Speaker 1: Hi, welcome to the dietitian business podcast. I'm Maggie Doherty, your host, dietitian and business coach. In today's episode, we had a one-time dietitian business coaching session with Adina Pearson from Adina Pearson nutrition out of Washington. She's been a dietitian for 20 years and has had her private practice since 2019. She came in today and she asked, what if I'm doing a terrible job?

Speaker 1: Why am I not growing? What am I missing? What haven't I done that I should do that'll actually grow my clientele? Or is this as good as it'll get and I should accept it? We talked all about different ways to increase her retention of clients, figure out what's going on in session, how she can provide more value in session.

Speaker 1: why she doesn't have more referrals coming in, how she can get more referrals coming in, what her messaging looks like. So if you're a private practice dietitian and you feel plateaued, you feel stuck and you don't know why you're not growing, this episode's for you.

Speaker 1: Okay, well, let's just hop right in. Tell me a little bit about your business, what's going on, what barriers you're facing, and where you want help today.

Speaker 1: Yeah, well, I started my private practice 2018 ish shared an office with a therapist for most of that time and then went out on my own and got my own office in my local downtown in 2019 at the very beginning, January 1st. And it's just been very slow, slow going. So I've never grown anywhere near where I expected or wanted to grow. It's.

Speaker 1: I had a

Speaker 1: surge during the pandemic. in 2020, when a lot more people were seeing dieticians than dieticians on the big side of Washington, Seattle, would forward clients onto me. And so I had this huge surge for two or three months. And then gradually things trickled down to a dull roar again. And so I'm at that dull roar stage five or six years in and

Speaker 1: about two years ago I took on a part-time job because it just wasn't feasible for my private practice to be the majority of my income. So I'm at the stage where I'm kind of like, yeah, this is good and it's gonna get, I guess. But I still, you know, I still would like to find some way for my private practice to be a little bit more lucrative than it is, you know. So guess I'm wondering like, is there hope? Am I missing things? Is there a way to grow slightly?

Speaker 1: So tell me little bit about what your client load looks like. How many clients do you typically see a week? Really kind of looking at what some of your KPI or key performance indicators are as it relates to your business. So I'd be super curious, how many clients you normally see a week, if that's been slowly growing or plateaued or what that caseload looks like to start.

Speaker 1: I think at the highest I was seeing like 10 to 12, I may have gotten to like 14, 15 once or twice, but really right now it's like three to six per week. But just not quite enough.

Speaker 1: Yeah, yeah. And do you know what your retention looks like? How many of those clients you're retaining or how many average visits a client does with you?

Speaker 1: That's such a great question. I've never looked at the stats on that. I have some clients that I've seen for six months to a year, some a couple years, and I have clients that I kind of know when they come in that my expertise in their, what they want is going to be like one to three visits. So I've, I've had more of those, like not really niched clients lately. And so I, there's some of those as well.

Speaker 1: are the the so you'd say on average how many sessions do you feel like a client does with you?

Speaker 2: I don't know because it's like the average is not representative. What's that other one? The mode. Like the, I don't know what that is, but I would say five or six, but I've seen some for 12, 50. So I don't know. I think the range is really wide. And with such a few clients, it's not a very representative number.

Speaker 2: Stay.

Speaker 1: Well, I think that's your first homework that I'd give you is we need so theoretically, if you've had a practice since 2018 and there's been three to six clients per week, over that long haul, I would expect you to be retaining between 60 and 80 % of those clients and for them to be doing.

Speaker 1: depending on your specialty, sounds like you're into eating disorders, know, having five to 12 visits as the average. And so the first thing I'm curious is retention is huge. If we don't retain our clients, it costs so much more to acquire a new client and so much more energy to like chart review a new client, do an initial assessment versus keeping a client happy and keeping them coming back.

Speaker 1: week after week, month after month for weeks, months or years. And so the first thing, anytime a clinician is struggling with their client load, before looking at how do we get more clients, I always like to look at how are we retaining our clients? So there's a lot of different ways to calculate retention. I typically recommend that the way people calculate retention should be whichever way your EMR does it.

Speaker 1: The easiest What EMR are you on?

Speaker 1: Simple practice.

Speaker 1: Okay, awesome. I am on simple practice too. So there's some EMRs that are a lot better with calculating it. Simple practice, you have to maneuver a little bit, but I have an article that I will share with you after this and I'll link in the show notes that gives a couple different ways to calculate retention. But I'd say your first homework is I'd wanna know what percent of clients are you retaining? And then I'd like to know.

Speaker 1: How many sessions on average does a client do with you? And are there things that we can tweak with our counseling skills and style to see clients for longer, whether it's 30 minutes and getting to 45, 45 getting to 60, going from meeting once a month to every two weeks or every two weeks to once a week, because we can ideally want our schedule full of existing follow-up clients.

Speaker 1: And so that's the first kind of thing I'd want to look at is like, do our sessions look like and could we improve the retention of a client so we don't have to work as hard to get a new one because our existing people love us and want to keep coming back.

Speaker 1: Yeah.

Speaker 1: So that's the first thing, because then again, let's just say we do this massive marketing effort, we start Google ads, we all do all this networking, we get all these new clients in, we can churn through them and then have to continuously be getting more new and new clients. I remember one time we hired a dietician and they were seeing a client for one to three visits. And so we were unable to hire another dietician because we were sending so many new clients to this person.

Speaker 1: and they had to keep getting new clients in order to be full. So that's really the first big area I look at is like, what can you do to improve the value that you're giving in your sessions with clients? So they do wanna come back again and again and again again.

Speaker 1: Mm-hmm.

Speaker 2: Yeah, mean, I think at this point, there's, have enough non-eating disorder clients that aren't the best fit for me, that it's hard to feel like that number means something. Whereas I think when things were a little bit better, I had more of my ideal client and I saw those more frequently. You know, if I get a guy who is really just wanting quick weight loss and I'm trying to help him through some

Speaker 2: foundational things about eating. Most of the time, these are people who have such busy schedules, they want to see me once every two months. And so I'll see them three or four times and then they're not. So the clients I get that come from therapists tend to be longer lasting unless their aversion to working on food is high enough.

Speaker 2: That's it.

Speaker 1: Yeah. And imagine if your whole caseload was people who wanted to see you once every two months, you would need so many new clients to fill you up. would be really tough. You'd have to a lot of marketing to get that many clients in.

Speaker 1: What's a normal?

Speaker 1: What's a normal flow of new clients? Like referrals per month or calls per month or anything like that where new prospective clients are inquiring about services, how many per month or week.

Speaker 1: That's a great question and it depends. So the first thing that I would recommend for you is I want you to benchmark against yourself. At this point, it's irrelevant if I get 10 referrals a month and you get one. Sure, mean, it can make you feel like, wow, that's kind of my goal. What I'd want to look at is how many referrals have you gotten?

Speaker 1: the past 12 months, how did you get those referrals? And how do we do more things to get those referral sources to give more referrals to you? So Simple Practice has an awesome referral report. Have you used it before?

Speaker 2: started and then I didn't keep it up. then I have separately I have my own little excel sheet that I was starting to use and I did that maybe three months max because it was such a pain.

Speaker 2: Because it would allow me to see how many times I called them and who sent them and why they didn't schedule or if I didn't reach them or stuff like that.

Speaker 2: Yeah. So I would recommend getting a little system in place, whether you do it at least once a week, at minimum once a month to pull that referral report and see where are your referral sources coming from. For example, at my old group practice, we had a handful of doctors who made up the majority of our referrals.

Speaker 2: But because of that, we made sure to keep those relationships up with those doctors because they were providing us so many referrals. So it was grabbing coffee, swinging by their offices a high, doing a free lunch and learn, updating them with how our clients were doing and like really nurturing that relationship because it was literally paying off. In my current practice, when I look at my referral sources,

Speaker 2: I try a lot of different marketing efforts and when a client comes to me, I'll put that as their referral source. And so for example, last year I was doing a lot of free webinars to build up this new business of dietitian business coaching. In my referral sources, there's a tag that I have as free webinar in this certain date. And there's now thousands of dollars that I have brought in through clients for that free webinar. So that tells me,

Speaker 2: hey, I did this thing for free and it generated thousands of dollars of client income. Another one is even right now I'm tagging, so when I've been on different podcasts, if someone hears me from a podcast, I'll tag it as that. And so then there's been podcasts that I've done for free, I've spent a couple of hours of my time, but again, it's generated thousands of clients back. And so that's where it's really important to know

Speaker 1: where your referral sources are coming from and what's actually generating an ROI or return on investment.

Speaker 1: Yeah, so I haven't tracked that, but from my observation, it is so widespread that none of them are amazing. I would say there's one therapist right now that I've had a handful of clients from and like a drop from this doctor, a drop from that doctor, like nothing has stood out. I have had coffees with therapists and local people that might have a referral source. I have like done

Speaker 1: snail mail marketing so hard to doctors for like two years. have nobody here really wants to meet with a dietician in person. Like there's the hospital system doctors. They are pretty closed off to outsiders. So it was a miracle that I managed after trying quite a bit to get in to see two of them for like five, 10 minute talks with them. Referrals from them are poultry at best.

Speaker 1: Even the ones that like I'll have a client come from doctors so and so and she'll say, doctors so and so said you were amazing. But that same doctor gives me like a handful a year. So it's not like a lot. there's, and I, I write treatment summaries after my first visit with patients to thank them. And here's what we've worked on. I have, I've tried so much, even when I worked in the clinic that half these doctors are from, barely got.

Speaker 1: enough referrals to keep me part-time employed.

Speaker 2: That's where I feel like I've done nearly everything to try to network except like, you know, hang out and have coffee every week with everybody because that's not possible and they don't want to. That's I can't do lunch and learns because they don't have that option. They don't bring people in for those. I've offered. I've dropped off like baskets of fruit and snacks. I've, you know, I've stopped by. I've dropped off my letters in person, like all these things that I did. Nothing.

Speaker 2: was like, this thing right here, do that a lot because that really has a high ROI. It's all just like a little trickle from places around, you know, nothing gushing.

Speaker 2: Yeah. I'd be really curious about what your messaging looks like. So again, we're, a lot of my philosophy in business is try a bunch of things, see what works. If something doesn't work, see if you can figure out why and pivot there or try something different.

Speaker 2: And so if it sounds like you've done all of these different things and everything has produced a small amount of referrals, but nothing's totally taken off. So my first thought is like getting back to the foundation, like, okay, why are those things not working? What is our messaging not landing? Is the way that we're selling it not settling right with the other person is...

Speaker 2: Are services not clear? Does it seem like we're providing this value? Are we speaking to the person's pain points? And so I'd be really curious on like what those conversations look like, what you're sharing, what your emails look like, what's kind of being talked about there. And it could be, okay, our message isn't landing right. It's not landing right, so people aren't buying.

Speaker 1: And so that could be one thing is kind of digging in there. There's a really good book that I love that when I have dieticians that are struggling with branding or messaging or selling or marketing, I recommend the book, Book Yourself Solid by Michael Port. And I'll put that in the show notes, I'll send it to you afterwards. But there's,

Speaker 1: I have a free handout on my website. I'll get that to you as well and link that too. But that's one activity I'd probably say would benefit you is let's do some breakdown and reconstructuring of how you are selling yourself. Because if you're doing all these things and it's not clicking, again, I always like to start at the foundation. So kind of looking at what that branding and messaging and how you're selling it.

Speaker 1: Book Yourself Solid is really great because again, as dieticians, we don't get a lot of marketing, business, selling experience.

Speaker 1: Yeah. mean, I really, with pediatricians, I would focus a lot more on that. I'm not interested in this area as much anymore, but I did a lot of like child feeding stuff. Like I would provide like handouts and like I would create headlines for the doctor that I thought would resonate with them. So it's possible my messaging was just landing poorly. I don't know how to check that versus they just don't think to.

Speaker 1: refer on. And then for when I was more focused on eating disorders, which I still would say I am, I just haven't been getting those clients. I did a lot of like postcards, I would send them postcards like criteria or things to look for like questions to ask, you know, I would give like, like tips on is this binge eating disorder or overeating, like here's things to ask, like try to be helpful. Try to show

Speaker 2: And other mailings, I would try to show them how I can help and things that like maybe women struggle with with body image and like they're no longer than either a postcard or a one page letter with like header and signature. So they weren't like lengthy reads. And I try to put it like a catchy headline at the top of the letter.

Speaker 2: So with saying that you don't notice many referral sources are coming from word of mouth or from existing clients and you've been in business for so long, again, it kind of gets me back to what is that client experience like with you and are clients having such a profound and value experience with you that they continue to come back again and again and continue to tell all their friends about you.

Speaker 2: And so again, it kind of comes back to maybe reworking a little bit of what you're doing, your counseling style. I don't know if you have ever been shadowed by another dietician, but one of my favorite things that I implemented at my group practice was when we were onboarding dieticians, we shadowed them and it was a really cool opportunity to give

Speaker 2: feedback, give perspective, and also for the other person to learn other ways to counsel. But that's one big pro of being in a group practice where you can get shadowed and someone be like, know, Adina, what, like, you could have said this X or Z or like, what about using this handout or this philosophy or did you see this one thing? So I'm wondering if you're missing that, that supervision piece. Have you ever had a

Speaker 2: like a supervisor or business coach or anyone that you've kind of bounced right in this off.

Speaker 2: I've had supervision sessions, but not shadowing me, not present as much as like, here's the case, here's what we're working on, here's the challenges, kind of supervision.

Speaker 2: Okay, so it's one, so as I moved from my group practice to doing business coaching for other private practice dieticians, that was one huge thing I noticed with a lot of private practice dieticians. They don't have that other perspective of how they're doing. And I had another dietician in my program who reminded me a lot like you. She'd had a practice for a while. She was very intelligent.

Speaker 2: but referrals weren't coming in and clients weren't sticking around. And y'all story sounds a little bit similar. And what I recommend to her is I'm like, we gotta get someone in to like shadow your appointments and give you some feedback. I feel like if you were to have someone shadow an appointment, I feel like supervision is great, but it's totally different to live see it. So it can be as simple as just getting consent from a client for someone to shadow you.

Speaker 2: And either if you have a dietitian that you trust and respect come in and sit in your session, or whether you have a supervisor or a business coach, something like that, I think that could be a really powerful, powerful tool and idea.

Speaker 2: So that would probably be like virtual for a lot of clients sitting in virtually kind of with the camera off more or less or.

Speaker 1: Yeah, so again, on simple practice, you just join the virtual session. And then let's say I was shadowing, would turn my video and my mic off. And then if I were you, I would just tell the client, okay, you know, I have someone supervising or I have someone shadowing. They're just here to kind of give feedback for me. It's for my personal growth and learning. They're just gonna be a fly on the wall. And we've had great experience with that. We haven't had clients push back and dietitians learn a lot.

Speaker 1: Yeah, I think most clients would be open to it. That's a hard one to think about in terms of like, is it me? I think though, like I would expect my long-term clients to be satisfied and like finding our sessions valuable. I don't know if that's a big leap, like maybe they're just stuck with me and that's, they assume this is as good as a dietitian gets, but I feel like those clients you would, I would think would

Speaker 1: spread the word. But again, like if they're an eating disorder client, is that common for someone, some 20 year old eating disorder client to be like, Hey everybody, my dietician's amazing. Go see her. Like that seems like I don't hear that about therapists necessarily. I don't, I rarely hear anyone tell me about their therapist. Maybe I just don't have friends that are in therapy, but I just don't hear about therapists. And so I wonder if it's kind of similar.

Speaker 1: Have you ever surveyed your clients about what their experience has been like? What do they want more of? What do they want less of? What should they think? What would they rate it on a scale of one to five stars?

Speaker 1: have at times. Yeah, I've sent out surveys and feedback forms. I've never gotten anything that stood out. You know, if it was like some unhappy person who saw me once, but like no one that's seen me regularly. I don't think I've gotten any any negative or constructive feedback.

Speaker 1: I would encourage you to mass email all of your clients, say, hey, how are you guys doing? I have this quick one, two minute survey that I'd love for you to fill out about your counseling. It is anonymous and fill it out by the end of the month and one person will win a $25 Amazon gift card. So then you're incentivizing people to fill out this survey.

Speaker 1: by offering a $25 gift card. You make the survey anonymous or if people wanna leave their name, they can. And give you a review of one to five stars. What did you like about it? What do you wish was better? Questions like that. And again, then you lean into the things that people are saying are great. And people will leave constructive feedback or

Speaker 1: very not nice feedback when someone's anonymous. You take that, you get a better idea of how you're doing. The people who leave positive reviews, if they leave their name, you reach out to them and ask them to post a review on the insurance websites, post a review on Google, Yelp, Facebook. I think I was on your Google page and I didn't really notice any, I think you had one reveal.

Speaker 1: but there weren't really many Google reviews for your business. And again, you've been in business for several years. So I would expect there to be more reviews.

Speaker 1: Yeah, I felt conflicted on the like ethical ramifications of having reviews on there or encouraging them or HIPAA. So I just wasn't sure about something like that. Yeah, so

Speaker 1: Generally, what I will do is if I have a client who I know we have a great relationship, they've been with me for a while, I'll email them and say, hey, you know, I've had such a great time working with you. I'm trying to build my online presence, trying to build my base. And I would love for you to write a testimonial on Google. If you'd be willing to do it, here's the link.

Speaker 1: How easy is it to do anonymous ones on Google?

Speaker 1: you can't do anonymous on Google. So you can let them know, hey, you can't do anonymous, but you can make it, you you can make a general blanket statement. It can be tougher in the eating disorder population for people to write reviews because there's guilt and shame along with it. So typically what I'll share with those clients is, you know, you can make it super basic. If you're willing to, you don't have to at all, not putting any pressure on. But again,

Speaker 1: If I look to how I choose my healthcare providers, I will not go to a therapist or a doctor who doesn't have reviews or has less than 10 or has multiple bad reviews. I generally look for a practitioner that has more than 10 reviews, no more than like a thousand, otherwise it's gonna be too big.

Speaker 1: But I won't go to a provider if they don't have reviews. And if I won't do that, that means someone won't come to me if I don't have reviews.

Speaker 1: Mm-hmm. Yeah. So that would be another thing I'd put on your homework is, you know, get that internal survey out. You know, make it to where people can make it anonymous or put their name. If people leave a good review, tell them thank you, send them the link to put a review anywhere else on any of public forums that you have. And if it's negative feedback or constructive feedback, you know, really take that to heart and what can we...

Speaker 1: What can we do differently to give clients an even better experience or just a better experience?

Speaker 1: When it comes to dieticians who do shadowing kind of supervision, from my experience, those cost about as much as the session I'm billing for. And with only three to six per week, that could be pretty big chunk. So that's kind of one of the things that holds me back from doing supervision. Also this ridiculous thing.

Speaker 1: I've become superstitious about it because I swear every single time I've gone, I've taken a case to supervision, that client stops coming. Like I get the case supervision and then I don't get to use like the suggestion. And I know that's really ridiculous because I don't believe that would be like causal, obviously, but it's kind of like made me gun shy to sign up for supervision and probably because those are the tougher cases, the tougher clients.

Speaker 1: So if I'm struggling, then it makes sense that maybe the client is not getting everything they need.

Speaker 1: So the idea of this type of supervision would be, so sure, you're spending, let's say $200 on a supervisor to shadow you for an hour or to business coach you for an hour. The idea of that is you get an ROI on that coaching session. So for example, I were to shadow your session and give you feedback.

Speaker 1: I would expect instead of that person being with you one, two or three times, based on that coaching, we get them in four, five, six, seven, eight, nine, 10. Again, kind of same thing when I, know, I track my metrics on the dietitians I work with, I am hired to help them on their business and we track their KPIs. And so we can see they're getting more and more clients.

Speaker 1: as we continue to work together, or they're retaining them more, or they're hiring more dieticians. So you may be thinking a little bit too immediate short term, like, hey, I'm paying $200 and what am I getting out of it? The idea is you pay 200 and now this client stays on with you for $1,000 worth of sessions. I do. I think it's this, I think it's you have two parts.

Speaker 1: Really.

Speaker 1: I think something is going on in your counseling sessions with clients where clients are not staying with you as long as they need to stay with you for you to have a profitable private practice. And then I think on the other side, something with your messaging or branding is not totally landing with people, so they're only sending zero clients or one to you.

Speaker 1: And so I think it's kind of really, really diving in and not being afraid to see what's underneath and what the truth is from other clients, other peoples or what you see. And what can we do to really make your sessions so valuable that a client comes back again, a client tells their friend, a client tells their doctor and you have referrals coming in just from one client having a phenomenal experience with you.

Speaker 1: And then the other part is how do we make your branding really clear and confident? And so when you're having these conversations with doctors, they're like, gosh, I want to send this person to Adina. And I think those two parts we've got to look into by you surveying your clients, you having other people look at your material and possibly having someone supervise your sessions.

Speaker 1: And I view this as a investment where if you can uncover and figure out these things, you should be able to get from three to six clients a week to 10 to 12 to 15 to 20 and finding your max. And again, as we kind of do these things, you do these things, you see what you find out, you keep going down that path.

Speaker 1: versus if you do these things, nothing comes up, then okay, we look elsewhere. But I think you're in a spot where there's some things that are working, but there's some that's not. And we've got to figure out what's not working so you can figure out if you can make your private practice work.

Speaker 2: Mm-hmm. Yeah.

Speaker 2: That's a lot to

Speaker 2: Then again, let's just say, know, again, the whole, like if you think about the pain for a supervisor, let's just say I charged you to be here today and you paid $200 for a business coaching session. I would be measuring and expecting you, if you had three to six clients this week and you had zero referrals come in, by the next time we meet, I want to see, okay, can we get more referrals in? Okay, what did we do to get those referrals in?

Speaker 2: how many clients do you see? Okay, what do we need to do to get more referrals and more clients? And so kinda as we get back to knowing your numbers in your business, that's why it's really good to see like how many clients you see each week, where are your referrals coming so you can see what's working and what's not. But you're in a great place where you're like, something's not working and I've gotta change something to grow.

Speaker 2: Yeah, my head is just swimming with the thoughts. I feel like I'm so underwhelming in my reaction, but I'm just like turning it over in my brain. yeah, like it's scary to think that what if I'm just doing a terrible job? Like that's the worst part with the idea of shadowing. I don't think I am because I've had those long-term clients that are

Speaker 2: the good fit and they are what I'm looking for because I'm accepting these other referrals that are not what I would choose if I was full. Like I would not choose to work with people whose main goal is weight loss. I don't even do weight loss. We don't get to that part. We just try to normalize eating. And then with the goal of like, okay, when you are taking good care of yourself with food, you're actually eating meals. You actually have balance. Now let's think about, are you willing to like,

Speaker 2: possibly disrupt this and that's as far as I'll go and we haven't gotten there lately with clients that are looking for that.

Speaker 2: to like that first thing you said is like, you know, I think they're having this good experience. I think this, I want you to be able to go from I think to I know. And the only way you can say I know is when you get those hard number and stats and feedback through those forms or through those other ways. But again, that's gonna be a big shift to go and be like, I think this thing's working or I think this isn't working to like.

Speaker 2: I know this is working because XYZ and I know this isn't because XYZ. And so think you're just missing that analytical piece where you're really analyzing what working and what's not. It can feel like it takes time to do, but again, if we spend the time and we fix something and we get more clients and we retain them for longer, again, that's what makes a profitable business.

Speaker 2: Yeah, I have the piece of the entrepreneurial mind where I like the creativity and the marketing, but I don't have like that CEO side naturally where I'm going to be looking at KPI and the numbers and ROI and like actually tabulating and having numbers that part. And I'm like, that's for somebody else.

Speaker 2: Yeah. Yeah. And that's, that's normal. A lot of the, you know, the private practice dieticians I do work haven't, haven't tracked those numbers before. but they're, it's a, it's a really cool thing to start knowing and really understanding your business and like what's happening within it. Well, I'm glad we got this time to talk. I'm to go ahead and wrap us up, but I'm excited to stay in touch with you and hear, you know,

Speaker 1: if you go down the path of exploring these things and if so what you learn and what changes. So thanks for being on here today. If people want to find you, where can they find you? Where are you at?

Speaker 1: And I'm

Speaker 1: Beautiful, beautiful, I love that. Okay, well we will see you later. Thanks for hanging out.