Enlightened Practice Podcast
Planning your maternity or paternity leave is essential to ensure you spend more time with your newborn while continuing to provide the best care to your patients/clients. This plan should include informing clients/patients and colleagues in advance and offering treatment alternatives while you’re absent.
Dr. Ken Braslow and Dr. Kari Kagan share their experiences on parental leave and answer your questions on setting up a realistic schedule for your return, identifying what type of patients/clients to take in when getting back to practice, how much time is enough, and more. Enjoy!
If you want your question featured and discussed on the show, send it to [email protected]. We’d love to hear from you.
Transcript of the podcast
Ken: Hi, Kari. Welcome back to the podcast.
Kari: Hi, Ken. Thanks for having me.
Ken: Today we have a question from a listener about preparing for maternity leave. And I thought that this would be a great topic for us to explore, knowing that you have experienced this yourself, and a lot to think about from the business side of things. Of course, it’s an exciting time and maybe an emotionally overwhelming time, or at least very powerful. But there’s a lot to think about just from a day to day how to run your business point of view. And so while there’s a lot we could be talking about emotionally as a clinician or how you process it with your clients and patients on a psychotherapeutic level, I think today we should talk a little bit about just how does this affect the day to day management of your practice, which is your business. I’m curious to get your take. I myself have been on paternity leave, but I get that that is not the same thing. And so I can also talk a little bit about my own experience with it. But let’s start with maternity leave. When do you even start thinking about this? Are you thinking about this before you are even pregnant, or once you’re pregnant, or? Take me through how you approached it.
Kari: Yeah, I think it’s probably something that mostly you start thinking about once you’re pregnant and getting through some of the initial stages of pregnancy, feeling a bit more confident in your pregnancy. But certainly it’s worth thinking about before even potentially going into private practice. Just if you know that you would like to start a parenting journey at some point, it’s worth starting to collect some information about what that looks like in private practice, because it probably does look a little bit different than working for an employer. So there might be some thinking that goes into it then. And maybe just for listeners today, this might help them to start to understand what it looks like. Mostly in my experience, I really start to think about it actually when I start to feel a bit more comfortable in the pregnancy, so pretty much after the first trimester has been when I start to think more seriously about what the plan should be in terms of timing and telling clients. But for the first trimester, I usually am kind of just in a take it day by day process for the first 10 – 12 weeks kind of thing, and then I start to come up with a more serious plan.
Ken: It makes a lot of sense. Don’t want to get ahead of yourself and you don’t want to reorganize your entire life. On the same token, these things need to be thought about at least even if you don’t have to act on them right away. So what has been your approach in the past for when you do start to think about telling your clients, is there a particular week of pregnancy that you’re aiming for, or does it vary based on where the client or the patient’s at in their therapy process?
Kari: It really does vary. It depends on your pregnancy journey. It depends on where you’re at with a client in therapy, there’s so many factors to consider. For example, I didn’t personally have this experience, but I know for people who are having twins, the timing in which they tell people is different usually than when you’re not having twins. Sometimes it’s because you’re showing earlier and you kind of have to if you’re in person, sometimes it’s because those are higher risk pregnancies and you can have to leave earlier than you were expecting. So you need to give clients a little bit more time. So definitely there’s a lot of variables to consider that are going to change from person to person. For me, if it could be totally my choice how I want to do it, I did have an ideal week I would wait till, and that took into consideration both my needs and the client. So for me that was always like the 20 week mark. The reason for that is because there’s, at least in California, I don’t know how this is in other places, but there is a pregnancy scan that you get around the 20 week mark that gives you a lot of information about the health of the baby. So for me, in terms of sharing a bit of a more vulnerable thing I’m going through, which is being pregnant, I always want to try to wait until I had as much information as possible to give me relative confidence that this was going to be a viable pregnancy and all of that kind of stuff.
And I also feel like that 20 week mark still gives a lot of notice and a lot of time to work through it with clients and to come up with a plan for when you’re gone. So if I could totally have control over the situation, that’s the point I would ideally wait for. But I know that sometimes people are feeling really sick and they decide that they need to tell people, I might not be able to be around as much because I need a leave session to go take care of myself. So you really have to find the right balance between what you’re comfortable with in terms of what you feel like sharing with a client. And when some people are okay sharing a lot of information with their clients, and some people want to keep things private. So just finding the right balance between like what your personal desires are in terms of what you want to share with clients and when, and then also maintaining some kind of professional duty, like giving enough time for a client to really prepare in a meaningful way for when you’re gone.
Ken: So you’re helping them to prepare for not only maternity leave after, but also that you may not be available up until the very day that you are giving birth. Just from a pure logistical point of view, did you keep scheduling clients as you were getting toward higher number of weeks, but you told them there’s possibility we may not be meeting, or did you just say, okay, after this certain point, I’m not meeting with clients?
Kari: Yes. Again, I think it’s going to vary so much depending on your pregnancy and what you’re wanting in terms of how much time you want to prepare. For me, I always gave a date that I plan to take leave based on how much time I wanted before having a baby. For me, that changed from two weeks at one maternity leave, to one week before the due date with a different one. And I always share the caveat that we make our best plans when it comes to pregnancy and who knows what’s going to happen. Most people really understand that and are flexible. So what I do is with a bunch of notice, I say, okay, hey, I’m going to be leaving October 1st, and if anything were to happen before then, this person, as in one of my colleagues, we’ll be reaching out to you and letting you know. And whatever plan we had come up with before then will go into place earlier than we were expecting. So I do let them know that someone else might be contacting you, letting you know I’m actually not going to be coming to our session next week, which did actually happen. And everyone of course is so understanding. But as far as when you decide you want to leave. That’s really personal. Some people want ten weeks of time off before they have the baby. Some people want one day. So it really depends.
Ken: And how about for after the due date? How did you think through how much time you wanted to take off?
Kari: Again, first I’ll say that the whole time, very personal. You have to factor in finances. How much time do I feel I can take off? And if there are practical responsibilities that you have to your family, or bills to pay, all that kind of stuff, that definitely influences how much time you take. Of course, how much time you want to be spending with your baby. And it’s just not always easy. There’s not always an ideal time because it’s probably never enough time with the baby. So it really depends. I think that’s when you’re going on leave. How I’ve always approached it is I did my best to guess what I thought would be the right amount of time for me, especially when I was a first time mom and I had no idea. Like some people can’t wait to go back to work. Some people decide they never want to go back to work. So I did my best to give some kind of timeline, which I think was 12 weeks. And also I might need some flexibility because I did want to give myself that option to decide maybe I’m going to want more time. Maybe there’s going to be some health issues. You just never know. I think that you do your best to try to pick a time that works for you practically, emotionally, all that kind of stuff. And then I think it’s helpful to share that with a client so they have some understanding of what’s ahead. And then leave the door open a little bit to change the plan as well. And I could talk about how like different options I give to clients in terms of how to leave, and what to do in the meantime, and all that kind of stuff.
Ken: That sounds great. What kind of options do you give them?
Kari: I usually give them three options. So it really depends on where I’m at with a client. But sometimes it’s a nice time to work toward a termination. Like if we know we have four months left before I go, and this is how far we are into our treatment, that might be enough time to actually work toward termination. And so sometimes that ends up becoming our goal that the plan is to actually finish treatment together before then. And as with any client, when we terminate, they’re welcome to reach back out and all that kind of stuff. But that would be the end of the relationship unless I heard back from them. So there’s that, coming up with a plan to work toward a termination. Sometimes the other option I’ll give people is just to pause and then resume. So that could be a good option for people who are pretty stable, who I’ve usually worked with for a decent amount of time. They’ve made some progress and it’s a good opportunity for them to practice a lot of the stuff that we’ve been working on, on their own, and we’ll come up with a plan for like how they can be working on that stuff while I’m gone, set some goals so they feel like they have some concrete stuff to hold on to while I’m gone. And we’ll just pause and then we’ll resume once I’m back. And that actually is the option I would say most people picked for me personally. The other option I give people is to see someone else, and that could be either temporary or permanent. And I’ve had it both ways that sometimes they see someone as a placeholder just to kind of check in with, have some accountability for whatever they’re working on, and then once I’m back, sometimes they come back and we pick back up or they actually decide, hey, I’m liking the progress I’m making with this person. I’m going to stick with them. And for anyone, I always give them referrals. Like even if we terminate, I’ll just say here’s three people that you can contact if anything changes, because I don’t want people to email me on leave and then I can’t get back to them and it’s some kind of crisis situation or they really need help. So I just cover my bases and regardless of what they want, I’m just like, here’s some names. Take the take those names and if you need help, this is who you can call. And that’s nice because then you kind of know you’ve covered all your bases and you can actually take your break, your leave and hopefully not worry too much about how your clients are doing.
Ken: Wow you have really thought this through in a really comprehensive way. There’s so many intricacies there. How do you think about coverage while you’re out? I mean, what you’re saying is designed to reduce the need for coverage at all. But it’s maybe not foolproof. So, what’s your thought process behind coverage?
Kari: Yeah. It’s hard because you also can’t predict people’s availability. Although I do find that when it’s when you ask someone to cover for you for a short period of time, sometimes they’re more willing to make themselves available, even if they’re not always available usually at that time or yeah, when you’re gone. So I think about the thing, for lack of a better word, that I’m working on with a client. And then if I know people in my network who have experience or specialize in a certain diagnosis or treatment that I’m working on with someone such as OCD or something like that, then those would be the people that I reach out to and personally ask for a favor, basically, like, can you provide coverage? This is in your wheelhouse, and if the client gives permission, you could also consult with that person before you go and catch them up a little bit on what you’ve been working on.
I think a client could also probably feel somewhat like a provider in on that as well, but sometimes they want you to do that work for them. So that’s something you can offer. And if I don’t specifically know someone that has a certain specialty or something that I’m working on, then I would just reach out to a broader network. And it might be that I refer one of my clients to someone that I don’t personally know, which is always a bit scary because you want to know that they’re in good hands. But at the same time, if it’s coming from a friend of a friend or a colleague of a colleague, it might be the best that we can do to basically give them a lead and see where that goes. But usually I do try to find someone who I know has some experience in whatever it is that I’m working on with the client.
Ken: That’s how you custom tailor it. It’s not just one colleague who bears the brunt of covering your entire practice.
Kari: No, that would be a lot for one person.
Ken: Got it. That makes a lot of sense. How do you approach taking on new clients? We’ve been talking about established relationships and that’s complex enough. What’s your take on new evaluation requests?
Kari: For the kind of work that I do, which is cognitive behavioral therapy, I would pretty much stop taking new clients all together when I’m down to about 12 weeks left because in my mind when we’re talking about cognitive behavioral therapy, 12 weeks is a pretty solid amount of time to either potentially meet a treatment goal or make a good amount of progress. If I had less than 12 weeks, I probably just wouldn’t take a new client. In terms of before that, let’s say there’s 20 weeks left or 25 weeks left, I actually do tend to tell potential new clients that I’m pregnant, a little bit earlier than I would tell a current client because I want them to have informed consent. It’s tricky you know. I don’t want them to feel trapped, like you take them on and then two weeks later tell them, by the way, I’m leaving in a few weeks. It’s still a good bout.
You still need to find the balance you’re comfortable with in terms of sharing personal information with a client that you certainly don’t have to share, but you also wants to maintain that professional honor, that professional duty, like make clients have all the information. It can be disruptive. So even if I’m still taking new clients, I’ll tell them potentially a little bit earlier so that they can be informed. But yeah, I think at some point in a similar fashion, not taking new clients is potentially the professionally right thing to do to make sure that you’re actually able to provide ethical treatment in a reasonable amount of time, and you’re not opening up a wound that you can’t not necessarily totally see it through but at least work through it enough that the client can go on for a few months without you.
Ken: That makes a lot of sense. And what about when you’re coming back from leave? Do you wait till your first day back in the office to make sure, okay, I’m doing this, I’m back? Or would you consider starting that process with screening or talking with potential new clients even before you’re officially back?
Kari: This is what I love about private practice is the flexibility that you can kind of take your time coming back. I have always reached out to previous clients before I’m actually coming back, so probably like three weeks before and I would let them know, hey, I’m planning to start to come back in a couple of weeks. Let’s start to talk through the schedule. So I give priority to those people since they were probably waiting for me or we’ve already had an established relationship, and I do that work while I guess I’m still technically on maternity leave. And then usually I don’t start taking new people until I am fully back. I want to see how does that feel. And you know, one of the benefits of private practice is you do get a little bit of flexibility so I don’t have to come back doing 9 to 5, five days a week, but I can start with fewer and see how that feels and work my way up. And it can be a slower process. So there’s the financial element to consider there. But yeah, so that’s how I’ve done it.
Ken: Yeah. Well, on that note, with the financial process or the financial side of things, of course, nobody wants to think about that. It’s supposed to be a joyful time of life. And as an employee, your financial life doesn’t get affected to the same degree as it would if you’re in solo practice. But given that you’re in solo practice, what can you do or thinking about even colleagues who might be thinking about getting pregnant, any recommendations for them on minimizing their financial vulnerability here during this time? Or is it a matter of they just have to deal with it? Is there any in between?
Kari: Definitely it can be a financial strain for sure, anytime you take time off of work for whatever reason. I think that you can prepare. I think definitely doing things like making sure that you’re setting aside savings for paying taxes and stuff like that, just to prepare for bills or expenses that you know you’re going to still have even when you’re not making income. So making sure you’re saving for rent and stuff like that. This is going to be one of those times that you’re probably digging in to your savings. And so that’s one way you can prepare putting a little bit of extra money aside just in anticipation of needing to pay rent, needing to pay taxes, all that kind of stuff. When the income isn’t the same, I think mentally preparing that that is coming and hopefully will be a short term temporary problem. That can be incredibly stressful in the moment, but oftentimes you work through it and it evens out like you don’t even really remember the hit a year later. But when you’re in it, of course it can feel really stressful. So I think financially preparing in that kind of way through savings, I think mentally and emotionally preparing that is kind of part of. It’s to be expected when you are self employed in private practice and you can’t work. There are potentially some options for getting help through federally funded ways. I don’t know as much about that. I think you might know a little bit more about that and that’s something to consider as well.
Ken: Yeah, it’s complicated. I’ll just say I really like your thoughts about emotionally preparing for the financial side of things. Unfortunately, there’s very limited options. There’s FMLA, there’s disability insurance, there’s paid family leave, so even the terminology can get confusing. But most of those apply to employees. In California you have the option as a solo practitioner or if you’re a sole owner of a corporation, of not paying into disability. And most people would probably not want to pay in, but this is where you would be able to collect theoretically if you had been paying in. I know the state also offers a specific program for those who are self employed also, but you probably cannot get benefits from it once you’re pregnant if you haven’t been paying into it before you were pregnant. You have to do some real advance planning in that regard. And if you’re giving money to a state program, could you just be setting up another savings account in the bank and just having your money go there beforehand. I haven’t looked into the actual economics of it, but psychologically you’d want to be doing something to prepare. And this is where having a good sense of what your monthly budget is and what your annual budget is. Those are two different things. Monthly budget will help you figure out how much you need to typically have in the bank. But if you have big one-time expenses that are going to hit your bank account that just happen to come through while you’re out, you also need to have extra buffer for that. So for example, although everybody in private practice who’s a solo practitioner should be paying estimated taxes on a quarterly basis, if you’re not or if you’re underpaying and you’re to not be having revenue come in when it is time to pay your annual tax bill, that’s going to be a really big hit.
You can get an extension on your tax returns, but you don’t get an extension on the payment that’s due. So, those are really meaningful to think through. Most of our expenses are on a monthly basis, but this would also be a really good time to sit down with your financial planner or accountant and make sure that all your ducks are in a row so that you can really get into the process emotionally. The other thought is, this is more general, just talking about taking time off and practice and how hard that is and that if you think of it as lost income, that’s going to shape your experience of it psychologically in a different way than you think of it. And then if you think of it as time that you gained and can you find the appreciation and can you be grateful for that extra time as opposed to just feeling it as a loss in a different sphere. So that applies to taking any time off. But then especially when you’re talking about taking months potentially off, it gets amplified. And ideally those first few months of life, it’s exhausting as it is and you don’t want other extraneous concerns like finances to further exhaust you or get in the way of bonding with your little one.
Kari: Yeah, I totally agree with that. And also, I’m just curious if some of the things you have to consider before paternity leave is pretty much the same as the stuff that I was talking about or if there’s any other things?
Ken: Right. It’s similar. It’s not typically as lengthy leave that is taken. So, it doesn’t require quite the same degree of advance planning, but from a meds point of view, it does because if I’m going to see somebody in three months for a checkup, well, hold up a second, I’ve got to do the math and make sure. So, even if it’s a therapy patient, I may only take off a couple of weeks or a month, or whatever it is that you might feel like from the dad’s perspective how much time you want to take off, either before the due date or after the baby is born. So, for a therapy patient that conversation comes up, but much later in the process. But, for a meds patient ironically it comes up much sooner because they need to know can they book a follow-up with you.
So, it was a little bit of a head scratcher when I was seeing folks at around that five month point and not really knowing what I was going to be doing three months from then or let’s say in the sixth or seventh month point. It was really up in the air. Due dates are notoriously inaccurate. It was hard to predict and I didn’t want to schedule a lot of follow ups and then have to cancel all of them a week or two before. On the flip side, I didn’t want to unnecessarily tell people, well, I’m not going to be able to see you then and then either have to really frontload it or have to alternatively tell them I’m going to be out this whole time and I won’t be able to see you, let’s say for six months. And if they’re stable, can you see your primary care doc in the meantime? That was a lot to wrestle with at that time.
Ken: So, going into the process, I did take on fewer new patients because I knew that come month five, six, seven, I was going to be in this dilemma. So, I just decided I’d rather not be in this dilemma, and I should probably take it easier anyway given that all this stress that pregnancy brings, let alone delivery and after the baby is born. I kind of ducked the question by just taking on fewer patients and then not being put in that position. Fortunately, most of my med patients were stable at that point and I could say to them, I of course gave them referrals. I could say to them, could you get a refill from your primary care doc, or if I knew that they were really stable, I snuck in a refill in between feedings, you know, in the middle of the night.
Ken: And that would have been harder to do if it were my first year in private practice and I didn’t really know my clientele, but I knew most of them pretty well, to very well. So I felt comfortable doing that and it was also a family decision. We weighed through the pros and cons of all these different options and decided that this path worked for us, but understanding that it might not work for everyone else.
Ken: And then after the baby was born, especially the second one, I was exhausted. There’s nothing like being in session and a patient saying, wow, you look horrible! So, I tried to approach it with some humility and grace, and my coffee consumption probably escalated at that point more than ever before. It’s not just the pregnancy. It’s how do you reintegrate back into the world after. And I would say for a few months, I just decided not to take on new patients. It was just too painful. It was really once they were sleeping through the night that I thought, okay, now I think I can approach sanity and take this on, but even then I went slower and I really wanted to be present for my patients in session, even if I’m present, the yawn. You know that deep yawn you feel when you’re just so sleep deprived?
Ken: I really wanted to avoid that so I went slower, but I had the luxury of doing that because I was a little more along in my career. So, those are some of the considerations and then we just took the financial hit. There was no disability, no other income. That was that, but we made it through, and I really liked your point about, in a year will you even remember this, and in ten years will you even remember this? No.
Ken: And I would say, if your financial situation is so precarious that it would be incredibly derailing, then maybe you’re not at the right stage of your life for private practice because it shouldn’t be that you go bankrupt or you’re going to lose your house, or get kicked out of your apartment because you’re not able to pay your bills.
Kari: Yeah, absolutely.
Ken: So, those are some thoughts from the dad’s perspective.
Kari: Yeah, really interesting. And it sounds like just being a prescriber there’s some unique challenges.
Ken: That’s a good point. Yeah, that would be there whether you’re maternity or paternity leave. And then it speaks to having a good network of colleagues also, and then we’ve talked about this in other episodes, not that you’re forming a network so that they can cover for you, but that’s part of the perks of having that. And you’re doing it for them, and realizing everybody goes through this. We’re all just humans on earth together and it goes better when we are all generous with our time, and willing to cover for each other even if we may not love it we’ve all been there ourselves.
Ken: It’s nice to think about all of us in this together as a community. So, I didn’t feel too much guilt about asking colleagues to cover just a little bit. Well, okay this was great. I learned a lot here. I think there’s a lot of great info for folks who have not even begin to think about this process, for them to digest and if today they don’t need to process it, when the time is right, when they’re being called upon to make these decisions, this episode I think will be a great reference for them. So, thank you very much Kari, for your thoughts and your time and sharing it with our audience.
Kari: Yeah. Thank you! Same here.
Ken: Thank you and look forward to chatting soon.
Kari: Yep, see you.
Ken: Okay, take care, Kari. Bye.
Kari: You too. Bye.