Office Hours with Angelique and Toby. Released April 1, 2026. 13 minutes.

About this episode

Angelique’s practice is approaching fully booked several weeks out, and she asks Toby how he manages rapid growth. They discuss leaving buffer slots for emergent care, communicating capacity limits to patients, telling a temporary peak from a new normal, building a referral network for urgent needs, and when to consider going all cash or adding staff.

Topics

Approaching full booking
Communicating capacity limits
Peak or new normal?
Buffer slots for emergencies
Managing new patient intake
Referral networks
When to go all cash or expand staff

A note for listeners: this is a conversation among practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically and lightly cleaned up. It may contain errors, especially in names and Chinese terms.

Angelique: So I'm actually curious what and how you manage. I'm approaching the kind of place of being fully booked and being fully booked a few weeks out, is a new and different and experience. And again, not throwing myself a party just yet. I'm that place where I'm getting all of a sudden a whole bunch of new people. So I don't know if I'm at a peak right now and there'll be a valley later or, but it feels very much when I first started and started to gain some momentum. have so many inquiries and then I'm trying to schedule them in a mindful way, but I'm still finding that sometimes the patients I've been treating who haven't, for example, booked out are now no space for them. And that's an awkward conversation to have. And then I found myself. squishing people into places where I don't like doing necessarily and staying longer for some people just to make sure that care isn't interrupted. So yeah, I know if like, I remember we talked about maybe an assistant being hired at some point, which I think would be a dream, except that I don't for sure this is my new normal or if this is just a peak and I don't want to pull somebody into my sphere that I might not be able to support. for the longterm and then be in a weird place that way. So yeah, I'm just kind of juggling. And then I received an email that there's another practice that's gonna be dropping a particular insurance and they have a multitude of patients that have this insurance. I take that insurance. There's only a couple of other practices. And so they're trying to find homes for them. And I'm like, my God. I'm feeling overwhelmed by the volume all of a sudden, which is new. And I guess I'm that's a good problem to have, I guess. But at the same time, I'm... Like I'm like, whoa, cause you know, I'm the one woman show at my place. So of my head spinning a little bit. I'm feeling some of that like nervous sort of energy I had in the very beginning.

Toby: Yeah, it's certainly, yes, it's certainly understandable. I've been through this certainly. This is a peak followed by a valley. Okay. So can cover yourself a little bit with that because especially first starting ultimately it will just be just peaks. And so, then that's a little bit conversation, but now you want to kind of weather this peak. How I it is, I and leave a one or two slots, you know, that I can put somebody in comfortably in per.

Angelique: Okay.

Toby: Clinic day because almost always there'something emergent, almost always there'something. And then again, people have to reschedule. So then that opens up another spot or two, but always have make a little bit of breathing room because I work with a of cancer patients. Almost always there's a crisis almost every clinical day. So I need those one or two slots. So I always do that. So I recommend as you are under pressure, and put out, and this another part of that is try and put out new patients as far as possible to give yourself plenty of breathing room so you can take care of the patients that you already have. Again, I tried to treat everybody all at once. When I first started, just, again, that really harmed my health and I've learned, I have a somatic understanding of that you can'treat everybody in the world. So you have to manage that well. You want to take care of the patients you already have and have a little bit of breathing room for emergent things that are happening with your current patients. That's my first recommendation. Second recommendation is you were thinking about going to all cash, eventually this will be a good push for you to do that. And then any practitioners newly graduated, you could bring into office and then have them do the insurance for these people so can learn that process. It may be great learning for them. Again, it take a lot of pressure off you. again, something like might be reasonable to Aside from taking somebody into office, again, local practitioners that maybe are new or a little bit more space, then you want to make sure you have that referral network. I've got a few Saam practitioners near me. especially patients that I need Saam I need it now, especially new patients that don't want to, if want to wait three months or something, that's okay. But otherwise, if they want something now, then I have some local practitioners that I can refer to. So again, this is a tough balancing act. But I think likely this is a peak and then valley. So yeah, don't do anything dramatic yet. But try and capture new patients, but just put them off a two months, and then be ready they're like, that's too long, then say, you might want to consider these local practitioners. And again, if those local practitioners take your insurance, then they just have to wait for you. But at least you're trying to help them get care sooner. But some people will want to come to you. or their insurance and then they just have to wait because you want to take care of the patients you already have. So a good way of doing it. Just the new patients push off patients already have, give a little bit of breathing space.

Angelique: OK, those are good tips. I haven't had anyone be like, I need Saam now. That would be a great thing.

Toby: Be next week. That happens. Because this tradition sometimes really potent, right? And so when it's potent, and they associate that with Saam, patients, they're not super educated, they understand Saam and then something amazing happened to me. So then they demand that or something. So that may be happening soon with

Angelique: Yeah, I don't feel I don't feel confident enough to be able to be like, yeah, I'll just take all cash now. I feel Not yet.

Toby: But as you only peak, then you'll have to do something. all cash is very comfortable. And then you just get rid of the entire insurance billing, which is just a sweet space to be in. then you just do everything all yourself, just cash. other thing is when you get to full peak is then you have to get some Again, that is one of the smartest things I've ever done. And then again, you want to make sure that it'someone that's going to be able to really help you. rather than harm you, which I think I shared with you before. I had people that made things worse. I was paying them to make things worse.

Angelique: So how does one know when they're past the peak and valley point and at the point when it's time to make a move?

Toby: Wait for two or three peaks and valleys and then you'll have a sense about it. Again, I think every practice is totally different. And let'say if it's a sustained, peak for three months, I would say then that's just your new normal. But again, likely cure some people will away or something and then there'll be a little bit of coming down. As you stay the same area for longer, it's coming up in 25 years for me, right? So then people know you. you won't see them for 15 years and they'll reappear and things like that. So that gets even worse forward, but especially as a new practitioner, right? It usually comes up like that and then drops.

Angelique: Yeah, is the first time that this has happened since I've opened. Like I had a newspaper article done my practice just to like say, hi, I'm here, know? And I had this of people coming at that time because I was new in the area and whatever. But this was unspurred by anything I did, you know?

Toby: Not true. Anyways, been delivering clinical results at a price. people can't help talk about that.

Angelique: Okay, I mean, but I didn't intentionally put out an ad or, know, do something.

Toby: But this is much more effective. this is what I had patients, right? Scheduled for a knee replacement, you give them an acupuncture treatment, they get full range of motion and no pain. They're not going to keep that to themselves.

Angelique: Yeah, that's true. That's true. Okay. Yeah. It's just been a, it's been a wild, a wild time looking at my schedule and just being like, my God, I had someone have to cancel an appointment for next week, but wanted to reschedule in the same week. And I was like, there's no spike. There's no space.

Toby: But again, someone that like in that case, then you push them off and say, you should have kept that. You know, makes it makes your people really to cancel and reschedule because they realize that's that's a valuable slot for you. So that's that's helpful. A little bit training your patients to like it's very rare for me to get cancellations because they know again, my office Stephanie, has like an algorithm, right? If you cancel, then you're way down the list. you know, for getting back in. it could be five or six weeks to get in again.

Angelique: So don't cancel.

Toby: Yes, it's training the patients to really respect your time because they not get another shot at you for weeks.

Angelique: Yeah, that's a good point. Yeah, so that just organically occurred with one patient. added him. There's a wait list function on the EMR that I use. so I just added them to their ideal time to the wait list. But now I have people like three and four deep stacked on my work days that are wait list people because they aren't able to get in, which is great if I have cancellations because then I can just pull people from that list. So been really nice.

Toby: It automatically do that? Does it automatically pull?

Angelique: It depends. It doesn't. Well, it depends on if have to have formulaically added it correctly. if the patient, I have particular appointment times that I have that I have set because I allow online booking and it was complete madness when the electronic medical record, if you just say I work from 6.30, it would put people in kind of. willy-nilly and I'd have people like 1255, like who had who come? No, absolutely not. So I had to have predictable slots. So I built my schedule so that each is its own like shift in Jane so a patient adds in the right parameters, it won't automatically pull them. But when they do, it does, it brings that person down and then it starts a timer for me where I have like four hours or something before it will release the slot to accept the patient into the slot. I have to confirm it.

Toby: That's it. That's interesting. you might at some point, you'll have a human do this because Stephanie, my office manager, she triages the patient to she knew I've told her enough about the patients to know, oh, this person needs that slot. This person doesn't. If she's unsure, then she just finds me in a clinical room, lets me know this is what the situation and then do. So again, this is invaluable having a office manager that do this. I think AI is good and probably getting better all the time, but again, it's nice to have a human in the loop for that.

Angelique: No, I can't wait to have a human. just don't know. I haven't reached. I'm in that middling ground. I'm in the true growing period of, OK, we might be approaching that time.

Toby: More of advice, right? As peak comes, try not to stress out. And when the valley comes, try not to stress out. I so much time doing that. Okay, but again, try at least try and remember my words when this because you're to panic, oh, too many people. And then you're going to be like, oh, not too many people. And then once you go through that cycle a couple of times, again, if your practice is like a normal practice, you go through it a few times and eventually you're like, okay, well, this is so great. I'm in a valley. I can study. can, I mean, you know, get caught up on your admin. You know, there'so much stuff to do. So you kind of look forward to those valleys. And then, like I said, at some point it just peaks. So then you have to figure out something else.

Angelique: If I'm lucky, it'll just stay peaks.

Toby: Yeah, again, people need Chinese medicine. And so once they find someone that can help them, they continue for any Chinese medicine problems they have in the future and then tell everyone about it. that's usually that's what happens.

Angelique: Yeah. And one of the things that I remember you telling me too is that people will pay for what they value. And I've noticed that more from people, but on both ends, either they're willing or they're not. And it's like, well, I'm now seeing what you value. people who are saying they had a hard time paying for acupuncture, spending $200 a month on supplements that are silly. In my opinion, were silly. was like...

Toby: Anyways, we can use the term, we can substitute that for ineffective sometimes. So $200 a month for ineffective things or your services which can be effective. it forces people to decide again, especially with limited budgets. anyways, yeah, I think anyways, almost to a person, we provide such incredible value for people, especially when you look at biomedicine field, right? It'so crazy expensive. Somebody went to ER for... a day and a half that was recently told me it was like $200,000. So, I mean, again, with sophisticated things, everything, of course, yeah, that's expensive, but 200,000, you know, I mean, it just seems insane.

Angelique: My god. It's insane. Well, that's like my update for So I appreciate your tips of advice. And for those of you out there that are in the same boat, I guess welcome to that boat with me. Let's it together.

Toby: Yes, again, you're starting to have good problems. I'm so happy to see that.

Angelique: Thanks. see how it goes for sure. I'll keep you posted. Right. Well, until next time.

Toby: Yeah, everyone take good care, okay?

Angelique: All right, take care, bye.