Group Practice Referrals

[Oh the Irony]

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I never imagined I would end up in a group private practice environment, but here I am! Given my very limited background in this type of environment (I was heavily research focused in graduate school and in the VA for all of my post-doc clinical work thereafter), I am trying to navigate the process of building a client load. My short-term brain tells me, "full is best!", but my long-term brain tells me that the quality of my caseload is going to have a real impact on my quality of life/work satisfaction. Making clear what kind of clients I do/do not want to work with seems important to establish early on for precedence sake. I am getting some referrals very much in line with my self-described areas of interest, but I am also getting some that are way, way outside my scope (e.g., I work with adults and will get requests to see adolescents/I do CBT for anxiety and PTSD and get requests to see people with schizoaffective disorder, etc.) How do I navigate these politics so I am not viewed as someone who turns away referrals, but not take on a caseload of people that I feel are outside my range?

 

[erg923]

I never imagined I would end up in a group private practice environment, but here I am! Given my very limited background in this type of environment (I was heavily research focused in graduate school and in the VA for all of my post-doc clinical work thereafter), I am trying to navigate the process of building a client load. My short-term brain tells me, "full is best!", but my long-term brain tells me that the quality of my caseload is going to have a real impact on my quality of life/work satisfaction. Making clear what kind of clients I do/do not want to work with seems important to establish early on for precedence sake. I am getting some referrals very much in line with my self-described areas of interest, but I am also getting some that are way, way outside my scope (e.g., I work with adults and will get requests to see adolescents/I do CBT for anxiety and PTSD and get requests to see people with schizoaffective disorder, etc.) How do I navigate these politics so I am not viewed as someone who turns away referrals, but not take on a caseload of people that I feel are outside my range?

You are under no obligation to treat anyone you don't want. You aren't in grad school anymore.

 

[Oh the Irony]

You are under no obligation to treat anyone you don't want. You aren't in grad school anymore.

That's definitely how I would like it to be, because that's what my head tells me. But the front desk handles all the scheduling (i.e., they pick which clinicians to assign to people that call in and this is a process I have no say over) and I don't want them to view me as someone who is picky. Even if this unintentionally biases them, it could have long-lasting effects that aren't conducive to keeping my job.

 

[erg923]

That's definitely how I would like it to be, because that's what my head tells me. But the front desk handles all the scheduling (i.e., they pick which clinicians to assign to people that call in and this is a process I have no say over) and I don't want them to view me as someone who is picky. Even if this unintentionally biases them, it could have long-lasting effects that aren't conducive to keeping my job.

I really would not let a front desk staff member dictate my clinical practice choices and patterns.

 

[psych.meout]

I never imagined I would end up in a group private practice environment, but here I am! Given my very limited background in this type of environment (I was heavily research focused in graduate school and in the VA for all of my post-doc clinical work thereafter), I am trying to navigate the process of building a client load. My short-term brain tells me, "full is best!", but my long-term brain tells me that the quality of my caseload is going to have a real impact on my quality of life/work satisfaction. Making clear what kind of clients I do/do not want to work with seems important to establish early on for precedence sake. I am getting some referrals very much in line with my self-described areas of interest, but I am also getting some that are way, way outside my scope (e.g., I work with adults and will get requests to see adolescents/I do CBT for anxiety and PTSD and get requests to see people with schizoaffective disorder, etc.) How do I navigate these politics so I am not viewed as someone who turns away referrals, but not take on a caseload of people that I feel are outside my range?

This seems like a very reasonable rationale for being selective about assigning you patients. If you don't feel you have the training or experience to provide the best care possible to a population, then you shouldn't be doing it. If the front desk staff is not responsive to this, go to the owner of the practice (who I assume is another provider) and explain this situation. If they aren't amenable to this, maybe this practice isn't right for you.

 

[erg923]

You dont need to navigate any politics. Its an ethical issue and you should be assertive about it.

 

[deleted343839]

I never imagined I would end up in a group private practice environment, but here I am! Given my very limited background in this type of environment (I was heavily research focused in graduate school and in the VA for all of my post-doc clinical work thereafter), I am trying to navigate the process of building a client load. My short-term brain tells me, "full is best!", but my long-term brain tells me that the quality of my caseload is going to have a real impact on my quality of life/work satisfaction. Making clear what kind of clients I do/do not want to work with seems important to establish early on for precedence sake. I am getting some referrals very much in line with my self-described areas of interest, but I am also getting some that are way, way outside my scope (e.g., I work with adults and will get requests to see adolescents/I do CBT for anxiety and PTSD and get requests to see people with schizoaffective disorder, etc.) How do I navigate these politics so I am not viewed as someone who turns away referrals, but not take on a caseload of people that I feel are outside my range?

You're on the right track. It's easier to shape expectations now than when you're burned out and frustrated with your case load. This is not politics, it's good practice. Monitor your schedule closely and give feedback on every inappropriate referral until the scheduling staff has learned your pattern. You don't have to be rude or condescending. Just be matter of fact about it. Of course it makes the desk staff's job easier for you to accept all comers, but that is irrelevant.

Decide on two things: (1) the population you are able to see and want to see and (2) the population you would like to see but don't yet feel comfortable with skill-wise. Take the referrals that fit into category (1) without delay. For category (2), seek consultation and start seeing those patients soon after you obtain some basic training and a way to get help if needed.

 

[Oh the Irony]

Thank you all, this is very validating. I don't want to open the floodgates to clients that are outside my scope of practice. My definition of "generalist" may be different than the director of the clinic's...there are many patients I do feel comfortable seeing, but I certainly can't claim to be competent in treating every single thing that walks in the door. I can certainly seek consultation/supervision for things that stretch, but don't exceed, my scope and I'm more than willing to do that. But I have never been a child/adolescent psychologist and don't plan to start now. I also have never, ever, done couples or family work, but I may consider trying that out. I just hate that at this point I keep getting sent so many things that I simply can't say yes to...I wish there were more opportunities to say yes so I don't appear so picky!

 

[psych.meout]

Thank you all, this is very validating. I don't want to open the floodgates to clients that are outside my scope of practice. My definition of "generalist" may be different than the director of the clinic's...there are many patients I do feel comfortable seeing, but I certainly can't claim to be competent in treating every single thing that walks in the door. I can certainly seek consultation/supervision for things that stretch, but don't exceed, my scope and I'm more than willing to do that. But I have never been a child/adolescent psychologist and don't plan to start now. I also have never, ever, done couples or family work, but I may consider trying that out. I just hate that at this point I keep getting sent so many things that I simply can't say yes to...I wish there were more opportunities to say yes so I don't appear so picky!

You are doing the right thing by being skeptical and cautious about your scope of practice and competency. The problems are that these are not necessarily universal qualities and doing the right is rarely the easy thing.

 

[WorkLifeBalance]

I wonder if you're getting these referrals because you're new and the other clinicians have already made it clear that these patients are outside their scope...?

 

[psych.meout]

I wonder if you're getting these referrals because you're new and the other clinicians have already made it clear that these patients are outside their scope...?

It wouldn't be the first time that the most recent hire got the shrot end of the stick compared to people with more seniority and experience.

 

[Oh the Irony]

I wonder if you're getting these referrals because you're new and the other clinicians have already made it clear that these patients are outside their scope...?

Well, the part about me being new that does influence what referrals I get is the fact that there are only two other psychologists in this practice (and one is the director) and the rest are psychiatrists. So since the other two psychologists have more full caseloads, I am the most available one. So I become the catch-all in that regard, because in some cases, if I can't see them, no one here can unless they are willing to wait. So that part does result in more pressure on me to take each person so the practice doesn't lose clients due to lack of availability.

 

[hamstergang]

How do I navigate these politics so I am not viewed as someone who turns away referrals, but not take on a caseload of people that I feel are outside my range?

I don't want them to view me as someone who is picky.

So you want to simultaneously turn away referrals and be picky with who you take while not having anyone realize that that's what you are doing? I don't think it works that way. It's okay to be picky and only work with those you actually feel competent to treat and comfortable treating.

 

[Oh the Irony]

So you want to simultaneously turn away referrals and be picky with who you take while not having anyone realize that that's what you are doing? I don't think it works that way. It's okay to be picky and only work with those you actually feel competent to treat and comfortable treating.

I don't think I'm trying to have it both ways, I think what I view as turning away inappropriate referrals is viewed by the staff (who is not clinically-minded/considering ethical obligations to only practice within one's competency) as picky. I think what I'm trying to say is that I want to be selective about my criteria so that I am not in over my head with people I'm not prepared to treat, but it is possibly being perceived as "I could see them, I just don't want to." And that isn't the case. There are certainly people I've said yes to that I knew would be challenging people to work with, but I felt comfortable with their presenting concern even though they are tough cases.

 

[erg923]

I don't think I'm trying to have it both ways, I think what I view as turning away inappropriate referrals is viewed by the staff (who is not clinically-minded/considering ethical obligations to only practice within one's competency) as picky. I think what I'm trying to say is that I want to be selective about my criteria so that I am not in over my head with people I'm not prepared to treat, but it is possibly being perceived as "I could see them, I just don't want to." And that isn't the case. There are certainly people I've said yes to that I knew would be challenging people to work with, but I felt comfortable with their presenting concern even though they are tough cases.

Do you like seeing outpatient patients, all day, everyday?

Cause I actually found this challenging (and kind of a drag) when I was just only seeing patients within my scope.

 

[Therapist4Chnge]

It’s important to shape referral behavior EARLY. You will fight against the tide if you don't clarify and reinforce your patient populations, types of interventions, and schedule preferences up front. Meeting with staff, bringing coffee/lunch to primary referral sources and educating them about what makes a good referral, and providing some guidelines for types of cases, dx’s, and intervention (and assessment?) to your front office staff will be huge. If you can do this in the first few months it will save you a ton of hassle on the backend.

 

[Oh the Irony]

Do you like seeing outpatient patients, all day, everyday?

Cause I actually found this challenging (and kind of a drag) when I was just only seeing patients within my scope.

That remains to be seen 🙂 I've never done outpatient exclusively, other than a rotation on internship. I have typically had a mixture of residential and outpatient responsibilities. I've always wondered if just doing "one thing" all day would give me better work/life balance, but I also realize it may get boring. I will know, I suppose, once I have a full caseload.