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Welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon your host. Today I have an interview with Rob Magill. He is a group practice owner who actually doesn’t live too far away from me. He lives about 20 minutes North of me in the same County in Lancaster, Pennsylvania and he became part of our Practice of the Practice community and decided to do some consulting with me to grow his group practice. And he has just had explosive growth in a short amount of time and he’s going to tell you all about that in the interview. I’m just really impressed with everything that he’s done and I think he is really a testament to just continuing to make little small steps that get you to where you want to go and just being persistent. He made some really strategic investments with getting help from a virtual assistant early on, and he has some really good advice for people who are looking to start a group practice. So definitely listen to this interview, if you’re in a position of really wanting to scale up your group practice. Even if you’re just thinking about starting a group practice, this would be the one for you to listen to. So here is my interview with Rob Magill.
[ALISON]: Hi, Rob, welcome to the podcast.
[ROB MAGILL]: Hi Alison. I’m glad I can be here today.
[ALISON]: Yeah, can you just start out giving us a little bit of an introduction of yourself and your practice?
[ROB]: Yeah, absolutely. I am an LPC and I have a group practice in Ephrata, Pennsylvania. We tend to focus on helping couples and families and I have about 10 clinicians working for my practice at this point filling them up the last year and a half.
[ALISON]: Yeah, that’s amazing. I’m definitely going to ask you more questions about that, but I just wanted to say that you and I are neighbors. We live probably about 20 minutes apart.
[ROB]: It’s a small world.
[ALISON]: Although we have never met in person, I don’t think.
[ROB]: No, we haven’t. I think we wee planning to meet up and then all the COVID stuff came up and I think that got hard a little bit,.
[ALISON]: Right, right, right, right. So yeah, that’s amazing. So when did you kind of decide that you wanted to start the group practice? Like what was that decision making process like for you?
[ROB]: So it was a little bit of a longer process. I worked at an agency and then ended up in private practice and put up most of the skills I needed to run my own practice. I was, “Well, if I can do this, I might as well start my own practice.” I also enjoy kind of the mentoring aspect of things. So even starting my own solo practice, I knew I eventually wanted to make it a group practice and got kind of everything working pretty well for just myself and then figured it was kind of time to jump into adding clinicians. I also recognized at that point that for my income to change, I would just have to keep adding more and more clients. And that wasn’t something that I wanted to do. I didn’t want to work 80 hours a week again as well. So my solution for that was to start hiring additional clinicians.
[ALISON]: Great. And are your clinicians contractors or W2 employees?
[ROB]: They are 1099 contractors.
[ALISON]: And was that hard to make that decision or was that something that you felt like was pretty simple to make that decision?
[ROB]: No, that was pretty straight forward. Every job I’ve had in the field, it was a 1099 position and some of my perspective is to hire great clinicians and then just kind of support them so they can be free to go and do the work that they do. So the 1099 model made more sense where they just kind of go and do their own thing and I provide some support for them.
[ALISON]: I think that’s a very common model in this area, like in Pennsylvania in general, that most of the practices are set up that way. That’s how I had my practice set up in the beginning, so yeah, there’s a lot of advantages to it, for sure. So do you have like a specific, I know you said you sort of focus on like couples and families. Is there a specific way you market the group practice as a whole, or how do you kind of present that to the community?
[ROB]: Absolutely. So I do present it as, we work a lot with couples and families, but that all of the clinicians at the practice have their own specialty with a little bit of overlap. So what that allows us to do is if I’m working with a couple and the husband or wife will both need to meet individual counselors, someone else here is going to have the experience and training to help them as well. And it also lets us work really well with an individual because we have such a wide breadth of expertise. We can probably help most people that will call looking for services. And it allows us to address the whole family system instead of simply the one client or the couple that comes in. We have that capacity to help that whole family.
[ALISON]: Yeah, that’s great. Because I think that once people get familiar with a practice and they obviously are having a good experience, like if they have other family members or need other types of services, they would just rather come to the same practice.
[ROB]: Absolutely.
[ALISON]: Great. So I’m curious about, I know you said in the past year, a year and a half, you’ve grown from obviously one clinician, which was you to 10 clinicians, which is amazing. So, was that something that was very kind of well thought out for you or did that happen organically or is there, you know, to grow to that size in that amount of time, is that something you would recommend to other people or not?
[ROB]: So, literary both.
[ALISON]: Okay.
[ROB]: So, initially, it was myself. I hired my first clinician and I was able to muddle through some of that and then I was looking to bring on a third clinician and I was thinking down the road for that and I realized, I didn’t know what I don’t know. And then that’s when I reached out and connected with you. So that whole process I’ve been strategic and also a little bit organic, mostly organic, a little bit strategic with that. So my general rule of thumb is I’ll try and bring on maybe two or three clinicians at a time and then wait until their caseload is pretty full and then kind of reassess how are the intakes and probably look to hire another two or three clinicians and just kind of keep going. I don’t want to have any more than 15 clinicians, just my experienced practices.
I don’t want to get any larger than 15. So just doing really good with the intake process, the referral process, and as things catch up, fantastic. It also gives me a chance to figure out how each clinician manages their caseload here. Some clinicians are fantastic at client retention, some, just the clients that they work with and their approach, it tends to be a little bit quicker. So it gives me a chance to figure out how all of that balances out and then calculate when would be decent time to hire another clinician.
[ALISON]: So I’m going to ask you a question about that. So that’s interesting to me that you bring on like two or three clinicians all at the same time, because I think a lot of people just like hire one, wait until they get pretty full, then they hire the next one. And so they try to like stagger out one person at a time. What do you think is the kind of advantage to hiring two to three people at the same time?
[ROB]: So one of the advantages is if one clinician has a difficult time building their caseload, I have the other clinician to balance out some of the revenue at that point. Another advantage is that I have, I’ll say more buckets to hold new clients. So in terms of the other clinicians at the practice, the referrals might slow down, maybe one or two clients a month, not massively significant until the other clinicians catch up. But I also have a lot of clients calling in that have to go somewhere. So it gives more room, more flexibility for that. And it can take me maybe three or four months from the time we started looking for a clinician until they’re onboarded and have a decent rhythm down. So it doesn’t make sense to me to go through that process. “Oh, wait, everyone’s pretty full. Let me start that again.” I really don’t have that three to four months to wait without referring clients out. So by bringing on multiple conditions, it allows me a little more time and flexibility with that as well.
[ALISON]: Okay, nice. I know Whitney Owens, my fellow business consultant says that she feels like it’s always easier to bring on two clinicians at once because then she can just do the training one time for two people, because that can be time-consuming too.
[ROB]: Yes, I especially with a log of remote work this past year, I ended up creating some help videos basically, and then I’ll have that an online course for my new clinicians, to make that more consistent, more accessible. And then it doesn’t matter, bu3t we don’t have to necessarily meet. It can just be, “When you have a chance, go ahead, look at these videos and get shaped pretty up to speed.” And I’ve found that that is really helpful in pushing out some of that basic information, making sure they know how to work the platforms and all of that without being more time intensive than it needs to be. Plus they to do it when they’re relaxing on a timeframe that works.
[ALISON]: That’s great. And I think that’s something we definitely recommend to people is having that training, at least part of it documented in some way. I think it’s just when you’re already so busy, it’s hard to think like, “Oh, how am I going to take a couple hours out of my day and like make these training videos?” But you’re really saving yourself time in the future.
[ROB]: Yeah, absolutely. And have something to refer back to. So if a clinician keeps asking for help with the same platform, “Hey, go back. Rewatch these two or three videos and that should help you align. And then if you have any questions on that to follow up.” And that’s been helpful as well.
[ALISON]: Great. So I know you’ve done a lot with making sure your systems were set up. So everything was running really efficiently and I know you kind of hired a VA early on. So do you want to speak too a little bit about the systems and how that has influenced how your practice is running?
[ROB]: Yeah, absolutely. I’m huge on systems. If the system doesn’t work, then the practice can’t work. And a really good system takes a lot of stress and pressure off because then when something comes up that applies to that system, it’s just kind of plug and play. Just plug into the system, but the system play out and you have a result that you’re looking for or at least pretty close. So, and systems that work for one person or even two or three breakdown when there’s nine or 10 or as things grow. So the initial system was basically I did everything.
[ALISON]: Which probably was not sustainable in any shape or form, right?
[ROB]: Even shortly before I hired my first clinician, I was starting to look for a VA in part, because I would be out with my family, I’d get an intake call. And I noticed for new clients, if I didn’t get back to them within two or three hours, I probably lost them as a new client.
[ALISON]: Right.
[ROB]: So I’m driving down a highway and my work phone rings and I go, “Great. What do I do with that?” So I knew I was missing new clients and I couldn’t give them the focus I needed. So having a virtual assistant helped because they were available during normal business hours to take those phone calls. So I didn’t have to. And you know, their strong advantage is they’ve worked for other practices as well. So that means I don’t have to pay them to be available 40 hours a week every week. I just pay essentially for the time that I use and then the rest of their income comes from the other practices doing the same. S\o it’s a pretty, I found it to be a pretty cost effective way to get, I’ll say, intermittent or sporadic help throughout the day and take a huge workload off of me.
[ALISON]: I think that’s the big advantage of hiring from a VA company, especially when you’re just starting out because you don’t, you’re not big enough or you don’t have enough money coming in to hire your own in-house person. So it’s a really nice way to get that help without having to pay like a full-time salary for someone.
[ROB]: Absolutely. So with that, I had to start documenting all my processes. I basically just sat down and did all the processes I wanted to offload myself and then noted down every single little step for that and then basically transform it into almost like a training manual for the VA as a way to document that. And I like to keep things pretty fluid. So as the practice expanded I was initially using three, basically three sets of software were initially involved in the intake process [inaudible 00:15:24] The practice changed but then that workflow, not working as well when there was more clinicians. So one of the changes we made is clients are required to complete their paperwork within 24 hours of getting an appointment scheduled. It’s not before their appointment, but after we schedule with them.
And the reason for that change is that we noticed a lot of new clients who don’t fill out the paperwork or fill it out very last minute or might not show up anyway.
[ALISON]: Right.
[ROB]: So it’s a way to reduce the no-shows, but then with that, okay, now we need a new workflow because the next day we’re calling to follow up and then that’s when work for the VA. So there’s a way that we can streamline that. So just being very open and responsive to feedback. And same thing from clinicians. I’ve heard them mention sometimes, “Hey, maybe this piece of software isn’t working right in this way, or when I get this email, it doesn’t make sense.” So being receptive to that and not trying to do it my way, trying to do it in a way that’s going to work for the staff and for the clients, because when that works, then everyone’s going to be happier. And in the end, that ends up working out best for everyone.
[ALISON]: I’m really glad that you brought up that point about systems have to be somewhat fluid because like you said, as your business grows, volume increases, the system you originally had may not work anymore. And so you need to be flexible to realize like, “Oh, we need to tweak things or find a new way of doing this or whatever.” And I think that’s the one thing that I see happen a lot; is group practice owners get so bogged down in like the day to day of just trying to see clients and do all of the bare bones stuff to keep the practice running. They forget to look at, “Are my systems still running well because I set them up six months ago?” And then it, you know, things might be different now. So you might have to look and see like, are we doing a lot of redundant work or something like that.
[ROB]: And one of the things I’ve found helpful from Practice of the Practice was that you almost want to hire additional admin staff a little bit before you can afford them. Not that you want to go broke with that, but I found this huge value in having a VA and I hired the practice manager as well; is just how much time that frees up on my end so I can focus on other things. I can focus much more on networking on the marketing piece, on the social media, because I’m not bound down with the day to day. And then just checking in with two people pretty consistently. So I even try and check in with 12 or 13 people consistently.
[ALISON]: Yeah, that’s great advice because I feel like people, what we see happen, especially in the VA company is that people wait too long to hire a VA and they’re like totally drowning in work and don’t even have the time to train the new person. So I’ve actually done the same thing. Like I hired my office manager that I have now back when we didn’t quite have full-time work for her. But I hired her full time and it really forced me to like, look at what I was doing and see how many other things I could give her so that obviously she could work full time. So yeah, I totally agree with that. Even if you’re like, “Oh, I don’t really know if I have 30 hours a week of work or whatever.” Like just hire the person and you will find work for them to do.
[ROB]: Yeah, absolutely. The package I got, any smaller package was not enough, but then the initial package I got with my VA was more than I needed. So then the end result is that first month, “Okay, Hey, can you do this? Can you do that?” And I had to get creative in what to offload. But then it also forced my mindset of, “Wait, why am I doing these routine tasks that I know particularly like, and my VA absolutely loves doing a lot of that?” So fantastic. She’s doing something she loves. I’m not going to be doing something I don’t like. And it frees up my time.
[ALISON]: Total win-win. So I’m curious, what is the difference then between your office manager, who I assume is like, if the office was open, would be physically there versus the VA who’s obviously remote.
[ROB]: So there’s a little bit of overlap with this, but the way I generally try and set it up is that the VA handles the client side and the practice manager handles the clinician side.
[ALISON]: Oh, okay.
[ROB]: So, the VA handles the intakes, any general requests for information, client scheduling, if they’re going to reach out to her instead of the clinician, following up with intake, paperwork, things like that. The practice manager follows up with, so she does help with billing. She helps with clinician schedules, kind of monitoring the clinicians’ caseloads, a thousand random tasks that, what makes sense for the VA to do, she does as well.
[ALISON]: Okay, great.
[ROB]: A couple weeks, a month ago, I wanted to say, I had to be out for about a week and my practice manager had to be out for a week.
[ALISON]: Oh, no.
[ROB]: In the same week, but the advantage of having them, and they’re going to finish up next month with the cross training, is all three of us can do everyone else’s job as well. So in the unfortunate, in case that happens again, it might not be ideal. It might not be pretty, but all of the functions of the practice can continue even with a majority of the admin staff not there.
[ALISON]: Right. And that’s really smart because obviously, people are going to go on vacation or get sick or whatever, and you have to have a backup plan.
[ROB]: Yep. Absolutely. And they’re both very competent in what they do and they could do each other’s job if they had to. So why not? And I’ve found that the longer I’m not doing what I’ve delegated to them, the worse I am at that. So sometimes a bigger help it is if I don’t step in, but it’s a good sign that I’m able to focus on other things as well
[ALISON]: Yeah. Great. I know obviously, growing to 10 clinicians, you probably learned a lot along the way. I’m curious what advice you would have for other therapists who maybe like right on the beginning stages of starting a group practice.
[ROB]: So I think two suggestions I’ll have. One is in terms of hiring clinicians go very slow. Most of the about three months to onboard someone is me finding the right clinician. To steal from Simon Sinek a little bit who wrote Start with Why, I try to find clinicians, find and hire clinicians who share very similar values that I do and that want to have the practice have. And they don’t have to say the same way I do, but through the interview process, I want to hear if they’re able to express it, those same values. And what I found is that allows for a very client success oriented practice. And they’re all willing to work with each other really well because they have those same underlying values that drive them to be willing to work together.
[ALISON]: So how do you make sure then you’re hiring people with the similar type values? Like, are you talking about that in the hiring process or how do you figure that?
[ROB]: So some of that is through my interview with them. Just the way that they respond to some of the questions I ask about some difficult things that they’ve accomplished. Some things that they’re really proud of with working with clients. A lot of times I’ll present like a case study to them basically, and see how they respond to that. I ask about kind of their flow of your ideal client walks in for their first session up through discharge. What’s that process look like for you? And typically through the answers to those questions, I’m going to get a pretty good feel for their approach and what’s important to them and if by the end of the interview, that’s not there, I’m going to pretty bluntly basically say, “Hey, here’s some values that are pretty important. Can you elaborate on kind of your perspective on them and see what they say?”
Also I tend to be more extroverted and make decisions kind of quickly. So we as counselors, help people who are not in a great spot, especially when they show up for their first couple of sessions. If I’m interviewing someone and I feel more anxious interviewing them, or they don’t put me at ease, or if I feel like I’m pulling teeth to have a conversation with him, well, I just kind of ramble naturally. So something about the interactions kind of shutting things down, that’s probably not someone I’m going to hire. I rather have someone that feels like I’m just having a conversation with and that can put me at ease. I don’t feel any more nervous with them. So those are signs that they’re probably going to be able to work well with the client to get them to talk. They’re not going to try and overstep the client that they can help put them at ease as well.
[ALISON]: I think that’s a really good point. One of my kind of measuring sticks is if I would feel comfortable sending one of my family members or friends to this therapist just from like that initial kind of rapport that you build with them in the interview and kind of the, I don’t know what the word I’m trying to think of is, but sort of just that feeling you get from that person. And that, if it’s somebody I wouldn’t send a family member or friend to, then I won’t hire them. That sounds like you’re thinking about it in a similar way.
[ROB]: Absolutely. One last point on this, and I’ll mention the other point, is also just because you’re a great therapist doesn’t mean they’ll be a great therapist for your apprentice.
[ALISON]: Right.
[ROB]: I know from talking to colleagues in the area that they’ve hired some clinicians I thought would be absolute disaster for me to hire but did really good at that other practice. They’re not a bad clinician. They are probably a great clinician. They are just not a good clinician for here. So to be very focused in, they could have great references but doesn’t mean they’re going to be a great clinician here. How are they going to fit at that practice?
[ALISON]: Exactly. Any other advice you have for people who are just starting out?
[ROB]: The other one is to be creative and I don’t mean artsy, but it’s okay to think outside of the box. One of the most helpful things in terms of online marketing, so like Psychology Today, things like that. One of the segments I watch through Practice of the Practice was on and I think it’s like storytelling marketing. So helpful. So I changed my Psychology Today profile and basically told a story from the perspective of my ideal client and then basically said, “Hey, I love working with people like that and can be very successful in helping them give me a call.” It is based on my Psychology Today profile. It connects because it shows the ideal client I get their day-to-day life to the point that I’ve had clients, some say, “Hey might wait for it to Psychology Today profile.” And I said, “That’s me.”
[ALISON]: Oh, wow. That’s awesome. So did you notice a big change when you changed up your Psychology Today profile to have it, because I think I’ve seen it. It’s more of like a story about your ideal client. Obviously it’s a fake made up story, but did you notice a big difference in the amount of calls that you were getting?
[ROB]: Yes. What I noticed was in the type of calls. So I wasn’t getting the strangest client that I can work with them. I don’t love working with them, but I can. Pretty much all those calls stopped happening. The calls that I was getting, they were all pretty much my perfect client.
[ALISON]: Wow.
[ROB]: Do I get as many? I’m not sure. Most of my clinicians have Psychology Today profile. So when it’s a referral from there, I’m not sure if it’s my profile or one of theirs. That being said, I do know that we do get probably two or three clients from that a month, if I had to take an educated guess at that. So I want to say that that’s gone up a little, I know that it’s absolutely gone up from where that was a year and a half ago. So yeah, and it’s not, one of the things I really see was there was probably infinite number of clients who need help. So if I’m not a great fit, fantastic. Don’t work with me because it’s going to be miserable for both of us. Let me help you get connected to someone that you’ll enjoy working with and that will enjoy working with you. And then it’s going to be a win-win.
[ALISON]: Right. Exactly. That’s great. I think that’s a good example of like the power of niche marketing. And I think that that whole concept of like using storytelling and marketing actually comes from that book called StoryBrand by Donald Miller. I don’t know if you’ve read that book, but I keep meaning to read it.
[ROB]: You know, I have not read it, but I’ll definitely writing it down to read.
[ALISON]: Okay. Everyone like raves about it and says it is awesome. It is and I know it’s one of Joe Sanok’s favorite book, so yeah, definitely. If you’re struggling with your marketing and kind of how to tell your story and how to communicate who your ideal client is, I would say definitely check that out, because I know it’s been a game changer for a lot of people.
[ROB]: I think last bit of advice I would give is to be persistent and flexible. I don’t know how much money I spent on Google Ads that didn’t work.
[ALISON]: Oh no.
[ROB]: And I have a full list of ads I pretty much don’t run anymore. However, I basically constantly run the same two ads now, and that gets me referrals from parts I’ve networked with and social media have given me the referrals I’m very comfortable with. So even if you hit some failures initially, and you’re going to, there’s lots of things I came up with that kind of fell flat. Take that as a warring opportunity. What can you learn from it? How can you do it differently or better and go from there? Or there has been some ideas too I came up with trying. It just didn’t work, fantastic. It’s in the garbage can. Just kind of move on from that, but that’s going to be part of the experience. So it’s not that we’re horrible practice owners when something doesn’t work. That’s just kind of par for the course and take that as a learning opportunity instead of a failure.
[ALISON]: I’m really glad that you brought that up because I feel like that’s such an important mindset to carry you through as a business owner. Like it’s not all, as for as much as we want it to go perfectly or we want to plan. So everything runs smoothly, like the nature of running a business. And obviously what we’ve all been through with the pandemic has shown us that like you have to be a business owner who can sort of like be nimble and pivot and switch gears if you need to, if the world changes. And yeah, I think that’s just something that we have to do on an ongoing basis.
[ROB]: Absolutely.
[ALISON]: Well, I really appreciate your time, Rob. I’m very excited about all of your success and it’s great to have another group practice owner just up the road from me. Hopefully one day we’ll actually get to meet in person, right?
[ROB]: Absolutely. Absolutely.
[ALISON]: If folks have questions about your practice or want to get ahold of you, what’s the best way for them to reach you?
[ROB]: So the practice website is magillcounseling.com, [M A G I L L] counseling.com. And my email address is [email protected]. So those will probably be the two most effective ways to get some information and also to email me as well.
[ALISON]: Okay. Excellent. Well, thanks so much, Rob.
[ROB]: You’re very welcome. I’m glad to be here.
[ALISON]: All right, bye.
I hope you enjoyed that interview. I know it was so great for me to hear all the things that Rob has accomplished in such a short period of time. And I felt like he had lots of great advice to share. So I will see you all next time.
I wanted to say once again, thank you so much to Therapy Notes for sponsoring the show. It makes notes, billing, scheduling, and tele-health a whole lot easier. And 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] to get two 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.