[ALISON PIDGEON] You are listening to the Grow a Group Practice podcast. Whether you were thinking about starting a group practice or in the beginning stages, or want to learn how to scale up your already existing group practice, you are in the right place. I’m Alison Pidgeon, your host, a serial entrepreneur with four businesses, one of which is a large group practice that I started in 2015. Each week, I feature a guest or topic that is relevant to group practice owners. Let’s get started. Hi and welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon your host. I hope you are doing well. Today I have an awesome interview with Dr. Wendy Dickinson and she is doing so many cool things. I actually asked her if we could do a two-part episode, so today is part one, and definitely tune in next week when we’re going to air part two. But let me tell you a little bit about Dr. Wendy Dickinson. She has a large group practice that is all self-pay in Georgia, that she will tell you about called Grow Counseling. She’s also the founder of something called Grow Restored, which is a nonprofit organization with the mission of providing counseling services to those in need both locally and around the world. She also started some other businesses, which she will explain to you. It was so awesome speaking with her. She has been in the field of private practice for a long time, has tons of experience and I think you will really enjoy listening to this interview with Dr. Wendy Dickinson. Hi, Wendy. Welcome to the podcast. [DR. WENDY DICKINSON] Thanks for having me. I’m so excited. [ALISON] Let’s start out by hearing about you and your practice. Can you give us a little introduction? [DR. WENDY] Yes, so I am a licensed psychologist and we have a practice in Metro Atlanta, Georgia called Grow Counseling. We have been around since about 2007 and have grown significantly since then. We’ve got four physical locations and then of course our therapists do virtual work as well throughout the state of Georgia. Then we have a handful of people that are licensed in Florida. We have someone in North Carolina, Virginia, so we can cover a larger geographic area for people. We always sort of, our internal joke is if you’re between the ages of three and 93, we probably have somebody who can help you. So we have people that specialize in all kinds of different areas. [ALISON] Oh, nice. Are you insurance based or self-pay? [DR. WENDY] We are exclusively self-pay. We do provide receipts. People can file on their own. Then here and there, we have some agreements with third party payers, churches, schools, family members corporate corporations. [ALISON] Amazing. How many staff do you have now? [DR. WENDY] We have about 45 people right now. There’s sometimes a little fluctuation there. We’re getting ready to hire a handful of people in graduation, after graduation in May, so we’re excited about them coming on. [ALISON] Yes, that’s awesome. When you first started the practice, I think you said back in 2007, did you set out to create a practice this large or did it just sort of happen organically? [DR. WENDY] 0% did I start out to create a practice this large. I would like to say that it was all vision and I’ve been like at a dream board and this is truly, it’s just unfolded over the years in a really organic way. I’ve loved that because it’s felt really natural. I and the team have worked really hard, but we just go, okay, what’s the next right step? Where is their need? Can we fill that? Does it make sense with the people we have? So it feels very genuine. It doesn’t feel like an artificial goal we’re driving at. When I first started, I was an individual practice and probably like a lot of your listeners, I was sharing office space with some other people and so we weren’t joined as a practice. We just shared overhead expenses. I personally found it to be a little bit lonely. We were ships-passing occasionally in the office and at the time I was single and I had worked on some really great teams. So I knew the power of community and for me having that support was really important to me. So I started thinking about what does this look like to build some community? I thought, oh, I’ll just go join another counseling team that already is up and running and has community. I was surprised really actually to find that in the private practice space at the time, this was like late 2000s, there really weren’t many healthy community focused counseling practices. So that’s where my longing was, was to find a place that I felt like, yes, we’re doing hard work in our work lives, but we can lean on this sense of community and support to help us do that work better. So I couldn’t find it so I thought, well, maybe I can build it and started out by hiring a couple of students largely that I had been teaching. They graduated and needed a place to practice. I sort of started from there and I’ll be real honest with everybody it was a learning curve. The business of running a practice is different than doing therapy. We are not taught in school how to run a practice. We’re not taught those leadership skills around how to help people be the best versions of themselves, not just clients, but staff. So I would say I have learned along the way, and I continue to learn about those things, because I think it’s an ever-changing field and in terms of how many people you have on the team and what they need. So it’s an edge that’s always growing for me. [ALISON] Yes. I agree with that. So you started right before the recession happened in 2008, 2009, right? [DR. WENDY] I did. It was an insane time to start a private practice. [ALISON] Yes. What was that like for you being a new practice going through that time? Was that difficult or did the recession not really affect you? [DR. WENDY] I think it’s hard for me to compare because it’s the only experience that I have but I think one of the things I do look back on is if I could do that, then I could probably do almost anything now. It was such a, I work a lot from a narrative perspective with my clients and it was such an important part of my story and the narrative that I hold onto in my life is that was a really hard time. I graduated, things feel like they come to a screeching halt, like graduation, you’ve worked so hard and things are so busy and you have so many balls in the air and then all of a sudden nothing. That was a hard shift for me. Then just that, like you mentioned, the recession people didn’t have gratuitous income to pay for counseling. So there was a lot of hustling and a lot of scrambling. I laugh when I talk to clients about work life balance, because I’m like, don’t do it as I did. Let’s talk about a different path for you. But I remember the days when I would see a client at 7.30 in the morning and then at client at like 8:00 PM at night and probably go home and take a nap in between but it was a lot of showing up and just taking what I could and trying to take that, whatever the next step forward was. A lot of saying yes to opportunities, not all of them worked out, but if there was an option to speak at something great, if there was an option to go up to a networking thing, I did it. I think one of the things that’s so interesting now is that time now is the time to be a therapist. We’ve joked around the office about when we bring people on, they used to, well, they still ask like how long does it take to build a caseload? We used to say pre-pandemic, oh, that can take a while. It depends on how hard you market. It can be six months, it can be a year and now we’re like, well, how many clients would you like tomorrow because we’ve got a waiting list. So I love that. I think there’s been a lot of shifts, not just people are in need obviously, and I’m glad we can help them but I think also just the normalizing of therapy over the last 15 years has become so much less taboo and more spoken about and it’s just a normal part of people’s lives. So I love that part of it and I think that makes it easier as well. [ALISON] I love the part where you said that you look back on that time during the recession and you just think like, well, if I could make it through that, I could make it through anything because you always have those challenges as a business owner. I think for me I didn’t go into business until 2015. So for me it’s like the pandemic. That’s exactly my thinking. I look back on the last two years and think, okay, if I got through the pandemic, I can handle anything that comes around because that was definitely a super stressful time for me as a business owner. [DR. WENDY] I love that. I love that, it’s part of your story forever. [ALISON] Yes, yes, for sure. I’m curious about your perspective or tips that you have for folks who might be looking to grow their practice because I know in my own experience growing to the size we are now, there’s been times where we’ve had to shift the structure and change different things and hire for leadership positions. So can you talk about that a little bit? What were those sort of like thresholds where you realized, oh, we need to do something differently here because now we have so many more people. [DR. WENDY] That’s a great question. I think one thing, and you alluded to it, but it feels like there’s almost constant pivot happening. So it’s just about the time something feels comfortable is about the time that it needs to adjust to accommodate something new, so maybe that’s a system, maybe it’s the number of staff, maybe it’s the amount of office space. I find that if you’re somebody who likes homeostasis and you like control and you like things to be predictable that running a business model like ours is probably not going to be a super comfortable fit. It doesn’t mean that you can’t do it, but it’s not going to be really comfortable. I think you have to be comfortable with change, with reassessing, with problem solving with pivoting because it feels like there’s always something that we’re going, okay, let’s rethink that. Let’s look at that. Let’s figure out how do we make that thing work better for where we are now. So I think even in terms of our systems and when we first started, we were writing down how many sections we had and we had these little slips of paper we’d attached to a check and it was very quaint. Over the years we’ve evolved and gone through some iterations of different things. We have a system now that is fantastic and it’s one we’ve pieced together. I wish I could make a plug for it so people could sign up, but we pull, we use some QuickBooks, we pull, we use a program called the air table to track a bunch of stuff. It’s like a database. I have an amazing assistant who is unbelievable with systems. She really comes from that problem solving standpoint. That’s one where I look back and I go, wow, we’ve probably had at least four or five different clear iterations of how do we handle charges and all of the finance side of things. It really does have to evolve. I keep coming back to this word grow because I love it but I think things have to grow with you. The other thing that I’ve noticed and have gotten better at, was not great at, to begin with, but, so my bias in business is spend less. Like if there’s a way to do something and spend less, I want to spend money on the things that matter. I want the environment to be great. I want the client experience to be great. I want the counselors to feel supported. But in terms of like, hey, let’s pay for this subscription, let’s do this, let’s do that, I’m always questioning how do you spend less? How do you get the same bang for your buck, but maybe spend less? The area where I think I’ve had to really think strategically about that and grow in that direction is I find almost always you need to hire maybe just before something becomes uncomfortable. So in terms of having an assistant or, we don’t have a model where we have a front desk person, but for people out there that do, I think you want to hire somebody before it gets to be that crunch point. Because by the time there’s this crunch point, you’re a little bit behind the eight ball and trying to find a great person and hire them. It’s a lot easier to make hiring the stake at that point, if you’re trying to rush through it. So we use the same rule of thumb with staff. We try not to over hire meaning we don’t want a whole bunch of people on our team who have tons of openings and maybe even feel like they’re competing with each other to get referrals and that thing. But we try to hire right before we have a gigantic waiting list, because we don’t want to feel this pressure of we’ve got to get somebody in right now and then end up making a mistake in the hiring process. So I think that’s another thing that I’ve seen over the years that that has been really helpful. I think the third thing is I’ve talked to business owners goes back to that like financial side of spending less, having a budget. I looked for years to find someone who was really helpful on the business side of things, a business advisor and actually I liked him so much I ended up marrying him. It worked out great on levels, but it was fantastic. The way we got to know each other is we were referring clients back and forth and then I started talking to him about the practice and was like, hey, I do a lot of business consulting. Why don’t we come in and we’ll look at your books and stuff. I remember when I first started the practice, I naively thought my accountant was going to help me with that stuff. So I would ask him these questions and his response was like super helpful, I mean, super nice, but not all that helpful. He would say things like, well, yes, I mean, you can do that however you want to. I’m like, no, no, I’m the counselor so I don’t have a want to own this. I don’t even know what the options are. So I kept trying to find somebody who could help me with that sort of the budget, the business, how do I grow, how much should I be spending on rent, what about a savings plan, should we have employees, what does that look like? [ALISON] It’s like what a CFO would do for you basically. [DR. WENDY] Exactly. That’s exactly it. That’s what David does is outsource CFO work basically. He was very helpful in really my confidence around what we were doing and the way we were doing it. He made some tweaks that were really helpful, but it also was just such a confidence booster for me to know that somebody had looked at it and was like, yes, you haven’t missed anything. You’re doing this right. There’s no surprise thing that the IRS is going to come back and say to you. So that really helped my level of anxiety around the business side of things to go down and my confidence around making decisions on a financial side of things to increase. I strongly recommend that people, it may be a stretch to pay someone to do that work for you. I did pay him in the beginning. He didn’t do it for free. But I recommend finding somebody. He knows counseling practices and he knows small businesses so if you’re interested in his information, I’d be happy to share that with someone, but even somebody local to wherever you are that does that work would be great. [THERAPY NOTES] Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and tele-health a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over a thousand verified customer views and an average customer rating of 4.9 out of five stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE], J-O-E to get three months to try out Therapy Notes, totally free, no strings attached. Remember telehealth is included with every subscription free. Make 2022, the best year yet with Therapy Notes. [ALISON PIDGEON] I’m glad you brought that up because that was the one thing I felt like I was missing in my practice too. I ended up hiring Green Oak Accounting to do that for me. It’s been huge in terms of our growth and making smart decisions and how to grow the business and all that stuff. So I have a follow up question to the second thing you said, which was hiring ahead of when you start to feel uncomfortable. I think that is so tricky to figure out what is that point that you need to hire, like anticipating that, oh, we’re going to grow by this much or whatever the case may be. So have you found any sort of magic formulas to figuring out when to hire ahead of where everybody is like, so stretched thin that they’re freaking out? [DR. WENDY] I have all the magic. Now I wish there was a magic formula. I looked for that book, so if you want to write it, I think that would be awesome. [ALISON] I don’t know the answers. I was hoping you did out there. [DR. WENDY] No, I think that for me, that looked like I was more comfortable hiring people that were maybe in a contract role or an outsource role where I could say, I think I’m going to need 10 hours of time. So for example, I had somebody for a little while that did social media for us and that’s all she did. So we said, hey, I can pay you for five hours. What can you give us in for five hours? So instead of hiring an employee who was going to have all these different things on their plate, it helped me to parse it out a little bit. Now the downside of that are, there are more balls in the air, there’s more things to manage, there are more people in the mix. So you become a little bit more of a cruise director, making sure that everybody has what they need. It’s not a silver bullet, but I think it’s helpful to think about it in terms of like, what could I, especially when you’re small and you’re growing, what could I outsource in a contract type role versus hiring a full-time employee? One of the mistakes that I think people make a lot is, hey, we’re going to hire an office manager. The truth is they probably do need somebody to assist with some office work here and there, but did they need a full-time support person, maybe not. We went for years with having somebody that was maybe 10 to 15 hours a week supporting some of our backend operations and then added from there in terms of the need that we have. So I think that’s another way to think through that, how do you spend less and still get some support or still go to the next level? You do need to sometimes like we’re talking about spend ahead of where you are, but I don’t think you need to spend so far ahead that then becomes a stressful element too. It’s I have to make enough money to pay this other person a full-time salary before maybe you’re at that point. [ALISON] I like that because it feels like you’re sort of building a bridge or taking sort of steps to get to maybe that end point is hiring a full-time person, but usually when you start, you don’t need instant full-time help. [DR. WENDY] Right, and I think that idea of like, where do we need help. Especially when you’re a business owner and you’re in the beginning stages there’s a lot you’re going to end up doing on your own. So to think about what are my strengths and what are the things that I could carry on my plate for a little while. I am not a big social media person, so that has always felt like a little bit of a stretch for me because it’s just not a world that I do a lot in. So that’s something that I’ve pretty consistently outsourced to people, but my background was in public relations and my undergrad degree was. So I did for a long time, a lot of the look and feel the branding, the marketing, laying out flyers, anything that sort of had a feel to it. I did that part for a long time. So I think it’s that idea of like there is, if you want something to be great, I think there will be seasons of hustle. If you’re going to keep something on your plate, what can you do? Well, make sure you’re keeping the things that feel like they’re in your wheelhouse and then you’re outsourcing the other things. [ALISON] That’s great advice. And a follow up question to that then is now that you have 45 staff, what are you doing now as opposed to, most likely I’m guessing when you started, you were doing all the things, wearing all the hats. What have you delegated out and now what do you focus on? [DR. WENDY] I feel like my main role now is to send one to million emails a day. That’s what I do every day. [ALISON] Now I’m laughing because that’s what I feel like I do. [DR. WENDY] All the emails. It’s interesting we were talking in the office this week about how a fast-paced nature of things and how everything just keeps getting faster and faster. Like you used to fill out a form and mail it off, then you had a few days, at least, or a week, even if you FedExed it before somebody was going to respond. There was all this downtime and now with the speed of communication, there’s just no downtime. I mean, somebody is center responsible where you can even move on to the next task, which I don’t think is all together bad, but it’s part of the reality. So anyway, this is sort of a rabbit trail, but I was just thinking about like how even from 2007, until now the nature of running a business has changed because of the fast-paced response time. Back to your question about what I do, I do see clients about half my time still. My caseload is maybe a little smaller than it was for a while, but I probably see depending on the week around 15 clients a week. Then the rest of my time, I would say, I end up, I spend time talking. So we have, the way our offices are structured, we have a director in each office who may or may not also be the supervisor. In some cases, we have additional supervisors. We have a director in each office and then I have a full-time executive assistant who I would say is really more like the director of operations. She handles all the systems and the website and the financial end of reconciling accounts and onboarding therapists and all those logistics. Then we have an outsourced social media person still, and we still have, my husband still helps with the CFO work. That’s what our layout looks like. Then I’m over all those things. So I am, it does feel like I’m playing cruise director a lot, checking in with people, how are you doing? What do you need? What’s working? What’s not? What do we need to brainstorm? Always the directors and I are always in conversations about the staff and how they’re doing personally, what they need to feel supported. We just recently overhauled our referral system because we recognized that what we had been doing as a 25-person group, it wasn’t working as a 45-person group and we were getting so many inquiries for clients, but that things were falling in the cracks. People were doing the best they could, but they’re busy and people were falling through the cracks. So that was the project for probably a couple weeks, was really looking at that. What’s working mostly? What’s not working? How do we revise that? So I would say a lot of problem solving, a lot of people, relational work to make sure that people are feeling good and taking care of. Then I like to have a project. I like there to be something on the horizon. So we always have a couple of things we’re working on that are sort of the next version or the next step. So that brings me a lot of satisfaction as having something that’s future looking. I’m not as good with maintenance mode as I am with like something new and creating something. [ALISON] Well, I wanted to say thank you to Therapy Notes for being a sponsor of this podcast. We know your EHR is awesome and we are happy to tell other people about it. So if you want to get Therapy Notes for free for three months, use promo code [JOE], J-O-E no strings attached, and you can check it out and see if you’re ready to make the switch. Thanks so much for listening. I hope you enjoyed. As I said in the beginning, if you want to listen to part two, definitely tune in next week, because the rest of my interview with Wendy will air then, and hope to talk to you all next time. If you love this podcast, will you please rate and review on iTunes or your favorite podcast player? . This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.