When managing our private practice we can often get caught up in the small details such as how our voicemail is set up, how our logo looks or how we should advertise ourselves. These are all important to some extent, but research is increasingly showing that one issue matters above all when it comes to attracting and keeping clients: keeping wait times low.
Clients Demand Low Wait Times
We live in an economy that is getting faster by the day. With next day delivery and instant communication being staples of daily life, consumers expect instant gratification more and more. When it comes to a service critical to one’s personal health, such as therapy, clients expect to be in a provider’s office as soon as possible.
A recent study by the Cohen Veterans Network found that 81% of patients feel that they should not have to wait longer than 1 week to receive therapy from their first point of contact. [Cohen] So once you receive a communication from a potential client, the clock starts ticking for you to meet that expectation.
Wait Times Impact Public Health and Your Bottom Line
On a community level, the wait times significantly deter access to treatment . “For every one day of wait time [that you present to a client],” says NCBH President and CEO Linda Rosenberg, “you lose 1 percent of the patients — so if you have a 21-day wait, 21 percent of the patients seeking care just will give up and not show up.” [Chicago Tribune]
From the standpoint of your practice, wait times impact your bottom line. One study of small businesses by Lead Simple found that giving a potential client a call back within 5 minutes of their initial call is 21 times more likely to result in a qualified lead (a scheduled client) than a call back after 30 minutes. If this translates into a similar 2100% increase in client bookings then no other single action can be better for your private practice’s bottom line than this one.
We can look to addiction treatment providers to find a more familiar comparison. Addiction specifically requires a fast response to ensure effective treatment, so perhaps we can compare the addiction field to our own mental health private practices. People are seeking help now, but may not be after a few unanswered phone calls. For addition, similar to mental health, the waiting period is the most commonly listed barrier for addicts seeking treatment. (Appel, Ellison, Jansky, & Oldak, 2004; Farabee, Leukefeld, & Hayes, 1998).
When it comes to addiction, the longer the wait time between contact and treatment, the lower the long term retention rate of clients. (Festinger, Lamb, Kountz, Kirby, & Marlowe, 1995; Hser, Maglione, Polinsky, & Anglin, 1998). Similarly in private practice, the longer the wait time for clients the more likely they are to no-show or not follow up on your scheduling requests.
This is why Festinger and colleagues (1995) proposed that the first 24 hours after a client’s initial phone contact is a critical period in initiating treatment. Therapists can use these same guidelines in our own practices. Answering in the first 24 hours is critical, and in the first 5 minutes is ideal. In fact, that’s why we at Thrivelution have made it a point to guarantee that clients in our system will be booked with a counselor within 24 hours of their contact with us.
Why are Wait Times so Long for Therapy?
If we want to reduce wait times in mental health, an important step is to understand what has caused this situation. Perhaps the most important contributor to this wait time crisis is the classic issue of supply and demand. Insurance companies have either decreased or maintained the amount that they reimburse therapists over the past 10-20 years. As a result, many therapists are leaving insurance networks and operating entirely cash based practices. In fact, around 30% of psychologists don’t accept any insurances.
This is without to mention the added costs of insurance billing and prior authorizations (not to mention the staff needed to do these tasks.) Plus there is an added doubt as to whether you will be paid at all after you have jumped through these hoops. Yet still there are a few things we can do on an individual basis to reduce wait times in our practices.
Option 1: Streamline your practice
If you are attracting clients to your practice, you are likely spending some money on marketing. Marketing circles refer to cost per acquisition (CPA), that is the total cost it takes to attract a client to a first session of therapy. If you are spending the same amount in advertising, but convert more people, your practice has a low CPA and so high profit. Without changing your marketing spending or strategy, the biggest impact you can have on your bottom line is how well you convert cold calls to your practice into clients.
With that in mind, there are a few guidelines that are proven to increase the value of your marketing. The most common sense solution is to offer a treatment appointment date immediately (Stark, Campbell, & Brinkerhoff, 1990) You can also remind clients of their initial scheduled appointment, which usually improves the rate at which clients will begin treatment (Gariti et al., 1995).
As they say in carpentry, “measure twice and cut once.” So you should be asked: “Do you currently know what your average wait time is?” If you don’t know, finding out could be your first step. Most successful service businesses use a customer management system (CMS) to manage their client contacts and keep their marketing organized. Most CMS also offer tools to help you measure how quickly you are answering client inquiries, where they are coming from and how many clients follow through with therapy. There are many CMS systems dedicated to healthcare that are HIPAA compliant. You can read about some here.
You should consider a CMS or organization system that will reduce the number of steps between a client call and their first session. We may think of a client journey as a series of steps like the following:
- They fill out a contact form on your website.
- You email back and forth a few times to answer questions.
- You agree on a time to meet.
- You send them intake paperwork to print and fill before your session.
- You send them a couple reminders before their appointment.
- Keep the session notes organized during the session.
- Meet and find a regular time to meet going forward.
Steps 1-3 are perhaps the most critical as they happen early in the intake process, and there are a few things that you can do (even without a CMS) to increase how many clients make it to later steps.
For example, a scheduling email might look like this:
In this typical example, maybe the client answers, maybe not, but this back and forth alone didn’t get to step 2 of the intake process and will likely cost your practice a couple hundred dollars.
There are some ways you can streamline this process right now.
1) Have an auto scheduler on your website so clients can schedule themselves and complete the basic paperwork ASAP. Some CMS options offer this and an auto responder, so that the only work you need to do is on the day of therapy. There is no back and forth this way.
2) Prioritize the ability to contact you over the phone. Phone calls are the most responsive and personal way to communicate with a client and so are most effective at retaining a client lead. The next most effective method is text and lastly is email. You can prominently display your phone number, or else leave an explicit field on your contact forms “when is a good time for us to connect in the next 24 hours? Ex. Monday mornings…” That reduces the chances of playing phone tag.
3) During these conversations preempt common concerns. Talk about insurance, how to get to your office, what to bring. This helps to prevent no-shows. There is a commonly used technique in sales where you have the customer invision using the product, that way they are more in the mindset to buy. Therapists can do this as well by letting clients know how to physically get to the office (landmarks they will see near you, etc.). It may help to script this conversation ahead of time so you don’t leave anything out.
4) Lastly, if you can answer calls at any time and check messages as soon as possible, do it. If you are making excuses, leave a note or goal for yourself to answer calls as soon as possible or do them all at a certain time in the day that you can add to your calendar.
But I have openings in my schedule, and I don’t have time to call back.
Therapists are busier than ever, so this is a common concern. If you are a single provider practice. It’s not like you can step out in the middle of a session and answer a prospective client. You likely aren’t in a position to hire someone full time to answer your phone either. Perhaps a solution from the 90s can be repurposed for today. An answering service or the modern equivalent of a virtual assistant can be a good investment. Many companies are also offering this service specifically to therapists. A quick Google search can give you some options.
The math to justify the expense is simple. If you figure the lifetime value of a client is $1000 on average, then going from 15 initial clients to 30 makes your practice $15,000 more in revenue. If these initial calls are 10 minutes a piece on average and half of the calls convert to client, then you pay the virtual answering service for 2 hours in total ($40/hr maximum). That’s a good investment.
But I don’t have time to call back, and can’t take them anyway.
This happens often too, but if a series of therapists do this, a potential client gets burned out and stops looking for therapy. This means less clients overall for therapists to support and hurts the collective mental health industry overall.
Instead, referring these clients to a colleague or service that can connect them the same day with a provider makes you look good in their eyes. Take a page from the Miracle on 34th st and be the therapist equivalent of the Macy’s Santa Claus. By acting selflessly, you give a good name to department store Santa’s everywhere and leave clients remembering your help as their friends are looking for therapy.
You don’t have to explicitly return each call, but can instead leave a message on your website and voicemail that you are full, and that instead the client should check out such and such LCSW at XXX-XXXX. .
If you aren’t building a personal referral network, then refer them to Thrivelution. We offer a guarantee that clients referred to us will be matched within 24 hours.
Option 2: Try Thrivelution
Thrivelution is based on a revolutionary proprietary algorithm that matches clients with their best mental health counseling fit. By being a centralized referral source, we are able to quickly connect potential clients with qualified providers. Research regularly shows that centralized referral sources such as ours increase access to care and reduce hurdles like wait times.(Stephens, Scott, & Muck, 2003)
Furthermore, our system only displays the 3 best fit clinicians to clients, and so therapists on our service receive less undedicated calls that use up time, and so you only talk with the clients that are most motivated to speak with you.
“By presenting counselors and clients with only the best matches for them, we take the busy-work out of connecting counselors and clients.” – Colleen Hilton, MA, LMFT, Co-founder of Thrivelution
Our lead dashboard also streamlines your client management and lets you know your average response times so that you can decide what to improve in your intake flow.
