PoP 161 | How To Grow A Group Practice

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How to grow a group practice

Today we’re talking about how to grow a group practice. When you grow a group counseling practice, you have to decide a number of things:

Group Practice Structure

Will you sublet a space, hire 1099s or W2s. You have to look at the impact of your deisions, expenses, and mindset.

Also, you need to understand your paperwork flow and contracts with 1099s. Your phone system has to be set up for multiple clinicians. You may need a virtual assistant to help with your phone. You have to decide on a calendar system, website, and marketing.

What usually stands in the way of a counseling group practice?

  • Time
  • Automating
  • What do you do best
  • Clear goal setting

Today we cover all of this on the podcast!

Meet Joe Sanok

consultant headshot JoeJoe Sanok, MA, LLP, LPC, NCC is one of the world’s leading private practice consultants. He is the owner of the Traverse City counseling practice, Mental Wellness Counseling. Joe helps counselors to start private practices and grow them.



Podcast Transcription

Pop 161 | How To Grow A Group Practice

[0:00] Music.

[0:25] Group you felt apart for me i remember one time today.
An unexpected connection was when i was in eight grade.
It started as high ropes course and i’d never done team building activities a never done ice breakers i never gone up that high in the air and trusted.
A couple of strings and caribbean yours to keep me alive and.

[0:54] I remember connecting with my class and feeling a sense of wow together we could do something else course.
Entering high school while things change in our class wasn’t as bond is maybe we were we’re at the high ropes course.

[1:09] We’ve all had those moments when we feel connected to a group and today i’m not talking about.
Starting a group practice but not just from the standpoint of how do you do it and how to make money.
But what i can do to your soul what i can do to yourself as an entrepreneur what i can do in regards to use setting a bigger vision.
Just last night we had a barbecue as a group.
And the commission scheme and the family is and i was sitting there as you know we’re eating and just chatting and hanging out and thinking to myself.
About how amazing is that this group of people all came together around one purpose and that’s mental illness counseling.
And seeing our kids play together and thinking about what if i had never taking action on a really started can hit me.

[1:58] So today we’re gonna dive into some reasons why you should start considering a group practice.
We’re gonna talk also about the lid just stick some of the things that got away some of the things that have slowed down my growth that will hopefully speed up your growth.
So i want to make sure we talk at the beginning we talk structures are gonna talk about some different ways that you can set it up.
Is well with and then talk about the why the rear talk what can some of the course central logistics and then we’re gonna talk with stands in the way.
Of your particular practice or actually an also talk about a big transition in regards to your website hosting you’re gonna wanna start to look at start to evaluate as you grow,
and as you do more with your website Beyond maybe where you’ve been when you were just bootstrapping it slow start so we’ve got structures so.
A few structures and a few kind words to know is sublet so sub letting is when someone canopies for the use of your space and it’s a set fee every month or sat percentage every month.
The other one is a ten ninety-nine kind.
So counter drugs going to the details and a minute and the other is a two-three hundred all three of these models are gonna talk with the pros and the cons in some of foggy areas.

[3:20] So let’s start with sub letting.
So one structure you can have is that you have an office in your not using and certain days and you rent it out by the hour but half day by day and someone says i wanna have every friday morning.
Like every tuesday evening or i’d like to just read this office from your for certain days.

[3:39] This is a great way to set it up if you don’t really want to manage people at all if you don’t have them on your website,
i don’t want to worry about getting them clients of you don’t wanna answer structure you can also add in assistance and calendars and all that.
But if your sub letting i’d say the easiest way is to just say i’m gonna just.
Have them go and can rent it out there more to re enter with out the part of your bigger group practice maybe are name but they really aren’t.
Do a whole lot more than just that the collective of counselors in one place.

[4:09] The second way that we can think about having a group practice is with ten ninety nine contractors do anything about a ten ninety-nine is basically a business within your business.
I think about hair salon to go if you outsource something to someone that does your lawn you don’t have a lot of control over how they do it just kinda what they’re doing so for example.
You’re not gonna be able to tell them how to dress you can tell them what kind of paper work they need to do but you can see me to follow the ethics of your field.
You can say the need of our state licensing but you are gonna necessarily say,
well here’s the exact paper work on the audi you i’m gonna make sure that you’re doing all these things correctly together on liability insurance again by their own business cuz you may provide the branding for them,
i am but they have to have the choice whether to use that it’s really it’s a hands off approach not a lot of micromanaging,
the same way you think about someone moisture line you can tell them to wear red shirt vs a blue shirt seems are thinking of a ten ninety-nine contract.

[5:12] Who is an employee and such actually bringing someone and with payroll,
often times there was set hourly rate some states allow you to do a percentage but if they’re doing things that non clinical such as blogging attending meetings,
they may have to get a release minimum wage for that you wanna make sure you talk to your own content or attorney ron harris is the guy that i use for my counting he does nationwide accounting,
so if you’re going to appear i definitely just talking to someone that ron i talk to him just a couple episodes ago all about lol sees escorts things like that really important things to know.

[5:48] So deciding what kind of clinicians structure you wanna have is really important.
So what i do is i have ten ninety nine contractors and then i get a percentage of what comes and.
And it’s a really say that a lot of the aca american housing association people i will we is and if he’s putting.
But when you look at what the definition of the splitting is in the legal world it’s when you get basically a kick back for referring somebody so for example.
I send a certain primary care doctor one of my clients to get a med review he gives me a hundred bucks back for doing that they gets in the way of me deciding,
who i’m going to send that person to no matter what now the aca has also said well you know you’re more likely to refer to some within your practice well even if there my employees,
i’m not a percentage if somebody calls mental illness counseling says i’d like to work with someone from entrance counseling.
Of course i’m gonna refer someone there and said that legal definition of kick backs fy splitting up as much,
different than the way that discussion is happening right now especially within the american counseling association something that’s really important to talk to an attorney.
You’re an accountant making sure that you look at your own ethics within your state and then deciding for yourself what you feel good about,
i feel good about having a percentage split with my a ten ninety-nine contractors here pays for the rent and his marketing it pays for my time if i had just have,
the cost of what’s going on here and didn’t get paid for any of my time that would be ridiculous nobody would stay and pack.

[7:19] Is doing that is really important to look at what makes sense and what’s really the spirit of the ethics of your own ethical code.
Alright so i landed on time ninety nine with a percentage split we started fifty-fifty for the first thousand dollars then it sixty five thirty five after that.
All the way up to twenty five hundred and then after that it’s seventy five percent and twenty five percent for me,
and you may live in a community that as much higher at the traverse city you may have costs that are just astronomical especially if your taking insurance,
you definitely gonna have cost with electronic medical records and a lot of other things it’s really important to make sure you look at how much do you need to come in,
to make it worth it for you because if you could see counseling clients and make more than what you make with the time you put into practice than you might as well just to counseling,
of course is that scale will be wanna make sure you’re be able to compare yourself for that time.
So let’s look at little bear on the wife so the first reason a lot of people want to go into a group practices start a group practice is for impact.
Because they see the work that they are doing there may be doing really good work around trauma or sexual abuse are women’s issues or whatever their spouse specific specialty is.
But they realize that they have a lot more clients and there’s a lot more need the community and the impact of the greater if they hired on or bra i’m contractors or w two employees that they could actually scale help more people make a bigger impact,
could all those reasons that they went to counseling and then they can also train a lot of those people that can train them in the model that works train them and what they see working within their field.

[8:53] As well meet again supervision as part of that with ten ninety nine’s a highly recommend the separate that out my attorney has advised me that the more that you can.
Can not provide to your ten ninety ninths the batter in case you ever get audited i know i said it before but of course dr on attorney talked your own accounts about that.

[9:12] The second reason a lot of people want to start a group practice is the financial side of us run some quick numbers say you took fifty percent from five people in a group practice and say they are doing ten sessions a week.
And that was a hundred twenties dollars per session three months without times forty eight weeks that’s fifty percent of five people ten sessions a week.
Hundred twenty dollars per session forty weeks usually get a month off.
That ends up being a hundred and forty four thousand dollars in profits they bring in that’s gross so that’s not taking a,
the cost of rent setting up the cost of your website of high upgrading to dedicated servers some of the things that are really important to consider.
But i mean if you think rent for five people this making me five offices at ten sessions a week i mean really you could probably get by with a two or three office suite.
So maybe thousand two thousand dollars depending on your,
your counsel associates the same streets two months twenty four grand give yourself can double that for other marketing expenses,
you still making a hundred thousand dollars a year and that’s not counting and if any of your own clinical work clinical work any of your passive income,
any other streams of income and so right away if you can get five people that you ten sessions a week at hundred twenty bucks a session and you take fifty percent you’re pretty much making six figures right there and all you doing is managing a practice.
So it’s a great way to hit the six figure mark if you want to it really quick way the third thing is that.
Why people really wanna going to practice is that can sense of achievement that they have a mindset that they wanna have something that they build.

[10:46] They either all lives them because beyond them that their part of the test also is bigger than they could have done just on their own but i think that when you really get to the heart.
Of helping people and why you into counseling when you start a group practice you are able to have the bigger impact and create something that potentially could sustain well beyond you.
Alright we talk structures we talked about why was going to cancel the needy greedy kind of essential of what you need to start a group practice.
I’m so at the very beginning you wanna look at some of your structure around power phone calls and scheduling gonna coming,
what i use i use a system called grasshopper you can go to practiceofthepractice.com/grasshopper,
it’s a great summer cause the local number and then based on whatever number they hit next it brings that person cell phone so if you hit zero i can go to your system.
Thirty seven hundred can get you seven to wonder somebody else.
So it’s a really great way to not have to buy a full on phone system and also if you may be mobile of your changing offices every few years,
are stuck in a renting i have bought a building you know that your number my have to change if you’re changing spots.
Your detailed any of that any of the down time so make sure that phone system set up on second you’re gonna wanna look at,
can your calendar system so how is it that,
you do your calendars now it is that scale of you are virtual assistant that was kinda monitoring your calendars that was scheduled for other people.
Really making sure that you look at your calendar system so they could be using like google business calendars or could be something else such as simple practice or some other system that can allow you to schedule.

[12:24] I’m into most people’s calendars and when i see you i don’t mean you because you would be the most overpaid executive assistant if you’re making,
one hundred eighty bucks an hour for your session,
are you could easily bring in a virtual assistant that can do this for you know twenty to twenty five bucks and you get a really good assistant for that range is so,
we’ve got your phone we’ve got me she got your calendar set up,
Mexican want to really look at a contract and so a contract is really really important to have with your 1099s or your W-2 is where your outlining the scope of what you’re expecting and the scope of what you’re expecting in return,
is she important to do that and so for example i have my ten ninety-nine contract.
That a lot my consulting clients all included as part of the package though the other turning up to spend fifteen minutes with their attorney going through and adjusting for their own stay in for their own situation.
And then they’ve saved you don’t hours of paying an attorney to be able to get that contract.
Is well we’re doing that you wanna make sure that you all and what you’re providing what you’re not providing that contract what’s the percentage what are the getting what you getting how are you gonna pay.
All of that’s really important is your kind of setting up your contract.
Next you’re gonna look kind of your on boarding checklist so when someone does come on board what do you need to make sure that you hit you getting in the key setting up their email i’m getting them on the website,
there’s all these different things that you wanna make sure that you have periscope tell before you take on that first person so then next how do you find somebody.

[13:58] The best way i’ve found is to personal connections so the more that you can be getting connected to grad schools getting connected to newly licensed people so the in about ten to get a couple of years of experience maybe they wanna moonlight with you,
or just the evenings or saturdays then you can help grow them into a full-time practitioner.
Is well i think just letting other counselors know that you’re looking to bring on a couple of contractors to your pract.

[14:22] And then the flow that I do is I sit down with people I’ll have a cup of coffee with them because I want to make sure that I have people to join or practice that I want to be around,
if i’m gonna be in practice all the time with these people on may trade along and actually don’t bring drama into the practice on make sure that we can work together well.
And then from there we look deeper into the clinical skills to the fill a gap that i’m looking for really making sure that there’s a connection with that person.
So then after that we sign the contract we go through the on boarding checklist add them to the website the email set up their extension set up in all of that going.

[14:59] So next what you wanna do after that contract.
Is really start evaluating your website where you can switch from I to we when your solo practitioner.
So many people will have to be i do this i do that i do this i do that that’s good.
But if you’re planning the next year to be switching over to a group practice us are thinking and we chair so when we do the intake air when you are doing the intake with the intake coordinator you’re gonna experience these things.
It’s a big switch of switching in names switching in maybe even your url if it’s just been mentalwellnesscounseling.com.
For me to scale and in death something different such as mentalwellnesscounseling.com where its a brand that i’m building not just based on my own personality.
And then you wanna look at marketing how you gonna market these people are you gonna help them market themselves one of the biggest things i look for people that are willing to get up there and market themselves and bring.
Them a network of people that are not rd connected for with.

[15:59] In the past I used to think have this mindset of a home and I don’t have enough can intake calls coming in to Warrant bringing someone else into the practice.
I remember when i brought sarah into the practice her first saturday she saw people she is six clients in so important to look at,
what do people bring to the practice she knew people that i didn’t know she was able to market herself and those little light bulb moment for me,
because i was really able then to think about okay i don’t have to have you know twenty unfilled spots of twenty unfilled client that i can’t put into the schedule before i bring someone else on,
each person brings on value when they when they join that group when they able to help that group.
Alright so contract phone i’m having that flow is touch and having a virtual assistant,
but it’s really important i was even before you have in our group practice to get nba,
it’s so easy now to have someone in any state be your virtual assistant to train them in HIPAA make sure that that’s disclosed on your paperwork.
So that you really can U most efficiently use your time.
People so often are trying to bootstrapped be spending hours and you could be doing counseling you know returning phone calls scheduling people.
And really that’s not best and most effective use of your time,
so it’s really important virtual assistant i have a new virtual assistant that i’ve been training i am looking at having her potentially be able to work with other people can the around the country and some training her to do that.

[17:30] I’m willing to the application over on the website but i’m just gonna go through all of these different steps to growing your practice.
So then once you have those logistics then the next thing i’m gonna ask is what’s standing in the way.
What would most people I would say that it’s time they aren’t taking the time,
just specifically think through what is their goal here is it to add someone in the next year.
What are the specific steps that you need to do each month so catch on get out and what do you need to each week and what are some really micro goals that you could have,
if you have your client is running late with something you can do in ten minutes so you can start to.
Can I find those people that might want to join your practice also the big thing that I see is that people aren’t automating things in their practice when they have a solo practice.
And the more that you can cut out and outsourced before you have a group practice the more you can work and just the things on you can do,
there are things and run a group practice that only i can do right now,
in that i want to do so i want to be the one that touches the money and i want to be there when the deposits and want to be the one that’s writing those checks because you just enough people out there that have stolen money they’re done things not for me,
be here all the time that something that for me i wanna be the one that just physically touches that money and deposits it.
Are you the only vehicle but figure out what those things only you can do and what are the,
things that you can outsource to somebody else it’s so cheap house are things now compared to what you’re charging for your practice really moving toward that is really really important.

[19:00] Also what do you do best is it the managing side is that the scheduling side is at the on boarding side and then what can you have either other clinicians or other virtual assistants do to help you in growing York.
Leslie really go back to that clear goal setting and i want you to really think through what is it that you can do each month by checking out that goal of starting a group practice.
Putting in two different excuse me goals per week and then really have those micro calls that on a daily basis you can say okay here’s how i’m moving the needle forward.
In regards to building this group practice.

[19:37] Who is so fun to have this like identity is mental illness counseling you get to create and shape and influence and to have different conditions blogging,
for me it’s just been really really exciting to have a vision for a team and be able to say i’m impact our community in a way that before mental illness consonants here.
We were able to have that same sort of impact so where are you gonna get stuck on let me just go through a couple of resources that are gonna help you move forward.
I mention dedicated server.
So when you first started i recommend doing blue house that’s when you can a bootstrapping its like five bucks a month for hosting for your website.
As you grow it’s probably gonna make sense to move to a dedicated server now dedicated server is gonna be a lot faster,
your e-mail could be a lot faster on there’s gonna be just amazing support.
I just switched over and i still recommend to host those people are entry level of just switch over to liquid web,
can you can go to practiceofthepractice.com for special liquid web mr tuck all the different kind of ways that you can have a dedicated server.
In the way i thought about it when i switched over was if because of the loading speed to my website because as you grow its gonna get more bulky.
If my load speed is as fast as possible and someone clicks back if i lose one client because of that then it for me that more than pays for the dedicated hosting per month.

[21:03] And so you can get plans anywhere from eighty to me eighty dollars and up per month and if so if i get one more.
Counseling consulting client because of that you know even per year on that definitely pays for when i was in blue host my what’s that wasn’t the point,
that was so bulky they things are just letting super slow and as soon as i switch over to liquid web was super helpful so that’s one thing.
Also i have a link in the show notes over practice and the practice at home for slash one session one six one.
To my paperwork packet and if you type in to five off twenty five off thirty twenty five bucks off of that just for listening to this episode today.

[21:49] And then if you have an over at practiceoftheoractice.com/grasshopper or over two packs of the pictures that come for slash session when sixty one there’ll be a link there to,
to set up phone and then also there are gonna be a link if you want to apply to use cases as a virtual assistant to help answer phones and schedule with your practice.
How we covered so much stuff in twenty some minutes.

[22:13] Thanks for letting me into yours and into your brain you guys rock thanks for e mailing me about how to start a group practice this is probably the first of many,
hopefully pretty assorted of podcasts about this,
and picture me in two years and into your brain again practiceofthepractice.com/161 and you can get all of those links they’re have an awesome day talk to so.

[22:36] Music.

[22:44] And special thanks in advance ounces sexy and a productions we like your music and this podcast is designed to provide accurate and thirty of information in regard to this subject matter covered.
Is gonna understand that needed to host the publisher or guess rendering legal accounting or other.
Any color professional information in your professional she find one like.

[23:07] Music.