73 | Finding your Goldilocks Case Load

Leah
Hey there, Annie.

Annie
Hey there, Leah.

Leah
How are you?

Annie
It's good. It's so funny that it was so recently that we were together at USLCA and now I don't know when I'm going to see you again.

Leah
I know I'm a little bit sad about that. I was thinking about that. I'm like, how can we figure out a way to see each other again, I guess for now, it'll just be virtual. But good news, we have a bunch of virtual things coming up. So I feel like at least we'll have a little bit of connection over the next couple of months.

Annie
Yeah, it's so nice to come together. We had a great deeper dive last month with Alison Walsh and Lashonda Dandridge about supporting pathway three mentors. Then we have somebody really exciting coming on November 7th at 1pm. Eastern, we're going to be live with Cathy Watson Genna. We're doing a deeper dive into supporting sucking skills. Some of you may have come to the deeper dive we did with Cathy a year ago, which was on clinical complexities. If you were there, you know, and you can also the recording is available of that one, we always make the deeper dive recordings available so you can watch them later, purchase them later. But this time, we're going to be talking with Cathy about creating the new addition of supporting sucking skill. I'm so excited. I've been going through it and I've been doing the book club that Barbara Robertson runs to make myself, really not just like skim for what I think I need to know. I already after just the first chapter and redid all of my charting templates.

Leah
I love it. Yeah, I did that book review or book club last year, I think. It was really good. It was so helpful. I just loved when we had Cathy last time, her energy is just so great. I loved how she just made everything seem so I don't know, just like real and tangible. I can't wait to hear about the new additions to the book and things that she changed and how she figured those changes out. I just can't wait to hear it. Just open up your brain to us, Cathy, that's all we want. That amazing brain.

Annie
She's so generous and she's so kind. I got to be with her in Dallas at the end of August for the Dallas Lactation Consultants Association. We were the two speakers and it was just so soul-nourishing to spend time with her. She's just really such a kind person but so smart. The things that she just has at her fingertips. So I'm just really grateful, we both are, that she's going to be spending an hour with us. Coming up very soon, it's Monday the 7th. So you can find all of our deeper dives at learn.paperlesslactation.com/deeper-dives. I'm also working on migrating the past deeper dives over. It's just been a kind of a slow process but they will all be there eventually. You should see the upcoming ones, this one with Cathy and then our December one, which will be a deeper dive into watchful waiting with Susan Howard. So that's happening in December and a whole bunch that we've already done should already be up there. Slowly but surely I'll get them all there. But today, Leah, what are we going to talk about on the podcast today?

Annie
Oh, it's such a good topic because it's been such an evolution of figuring out your Goldilocks caseload like what's the perfect amount of work cases for you to be taking on at a time. I just feel like, Oh, my goodness, the pandemic definitely brought all of this home for me like in my face and really have been soul searching and trying to find that magic Goldilocks number. It's still kind of a work in progress. But I know you have been on the same journey because we have had quite a few Voxer exchanges going back and forth about like, it's too much. It's too little. It's too much. It's too little. So we're still working on Goldilocks, it's just right. But I'm really excited to have this conversation today.

Annie
It is an emotional roller coaster doing private practice because I feel like I'm either convinced that, it's all gone like something has happened and I have no private practice anymore or two days later, I'll be like, oh my gosh, I'm overwhelmed.

Leah
I'm drowning.

Annie
Too many babies, the babies just falling from the sky.

Leah
Yes, it really does feel like that and it in its kind of like keeping your emotional self balanced through that I think is really hard but also I feel the second I put up more boundaries and say I'm going to reduce my load or I'm going to stop my day sooner or any number of things that I'm trying to work on as far as finding my Goldilocks caseload. I get a lot of emotion and what if I back off, what is that going to do to my business or I have to keep pushing hard, I've been pushing hard for 10 years, maybe I need to keep pushing hard for another 10 years. Then my body's like, no, you won't. No, you won't. Also, just the emotional toll, we all go through cycles of I think burnout and especially coming out of the pandemic, when everything was so stressful, we all have this added layer of stress on everything we're doing. I feel like I've heard burnout a thousand times from every provider in healthcare right now is feeling that but I'm really finding it challenging to both set the boundary and to push hard like to find my emotional, just balanced state and all that.

Annie
It is, I find it really challenging for me because I think one thing I realized during the pandemic was that I think my stress response is work. It was a lot of like, for me, dissociating through work, like how can I find ways to just occupy my mind so I don't have to think about what's happening in the world. What I'm worried about, I can just fill my mind. There were great things that came out of that, for me, like really being able to support so many families virtually and running conferences. I loved all the individual pieces of the things that I did but I hit a point where I was maintaining a full caseload and running a conference over multiple weeks, this spring, and my body when it was over was just like you are done. You need to stop. All of a sudden, it was funny too, that like, I guess desire to maximize every second of my day. It was kind of like it went away. In a way that I felt like I was waking up or was stepping out of the shower or something or like, the clouds parted. I don't know. I'm trying to make it sound more miserable than it was. It really was. I was like, you have to stop. You can't do this. I had said that to myself many times, like, okay, you have to slow down, you have to take a break. But this time, I was like, no, it was real to me. I really took a very light summer, both of my kids had nothing to do because they're too old for camp and too young to work. I was like, I'm just gonna pretend like we're back in our real homeschooling days, and spend time with them and hang out with them and read books and go places and spend time in nature. Then the thing that happened was that I got to the end of the summer, and I was like, my soul feels very revived, my bank account not so much.

Leah
Right? I know because that's like the other side, we're talking a lot about our emotional needs and burnout and just the stress level of having a very busy caseload. But the other factor is we're trying to make money and contribute to our family needs and support ourselves. So yeah, you can be as rested and revived as possible but if you can't pay your grocery bill or your rent then you're definitely going to have a whole new level of stress coming up. So there really is all these, I think of you know, just all these convergence of needs that come up that then make out this like Goldilocks thing. It's like the needs of your clients, needs of the community, your needs, and then your financial needs. I'm sure there's many other pieces to it and that's really hard to find that really sweet spot, I feel like.

Annie
The financial piece too, is it often ends up being the most pressing, especially because the reason I could take a lighter summer was that my husband was working a lot more this summer and he's a freelancer. So there's like a trade off that has to happen, we sometimes we're like we're always going to be a one income family. One is always going to work more. That's a different kind of Goldilocks but like just having that, like we do need to have income coming in like that just financial insecurity. When you're not able to meet your basic needs. I've certainly been there in my life where I'm like, oh no, I overdrew my bank account to pay rent. My husband and I still talk about those days and they don't often sometimes don't feel that far away, all of the uncertainty with the economy. But inside of that, we can't bring that energy to our clients. So one thing that can happen with that income insecurity is that you're like, okay, I'm gonna work, work, work, work, work, stack your schedule, and then you have all these people with these really complicated needs and you're like, I can't remember. I can keep track of you. I'm trying to see you through. What is that like for you to really look at what is a caseload? What does that even look like?

Leah
Yeah and you have to be so careful because you could have ten cases that are the like, oh, you just needed to tweak your latch and lean back a little bit and then everything's perfect and then you can have that wave of five people who keep you up at night because there's so complex and so many referrals needed and so much coordination of care. You don't have any warning signal of like an alarm that's gonna go off like here they come be prepared. Move all your other activities out of the way because this caseload or this specific case is going to be really intense. I think when you're contemplating what is my perfect caseload, you almost have to build in a buffer for the more intense cases that need our extra support and hope that you get a mix. Sometimes it doesn't happen because I feel like things always come in waves. But hopefully, you also alternatively get a little bit of a mix of these less intense caseload. But I do think it's so important to recognize that there are always going to be those cases that are going to go outside of our normal care. I just feel like you have to be prepared for that and almost built in a plan for when that's happening. I oftentimes, if I'm getting through a week and I usually booked out a week or a week and a half. If I'm getting through a week, and I'm like, whoa, so many of these people need follow-ups, then I will start blocking spaces that week or week and a half later. Because I'm like, I need to make space for this. Sometimes I'll even block them once I read their intake because I'm like, oh no, just leaves some space open because this intake, I think I'm walking in on something pretty intense. How about you? How do you manage that?

Annie
Well, that's a great tip about blocking time based on the intake. I have never thought about doing that but it's so smart. I have done the like, I'll just block everything in IntakeQ and it'll just say hold for existing clients. Then once I have all of them sorted out then I'll reopen it and then some new people can come in. I've had a lot of postpartum depression lately. Those cases are so just there a lot of everything, a lot of investment emotionally and timewise. Those are the ones where I do end up staying at a home visit well past when I would ordinarily stay just because I'm like, I can't leave until I feel like you understand what we're talking about here. That you're going to make a phone call. That there's gonna there's a support plan in place. Not that I'm there because I'm not there being their therapist at all. A lot of times, they'll just keep asking questions and I'll keep trying to answer them about their care plan. Then saying but we also need to address the mental health piece or the anxiety piece because I'm not the person for that. But those really like I stay a long time. I think about them, they keep me up at night. Those families, it's just so hard for them and it seems like there's a therapist shortage,understandably. Then the other ones that I feel like I have to make. and this is more like mindset room for rather than scheduling room for, but it's a little bit of both are like I have some cases where it gets really complicated. We're doing multiple visits and then four visits in the EOB start coming from Aetna and it will be one of those where everything is all messed up. I'm like, okay, I haven't gotten paid for this yet. We're trying to get paid but what if I never get paid? Then in the middle of that, they'll reach out and say, can I come into your office or can I do another home visit. I have to turn off the part of me that's like, I might not get paid for this because at that point, I have a duty of care. I'm invested in them so financially, budget wise, I have to build that buffer in too. I have to know that there's gonna be a certain percentage of cases that I'm just not going to get paid for or they're going to be sliding scale. So I've chosen not to get paid or not paid as much for but some that where the insurance company is just going to screw me over.

Leah
Yeah. Which is so hard to be able to predict all of these factors. So as me and Annie have learned after I've been in business for almost well now actually eleven years, and it's just so crazy to me because of the evolution that time has taken. I've pushed more, pull back, push more, pulled back and really tried to find the sweet spot which I don't think I'm there yet. I still feel like I'm in this kind of searching and also different stages of your life. That's the other factor is different stages of our lives might dictate that we're gonna push more or pull back for other reasons outside of our control. So I feel like that's a piece to it, too. I know that you and I have had so many conversations about how we've been evolving and changing and looking at all this. I love that you also, one time mentioned to me that you had sat down and looked at this is how much money I need to make in a month. This is how many cases I would need to take. This how many follow-ups. You had kind of, in a very Annie wonderful way, with a spreadsheet I'm certain, had kind of map that out. That's something that I've always really appreciated and have thought about a lot and helped guide me a little bit because I have worked out those numbers. The numbers side of it, I think people just don't know. You might be like, oh, I'm gonna make X number of dollars a year. But I'm like, okay, but really what would that look like? You got to break that all down and look at like, I would have to do ten initial visits a week and five follow-ups a week to make those numbers work out. You've got to really put pen to paper or fingers to keyboard and really break it all down if you have some specific needs around that. So you can really get an idea of what does it actually look like to make the money that you maybe feel like you need to make or want to make or goals, that kind of thing. That was something that when you had mentioned it to me, I was like, oh wow, I think I had a very rough idea of that. But then when I started putting the numbers down and mixing it up because I have a lot of different places that I get income from, different settings. So I was like, oh, I can add more here or takeaway some here. That's been super helpful for me too. So thank you, Annie.

Annie
Sure. Where it's been helpful for me is like when I'm feeling it's helpful as anxiety assuage or so when I'm like, oh my gosh, like I haven't worked enough this month, and then I can actually go in and I can run my month to date and year to date. I don't look at income, I look at the number of sessions that I do. I can compare it to last year and then I can say, oh look, I'm actually ahead of my yearly goal. Then I'm like, okay, I will take off a morning. I'm allowed to do that because I'll make it up. Then it also prevents me from doing things like being like, I'm gonna see ten people this week, I'm just gonna say yes to everything and not see my family. It just stops me from making those really impulsive, I tend to be very impulsive and kind of panic. I'm a look before you leap person, Leah knows this about me. I'm like I have a great idea. It's gonna change everything. Then it sometimes makes more problems for me. I will share, to wrap up, I'm going to actually share something because when I'm worried about money, I make stupid decisions. So I have to try to do things to stop myself from making stupid decisions. But I made literally one of the dumbest decisions that I think I could have possibly made. I'm now building it up. For me to do this, it's embarrassing. I was looking at my expenses. I'm like, okay, I'm gonna cut my expenses. What can go? What's extra? What's extra? I was like, oh, Spruce has fax. I'm like why am I paying for SR fax when it's included with Spruce? I immediately wrote a number. I'm like, can you port my number from SR fax? Spruce was like we sure can. Within like four days, it was done. I was like, yeah, now I'm not paying for SR fax anymore. Then SR fax sent me a refund for the year because I paid by the year. I was like, this is amazing. I mentioned it to a friend of mine and she was like, but what about the IntakeQ integration? And I was like..

Leah
Oh, yeah, there's that.

Annie
Oh, yeah. There's that. So now, that was a couple days ago, and I'm like, I cannot walk this back. I'm like, okay, now I'm just gonna figure out what is the smoothest workflow because it's not integrated with IntakeQ. I just have to laugh at myself. That's the kind of things that I do when I let fears about money control my decision making. It has to come from a different place. We have those fears. I have those fears. You have those fears and that insecurity and all of that. But we have to really figure out how to take care of ourselves around that so that we're not making decisions that might have implications we're not thinking about.

Leah
Yeah, and I think that's where this discussion can kind of learn from our, we always say this, I think on every podcast, learn from our mistakes. Learn from what we've been through for the last ten years. My biggest tip is know thy self. Annie knows that I'm gonna make fear based decisions so you have ways to guide yourself out of that. Sometimes you don't use them but you have ways to guide yourself out of that by saying, wait a second. I do the same thing you do when I get like all fear and I'm like, I pull back too much, my business will never survive. Then I'll look at the numbers and be like, nope, no, I am doing just fine. I have just the same amount or more or whatever I'm looking for. I'm like, ah. It just helps me so much but also know thy self, what's too much for you? What's gonna make you not a good provider? These are things to be reflecting on. Notice on a Friday at the end of the day, are you just like, oh my god, I can't believe I made it through this week. It was so hard. It was the worst ever. I mean do you really want to go into every weekend like that? Or is there a way to adjust your schedule where it doesn't feel like you've finally got to Friday, but it wasn't a crash and burn? Do you feel expansive on Fridays, you feel like, oh, my gosh, I could have done more. It's just having that awareness, that self-awareness, I think is just such a powerful tool. Annie and I are still figuring it out.

Annie
We are very much still figuring it out. We figure a lot of stuff out during the deeper dives. Also just talking to each other, doing these podcasts together. I'm such an external processor and I know Leah has some of that too. A lot of times, it's really legit that we get to the end of a podcasts snd the two of us have new insights that we didn't have before we sat down to start recording. So even just talking about it, having somebody to talk about it with, having somebody that you can actually like be honest and say I'm scared about money right now. That in itself can be a scary thing to say. So who do you trust? Who's going to help give you those checks? Also, what other things do you have in place for those times when there might be times where you're not making enough money? That also happens. We talked about paring back and leaving room and not getting anxious but there definitely have been times where it's like, it isn't enough. It's not possible and it might be not possible because there's no people calling you. it might not be possible because you have a family member who is sick. You and I both have teenagers and we've got aging parents and so we are in those sandwich years that our kids and our parents need us and so that makes demands on your time. So thinking about too what other things do you have in place what other like we've done talked about diversification before. I know we'll do it again in the future but really thinking about how can you diversify what you're doing so you're not just dependent on one type of thing to make or break you.

Leah
Yeah, definitely. Definitely. Yeah, well, I mean, I think we could talk about this for hours because it's such a deep conversation and we should totally come back to this and maybe have a deeper dive on this one. I feel like it would be so helpful to talk to some professional about some of this. I think it would be such a valuable conversation to continue on. I cannot wait for our deeper dive I hope you guys will all join us for both of them. They're going to be so awesome with Cathy in November and Susan in December. I'm so excited and can't wait and I hope you guys will all join us.

Annie
I hope so too. Go to learn.paperlesslactation.com/deeper-dives and you'll see our upcoming deeper dives in November with Cathy Watson Genna, deeper dive into supporting sucking skills, and December with Susan Howard, a deeper dive into watchful waiting. Really hope you'll be there. You can find recordings of our past dives as well and post comments. We're there in the community. We'd love to be interacting with you there as well. So thank you so much for listening. Leah, this conversation really did a lot for me today. I really needed to start my week with it.

Leah
Definitely. It's so good to talk to you, Annie. Talk soon.

Annie
Bye.

Leah
Bye.