What are some different and interesting ways to start a wellness center? Can you merge a counseling center with a preexisting business? Why should you consider hiring administrative staff when your practice grows big enough?
In this podcast takeover episode, Alison Pidgeon speaks with Alyssa Buchanan about how to start a wellness center and growing her group practice.
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Meet Alyssa Buchanan
Alyssa Buchanan is a licensed clinical social worker. In 2017, Alyssa opened Skylight Counseling Services in West Melbourne, Florida where she invests her time in facilitating an environment where clients and families feel heard, empowered, and comfortable working with their clinician toward their overall healing and growth.
Last year, Alyssa saw a need for counseling services in her hometown in rural Ripley County, Indiana, where there were little to no counseling resources. Alyssa opened a second location in Batesville, Indiana to serve the population in her hometown.
In This Podcast
- Things to consider when starting a wellness center
- Hiring more clinicians
Things to consider when starting a wellness center
If you are considering branching out your businesses or you want to add another branch to your preexisting company, Alison suggests really thinking about your business model and then how much money you need to get it started.
With a basic business model, you will consider costs that relate to:
- Renting or purchasing a space to use
- Furnishing the space with adequate products as well as any equipment necessary
- Marketing expenses such as launching a website and purchasing ads
You can create the model in the way that suits you best, either allowing you more control or more freedom in your time and energy because you can set it up to be more self-sufficient if you would like.
There are options for starting a wellness center in different ways. You can:
- Approach a gym and see if they are open to collab to create a wellness center,
- Approach a healthy restaurant chain and see if they would be interested in working with you in your branch.
Hiring more clinicians
When you hit about 15 to 20 clinicians you have to start structuring the business differently [because] it gets to be too much for you to manage it all … this is something to keep in mind if you keep growing you’re going to have to look at potentially hiring other leadership positions or hiring more admin staff. (Alison Pidgeon)
When you reach high numbers in terms of having hired many clinicians in your practice, you can start to consider, or reconsider, your goals and time invested: do you want to cut down on the number of clients that you are seeing? Do you still have referrals coming in?
You can switch out some clients to clinicians to free up your time, hire some administrative staff to help you run the business and you can switch up your role from being a clinician yourself to being a full-time CEO.
If I was you I would probably hire somebody whose like an office manager who is physically there as well instead of a virtual assistant who doesn’t ever come into the office [because] you are not physically there, you may want somebody who is physically there. (Alison Pidgeon)
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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 and has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting
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[ALISON PIDGEON] This is the Practice of the Practice podcast, episode number 559. Wow, I am taking over the podcast today. I am Alison Pidgeon, one of the business consultants with Practice of the Practice. We are doing a five episode series where we’re featuring different members of our Group Practice Boss community, and we’re doing live consulting calls. So today I am talking to Alyssa Buchanan. She has been in our group from the beginning so I’ve gotten to know Alyssa quite well. She has a practice both in Florida and the same practice at a different location in Indiana and she talks in the interview about kind of having a practice in multiple states. She also talks about wanting to start a wellness center and we kind of have a conversation about that and I answer some of her questions related to that. So I hope you enjoy this live consulting session with Alyssa Buchanan.
[ALISON] Hi, Alyssa, welcome to the podcast.
[ALYSSA BUCHANAN] Hi Alison. Thanks for having me.
[ALISON] Yes, I’m happy. Happy to have you on the show today. So we’re doing a consulting session, so I’m happy to answer whatever questions that you have.
[ALYSSA] Yes, sure. So in thinking about kind of growth for my practice and expanding to not only a group practice, but kind of thinking more of like a wellness center. So kind of like just trying to think financially how to plan for that growth and it kind of just some insight on maybe like financial planning for growth.
[ALISON] Okay, great. Yes, could you explain a little bit more, when you say wellness center. Are you talking about like a totally different business, are you talking about expanding the current group practice that you have? What does that look like?
[ALYSSA] Yes. So in thinking about that. It probably looks a little bit like a separate business. So that would kind of entail like full body wellness. So gym training, diet, dietician, nutrition, as well as possibly like massage work and also considering maybe like chiropractic in there. So that’s kind of essentially a second business, but a branch of kind of the group practice as well. Like they would play off of each other.
[ALISON] Yes. Nice. I know a lot of people now are thinking more along those lines of how do you integrate health care together, because everything is so siloed and so now this new concept of the wellness center is really taking off, which I think is really cool. So I guess you would need to think about what is the business model, like how are you going to make money essentially and then once you figure that out, you could start planning for how much money you need to get it started.
[ALISON] Does that makes sense?
[ALYSSA] Yes, for sure.
[ALISON] Okay. Okay. So have you thought through what the business model would look like?
[ALYSSA] Yes. So there would be money obviously coming in, different revenue streams depending on what services we do offer kind of like with a group practice. Obviously, we offer mental health counseling and that revenue stream comes in through that. So it would be essentially the same kind of thing where revenue stream would come in from those different avenues.
[ALISON] So you would employ the different wellness practitioners in some form or fashion, like they’d either be contractors or employees or something?
[ALYSSA] Yes, that’s correct.
[ALISON] Okay. So essentially startup costs for that model would be getting the space and I’m guessing you would maybe furnish the space or would you expect them to furnish their own space?
[ALYSSA] Yes, so we would probably furnish it for them as well as like, if we do a gym that would obviously like gym equipment and such, but it would be furnished.
[ALISON] Okay. So that’s probably your main startup expenses would be the space, the furnishings, the marketing, the website, all of that kind of thing?
[ALISON] Yes. I don’t know if there would be another, probably having some kind of front desk staff would be necessary like right off the bat.
[ALISON] So you’d have to hire somebody, a person kind of admin position or a receptionist or something. And then I guess it comes down to how big is the space that you’re going to need. Like, do you need five distinct spaces? Do you need 10 distinct spaces? Obviously that can, the price of that could vary.
[ALYSSA] Right and so that kind of leads into the next question that I’ve been debating is looking for a space to rent or building a building and what that looks like in our area. So I’ve also been taking that into consideration.
[ALISON] Yes. Yes. I actually had a similar idea a couple of years ago and we were looking at a space to purchase. That ultimately fell through, but I can kind of share with you the business model that we were going to do, if that would be helpful because it’s somewhat different and it might be more appealing.
[ALYSSA] Yes, sure. I’d appreciate it.
[ALISON] Okay. Yes. So what we we’re going to do is we’re going to purchase the building as a wellness center and it was an older building so it needed to be remodeled, but had this space, like had lots of different office spaces and had like a big lobby area. So we were actually going to, it was going to be more of a tenant model where people who had already established like wellness businesses, like you’re talking about, a massage therapist or chiropractor or that kind of thing could move their business into our space, and basically they would still operate their business as they were but they would be paying rent. And then on top of that, they’d be paying more for like the other amenities that were available to them like the wellness center being marketed as a whole, having access to the receptionist at the front desk. All of that kind of thing.
So in that model, I think obviously you still have that initial like startup costs of the building and maybe furnishing some of the spaces, but maybe the other spaces that people are renting that would be their responsibility to furnish, or they might have already everything they need because they already have an established business.. And then we were looking at it like, we’re the landlords and they’re the tenants. And so I’m not necessarily involved in the day to day of like having to get you clients or whatever. It’s just like we’ll market center as a whole, we’ll provide the receptionist at an added fee, and then we were also looking at potentially putting in like a cafe that would sell healthy food and also potentially like a little like retail area that would sell other kind of healthcare products, just as a way to generate other income. So all that being said, there’s a few different ways that you can go about it. I think you just have to think through like, what makes the most sense for your situation and how involved you want to be on a day-to-day basis as well? I liked that model because it felt like I wasn’t going to have to be as involved in the nitty gritty of the practitioner actually providing services. I was more going to be like the landlord.
[ALYSSA] Right. So, yes, I hadn’t really considered looking at it like that. So that actually gives me some good insight. I maybe thinking about it a little differently. So not being quite so involved, like you’re saying they already, you had figured they would already have their businesses established and then they’re just renting this space, but you’re still marketing it as the wellness center as a whole.
[ALYSSA] Okay. Cool. Well, thank you for that insight. I mean, that definitely gives me a different way to think about it and a little more hands-off with that approach as well. So cool.
[ALISON] Yes. So, again, it might be a little bit less expensive to start it up that way but the other thing too, for the things that you don’t necessarily know a lot about like starting a gym or something like that, like maybe you approach an already existing gym and say, “Hey, what if you had a kind of satellite in our space or,” you know what I mean, and then like they come in and they already know how to do everything and they just set up another version of the gym and your wellness center. So again, you’re not having to like reinvent the wheel, trying to figure out how do I set up a gym or like buy all the equipment to start the gym.
[ALYSSA] Right. Great thinking. Don’t re-invent the wheel.
[ALISON] Right. Yes, we were actually going to do the same thing with the retail and the cafe. Like I was talking to a local restaurant that specialized in healthy food, like gluten-free and vegan food and that kind of thing to like, “Hey, could you come in and basically you just rent the space from us, but you are worrying about making the food and having somebody there to serve the food and all of that kind of stuff?”
[ALYSSA] Great. Cool. Curious, what made you not proceed with this avenue? Did it just not like work out the way you were thinking? I’m just curious what made you not proceed.
[ALISON] Yes, so our whole model was really based on like owning the building and the way that we were doing the financial projections, like, it seemed to be quite profitable, but we were like outbid for this building.
[ALYSSA] Got you.
[ALISON] And then we ended up kind of going in a different direction and haven’t found a similar building with the same kind of setup and the size. Like the building I think was like 10,000 square feet. So it was a really, it was just laid out very nicely for that kind of a model, but yes, like I said, ultimately we got outbid for the building. And so the idea sort of went by the wayside along with that, along with purchasing the building, unfortunately. But if somebody else wants to take my idea and do it, I would love that. I think that would be so cool to actually see it come to fruition.
[ALYSSA] Right. Yes. Well, cool. Okay, so switching gears a little bit and talking more about the group practice that we do have, and considering kind of like hiring needs. So at what point does hiring again make sense or hiring again doesn’t make sense. So like coasting with what we have or continuing to grow, and I feel like I’m in this spot where it could go either way and kind of maybe just some insight in your experience about continuing to hire, just kind of letting things coast. And is there kind of like a max that you want to get to or not? I haven’t decided that for myself yet, but just talking through that a little bit.
[ALISON] Sure. Yes. So how many therapists do you have now?
[ALYSSA] Yes, so we have 10 clinicians within two locations, including myself.
[ALISON] Okay. So I think here’s a few different ways to look at it. One is when you hit about 15 to 20 clinicians, you have to start structuring the business differently. Like it gets to be too much for you to manage it all. So that’s not telling you not to do it, but it’s just something to keep in mind. Like if you keep growing, you’re going to have to look at potentially hiring like other leadership positions or hiring more admin staff or something like that because it just, the volume hits like this tipping point and you have to start doing things differently. I think you also have to think about what are your goals in terms of income or your time, or do you want to cut down on the amount of clients that you’re seeing? But obviously you probably want to keep your same income or increase your income and then that necessitates hiring more people. Do you have the referrals coming in?
[ALYSSA] We do. Yes, we have the referrals, so filling a person isn’t really the issue. We are kind of starting to run into a bit of a space issue as far as, because we are seeing people in person for the most part, so just kind of like scheduling with the space we have. So that kind of leads into the other thought of another location, but then that adds more costs. So there’s just kind of a lot of factors that are playing into it right now, but the referrals are definitely there.
[ALISON] Okay, and does it tend to slow down for you in the summertime or does that not seem to be —
[ALYSSA] I would say maybe a little bit, but not significantly.
[ALISON] Okay. Because I know that where, I mean, obviously COVID has really messed all of that up, but where I am at it typically slow down in the summertime and so I will try not to start somebody like in July because it’ll just be really slow to get their caseload filled up. So at this point, like if I don’t hire somebody soon-ish, you know we’re talking now the end of March I’ll just wait and hire somebody to start like September.
[ALYSSA] Got you. That makes sense.
[ALISON] Yes, so I mean that, it might be a little bit of strategic timing on your part too, just given that you probably know when things slow down and when things get super busy, but I guess my other question for you is what is your vision of the practice, like how big you were thinking you wanted it to be?
[ALYSSA] I’ve been asked that question a lot and I don’t ever really feel like I have a great answer because I never thought it would be this big as where I’m at now. And really the goal has just been to be continuing to serve our community in whatever fashion that looks like. And as a result, we’ve just kept growing because the need has been there and obviously the need is still there. So the goal has been to serve our community and I feel like in order to keep doing that, we will have to keep growing. And I’m not really against it. I just want to be able to do it in the right way. So it’s not too fast or not effective I guess.
[ALISON] Yes. So I think in terms of the not wanting to grow too fast question, I think that really comes down to, do you feel like you have a good handle on catching small problems before they become big problems? Are you tracking data? Are things running smoothly, because obviously if there’s weak spots, you want to get those shored up first before you start hiring more.
[ALYSSA] Yes. So I feel like the systems we do have in place are effective. We are tracking and things run for the most part pretty smoothly and if things come up, we’re able to handle them without a major episode happening. I do think that we’re at the point where we need to hire some more administrative help and I think that would definitely have to be done maybe even first before we would hire more clinicians. So kind of right at that point where the office manager is kind of struggling to handle it all. So I think giving another person would give more work. So we’re kind of right at that breaking point as well as far as things are running smoothly. I would say for the most part we run pretty smoothly.
[ALISON] Okay, good. Yes, good for you, because that’s actually probably not common. Most practice owners are like, “Oh yes, this thing’s broken and this thing needs to be fixed.” So in that case, yes, you’re absolutely right. You should probably hire more admin staff before you hire more therapists because you want that person in place before the volume really starts to ramp up, otherwise what ends up happening of course is that those things fall back on the owner. And you don’t want to be the one answering the phone and stuff. So even though it may feel like a little bit of a stretch to maybe hire somebody or you’re not quite sure if you have, you know a lot of hours for them yet, I would definitely get them in place. And then I think the only other thing, like I said is when you hit that 15 to 20 clinician threshold is when things really have to start functioning a little bit differently and just kind of deciding am I going to stay under 15 or am I going to go above that?
And then obviously if you go above that, it’s a whole another discussion that we can have about what that looks like, but I think you probably would be fine with adding more admin staff, hiring some more therapists up until that point. And you could probably just keep running things as you are now.
[ALYSSA] Okay. Thanks for the feedback.
[ALISON] Yes, does that answer your question?
[ALYSSA] Yes, it does. Thank you. So also kind of along the same lines, we do have an office in Indiana, which, our primary office is in Florida, but we have an Indiana location and I have been running that kind of from a distance along with the clinician that works there. So in terms of growing that location, just trying to think about being effective from a distance while making sure to support her and any other staff we bring on there. So that is something that I’ve been mulling around as well, like how to be an effective boss, I guess, from a distance and support the staff there and meet that need as well.
[ALISON] Yes, that’s a great question. And I think it’s so great that expanding into multiple states. I know a lot of therapists ask about that. So I think it’s really cool that you’re doing that.
[ALYSSA] Yes, thanks.
[ALISON] Yes, and I would say this is actually not uncommon either that somebody might start a practice and they move away or just for whatever reason, they’re operating a business at a distance. So obviously you’re not like running up to Indiana all the time.
[ALISON] Which is totally fine but I think you just have to think about it a little bit differently in terms of like, you need to have somebody physically there who has some sort of leadership role or some like authority to do things. So for example, like maybe you want to have somebody as the clinical director and they’re like the first kind of point of contact if they run into an issue and then obviously if the clinical director doesn’t know what to do, they can reach out to you. But I think it’s just so important to have somebody who’s like physically in the office who’s like noticing things that maybe other people aren’t noticing like, “Oh, this thing is broken. It needs to be fixed”. Like they’re the ones who call the landlord. Like you’re not going to be in the office. Like you’re not going to see that thing is broken, you know what I mean? It’s like somebody who has that sort of perspective and also has the authority like to do those things on your behalf. Does that make sense?
[ALYSSA] Yes, for sure. I feel like my clinician that’s there currently would probably move into that role of like kind of more a director and probably maintain a caseload as well, but oversee other staff that we would bring on. I would feel pretty confident with her doing that. So I agree with you that, that is important because I am obviously not there so I can’t see what’s going on day to day.
[ALISON] And I would say too, if I was you, I would probably hire somebody who’s like an office manager, who’s physically there as well, instead of like a virtual assistant who doesn’t ever come into the office because you’re not physically there. So you just want somebody physically there, whether it’s because the mail needs to be picked up or supplies need to be ordered or whatever, but I would definitely have that structure set up as well.
[ALYSSA] Okay. That’s good feedback too. Thank you.
[ALISON] Yes. Yes. What other questions do you have?
[ALYSSA] So those are my three questions for you.
[ALISON] We solved all your problems.
[ALYSSA] Yes. Well, thanks for today.
[ALISON] I can certainly answer your other questions or if you have a few more minutes, maybe we could talk about how you opened up your second location in a different state. Because like I said, a lot of people do have questions about that. So if you wouldn’t mind talking that.
[ALYSSA] Yes, sure. I don’t mind speaking to that at all. I’ve been asked that question a few times, so I’m happy to share my experience with that.
[ALISON] Okay, great. So how did you do that? What were the logistics of having to set up an already existing business in another state?
[ALYSSA] So I should probably answer the question of why Indiana first, because that’s almost the first question I get. And the reason is because that I grew up in Indiana, a very rural community there, and there is just a need for services of all kinds, but there’s really no, not many, I should say counseling services there. So kind of was approached knowing that I had this business in Florida, it was something that I would be able to duplicate there to meet the need that they experienced. So I opened last year in the middle of the pandemic. So logistically we opened just online for telehealth. So I didn’t have to have an office space at first. So I think that made it a little bit easier because it was just telehealth and so the need to open an actual physical location wasn’t prominent because of the pandemic. We were only doing telehealth so that need initially wasn’t there. We have since opened a physical location, but I knew a clinician needing a job, so I was able to hire her right away and then we just basically duplicated the things we already had in place in Florida.
We just made them specific for Indiana. We did have to make a whole new website to keep it separate as well as kind of our social media accounts. They’re separate. So those things are separate. Our EHR, we also have a separate EHR for Indiana, just to keep it separate because it would have been way too confusing if it was together and then a separate phone line, obviously. But as far as opening, the opening itself went fairly smooth. Like I said, because it was all telehealth at first. And then we were actually approached by, well, we had some conversations with the local chiropractor there and he had some office space open and was aware of the need and kind of just reached out and said, “Hey, if you want ,whatever you want to rent some office space, I have the space. You’re more than welcome to rent it from us.”
So that actually just kind of fell into our lap and worked out really well. So we share an office space with the chiropractor and kind of work off of each other. So we get referrals from him and give him referrals and it’s actually a really great partnership there. So that worked out really well. I do think well, I mean, we’ve grown a lot even just since we opened in August, so we’ll probably eventually have to get a bigger office space. So that’s kind of in the works as we consider growing and then obviously like just talking to an attorney in Indiana to make sure we’re following all the legal forms and ways of opening a business in Indiana. And we just ended up opening like just, it’s called a foreign entity. So we had to fill out paperwork for that since we are already established. We just had to establish with the state of Indiana, but I believe every state’s different. So it’s probably just wise to talk to an attorney that’s familiar with like the state laws where you’re opening.
Yes. I don’t know if that answered all the questions, but that was kind of the basic process for us as far as opening.
[ALISON] Yes, that’s great. So do you have your admin staff in Florida helping out at the office in Indiana?
[ALYSSA] So she helps out when needed, but the clinician in Indiana is, she primarily handles the phones herself. That is going to be probably our next hire is to hire someone who takes that role over from her because now that she’s really busy that’s kind of becoming a little bit more challenging for her to handle. But our admin in Florida does help out when needed so I think that will definitely be a separate need though, to have a separate office manager for Indiana.
[ALISON] Right, right. Nice. Yes, that’s great. That’s really helpful kind of just running down on the bullet points of all the things that you did to get it set up. And I know that was kind of a question that you had about do we keep websites separate, social media separate and it sounds like that made the most sense in terms of just lessening confusion to keep all of that separate, even though it’s the same business name.
[ALYSSA] Yes. So, so we did that because of like, the reason why we ended up doing a separate website was because of the feedback we got was for SEO purposes. It needed to be separate. So it could pull from two separate locations, which, thinking about it, like that makes complete sense. And then as far as social media goes, a lot of our posts are the same. We just share them between the two social media accounts. But for the same reason, it just made more sense to have a separate social media account too so people didn’t get confused when looking at it and were like, “Wait, Florida? I’m in Indiana or Indiana, Florida.” So it just was hopefully not as confusing for clients seeking those services.
[ALISON] Right. Awesome. Well, thank you so much, Alyssa. I really appreciate your time and your questions and you need to keep me up to date on what you decide about the wellness center.
[ALYSSA] Yes. I will. Thank you so much for your feedback on everything. I really appreciate it.
[ALISON] Yes, absolutely.
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Thank you so much for letting me into your ears and into your brain. I’ll talk to you soon. Bye.
Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.