from our email campaigns, but that is a poor return on that strategy as we've been discussing.

Regarding our traffic it's been very substantial (I've posted a screenshot of our data below), especially compared to last year. Our marketing company has been measuring outcomes and have seen very solid and linear results from our approaches thus far, so SEO and Google Ads are paying off to a good extent, but again, the present conversion rate is not at the level I am hoping for. I see this as a multi-pronged approach where on one hand, I want to maximize our internet marketing/SEO approaches while on the hand, we are significantly maximizing our referral sources.

It seems like maybe we should be more specific with the contacts we select from hospitals to be more strategic. It would make sense that our emails are being trashed for the reasons you pointed out, and was something I brought up to my marketing company, and they also agreed that emails are likely to yield minimal results.

Also....I prefer working in shorts and a polo or t-shirt, waking up to make a nice breakfast and have French pressed coffee over getting up at 6AM to sit in 40 minutes of Houston traffic, parking a football field away and trekking into an office like I once did. I also like being able to see my patients anywhere in the world where I may be. That for me, is a massive improvement to quality of life.

 

[Sushirolls]

Google ads just aren't productive unless you are a large PE group.
Website traffic means nothing.
I used to watch and pay attention to my "quality" website data and it didn't correlate to anything. Thousands of views also. But no correlation to calls. And when you do look at the phrases that preceded finding the website...

Big Drum Roll

It was ... Psychiatrist near me

Or something similar Psychiatrist in My Town

A telepsychology practice doesn't have that to route traffic. And I suspect that same behavioral pattern/preference exists for people seeking:

Psychologist near me
Therapist near me
Therapy near me
Counselor near me

With my practice I note that I do telemedicine, and have licenses in X states. Still, I only get inquiries from the area I used to be, because old referral patterns die hard, some PCPs still think I'm in the area. And in my current area because of developing referral patterns, google searches 'near me', zip codes on Psychology Today. It is very, very, very rare to get calls from people outside those geographic areas. Like 2 per year.

 

[Liquid8]

I think people need to know the person they’re referring to.

Emails, cold calls, posting out fliers or handing out business cards without direct personal contact (as in through a receptionist or practice manager) are unlikely to leave a positive lasting impression. I think I have probably met most of my regular referrers in person – some I have worked with before, but most are mainly through providing a lunchtime in-service at their practice or running education sessions for CPD at the hospital I’m attached to.

I receive feedback from a lot of patients that they do not like telehealth only services although my patient population may be biased, as I mainly provide face to face services. I take the view that there’s something about the setting for a consultation that adds therapeutic value, and not all patients have access to a similar space at home or at work that is appropriate.

While there’s no doubt telehealth is more convenient for the service provider, giving a patient the opportunity to temporarily leave their usual environment (which in some cases may be contributing to their distress) may provide some temporary respite and likely outweighs any personal inconvenience.

 

[dl2dp2]

You are growing slowly, tho, right?

Btw, your experience is not unique. Especially for psychotherapy, the market is kind of tough and saturated for the most part.

 

[deleted1129370]

Correct, we are growing. Where we are today is vastly different than last year. I was making about $10K a month steadily last year, and beginning early 2024 I slowly went up to hovering around $12-14K, then these last 3-4 months I've been hitting $17-18K. The data I posted above is commensurate with what I am describing and what me and my marketing team have been tracking. This is just on what I bring in alone, not including my other 3 contractors. The idea is I want to accelerate the growth so I can fill up each of my providers' schedules with 20-25 patients a week, and of course, add more as time goes by. My primary business goal is that I could be earning $200K or more a year via passive income, that will allow me to travel, etc.

While I can certainly appreciate the value of in person sessions, and that was what I was used to doing for a long time, I found it no longer preferable. If other patients want that, that's fine, they can go see a provider who offers that, but the data Ive been seeing shows more favorability towards providers offering tele-health and/or a combined offering of in person with flexible tele-health options, the least amount of people want in person only visits. That is consistent with what I've observed with a lot of my colleagues I know around Houston area who are frequently advertising to sub-lease their office space because they can no longer afford the overhead expenses and are moving into a tele-health only practice operation.

I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. It was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Case in point, there is a dental practice here that specializes in sleep dentistry and they paid for me and like 12 others to attend a very nice 4 course meal at Perry's Steakhouse while they presented a powerpoint on their practice. Booze included. I certainly didn't follow up with them, but I was happy for the free meal. Those are my thoughts.

Surely there has to be other things we are missing here as if the bigger reason for my slow progression with scaling is mostly due to the fact that I am tele-health only, not providing free lunch meetings to folks in the community, and having a clinical pharmacist on staff (who is my husband)....these seem very suspect as far as reasons. They could be true (to an extent). I actually had a psychiatrist in San Antonio call me to ask me what my needs were, etc., and they were trying to market their practice, granted, it wasn't a good fit because they are cash pay only, and majority of my patients are insurance based and will not pay $400+ an hour for a medication. However, if that is a strategy to try using, perhaps it's worth trying to get ahold of a live psychiatrist in some of these practices. Maybe that would improve the situation?

 

[Egg122]

"I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. IT was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Those are my thoughts."

This is very normal and common in the medical field and specialists will frequently come and introduce themselves in a lunch. It is a way to create a human to human connection. Primary care offices are also very overwhelmed and many times the only break they get (if they get a break at all) is at lunch. Offering lunch also draws the office staff, who many times are the ones who actually set up the referrals and provide patients with the information for them. This lunch gives you an opportunity to listen to the needs of the practice and explain how your practice can meet their needs and what differentiates you from the VC backed online firms of the world. So, while it may not seem ideal, investing a minimal amount money into this by doing it for several select high volume practices may create more value for you than paying marketing people to send emails. Trust me, if they think you are not good they will not be referring patients to you simply because you brought Panera once so it only serves as an entry way for your to highlight your practice's talents and skills. You do not want to do what that dental office did and invite random people to an expensive dinner just because they have a clinical license- that is just bad marketing.

Also, if you are looking to scale the business and reduce your own hours to earn passive income, it will involve you taking more of a hand on the administrative side of things. You may have to consider cutting back your hours in direct patient care to achieve this goal.

 

[deleted1129370]

"I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. IT was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Those are my thoughts."

This is very normal and common in the medical field and specialists will frequently come and introduce themselves in a lunch. It is a way to create a human to human connection. Primary care offices are also very overwhelmed and many times the only break they get (if they get a break at all) is at lunch. Offering lunch also draws the office staff, who many times are the ones who actually set up the referrals and provide patient's with the information for them. This lunch gives you an opportunity to listen to the needs of the practice and explain how your practice can meet their needs and what differentiates you from the VC backed online firms of the world. So, while it may not seem ideal, investing a minimal amount money into this by doing it for several select high volume practices may create more value for you than paying marketing people to send emails. Trust me, if they think you are not good they will not be referring patients to you simply because you brought Panera once so it only serves as an entry way for your to highlight your practice's talents and skills. You do not want to do what that dental office did and invite random people to an expensive dinner just because they have a clinical license- that is just bad marketing.

Also, if you are looking to scale the business and reduce your own hours to earn passive income, it will involve you taking more of a hand on the administrative side of things. You may have to consider cutting back your hours in direct patient care to achieve this goal.

I think you make some good points here, so I appreciate it. I will reflect on this more. I actually like the admin stuff. I have an admin assistant I am training to be a practice manager in the future as we grow, however, before hiring her, I did everything. I was doing all of my marketing, billing, insurance verification, and I got myself credentialed with insurances, I didn't hire an insurance credentialing company to do it for me. I've literally done everything in my practice, so that when I delegate, I know exactly what I want, what I am looking for, etc., and it helps me teach others and expand our business as a result of this. Truly, much of my desire is to manage the business, as they say "work on the business, not in it." I do like clinical work, and I will do some, but by no means at the volume I am doing now. I see 30 folks a week, it's very draining, and it is not something I want to sustain. I have certain financial goals in mind and this is a business, like any other, that can help me achieve those goals.

 

[Jules A]

Generally speaking my patients want in person for therapy especially initially to build a solid rapport. Even with med management about 30% request first time in office then change to virtual. When you are at home in your comfy pants without offering any office encounters that is certainly your choice but recognize it is reducing your client pool. If you were invited to an office for lunch meet & greet and declined you likely missed a significant opportunity in your community. In my experience having contacts- friends and colleagues in the area is the way to get referrals.

 

[calvnandhobbs68]

I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. It was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Case in point, there is a dental practice here that specializes in sleep dentistry and they paid for me and like 12 others to attend a very nice 4 course meal at Perry's Steakhouse while they presented a powerpoint on their practice. Booze included. I certainly didn't follow up with them, but I was happy for the free meal. Those are my thoughts.

I have certain financial goals in mind and this is a business, like any other, that can help me achieve those goals.

It sounds like you really just don't know what you want and also don't really get basic concepts like return on investment. You're not actually thinking like a business person and thinking very short term. Also, get used to "feeling transactional" if you want to run a business....

ROI is actually very high for these types of interactions, that's why businesses do them. Why do you think drug companies are constantly asking me if I want to do lunch every month even though I barely prescribe some of these drugs? Because they know that if I even put 1 more patient than I usually would on Qelbree or Azstarys or Dynavel or Rexulti or whatever, that they've basically made all their money back for all their lunches for the year plus more.

If you spend $150 on lunch to talk to a PCP's office and their staff about the kind of services you can offer their patients and you get ONE more referral EVER than you usually would from that office with a weekly psychotherapy patient, you've returned many multiples of that investment.

 

[deleted1129370]

It sounds like you really just don't know what you want and also don't really get basic concepts like return on investment. You're not actually thinking like a business person and thinking very short term. Also, get used to "feeling transactional" if you want to run a business....

ROI is actually very high for these types of interactions, that's why businesses do them. Why do you think drug companies are constantly asking me if I want to do lunch every month even though I barely prescribe some of these drugs? Because they know that if I even put 1 more patient than I usually would on Qelbree or Azstarys or Dynavel or Rexulti or whatever, that they've basically made all their money back for all their lunches for the year plus more.

If you spend $150 on lunch to talk to a PCP's office and their staff about the kind of services you can offer their patients and you get ONE more referral EVER than you usually would from that office with a weekly psychotherapy patient, you've returned many multiples of that investment.

I would not jump to conclusions about knowing me or my background, you are making inferences off what I've posted, but please know, I do understand and appreciate business. I may be making different decisions than you, and most businesses do vary in their decisions relative to their competition. Some are more successful than others by the decisions they make. I have taken into consideration what you and others have said, and you make solid points, so I am evolving on the matter regarding doing lunch meetings.

I have made a lot of decisions in my business where I had to front large sums of money with the gamble and hope that I would be getting a ROI. Just because I elected to not provide lunches to people in the past, doesn't mean I don't understand ROI and investment. Again, that's why I am asking for insights and opinions, and I have discussed why I had apprehensions in the past about doing something like offering lunch and greets, but as you and others have described things and your viewpoints, they start to take on a more complete picture, and based on new information, I am evolving on that decision.

In the future, it would be nice to not make assumptions about folks before getting to know them. And yes, this is a defensive posture I am taking somewhat because you are making assumptions about me, my business-mindedness. Nevertheless, I appreciate the insights you and others have provided.

 

[Merovinge]

Sorry boss, but quoting you and then providing feedbacks on those quotes is the best case scenario when posting on a (very helpful) forum/message board. Someone took their time (which is worth probably $300-600 an hour) to provide you with examples of why this type of business practice is standard practice. This is clearly not something that is part of training in PhD or MD programs. Given how many people here run their own successful practices, might be worth further consideration rather than defensiveness. If I ever start my own practice, I would love to have constructive criticism by many members who post here regularly, it would frankly be worth thousands in consulting costs.

 

[littlefred]

Sorry boss, but quoting you and then providing feedbacks on those quotes is the best case scenario when posting on a (very helpful) forum/message board. Someone took their time (which is worth probably $300-600 an hour) to provide you with examples of why this type of business practice is standard practice. This is clearly not something that is part of training in PhD or MD programs. Given how many people here run their own successful practices, might be worth further consideration rather than defensiveness. If I ever start my own practice, I would love to have constructive criticism by many members who post here regularly, it would frankly be worth thousands in consulting costs.

Also posted on the wrong forum.

 

[smalltownpsych]

It is hard to give advice for how to target such a big market. More internet advertising is the way the other online platforms do it. Popular streamers is one way they did It. Marketing small localized practices is more of what most of the folk on here do.

 

[Candidate2017]

You're making about double the average doctoral level therapist. All businesses have a ceiling. Perhaps it's time to invest in something else. This is kind of a first world problem with about as much insight as a cardiologist complaining about making $2 mil.

Also, there's no mental health crisis. There's just a bunch of people not willing to do what they need to do, including politicians.

I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. It was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Case in point, there is a dental practice here that specializes in sleep dentistry and they paid for me and like 12 others to attend a very nice 4 course meal at Perry's Steakhouse while they presented a powerpoint on their practice. Booze included. I certainly didn't follow up with them, but I was happy for the free meal. Those are my thoughts.

Bluntly, I'm not sure you're a good therapist as you don't seem to understand healthy relationships involve give and take.

You seem all about me, me, me. Your attitude is basically, "I ain't gonna waste my time, my money/clinical billing. Why can't these damn PCPs waste their time, their money/clinical billing to accommodate ME??? But, I'd happily have someone else pay the bill for my food and booze, suckas!!!"

 

[the5thelement]

Yes unfortunately the OP almost sounds like a troll trying to get a rise out of all the well meaning people who have offered their valuable advice. There is no way I would ever send any patient to someone who acts like this.

 

[Jules A]

Also, there's no mental health crisis. There's just a bunch of people not willing to do what they need to do, including politicians.

AMEN!

 

[TexasPhysician]

Correct, we are growing. Where we are today is vastly different than last year. I was making about $10K a month steadily last year, and beginning early 2024 I slowly went up to hovering around $12-14K, then these last 3-4 months I've been hitting $17-18K. The data I posted above is commensurate with what I am describing and what me and my marketing team have been tracking. This is just on what I bring in alone, not including my other 3 contractors. The idea is I want to accelerate the growth so I can fill up each of my providers' schedules with 20-25 patients a week, and of course, add more as time goes by. My primary business goal is that I could be earning $200K or more a year via passive income, that will allow me to travel, etc.

While I can certainly appreciate the value of in person sessions, and that was what I was used to doing for a long time, I found it no longer preferable. If other patients want that, that's fine, they can go see a provider who offers that, but the data Ive been seeing shows more favorability towards providers offering tele-health and/or a combined offering of in person with flexible tele-health options, the least amount of people want in person only visits. That is consistent with what I've observed with a lot of my colleagues I know around Houston area who are frequently advertising to sub-lease their office space because they can no longer afford the overhead expenses and are moving into a tele-health only practice operation.

I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. It was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients). Case in point, there is a dental practice here that specializes in sleep dentistry and they paid for me and like 12 others to attend a very nice 4 course meal at Perry's Steakhouse while they presented a powerpoint on their practice. Booze included. I certainly didn't follow up with them, but I was happy for the free meal. Those are my thoughts.

Surely there has to be other things we are missing here as if the bigger reason for my slow progression with scaling is mostly due to the fact that I am tele-health only, not providing free lunch meetings to folks in the community, and having a clinical pharmacist on staff (who is my husband)....these seem very suspect as far as reasons. They could be true (to an extent). I actually had a psychiatrist in San Antonio call me to ask me what my needs were, etc., and they were trying to market their practice, granted, it wasn't a good fit because they are cash pay only, and majority of my patients are insurance based and will not pay $400+ an hour for a medication. However, if that is a strategy to try using, perhaps it's worth trying to get ahold of a live psychiatrist in some of these practices. Maybe that would improve the situation?

That is incorrect. I get multiple calls per week to do zoom meetings, hear sales pitches, and discuss others’ services. If you had a thriving practice, would you burn 10-30 hours/month listening to pitches that have no chance of helping you financially? That is time away from family and hobbies. I’m not exaggerating either. Some are so aggressive that they run background checks on my family and call my spouse who doesn’t work at the practice. Buying lunch is one of the few ways to get my attention. I won’t do dinners any longer (time away from family) even if offering Taste of Texas. I do allow a few minutes for local clinicians to chat between patients if they show up in person and wait for me to be free.

If you want to market to referral sources, you need to get in front of difference makers in a way they are willing to listen.

 

[splik]

It sounds like you are actually doing very well. It's not like you're hurting for patients. As discussed above, you have to contend with the fact you are only telehealth, and that you are competing with these online companies who dominate the online market place and are now very heavily advertising on google etc This is still very much a local business so being licensed in 44 states does not actually help to the degree people think it will.

If you are wanting to find some large referral sources I think what you need to do is try to get contracts with some of the larger employers in your areas to offer EAP type services. That space is becoming harder to compete with now as there all the companies like Lyra, Spring health, not to mention insurances like cigna etc offering such services with a lot more clout.

 

[Stagg737]

Surely there has to be other things we are missing here as if the bigger reason for my slow progression with scaling is mostly due to the fact that I am tele-health only, not providing free lunch meetings to folks in the community, and having a clinical pharmacist on staff (who is my husband)....these seem very suspect as far as reasons.

So you're telehealth only and see patients in 44+ states and are advertising nationally and having problems filling? Or am I off base with that?

I showed this to my wife who was in advertising and marketing for 10+ years and you have two options if you want a more steady stream. Focus on targeting patients more locally or on a limited number of markets (2-3 tops) to ensure you're optimizing a narrower audience who will actually find you OR start dropping those big bucks to compete with the nationally scaled companies like BetterHelp and Talkiatry (which will almost certainly cost you 6 figures per year to hire a decent agency to accomplish this). How are people supposed to know that someone 5 states away can see them unless it's popping up in the first 4-5 hits on Google? Answer is they won't and even patients who really want therapy don't know how to dig to find you.

It also tends to correlate with markedly reduced no shows and late cancellations since most of them then can make their appointments even if they are just getting off of work and don't need to fight traffic to show up to the office 10-15 minutes late (at which point makes me get backed up in my day).

I hope this continues to be your experience. I've done outpatient telehealth 5-6 hours a week to a large rural area of our state (4-8 hours from where I'm at) for the past 2 years. My no show rights are slightly higher than our general clinic (7% vs 5%) and my same day cancellations are significantly higher (22% vs 9%). Note, these are not patients who are cancelling and not coming back, they are cancelling and asking to reschedule for a later date. The general attitude is that because it's telehealth that it's not as big of a deal to cancel and reschedule and I've had to reiterate to many of them that this isn't acceptable. Additionally, even though I'm telehealth, many of my patients still choose to go into their local clinic who then connects them to me via an ipad rather than using their own devices. So they're essentially still going "in person" even though all of our appointments are telehealth. If you're going to stay in a local area (like Houston), it may be beneficial to offer your services to a PCP office in exchange for them having an ipad in a broom closet that patients can go do their appointments at. Probably not, but worth a thought.

 

[Therapist4Chnge]

I've called a few offices around town (primary care clinics) and they wanted me to come in person to offer lunch, etc. That felt gross to me. It felt very transactional in that sense. If you want to get to know me, my practice, etc., there's nothing I couldn't say over a Zoom call or phone call that would substantially differ if I came in person paying $150+ for lunch for them and their staff, all the while I am missing out on my own patients because I had to avoid scheduling them to accommodate coming in for a lunch meeting. I hate meetings. It was one of the biggest turn offs at the VA. It's very old school and a waste of my time and money (I'm losing out on money by not being able to see patients).

You COMPLETELY missed the point. First, if they are mid-career or older, then they are accustomed to the model where pharma comes in to pitch their services, and with that comes food/drinks. You aren't gonna want to hear this, but SUCK IT UP. Spending $150-$200 to cater a lunch is CHEAP compared to any other referral source that will produce close to what a solid referrer can send you.

When I first split off to run my own boutique practice I did 3 lunches and they were fruitful. At Office #1 (Occ Med practice) they "knew" me from my prior practice, but they needed to know me as my new biz. I met with providers for maybe 5-10min, but I spent most of the time with staff because they were the ones reminding the providers and handling the f/u stuff. I make a point to treat OTHER providers' staff very well bc a little bit of attention can go a long way. Office #2 (Neurology) and Office #3 (PM&R) both used my office for specific referrals (e.g. pre-surg evals, PTSD therapy, and chronic pain management). Providing food was just a good time to check in and remind them I'm around.

Your biggest problem is you put yourself in the ocean for competition. If you try to market nationally it'll probably be a poor return. I still think going local is the way to go, and then adding outside referrals to supplement the local referrals. Even if you drop $1k/month on an office for yourself to do in-person for a handful of patients a week, having a physical space matters to other local providers. Having defined niches and targeting sources in those niches is key because competing on "we do therapy!" isn't helpful. If you are on insurance panels, you need to know which ones are used by the largest companies in your metro area. I'd take the best reimbursed plans and then take a couple/few weekends and do a bunch of research into them.

You can't be everything to everyone everywhere. Instead, be very good at 2-3 things locally, and then build from there. Look at EAP programs too, as they can be a good door into a place, and after the covered sessions you can often transition those patients to private insurance. I don't take insurance and therapy is only a small portion of what my practice offers, but it still comes down to connections and making it easy for other offices to send you their patients.

 

[Therapist4Chnge]

It sounds like you are actually doing very well. It's not like you're hurting for patients. As discussed above, you have to contend with the fact you are only telehealth, and that you are competing with these online companies who dominate the online market place and are now very heavily advertising on google etc This is still very much a local business so being licensed in 44 states does not actually help to the degree people think it will.

If you are wanting to find some large referral sources I think what you need to do is try to get contracts with some of the larger employers in your areas to offer EAP type services. That space is becoming harder to compete with now as there all the companies like Lyra, Spring health, not to mention insurances like cigna etc offering such services with a lot more clout.

I guess I should have kept reading. 😆

 

[deleted1129370]

You COMPLETELY missed the point. First, if they are mid-career or older, then they are accustomed to the model where pharma comes in to pitch their services, and with that comes food/drinks. You aren't gonna want to hear this, but SUCK IT UP. Spending $150-$200 to cater a lunch is CHEAP compared to any other referral source that will produce close to what a solid referrer can send you.

When I first split off to run my own boutique practice I did 3 lunches and they were fruitful. At Office #1 (Occ Med practice) they "knew" me from my prior practice, but they needed to know me as my new biz. I met with providers for maybe 5-10min, but I spent most of the time with staff because they were the ones reminding the providers and handling the f/u stuff. I make a point to treat OTHER providers' staff very well bc a little bit of attention can go a long way. Office #2 (Neurology) and Office #3 (PM&R) both used my office for specific referrals (e.g. pre-surg evals, PTSD therapy, and chronic pain management). Providing food was just a good time to check in and remind them I'm around.

Your biggest problem is you put yourself in the ocean for competition. If you try to market nationally it'll probably be a poor return. I still think going local is the way to go, and then adding outside referrals to supplement the local referrals. Even if you drop $1k/month on an office for yourself to do in-person for a handful of patients a week, having a physical space matters to other local providers. Having defined niches and targeting sources in those niches is key because competing on "we do therapy!" isn't helpful. If you are on insurance panels, you need to know which ones are used by the largest companies in your metro area. I'd take the best reimbursed plans and then take a couple/few weekends and do a bunch of research into them.

You can't be everything to everyone everywhere. Instead, be very good at 2-3 things locally, and then build from there. Look at EAP programs too, as they can be a good door into a place, and after the covered sessions you can often transition those patients to private insurance. I don't take insurance and therapy is only a small portion of what my practice offers, but it still comes down to connections and making it easy for other offices to send you their patients.

You did see my other responses above right?

 

[deleted1129370]

Yes unfortunately the OP almost sounds like a troll trying to get a rise out of all the well meaning people who have offered their valuable advice. There is no way I would ever send any patient to someone who acts like this.

Not a troll. I was genuinely interested in insights, but it doesn't mean I have to just blindly accept certain tips, nor flagrant mis-generalizations. I would not want to take a referral from someone who jumps to conclusions.

 

[deleted1129370]

You're making about double the average doctoral level therapist. All businesses have a ceiling. Perhaps it's time to invest in something else. This is kind of a first world problem with about as much insight as a cardiologist complaining about making $2 mil.

Also, there's no mental health crisis. There's just a bunch of people not willing to do what they need to do, including politicians.



Bluntly, I'm not sure you're a good therapist as you don't seem to understand healthy relationships involve give and take.

You seem all about me, me, me. Your attitude is basically, "I ain't gonna waste my time, my money/clinical billing. Why can't these damn PCPs waste their time, their money/clinical billing to accommodate ME??? But, I'd happily have someone else pay the bill for my food and booze, suckas!!!"

Again, more flagrant mis-generalizations without knowing much about me. It's scary to know there are providers out there who have these tendencies, then again, I get patients who have come to me telling me they had similar experiences.

 

[Sushirolls]

Well, this thread has run its course. No good deed goes unpunished.

 

[Doctor Eliza]

Very minor point, but is your Psychology Today profile one profile for your practice or a profile for each provider in the practice? A friend of mine is in a group that did individual profiles for each provider and that has been helpful.

 

[ObsequiousAplomb]

Again, more flagrant mis-generalizations without knowing much about me. It's scary to know there are providers out there who have these tendencies, then again, I get patients who have come to me telling me they had similar experiences.

You have zero insight into how insufferable you are. Sad.

 

[littlefred]

You have zero insight into how insufferable you are. Sad.

Agree, we should stop entertaining this thread. Every time they post we should just direct them to : Psychology [Psy.D. / Ph.D.]

 

[Therapist4Chnge]

You did see my other responses above right?

I read your responses, yes. I understand what you are trying to do, but I feel like you’d get a better long-term ROI by leveraging local referral sources. Feel free to ignore my advice, but others pay $350-$500/hr for my consulting expertise, so I think it probably has some value.