Welcome to the Power LEP podcast. I'm your host, Janet Parker, I'm a licensed educational psychologist, I'm a group practice odor, and I am the odor and adventure at Empower LEP. Today, I posted a friend of mine, Dr. Rebecca Marie Betzker. She is a political psychologist and she works at the Bay Area. She has a practice called SF Line Matters and she is in both the Super-Cisco Bay Area and East Bay. She is just a wonderful person. She is so helpful. We have become friends, colleagues, she's a mentor. She is just a great thought partner, we can misery on all the ins and outs of group practice. I can call her whenever I need her and I feel very fortunate to have a person like her in my life. And I had a wonderful conversation with her about her group practice and what it's been like for her. She employs both a clinical psychologist as well as LEPs. And it's interesting to hear her perspective on treating inventory people who are getting into the field of testing psychology. So as always, I hope that you enjoy this conversation as much as I enjoy having. Welcome back to the Empower LEP podcast. I am here with one of my very favorite people, Dr. Welcome Rebecca. Thank you, Jenna. I'm happy to be here. Awesome. It's good to see you too. Rebecca is a clinical psychologist and she has been a person who has become a thought partner, a fellow group practice commiserator, a mentor. And the best thing I think, well, there's so many good things about Rebecca. One is, she is so intelligent and just says like so many things to say about so many things that are actually like backed by research. And so she spends a lot of time on, um, replying to people's Facebook posts in a very, very thoughtful and informative way. Number two, she has a cynical and hilarious personality. And I just like just really love her. So I hope everybody else loves her as much as I do. Chances are one in 10. Someone won't. That's that's apparently the statistic in the world. It happens. It happens. I didn't realize this was going to be like a little love fest at the beginning. Thank you. I appreciate hearing those things. Oh, absolutely. Okay. It's my pleasure. I usually do a little love fest at the beginning. I love all my guests. Um, so I brought Rebecca on because she has a practice in San Francisco and Berkeley area. And she um, employees both clinical psychologists and LEPs. And I wanted to talk about a couple things. First, just being, um, I want to hear about, um, why a group practice and what have been some amazing things about running a group practice and also some things that have been difficult. So you give our audience a little bit of insight there. And then what it's been like as a person who's employed LEPs and kind of the things that you have noticed about the strengths that LEPs bring to private practice as well as areas for growth as they come in and start doing private practice for the first time because it is different. And I think that there's a lot of people in our field really wanting to make that transition from schools. They don't have a company that they're working for or people to help guide them. Um, I'm hopeful that your insight can just give them like things to think about as they make the transition that will help them go out and get whatever. Uh, supervision or clinical training or things that will help them in their own practice. So what do you think? I think that sounds good. Okay. Amazing. Alright, so Rebecca's business is called SF Mind Matters and tell us how you started to develop that practice or tell us a little bit about you in training and why assessment, you know why this is becomes something that you love to do and where you got your training and then how you could branch off for where you were into having your practice. Sure. So I attended the right institute in Berkeley for graduate school, which is a CID program and like most like all CID programs and most programs, it was heavy on therapy training. So a lot of my practice and placements were geared towards that and I enjoyed it, but it wasn't quite, it didn't feel quite right and I didn't know why and then it was in my predoctoral in in as a license psychologist, you do a predoctoral year and a postdoctoral year with a total of 3000 hours of supervised experience. And so it was really in those placements that I got to do assessment for the first time as part of multi disciplinary teams. And I just really enjoyed it. I think the combination as I'm sure all of your listeners say, I mean when I interview people, this is a very common. It's like a puzzle, figuring out how to describe a kid in a holistic way, figuring out how to help the adults in their life, help them. It's very action oriented. I think often therapies felt way too slow for me and not enough change happening, which some people love that about doing therapy. But for me assessment where we could look at the situation and come up with a plan just really fit my personality and how I wanted to be in the world. So I worked after a licensure I worked for nine years and someone else's private practice in the area and learned a ton. And as I know is similar to your story and then finally felt ready to kind of do things my way. And in my opinion, I think it takes, I mean it took me that long to feel like I really knew what I was doing. But I still every day find something I didn't know need to know. So that's part of what I love about the field too is that you can be constantly learning and growing. Because the need to be helpful to kids requires that from us. So I started basically a solo practice but worked jointly with a, an educational specialist who'd been a special education teacher in public schools for, I think, 10 or 15 years. And so she did the academic component of the testing and I did the psycho or the psychological cognitive components. And I learned so much from her about, I.e. P's goals, methodologies for helping kids. What's practical for a teacher in the classroom? These are things that I had started to learn but working with somebody who is a teacher and has that mentality really helped me. And that's something I think, you know, is not usually present in a licensed psychologist training. So it is when I think about like, what do the license like spring versus what are the school psychologists spring. It's definitely a lot of time needs to be spent supporting my license, psychs learning that piece about schools and what's practical and how to look at an IP and all of that. So just, just on that note, I will say that a lot of times and you probably hear this, maybe you do from the people who work for you that as school psychologists when a clinical psychologist does like an IE sometimes they're fantastic and give great recommendations and other times were like, oh my god, like we could never, like this is not an appropriate kind of a common, like a combination or service that we could provide like this is this doesn't exist right and so it can get frustrating as a school psychologist like, hey, like you don't, you don't understand that right. So I think it's so cool that you got to work alongside somebody who had all of that insight and and that you, you know, see that as an important part is your training your clinical staff. Because that I think as a school psychologist being on the school side, we want to be able to consider the evaluations that come in through clinical psychs, you know, private in private practice. And sometimes it's difficult because there's like a mismatch between what a clinical psychologist has recommended and what the
periods then think that they can ask the school for and like what the reality actually is. That's so cool that you've just got that experience. Did you feel like when you were working in the other practice that you got some of that too? Because I know in that practice there had been some, like there was like a lot of experience from the people that you worked with there too. Did you feel like you got any of that school piece there? I would say some orientation to the IEP process and advocacy for kids. I think there's all kinds of styles of being when you're sitting at an IEP meeting and I think my style is different but in terms of content and understanding for sure. I learned that but I also think it's a constant process. One of the great things about being a private provider is you get to sit with all different school teams. So I have, it is true that sometimes I make recommendations that maybe aren't as practical as a school team needs but I also have had instances where school teams have said, oh we can't do that but I actually have seen another school team do it and so I'm able to offer a suggestion of the way another school team handled it. Which if you're working inside of a system you know that system really well but it can put those blinders on. So it's a great position we all are in where we can bring, you know, kind of cross pollinate some things. So yeah, just to your point about trying to be practical. So I think I was at the point where I was telling you how I started my practice and so I would cut you off. No, it's okay. I was at Rambley on that point. I was in a solo practice essentially right on the verge of COVID but didn't know it was coming and someone reached out to me and asked if I mentor psychologists who want to develop their testing skills and I had not thought of having a group practice at all. In fact, I thought I probably wouldn't because it seemed like a hassle which it is. But a wonderful hassle. So yes, yeah, that's a good time. And so I decided to try it and see how it went and I loved that process of mentoring someone and helping them become better and learning you learn when you mentor somebody. They bring their experience that you don't have. You learn from that. That's part of what I like about the group practice model. And so, you know, starting a group practice at the time COVID started, the demand was just kind of endless and we grew because there was demand and there were clinicians who wanted this kind of mentorship. I do think there's been a shift in the last year and there's not. It's not as easy to start a group practice now. It's not as easy to start a solo practice now. There's not as much private work as there was. I still think there's plenty but it's not the dams not overflowing in the way that it was. And you know, there's many ways in which that's a good thing. Hopefully it's a sign that kids are doing better and that parents have more help but that may be too polyannish as thin. So. Yeah, I have felt. I think that there, I want to even say that through social media people are, after COVID, people are just opening practices or getting into psychological testing and potentially more than before. So when we, so maybe the pool is bigger and so maybe the demand is kind of more spread out. That could be also true. Yeah. I know, I know you're a fan of Jeremy Sharps testing psychologist, Todd Gess and he's been talking about how nationwide there's this trend as well. So there's I think a number of factors. Not just our area and people getting into the profession. Yeah. And I think that's a lot of people are getting into the profession. What, how extensive of an evaluation their child needs and so maybe choosing the wrong service for what they need. I think that's happening too. Yeah. I'm sorry, but it was so stuffed up. I feel like I sound like awful, but. Yeah. I'm like, I'm so happy. Okay. So as you, let's talk a little bit about first I want to go back to what you said about you worked in another practice for a long time before you felt ready to go on your own. What are the kinds of things that you felt were important for you to learn and when like how did working in somebody else's practice help you get that confidence in those skills. And at what point did you finally feel like, okay, I'm ready if you could go towards to that. Well, I think you're learning to use the tools. Learning the tests, learning how to administer the tests fluently. Learning how to interpret the tests. That's quite a lot to learn. And I think to become really fluent with the test, you have to administer it at least 30, 40 times to really know it back and forth. And then interpreting probably even more than that. And so being able to do that in the context of somebody who already was fluent with these tests was very helpful because I could consult and get guidance. The clinic director also read all of my reports and gave feedbacks for five years. So I was licensed, I was fully licensed, I was signing my own reports, but I got feedback on how to word things more understandably what recommendations I could make it would be more practical. If I had a tricky diagnosis question, consult on that. And so there was a learning process across all of those areas, really. And then kind of the practicalities of running a business, you know, you're working with families and kids and you'll run into different personalities and different situations and sometimes conflict and figuring out how to handle those situations when you're the person where the buck stops. It's nice to watch someone else do it for a while before you have to do it yourself. And then learning just being familiar with the area, the schools in the area, the providers, because in private practice you are recommending private services. It's different from being in the schools where my understanding is that's kind of a no-no. You don't want to recommend a private service, that's not really the domain. And so you need to know people to refer to. And so that was very helpful because I could ask the clinic director for suggestions until I got to the point where I felt like I had a really good network myself. So there's just some of the things I'm sure there's so many more things I'm not asking about. I mean, what are things come to mind for you? Because I know you did similar route. Yeah. I mean, for me. So, and that's one of the questions that I have for you like next. But for me, I came in having a lot of experience with assessment. You know, as a school psychologist, it's like all we're doing day in and day out is assessment. So we have like tons and tons of training on assessment. What we don't have a lot of training on is how to take those assessment results and really understand what we're looking at from a clinical perspective, more than from California ed code. So I think that was a big shift for me, really learning how to use the DSM and under, yeah, just understanding things from a more clinical perspective. And then I would say like it was nice. I also got feedback on my reports from other LEPs who have been doing it for longer, also from the doctor who I worked for, who, even though. even though he wasn't a. psychologist, he had worked with several for a very long time. And so he had, he had just on how he looked at cases. And so he could give me some guidance and advice. And just like you're saying, like, have a connection to the community, because I didn't have to worry about where my business was coming from. I didn't have to worry about whether or not I was going to get scheduled. I didn't have to worry about the front end of a business, which is a whole other aspect of, you know, getting your clients, doing the paperwork, taking payments, you know, all of that stuff was done before me. And so I could learn how to do the job of the private clinician without having to worry about the business side of things. Right. Absolutely. I mean, you've been having your attorney in place, your accountant in place, all of those was, I remember several times he consulted his attorney on my behalf, which is really nice to have someone else do that for me. Yeah. I felt like I had a backache, like kind of like what I worked at a school, you know, like I wasn't just on my own. Yeah. Yeah. So what did you find, like, or what do you find as your bring it on LEPs into your practice? What are some things that you have felt like have been amazing about bringing LEPs into political practice at what are some areas that you have really worked with them to develop? Well, you know, it's true of license, like, two, everybody has different training. So really understanding where they're coming from and what their prior experiences are. The answer to your question can really vary from person to person. Most, I guess, all of them had experiences at least two years of experience in schools because they had to in order to have the LEP license, but some more than others and some had worked in the classrooms and some, you know, had worked in other practices before. So they had arranged, but I think the school experience as I was speaking to before with my earlier practice partner. Having that school experience and understanding what's what's available in a school, what kinds of services a school district is required to provide and what might be available and what language to use for how to ask for those services. How to communicate with teachers, understanding the different roles and then just being able to look at an IP and process it so quickly. That's a skill and that took me a decade to really they're pretty confusing documents. Totally. It took a long time. So when we consult as a team, which in our practice, we do team meetings twice a month and a lot of times that's a case consultation. And it's so helpful when we can throw up the the recent IP and the LEPs are able to look at the goals and like that. See, oh, that goal is not measurable or those that should have objectives written out or, you know, various little, little helpful things that the psychologist can pass on to the parents and say, hey, if you might want to ask the team to reconsider this goal or to make spell out more clearly how they're going to measure it. And that's really, I think it's, it's something that most license sites wouldn't know from our training. Also, I think, I mean, generally, the LEPs are very well trained in terms of administering cognitive and some processing measures. Not it really varies what districts they run, whether they know how to do academic testing. Yes, so that has been an area where the way we do it in our practice is I never want anyone to learn more than one or two measures on a kid. So I don't I don't want them to be doing all new measures for a child. So I'll come in and do some of the testing. And that's a common one where they're needing to gear up and practice and, you know, we bring in fake clients for them to practice with. So that's that's something that often they need to learn. And I mean, there's there's other instances it just depends. I think some have come with a lot more clinical experience like their program has focused more on therapy. And and so they have a wider knowledge of social emotional presentations and strategies for how to help the clients and are able to make more recommendations and description in that area and others need support with that. So it's just I think each person has to look at where have they trained. What do they know? What do they need to get? You know, before they're out on their own. I completely have a pandemic achievement. This one is things. I train psychologists on it because we don't get a lot of training in it. We, you know, we took one course at our graduate program. I don't know what graduate programs are like now, but we didn't get a lot more than that. So it's a whole, you know, if we're the only one now making decisions about what's going on with kids like we really have to understand the achievement data. And I honestly don't know how I didn't do achievement test state as a school psychologist. I find so much meaningful information there. That was new to me when I started, you know, however many years ago doing this. And so that's a it's a really important piece. That people that translate for schools and practice. What about like clinical diagnosis? Yeah. So I always asked my clinicians where they feel comfortable and where they feel they need support. And so I would say the majority of LEPs have told me they feel pretty comfortable with learning differences. Although not always in terms of exactly what dyslexia is because it depends if they came from a district that use that term and talk to that that learning disability in terms of what goes into it underlying process scenarios. And then ADHD and money, I think feel real comfortable with autism and can recognize anxiety and depression when they see it. But maybe don't know exactly what DSM label fits best and needs support because they're not working with the DSM and the schools. And then I think less common presentations like bipolar disorder, you know, we work with kids so we don't have to worry about the personality disorder labeling, but there's some aspects to personality disorder that can start to emerge. And so being able to recognize that. I think those are some areas where people have needed more support. Change of gears a little bit just what have been some of the great things about having a group practice and what have been some of the challenges we talked about this all the time. Well, a great thing about it is I think I'd have reached a point where I felt like I knew what I was doing in terms of assessment, obviously always still learning, always still getting better and always more to improve on. But with that, I felt ready for the next stretch and so helping other people do something is a great way to stretch myself. And developing closer relationships with colleagues because you are when you're in solo practice, you can network, you can have friends, you make phone calls, but really working more closely with people. And I think that being able to help more clients in the way that I personally think is helpful. I mean, not everybody needs the kind of evaluation we provide. That's for sure. but for those who do, I feel like
were able to do good work and were able to do more of it because we're a group and giving clients some choice of who to work with and maybe enabling some people because of my practice model most of my clinicians only they a lot of them have other jobs they work in schools or they work in hospitals or their professors and so they can only do one case a month and so enabling people to be working in the field to maybe couldn't otherwise and giving clients an opportunity you know to work with a bilingual psychologist or work with someone from their cultural background or just having more variety I think it's nice so people don't necessarily have to choose me right they could choose choose from somebody who fits them better so I like that part and the struggles you know it's like anything that involves there's financial ups and downs there's stressors I've been I should not go and what I've been really really lucky with my staff and having wonderful really professional people who exited with grace took care of their clients you know nobody nobody dropping a case in the middle so I really feel lucky in that regard but there's always ways you have to shift yourself when you're working with somebody else and that can be stressful there are so many little details to know Jenna every week I'm discovering something I should have known two years ago about some type of paperwork I'm supposed to file with the you know the state or Medicare opt-outs or you know some some thing we're supposed to be doing even with a professional accountant professional attorney professional HR consultant there are still things like that and that that is hard because I'm a thorough person and I like to do things correctly and it's really hard to keep on top of all the little details well I didn't really leave you with all the little details things should do I think that's crazy no when you're when you're an employer it is that the kinds of things you have to like forward think about right it's like it never ends right yeah yeah and that's why I think like groups like the one you facilitate it's so important because when you share you share those little tips with each other it saves so much headache and so much time yeah yeah it's nice to be part of groups of people who are like really in the business piece of it in a way that's like legit you know because there's a lot of like interesting business practices out there and what I've learned is that I just don't want to get caught up in that something that I could have prevented you know by you know so anytime that I find out something that I should be doing I better look into that you know because I don't want to be you just put yourself at such risk when you are a business owner and you have to just make sure your backs of my sake like protections for everybody so that you're never because things do come up all the time you just don't want to be caught in the place that's not ideal for you or for your employees right absolutely yeah thank you for all the learning that you've given me and you're so good like if anybody if anyone listening here is ever on the testing psychologist group like Facebook group Rebecca is a wealth of information oh there's lots of different ways to do the same thing correctly there's definitely some wrong ways for sure I'm not saying that anyways right but I love that kind of Facebook group because you'll hear all these different approaches the the same issue and it becomes really useful later on when you're facing some problem yep well I've also like really loved having a group practice for like you know I've used to working in a group you know we're used to working at a school it's nice to come to work and have other people here it's nice to be able to you know after working in schools for so long where we have such burnout it's nice to be working alongside people who are happy to come into the office and want to be here and are happy to be doing the job that they're doing here they feel I think they feel a sense of reward for the work that they're doing you know it feels good I feed off of that with my staff yeah I've wondered about that issue of burnout because I don't think it's easier in private practice well not for us as business owners no right right um I'm not even sure it's financially more rewarding right because I've recreated friends who are school psychologists and I factor in their benefits and their vacation time and all of those things you don't get in a solo private practice right um and unless you pay for them yourself right um but you have choice you have choice when you're working for yourself even when you're working for a group practice depending on the setup of the practice but like in my practice clinicians choose how many clients they want to see they choose what days they work if they want to take a month off they take it off you know and you don't have that same choice in systems like schools or even you know hospitals large clinics that are more rigid around their rules and I think that helps prevent burnout right as long as you make the choices that are good for you um yeah it's like it's quality of life I have somebody who's get a transition from working in schools to working with the full-time desk clear um so I'll have a second full-time LEP that I'm super super excited about and we were talking about you know compensation and you know kind of like the differences she was trying to try to like work out like is this gonna work for me and you know we got to like uh you're probably going to make around the same amount of money that you were making it school salary-wise but then of course the pension is not the same and the benefits are not like the same um but and then she said well that's for a lot more days though right like like it might be the same amount of pay but in schools you only work 10 months whereas at this practice you'd be working the whole year they said yes but the biggest difference I think is that you're gonna pick the days that you actually have to come in to do work and the other day is you can work from home so depending on how many cases per month you take those are the times that you need to come into the office and you can make up whatever you want so you might be in the office like half the month but that half the month you're gonna be at home doing what you need to do and if your kids have a they get school that you want to go to you just scheduling yourself around it you know there's no like oh can I take this time off of work or you know feeling yeah like I still have PTSD I was just saying the other day I still have PTSD if I'm like going through the car wash at 11 a.m. like is somebody gonna see me like out at the car wash you know like because we were so used to clock again for this time in this time for like so many years of my life yeah so it's just it's just different and then she said something about like you know we will have the same holiday breaks and like but like you don't even think about work like that anymore you're not like oh I can't wait for spring break because I'm so overworked you're just like oh it's spring break cool like let me actually be more available because kids are out of school right now and then I can take a break when all the kids are back in school and it's not as expensive to take a plate trip because not everybody's trying to take the break right now you're not living through the weekends and everybody's heard vacation exactly yeah they're definitely a lot of a lot of pluses to that but is it consistent you know what it's scary and you know kind of back to like the financial piece of like group practice versus solo I think I'd certainly be making more muddy if I were doing the solo practice like if I would be making more muddy if I were doing the solo practice um but then I also wouldn't have uh work
happening when I'm not here. Or, you know, like the system is set up to run without me. So it's nice to be able to not be the only person who I've relied on to have any kind of aid cup. Yeah, I think if I spend all the time I spend on the group practice, if I just spend at seeing clients, I would definitely make a lot more money. But I enjoy this other type of work that I'm doing, mentoring clinicians and figuring out systems and then also just the feeling of building something. I think some people have that in them where they want to build something and create something and that is gratifying in and of itself. So that's all factors in to, it's not just about the money. I've been seeing and watching it grow. Yeah, I could fully agree and thank goodness for you to be able to call and have a moment with my source. Well, if you have, do you have any final thoughts for like people who are maybe thinking about making a transition? It's the private sector. I'm not steady. You could think right. I think what we said before around reflecting on what your experiences and where the gaps are and finding an opportunity to start filling those in, whether it's with part-time experience in the private sector to ease yourself in or trainings or reading. I have learned a lot just from reading some of the books that have been published by experts. Just make sure they're from experts. And just doing that sort of self-analysis, I think is really helpful. You don't have to jump into the ocean right away. You can ease into it if you aren't quite feeling ready. And then there's that fantastic program that you did, this full neuropsych program, I think, is really helpful for getting that more holistic mentality around assessment. Then connecting with groups like yours or the testing psychologist so that you have colleagues, so as you start to make that move, you have people who already know the answer so you can tell you what you need to do instead of having to learn the hard way. I think those are really key. Yeah, well thank you. I love how it goes a front and a mentor and a colleague and I appreciate everything you do for the field. Yeah, just thanks for coming. You've been on the show. Yeah, Vice-Sorsa. Bye, Jamal. Thank you. Bye. That is it for today's episode of the Empower LEP Podcast. I hope that you found this conversation insightful and inspiring as you navigate your journey in private practice. If you enjoyed the episode, I'd love for you to subscribe and leave us a five-star rating and review on Apple Podcasts. It really helps us reach more LEPs and school psychologists who are looking to build their own path in private practice. For more resources and community, you can connect with me at EmpowerLEP.com on Instagram, @ EmpowerLEP, on Facebook in the Empower LEP Facebook group, or by email at
[email protected]. And just a quick reminder, the information shared on this podcast is for educational purposes only and should not be considered legal, business, or clinical advice. Be sure to consult with the appropriate professionals for guidance on your specific situation. Thanks for tuning in and remember you have the skills, you have the knowledge, and you have the power to create a private practice that truly makes an impact.
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