Podcast Episode 4: More on Scheduling

Enlightened Practice Podcast

In this episode, Dr. Ken Braslow and Kari Kagan continue their conversation on scheduling. How has scheduling changed since they started their practice, and how to make the most of today’s tools to save tons of time. Plus, they introduce online booking as an incredible time saver that also presents a new set of challenges.

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Transcript of the podcast

Ken: Hi, Kari. Good to have you back in the studio.

Kari: Thanks Ken. Good to be here. 

Ken: So, last time we left off talking about the challenges of scheduling and setting limits in your schedule, finding just the right balance of what works for you. What works for your clientele? Today, I thought we’d talk a little bit more about how scheduling is different for new grads versus if you’re already established in practice. And then maybe we could talk a little bit about online booking, which introduces a whole other layer of incredible time-saver and also can introduce its own new set of challenges. So, I’m curious when you started your practice what was your thought process in terms of schedule template?

Kari: Yeah, I do have to go back in time and channel early new career psychologist, Kari. But I’ll be curious to hear what your process was as well. I remember thinking through a few things. So, one was the experience that I wanted to get. So that was a big consideration I thought of when I was thinking about the kind of schedule I wanted to make for myself and how flexible I wanted to be was the importance of the range of clients that I wanted to see and how much I was willing to be flexible in my schedule in order to get those experiences. So for example, if I was really wanting to see insomnia patients at that time, and I happened to come across one or I got a call from one who could only meet at a certain time that was outside of my ideal schedule.

There was a good chance that early on I would have been willing to be flexible in order to gain that experience because gaining experience was so important to me. I mean, still is, but really like when I was wanting to develop more of an expertise, you know. I wanted to prioritize getting more and more experience over schedule. So, that was something that I considered in terms of how rigid or flexible to be. It was, you know, what kind of experiences was I looking for? And then some advice that was given to me early on was to first create my ideal schedule in terms of just hours and for whatever reason, certain hours were better than others. So, am I a morning person or a night person, breaks, what other things are going on in my life at that time?

And then to create my ideal schedule and do my best to fill in based on the hours I had identified that were ideal for me, and that was helpful just to, as like a thought exercise. Because you know it was kind of a new experience to be in control of at least in private practice to be a hundred percent in control of my schedule. And I can literally work any hours from 6:00 AM to 10:00 PM if I wanted. So, it was helpful to just think through what would ideally work for the kind of lifestyle that I want to have and then to do my best to hit that mark. And then if I was going to step out of that, I would want it to be for a good reason at that time, such as, like, it was really important for me to get a certain kind of experience with the client, like I was saying before.

So, having my ideal schedule was helpful just to give me some like focus and structure when I was considering taking new clients on. Another thing that I’ve thought through early on in terms of my schedule was the kind of clients that I was seeing. So, I work with adults and the primetime hours for adults are early mornings and evenings after work. So especially getting started when another high priority was built in addition to getting certain clinical experiences was just like running a business, right? Needing to have clients in order to stay in business, if you will. So, that was something that strongly guided the early building of my schedule, was making sure that I had hours at times that would, that would fit the population that I was working with, so mornings and evenings. 

And so with that in mind, I did have a longer day with more breaks. So, if I was seeing an 8:00 AM client before work and also a 6:00 PM client after work, that’s a pretty long day. And that really was what I felt. It took, really, a momentum in my practice. I had the luxury of being able to adjust my life a little bit around that schedule. So, I didn’t have kids at that time, for example, so I could fit things in, in the middle of the day, like go for exercise or go home really quickly. Because my office wasn’t too far from home at that time, and it was just kind of a new norm to wrap my mind around that I didn’t have to be working nine to five. Then it could look a little bit different and that could still be working.

And then also just using those extra hours for other things like doing research for a client or trying to learn a certain kind of treatment that I was wanting to learn more about. So, making use of the time that I wasn’t seeing clients was what helped me to kind of be more comfortable with that longer day kind of schedule and the extra hours in between. So, those are some of the things I’m recalling at the moment that were factors that I took into consideration when developing my schedule early on. I’m sure there were others, but I’m curious to hear about yours. 

Ken: Yeah, that’s really interesting. Two pieces of advice I got, the first one was don’t start full-time, it’s just too much pressure. Get us a gig where you’re employed at a clinic or somewhere something that pays the bills and that way you can have a lot less pressure in terms of filling your schedule. I thought about that and probably did that for a month or two. Once I was able to be on my own. But in general, I think it is good advice if you can pull it off. Unfortunately, what ends up happening in that scenario is sometimes your part-time job becomes that you only get paid part time, but they really want you there full-time and then you’re drained at the end of the day, and it’s hard to run a private practice with just a few patients.

It could be considered a labor of love at that point, but maybe you’re just breaking even. And whether you have a full practice or a tiny practice, you still have to do the same amount of work in terms of systems and policies, and infrastructure. And so it’s just a lot of extra burden to weigh if you’re not going to be in it at least half time. 

The other piece of advice I got was to work backwards, to figure out how much money do you want to make and divide it. How many weeks a year do you want to work and how much are you going to charge? And do the math and figure out how many hours you need to work on average per week in order to hit your goal. And then that’s of course not taking into account all the expenses of running a private practice, and that can be hard to estimate.

Maybe that should be over our next session. But doing the math and figuring out what is icing on the cake after that. And then to think about your life and how quickly do you want to get to that goal? So, if you need to get there right away or want to get there right away, then you have to be more flexible in terms of your hours. And for sure, there’s prime time, hours and then there aren’t, and before work and after work or prime time and weekends and midday, you can hear crickets at times. So, that’s one challenge. If you say, you know what? I don’t need this or I’m going to take the slow boat to get there. Then you can be a lot more picky in where you’re going to draw your boundaries.

So, what I found was at the beginning, I ended up taking on any case that called me because I wanted to fill my schedule. And then I realized that’s not a good idea. I’m all for having variety. I really enjoy that there are so many different types of cases we can see, but there are some that I feel like I’m just not the right fit for. So for example, I love working with kids and families, and parents, and adults. But if we get into complex geriatric cases, dementia people on multiple medications for their general health, along with mental health issues, that’s just outside of my expertise. And I took some of those on anyway because I wanted to fill my practice. And then I realized I’m just not the right fit for these people. And I ended up feeling a lot of pressure.

So being able to not only just tell people here are my limitations on my hours, but also in the intake process to be able to tell them here are the limitations on what I see and don’t see clinically is not necessarily a drawback. It makes people realize either really you’re not the right person for me, or, wow, this is great. You specialize in what I’m looking for. So, I think it’s a win-win not just setting boundaries with time, but also that overlaps with what you’re going to see clinically. And then one more point when I started out, it was a little slow going. And then finally my name got on the website of one of the insurance companies I was taking at the time. And literally within a week, my practice was full and wow. I haven’t looked back since then. So, we can talk about how maybe as a different version how to keep your practice full or close to it. But that’s certainly one way if you’re going to be working with insurance or other referral sources, and they’re going to be sending you a lot of people, then you can be more picky and choosy with your hours right at the beginning. 

Kari: Yeah, absolutely. The other thing I was just remembering from early on was at that point, of course, just getting started and I think this might be the case for a lot of people just getting started is you might not get as much say in the days and hours you have, if you’re subletting your office. And I’m just remembering that now that that was actually a big part of what determined my schedule was just like, when am I allowed to be in the office? And that’s just something to take into consideration for when you’re picking an office, right. Like to find out when it’s available and are there evenings available? For example, if you’re wanting to work evenings and, you know, it’s all kind of related. But I’m remembering now that that was actually a pretty important thing, finding an office space that had some of those primetime hours available. And if it didn’t, I might not have picked that office. That just popped into my mind. 

Ken: Right.

Kari: There was another thing that I had just remembered in creating my schedule early on. Oh yeah. And this was kind of what I think you were just eluding to that. It kind of happened for me like that as well, that it seems, like, kind of out of the blue, you had a clear, like a precursor, which was you getting on an insurance panel and that you got all these clients. For me too, maybe it was a similar thing. It was one of these, um, local insurance panels, if you will, like Lira Health, where all of a sudden there were a lot of referrals. And I remember a feeling of slight disappointment or regret that I didn’t have space for some of the clients that I really wanted to see from a clinical perspective. Like if, again, like at that time, I think what I was really focusing on was insomnia.

And so if an insomnia client came in and I didn’t have space, I remember feeling disappointed that I didn’t. And so it was one of those hindsight moments that I would then want to pass on to someone just getting started is to have a little bit of patience and faith in the process. Like you were saying before, like to not fill every single slot just because you can, but it, you know, if you can, even if you have an open spot for a couple of weeks, to be able to save some spots for the clients that you really want to see, for whatever reason. If it’s something you’re trying to get more experienced with or it’s something that you feel the most competent in treating, there’s value. And at least from a clinical perspective, I recognize that there’s the business side of things too, and that has to be taken into consideration, but from a clinical perspective, there’s value in saving some spots for the clients that feel like the best fit for you.

Ken: That’s a good point. As you were saying that it made me think of a couple of my other startup memories. One was the first summer I was in practice. I was like, what had just happened? Did I just go out of practice? I didn’t realize there was this concept of the summer lull that everybody goes on vacation, especially working with families. And I had like no patients in August and I didn’t know what was going on until I talked to my colleagues and they’re like, Oh yeah, that’s why everybody takes off in August. You should too. And I was like I wish I would’ve gotten the memo on that one. So, as you’re doing the math and thinking about income and maintaining a steady practice that around the holidays, summer break invariably people will cancel. And you’re going end up with days that you have big holes in your schedule and maybe that’s okay and it’s refreshing or maybe it’s better that you just take that day off and enjoy it fully, as opposed to you taking off other days that you’d have a full clientele and now you’re giving up revenue on those kinds of days.

So, taking into account the lulls is very important. Yeah, it’s challenging starting out. There are no rules. It is wonderful. There’s part of this freedom that you get. When you’re in training or if you’re working in a clinic, you got to play by their rules. There’s certain excitement, I get this whenever I want. I remember having 8:00 PM patients and thinking, this is great. It’s great for them. And I’m done, and then I can stay up late afterwards and then that faded pretty fast. I think it’s useful to think about that. This is my template maybe for starting out, but that in six months, in a year it’s subject to change. And the challenging part there is what happens if you’ve given a client or a patient a prized prime time slot and then you can’t or don’t want to meet at that time anymore? And I’m curious how you handle that.

Kari: Yeah, well, I’ve been in that situation before, where I decided to make a radical change in my schedule from working evenings to not working evenings when I had many clients and evening spots and genuine transparency was my approach. Just letting them know that my schedule was changing. And what that meant was that we were going to have to find a time earlier in the day. And where I was hoping to meet some clients halfway was to offer virtual sessions at that time. So, that actually helped a lot when I made that transition, because clients could meet from work. So, they would stay at their office, close the door, log in, and then that allowed us to do daytime sessions. If I felt virtual was a good fit, obviously right now, everything is virtual.

But at that time, anyways, I wouldn’t have forced that or wouldn’t have offered that option if I didn’t think it would be at the right fit clinically. In which case there were clients that I ended with when I had to make that schedule change. And again did so in a clinically responsible way, like I didn’t end the next week. We did like maybe a month long transition or something like that, where we worked on doing a warm handoff to someone else or terminating if that was appropriate. But when it came time to make a really big shift in my own schedule because of some stuff that was going on in my life, which at that time was having kids, that became the highest priority. And I found that I could kind of do it all where either clients could actually be a little bit more flexible than they had thought and that I had thought or that it was going to be okay to transition them to someone else.

And I had to be okay with that if I wanted to change my schedule. Sometimes it was uncomfortable. Sometimes it was hard conversations to have, but I think ultimately it was the right thing to do because it doesn’t feel the right thing to do when you’re sitting across from a client and you really don’t want to be there, or your mind is somewhere else. So, yeah, I went through that change and I would strongly encourage anyone considering making that change to do it, of course, again, in a very responsible way clinically speaking. I think it’s important to have the schedule that you want. I think that will always be in the client’s best interest. 

Ken: Yeah, no, I don’t blame them for being disappointed to get this great time slot and then to have it fade away, especially if you’re in the middle of really powerful work and they invested a lot of their vulnerability and their time and energy into it. And those are times when I think about clinically, if it’s indicated and you sort of for them talking about my experience and the challenges and using that as a way to model for them, working through internal conflict, but also just validating that there isn’t always a great answer and trying to be flexible and meet them halfway, but also trying to just empathize with them and kind of commiserate and talk about our shared disappointment, so at least to have the transition or the termination be as clinically meaningful as it could be, even if the work isn’t really done. Well, I noticed we didn’t get to online booking today. Is there anything else you think we should add to our list for next time on this topic?

Kari: I’ll be curious to talk about online booking because I don’t do that. So I would love to hear more about your experience, and I can talk why I made that decision.

Ken: Okay, yeah. That sounds great. All right, thanks again for making my head spin, thinking about all these different memories from the distant past. And now, I’m going to go take a look at my calendar and see what needs to be done.

Kari: Me too. All right, talk to you soon

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