How does a group practice owner create a sustainable work environment and motivational work culture? What are some benefits that group practice owners can consider offering their clinicians? What are some tips for hiring out assistance for your practice?
In this podcast episode, Alison Pidgeon does a live consulting call with Bren Shantz about how he can grow his group practice.
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Meet Bren Shantz
Bren is an LPC who has practiced since 2014 in Grand Rapids, MI. He has worked in both community mental health and university settings before starting a solo private practice in 2019. He has been moving to a group practice over the past month and hopes to have several employees up and running by this fall.
His specialties are working with trauma and supporting various sexual and gender identities through the use of EMDR, CBT, Mindfulness, and Existential techniques.
In This Podcast
- Establishing great culture within your group practice
- Essential benefits to offer your clinicians
- Hiring assistance
Establishing great culture within your group practice
For Alison, the importance and ability to create a sustainable group practice culture relies on the balance between having a mission vision and values in the practice.
I spent a good time thinking about ‘okay, how can I actually convey to the therapists that they are respected and have autonomy and [that] I want a collaborative relationship with them … a lot of that is modeling [those values] for them and being open to hearing feedback, whether it’s positive or negative.(Alison Pidgeon)
Over time, the staff in the practice will get to know the owner and see how the owner embodies the values that they encourage the staff to have because it is a lot easier to follow someone by example and to embody principles when they are enacted in the shared space.
As an owner, it is important to be intentional about creating the space that you want your staff to work in and contribute towards.
Essential benefits to offer your clinicians
In Alison’s practice, she found a large request for benefits to be offered that covered health insurance and a retirement plan.
You can do it a few different ways and it depends a lot on your area and how the insurance companies set up the plans but where I am the requirement is that I legally have to pay up to 50% of the employee’s premium. I could pay for more but that is the minimum I have to pay and I do, so they pay for the other 50%. (Alison Pidgeon)
In this way healthcare then becomes quite affordable to the employees and is, therefore, a major attraction of their job.
Depending on what things in your practice you need help with, you can decide on hiring a virtual assistant and how much work they take on from you.
The other structure that you could have which is what we did in my practice was that the therapists actually did their own billing and then the assistant did everything else. She checked the benefits, she entered the OB, followed up on problem insurance claims, she answered the phone, she scheduled people – so again, not a right or wrong, it just depends on how you want your set up to be. (Alison Pidgeon)
Hiring assistance greatly helps you because by delegating out you clear up some time on your hands, enabling you to focus on growing the practice and working on tasks that fall under the CEO categories.
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Meet Alison Pidgeon
Alison is a serial entrepreneur with four businesses, one of which is a 15 clinician group practice. She’s also a mom to three boys, wife, coffee drinker, and loves to travel. She started her practice in 2015 and, four years later, has two locations. With a specialization in women’s issues, the practices have made a positive impact on the community by offering different types of specialties not being offered anywhere else in the area.
Alison has been working with Practice of the Practice since 2016. She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
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Grow a Group Practice is part of the Practice of the Practice podcast network, a network of podcasts seeking to help you grow your group practice. To hear other podcasts like The Imperfect Thriving podcast, Bomb Mom podcast, Beta Male Revolution, or Empowered and Unapologetic, go-to practiceofthepractice.com/network.
Welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon your host. Today, we are going to be doing a live consulting session with one of our members from our new program called Group Practice Launch and we’re really excited about this new program. So for years, I taught a mastermind group for people that wanted to start a group practice and did individual consulting and decided to kind of take everything that we’ve learned and everything we’ve created and put it into a six-month course called Group Practice Launch. We just started it in March of 2021 and so far it’s been awesome. It’s so cool to see people really doing their homework, watching the videos, looking at the paperwork, and then they show up to our weekly webinars with good questions and tell us what they’ve been doing.
So I thought it would be cool to invite some of our Group Practice Launch folks onto the podcast and do some live consulting with them just so you can kind of hear what are the common questions a beginning group practice owner has. And if you’ve been thinking about starting a group practice, or if you’re just in the process of starting, this will be a really good episode for you to listen to. So today I have an interview with, or not an interview, I guess, a consulting session with Bren Shantz. He is an LPC who has been in practice since 2014. He is in Grand Rapids, Michigan. He will introduce himself at the beginning of the podcast but he started his solo practice in 2019 and then decided that he wanted to start a group practice. He has experience working with trauma, supporting various sexual and gender identities through the use of EMDR, CBT, mindfulness and existential techniques. So I’m really excited for you to hear our consulting session today. And without further ado here it is.
[ALISON] Bren, welcome to the podcast.
[BREN SHANTZ] Thank you. It’s so good to be here.
[ALISON] Yes. So I thought we could start out just hearing a little bit about your practice as it stands now, and you are working on getting a group practice going. So maybe you could also fill us in on what you’ve been doing to make progress towards that.
[BREN] Sure. So I’ve been in private practice about two years, started part-time while I worked at another agency at a local university and in about December of 2019, switched over and went full-time. I don’t know that I would’ve done that if I could have known that there was going to be a pandemic three months later, but as with many clinicians that I’m interacting with online and locally, the need is real high right now. So I have no issue staying full through all of that. So over the last probably, I don’t know, six months have been kind of playing around with the idea of going to a group practice model, felt pretty comfortable in a solo practice and might’ve stayed there for a lot longer, but had somebody that I knew that was just finishing up with her program. And we started to talk a little bit about it, about supervision and space and gears started turning and little snowball rolling down a Hill, became a great, big, huge avalanche pretty quick, and just have been binge listening to tons of podcasts.
I got connected with Practice of the Practice through that and been researching stuff that I never would’ve dreamed about, human resources and pay models and all of that kind of stuff. It’s been both exciting and overwhelming at times, but so just over the next couple of months now, I hope to be hiring my first couple of clinicians. So that’s about where I’m at now.
[ALISON] Excellent. That’s great. So I know you have a bunch of questions for me, so I’ll just let you jump right in.
[BREN] Yes, because I’ve looked at this, I’ve got a couple of different, I don’t know, stages as I’m looking at what’s going next first. I’m hoping to get a couple of clinicians hired and I’m moving into a new office space this summer that has six offices. And then thinking about office manager, virtual assistant, something like that and somewhere in that range and then looking at filling my office, but long-term, I’ve been kind of thinking towards the larger practice. I had in my mind, 20 to 25 clinicians and then as I’ve listened to you talk about your own practice, noticing that you’re kind of in that same space, I was just kind of, I have this broader question of what would you, if you knew then when you first started that you were going to be where you’re at now, what would you have done differently? How would you have approached it? What are your thoughts towards moving toward a large practice from solo?
[ALISON] Great question. I think what I didn’t realize, because I hadn’t done it before was that things are going to change in terms of the structure as you get bigger. So I found that I could be sort of the only person in a leadership position. So it was like me and then I had an administrative assistant and then the therapist and until we grew to about 12, and 12 felt very unmanageable, and then we started to grow bigger than that. And that’s when you really need to look at maybe having a clinical director or somebody else who could sort of replace you or do some of the work that you were previously doing. And then I think also when to hit the 20 clinician mark, again, you almost need a whole another structure, because it just gets to be too much for one person to manage. So I don’t know if you have more questions about that, but that’s just one big thing that stands out to me.
[BREN] What does, when you talk about a clinical director, is that my man goes to community mental health and just knowing kind of what they look like there, but it was a largely one person that oversaw a pretty large staff? What does that look like in your model in private practice?
[ALISON] Yes, I think it can look like a number of different things depending on what you were preferences are. So for example, you might have a clinical director who just does clinical supervision with the therapist and that’s really their main job. My clinical director, that’s the model that I had for awhile, she really was like a replacement for me when I wasn’t there. So if I was on vacation or when I went on maternity leave, like she was really running the practice. So she was doing a little bit of everything from marketing to checking with a therapist to helping the admin, if she needed help. So yes, it really just depends on what you want to delegate and what you don’t want to delegate. I don’t think there’s a right or wrong there.
[BREN] Sure. So when you say supervision, is that largely like limited licensed clinicians?
[ALISON] We never, we haven’t really had people who need supervision to become licensed in my practice. We’ve typically only had fully licensed people. So we do supervision just as a best practice or little questions come up here and they’re like, “Oh, do I need to make this child abuse report? I’m not sure.” You know, and they want me to run it by somebody, so.
[BREN] Okay. And that’s a one-on-one monthly situation or do you meet more regularly or in a group practice —?
[ALISON] Yes, how we have it set up now is that the staff meets in small groups. So there’s like three or four people to a group once a month and they can attend more often if they want, but the minimum is once a month.
[BREN] Okay. That makes sense. And you said you don’t have anybody that requires supervision. This is just all, it sounds like it’s still required as a part of your business model, but not from the state for licensing.
[ALISON] Right, because they are all fully licensed.
[BREN] Sure. So have you then mixed up as far as what licenses that you’ve brought in as you’ve expanded?
[ALISON] Yes. We have a mix of psychologists, professional counselors, and clinical social workers. I think we have an LMFT too, so yes, I’m mixed.
[BREN] Well, the thing about whether it’s small or even as you get larger, how did you emphasize culture that you were wanting to set up? How did you establish that?
[ALISON] Yes, I know in the group, the first month we talked about mission, vision and values, and I always go back to those things, especially the values when we talk about culture. So I feel like it’s one thing to write it down on paper. It’s another thing to figure out how you actually going to to live it out. So I spent a good deal of time thinking about, okay, how can I actually convey to the therapist that they’re respected and they have autonomy and I want a collaborative relationship with them and I want good communication and all of that kind of stuff? So I think a lot of that is modeling that for them, and being open to hearing feedback, whether it’s positive or negative from the group. And I think that over time, obviously your staff gets to know you and they see like, “Oh yes,” even if I have something negative to say. Like, it’s okay.
So yes, it’s like those types of things that I have been very intentional about. And I think too, I saw what, you know, how therapists are treated typically in community mental health, which is not very well. Like you’re typically just told, like you need to work harder, you’re not seeing enough clients, and I didn’t want them to feel that way. So I tried to design the structure so that it felt very manageable. Like they only have to see 25 clients a week to be full-time whereas in community mental health, it’s probably like 30 to 35 which I think is really not sustainable. So yes, I guess that’s the other piece of it too obviously, outside of the, you know the values are infused into all of that, but also setting up a structure that really does promote to them like, you can have work-life balance. You don’t have to be here 40 hours a week. You can come see your 25 clients and be done. And a lot of them work four days a week and I think they appreciate that.
[BREN] How do you do, I’m just thinking, like, do you require any weekend time, half a day and a weekend time? How have you looked at? I guess to add onto that, I’ve got a, like I mentioned a suite of six offices and just thinking like, as I fill them, how do I do that to get the most use out of them?
[ALISON] Right. So if they’re W2 employees, you can certainly dictate to them when they have to work. I know it’s not uncommon for some agencies or practices to say you have to work two evenings a week or something like that. I haven’t made that mandate to my staff because I want one of the big selling points of coming to work for us is that they have a lot of flexibility with their schedule and a lot of autonomy. So I haven’t required that and I think they appreciate that, but I mean, I see how, yes, from a business standpoint, you want to try to fill your space as much as possible and …
[BREN] Yes, it’s, I think more than anything of what I’m looking for. One of my, I’ve jotted down some values. I think I still have some more work to do with that to really flesh them out and make sure that I’ve got all of them that are motivating me down on paper so that I can have them out in the open. For me as I’m kind of considering different things, but I really want the space, the business to be a really great place to work, with great benefits that is really, has a good team culture. And I think as a part of that, not packing every moment of my available office space is I think probably going to be a part of that. So I don’t know some tension, I’m just trying to figure out, I could have six clinicians in there, or I could have 10 clinicians in there just depending on what, how well their hours kind of interlock with each other.
[ALISON] Yes, I think too, I mean, I don’t know what’s happening in your area with telehealth, but I think there’s so much opportunity now to have a whole arm of the practice be telehealth only. And so you could be twice as big or three times as big as the office space that you have now. So I think going forward, it will probably still be important to have office space, but maybe just not as much as we used to have in the past. And then also like, it may not be as imperative that the office is fully filled out because people will be doing sessions from home and that will contribute to the overall growth of the practice.
[BREN] And then do you, I don’t know, I guess along with that, do you anticipate telehealth, it seems like previously to this, it was, I don’t know, it was pretty rare. It seemed like in my area that there wasn’t a whole lot of offerings there, but now I’m wondering if it won’t kind of stay in a place where some people will always be seeking that.
[ALISON] Yes. I think it has done a lot in a positive way for people who were kind of not familiar with the idea. And so you would suggest it to them and they’d be like, “No, I don’t, that’s, I’ve never done that.” It was like the barrier was too great in their mind, I guess, to try it and now everyone’s been forced to try it. So I think there are people who see the positives of, “Oh, I don’t have to drive to the office and find childcare and do this and do that.” So, yes, I definitely think that it’s here to stay. I don’t think we’re going to go backwards.
[BREN] Have you then helped clinicians set up a, with a stipend some sort of home office? How did you manage that?
[ALISON] Yes, so that’s actually something we just started doing in my practice. We are giving all of the therapists, like we’re starting out with a hundred dollars a year just to go towards whatever they want to buy to set up their home office, whether it’s like earbuds or blue light blocking glasses or a chair or something like that.
[BREN] Just looking through my list here, how have you done interns at your office?
[ALISON] Yes, we actually haven’t taken interns up to this point. It’s tough with an insurance-based practice because so many people want to use their insurance, but Whitney Owens has taken interns before. So I’m sure she can fill you in on that if you want more details.
[BREN] Sure. What benefits have you found most desirable or like essential, maybe even …
[ALISON] For employees? You mean? I found that the two biggest things they asked for were health insurance and a retirement plan.
[BREN] Okay. When you do health insurance, then do you pay all of their health insurance? Do you give them monthly stipend?
[ALISON] Yes, you can do it a few different ways and it depends a lot on your area and how the insurance companies set up the plans, but where I am, the requirement is I legally have to pay for 50% of the employees premium. I could pay for more, but that’s the minimum that I have to pay. So that’s what I do and they pay for the other 50%. So I was actually pleasantly surprised that it is pretty affordable.
[BREN] Yes, just getting some quotes from different companies in my area and I was as well, so I married my spouse and I have five kids. So there is just like the range of potential medical costs. I’m kind of aware of what that could potentially be if there’s another, from hiring clinicians, with large families versus hiring somebody who is single. It’s just hard to figure out like how to predict all of that, I guess in the plan —
[ALISON] Yes, I would say one great thing that I did that was super helpful was reaching out to a health insurance broker. They’re typically paid by the insurance companies so they work with you for free and they can really give you the lay of the land of what is out there in your area and what makes the most sense for your particular situation.
[BREN] Okay. That makes sense. Do you offer short, long-term disability, life insurance, any of those kinds of things?
[ALISON] I haven’t yet done that. When we switched over to W2 employees, there was a lot to it obviously. And so I just thought, okay, I’m going to put in the bare bones or sort of the framework to get some of these initial benefits going and then if down —
[BREN] Yes. It’s kind of where I’m at as well, for the life and the disability of potentially adding those I don’t know, a year or two down the road as I figure out how things are working out. Can you talk to me a little bit about phones? It seems like such a generic question, but I, for all that I’ve listened to, I think you have one fairly recently with All Call Technologies with your podcast and I know. Practice of the Practice. Is it market or partners with spruce, I think it is. Currently I’ve just used Google Voice and I have, as coming through solo practice, just kind of hodgepodge a bunch of stuff together. And then I bumped into a few other people who use Google Voice so that you’re not using your personal cell number, but just thinking as I’m stepping into two or more people in the number needing to ring on more than just my phone. Just curious if you can talk a little bit about what do some of these phone systems do?
[ALISON] Yes, I think the ideal set up in a group practice is really to have a business phone number with a phone tree. So when they call, they can press one for the administrative assistant, they can press two for you, press three for this person. It just, I think gives it that professionalism and that way your clients feel like, “Okay, I can get ahold of somebody if I need to.” So I know Google Voice has a relatively new feature where they’re starting to do something like that but the main complaint that I’ve heard from my clients is that it’s like a robot voice and you can’t record over it. So they feel like, “Oh, this isn’t very personalized. It’s like a robot voice answering the phone.” So I think another obvious thing to think about too is signing the Business Associate Agreement that assures that it’s HIPAA-compliant. And there’s lots of phone systems now who will offer that for you like phone.com, Ring Rr. S1pruce is a great one, All Call Technologies, there’s a company called 8×8. So there’s lots of options and I didn’t realize this before getting into helping people set up group practices, but phone systems can be very complicated [crosstalk].
And there’s a lot of options and it probably feels like a little bit of apples and oranges trying to compare all of them, but I don’t think we have, you know because we’re not on the phone all day necessarily. So I don’t think you have to go crazy, like finding the perfect thing, but I think you definitely need to have the ability to like route calls to specific people. And what’s nice about the virtual systems now is that you can just have it connected to that person’s cell phone. So you don’t actually have to have a physical phone. You don’t have to have a phone plugged into the office or a separate phone for them, for work. It’s just connected to their cell phone.
[BREN] What brought you then to what, was that, All Call Technologies?
[ALISON] They were recommended by another practice owner and they have really great customer service. It’s Greg and his wife, and one other person running the whole company. And when you call, they answer the phone. So I just have had a really good experience with them and that’s kind of how I found them.
[BREN] So they have an app that you could download onto your smartphone?
[ALISON] Don’t have an app. That’s a kind of the main difference between them and the other companies is that, he was actually explaining to me in the podcast interview that when you have an app, then you’re relying on the internet for your phone connection. And if you don’t use an app, then you’re relying, I guess, on the regular phone system. I hope I’m saying that right. But he said that they don’t use the app because when you’re relying on the internet for your phone, it’s just like less reliability.
[BREN] Got you. That makes sense. I have a few more questions. I’m not sure how much more time we have.
[ALISON] We still have a few more minutes.
Okay, how, let me go back to that one, virtual assistant office manager, some of the questions that I’ve had about virtual assistants in my own head is just, and I think Joe, in one of his podcasts had talked about this. So there’s the virtual assistant being in Texas and how that’s a little bit interesting for clients is they’re like interacting with somebody who’s not at the practice, not really even isn’t really a part of the practice, but like contracted out a bit and then just strikes me as a little odd. I don’t know what your experience with all of that has been but thought maybe you can speak to that.
[ALISON] Yes. So I have a virtual assistant company. I don’t know if you knew that, but —
[BREN] I did, yes.
[ALISON] Yes. So, I mean, it works really well for small medium group practices that, obviously they need that support, that admin support, but they’re not big enough yet that they can necessarily hire their own in-house person. So I would say with good training, it works quite well, especially if you get somebody who already has a health care or mental health care background who’s already familiar with the lingo and can speak about insurance and all of that kind of stuff. So we actually have built into our training that like, you will explain to them how to, you know somebody is lost and can’t find the office, like they can help them figure out where to go and all of that kind of stuff. So I think somebody who’s well-trained, it actually works quite well.
[BREN] Okay. So I have a biller and the biller does a lot of the stuff that seem like some of what is sometimes like verifying benefits for instance, is a part of what sometimes shows up in virtual assistant options.
[ALISON] Yes, so, sorry, go ahead.
[BREN] No, that’s it. That’s it. I was running out of steam so thank you.
[ALISON] Okay, yes, I was just going to say, so there’s kind of a couple different ways you could structure this. So one is, yes, if you have a biller who’s doing all of the extra stuff, like verifying the benefits or maybe they’re entering EOB information into your system, you may then just need somebody who’s answering the phone and scheduling new appointments and kind of managing the scheduling pieces. In that case having a VA obviously would work, especially if you have a volume of calls and inquiries. The other structure that you could have, which is what we did in my practice was the therapist actually did their own billing and then the assistant did everything else. She would check the benefits, she entered the EOB, she followed up on insurance claims. She answered the phone, she scheduled people. So again, not a right or wrong, it’s just kind of depends on how you want your setup to be. And if you like your billing company, then great, you should probably hang on to them because it’s hard to find a good billing company. And then you would obviously delegate out the other kind of more scheduling based tasks or maybe some marketing based tasks to to an assistant.
[BREN] Okay. So when you say marketing, is that like, I don’t know, Facebook?
[ALISON] Yes, like they could schedule out posts for you on social media. They could I mean, depending on their skillset and they might be able to put together an email newsletter. Sometimes I’ll have my assistant like research, like, okay, what are all the PCP practices in the area? Let’s send out a mailing stuff like that.
[BREN] Okay. And do you, is that separate then from an office manager for you?
[ALISON] Since we are the size that we are, it is, like we now have three full time people, so they all kind of have their own specific tasks that they do. But yes, I guess it depends again what you want them to do and if you can find one person who has the skillset to do all of those things. I would say that usually it’s not common to find one person who can do everything that you need done in the practice. Yu may have to have a VA and then you may need to have, like, I have somebody who goes to writes blogs for me and does a lot of our social media, who has more of a professional writing background and like marketing background. So yes, definitely different skillset.
[BREN] So I do have a lot of calls that come through to my phone that I am unable to answer as a solo practitioner who is full and is often referring people out, never was something that bothered me too much, but as I’m bringing on people and needing to try to collect those inquiries, to see if we can schedule people, then that gets me a little bit more leaning toward the possibility of getting somebody, getting a virtual assistant on more quickly than I was initially anticipating, or just letting the new clinicians maybe handle those phone calls until they get a little full too. I don’t know.
[ALISON] Yes. I mean, I think that clinicians typically want to work for a group practice because they don’t want to deal with the hassle of all the administrative and business stuff. So I think they would probably appreciate having somebody in place maybe right before they start around the time they start. And we find that assistance typically are always like a net positive in terms of return on investment. Like they will pay for themselves over and above their actual salary because they’ll keep schedules full, they’ll capture clients right when they’re calling, that kind of thing. So it’s always a really good investment to have an assistant who will capture those new clients.
[BREN] Yes. We have so many, I live in Grand Rapids, Michigan, and there is a lot of clinicians in the area, a lot of need as well too. But I think a lot of times somebody might just bring up like Psychology Today or some other directory and just kind of call their way down. It feels like, anyway, if you’re missing those calls, then people are kind of on their way.
[ALISON] Absolutely. Yes. Absolutely. That’s what we find.
[BREN] Okay. That is helpful. How long did it take for the virtual assistant to onboard them and get them set up so that if I was going to bring them on, right when somebody, when I hired somebody and brought them in the practice that they would be ready to go?
[ALISON] I would say what we tend to do is something we call progressive delegation where you kind of like just teach them one task and let them get the hang of it and get good at it and then the next week you give them another task and then the next week you give them. So you’re not like dumping everything on them the first day that they’re there. So I would say it probably takes a good month to really get them trained. depending on how big your practice is. I mean, obviously you haven’t hired anybody yet. So it probably wouldn’t take more than a month is my guess.
[BREN] Okay. Does that, how do they, particularly as I’m bringing them on and they say the virtual assistant packages have 20 hours a month or 40 hours a month, whatever and that they have today and a call comes in, does that, well, they only answer it if they’re in the four hours a week that they happened to be working from my business? Or how does that work?
[ALISON] No, it’s just kind of as the work comes in, they do it. And if you know, one week you use six hours and the next week you use one hour, then that’s just how it goes. It’s not, it’s just in the month you get a certain package of time.
[BREN] Perfect. That’s really helpful. I’ve seen a lot of the stuff when I’ve tried to listen to the podcast and read stuff online about virtual assistance, but that is still cool to hear that
[ALISON] Yes, it can be hard to wrap your brain around, like how does this work? I mean you’re not even in the same state that I am in.
[ALISON] Yes, any last questions before we wrap up?
[BREN] No, I think that that about covers it. That was super helpful. Thank you.
[ALISON] Okay, great. Well, it’s great having you in Group Practice Launch, and I’m looking forward to seeing you start your group practice.
[BREN] Yes, thank you very much. Appreciate it.
[ALISON] Thank you so much, Bren, again, for coming on the podcast. He said it was his first podcast and I think he did very well. So stay tuned for some more episodes we have coming up with live consulting sessions with our Group Practice Launch members.
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