Generalist or Specialist?

Let’s say you want to open a bike shop. You think, “I’ve only got so much space available in my warehouse. I could stock just the kind of bikes that most people ride, regular street bikes. Or should I stock more unusual bikes, like recumbent tadpole bikes that only a few people like to ride?”

You ponder further: “If I stock the recumbent bikes, I’ll be the only shop in town that handles them, so everyone who wants that kind of bike will have to come here. But that is not a lot of people.

Would it be better to sell regular bikes that more people want, even though I’ll have lots more competition from the other bike shops in town?”

Choosing a Path for Your Practice

From a business perspective, these are very good questions to ask.

They apply equally to therapists who are opening a private practice. Should they try to develop a reputation as a generalist (probably treating lots of clients with anxiety and/or depression and/or relationship problems) or as a specialist (developing a reputation as the only therapist in town who treats phobias, for example). Just like the bike salesman, you can either opt for a small slice of a big pie, or the entirety of a small pie.

Why not do both?

It’s possible…but it has to be done carefully.

If you only talk about your phobia specialty when out in the community, you are very likely to be thought of as “the phobia therapist.” Any physician in town who encounters a depressed patient is likely to refer that patient to one of your colleagues – after all, they don't have a phobia.

On the other hand, if you only say “I can treat whatever comes through the front door” you are going to lose out on phobia referrals from distant physicians. These physicians would encourage their patients to drive the extra miles to work with an expert in this diagnosis.

How to Wear Both Hats

The trick is knowing when to wear your “generalist” hat and when to wear your “specialist” hat. When meeting with a local physician, it would be best to talk about your wide-ranging skills, with only a passing mention of your special interest in phobias.

When attending a meeting of therapists from your community, speak of your interest in phobia treatment at length, with only a passing mention of the fact that you see all sorts of other clients. Therapists tend to hold on to clients with depression and anxiety, but they may refer phobia clients out if they aren’t familiar with the specialized treatment regimens used in the treatment of phobias.

Could you also get the best of both worlds by becoming a specialist in a common diagnostic entity like depression, anxiety, or marital discord? Yes! Just make sure that your community has enough need for a practice consisting solely of that difficulty.

Be True to your Talents and Training

To be clear: when you advertise yourself as an expert in a particular diagnosis, make sure you really ARE an expert in that diagnosis.

And remember that as a specialist only, the diversity of your work will decrease sharply. Make sure that you have a SUSTAINED interest in that area, since your reputation as a specialist, once established, will be very hard to shake.