10 Questions to Ask Before Starting a Group Practice

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Hello, Thriving Therapist Collective, therapists out

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there. I’m here today with Emily Ferguson, the founder of Confident Private

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Practice. Emily is a super duper awesome human being who

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helps mental health practice owners achieve business confidence.

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So what does that mean? That means, and I’ll let you introduce yourself in a sec,

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but at the highest level,

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Emily offers business coaching to practices of all sizes.

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She utilizes her experience running the day-to-day operations of multiple therapy

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practices, working with practice owners to grow their business, reduce their

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stress, save time and money, and become financially stable.

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And I love so much about this too, especially the whole,

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I work with a lot of practice owners, and it’s just the stress and

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this just, “What do I do next? And what are the steps, and what’s

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the framework to do?” And you help them with that, and it’s

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a wonderful gift to have someone they can trust.

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And at Goodman Creatives, we work with a lot of solo practice

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owners who are excited about this dream of going to group

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practice. But there are so many steps in

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between being a solo practice owner and having the idea of

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going group and actually starting that group practice, hiring your first

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associate, your contractor, your W-2.

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Millions of questions. And that is what we are going to talk about today,

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or rather, Emily is going to talk about today, is how do you go

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from solo to group? What are all the things that people don’t

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know that they should know, things that people should be thinking about?

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But first, I want to pass it over to you.

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That was the little intro, but

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what would you like to share to everybody watching this at the start?

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I just want to say thank you, Greg, for having me here.

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It’s been a pleasure to get to know you and to find out all the great work that

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you’re doing for therapists as well, and I’m just really excited that we could do

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this together. And yeah, like you were saying, a lot of solo

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practices, they have the ambition, the drive, the

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excitement to move to group practice.

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They know that it would help them financially,

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and then they’re just not sure quite how to get there.

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Hiring might sound really intimidating, and then they know they’re going to need to

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do more marketing to bring in more clients, and so of course, that’s where you come

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in. But there’s so many things, so many

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questions, and so many things that they haven’t even realized are questions yet.

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And so that’s what I really want to touch on today is just 10 things to think about

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when you’re moving from solo to group practice and kind of get those wheels

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turning so they can either figure out if they’re ready to move to group

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practice or figure out what they need to do so that they can get ready.

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Awesome. And would you be open to sharing just a little bit about your background?

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What was really, I thought, fascinating about your background as addition to the

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coaching and all of that was the fact that you do have this

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experience in running the day-to-day operations of multiple therapy

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practices, group practices, solo. You’ve got this experience.

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So what did that look like for you?

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Yeah, absolutely. So I started out, I did operations management for

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some e-commerce businesses, and then I really wanted to get away from

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selling T-shirts because there’s not really anything fulfilling in that.

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And so I took a job as an intake coordinator for a therapy practice because I

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really love

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mental health. I’ve benefited in my own life from therapy.

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My family has benefited. And so starting right from the ground

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up, getting all that intake coordinator experience.

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I was a really good intake coordinator, had a high conversion rate, and I was

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helping a practice owner who had just hired her first therapist, and we moved

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that practice from basically solo practice to now she has six

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therapists in the practice.

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Nice.

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I’m still with her doing the operations management.

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And then I also do operations management for another practice as well,

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another small group practice. And so I’m in the day-to-day of these

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practices.

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Started out with intake coordination, moved into practice management for her, then

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operations management, so now we have a different intake coordinator and practice

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manager there. And so now, yeah, the operations management piece,

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I’ve just done everything business related, anything non-clinical

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that you can think of, and even some of the having to help

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with setting policies on the clinical side. I’ve done it.

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And so I took that into my business coaching,

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and that’s where all of that business coaching advice comes from.

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And so I think that is a really important piece for a business coach is you can

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go to school for business, and you can learn a lot of really

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basic skills, but there is a difference between somebody who’s

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actually done it and somebody who hasn’t.

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And then there’s a difference between someone who’s actually done it for a therapy

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practice. And so I really love to bring that

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experience to my business coaching clients.

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Yeah. Absolutely to all of it. And it’s true, the

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difference

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so often, general business, therapy is such,

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obviously, you know everybody watching this, you know the business of

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therapy is so different than any other

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business out there, even within healthcare.

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There’s so many unique nuances

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to what clients need, what therapists need as a business

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owner, as an empathetic human being who’s

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providing mental health care. There’s so

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much that needs to be addressed and understood.

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So that’s why you’re here because you do understand those things,

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and two, I think it’s great that you have that experience as an intake coordinator,

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too. Specifically, that is such a critical

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role that I think, and maybe you’re going to go into this, so I don’t want to jump

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into what you’re sharing, but the role of hiring a really good intake

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coordinator is,

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from the marketing side, it’s relatively easy to get leads, but

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converting those leads into clients, that’s where the real magic happens, and it’s

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hard enough for a solo practice owner.

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Then you do that at scale, and all of a sudden, you’re responsible for two,

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three, 10, 20, 50, however many folks’

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lives, jobs, and all of that. It’s a whole other thing, and so much of that hinges

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on the intake coordinator, and that you’ve had success in that, I think,

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speaks volumes to what you bring to your clients and I think

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what you’re going to share with- Might as well get started on that.

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That sounds good. Yeah, I’d love to get started on that.

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I’ll just go ahead and screen share here.

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You’re in for a treat, everybody. I’m going to sit back and let Emily

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present what she’s great at.

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All right. Here we go. So 10 things to think about when you’re moving from

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solo to group practice, and Greg, I just want to confirm you are seeing the

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slideshow there?

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I’m seeing you. Yep.

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Okay, perfect. I love when technology works.

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It’s nice.

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Okay, so first one, this is where I like to

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start with my business coaching clients, is on that foundational business piece.

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And this is so important because therapists, you go to school, you get your

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master’s degree, maybe even your PhD, you probably didn’t get a lot

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of education and training on the business side of running a private practice.

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So we really start at that foundation,

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looking at your vision and your mission, get really clear

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on why you even started this business in the first place.

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What is your mission?

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Who are you helping? Because you can’t help everyone in the whole world.

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Who are you specifically helping?

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And how is hiring going to help you meet your goals?

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So, make sure that the goals that you’re laying out can actually be

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helped by moving towards a group practice, and that you’re not just doing

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it without enough forethought.

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And then some of the things we go into with that foundational business work is

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your ideal client avatar. And so this is, I’m sure, something

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that you work with Greg, or something similar for nailing down who am I speaking

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to in my messaging?

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What are their presenting issues? How do they feel now?

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How do they feel after they work with you?

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And just running all of that content that you’re going to put out in the

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future through the lens of asking, is it going to resonate with that client?

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And this isn’t meant to limit you. I like to think of this like a target where

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you’re shooting your arrow at the center, which is your ideal client.

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But, if you say, “I really love working with women in their 40s,” that doesn’t mean

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you can never take on a male client, right?

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It just means you’re going to

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speak to the person that has the presenting issues that you’re

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best equipped to help and that you really enjoy.

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And then we’ve got SWOT analysis. So SWOT just stands for strengths, weaknesses,

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opportunities, and threats. And this is what we look at to get a

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really realistic picture of where your business is right now and where

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some opportunities for growth. And that’s all part of a business plan.

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Your marketing plan is part of your business plan, and so there’s a lot more pieces

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to that, obviously, that we can’t cover today.

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But, some of that foundational business work is where I like to have

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people start off.

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Quick curiosity, when you do a SWOT, are you looking just internally?

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Are you looking at the local competitors as well?

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Other group practices, other folks in the niche?

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Yeah, that’s a great question. So of course, strengths and

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weaknesses are the internal factors, and the opportunities and threats are the

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external factors. I focus mostly on the internal factors,

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though we will take a brief look at

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opportunities, what’s trending overall.

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For example, during COVID, everybody’s doing virtual sessions.

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So I’m like, “Hey, that’s an opportunity, you guys,” right?

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If you can’t afford to get an office space, you’re probably fine just

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doing virtual sessions. There’s an opportunity.

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Threats, I

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work almost exclusively with

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100% private pay practices, but some of my practices

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have one foot in the insurance world and one foot in the private pay world.

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And so, if the threats are insurance is paying less, and

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I’m like, “Well, let’s move more towards the private pay.” So we look a little bit

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at that, but not as in-depth as the internal pieces.

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Awesome.

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Okay, so step two, do you have a team in place?

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Marketing, of course, this would be Greg.

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You want to have your marketing piece in place before

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you hire because, of course, you’re going to need to be getting more clients, more

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leads into the practice before you hire, so that you can fill

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up their schedules.

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Your bookkeeper and your accountant, I know some solo practices, like

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your mom is really good at math, and so she’s helping you out on this end.

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And that’s fine in the beginning. But as you grow, you’re really going

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to need somebody who can advise you.

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And so unless your mom is an accountant, you’re going to need to hire somebody on

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that side.

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The admin and intake coordinator piece, so this can be one

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person, usually in the beginning, though as the practice grows, this usually splits

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out into an intake coordinator and a practice manager and maybe an operations

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manager. But in the beginning, this can be one person.

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You could even call them a virtual assistant.

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And I’m going to talk more about the importance of that here in

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a few minutes, but I’ll just say that this is the person who can take things off

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your plate that don’t require a master’s degree.

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So when you’re thinking about what could I delegate,

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it’s those things.

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And then business coach, I’m just going to do a shameless plug for myself here.

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You need someone walking alongside you who knows the pitfalls of

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where you’re going,

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what you’re going to encounter before you encounter them, and help you avoid them.

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So that’s going to save you countless hours, thousands, maybe even tens of

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thousands of dollars to just have a clear path

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to group practice ownership before you even start.

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And I think just the differentiation between the marketing coach, the

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business coach, these are such different things, and I’ve

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just heard a lot of confusion like, “Oh, the marketing is going to do all the

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business things.” And it’s so different.

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The service that you provide and that a business coach provides is just, as

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you’re seeing in this presentation, this isn’t marketing, this is business.

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And there’s a big difference between the two.

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Right. Yeah, and I run into that as well because I help with a little bit on the

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marketing piece, but then I get into an area where I’m like,

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“Nope, that’s where you need the marketing coach.

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That’s where you need the person who can run your ads, build your website,” all of

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those things that I don’t do. So yeah, they are very different roles.

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Okay, so number three: do you have some basic systems and

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processes in place? So I’m actually going to break this out into three

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different areas where you’ll want to have some systems and processes.

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But if you’re feeling scattered now, you’re going to feel so much more scattered

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and stressed when you hire. So we want to make sure that you’re feeling ready for

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that. You don’t have to have everything perfect.

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You don’t need to think of every scenario, but you want to make sure that the

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process of receiving clients and getting your to-do list done and

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locating the information that you need when you need it is all running pretty

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smoothly.

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So on the intake side, that would be credit cards are getting on

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file, no outstanding balances, auto-pay.

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Are clients filling out their forms? Who’s following up on that?

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Because as a solo practice, that might be you,

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but maybe that’s a place to hire your intake coordinator.

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And clients are getting a quick response with clear answers, clients are

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converting. So that’s all part of that intake coordinator piece, too.

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Where right now, you might just be doing it by yourself.

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You’re not getting a ton of leads in, and maybe you feel like you can handle just

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doing a consultation call and then setting everybody up yourself.

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But you want that process running really smoothly and having

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that intake admin person handling that for you is

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really key there.

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And then you’ve got your SOPs, your standard operating procedures.

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So this is just, can I easily find what I need when I need

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it? I have one place where information lives.

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I never have to ask the same question twice.

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So that just means, as things come up, as you solve problems,

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and as you answer questions, that information goes into one place.

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It doesn’t need to be anything super fancy, though there are some tools out there

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like Waybook that I like. But this can seriously just be a

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Google Doc.

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Just have the information somewhere, know where you can find it, and don’t keep

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asking the same question. Just plug in the answers when you answer them.

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What are some examples of SOP topics that someone

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might want to create?

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Oh, let’s see. Well, on the intake side, you want to have your

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process of booking your clients. What forms need to be sent out?

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You want to have policies, like if clients have an outstanding balance, what’s the

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process there for getting that covered?

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Email templates are really great,

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because then again, you don’t have to type the same thing over and over.

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And then on the clinician side, we usually break out

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two different SOPs, so one on the admin side and one on the clinician side.

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And so you can start building out frequently asked questions that come

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up there. Any

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policies around payroll, workplace.

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Who’s the building manager? And if I have a problem with the

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office, how do I get ahold of the building manager? All of those kinds of things.

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Great.

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Yeah.

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Okay, and then the third one there is you’re tracking some basic metrics.

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So this is just a very bare bones couple of

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examples of some metrics to track.

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And as a solo practice, you certainly don’t have to be tracking everything in the

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world, and there’s definitely some key performance indicators that are more

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important than other metrics.

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But you should be tracking some things.

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So on the marketing side, knowing how many leads you have coming in.

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Referral sources just means where are those leads coming from?

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What kind of keywords are working well?

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And then on the financial side, you know what your revenue is, your

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profit, your acquisition cost.

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Just some real basic understanding of your P&L

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that your accountant should be sending you.

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You have your expenses dialed in. You’re not spending crazy

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money on things that you didn’t even realize that you were subscribed to.

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And then your own performance. So track your own retention rate, your own

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cancellation rate.

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When you hire that intake coordinator, track her conversion rate, and

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there’s a lot of things that we could talk about in terms of metrics, but you want

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to make sure that you have a place to start tracking some of those things.

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Mm-hmm.

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Okay, and then number four is you’re feeling good about your own time management

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skills. So

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some folks are just kind of naturally organized.

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They have some things in place that they already do in their personal life that

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they bring into being a solo practice owner.

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But some folks, and sometimes it’s therapist personality, we

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tend to be more emotionally connective and doing all those

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things that us business people struggle with, right?

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The emotional connection,

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that human-to-human relationship, and so sometimes some of those time

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management things can be more the left brain things that can

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be tricky. And so getting your time management locked in can be really

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important because once you’re running a group practice and you’re the boss, you’re

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00:17:08.156 –> 00:17:09.956
just going to have so much more on your plate.

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I will also say, though, that with the right team in place, having a group practice

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can mean doing less work than you’re doing now, eventually.

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You can have a smaller caseload. You can have your administrative staff and your

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clinical lead running the day-to-day of the business.

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But it’s going to take some time to work to get there.

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And so if time management feels like a barrier, then we want to build some

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tools. And one of the things I help my solo practice coaching clients

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do is look at their schedules and make sure that how they’re spending their time

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actually aligns with their values, their priorities, and the goals that we’ve

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set. And so I get right there in the nitty-gritty with them and their calendar and

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help them make sure that their time makes sense.

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Okay, so if you’re feeling like some of those pieces are already falling

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into place, maybe you feel like you’ve done that foundational business building

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00:18:01.776 –> 00:18:04.946
work, but you’re just too stressed, or you have too much on your plate,

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then the next step is hiring admin support.

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And the admin support’s going to help you with the time management piece and

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00:18:11.176 –> 00:18:12.966
getting those systems and processes in place.

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So I like to have solo practice owners hire their admin

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support before they hire their first therapist,

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because that admin or intake coordinator can handle helping them build those

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SOPs. Instead of writing the SOP yourself, all you have to do

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is say, “Hey, make sure that gets in the SOP.” “Oh, I answered a question, make

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sure we get that in the SOP.” And then it’s their job to keep up on that.

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Researching and comparing products.

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So this can be things like, “We need a new phone system.

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Which one should we go with?” Your admin is going to lay out

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00:18:46.060 –> 00:18:48.920
a spreadsheet and all the pros and cons of the different ones and just help you

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make a decision. And then, of course, there’s the intake coordination piece,

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scheduling, client communication,

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00:18:56.120 –> 00:18:59.900
light marketing tasks. Like they can upload your blog posts, your social media

335
00:19:00.020 –> 00:19:03.689
posts, prep your newsletter, any filing and

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00:19:03.689 –> 00:19:06.640
record keeping. So again, it just comes back to finding the information that you

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need when you need it. If they have a good system, they can be your

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right brain,

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or your left brain. The left side

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of doing some of that type of work. And then your calendar management, so they can

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help you with that as well.

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Awesome.

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Okay. So the sixth.

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Wow.

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Number six,

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that thing to think about.

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How many leads are you receiving, and is your own caseload full?

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So there’s two ways to think about this, and I don’t think there’s one right

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00:19:40.940 –> 00:19:41.340
answer.

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It’s just what feels right for you in your stage of life and the goals

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00:19:46.200 –> 00:19:49.720
that you’re trying to meet. So if your own

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00:19:49.780 –> 00:19:53.420
caseload is full and you’re building a wait list,

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then you might feel like, okay, it’s time to hire because I

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00:19:56.700 –> 00:19:59.120
know I can get clients to fill

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00:19:59.940 –> 00:20:03.800
my therapists’ caseload. Right? In short term, you’re going to

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00:20:03.840 –> 00:20:07.240
make more money having your own caseload full now,

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00:20:07.840 –> 00:20:11.180
and then when you hire, the profit from that first

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00:20:11.900 –> 00:20:14.340
hire is just going to be some supplemental income for you.

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00:20:14.740 –> 00:20:18.580
So if you’re really feeling the pinch, like I need the income right

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00:20:18.620 –> 00:20:22.250
now, then you might want to go ahead and talk to Greg, get your leads rolling

361
00:20:22.299 –> 00:20:24.190
in, and get your

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00:20:25.000 –> 00:20:25.429
marketing

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00:20:26.240 –> 00:20:29.320
locked in so that you can fill up your own caseload right now.

364
00:20:30.280 –> 00:20:34.180
But the other way to think about it is if your

365
00:20:34.240 –> 00:20:37.780
own caseload is full, you probably don’t have time to be a practice owner.

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00:20:38.920 –> 00:20:42.880
So you could hire now while your marketing is still ramping up

367
00:20:42.920 –> 00:20:45.880
with the expectation that caseloads build over time.

368
00:20:46.080 –> 00:20:48.020
So when you’re interviewing people,

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00:20:48.880 –> 00:20:52.580
let them know you’re in private practice. Caseloads build slowly.

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00:20:53.220 –> 00:20:57.140
How does that feel? Do you feel like you need a full caseload right

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00:20:57.149 –> 00:21:00.880
this minute? If they do, they might want to go to a community clinic, not a private

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00:21:00.900 –> 00:21:04.850
practice. But of course, as you’re working with the right marketing

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00:21:04.900 –> 00:21:07.420
person, then that’s easier. But

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00:21:08.600 –> 00:21:11.720
long term, you’re going to make more money by hiring several therapists and then

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00:21:11.760 –> 00:21:13.220
just focusing on being the business owner.

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00:21:13.380 –> 00:21:16.560
So if you’re feeling like, hey, my caseload is half full right now, and financially

377
00:21:16.620 –> 00:21:20.560
that’s okay because within the next three months, six months,

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00:21:20.720 –> 00:21:24.660
year, I’m going to hire one to three therapists, and then I know

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00:21:24.720 –> 00:21:28.690
that I can get their caseloads full or at least get

380
00:21:28.720 –> 00:21:32.620
them rolling. I’ve got all my financial projections laid out.

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00:21:32.660 –> 00:21:35.300
We know I’m going to make a profit from that.

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00:21:36.140 –> 00:21:40.100
Then if you can wait, that’s really the better way to go because it frees

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00:21:40.160 –> 00:21:42.020
up more of your time to be the business owner.

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00:21:46.000 –> 00:21:49.600
Okay, so if you’re at that point, you’re ready to hire, then here’s a few things to

385
00:21:49.620 –> 00:21:51.000
think about with that.

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00:21:51.840 –> 00:21:55.780
Are you ready to be the boss? So one of the biggest issues

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00:21:55.860 –> 00:21:59.580
I see when I work with group practices is that the people that the

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00:21:59.600 –> 00:22:03.220
practice owner hired back in the day, years ago, they see the

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00:22:03.240 –> 00:22:05.660
practice owner as their friend or their buddy,

390
00:22:07.100 –> 00:22:10.600
and they’ll often resist change that would be good for the practice as a whole.

391
00:22:10.900 –> 00:22:14.830
Like as the practice owner is noticing, “Hey, we need to put some policies in

392
00:22:14.900 –> 00:22:18.790
place. Hey, the way we’ve been doing things isn’t really working.” There’s

393
00:22:18.820 –> 00:22:22.580
sometimes some resistance there because this is the way we’ve always done

394
00:22:22.640 –> 00:22:22.820
it.

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00:22:24.000 –> 00:22:27.960
And practice owners a lot of times let their first hires do whatever they want.

396
00:22:28.090 –> 00:22:30.880
They’ll set their own schedules. They might not follow up with clients.

397
00:22:30.940 –> 00:22:32.900
Maybe they have terrible retention rates.

398
00:22:32.980 –> 00:22:35.960
They might not participate in business-building things.

399
00:22:36.700 –> 00:22:38.600
So it’s hard to change those patterns later.

400
00:22:39.880 –> 00:22:42.660
And I’m not saying that you can’t be friendly or collaborative.

401
00:22:42.740 –> 00:22:46.600
You can definitely be a really good leader, a warm and

402
00:22:46.680 –> 00:22:50.510
connective leader. You can be an ethical employer, all of those things,

403
00:22:51.340 –> 00:22:54.900
and do build a team culture of trust and communication where people are

404
00:22:54.920 –> 00:22:58.569
empowered to do their best job, they’re empowered to utilize their strengths.

405
00:22:59.600 –> 00:23:01.340
But at the end of the day, it is your business.

406
00:23:01.420 –> 00:23:04.960
It’s your money on the line, and it’s okay to have workplace policies and

407
00:23:05.000 –> 00:23:06.520
expectations right from the start.

408
00:23:06.910 –> 00:23:09.840
And so just having seen that pitfall from other

409
00:23:10.820 –> 00:23:14.340
group practice owners and seeing how they really struggle to get those

410
00:23:14.620 –> 00:23:17.410
therapists who’ve been with them for a long time, to get them on board with

411
00:23:17.460 –> 00:23:20.920
changes, I would say just start out right, right from the beginning.

412
00:23:21.480 –> 00:23:24.360
Track performance, set policies,

413
00:23:25.160 –> 00:23:28.780
boost up your leadership and your team building skills, and

414
00:23:29.300 –> 00:23:32.200
just be okay with sometimes making the hard decisions.

415
00:23:32.780 –> 00:23:36.100
And then, of course, part of being the boss is people are relying on you for their

416
00:23:36.140 –> 00:23:40.060
income. So if you’re ready to be at that level, then you’re

417
00:23:40.080 –> 00:23:40.700
ready to hire.

418
00:23:41.860 –> 00:23:42.060
Mm-hmm.

419
00:23:44.120 –> 00:23:47.920
Number eight to think about is hire

420
00:23:47.960 –> 00:23:51.700
someone who aligns with your ICA, that’s your ideal client avatar that we talked

421
00:23:51.760 –> 00:23:55.630
about earlier. Someone who also brings new skills

422
00:23:55.720 –> 00:23:56.330
to the practice.

423
00:23:57.260 –> 00:24:00.569
So, if you’ve done that foundational business building work,

424
00:24:00.840 –> 00:24:04.060
you know who your ideal client is, you’re speaking to them in your

425
00:24:04.080 –> 00:24:08.040
marketing. You don’t want to have to speak to someone entirely different now

426
00:24:08.100 –> 00:24:11.069
because of this new therapist that you brought onto the practice.

427
00:24:12.160 –> 00:24:15.430
So you probably hire someone who’s the same licensure type that’s not

428
00:24:15.900 –> 00:24:18.660
Required, but of course, if you’re supervising them, it may or may not be,

429
00:24:18.920 –> 00:24:19.270
depending.

430
00:24:20.380 –> 00:24:23.280
But usually just someone who’s along the same lines, the same thought.

431
00:24:24.300 –> 00:24:27.760
Think of it as, could I just transfer at least half of my caseload to this person,

432
00:24:28.400 –> 00:24:29.880
is a good way of looking at that.

433
00:24:31.000 –> 00:24:34.920
And then you also want to hire somebody who does do something that

434
00:24:35.020 –> 00:24:37.900
you don’t do. So you don’t want to just hire a replica of yourself,

435
00:24:38.760 –> 00:24:41.410
but somebody who has another modality.

436
00:24:41.440 –> 00:24:44.590
Maybe they speak another language, or they have some kind of

437
00:24:45.060 –> 00:24:47.300
experience with some specialty that you don’t have.

438
00:24:48.500 –> 00:24:49.480
For example, you might

439
00:24:50.440 –> 00:24:53.260
hire somebody who tends to see the same clients as you.

440
00:24:53.360 –> 00:24:57.260
Maybe your practice works with a lot of trauma. You do EMDR.

441
00:24:57.400 –> 00:24:59.420
This person does IFS or somatic, right?

442
00:24:59.520 –> 00:25:02.470
So you’re still working with those trauma clients, but they can offer something

443
00:25:02.500 –> 00:25:03.000
that you don’t.

444
00:25:07.940 –> 00:25:11.320
Okay, and then another thing to think about is, does your state allow

445
00:25:11.360 –> 00:25:14.860
1099 contractors, or do your therapists have to be W-2

446
00:25:14.900 –> 00:25:18.780
employees? So I have had some practices run into this where they hired a

447
00:25:18.820 –> 00:25:22.660
bunch of 1099 contractors and then found out it was illegal in their

448
00:25:22.720 –> 00:25:22.960
state.

449
00:25:23.780 –> 00:25:27.740
And now all of their financial projections and the way they’ve been running things

450
00:25:27.800 –> 00:25:31.600
is all based around paying contractors, and now they’ve got to start paying

451
00:25:31.640 –> 00:25:34.860
payroll taxes and benefits and all of these things that they weren’t prepared for.

452
00:25:34.900 –> 00:25:38.330
So, if your state will allow either, then

453
00:25:38.640 –> 00:25:41.240
you have a choice, and then there’s some pros and cons.

454
00:25:42.540 –> 00:25:45.120
Contractors, they’re less expensive.

455
00:25:45.320 –> 00:25:46.380
You can just pay them the

456
00:25:47.620 –> 00:25:50.240
split, the employee share, the revenue split.

457
00:25:50.360 –> 00:25:53.340
And usually, you don’t have to pay a lot beyond that.

458
00:25:53.380 –> 00:25:56.760
Maybe you throw in a few other perks, but that’s usually it.

459
00:25:57.400 –> 00:26:01.260
Less risky because they’re not an employee.

460
00:26:02.060 –> 00:26:03.480
And they’re usually going to do–

461
00:26:04.820 –> 00:26:08.320
You can expect more help with the marketing because they’re seeing themselves as

462
00:26:09.260 –> 00:26:12.100
more independent, not entirely relying on you.

463
00:26:13.080 –> 00:26:16.700
Some of the cons is that they’ll probably work at other jobs, and you can’t

464
00:26:17.420 –> 00:26:21.120
dictate their schedules. So that can be a little tricky when you’re like, “I want

465
00:26:21.140 –> 00:26:21.980
to hire somebody

466
00:26:23.080 –> 00:26:27.060
to eventually have a full-time schedule,” but right now they’re just starting out

467
00:26:27.120 –> 00:26:30.710
and they can only do part-time, and then they have a second job so that they can

468
00:26:30.720 –> 00:26:34.380
make ends meet, and then pretty soon you’re in a situation where you’re like,

469
00:26:34.590 –> 00:26:36.500
“Hey, I’ve got you filled up two days a week.

470
00:26:36.540 –> 00:26:38.200
Can you take on a third?” And they’re like, “Nope.”

471
00:26:39.120 –> 00:26:40.600
And there’s nothing you can do about that.

472
00:26:43.000 –> 00:26:45.640
And they may just feel less committed to the team.

473
00:26:45.680 –> 00:26:49.640
Now, you could certainly build a really amazing team culture with 1099s that

474
00:26:49.720 –> 00:26:51.699
overcomes this, but sometimes that is the case.

475
00:26:52.720 –> 00:26:56.700
So if you go with a W-2 employee, the pros is you do have more control over their

476
00:26:56.720 –> 00:26:59.860
schedule. You can say right from the beginning, like, “I need you

477
00:27:00.620 –> 00:27:04.000
five days a week during business hours,” or “You’re going to have to work two

478
00:27:04.060 –> 00:27:07.080
evenings a week,” or, “You’re going to have to do a weekend day,” things like that,

479
00:27:07.240 –> 00:27:08.440
and that is okay to say.

480
00:27:10.200 –> 00:27:13.280
Then they’ll often be more team-oriented.

481
00:27:13.700 –> 00:27:17.640
But the cons is they are generally more expensive, as

482
00:27:17.680 –> 00:27:20.920
you have payroll taxes, benefits, and all of that.

483
00:27:21.820 –> 00:27:22.169
You also

484
00:27:23.260 –> 00:27:24.669
may be paying for more things,

485
00:27:25.720 –> 00:27:27.190
your EHR, your

486
00:27:30.760 –> 00:27:34.240
Psych Today profile, things like that, that you might not offer a 1099.

487
00:27:38.100 –> 00:27:40.880
Okay, last thing to think about before you hire.

488
00:27:41.460 –> 00:27:45.100
Are there any tasks that you want your therapist to do

489
00:27:45.180 –> 00:27:48.940
outside of clinical work? And again, this comes back to

490
00:27:49.340 –> 00:27:51.180
setting you up for success in the future.

491
00:27:51.400 –> 00:27:55.320
Some group practices have set it up years

492
00:27:55.360 –> 00:27:58.580
ago with their first hires that they don’t have to do anything other than clinical

493
00:27:58.660 –> 00:28:01.960
work, and now I’m coming on, I’m trying to help them build their business, and I’m

494
00:28:02.000 –> 00:28:05.190
like, “Hey, it’d be really great if all of your therapists did a blog post every

495
00:28:05.280 –> 00:28:08.000
month.” And they’re like, “No, we don’t do that.”

496
00:28:09.200 –> 00:28:09.520
So,

497
00:28:10.560 –> 00:28:13.480
things like that, if you can set up the expectation right from the beginning that

498
00:28:13.520 –> 00:28:16.720
there might be some additional work that you’ll pay them for at an hourly rate.

499
00:28:17.520 –> 00:28:21.120
So blog posts is one idea. They might do some other content

500
00:28:21.180 –> 00:28:24.860
creation, like some social media posts or some videos, for marketing

501
00:28:24.900 –> 00:28:28.480
purposes. And of course, this just helps them get clients.

502
00:28:29.300 –> 00:28:33.060
But if they can throw a reel out every week or even every

503
00:28:33.160 –> 00:28:34.199
month, that’s helpful.

504
00:28:35.160 –> 00:28:38.120
You might want them to do some physical office management things.

505
00:28:38.180 –> 00:28:41.920
Like, if your intake coordinator or your admin staff is not physically

506
00:28:42.000 –> 00:28:42.440
local,

507
00:28:43.640 –> 00:28:45.740
then the folks in the office are the therapists.

508
00:28:45.800 –> 00:28:49.340
You might need them to water a plant or check the mail, and you’d be surprised how

509
00:28:49.380 –> 00:28:52.840
much resistance there can be around this kind of thing if you introduce it years

510
00:28:52.880 –> 00:28:54.000
later.

511
00:28:55.080 –> 00:28:58.480
Some networking, and I really love to help practice

512
00:28:58.540 –> 00:29:02.260
owners get to the point where their therapists don’t

513
00:29:02.360 –> 00:29:05.000
have to do a ton of networking or marketing activities.

514
00:29:05.040 –> 00:29:08.940
Like, for the most part, 90%, the practice is

515
00:29:08.960 –> 00:29:12.740
doing all of that and really just bringing in a ton of leads,

516
00:29:12.940 –> 00:29:16.280
and the intake coordinator is booking those leads with the therapist, and all the

517
00:29:16.300 –> 00:29:19.600
therapist has to do is show up and be a great therapist. That’s our goal.

518
00:29:20.470 –> 00:29:23.940
But in private practice, there is a bit of an expectation that every therapist help

519
00:29:24.020 –> 00:29:27.980
out a little bit, do something. Go to a chamber of commerce meeting once

520
00:29:28.020 –> 00:29:29.980
a month, go to some networking events.

521
00:29:30.920 –> 00:29:34.680
Maybe take a flyer to a doctor’s office and connect with them as a referral

522
00:29:34.760 –> 00:29:38.600
source, that kind of thing. So setting that expectation up that a few hours a

523
00:29:38.640 –> 00:29:41.780
month, that kind of thing will be expected is a good place to start.

524
00:29:42.360 –> 00:29:43.160
Yeah. And it’s

525
00:29:44.060 –> 00:29:46.700
especially the networking, and this is one of my biggest

526
00:29:47.460 –> 00:29:51.440
soapboxes that I preach to everybody is just there is no

527
00:29:51.680 –> 00:29:52.100
better

528
00:29:53.580 –> 00:29:56.480
lead than a referral lead at the end of the day, right?

529
00:29:56.580 –> 00:30:00.540
It’s just a completely different caliber, and also that

530
00:30:00.620 –> 00:30:04.100
with a group practice, how can you instill a culture

531
00:30:04.180 –> 00:30:08.080
where every single person on the team thinks of themselves as a brand

532
00:30:08.100 –> 00:30:11.920
ambassador, right? And that comes– I appreciate so much what you’re

533
00:30:11.930 –> 00:30:15.320
saying, it comes from day one, is instilling that culture, that expectation in the

534
00:30:15.400 –> 00:30:17.260
hiring packet, in the job description.

535
00:30:17.760 –> 00:30:21.600
Part of what you’re going to get to do is write blog posts and social media posts

536
00:30:21.620 –> 00:30:25.540
and network, and just the more voices you have

537
00:30:25.600 –> 00:30:27.780
promoting the business, the better it is for everybody,

538
00:30:29.080 –> 00:30:30.260
from what I see.

539
00:30:31.492 –> 00:30:35.261
Yeah, absolutely. Like creating that team culture around, “Hey, we’re all

540
00:30:35.292 –> 00:30:37.632
contributing to this thing larger than ourselves”-

541
00:30:37.832 –> 00:30:37.882
Right

542
00:30:37.912 –> 00:30:40.232
… is really great. Yeah.

543
00:30:41.292 –> 00:30:41.832
Okay, so that

544
00:30:42.792 –> 00:30:45.092
wraps up the 10 things to think about moving-

545
00:30:45.122 –> 00:30:45.122
Cool

546
00:30:45.122 –> 00:30:49.072
… from solo to group practice. But I did just want to mention that

547
00:30:49.172 –> 00:30:52.652
I have a free live training on the third Monday of every month.

548
00:30:53.192 –> 00:30:56.472
I’m doing retention training this month, but I think this isn’t going to come out

549
00:30:56.552 –> 00:30:57.312
in time for that.

550
00:30:58.112 –> 00:31:01.602
But some future trainings will be on conversions, hiring,

551
00:31:01.952 –> 00:31:03.782
metrics, profit, leadership.

552
00:31:04.612 –> 00:31:07.332
So just if you pop over to my website,

553
00:31:07.432 –> 00:31:11.352
confidentprivatepractice.com, then you’ll be able to find what

554
00:31:11.392 –> 00:31:15.232
training is coming up next and get on the newsletter

555
00:31:15.312 –> 00:31:18.292
list, and then you’ll always be up to date with what’s happening.

556
00:31:18.392 –> 00:31:20.092
And those trainings are free.

557
00:31:20.792 –> 00:31:24.392
Awesome. Yeah, I love that the next one is retention too, because I often say

558
00:31:24.412 –> 00:31:28.142
the best way to reduce your marketing costs is to increase your retention.

559
00:31:28.252 –> 00:31:31.552
Because if you don’t have to get more clients because your clients are staying,

560
00:31:31.962 –> 00:31:35.311
then that’s extra profit in the pocket because you’re not having to spend that

561
00:31:35.332 –> 00:31:37.292
money on Google ads or something else.

562
00:31:37.832 –> 00:31:41.632
So I love all these topics. And then I had a couple of questions for

563
00:31:41.712 –> 00:31:45.592
you, just four specifically that I wrote down as I

564
00:31:45.632 –> 00:31:46.752
was listening to you.

565
00:31:47.592 –> 00:31:51.552
The first one was, you mentioned when to start full

566
00:31:51.672 –> 00:31:55.632
case load, partially full. When it comes

567
00:31:55.692 –> 00:31:59.592
to that sort of dip, the financial dip that often happens

568
00:31:59.632 –> 00:32:02.532
when starting a group practice because all of a sudden you’re investing in more

569
00:32:02.552 –> 00:32:06.512
marketing and all of that, is there a financial point that you recommend when

570
00:32:06.552 –> 00:32:08.632
someone should start even thinking about it?

571
00:32:08.672 –> 00:32:12.532
Because I know folks think about it at different stages of their business, but do

572
00:32:12.552 –> 00:32:13.852
you have any recommendations, like

573
00:32:14.852 –> 00:32:18.172
certain amount in savings, any financial

574
00:32:18.212 –> 00:32:19.012
recommendations?

575
00:32:20.812 –> 00:32:24.292
I think one thing to consider is I usually say marketing at about

576
00:32:24.312 –> 00:32:28.152
10% of revenue. So as we’re looking at financial projections, we’ll

577
00:32:28.452 –> 00:32:28.872
kind of

578
00:32:29.932 –> 00:32:31.551
plug that number in there.

579
00:32:32.372 –> 00:32:34.232
And beyond that, though, it’s really

580
00:32:36.252 –> 00:32:39.152
dependent on the individual person and where they’re at.

581
00:32:39.572 –> 00:32:43.412
Some people are single mom trying to build a business so

582
00:32:43.432 –> 00:32:46.992
this is going to be their livelihood or they’re not eating next month

583
00:32:48.072 –> 00:32:51.752
kind of situation. And then other people are like, “Hey, I’ve got some time, I’ve

584
00:32:51.772 –> 00:32:55.712
got some savings I can build. This is where I’m at.” There’s so many

585
00:32:55.772 –> 00:32:59.392
different situations and I would say that’s where we just need to get in there

586
00:32:59.432 –> 00:33:03.392
together into the nitty gritty of your finances, look at your current profit

587
00:33:03.401 –> 00:33:07.052
and loss, build out a projection. I have a spreadsheet where I can build out

588
00:33:07.092 –> 00:33:10.752
projections for people based on how many

589
00:33:10.772 –> 00:33:14.602
therapists they hire and what their average rate is and what the retention rate is

590
00:33:14.612 –> 00:33:16.932
and what their intake coordinator’s conversion rate.

591
00:33:16.952 –> 00:33:20.822
And it all just plays into one nice little formula that spits out, “This is what

592
00:33:20.822 –> 00:33:22.872
you need to do in order to hit this goal.” So-

593
00:33:23.392 –> 00:33:23.762
That’s cool

594
00:33:23.762 –> 00:33:25.492
… we can look at all of that together and kind of decide,

595
00:33:26.732 –> 00:33:28.212
see where you’re at, and see what you need to do.

596
00:33:28.772 –> 00:33:32.612
Okay. Yeah. I mentioned that partly also because that’s a question I get a lot from

597
00:33:32.652 –> 00:33:36.552
a lot of folks is, like, “How much do I need to be making to be able to

598
00:33:36.612 –> 00:33:40.472
afford the transition?” And then another one I get is, is it easier to do the

599
00:33:40.512 –> 00:33:43.892
transition as private pay or insurance? If you have any instinct.

600
00:33:43.912 –> 00:33:46.672
I know you talked earlier about the private pay, but

601
00:33:47.812 –> 00:33:51.692
there’s also definitely a market, especially in this economy and world right now,

602
00:33:51.752 –> 00:33:55.132
for insurance. So I’m just curious, what are you seeing, if there’s any

603
00:33:55.412 –> 00:33:55.901
difference?

604
00:33:57.152 –> 00:34:00.222
Yeah, I just can’t speak to the insurance piece too much because like I said, I

605
00:34:00.252 –> 00:34:02.952
work almost exclusively with private pay practices.

606
00:34:03.392 –> 00:34:07.252
The ones that have their foot in both worlds usually are

607
00:34:07.272 –> 00:34:10.872
moving away from insurance, though I do have folks who, because of the economy,

608
00:34:10.932 –> 00:34:12.872
they’re thinking, “Hey, it’s not COVID anymore.

609
00:34:12.993 –> 00:34:14.792
Things are a little tougher now.”

610
00:34:15.652 –> 00:34:16.692
Because we did have a big boom-

611
00:34:16.772 –> 00:34:16.803
Yeah

612
00:34:16.803 –> 00:34:20.772
… those couple of years. And yeah, so they’re thinking about moving to insurance.

613
00:34:21.672 –> 00:34:25.632
So I don’t know if there’s one right answer to that, but I do know that it

614
00:34:25.692 –> 00:34:28.453
is possible with private pay. And I think that’s the thing that people get-

615
00:34:28.621 –> 00:34:28.621
Right

616
00:34:28.621 –> 00:34:32.542
… worried about is, “Can I really get any clients if I’m not using

617
00:34:32.572 –> 00:34:34.621
insurance?” And I would say yes.

618
00:34:35.973 –> 00:34:39.872
But that doesn’t mean you can’t use insurance if it feels

619
00:34:39.912 –> 00:34:40.632
like it’s a good

620
00:34:42.172 –> 00:34:43.792
place for your business to be.

621
00:34:43.892 –> 00:34:47.652
Sure. Yeah. And the thing with insurance that from the marketing side that we

622
00:34:47.691 –> 00:34:51.632
see is when we’re talking about our numbers and your cost per lead, cost per

623
00:34:51.691 –> 00:34:55.033
client, and when sort of looking at the lifetime value, it’s like, okay, so if

624
00:34:55.072 –> 00:34:58.932
you’re already only getting $100 from the insurance company and you

625
00:34:58.992 –> 00:35:02.592
have a 60/40 split, all of a sudden that means that if your cost per

626
00:35:02.652 –> 00:35:06.511
client is the same that it would be for private practice, it’ll never be

627
00:35:06.552 –> 00:35:09.962
profitable. And I think that that’s a conversation that I have a lot of times

628
00:35:09.992 –> 00:35:13.072
with folks contemplating it. And speaking of splits, I

629
00:35:14.552 –> 00:35:18.202
get this all the time in my forums in the community is, do you have a

630
00:35:18.232 –> 00:35:21.032
recommended split for those 1099s?

631
00:35:22.632 –> 00:35:22.642
Yeah.

632
00:35:22.652 –> 00:35:25.332
Like I hear 60/40, I hear 50/50.

633
00:35:26.352 –> 00:35:29.032
Some folks who chime in are like, “Well, it depends on what other benefits you’re

634
00:35:29.072 –> 00:35:29.472
giving.”

635
00:35:30.552 –> 00:35:31.542
So I’m just curious if you have any

636
00:35:32.352 –> 00:35:35.592
high level tips on that, on even thinking about that.

637
00:35:36.392 –> 00:35:40.152
Yeah, absolutely. So I would say that is one of the pitfalls that I’ve seen.

638
00:35:40.872 –> 00:35:44.332
Usually when I come into a group practice, the first people that they hire, they’re

639
00:35:44.372 –> 00:35:46.632
paying 60%, and now they’re

640
00:35:47.712 –> 00:35:50.612
hardly doing any sessions because they never set any requirements, and they’re

641
00:35:50.632 –> 00:35:52.092
actually losing money on those folks.

642
00:35:52.102 –> 00:35:55.362
So, I would say, yeah, starting out,

643
00:35:56.092 –> 00:35:59.792
a 40% split usually makes sense when you have an

644
00:35:59.832 –> 00:36:02.772
associate therapist, someone without a lot of experience.

645
00:36:03.332 –> 00:36:07.232
I would say 50% at the most, and then allow

646
00:36:07.252 –> 00:36:10.622
yourself some room to give them bonuses or to do a tiered

647
00:36:10.692 –> 00:36:12.432
compensation plan is something I like to do.

648
00:36:12.512 –> 00:36:15.011
So the more sessions per week, the higher percentage you get.

649
00:36:16.032 –> 00:36:19.592
And speaking to the other side of that from the therapist, that’s not to exploit

650
00:36:19.632 –> 00:36:23.472
anyone. We’re not talking about making you do 30 sessions a week.

651
00:36:23.532 –> 00:36:27.132
In private pay usually it’s like 15 to 25, so still very

652
00:36:27.472 –> 00:36:31.412
doable. We want to be very ethical and very caring of our

653
00:36:31.432 –> 00:36:34.812
employees and not letting them get burned out because it is a very emotionally

654
00:36:34.852 –> 00:36:38.522
heavy job. But if you’re doing five, 10 sessions a

655
00:36:38.612 –> 00:36:41.452
week, there’s just no reason to-

656
00:36:43.920 –> 00:36:47.040
It just doesn’t make sense to have anybody who’s doing that if you’re paying them

657
00:36:47.220 –> 00:36:49.300
60%. It just financially doesn’t make sense.

658
00:36:49.740 –> 00:36:50.480
So I would say

659
00:36:51.520 –> 00:36:52.840
gear towards the

660
00:36:53.880 –> 00:36:57.040
lower end, and then you can always add in some benefits.

661
00:36:57.300 –> 00:37:01.200
As your practice grows, maybe you can start to offer health insurance later if you

662
00:37:01.280 –> 00:37:03.220
have employees, and

663
00:37:04.860 –> 00:37:06.700
give some room to grow later.

664
00:37:07.580 –> 00:37:07.980
Awesome.

665
00:37:08.920 –> 00:37:12.870
Well, yeah, that was amazing. Thank you so much for that incredibly

666
00:37:13.020 –> 00:37:13.820
detailed…

667
00:37:14.979 –> 00:37:18.740
It’s a gift to anybody watching this, really, to

668
00:37:18.760 –> 00:37:22.240
anybody who’s considering making that big jump, because there is.

669
00:37:22.780 –> 00:37:26.700
And those are 10 things that you chose in this presentation, and I’m sure that list

670
00:37:26.760 –> 00:37:30.480
is hundreds long of things that folks should even be considering.

671
00:37:30.500 –> 00:37:34.260
And the one that I found most interesting of what you said was to have the intake

672
00:37:34.300 –> 00:37:38.170
coordinator in place before doing that jump, because I

673
00:37:38.200 –> 00:37:42.160
know so many folks are like, “Okay, I hired my first associate,” or my

674
00:37:42.820 –> 00:37:45.740
1099, whatever it is, but they’re still the one doing everything.

675
00:37:46.230 –> 00:37:49.640
And just I imagine that’s going to lead to a lot of burnout and

676
00:37:51.500 –> 00:37:55.340
unhappy transitions into group practice, and it’s so simple, but yet

677
00:37:55.400 –> 00:37:59.350
to me, that was like, “Of course, it makes total sense to have that.” And

678
00:37:59.380 –> 00:38:02.570
this is why you do what you do, because these are the things that in marketing,

679
00:38:02.620 –> 00:38:05.090
it’s like, of course, it makes sense when you think about it, but to have a

680
00:38:05.100 –> 00:38:07.280
business coach who actually knows these

681
00:38:08.100 –> 00:38:10.900
things that you should be thinking about before transitioning or anything like

682
00:38:10.960 –> 00:38:14.820
that, it’s great. So is there anything else you want to share with anybody watching

683
00:38:14.880 –> 00:38:16.360
before we say “Arrivederci?”

684
00:38:17.420 –> 00:38:18.980
Yeah. I think I just want to encourage that

685
00:38:19.040 –> 00:38:22.920
moving from solo to group practice is

686
00:38:22.960 –> 00:38:26.180
really doable. You might not feel like you have those business skills.

687
00:38:26.200 –> 00:38:29.440
You might not feel like the things we talked about, like you’re ready right now,

688
00:38:29.940 –> 00:38:33.420
but you can be. You’re very smart. You’ve got that master’s degree, that

689
00:38:33.460 –> 00:38:34.040
PhD.

690
00:38:34.940 –> 00:38:37.860
You’ve put in the work. You’ve worked to build your solo practice.

691
00:38:37.930 –> 00:38:40.920
And so I really just want to encourage anybody listening who’s feeling like maybe

692
00:38:40.960 –> 00:38:44.890
they don’t have what it takes. You do have what it takes, and you can learn what

693
00:38:44.940 –> 00:38:45.590
you don’t have.

694
00:38:46.580 –> 00:38:50.420
So it can be a very profitable, great way to

695
00:38:50.440 –> 00:38:54.160
build something that really lasts, makes an impact on your community.

696
00:38:54.980 –> 00:38:57.440
Something that’s going to benefit a lot of people for a long time.

697
00:38:57.480 –> 00:39:01.169
And so I want to encourage you to just give it a try, and if you have any

698
00:39:01.220 –> 00:39:02.310
questions about

699
00:39:03.540 –> 00:39:07.040
how could I possibly do that? I have a free consultation call, a 30-minute

700
00:39:07.060 –> 00:39:09.720
consultation call. So if you hop on the website at

701
00:39:10.000 –> 00:39:13.600
confidentprivatepractice.com, do that 30-minute call with me, and we’ll

702
00:39:13.680 –> 00:39:15.130
see how I can help.

703
00:39:15.180 –> 00:39:18.900
Awesome. And if you don’t have to remember that, I’m going to drop it in

704
00:39:18.940 –> 00:39:21.420
whatever platform, medium you’re watching this on.

705
00:39:21.740 –> 00:39:25.000
Below this video are going to be Emily’s links, her website, how you can schedule

706
00:39:25.080 –> 00:39:28.920
that, information on her upcoming free trainings. Thank you, Emily.

707
00:39:29.020 –> 00:39:31.040
You’ve been wonderful. I appreciate you.

708
00:39:31.580 –> 00:39:33.640
And yeah, thanks for watching.

709
00:39:34.360 –> 00:39:35.200
Thank you. Bye-bye.