How should I arrange my schedule in private practice?
This age-old question never has an easy answer. When you’re working in a clinic, it likely dictates how many sessions you’re supposed to schedule in a day or week. However, if you’re out on your own, you get to call the shots. Well, what shot should you call?
The range I hear most often when talking with therapists who work fulltime in private practice is 20-30 clients per week. The amount that’s right for you might consider several variables:
This can be tricky to calculate, but I tried to estimate my earnings by creating a spreadsheet with a few simple calculations. First, I created buckets that align with what third-party payers reimburse. For example, I created buckets ranging from $75 (the low end of my sliding scale fee) up through $165 (the high end of my reimbursement.)
Next, I made a row where I can estimate how many clients I will see in a week under each bucket. $75 x 3, $100 X 7, $125 x 7, $165 X 3. All of these numbers get added up. Now I know roughly how much I will earn in a week.
Once I have this number, I multiply it by the estimated number of weeks I will see a client in a year. For me, it’s 40. I came up with that number by keeping track of attendance and also subtracting the number of weeks I will take off for vacations and holidays. The estimated number of weeks I will meet with clients multiplied by the estimated weekly income is roughly how much money I can expect to earn in a year.
Finally, subtract expenses from this number. Now I have a decent estimate of my earnings in a given year. Swap out the variables to figure out how many clients you need to see to earn your target. You can obviously see fewer clients if you can keep your expenses down or only contract with higher-paying third-parties.
You can only figure this out by trial and error. Maybe start off seeing 25 clients a week for a while and see how you feel. If you have extra energy, feel free to increase your caseload. If you’re feeling consistently run down, it might be necessary to drop a couple of times from your schedule. I caution against making any decisions based upon just one week. There will always be a tough week no matter what your case load is, so make sure to evaluate your energy from observing at least a month of work.
This also can only be figured out through trial-and-error. Do you want to sleep in and start late? Or get up early and get straight to work so you can always finish up early? This is perhaps the best perk of being in private practice. You get to arrange your schedule based upon when you want to be free from work.
I played around with my schedule for a while and eventually decided I wanted leisurely mornings. I start my day about 10 or 11 AM which works great for me. Early on, try varying your schedule throughout the week and see what feels best for you. When you get a sense of what day feels best for you, try arranging the other days to match. There’s no right answer, only what works for you.
If you’ve followed the approach above, you probably already have a decent idea about what this number will be for you. Maybe you are planning on seeing 25 clients in a week. If you’re going to work Monday through Friday, this means you’ll likely see about five clients a day. Five to six patients a day is a pretty typical number of clients for a therapist in private practice to see. Keep in mind, you want to buffer one or two slots in the event of cancellations to actually see the number of clients you are aiming for. If you want to conduct five sessions a day, consider scheduling six (see the secret tip later on in this article to be as efficient with this as possible).
This varies by individual. Some therapists see 35 clients a week for years and do just fine. Others can only see 20. You’ll have to experiment here. If you want to see more clients but don’t have the energy, you may need to evaluate how to increase your energy rather than changing your caseload. Are you getting enough sleep? Is it good sleep (not impacted by too much alcohol or other substances)? How is your diet during the day? If you are eating a lot of sugar maybe low energy in the afternoon has less to do with the number of clients you’re seeing and more to do with spikes in metabolism.
By now, you’re definitely getting the idea that each person has to figure out what works for them. To create a personalized schedule is the main reason many people want to work in private practice. Ranges are likely between 15 - 35 clients per week, but this a huge variance. Are you working full-time or part-time? Is this the household’s primary income or supplemental? There are many reasons why someone might have greater or fewer cases so don’t compare your caseload too much to others.
This is going to have a lot to do with how many clients you see each week as well as your approach to psychotherapy. Therapists doing short-term therapy will see a lot more clients in a year that someone doing long-term therapy. This number is also dependent on how many appointments a therapist has each week and how long those sessions are. A therapist who does 53-minute sessions will likely see far fewer clients that a counselor who does 45-minute sessions. There’s not a clear answer. If you follow the approach above, you can find the right number of clients for you and your situation.
Cancellations are a reality when running your private practice. Once you’ve figured out how many slots you have open, you’ll eventually fill them up and consider your caseload to be full. Since I don’t like wasting time at the office, I have a trick for getting the most out of my schedule once my caseload is full. For clients who aren’t in crisis who contact me, I will let them know that I’m full, but that we can work on a week-to-week basis until a weekly time slot opens up. What this might look like is having one to three clients who I call when I have a cancellation. This works for them because they can stop their search and start working with someone sooner and eventually will be next in line for a weekly time when it opens. It works for me too since I can try to keep all of my times full each week.