“My lease is coming up for renewal later this year. After wasting so much rent money during lockdown, is it time to shut up shop and go permanently online?”
Before 2020, there was curiosity in the profession about online practice. Having taken the plunge six years earlier, I was frequently asked to share my experience of this in webinars and conferences.
Lockdowns changed the landscape. Almost all practitioners, curious or not, have experienced the world of telehealth.
Now many naturopaths like Chris are wondering if it’s time to make a permanent shift to telehealth and say goodbye to the bricks and mortar clinic.
Has the traditional clinic had its day?
When I graduated, working in an actual clinic was the only option. Now three distinct models of consulting have emerged: the traditional, hybrid or virtual.
Which one works best for you?
The pros and cons of virtual practice
There is an increasing number of practitioners letting go of their clinics. But whether this is the best option for you will depend on your individual requirements and, to some degree, the type of clients you work with.
Not everyone enjoys working from home, or has the ideal set-up to do so. When forced to pivot to online consults, you made it happen but will this suit you and be best for your business in the long term?
Each practitioners’ pros and cons list will vary. Here are some common issues to consider before taking your practice 100% online.
Swapping rent for home office tax rebates is a potential win for both cash flow and income. No longer having to pay for the use of a room (or other contractual agreements) when you’re on holiday or going through a quiet patch is another bonus.
As many practitioners with a physical clinic have adopted a hybrid model of online and in-person consultations, some of the additional costs associated with a virtual business might have already been absorbed.
However if you’re working in a fully serviced clinic and thinking of going it alone for the first time, there are likely to be a lot of back-end services to consider. Secure cloud storage, payment gateways, practice management and booking platforms, and accounting software all come at a price. A comfortable set-up with an ergonomic workstation, noise cancelling headphones and the fastest computer you can afford are also important. If you don’t already have your own website or need to rebuild one, this tends to cost more and take much longer to create than we often expect.
On the upside stock, one of the biggest clinic establishment investments, is no longer an issue with online dispensaries filling herbal prescriptions and supplying almost every supplement imaginable. Most also offer practitioners a generous rebate, providing additional passive income.
The benefits of being part of a team
Working in a busy clinic on a wage, sublease or commission is a different proposition to renting a room as a solo practitioner. When a deal includes reception, dispensing, marketing and other admin support, there’s much more at stake than just rent. Going it alone, finding your own clients and being totally responsible for running your business is a huge leap in skills and time.
Working with other practitioners provides the opportunity for formal or informal mentoring. It’s invaluable having colleagues, from the same or different disciplines, to discuss a challenging case with. There may also be cross-referrals, personal support and greater social connections.
What do your clients want or need?
Are your clients happy to stay virtual or keen to see you in person? While no one misses parking hassles or travel time, in-person consultations can offer a degree of privacy that clients connecting from home or work can’t always access.
On-the-spot clinic dispensing enables clients to start taking remedies without delay, especially in time-critical conditions. Nor do they have the additional expense of postage. (Although some practitioners offset the latter by reducing their rebate for online prescriptions, so the client doesn’t end up paying more).
Some niches and specialties work better in person. Other than offering manual therapies, if you work with children or clients that regularly require clinical observations — like auscultation, blood pressure or hands-on palpation — the digital space doesn’t cut it. If you’ve invested in expensive diagnostic technology (eg VLA, Live Blood, etc) you may no longer be able to use it or access the information and income it provides. Looking at your client base, consider if your diagnosis or treatment would be impaired without these?
How important is location?
Having business premises can increase your marketing opportunities. How many clients have found you because they wanted a practitioner near home or work?
Theoretically going online means location is no longer a barrier when it comes to attracting new clients, but there’s more competition. The rise of specialisation creates the opportunity to grow reputation and target potential clients without geographical limitations. However achieving and maintaining effective SEO for your site to be ranked highly enough to be found easily can be expensive and time consuming. So too is a greater reliance on digital marketing and social media.
If you’re considering transitioning from in-person to an entirely online practice, it’s wise to review your current referral pathways. How much has location played a role? Will telehealth impact professional referrals from other health practitioners? Is your current online marketing (website, google searches, social media, digital marketing) responsible for attracting a large percentage of your new clientele?
Working alone from home can be lonely. Do you have strong enough professional and personal connections to avoid this?
Isolation is already a major issue for naturopaths/herbalists/nutritionists, contributing to reduced work satisfaction and is a significant factor in practitioners leaving the profession.
We need connection to feel part of the profession. This doesn’t have to come from working directly with others but in-person meetings, rather than relying solely on internet forums, can strengthen our sense of belonging. As well as inform and inspire our practice.
Where you are in your career
I’ve mentored a number of established practitioners’ transition away from busy clinics to entirely online practices. Some choose to maintain existing hours or personnel, while others use it as opportunity to step down workload, in response to burn out or life changes. Anecdotally I’ve found mid-late career practitioners fare the best, with some wishing they’d done it years ago.
For emerging practitioners or those who’ve never run a solo business, it can be a steep learning curve. The profession already has a high dropout rate in the first few years of practice, so it’s hard to estimate the impact that moving online has on this cohort.
Other than the support that you can gain from working in an established clinic, there are clinical skills that come with years of practice. Some vital non-verbal cues are lost when we consult on a screen (and even more when by phone). You can glean important information from the way a client sits in the waiting room (content, impatient, caught up in work calls), their gait, the temperature and feel from their handshake, body proportions and even odour.
Facial cues can be obscured when a client Zooms in poor light or there are glitches in the internet connection. We learn a lot by watching how someone responds to questions. These cues help us understand what makes someone tick and create an accurate diagnosis.
As alluring as it might be to avoid paying rent and other establishment costs, for new and emerging practitioners it’s important not to discount the opportunity to cut your teeth in an in-person, group practice. This early support can make or break a career.
It’s so easy to open the laptop out of hours and return an email or work on a case. Of course this can be an issue regardless of where you practice but there’s something powerfully symbolic about walking out of the clinic at the end of the day — the pause between work and home and, even better, when you have a receptionist to field enquiries.
For busy online practitioners, a virtual assistant (VA) can solve some of these issues, helping you to re-establish boundaries and take care of admin. But regardless of whether you have any additional help, establishing boundaries is an important skill to learn and maintain.
What if health rebates are reinstalled?
The biggest disadvantage to going online in 2014 was the loss of private health insurance rebates for my clients. While this was a minor annoyance for some, it was a deal breaker for others. Since then naturopaths have lost rebate status, but while we await the outcome of the latest review the question remains – if rebates are reinstated, will they still be only for in-person consultations? If so, would this change your decision to move to online practice?
How things have changed so fast!
I co-presented a session at the Australian Naturopathic Summit in 2018, Does being an online naturopath live up to the hype? So much of what we talked about seems redundant now. Almost all practitioners benefit from an online presence and the ability to provide telehealth consultations. Any additional costs involved are now universal.
Practitioners have hurdled the perceived barriers to entry, with even diehard technophobes catapulted into virtual consulting.
I’ve not regretted moving online, after running my busy clinic for 23 years. It’s allowed greater flexibility in my work life and reduced some the major business stresses. My biggest niggle is being dependent on a reliable internet connection (at both ends), as at times NBN comes up short. Initially I missed working with colleagues, which was also compounded by moving interstate, so it encouraged me to tap into new professional networks.
But the question is, what works for you and your clients? What are your individual pros and cons? Are your skills and client base well-established, without the need for the additional resources some clinics offer? If you plan to be in the profession for the long run, there’s a lot more at play than rent alone.
As naturopaths, we treat the individual rather than the disease. Our own needs as a practitioner require a similar approach. There’s no one size fits all solution. It can help to drill down your individual circumstances before making a change and necessary put supports in place for success. Mentoring might help you with this process and provide some unique solutions to help your business and life run smoother.
If you are struggling with where to take your business, invest in a 1:1 exploratory mentoring session.