STP 22 | The Pros and Cons of Expanding Your Practice's Services with a Testing Psychologist
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David Hall: Yeah, once you get the system going, it's, you know, there's plenty of demand and reimbursement, whether you're, if you're an insurance based practice, the reimbursement is strong for that compared to a lot of other services.
And if you're a cash based practice, the, the going fees are going to be high for that. So it is, as far as, uh, gross income, there's a lot to. To have for it. There is the barrier of that, uh, to what you said, James, like, it's not as ongoing of a relationship as psychotherapy is. Mm-hmm. And so you have to market it more.
But in most communities, there's such a demand. You don't need to necessarily, I think, advertise a lot to be able to develop that flow. Go back
James Marland: to a couple episodes ago we talked about developing relationships in your, your community or your network. And if you're offering something that other people don't offer that can support them with their work, you're gonna get, and you have, you're, you're a good neighbor.
Mm-hmm. You're gonna get referrals Mm-hmm. You just, you just will absolutely.
Hello and welcome to the Scaling Therapy Practice. This is James Marlon. This week we have a great conversation with Dr. David Hall about adding a testing psychologist to your practice. Thought it was, uh, a pretty interesting discussion about thinking through some of the things you might, you might not always think about when adding a new person to your office.
It's just like adding another master's level therapist, right? Well, Uh, not really. Throughout the, throughout the episode, we talk about the threads of, um, some decisions you're gonna have to make. Like, are you going to take the courses yourself or are you going to hire? And that talks about capacity and your strengths and what you really like doing.
And then another decision that for adding a testing psychologist is what type, you know, what's the niche? Is it, is it gonna be the, the medical ones? Is it gonna be for school children? Is it gonna be for work, is it gonna be for leadership or, uh, employment? Like what are the type of tests that you're going to offer?
There's a wide range, variety, and that probably will determine, uh, it's determined by who's already coming into your office and who are the preferred people that you like to see, because when you offer that specialty, you're going to get more of them for sure. Another decision is, uh, who to hire? Are you gonna hire a fully licensed person or are you gonna start up an internship program and kind of grow them?
And there's challenges with both, of course. And then reimbursements and compensation. Like that's, that's another decision. Can you afford, you know, can your practice afford higher, uh, overhead and higher reimbursement for the psycho psychologist? Of course we talk about the pros. Uh, the pros adding a testing psychologist is, its diversification.
You're adding another service. You're able to serve the community differently and better. Uh, they, they can be very lucrative. Uh, insurance reimbursements, uh, once you get the flow going can be quite, quite well. Um, and, and, uh, there's, there's always a demand like another. Another benefit is, uh, when I was, when I, when I worked with school children, that psychologist was busy.
It, it felt like a hundred percent of the time, overbooked with a wait list, a month long, uh, for, um, individual IEPs. I call them EAPs in the episode, but IEPs, individual education. Plan, I think it's called. She was so busy all the time. And then some of the other, some of the other testing ones, the ones for, uh, the medical appointments, uh, the bariatrics and the, uh, spine spinal fusion.
I think they, they couldn't keep up. Um, in fact, they had the, the interns, the psychologist, interns doing them, and they were supervised. So it was, uh, Quite good. So you can make a lot of money. Of course, the, the, the things to consider would be there's higher overhead. You gotta pay 'em more. You might have, they, they, psychologists send out so much more paperwork, there's more testing, there's more coordination of care.
So who's that gonna fall on you? The owner? Probably not. So we gotta consider, consider that and then the right fit. You know, are you, you, who's the right fit for your office? That can be some, some challenge for you. So let's get into the episode as we talk about adding a testing psychologist to your practice.
Thank you David Hall for, uh, bringing this to us and we'll see at the end of the episode.
James Marland: Hello and welcome to the Scaling Therapy Practice. My name's James Marlin. I'm here with Dr. David Hall. Hello, David? Yes, you are. How are you? Yeah, I'm well. Here I am. Uh, this week we're gonna talk about adding a testing psychologist to your practice.
A very exciting episode, but first we're gonna talk about our tool tip or tech of the week. I am gonna do go first. Uh, I've got this book Getting Things Done, uh, by David Allen. Have you ever read it? No, I've not seen it before. Oh, it's amazing. It's the Art of Stress-Free Productivity and uh, I was introduced to this book.
Uh, like three or four years ago at, uh, one of Joe Sanex, um, uh, the Killing It Camp mm-hmm. There in Colorado. And the, uh, a presenter did a whole thing about getting things done and I'm like, oh, this is great. I'm gonna buy the book. So I bought the book and it said on my. Shelf for like two years. But yeah, when I eventually, that's how, that's, uh, when, when I eventually got around to reading it.
One of my favorite tips from this book, and that it's filled with them is when you have a to-do list next to your item, write the very next thing that needs to be done. So if you're, I think one of the examples was, um, changing the oil in your car. Okay? Mm-hmm. So one of. That's a, that is a to-do item. The tip here is put next to it, call oil change off, you know, call the oil change mechanic or whoever, call mechanic.
That's the very next thing to do to get, to move that task down the list and, and you could complete the whole task with just that step, because you call it, you schedule it, you take it in, or it could be. You know, it, it, you, you call, they, you find a date, but then the next thing is like, find a ride. You know?
Find a ride to the, yeah. The place so that you can drop it off and drop it back. And that prevents you from like, losing things or getting stuck in the process. And also just not even getting started. Cuz I think that's one of my, you know, you have this big thing and you think you gotta do it all and, and it like becomes, Paralysis of analysis or overwhelming you with this big task.
But he said, do very, do just the very next thing. Write down the very next thing. And the, he has a whole system in there and there's, there's even software on how to do this on the getting thing done stuff. But I just love that tip for, uh, checklists and things. Mm-hmm. You know, what is my very next thing to do and then I do that and it moves me along.
So that is my tip of the week. Mm-hmm.
David Hall: Uh, mine is right before James and I hit record, we were talking about social media posting and kind of efficiency in that, and I've not used the system yet. And so we may come back on in a later episode and we may have a different opinion of it, but a podcast I follow and, and there was this, uh, something that came up that I took a note of.
Of like, oh, I want to utilize this in the future. And it's a repurpose.io is the website repurpose.io, and it's a, and there are other things like it, like Hootsuite, but like, this is one, one of the newer, uh, uh, sass software as a service, but where it allows you to post in one place and it will. Repurpose the content and allow you to then post, do a single post, and it goes up on multiple social media channels like LinkedIn and Twitter and Instagram and TikTok or whatever you're using.
Yeah. And the, you need things like that because, um, all these platforms are, you know, they, they don't like it when you record in one and then just take, you know, if it's, if it's the, the TikTok slash instagram reel slash. Uh, YouTube short kind of thing. That's a popular format right now, but it'll create watermarks and.
The, the AI knows it, and so the AI's not going to gonna be disinclined to promote in the algorithm something that's a repost from another platform or that redirects towards another platform. And so this service allows it to publish in ways that appear native and that will help you in your, your algorithm finding and all that.
But, If you're doing anything, you're trying to develop a social media presence, repurposing content and putting stuff in multiple places right now at least is, is a big thing. And as much as you can make things easier for yourself better,
James Marland: so, and just for, for my example, I have the, I have podcasts and, and sometimes they even record video, like newsletters and things, and.
Uh, I spend a couple hours, you know, cutting it up, making sure it's the right format, putting titles on it. Um, even just the very fact of, of signing into TikTok or Instagram and posting it takes a little bit of time. Not a ton, but I'd rather be doing something else. Mm-hmm. And it does have, uh, I, I'm gonna check into this, but it does have, you know, for $25 you can connect into a bunch of.
Video features and use it per month. I don't know how many postings it makes. I'll have to de dive into that. But for $25, could I upload a video and have it chop it up and throw it into my Instagram and my YouTube feed shorts and all that stuff? I mean, that sounds like a deal. Mm-hmm. So, we'll, we'll come back and talk to you about this.
Yeah. But, uh, there, there are lots of new tools coming out like this. Every. Every week it seems like. Mm-hmm. So, great, great tool. Uh, and tip David, thank you so much for bringing that back to my attention. Well, we're gonna get into a subject, uh, adding a testing psychologist to your practice. So my, my introduction to testing psychologist was I worked at a day hospital and every three times a week, uh, uh, somebody came in that I didn't really know and she went into a room.
And people would shuffle into the room, and then she would, they would leave. And, and, uh, she was always busy and eventually I, you know, saw her in the hallway and talked about what she did. And she was like a child, uh, psychologist who did testing, um, especially for EAPs. And, uh, Do you have EAPs in
David Hall: Tennessee?
Yeah, the, the, uh, in, yeah, the, um, educational plan, but it's the, or employee assistance programs. Yeah. But yeah, we, we do those, um, oh, maybe I use the wrong
James Marland: term.
David Hall: Are you said with the education, but for kids? Yeah, it was for education plans. Um, EAPs, usually employee assistance program, and that is something that we'll do.
But, but yeah, I, I can't think of the acronym for it, but it's a, it's an educational plan and it's a mandated thing.
James Marland: Yeah, so, so they needed a, a psychologist for that to get a diagnosis and to write up a plan. And there was also like a D H D referrals mm-hmm. And just all sorts of services that couldn't be accessed without a, a physi, a doctor giving some sort of diagnosis and treatment plan.
And, uh, she was busy, like all the time. She, the, the her wait list, especially during like the high peaks of school hours, Was incredible. Like the school, like the, the normal, like end of school ramp up times mm-hmm. To get services was incredible. And she, she said there just wasn't enough testing psychologists to go around.
Mm-hmm. And, uh, I've talked to other practices, you know, later in the career as they think about how they wanna scale and expand. And one of the things that comes up is adding a testing psychologist to the practice. Uh, so, so David, you, you're a psychologist. What do they do? Like what, like explain to, explain to us here, what, what did the psychologist do and what's their scope?
David Hall: Yeah. Um, it's a great question, James. The. For, for those people who are less familiar with all the individual disciplines in psychotherapy of marriage and family therapy of professional slash mental health counseling, depending on, it's called different things depending on your state, clinical, social work, psychology.
It's one of the unique things about psychology is the psychometric testing though, um, to, to say there are some te there are some tests that are administered by other. Uh, licenses as well. Um, for example, uh, I've done training in career testing. I'm a big fan of the, uh, the Strong's interest inventories one I use, and that's one that you have to have qualifications to do, but you don't have to be a psychologist.
You can be somebody with a master's degree in a few different disciplines, but. There's certain tests, uh, the wexler's one that a lot of, uh, the sort of testing that James is talking about for, to qualify for certain diagnoses, oftentimes related to IQ testing or disability testing. There's certain ones that are in most places are, uh, exclusive to psychologists.
And I trained in them. I, I did a doctor in psychology and I trained them. It's funny, I, I don't do testing. Mm. Uh, some of it is preference. Uh, I found it fascinating on some level and on another level, I found doing testing very boring. Because it is very rote for a lot of them. You go through certain exercises and there's a lot of, it's very kind of meticulous in some ways.
It feels, it feels very different than psychotherapy to me. Uh, cuz psychotherapy feels a lot more like playing jazz, at least how I do psychotherapy. It's a lot of adapting and the conversation goes in certain places, whereas, uh, testing is a lot more, it's like learning an orchestral piece. Like there's a lot of oh, fine tuning
James Marland: and being precise and.
Interpretation of what you're
David Hall: given. Yeah. And so I, I'm not interested. And the other thing is I don't maintain a license as a psychologist. I'm, I'm, I'm a licensed therapist. I wanna clarify for people, I'm not practicing without a license, but I'm licensed as a, uh, as a marriage and family therapist, as a professional counselor, and, uh, I, I don't maintain a license as a psychologist.
I'm a psychologist by education, but not my licensure. And so I can't do testing currently unless I were to change my licensure status. But as I said, I, it, I, I don't, I don't find it on a personal level of appealing. However, to your point, James, it's something huge in demand. I get, I get inquiries constantly because I am.
Trained as a psychologist. People will see like I'm a cd, a, a, a doctor of psychology, so people will look me up. I get asked all the time about it. Personally, I get asked just as a practice owner in my community for referrals and resources. I have a fairly, uh, short list of people in my community that do it and.
They, like what you're saying, are often on a wait list and particularly ones that will offer it to children in the different, uh, testing that's, that's needed there. But it, uh, there's definitely a huge demand and, and for entrepreneurial-minded people, um, practice owners, we'll, we will often think about like, well, is this, should I do this or should I, you know, whether personally should I.
You know, go on and get further training. Oh, go on and do it. Yeah. Yeah. Or should I think about hiring somebody to do this? And, and I, I did work in a group practice where there were psychologists that offered testing, same thing. Their testing schedule was booked out, um, quite far. I, I
James Marland: worked with a autism clinic and the, their wait list was like six months or something.
It was, it was incredible. And then, um, what are, what are some of the other fields? Uh, like I worked with, um, Uh, the, I think there's like bariatric testing. Yeah. That's a require, like spinal, spinal injury testing, right? Mm-hmm. Bariatric, I'm not, uh,
David Hall: for diff yeah. For different medical procedures, oftentimes you'll need a psych, you know, a specifically a psychologist assessment, right?
Um, using some of these, these, uh, tests. For that. Um, and
James Marland: then there's like forensic psychologists. Um, he was very busy. He flew around the country doing stuff. I don't, we just handled his schedule, but I don't remember exactly what he did. But he, his schedule was
David Hall: for forensic. Oftentimes that's related to criminal investigations.
Yeah. That's less specific tests, but more of just a process of assessment. But it, it is, and there's, there's demand.
James Marland: Yeah. So, okay, so the, we, we know there's demand and we know, you know, you need it for certain procedures, but why, why would somebody who's got a group practice, or even just a solo practice, why should they consider adding a testing psychologist to their practice to scale?
David Hall: Well, there's the income from the testing itself that it is, and, and, um, if you're an insurance based practice, oftentimes what insurance will reimburse and, and typically a lot of assessments are, Within scope of, of, uh, uh, an insurance reimbursement schedule. Uh, oftentimes it's quite lucrative compared to, uh, psychotherapy reimbursement, even for a psychologist.
Like what a psychologist will get reimbursed from an insurance company from doing an hour's worth of testing assessment versus an hour's worth of psychotherapy is vastly more.
James Marland: Are we talking like a hundred dollars more to, you know,
David Hall: I don't have any rates right in front of you Don't have it rates in front.
Yeah. But like, I mean, I think oftentimes it, it will represent double or more. Okay. Uh, of, uh, and that that'll be different in different insurance plans and things like that. Um, I definitely know out of pocket. And, and part of when you pay for testing out of pocket, there's the time for the assessment and then there's the, the writeup that the writeup up afterwards.
Yeah. Afterwards. And so there's more time involved, but even the time per money is, is often double or more. Okay. Um, so it, it's lucrative. Because of the demand. If you're a group practice owner that, let's say you're generally a psychotherapy counseling practice, but you add this as a service, it can be a way to build referrals for your other services.
Cuz people may be coming to your practice for assessment, right? But once they're there, they may also be interested in other services that you have to offer. And that can be a way to generate. Referral flow for the other providers in your office that are providing other services, more traditional services to what you may offer.
And the reason people are finding your practice initially is because you have testing. They
James Marland: have, they, you're solving a problem that they desperately need, you know? Yeah. They're, they're searching
David Hall: out. Yeah. And because of that, you, you may benefit from the trickle down effect. Mm-hmm. Cause someone's coming to your practice for that.
There's this benefit. Um, it can also help you in the credentialing process with insurance because insurance companies may be more willing to credential your practice as a whole and credential and, and schedule a higher reimbursement rate if you're offering a more unique service. Because they have certain measurements they, for, it's related to federal and state funding with Medicaid and Medicare programs.
Mm-hmm. The insurance companies have to be showing a certain amount of coverage and that will often affect what they'll offer for reimbursement. Uh, okay. And so there's, if you're particularly an an in-network practice, this can help. In your credentialing process, both getting credentialed initially with an insurance plan and what you can get generally for your reimbursement rates.
Cool. So speaking
James Marland: about rates, like what are some of the things you need to consider, uh, when you add a testing psychologist? I guess we'll go with costs first. Like what are some of the like. Everything costs something. There's a, there's a pros and cons like list, but what are some of the things to consider when you're adding another service line like this?
David Hall: Well, if it's hiring an outside person, what they will expect for remuneration, for pay, mm-hmm. Is gonna be different than a master's level therapist of Right. You know, it typically, it's been a while since I've looked, but I think the last time I looked, I, I think average pay for a psychologist, which is gonna be a doctor level person versus a, let's say a licensed professional counselor or licensed mental health counselor, is gonna be about a $20,000 more a year for a full-time person.
Okay. Okay. Uh, and of, of what just kind of average industry pay is. And, and, you know, they will, you know, they'll likely expect that. If you're hiring somebody as an employee, so there's the expense of you may be able to bring in more for their services, but they also expect to make more mm-hmm. In their services.
And that's one. Um, It's a smaller pool of people because in, in most states at this point, to be a psychologist, it requires a, a doctorate degree. I, I can't say that absolutely cuz it's changed over the years, but I'm pretty sure that's the case. Okay. Uh, cuz it used to be in certain states you could become a psychologist at a master's level and, and certain states had and still do have, um, They'll call them psychological examiners, but it, it changes.
Like that's a, that's a license that's been sunsetted in my state. There used to be, uh, a license in Tennessee. It was a licensed Psychological examiner, which was a Master's Oval person that worked directly under a psychologist, but that would do testing and psychotherapy. And the license still exists, but they don't license new people.
Okay. So it's gonna be, Ending. Yeah. Yeah. It's eventually, it's just people that have maintained licensure, but, and I can't remember when it was sunsetted, and so different states have different things, but assuming you're in a place where you have to have a doctorate, it's going to, that's gonna shrink your pool of people.
The amount of people in the, the job market that have master's degrees and a mental health discipline is gonna be far larger than someone with a doctorate degree. And so there are fewer people to recruit. Yeah. The other thing is the test themselves. So I, I was having lunch. Oh, yeah. Yeah. Because they ca they're expensive.
Yeah, they are. Yeah. And um, I was, I connected with a psychologist in my community about a year or two ago, and he had come across my radar and he had a very distinctive last name. And I realized, I knew his family. I didn't know him specifically, but I knew, uh mm-hmm. I had grown up with cousins of his. And I've reached out to him.
I go, Hey, I, I actually, I, I grew up with your cousin Gaines and, you know, would love to connect and we end up having lunch together. A delightful uh, uh, man, he's in my community, Dr. Frank Pittenger. But I asked him, he was a psychologist and I asked him about testing because that's often a need I had, and I don't know what the case is currently, but when I asked him, he said, well, I, I haven't spent the money to get the assessments and because he was trying to figure out what assessments to buy, because they, you have to buy them from a pty, I think it's who puts them out?
The American Psychological Association. Okay. And when you have a monopoly on something, it's amazing how expensive you can make it. Yeah. And so these are, I, I think a lot of them are in like the thousands of dollars and each test. Costs. And so some of it is even figure out what are the tests I'm most likely to do and what do they cost and how do I, but there are, so the, the testing material is an expense.
Yeah, that makes sense. Oftentimes a, a not, uh, small expense
James Marland: and sometimes you have to send them away to score 'em, and that's an expense. Mm-hmm. And,
David Hall: uh, yeah, and, and it's the. So there's equipment, I guess, involved with it. Yeah. And, and sometimes it's not just the paper in it, like there's, um, Of different tests that I did training in.
There was like spatial reasoning things with it. So part of using, getting tests was, there was these different pieces to it Yeah. Of like blocks and things like that. Yeah. And I had the benefit of when I was in school, I happened to work for a practice that had testing psychologist because I would've been, I don't know what I would've done because I basically, I, there were, I could borrow the assessments from the practice I worked for.
And I would've had to find something. I, I mean, I, I, I can't imagine exp, you know, buying it outright as a student, but that was a tricky thing and I was just very blessed in that I didn't have to go very far for it, but, all
James Marland: right, great. Well, that, that's something I hadn't thought of the, the testing equipment and the paperwork and all that, but what about, um, some things like admin costs or insurance costs?
Like, uh, do you, do you think, um, You know, adding a psychologist would increase the, depends what you're doing because, um, with people who are ongoing clients, they schedule once and then they might have a reoccurring appointment. Mm-hmm. Or they, they can use the portal. A lot of the testing patients you schedule once and then maybe you have a, a one follow up and a second follow up and that's it.
Like, it's, it's like
David Hall: you're churn. Yeah. It's a, it's a good question, James. I. I, I can imagine it being more burdensome, but it depends on what sort of system you're already running. Mm-hmm. If you already have like a scheduler that's scheduling for your therapist, and then that could, it could maybe slide into that.
I, I think about from, from my personal practice, you know, I don't have an admin scheduler person, like people book with all our therapists online or, or therapists manage their own schedule. With the, I, you know, there's a certain amount of admin we, we do, but we have it fairly streamlined. But that's for psychotherapy, for counseling, and in testing.
I don't know if I could get away with this current system. Yeah. And some of it is, is I work in a job market where putting some of the scheduling responsibilities on therapists is more acceptable. I don't know if, uh, if I could do that with a doctoral psychologist. Right. Uh,
James Marland: yes. Also, also they, um, They also send out more paperwork, like mm-hmm.
They just send, there's more paperwork. They, they receive packets and they need things at certain times to do their, their assessments, and so some of that adds a burden. Would you wanna put that on your doctoral, uh,
David Hall: staff, or would, and would they accept it? Yeah. Would they accept it? Yeah. Yeah. Um, so it, it is, those are the things I imagine having not done it personally as a business owner, it's, it feels kind of hypothetical to me, but mm-hmm.
Sure there is. Um, okay. Yeah.
James Marland: What about insurance? Does, is there extra insurance or things
David Hall: for I think it depends on, I think it would be really tricky if you're running a cash based psychotherapy practice. But then wanted to credential for insurance for this because it, you know, then, then if you are not already having insurance billing, then yeah, that's a, that's a whole different thing.
Um, it's more units, like one of the benefits of psychotherapy versus other medical disciplines is the units you're billing for typically are, are fewer. Um, you know, there's a. 9 0 43. Uh, I can't, I can't remember it now off the top of my head. Yeah. But it, it's, there aren't a lot of different things that we bill for in our practice.
Right. We, we do out of network billing and so I think there are three units we typically use. Yeah. Uh, commonly. And so this, these would be some different units and you would need to make sure whoever was providing your billing services was familiar enough of the coding needs. And, and so I could see that, but you know, I, I think.
Um, it's deciding, there are lots of things that people will think about, like, oh, this is great. I should, this is an added service. This is, I could see demand. I should absolutely do this. And my response to most people, depending on whatever that variable is, whatever your X is that you're thinking about adding to the equation, my general advice to people is maybe, maybe it's a good idea.
Uh, I think in the altru altruistic view of things, when you see a need and want to attend to that need, I think that's good and I want to encourage that in people and all that. But you've gotta figure out what is the space you have to close between the, the, you see the need and what does it mean to meet it and um, what will that take?
Out of you as a, as an entrepreneur, as a practice owner to do, whether to get personally trained or, as I said, like even if I, even if I was a psychologist in, in my licensure, I try to think of would I be doing testing right now and no. Mm-hmm. E even if I found it more stimulating, uh, and this sounds bad, I feel so selfish cuz I recognize there's a big need for it, but I just didn't wanna do it.
Yeah. And.
James Marland: People who love it. Love it. Yeah. Like they wanna do it all day long.
David Hall: But, and I love, yeah. And I, but I love doing psychotherapy. Yeah. And when I did my doctorate, I was, I did a lot of psychotherapy and I do a lot less now because I don't have time to do more, cuz I, I run multiple businesses and like different, uh, demands on my time.
And so because of that, I, I say that, you know, my, my job as a psychotherapist is like my fourth job. Cause I'm a supervisor, I'm a practice owner. I, I work as a teacher. Mm-hmm. Like all these things as far as my time goes. Uh, and so I could, I could have spent all this, this energy getting there and would, I've had the capacity to do it.
Now if I, if I, um, got licensed and credentialed and offered that service, I feel pretty confident I could fill my days with it. But is that what I is, is that scaling? Right, because, and then I'm, I'm in the exchanging time and so I think that's the tension. There are lots of things that are good and I, I think that's what's hard is cuz we, we ultimately wanna provide a service that is a benefit to our community.
And there's so many things that are good. Mm-hmm. Yeah. But is it, can you do it or can you make it happen? Here have been some things to consider though. What are, do you live in a community that has a doctoral program? That's producing psychologists, because that's a consideration because there, there is, the University of Tennessee in Knoxville is, is in my hometown in where I work, and they have multiple doctoral level psychology programs.
They have a doctorate in counseling psychology. They have a doctorate in educational psychology. They have a doctorate in clinical psychology. All of them are getting, um, trained in testing. So does that help or hurt? I think that would help. It helps because, because that is a workforce. Those are people in the Okay.
In the market that I could, if I was wanting to pursue that, I'm more likely to be able to find qualified people because there's a training institution. Mm-hmm. In my area. Versus if I lived in a town that didn't have a university that was graduating, uh, psychologist, it'd probably be harder for me to find them.
That makes sense.
James Marland: I would assume, now I know when I worked at the hospital, they had APA like, like we had, we had psychology or psychologists, interns who would come in. Could a practice do that and have That
David Hall: is an excellent point. Like yes. Cuz in most programs, once you finish school, you have to do a APA approved internship site.
And there's a process of being in an approved site. And that is a huge part of the funneling process because in most places, once you finish school, you, you can't just work independently. Right. You have to go through your, and it was one of the things that made me decide not to get a psychology license, cuz I finished my program and I had already, I know, I know it's another year.
So it's another year I finished my program. I was already licensed as a psychotherapist. Yeah. And, Where I worked was not an approved site, and so I would've had to have, get another job.
James Marland: And it There's a cutthroat competition out there for it. Oh, yeah. From, from the students I talked to, they would submit their applications and they weren't even sure I.
Where they were going, or even if sometimes you didn't get accepted or there were too many students for mm-hmm. The places. And so then they had to either go to a place that they weren't sure of or wait for the next round. It was, uh, I, I felt, well, I felt sorry, psychologist. I felt bad for you cuz you, you did your degree.
Yeah. And then you don't even know where you're going. And you might be working in a place that. You know, our hospital was great, but you might have worked in a place that it wasn't exactly your first, second, third, or fourth pick. So yeah. Maybe it's, somebody could set me straight on that, but that's how
David Hall: I understood it.
No, and it, it is kind of, it's, it's like residency matching for people who finished med school. Hmm. But, um, it can be, yeah. And people usually have to move for it. Yeah. Or often do. And so it, I, I would say that if this is a serious service you wanna offer. Then figuring out how to either partner with or become an a p a approved site can be hugely important.
But it is, we talked about this in a previous episode, but you're gonna have a problem. We've talked about this in a few episodes. You're gonna have a problem, like there's, there is, offering assessment services has offers unique solutions to people you're trying to serve, but also presents some unique problems for you as a service provider.
And it might be completely worth it for you. Mm-hmm. Or it might not be. And so it's figuring that out. The, um, but the other thing I'll, I'll say is, um, even though the, a lot of the assessments we talk about, I don't offer, I do offer some. I like career testing. Part of that is, is I like career counseling. I like the sense of vocational matching for people.
Uh, I've worked traditionally as a therapist with a lot of college students and graduate students, and oftentimes the trying to define and, uh, figuring out how to plan for and pursue career options. Is part of their journey and I really like that. And there's assessments I do for that that I like doing.
Part of it is the assessments are a lot more automatic. It's an they go on an online portal and I'm not, I'm not giving the assessment in the same way I would for a lot of psychologists only assessments. And, but that's a service I offer in my practice. And that is a niche because we advertise doing career testing.
And people come to us for that. And, and so sometimes it doesn't have to be all or nothing. Sometimes you can assess like, well, I wanna offer some more psychometric sorts of things. What might be things I can offer at my current licensure level, or what might be things that there's demand for. And so it, it's, it's, you know, it's rarely a binary decision, an all or nothing.
Uh,
James Marland: so what, so we talked a lot about the costs. Can we talk a little bit about how this could be a benefit? Like how can you make money in this situation once you account for all the
David Hall: costs? I mean, we talked about that in the sense of, you know, it, you make money cuz it grows your practice. Um, you make money because there's good reimbursement for it.
Okay. Those are the, the main ways I'd say these.
James Marland: Uh, insurance, maybe the insurance companies pay more for a certain thing. I know the specialized services, where I used to work was a big money maker. They did the, the, the, the weight loss, uh, the bariatric evals, the spine.
David Hall: Yeah, once you get the system going, it's, you know, there's plenty of demand and reimbursement, whether you're, if you're an insurance based practice, the reimbursement is strong for that compared to a lot of other services.
And if you're a cash based practice, the, the going fees are going to be high for that. So it is, as far as, uh, gross income, there's a lot to. To have for it. There is the barrier of that, uh, to what you said, James, like, it's not as ongoing of a relationship as psychotherapy is. Mm-hmm. And so you have to market it more.
But in most communities, there's such a demand. You don't need to necessarily, I think, advertise a lot to be able to develop that flow. Go back
James Marland: to a couple episodes ago we talked about developing relationships in your, your community or your network. And if you're offering something that other people don't offer that can support them with their work, you're gonna get, and you have, you're, you're a good neighbor.
Mm-hmm. You're gonna get referrals. Mm-hmm. You just, you just will absolutely. Uh, so did we cover, how do you add a testing psychologist? I think we talked about having that, that APA program. But
David Hall: yeah, I mean, it, it's similar to hiring and lots of things, um, but it's just being prepared. Like if you're seriously looking at it, um, the first thing I would do is go online to Indeed Monster LinkedIn jobs.
Look, what's, what are the psychologist employment opportunities in your area that will give you an idea of salary range that will give you an idea of just, I mean, there, there's few job ads I've ever posted that I didn't lift from somebody else. Mm-hmm. Uh, to some degree of like, well, what did somebody else post?
And like, how do I adapt it? Like, oh, they, they made sure to, to add this to it of, you know, for qualifications or for, and, um, uh, You know, figuring out what's gonna be you, you need to know the why for a potential candidate, why would they want to come work for you? Mm-hmm. And thinking about what are you gonna add?
Is it, is it clientele? Is it admin support? Is insurance billing? Is it the fact that you're an approved site for something they need? Uh, is it stability of income? And because. You might have a great idea of why this will benefit you, but unless you can, part of building a team is unless you can clearly articulate, articulate, art.
Articulate. Articulate. Thank you. Sorry. That, that word just didn't wanna come out. Right. Articulate the benefit to them then. Yeah. Uh, you're gonna be at a loss. So we're
James Marland: gonna, we're gonna, well we're gonna wrap up the question about, uh, adding a. Testing psychologist with this question, is it worth it? And I'm gonna nail you down a little bit because I don't want you to say it depends.
I want you to tell me who, who would, uh, this be good for and who would it not be good for? So who's it
David Hall: worth it for? I'm gonna start with it depends. Depends on who, but like, but here, but, but I will, I'll let the jello be nailed down. If, if you are the sort of like, it takes more organizational. Uh, predispositions in a system for this to happen because there are more components than just running psychotherapy.
Mm-hmm. Similar to having psychiatry or other medical sorts of things. This is more complex and if you do well with complexity or your system does well with complexity, it's, it's better to add in if you are already. Uh, well tapped into demand for this. If you're getting a lot of requests for this, if you're, if you're just hearing about this for the first time and no one's ever talked to you about it, it's gonna be harder to get it going than sure if you're, if you're aware of inquiries for this all the time.
Uh, and do you have a, um, Do you have the means to recruit for this either? Mm-hmm. Nearby programs, the relationships do you have, if you're in a very, uh, remote area and you're not aware of a lot of demand and you're not a really organized person, this isn't for you. Yeah. But if you're aware of the demand, if you have the organizational structure in place that can accommodate this, and if you have a plan for recruitment and retention for this sort of employee, Yeah, I think it would be for you.
James Marland: Cool. And just, just going back, uh, they're probably gonna need more clients than your regular mm-hmm. Staff, although their units are more too, so that sort of offsets it anyway. Mm-hmm. Good, good discussion. David, do you have, uh, one thing you want people to remember from this episode? Um,
David Hall: it depends. Is that I was saying the psych it that.
A lot that it, it scaling is r is almost never, uh, perfunctory. There are lots of things that we might talk about in our conversation, James, that our ideas of this is one way to scale and it's figuring out is this a good way for you? Because it may be, it may not be. And, and I think psychologist in testing is one of those examples of, that is a strong depend sort of thing that if that could be a great angle for you to take or it may not, it may be that that's not your, your burden to carry and that is not a sign of failure or lack of vision or lack of just, we, we cannot do everything.
Right. Um, I think testing's a really great service and I appreciate the psychologist in my community that I can refer to, but I personally have no vision for in my own business structure, to add psychology, to add, to add testing. Um, I've talked to psychologists as potential recruits for my practice, uh, in the past, and I've told them that if they wanted to do testing that I would be very supportive of that, but they would have to run it like.
More or less on their own because we run a practice that's pretty low admin. Mm-hmm. And if they're wanting insurance credentialing, they're wanting like that, that would be a process we would have to figure out because it's not in place. And so I, it's not been a big, um, uh, goal for me to, in that.
James Marland: Great.
Uh, I guess my one thing, we, we talked around about it, but I think, uh, my one thing is, uh, This, uh, adding a psychologist can improve your niche. You know, like if you see a lot of children, uh, adding a testing psychologist that supports that can increase your brand and help you with your niche. Same thing with, you know, the, the, the spinal clinic for older adults.
Like any of those things, um, Like, I remember, uh, we always sent people to neuropsych testing when we didn't know what to do with them. Mm-hmm. Like, like what the psych, the psychiatrist would see 'em and try a few things. It wasn't working like then we had to, there was a child one, so we send them to the child neuropsych testing who could help us like narrow down where things are going.
But it was super specialized, but it was that, it was. Lucrative, and they were in great demand because it was specialized. And so if you're, if you're tending to have some sort of specialty, um, you can support your brand or your office by being the center of mm-hmm. You know, autism, the, the center of autism in my area, well-known the, the, um, um, They, they're the place you go, you know, for autism.
And that just, uh, increases the value of their services. They can attract better quality employees, they can pay more, cuz they get paid more. Like it just feeds on itself. So, um, yeah, uh, uh, my one thing is this can help you with your niche, so. Mm-hmm. That's, that's okay. Cool. Well, Thanks David for joining me today.
Uh, this is James Marlon with Dr. David Hall. We'll see you next time.
Thank you for listening to the scaling therapy practice. I hope you enjoyed the show. I want to remind you that the content shared today is for general information and entertainment purposes only. It shouldn't be considered as legal or tax advice. If you need a professional advice in those areas, please consult with a licensed attorney or accountant, but thank you so much for listening.
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