[ALISON PIDGEON]
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You are listening to the Grow A Group Practice podcast. Whether you are 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.

Welcome to the Grow A Group Practice podcast. I’m Alison Pidgeon, your host. I am excited that you joined me today. We are in the middle of a series of podcast episodes where I am interviewing members of our Group Practice Launch community. So these are solo practice owners that are just in the beginning stages of starting a group practice. And I am doing live consulting sessions with five practitioners to talk all about whatever questions they have. And today I am talking to Rochelle Fong, who is a licensed marriage and family therapist. She is located in Hawaii and her practice is called Exhale Therapy Hawaii, which I love that name. And Rochelle is awesome. We had such a fun time talking and she also revealed a very big secret when we were having our consulting session. So I’m not going to give that away right now, but I feel very honored that she chose to share her secret on my podcast and she said I’m the second person to know. So now you’re all going to know as well. But we just talk about you know, various questions that she has related to getting her practice up and going and delegation. So I hope you enjoy this interview with Rochelle Fong.
[ALISON]
Hi, Rochelle. Welcome to the podcast.
[ROCHELLE FONG]
Hi, thanks for having me.
[ALISON]
Yes. I’m so glad that you decided to take me up on our consulting session today, and I understand that you prepared some questions, so I’m ready if you’re ready.
[ROCHELLE]
All right. Okay. So my first question was about hiring new therapists and I guess I have people that I trust, I’ve worked with. And so those are my easy go-to’s. They are, I’ve worked with them in the field already, but some of them are saying like, “Oh, I only want to work like three to five hours or maybe eight at most.” Is that worth it for me financially, to be able to take on someone for just a short amount of hours a week?
[ALISON]
Yes. I mean, you’d really have to run your numbers to be sure, but typically the average amount of hours somebody needs some work to make it financially advantageous for you as the owner would be about 10 hours a week. Again, that’s just a rule of thumb, but yes. Obviously with hiring a person comes along expenses and if they’re not turning enough of, or generating enough revenue to even cover the expenses, it doesn’t make sense.
[ROCHELLE]
Okay. Yes. I was kind of feeling that, but then it goes to my next question of what if I hire someone, go through the whole screening process and everything, and then I don’t like them after they start working.
[ALISON]
Yes. It’s like the worst fear, right?
[ROCHELLE]
Uh-uh
[ALISON]
So what I would recommend, because I know you haven’t started hiring yet, correct?
[ROCHELLE]
I have, well, I have one of my former colleagues that I’ve done, like group counseling with and everything that is on board. So having her sign the contract this week and she’s able to do 10 plus hours. It’s my other colleagues that are also interested, I’ve worked with before, but they’re like still working full time. So they don’t want to take as many hours.
[ALISON]
I mean, I would say that making sure your hiring process is really thorough. And obviously we talk about that in Group Practice Launch kind of how to really make them go through several hoops for lack of a better term, just so you can really see kind of the person’s true colors. Like I’ll ask for, let’s say, “Can you give me three references?” Well, if they take a week to get me their three references, that to me is a red flag because then I think like, “Well, if they’re so slow giving me their references, then are they going to be slow getting their documentation done? Are they going to be,” you know what I mean? So it’s those kinds of things I’m really paying attention to but if for some reason you got to the point where you actually did hire somebody and for whatever reason it wasn’t working, I would say right from the outset, I would just establish that communication is open and can go both ways and that means positive or negative communication. So you know, I don’t know if this is your style or not, but how I handle it is I just make it clear that like I’m here to give you constructive feedback, as much as I welcome constructive feedback from you related to me as the boss. So I think when you have that line of communication open, it really helps to address things right when they come up, rather than letting small things kind of fester and turn into big things, if that makes sense.
[ROCHELLE]
Yes. I’m going the 1099 route, the independent contractor route. I know with ,when you have an employee, there’s a lot of laws in place with letting people go. When it’s a 1099, is it similar? Is it easier? How does that work or different?
[ALISON]
Yes, it’s actually, from my understanding, obviously it could vary from state to state, but what I was told when I had contractors, it was actually easier to let go of a contractor. They don’t have kind of the same level of I don’t know if job protection is the right word, but yes, I mean, you can just say, “I don’t have a job for you anymore and your work here is done,” kind of thing.
[ROCHELLE]
Okay. Okay. All right. I will work on setting the standard that we have open communication and it goes both ways and then hopefully it all works out, that nervousness of it all.
Speaker 4:
Yes. And I think too, like we have regular meeting times with our staff and that’s usually the time where we bring that stuff up. And like I said communication can go both ways. So I think that’s also a really good time to bring those things up because they’re expecting to have those conversations. And then also it doesn’t feel like it comes out of left field like that, you’re like giving them some constructive feedback.
[ROCHELLE]
Okay. And then for independent contractors, would I add that into their contract that we would have, some meetings and that I would pay them for it?
[ALISON]
Yes. With a contractor, you don’t necessarily have to pay them for meetings, but you also can’t mandate that they show up to a meeting. So I used to have check-in meetings with my staff and they were contractors and I never said anybody had to show up, but obviously it was strongly encouraged and I think they saw the value in it. So they showed up and nobody kind of gave me a hard time about the fact that they weren’t getting paid.
[ROCHELLE]
Yes. Okay. So far the people that I have in mind that I’ve been talking to that are interested definitely would be open to that. So it’s just, yes. The other ones, the new ones, I think that can be, yes, that could be something that I think will be a good feel for starting the culture of my business. So yes. Okay. So I have to go through that hump one day soon. The other question I had was about like invoicing and payroll. I’m using Simple Practice right now and when it comes to paying my clinicians, it will give me like the income received for the month, which that was what I was planning on, paying them off of. But I got a little confused when we talked about invoicing because then their invoice for the month might not match up with how much I’m paying them because it’s \insurance-based. So it takes time for it to catch up. How did you like manage that?
[ALISON]
So what I had my staff do, was they put on their invoice what they did in that time period and then we ran the report in the EHR and kind of compared the two. And if the claim in there was fully paid, they would just delete it off their invoice and if they were still waiting on that money to come in, they would just keep it on the invoice.
[ROCHELLE]
Oh, okay.
[ALISON]
For the next time.
[ROCHELLE]
Oh, okay.
[ALISON]
Yes. Does that make sense?
[ROCHELLE]
Yes, that makes sense. So I would let them kind of take that lead on, keeping it on or taking it off rather than us doing all that extra. And then when I pay them, I will generate a report from the EHR and give that as like an attachment.
[ALISON]
Yes, that’s how we did it. We would run a report of how much money was collected during that time period and then my contractors got paid 60% of that. And so, yes we would just keep a record of the report that came out of the EHR and a record of their invoice and we would also give them copies.
[ROCHELLE]
Okay. Okay. That makes sense.
[ALISON]
So, in terms of payroll, you don’t have to do payroll in the traditional sense because you’re not going to have W2 employees really. You just need to write them a check. You could literally write them a paper check or the way I did it was I was able to set up direct deposit through my bank. So I could just send the payment right from my bank to their bank for a fee obviously. But that was preferable because everybody’s kind of used to having direct deposits. So that was something they were asking me for when I was writing them paper checks and they were like, “Can we just have direct deposit?” And I was like, “I don’t know, let me find it.”
[ROCHELLE]
Okay. It’s like, I know nowadays there’s Venmo. So could I use something like that or is that not business related?
[ALISON]
I am not sure. I know there was a new version of Venmo that just came out for business, but I’m not very familiar with what exactly it can do but it might be worth looking into.
[ROCHELLE]
Okay. Okay. That’s easy. So my biggest question of it all is so I, and you’re going to be the second person that knows, but I recently found out that I’m pregnant.
[ALISON]
Oh congratulations.
[ROCHELLE]
Yes, very, very early on. So not just like, “Oh, oh, I have to confirm.”
[ALISON]
Yes. You have a timeline now.
[ROCHELLE]
Yes. And so now I’m like, okay, what do I need to do? And can I even take a maternity leave? Am I going to be like delivering a baby and also writing some checks and like managing my business at the same time?
[ALISON]
Yes. Yes. So I’m glad that you brought this up and yes, bravo to you for sharing on the podcast. So I actually went on maternity leave with my third child in the summer of 2019 and kind of had the same realization when I found out I was pregnant that, “Oh, wow. I really need to get a lot of things in order so that I can be off and not be working.” Because that was my goal to just have a maternity leave and not have to worry about what’s happening at work or getting called all the time or whatever. So I definitely think it is doable. I think you do have some time. I think the important thing to remember is that you are really going to want to delegate as much as you possibly can. I think a lot of practice owners start out just like, kind of doing everything themselves because they’re the owner and you know, why hire somebody to do it when I’m here and I can just do it and you know, that kind of thing. But I think even if you don’t necessarily hire somebody to do the job all the time, you’re going to need to find somebody who can sort of be like your substitute, so to speak while you’re out on maternity leave.
[ROCHELLE]
Yes. And would that be like an admin assistant or would that be like another role?
[ALISON]
So what I would recommend is definitely having an admin assistant. I don’t know if you have that person now or if you still need to hire that person, but obviously you still have to kind of train them and have them work up to the point where they feel like, okay, they can sort of handle 99% of everything that would come their way and make decisions without having to run everything by you. That’s the other really important thing. And then I would probably look to hire somebody who’s sort of the clinical director. You could call it different things, but essentially this would be like your substitute when you’re out, like they’re a clinician, the other clinicians who come to them and ask clinical questions, if they need to do some of the things that you were doing in terms of marketing or troubleshooting problems or whatever, like that would be their responsibility. So that’s what I would recommend.
[ROCHELLE]
Okay. And what would be the pay structure for a clinical director?
[ALISON]
Yes, I think you could do it a number of different ways. So if that person is going to be a contractor, you could pay them an hourly rate. Like just decide what that rate is and you could write that into the contract. When I was on maternity leave, we had been doing it, the hourly rate structure and then when I went on maternity leave, I just ended up paying the director a stipend because it wasn’t really clear how much time it was going to take for her to do everything. And so we did a stipend and then we did like profit sharing. So in the three months that I was gone if we had made money than she would have gotten a percentage of that.
[ROCHELLE]
Okay, okay. Could I use one of my independent contractors as the clinical director and like maybe do a separate contact contract for that role?
[ALISON]
Yes. You could certainly do a separate contract or what I, and legally I’m not sure if it matters, but it might be something to run by a lawyer. I had just added an addendum onto my, like original contract that we had, or maybe I just like rewrote the section of the contract that talked about the tasks or their responsibilities and then the pay. So I don’t, like I said, I don’t know if you can just incorporate it into the contract you already have, or if you have to make a whole separate one.
[ROCHELLE]
Okay. That makes sense. Well, you don’t make it sound like not too scary.
[ALISON]
You know, it’s funny is that I read the book Clockwork by Mike Michalowicz. I don’t know if you’ve heard of that, but he basically —
[ROCHELLE]
No.
[ALISON]
Yes, so he wrote Profit First. That’s probably what he’s best known for. And one of his more recent books is called Clockwork and basically he talks about how to set up your business so that it can run without you. And he talks about how you as the business owner should be able to go on a four week vacation and not be bothered. And it was ironic that I was reading that right around the time I found out I was pregnant and I was like, “I’m not going on a four week vacation. I’m going on like a 12 week vacation. So we got to make sure this really is working well before I leave.” So fortunately I already had some of those things in place, like the clinical director was already there and I was slowly over time giving her more and more responsibilities. So it really was just like the final push of like, “Okay, here’s all the pieces that I still am doing that now you have to do.” And really the only thing I did when I was on maternity leave was send the checks to the therapists. That was it.
[ROCHELLE]
That sounds doable, but I don’t have anything on Clockwork yet.
[ALISON]
Yes, so I think that’ll be a good thing for us to talk about in the group when we cover different topics, how you can maybe delegate out quicker than maybe some of the other folks in the group would ordinarily delegate if that makes sense. Because I think as we go along through those different topics, if you’re looking at it through that lens, I think you’ll start to see, “Oh, okay. I’ll just do it this way. Or I’ll make sure that I have somebody else trained to do this thing so that when I’m out, they don’t need to bother me with that. They can just do it themselves”.
[ROCHELLE]
Yes. Okay, I have to just look at this new mindset and this new lens, adds a whole another dynamic to starting a group practice.
[ALISON]
Yes, but I think it’s totally doable. And I think too, like there’s people who start group practices who have other full-time jobs. That’s actually pretty common and I recommend to those people, like right off the bat, you’re going to have to hire to have people do other tasks in the practice because you’re working your full-time job and you just don’t have time. So I think it will be very similar for you. You’re just going to have to think now essentially like, “Okay, I need to start hiring an assistant. I need to maybe start talking to the staff that’s coming on board if they want to be in some sort of leadership role,” or maybe when you advertise to hire new clinicians, you put in the ad that there’s a leadership position available potentially that they could also apply for.
[ROCHELLE]
Okay. Yes, that makes sense. So I have some things to think about in this grand scheme of it all.
[ALISON]
Yes, I think a really good place to start too, and this is actually something we’re going do next month when we talk about hiring an assistant, but there’s a kind of a worksheet that I developed where you go through and you write down every single task that you do in the practice, and then you kind of mark up your list what could be done by somebody else versus what could only really be done by you. And so I think that’ll be really good for you to do something like that with, you know even what you’re doing right now and start looking at, “Okay, what can I give away?” Because it’s sort of like delegation is always a process. Like it’s not just like overnight, you’re going to be like having everybody else do all your stuff for you and you’re going to be like relaxing somewhere on a beach. It’s a process you kind of have to see like, “Okay, can they handle this? Are they good at it? Can I trust them to do it? Okay, good. Yes, they did it well. I am starting to trust them more. Now I’m giving them the next task and the next task.” So I think you could absolutely start now, but it probably, it will be a several month long process to finally get to the point where you feel like, okay, everything is now off of my plate and I’m going to go have my baby and have a whole another full time job to do.
[ROCHELLE]
Yes. So, okay, that makes sense. I can start slowly. I guess that was my other question was like, when should I start having this clinical director start the role, but probably sooner than later?
[ALISON]
Yes, I would start now. Like I said, and just have them do little things to start and then as you see what they’re good at, what they’re not good at. And yes obviously you have to build up trust too. Like I hired my assistant that I have now and like I didn’t hand her the business debit card on day one because I had to see if she was trustworthy or not, but you know, 90 days into working with her and seeing that she was trustworthy, I did trust her to give her the debit card and start ordering supplies and that kind of thing. So yes, it just takes time.
[ROCHELLE]
Okay. All right. Things to think about.
[ALISON]
Yes, and I think obviously it’s like a bigger topic than we could potentially cover in the 10 or 15 minutes that we have in our conversation today. So like I said, I think you’re going to start to see as we go through the different topics, how you can apply that and you know, certainly post in the group too, if you’re like, I’m not sure I’m doing all of this type of tasks. I’m not sure how to delegate it or who to delegate it to, or you know, that kind of thing. We can continue having that conversation.
[ROCHELLE]
Yes, that’s helpful. I knew that I was going to have to start hiring an admin assistant and I was already starting to jot down, “Okay, what are the things that I need them to do and what are the things I’m currently doing?” I guess my other problem is my husband is my accountant because, free labor, why not?
[ALISON]
It’s nice.
[ROCHELLE]
But he’s probably going to be a little busy too. You know, a newborn is busy for everyone in the house.
[ALISON]
Yes. So is he doing your bookkeeping for you?
[ROCHELLE]
Mmh yes. So, and he does all my taxes and, which is our taxes really, because it goes together in the end. And so I’m also thinking about like, oh, I wonder how much he can handle and what’s that going to look like?
[ALISON]
Right. Yes, so maybe that’s a good conversation to have with him, especially depending on the time of the year that baby’s born. I guess depends on if he’s going to be busy with taxes or not, but yes, maybe talk to him about, “Do I need to hire a bookkeeper or do you think you can handle this?”
[ROCHELLE]
Yes, that makes sense, because it is around, supposed to be around ending of December. So at the end of the year and then beginning of the year and then there’s tax season again, so.
[ALISON]
Right, right. And you got to do all that end of the year stuff that you forget about until you’re at the end of the year and you’re like, “Oh yes, all this accounting loose ends that I need to tie up.”
[ROCHELLE]
Yes. And then do you recommend that admin assistants become W2 employees or 1099?
[ALISON]
I think it depends on how you want to treat them. I think it also depends on your state and how friendly they are towards contractors or not. So when I asked my lawyer, if he thought I could hire an admin assistant as a contractor, he said, “Well, if they have other clients and they legitimately have their own business, like yes, you could totally hire them like contractor, but if they’re only working for you and you’re telling them how to do their job, then you should really hire them as a W2 employee.”
[ROCHELLE]
Okay. Yes, I was thinking about, well, my mom retired, so I was like, “Oh, maybe I can give her some work to do.” She might also be busy with the newborn too though so that might be a problem. So that was kind of where I was like, but I definitely would have to hire as a W2. If I did or it’s just, yes, I have a hard time with trusting people don’t know, so —
[ALISON]
Yes, absolutely. And I think that’s one of the big hurdles of starting a group practice and hiring people is that you really start to have to trust that other people are going to do your job, the right and ethically, and they’re going to be trustworthy because you can’t possibly be with them every second of the day. So that’s where I think going back again to the hiring process is so important because if you do a really good job of really seeing who the person is and how they’re going to be as an employee in the hiring process, then you’re likely going to make good hires as opposed to not doing enough of that vetting process. I think a lot of times therapists tend to be very optimistic and they’re like, “Oh, they seem so nice. I’m sure this is going to be great.”
[ROCHELLE]
Yes.
[ALISON]
Well they’ve had one conversation with the person. Well, lots of people can seem nice after one conversation, but are you still going to seem nice after five conversations?
[ROCHELLE]
Yes, and then trusting them with the client stories too, and being able to have that empathetic approach. And yes, that’s the part I’m like, I feel like I have to hire a clinician to do the intake calls, but I know that’s not feasible financially.
[ALISON]
Right. Yes, yes. Yes, if you do get a good assistant though, they can definitely do a good job with that. You know, the other option too could be, especially because you’re needing an assistant sooner rather than later, and somebody who can be really on the ball with things you might want to look at hiring from a VA company. That might be a good path to take right now. Eventually you might get big enough that you need to hire your own in-house person, but when you’re just getting started, a VA company is a nice option.
[ROCHELLE]
Okay. Yes, and typically they’re already trained in the field, so there’s not too many training opportunities that I have to provide?
[ALISON]
Yes. So the one big advantage is that they would likely already be familiar with like your EHR. They already have HIPAA training. You know, if you hire a VA specifically that works with mental health practices, they understand and have training around confidentiality and how to talk to clients who were upset on the phone and all of that kind of stuff that we do within our profession. So yes, much less training. Obviously you still need to train them on how you want particular things done, unique maybe to the circumstances of your practice, but yes, it’s definitely, and then you don’t have to do the whole hiring and vetting process either. Like the VA company’s already done that before.
[ROCHELLE]
Okay. Okay, well it sounds easier.
[ALISON]
Yes. I think, especially with your situation right now, if I was in your shoes, that’s probably the way I would go and maybe just, okay, we’ll do it for a year and maybe after a year we reassess, do we have enough hours and it makes sense to hire our own in-house or is this working out really well? We’ll just keep them.
[ROCHELLE]
Okay. Yes, that makes sense. The other thing is I’m like wary to hire too many clinicians before I go on maternity leave. So I have one that’s going to get hired soon but then I’m a little worried, like, should I stop hiring soon?
[ALISON]
Hmm. That is a good question. What do you think is your bandwidth in terms of how much you’re working now and now that you kind of see how much time goes into bringing on a new person to keep hiring more people?
[ROCHELLE]
Well, I’m hoping that it’s gets easier over the months, once they’re onboarded and they get the systems in place.
[ALISON]
It will. Yes, for sure.
[ROCHELLE]
And so I have been getting a lot of calls. I worked really hard last month on like building up my marketing and so forth. And so I’ve been getting calls and emails like a bunch every day and so it makes me sad when I’m like, “Oh, like, sorry, can’t take you on, or let me put you on a wait list.” And people don’t really want to be put on wait lists all the time. So that’s where I’m like, I really want to hire more people, but I also know, oh, this impending time clock is ticking and do I really want too many people under me while I am going to be unavailable?
[ALISON]
Yes. I actually think in a way that be better. Like I can kind of see both sides of the coin. So that may be an advantage because then when you’re gone, they feel like, oh, there’s other people around, you would have enough money coming in that it would probably feel fine to be paying the clinical director to be in charge while you’re gone. Yes, I could see how it might actually end up being good. I might not hire anybody like three months out from maternity leave just to give them enough time to like, get used to the practice and get to know you a little bit and all of that kind of stuff. But I think up until that point, it would probably be fine. And if you have that many referrals coming in, you could probably even hire like two people at a time and then you just train them both at the same time. So you’re not having to do it like twice in a row, basically.
[ROCHELLE]
Okay. That makes sense, because I was thinking, how am I going to pay a clinical director and an admin assistant with only having one clinician on?
[ALISON]
No, you’re not. If you only have one clinician and they work like 10 hours a week.
[ROCHELLE]
Yes, okay good.
[ALISON]
Good. I guess I was just asking what is your bandwidth for doing that? Because I know that pregnancy is very tiring and I don’t want to stress you out.
[ROCHELLE]
Yes. And the last child made me really sick for the first trimester and a lot of the second trimester. So I’m like, “Oh, I need to prepare for the possibility that I may be not at my desk as much as I am trying to get myself put back together.”
[ALISON]
Right. Yes.
[ROCHELLE]
So the fun part of it all.
[ALISON]
Yes. Any other questions before we wrap up today?
[ROCHELLE]
No, I think I have a lot on my brain now to like put together things and I’m definitely now more motivated and I’m feeling braver to trust other clinicians that are just not out of my network of people because yes, I think that’s just kind of where it’s going for me, especially with this baby on the way.
[ALISON]
Yes. Great. Okay, well you have to keep me posted on how it’s going.
[ROCHELLE]
Yes, I will.
[ALISON]
Thank you so much, Michelle. It was great talking with you.
[ROCHELLE]
Yes, thank you so much.
[ALISON]
Once again, thank you so much to Therapy Notes for sponsoring this show. It makes notes, billing, scheduling, and telehealth a whole lot easier. And if you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your client’s demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE] to get three months free to try out Therapy Notes.

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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.