Who Has Your Back? Part I - The Front Lines

For any mental health care provider, addressing your stress starts in the same spot. It doesn’t matter if you are in private practice or working for a larger organization - or if you are just starting up your new clinic - ask yourself this: Who Has Your Back?

Now, who has your back can mean a number of things, but for the point of addressing occupational burnout, let’s look specifically at your occupational team. What I mean here is, primarily, your support staff. Why? Because they are your front line! Are you feeling stressed? Made a sleep-deprived mistake? Your support staff will be handling the fallout. Need to set a boundary? Your support staff will be implementing it. Who knows the ins and outs of the practice, of all the providers and all the patients? You guessed it, the support staff.

You and your practice need to employ stable, professional help, people who care about you, who care about your clients and you have impeccable customer service skills.

Your Team Cares About You AND Your Patients

Your staff need to have your wellbeing at the front of their minds at any given time. Great staff understand that their success as well as the success of your patients is tied directly to yours. In an ideal world, they also care about you as an individual, so they want to see you succeed as a friend they are rooting for. Great support staff are your front line, your generals, your gatekeepers.

Your #1 is the nerve center of your practice, large or small. This is the Magnificent Receptionist.

This person is the first voice a patient hears and the first face they see; this is the person that makes a potential client feel safe and welcome, or uneasy and skittish. This initial reception will immediately impact how a patient views YOU. That’s some serious power!

In time, many of your patients know your receptionist better than you. Who are they calling with refill requests? Who are they describing their concerns to? Or talking with in the waiting room, or reaching out to when a bill seems wrong? In return, who is calling your patients with the answers you give, or to schedule follow ups, or to check on them because they left in rough shape the other day? Your Magnificent Receptionist. And if they are really skilled customer service personnel, the receptionist is also doing a filter dance to protect you, one so subtle you don’t even see it. They know that when Liz Lemon calls and leaves a two minute information-dump-message on the office voicemail at 10 pm on a Thursday night, that she is okay and just needs to get things off her chest. Your receptionist charts it, sends you a copy and moves on. Your receptionist also knows that Chris Traeger’s hypochondria is fragile and excessive, so when he catches a cold, he needs to be scheduled right away or he will spiral. Your receptionist knows when you ask you what you want to do, who to refer to and when, they know when to needle you because this prior auth is still not done, and they have overheard you curse that you forgot to call that therapist back again, so they call ahead and get it on your schedule for Friday.

Phew! They do a lot.

Next is Your Intake Manager. This is who will be screening potential patients. They will know your likes, dislikes, strengths and weaknesses, they will know your personality and your long term goals for your practice. They will accept patients that they believe will match you - and they are doing this as much for your benefit as for the patients (who has ever had a provider that they don’t click with or, worse, do not like, do not respect or do not trust? Did that work well?). Your Intake manager may also be ensuring paperwork is in, insurance has been accepted and verified, that patient’s have been alerted to deductibles and that payment schedules are arranged ahead. If they do not believe an intake is a good fit, they may be referring them to a more appropriate option - and one who, they know, is accepting patients. They’ve done their research, they know the community. They are making sure a new patient knows where to go, what to expect, that they understanding incoming policies and procedures, and, much like your Magnificent Receptionist, they are doing it with expert customer service. Your patients feel secure, safe and taken care of by capable hands.

Your Biller matters. A lot. Consider life without them: maybe Reception submits claims when he has time. Several claims have bounced back, but Reception hasn’t had time to call and follow up; when they do they don’t understand the problem. Oh, and Chris Traeger has stopped paying. Yeah, he has great insurance and a $45 copay, but he hasn’t paid it the last three months - and his last 2 claims have denied, too. Oh, by the way, seven other patients have done the same thing and now payroll is short. Ahhhh!

In office or out, your biller is the person who is ensuring you get paid. Verifying insurances, collecting copays, sending out statements, submitting claims, chasing down denials, arguing codes and notes with insurance companies - these folks are busy. They are also incredibly knowledgeable. They often communicate very closely with intake and reception on a daily basis, they may or may not be reviewing Aging Reports each week and coordinating follow ups or termed policy updates. Billing is tedious, challenging, frustrating, and it takes a very special person to want to do it and to want to do it well. Cherish this role!

Lastly, consider your Office Manager, who is ensuring that your staff and your patients all have when they need to perform. Coordinator Royalty, they are updating your website and social media, encouraging community interaction and maintaining informative standards. They are smoothly adding in that new No Surprises Act form that the state implemented for the New Year, they are updating a policy change and quickly getting all existing patients up to speed on changes. They are stepping in on the occasional conflicts that escalate - sometimes, they are putting down hard boundaries on your behalf.

“Liz, your message got too aggressive last night and you are bordering on abuse of staff, you need to cool it - and, maybe, your substance abuse is escalating, so let’s schedule you a formal appointment next week and talk to Intake about adding an addiction counselor to your team, shall we?”

So if you go to your office manager and tell her that you are completely frying out and from now on, your day has to end at 5 pm, paperwork and all, what does she do?

1. First, she says, “Okay, we’ve got this.”

2. Reception, please schedule accordingly - last appointment is at 4 pm beginning the first of the month. Can you help anyone already scheduled after that move to a better spot? The more notice the better.

3. Intake, please let new patients know that we are not operating evenings anymore and help them find an appropriate provider if evenings are all they can do. And alert any referral sources who send patient’s our way on a regular basis.

4. Office manager, change the online hours and adjust policies and procedures, alert existing patients of the change, update messages.

In many offices, the above mentioned positions are not three, four or more folks, but one or two people. I have heard many new start-ups, particularly single-practitioner behavioral health providers, say that they will just do this work themselves. Do you see the above? It's not sustainable, you will need help.

Keep all of this in mind when you are working your day. Your support staff runs your show. They are taking loads off of you and getting you to work as what you are. A provider! You are a therapist, a nurse, a psychologist, doctor, PA - whatever your role, you are allowed to perform it to your utmost capabilities because of your front team.

So. Never accept abuse from patients, family, vendors or anyone else. If your team is not working, figure out why and address the issue. Balance long term and short. Constantly be training in customer support - great customer skills can save everyone a lot of time and grief down the road. Never stop analyzing your team, talking to your team and appreciating each other.

Together, you and your crew can pull off anything. After, you can toast your achievements at a Happy Hour on Friday (because there will be time to do it). Cheers!