A fresh look at practice management

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A Fresh Look at Practice Management
by Mary Aspinwall

(This month I was asked by the Cork regional group to prepare a talk that we decided to call ‘A fresh look at Practice Management’. The article below is a summary of that talk.)

Maybe you are reading this just as you are beginning to set up in practice. Since hindsight is reputedly 20/20 I thought you might like to hear from someone who was doing the same thing about five years ago. It’s the kind of article I wish I had read then! If you are already in practice and blissfully happy and rich (in all aspects) then skip this article, but please write and give us your tips in the next issue with a plan of your office so we can check out the Feng Shui…

Before you set up in practice do some visualisation. Imagine you are ill… what qualities would you seek in a therapist? The public’s perception of you will be a key factor in your success. How can you create confidence in your professionalism? If you’re not sure if you are getting things right put yourself in your clients’ shoes.

Before you launch your practice you will have to decide on certain basics like:
1. Why am I doing this?
Always a good question. I remember watching a documentary on doctors. They were asked whilst they were working 80-hour weeks as junior doctors why they had chosen to go into medicine. Strangely of the dozen or so interviewed not one mentioned healing or even helping people. Perhaps they were too exhausted to think straight. They cited status, money, job security, family tradition and opportunities abroad. I doubt if many homeopaths would come up with these answers. So why are you going to be a homeopath?
Now might be a good time to reflect on the opening paragraph of Samuel Hahnemann's Preface to "Chronic Diseases".
"If I did not know for what purpose I was put here on earth - to become better myself and as far as possible and to make better everything around me that is within my power to improve - I should have to consider myself as lacking very much in worldly prudence to make known for the common good, even before my death, an art which I alone possess, and which it is within my power to make as profitable as possible by simply keeping it secret."

Hahnemann was very clear about his motivation and about the importance of being generous with his ‘god-given’ discovery. Having said that he is not saying there is anything wrong with making money and there is no need to feel squeamish about it. Think of it as an exchange of energy. I heard a great story from a fellow homeopath. He treated a man for a headache and at the end of the session the client asked to pay half the fee. He said that he was hard up, although he was in full-employment and well dressed. When he came back the headache was still there, but only on one side of his head, where as previously it had been all over. The homeopath suggested he pay the full fee and at the next visit the other half of the headache had also gone!
When I first started work I used to treat some clients for nothing, but the strange thing was they didn’t do very well. Perhaps people need to be invested in their own treatment! Now I always charge something, even if it is a token amount.

2. Where am I doing this?
Do you want to work from your home or an office? Of course there are pros and cons for each. The main argument against working from an office is the higher overheads, but if your home is remote, inaccessible or unsuitable you will need an office.
Start by calculating what the total overheads will be (rent, rates, water rates, lighting heating, telephone, accountancy fees etc) for the whole year then divide this by the number of weeks you intend to work per year to work out your break-even point for each working week. Once you have done this calculation accurately, you will probably be keen to find ways to reduce your overheads.
One way is to share them. You might not intend to work every day, on the days you are not there you could rent your office to another therapist.
Investigate ways to keep costs as low as possible. For example Ocean or Spirit are cheaper for local calls than Eircom. A dehumidifier running constantly cuts your heating bills dramatically. Viking Direct is very cheap for office supplies and furniture and they deliver free (next day) if your order is over £50.
Take your time in choosing the right place. Is it user-friendly? Does it have easy access for the disabled and those with buggies? Will it be possible to provide a waiting area with chairs and magazines? Is the consulting room spacious enough for a children’s area (for toys, low chairs and table, colouring pencils) a consultation area, a desk and a remedy storage area. Have you got a shop front? If you have, how can you take maximum advantage of it in terms of telling the public what you do and at the same time maintain your client’s privacy?
If you decide to work from home you will save money but there are disadvantages, particularly if you have a family. It may be difficult for them to accept that you are working and they may expect you to fulfill other roles at the same time. Remember, people coming for treatment will be expecting your full attention and paying for it!
As far as possible separate your work and home life with clear boundaries. Work at fixed, regular times, when you have childcare. Get a second phone line with an answer phone for business. Do not give out your home number. Create an area where you see clients that is as separate as possible from the rest of the home, with easy access to a toilet. If you use the room for any other purpose put in a closed storage area and put anything inappropriate to a consulting room away before a client arrives.

3. When am I doing this?
Will you work full time or part time? Will you give up your day job? These are very personal decisions. My experience was one of gradually building up my confidence through sitting in on a lot of live case taking and clinic hours. I was lucky enough to organise and apprenticeship with a homeopath in Britain. I worked as her practice assistant, helping her to reorganize and administer a very large London practice. In return she let me sit in with her two day per week and she supervised my own cases.
In the meantime I had designed the Double Helix/Helios remedy kits and when I came to Ireland I had an income from royalties that allowed me to concentrate on setting up my practice without having to do anything else. For me this was ideal. So much so I would recommend trying to save enough to have a period like this where your basic needs are covered and you can take a break from your other work and concentrate 100% on setting up as a homeopath. It’s great if you do not have to worry initially about how many clients you have.
Allow yourself 3-6 months to get up and running. Decide which days you are going to work and stick to them. Don’t change your days or your phone number unless it is unavoidable. There is a great deal to be said for consistency. Even if you have no appointments be available on those days. Answer enquiries, encourage people to call in for a brief chat with you, work on your leaflet, prepare talks, read Materia Medica – use that time for Homeopathy and nothing else. It is a natural law that you will get out of something what you put into it.
Personally I have never seen clients for more than 3 full days per week as it is very intense work and you will also need to have time free to do casework. I chose to work Tuesday, Wednesday and Thursday so I could have a very long weekend!

4. Who? How can I let people know I am doing this?
Most therapists agree that nearly all of their clients come to them as a result of word-of- mouth recommendations. If you are setting up practice in the same area as you did your student cases and acute prescribing a few people will already know a little about you. You need to build on that. Everyone agrees that Picasso was a brilliant artist, but you could argue he was an even better self-publicist. If you want to make a living start by making your presence known.
Give talks to any group that will have you. Teach beginner’s courses in Homeopathy. Explain what it is appropriate to treat at home and what needs to be treated by a qualified homeopath (that’s you).
Offer to spend a few hours in your local whole food shop or chemist. They will be happy to have you. It will help them sell more homeopathic medicine and raise your profile. Do it at the same time each week and advertise that you’ll be there.
Offer to teach their staff. Make sure they are clear on the cases that are suitable for acute treatment and those that need to be referred on (to you). Meeting the public in this way allows them to form an opinion of you before they commit to having you as their therapist. If you are confident, personable and know your stuff the chances are they will either come to see you as a client or recommend someone else to come and see you.
Prepare a leaflet describing homeopathy and the service you provide using your own words. This will also give people a good sense of who you are.

5. How can I make a success of my practice?
When it comes to defining “success” here are some possible criteria
· Successful case management
· Financial success
· Job satisfaction
· Avoiding burnout…

Financial success
I think this bears repeating…it is OK to make money.
Charge a realistic fee for the work you do. The fee should accurately reflect the costs to you both in money, effort and time of your training and experience. Include the cost of books, computer equipment, software, seminar attendance, conference costs, registration charges and all overheads.
Acknowledge that you are self-employed, not in an established framework like a Health Board worker. Therefore you will need to actively promote yourself and Homeopathy.
Buy a computer, they are invaluable for literature: leaflets; posters; window display and you can even create a simple website for clients and potential clients to visit. They will also save you hours and hours if you buy a repertorisation programme for casework.
Cultivate other sources of income.
Supplement your income so that it is not entirely dependent on clients.
Sell things: Kits, remedies, ointments, books, and any other products you think have value (e.g. eco-friendly nappies).
Seek out public speaking opportunities (you may only receive a small fee, but it’s a great way to get referrals).
Teach. Lay people initially, later you could be teaching students and fellow practitioners.
Success breeds success but you’ll need to get the ball rolling by…
Getting recommended by your peers.
Write articles. Let people know how you work.
Join The Irish Society of Homeopaths. It does great work and raises the professional profile of Homeopathy; by joining you are making a contribution to sharing the costs of PR and promotion. Support them in any way you can so they can support you. Go for registration (you are eligible one year after graduating).
Getting recommended by the public.
Meet the public on neutral territory so they can suss you out.
Consider your public image. On reflection I think my logo (a Matisse style creature reaching for a star) was too hippy and put some people off coming for treatment with me.
Teach beginner’s classes. (For a free download of a beginner’s course visit www.homeopathykits.com and go to the Practitioners Page).
When you deal with enquiries (on the phone or in person) consider carefully what you can and can’t say. Read the Code of Ethics carefully. You cannot give any guarantees. Each case is different. People are not impressed by spurious claims. Be clear and honest. Let them know your fees and how long they will be with you before making an appointment.
Getting recommended by your clients.
If they feel you have done your best and treated them with consideration and respect your clients will recommend you. Offer reductions for treating close members of your client’s family.

Successful case management
What are you paid to do?
I was teaching a group and I mentioned a case where I had prescribed the same remedy for two years, but eventually realised it was only palliative and had changed the remedy. Someone asked: “Did you give her her money back for the two years then?” It was a good question, because a common delusion is that we are paid to cure someone. We are actually paid to use our skills, energy, training, experience and all available means at our disposal to do our very best to find the most similar remedy.
Have you done it? Are you using all the resources available to you? Are you drawing on what you have learnt and experienced? Do you go to conferences, seminars and take advantage of on-going education? Do you get peer support and supervision? Do you buy the latest publications and keep abreast of new provings?
If so then you can claim your fee with a clear conscience.
Nobody said you have to cure every case. If you get stuck with a case honesty is the best policy. May be you need support or supervision. May be it is time to pass the client on to someone else. Discuss this openly with your client.

If generally speaking you are financially successful and your cases are managed well then the job satisfaction should be immense. The problems you have getting going will then change, once you have a busy practice, and your main task will be to avoid burn out. Strangely the way you structure things from the very beginning can be a big help in avoiding burn out.

Avoiding stickiness.
Most sticky situations are the result of poor communication.
Consider your expectations of yourself, your clients and your practice. Are they realistic?
Does anyone, apart from you, know what they are? ! Remember ASSUME makes an ‘ass’ of ‘u’ and ‘me’. What exactly is the service you provide? Set boundaries. Keep to them. Don’t give in to bullying or other peoples’ pathology.
Be very clear about your policy on:
Working days. Phone in times. Returning phone calls. Availability. Home visits / prescribing during Labour. Acutes and injuries – self-prescribing. Locums.
Communicate all of this to your clients and make sure your client also has basic information on Homeopathy, what to expect if a remedy is working (direction of cure), possible antidotes etc.
These details may not seem important when you have only a handful of clients, but in a few years time when you have a thousand plus on your books you’ll be glad that you didn’t give them all your home number and say phone me any time.

Parting thought.
Being a homeopath is a great privilege and a fine vocation. As a way of making a living it beats selling fridges to Eskimos.

© Mary Aspinwall