Marketing 101: A Guide to Unmanaged Care

What dentists and car mechanics can teach us about marketing a fee-for-service private practice.

By Ofer Zur, Ph.D.

Reference: Zur, O. (2000). Marketing 101: A guide to unmanaged care. The Independent Practitioner, 20 (1), 28-31.



The Dog Ate My Homework

Psychologists have, since the inception of the field, rationalized away their fears and trepidation of marketing their private practices. The old excuses tended to be along the lines of “I don’t need to sell an image, my degree and license tell it all” or “I’m a care giver not a salesperson.” The latest excuses sound more like: “I don’t stand a chance at fighting managed care corporations” and “There isn’t enough out-of-pocket money to go around if all psychologists practice on a fee-for-service basis.” The fact is, that past and present successful therapists have always found effective ways to market themselves.

As clinicians we know well how people, “even” psychologists, will justify and rationalize any behavior they try to avoid. It is plain to see that, where marketing is concerned, we are dealing with fears, intimidation and lack of training rather than with professional and economical realities. While the lack of skills is due to our profession’s education, the fears are systematically induced by the managed care companies and by those who are in bed with this industry (such as managed care executives, politicians, some APA dignitaries, etc.).

The marketing approach I will propose here, is far removed from that of the smooth talking used car salesman and his glossy brochures. Rather, it is consistent with the spirit of our hearts and vocation as healers. Education, service and care are the foundation of this approach, not trickery or manipulation.

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Principles of Private Practice Marketing

The most general principle of marketing is that people will pay for what they value, whether it is health, looks, image, love, sex, etc. As a result they will purchase memberships in health clubs, seek the services of cosmetic dentists, pay for diet programs, buy certain cars, clothes and houses or take large quantities of Prozac or Viagra.

More specific to psychotherapy are the following marketing principles:

  1. People will pay for psychotherapy if they understand what it has to offer them. They will pay as much or as little as its perceived value.
  2. People will pay in FULL and out of pocket for YOUR services, if they view you as an expert who can give them what they want. The same way they pay for personal trainers, attorneys, manicurers or gardeners.
  3. Elimination of clients’ expectations of third party reimbursement is essential for the development of a managed-care-free practice. Educate the public about consulting for life’s problems and differentiating your services from mainstream medicine. It also means dissociating yourself from experimental and academic psychology, the prescription and hospital privileges movements and hardest of all, DSM.
  4. Market a practice that keeps you close to your inherent talents, best skills and, most importantly, your passion. Choose a specialization that is close to your calling. Follow your bliss.

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Challenges of Marketing

Stating these five principles helps us identify the following most important challenges or tasks of marketing a fee-for service private practice. In your marketing effort you must remember that you do not market yourself, you market your services. It is not about ego it about the usefulness and value of what you deliver.

Help People Reshuffle Their Priority List

A top marketing strategy for therapists is to help people reshuffle their list of priorities so they invest in budget items, such as relief from depression, sleeping well, parenting better, or improving intimate relationships. The idea is to aid people in seeing that these items are as important or much more important than a trim body, fancy car, manicured lawn, Caribbean vacation, or beautiful hair cut.

The attempt to allow a prospective client to reorder their priorities must often be done in the first phone call during which I ask people questions such as: How important is it to avoid divorce so you can see your children every day? Compared to your last vacation, how precious is it for you to sleep through the night? What would you give up so you can live without your daily headaches? How much would you invest in helping your adolescent boy deal with his suicidal feelings and drug use? Or how essential is it for you to be able to find meaning and an aim for your life so you die with the fewest regrets? Once the right question is phrased appropriately and is consistent with the client’s values and yearning the issue of payment for therapy rarely comes up.

Discover Where The Money Goes?

One of the first tasks in your marketing effort is to identify where people are most likely to spend their money. A simple trip to the best seller and magazine sections of your local bookstore will shed light on this question. People, in this day and age, are most interested in health, personal growth, financial independence, looking good, spirituality, stress management, parenting and of course love, sex and intimacy. There is also a huge growing interest in aging with dignity and elderly-parental care fueled by the most dominant, prosperous and affluent group in American history, the baby boomers.

The above list clearly indicates that we are positioned really well in the present and future marketplace, as our scope of practice covers most of these areas of public interest. To effectively attend to these interests we must re-examine our clinical roles and get out of the bed of traditional western medicine and narrow- minded psychology. In order to fully claim these concerns as our expertise, we must learn to be coaches, guides, mentors and consultants for life’s issues or problems, rather than doctors who treat pathology and “mental and nervous disorders”. (See articles in F/99 issue of I.P. by the same author for further elaboration).

Build Trust In Psychotherapy Again

People hire and pay out of pocket car mechanics with the expectation that their cars will be fixed, they go to dentists to stop their toothaches, and they hire gardeners so their gardens will look beautiful. In reality people do not value therapy because they do not trust it will deliver. The “Woody Allen Syndrome” captures people’s view of us therapists as essentially greedy, ineffective and a bit crazy. Daily cartoons and big screen movies confirm this perception. In fact, only about seven percent of those with mental health insurance coverage use it. Apparently, even when our services are free or almost free and unmanaged, people still will not seek our help. Obviously, if we want people to pay for our services we must first, convince them that we can deliver. The effort of marketing, as outlined below, is primarily aimed at persuading people that we can help them.

Become a Helpful Expert

Marketing is the art of positioning oneself as a “helpful expert.” When people see you as an expert it will increase their belief that you can help them, which in turn, increases the probability of you being hired. How does one do this? A difficult task if we remember the publics’ mistrust of therapists and the fact that there are about half a million practitioners in the U.S. To top this off, most psychotherapeutic services are given by primary care and family doctors.

Establishing an expertise requires consistent and intentional efforts. However, it can be done in numerous and personalized ways. Following are some of these options:

Writing: One simple way, if writing is preferable to public speaking for you, is to produce an educational brochure. You can leave free copies at the local hospital, library, community center etc., or send it to any interested person. You can write an article in the local paper or a paper in a professional journal (send this article to whoever may be interested). Articles in a paper are far superior to advertisements. The former positions you as an expert while the latter shows that you have some money. Books, which take years to write, generally make neither much money nor generate a large referral base. Make sure that your writing is helpful rather than self-promoting. Make sure it gives information, suggestions, new ideas, “how to’s”, warnings, resources, tools or advice. Do not view your writing as a teaser, don’t provide a long biographical note, and never put in “For an appointment call xxx.” Your name, phone number and address is more than sufficient.

Public speaking: The fastest and most powerful way to generate referrals is to find ways to speak in public, however, many people are intimidated by it. Lectures, free talks, brown bag lunch presentations, seminars, classes, radio talk shows or workshops provide people with first hand experience of the therapist and a direct way to evaluate compatibility, personal comfort and expertise. Make sure that you never read from notes because it is impersonal. Also, make sure that your presentation includes some of the following: a. Successful case studies (stories) where you demonstrate how you helped people, often against all odds. b. Personal stories about your own struggles and failures and ways you overcame them. c. Statements about your own moral, ethical and spiritual values or the principles that guide you in your work and personal life. I am aware that graduate schools and most supervisors do not emphasize personal disclosure. I have also found out that the “blank wall” dogma and the corresponding practice of “no self disclosure” is one of the causes of the public’s mockery and mistrust of us. Without these three elements people are not likely to feel connected with you or feel hopeful that you can help. At the end of your presentation it is better if people leave with a written summary of your presentation, on your letterhead, of course. Such write-ups are much more effective than the obvious practice of leaving your business cards for people to pick up.

Mediating-Facilitating: Wherever there are people there are conflicts. Conflict needs resolution. Mediation is the process that brings about resolution. Any community has numerous and endless needs for mediation and facilitation. I have mediated conflicts at the local schools, among local boards of directors, between members in family businesses, amongst neighbors and between divorcing couples. If your talent is facilitating there are also numerous needs in your community for expert facilitation. I have facilitated local board retreats, and community, neighborhood, or PTA meetings. Frequently after the mediation or facilitation sessions are concluded several people call for further help because these sessions demonstrated my expertise and gave people first hand experience with my effectiveness, values and style.

Learn From Dentists and Car Mechanics

We need to educate people and ourselves that they do not need to be sick or broken in order to seek our services. Frequently, this is surprising news to consumers and therapists alike. This stigma is our own creation. In our jostling for parity, income, security and power, we have wedded ourselves to the medical establishment, insurance companies, DSM and lately to efforts to gain prescription and hospitalization privileges. In other words we got exactly what we asked for. Dentists, have their cleaning and check- up reminder postcards, and car mechanics have their oil change and tune-up routine. They should be our guides in helping people view our professional services as on going and preventative, rather than exclusively reactive and crisis oriented. To free ourselves from managed care we must learn to conduct intermittent, long-term therapy where we work with people and their families throughout their lives on developmental, existential, and spiritual concerns. The recent trend in cosmetic dentistry, like traditional cosmetic surgery, can give us guidelines as to how we may approach people with the idea that we can help them get what they want or increase the quality of their lives, rather than fix what is supposedly broken.

Avoid Ego Brochures And Yellow Page Ads

Many of us have spent a half day with an expert or a day reading a book learning how to place an ad in the Yellow Pages. Others spend large sums on consultants who help them develop fancy glossy brochures with long biographies. I have found these approaches to be ineffective in building a private pay practice. While these approaches may draw some people, you have to watch out that you don’t get what you are asking for. Private pay practice will thrive on people who are invested in growth, depth, meaning, and quality of life. The same people who spend billions (with a ‘b’ again) of dollars each year on health clubs, personal growth retreats, diets and nutrition programs, yoga and meditation classes. These are educated people who seek experiences to feel that they live wholly with quality and meaning. They are not impressed with big Yellow Page ads or with glossy brochures. They are mostly impressed with friends’ personal recommendations or when they personally learn something helpful from a clinician writing (article, brochure, book) or speaking (lecture, seminar, or an audiotape). We must aim our marketing efforts towards education, guidance and help rather than tooting our own horns through glossy/ego brochures. (P.S. Do not use the real estate technique of leaving your business card everywhere, it projects an image of a desperate person instead of a proud professional.)

Personal Contact Is The Key To referrals

The old feminist’s argument that most deals happen in the bars or on the golf courses is absolutely true. People prefer to do business with those who they feel familiar, and with whom they have good, warm or friendly feelings. As a result, personal contact with potential sources of referral is very important. There are many ways to establish personal contact with other professionals. In general, any social gathering, such as a Gallery opening, Hanukkah celebration, Christmas or birthday parties, can be a good start. Lunches, after hours drinks, golf rounds are also helpful. Better yet, are free consultations with pastors, orthopedic surgeons, dentists, school counselors and vice principals, attorneys, ER physicians or any community leader. As described above, in all these meetings insert personal and professional success stories into the conversation. Usually an introductory letter does not do as much good as personal contact. Phone consultations can be effective if you are indeed helpful, personal and clearly establish yourself as a competent colleague, friend and an expert.

No More Begging

Many therapists associate business meetings with other professional as an exercise in begging for referrals. I suggest that each time you meet with other professionals, you feel clear about the ways in which they need your help. Take the “How can I help you?” approach. You can: help the pastor with a couple on the verge of divorce, as they frequently bring tension into the congregation; help the capitated, underpaid and over burdened orthopedic surgeon by taking his patient in chronic pain out of his waiting room; help the school principal deal with a difficult teacher; help the head of the Emergency Room educate his staff about the chronically mentally ill; help the internist by educating his patients with cancer or diabetes about the life changes they must make to survive; help the surgeon achieve successful outcomes and lower infection rates by doing pre and post surgical counseling; or help a divorce attorney deal with the emotional aspects of their clients so they can negotiate more effectively.

Be Involved In Your Community

Community involvement not only benefits the people of the community, your conscience and your soul, but it can also benefit your pocketbook. Make sure that you maximize your involvement by using your professional skills (facilitating, lectures, etc.) for the benefits of the community. This can be through involvement with PTA’s, community boards, committees, donating consulting services to fundraising auctions, etc. Licking envelopes may be important but neither maximizes your contribution nor generates referrals. Working within one’s community however, requires the capacity to work professionally and ethically with the complex web of dual relationships. We must remember that unlike the prevailing belief, the APA Ethical guidelines do not prohibit dual relationship unless they are potentially exploitive, harmful or might impair the psychologist’s objectivity or effectiveness.

Create And Carry Out A Marketing Plan

Marketing plans are essential first steps toward establishing a successful private practice. The basic steps of any marketing plan are:

  1. What are the markets you wish to penetrate or the niche you want to occupy?
  2. What product/s or outcome/s will you deliver (relief from depression or anxiety, increased love, assessment, etc.)?
  3. What do you need to do for yourself to become a true expert in this field?
  4. Who are the consumers or the clients you would directly serve?
  5. What is the flow of referrals in this field or niche? Create a flow chart.
  6. Are there gatekeepers? If yes, who are they? Who needs to know about you so they will refer to you? (Identify as many positions/names as possible).
  7. How can you help the gatekeepers or other sources of referral? What is in it for them? How will they benefit from referring to you?
  8. How are you going to reach the consumers and/or gate keepers? (Direct mail, lectures, articles, personal meetings, etc)
  9. Establish a general time line, detailed budget, and exact times during the week you will devote exclusively to marking.

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Marketing efforts must be consistent over a long period of time. In order to develop an out-of-pocket paying practice we must let go of several beloved security blankets, such as the medical model, DSM, expectations of reimbursement and diagnosing-pathologizing our clients. For many of us it means choosing to make changes in our professional identity. It may require dismantling most of what we learned in graduate schools or were taught by our supervisors. If we choose to follow this path, we must shift from being ‘doctors’ who focus on diagnosable pathology to being guides, consultants, or mentors who help common folks deal with the complexities of living at the end of the twentieth century. Like the dentist and mechanic, our clients will use our services preventatively and regularly for the rest of their lives without any expectation of third party payment. Instead of dropping our fees we ought to increase people’s perception of the value of our services. If our marketing efforts are educational and caring, we can make them with pride, joy and dignity, which ought to be like the spirit of consulting and psychotherapy.

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