Are you considering purchasing an already existing group practice? What are some of the challenges you might face? How can you work towards creating success in the practice by your own definition?
In part 1 of this 2 part podcast, Alison Pidgeon speaks with Kami and Porter Macey about the benefits and challenges of buying an existing group practice.
Kami and Porter Macey are the owners of Amber Creek Counseling & Psychiatry in Sandy, UT. They purchased the business a little over a year ago. They have been married for almost 15 years and have 3 children.
In This Podcast
- Kami and Porter find it an occasional challenge to be a married couple that runs a practice together because they occasionally need to critique one another’s management styles and sometimes argue over business-related things while they raise children together too.
If I have something that I want to say or change or suggest about the business, I will often lead with ‘this is coming from a business partner, I’m talking to you as a business partner right now’. Of course that doesn’t eliminate all the emotions that we’re going to have, but at least it helps us to respond to our defensiveness or our insecurities in a different way. (Porter Macey)
- It is sometimes tricky for them to manage the boundaries between home-time, work-time, and not bringing work issues home with them.
- During the pandemic, they are still deciding who stays at home and minds the children while working and who goes into the office, because they both feel more productive being at the office however they still need to make sure their children are cared for.
- Although some therapists have chosen to move on, Kami and Porter have good relationships with the therapists they manage in the practice.
- They both came into the practice with a vision of what they wanted to do with it and although the transitions were difficult, they have been able to instill some of the ideas and activities they wanted to in their practice and make it a space they felt was authentic to them.
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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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Hi, and welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon, your host. So we are in the month of November, I hope everybody is healthy, and your family is safe. And my family is getting together with our parents in our quarantine bubble to have Thanksgiving this year. So I’m feeling grateful for that. And my kids are doing well. And we’re just trying to make the best of being at home and, you know, not not being able to go as many places or do the things that we used to do because of the pandemic. But we got some fun Thanksgiving games to keep the kids entertained and I am cooking Thanksgiving dinner. So I think that is going to be fun for me because I enjoy doing that kind of thing.
So yeah, so I just wanted to tell you a little bit about the interview that I did with Kami and Porter Macey. So these folks were consulting clients of mine over the past year. And I asked them to come on the podcast because their situation was a little unique compared to most people I work with in that they actually purchased an already existing group practice. And with that, obviously comes a lot of benefits, but also a unique set of challenges. And so we talk all about how that process was for them, how that came to be, what the challenges were with taking over an already existing business. We actually talked for so long that we split the episode up into two. So if you are enjoying this interview, definitely check out the second half of the episode which will come out next week. And Kami and Porter Macey are from Sandy, Utah, they own Amber Creek Counseling and Psychiatry. And Porter is a clinician and Kami helps to run the business. They have been married for 15 years and have three children. And I just really enjoyed working with them this year and helping them make changes in their group practice that they purchased. So I hope you enjoy this episode.
Porter and Kami Macey, welcome to the podcast. [KAMI]:
Thank you [unclear]. [ALISON]:
Yeah, thank you so much for taking the time to talk with me today. I had invited you to come on because I don’t often work with people who have purchased a practice, an already existing practice. I work with a lot of people who start their own group practices. And I just thought it’d be really great to hear kind of your story about how you came to purchase the group practice and, you know, give people tips if that’s something that they’re looking to do for themselves. But maybe we could just start out by hearing a little bit about your practice as it is now and yeah, where you’re from, and all of that. [KAMI]:
Yeah, absolutely. Um, so we are located in Sandy, Utah, and our practice is Amber Creek Counseling and Psychiatry. And so we have different therapists with different specialties as well as psychiatrists, and nurse practitioners and are able to provide medication management. So it’s a really awesome combination and a really fun group. And yeah, we’ve had it about a year and a half and done a lot of things to make it our own since we did buy a previous you know, practice that had been running already. Is there anything you want to add, Port? [PORTER]:
Um, yeah, I know I really like the combo of the therapist and the med provider and it’s nice to have them right next door in the same office. There’s a lot of good collaboration that goes on that way. [ALISON]:
Nice, and Porter, you’re a clinician and you have a PhD in marriage and family therapy. Is that right? [PORTER]:
And then Kami helps to run the business side of things. [PORTER]:
Yeah, Kami does pretty much everything except clinic director, it’s really hard to find her at title because she could be our marketing manager, our president, our human resources, everything. [ALISON]:
You should call her the glue that holds everything together. [PORTER]:
Yeah, we’ve called her that. We’ve done that before. [KAMI]:
[Unclear] manager who I think is the glue that holds everything together, so it’s been great. [ALISON]:
Yeah. Nice. Um, so what is it like being married and running a business together? Is that enjoyable? Is that challenging? Did you do that before you bought this practice? [PORTER]:
I would say both. It’s really, really enjoyable. And it’s also challenging. We’ve never done it before. But we’ve talked about doing it our whole marriage. So it was something that we were really excited for. At least I was really excited for it. [KAMI]:
Oh, yeah, me too. [PORTER]:
But I’d say for me, that’s one of the biggest challenges is being a romantic partner and being parents, and, you know, trying to play and then trying to like, critique each other’s business styles and argue with each other over what’s best for the business in a professional way. [ALISON]:
Yeah, so how do you manage that? [KAMI]:
Well, we’re open to tips from any listeners [unclear]. Because it’s definitely something that we’re learning as we go along. You know, I second Porter, and that we’ve talked about, we’ve been, you know, so before we were even married, or just, you know, when you’re talking about your future together, we had all these ideas of things we wanted to do together, and we wanted to work together. And it all sounds really exciting. And you don’t think about the challenges that come along with that. And so, you know, this, this past year and a half has been a process and we’ve had a few conversations of, of trying to decide like are, you know, there’ve been times where we’ve definitely hurt each other’s feelings. I think I’m probably a little more prone to that. And, and maybe that comes because I question sometimes my credentials, because I’m not a therapist, and I kind of jumped in from being a stay at home mom. And it fits really well with me doing all this stuff and I have a lot of skills that are great for it. But I tend to get my feelings hurt a little easier and Porter has to be more sensitive to that, or he doesn’t have to be but he tries to be. And so yeah, our confidence grows in what we’re doing, and we’re getting better at it, we’re getting better at having conversations. And it’s definitely a work in progress. And we’re open to tips. [ALISON]:
I imagine that one of the hardest things would be to sort of set the boundary of like, home time is family time versus, you know, maybe being at the office or I don’t know if you’re going in the office right now, because of the pandemic, but, you know, how do you manage those kinds of boundaries? Like, where do you cut off? Like, we’re not going to talk about work anymore tonight, or something like that? [PORTER]:
I think that usually happens when I get exhausted because Kami can work a lot longer than I can. Yeah, so I try and be really overt about where I’m coming from, you know, if I have something that I want to say or change or suggest about the business, I will often lead with this is coming from like a business partner, like I’m talking as a business partner right now. Of course, that doesn’t just eliminate all the emotions that we’re going to have, but at least helps us respond to our defensiveness or our insecurities in a different way. And I think that we’re getting really good at getting mad at each other, getting in a fight, and then letting that go because we need to talk to a clinician or make a decision or go to work. So we’re getting good at recovering quickly on the business side. [ALISON]:
Oh, good. [KAMI]:
You know, back to your question, kind of, you know, are we at work? Are we at home? How are we managing that? That’s also been a little tricky for me, because the first year that we owned the business, because of so many changes happening, I was mostly in the office, I was learning the role of office manager. Our office manager, she moved states not long after we took over and so I was learning all the ropes and I didn’t have to balance work and home as much, I guess I would go home and keep working. But now with the pandemic and the kids, you know, we have one that’s still at home, she’s four, almost five. And so I stay home and try to work from home and to be with her. And so Porter will come up and work at the office even when he doesn’t have clients. And I find myself feeling like, I’m not sure this is how I want things to go, you know, do I get a caretaker for Carmen, our youngest? Do I…? You know, because I’m definitely more productive when I come up to work. But also, I really like to work from home. And it’s, you know, so there’s these pros and cons to both. And we’re still, we’re still in the process of that. And I tend to think, you know, when all the kids are in school, that will be an easier time to make those decisions. When we’re not in a pandemic and the kids are in school, you know, and that’s only a year and a half away. So I’m thinking long term here. [ALISON]:
Yeah, I think that is so tricky. Because I think that, you know, before the pandemic, if you’d asked somebody like, oh, would you like to work from home? Like they would have been like, yeah, that sounds amazing. But then when you actually do it, you realize that there’s drawbacks to it, too. [KAMI]:
Yeah, yeah. So I want to talk about how you came to purchase the practice, because like I said, a lot of people kind of start their own group practice. And so I was curious, like, how that all kind of transpired in terms of, you know, did you think about starting your own practice, but then you got this opportunity and thought it’d be better? Like, what was your thought process with all of that? [PORTER]:
Yeah, I think that, basically, that we’d always wanted to start our own practice. And we had bounced around like Kami said earlier, we had a lot of ideas. And so we were kind of deciding what direction we wanted to take it. And I was working like a couple of different jobs, different, like group practices, doing wilderness therapy, doing all this stuff. And, honestly, we’d been prepping for it so long, just like emotionally, and mentally and just planning for it. With this particular business, it kind of felt like we were just in the right place at the right time. And because we’d been wanting it and prepping for it, we were able to take the opportunity when it popped up. And so it wasn’t something that we were specifically seeking out. The owner had approached me and just said, hey, I’m moving to Montana. Do you want to buy this clinic? [ALISON]:
Wow. And how did you know him? [PORTER]:
So I’d been working there as just one of his therapists for two years about. And so yeah, we’d worked together for a while and just talked and got along. And I honestly have no idea why he approached me before he approached other people. I never really asked him and I was always kind of surprised by it. So yeah, I don’t know how it all came to be. Honestly, that’s probably something I should ask him about. [ALISON]:
Yeah, that would be interesting to know why he picked you. So when he said that to you, what was your initial reaction? [PORTER]:
I gotta tell Kami. Yeah, that was my initial reaction. But beyond that, fear, uncertainty. Um, you know, one thing that was really interesting and this is going backwards a little bit is, so I got my master’s and then I got my PhD because I wanted to be a professor. And then as my PhD program progressed, we kind of started weighing the pros and cons of actually becoming a professor and we chose not to and it was kind of at that point like, wow, I don’t know if that was a good investment. A PhD program is expensive when you have a family. And it’s crazy hard work and all the extra stuff that comes with it. And one thing that I’ve come to recognize, though, is that without all the things that I did during my PhD, I don’t know if I would have had the confidence. I think my insecurities or my doubts would have been too big to say, well, we’re not totally ready but this is a great opportunity. So yeah, let’s just do it. [ALISON]:
Yeah, so you felt like even though you were scared, you felt like it was still worth pushing forward and seeing where it would go? [PORTER]:
Yeah, yeah. And it was kind of like a leap of faith that you had to just jump into, at least for me. [ALISON]:
Yeah, yeah. Well, I feel like all entrepreneurial pursuits are a lot of leaps of faith. [PORTER]:
Yeah. Um, so then, like, what was the process then? Like, obviously, you talked about it and you decided, yeah, let’s go down this road and see what this would be like. So like, what was the process once you told him you were interested? [KAMI]:
We just had, we had a few meetings, of course. And I guess, I kind of feel like I need to rewind a little bit and add to what Porter shared too. You know, it’s funny, because when we had that opportunity, for me, it was like, immediate, yes, in my head. But then like, oh, we have to talk about this, and we have to figure it out. But for whatever reason, we were really ready. We’ve been talking about having a clinic and all of that. And so it was more about logistics after that. And one thing that really helps in buying from someone else is the trust that we had for the previous owner. He’s just a man of so much character, and so much goodness, that there was a lot of trust in him that went into the process, because he had built it from the ground up and he’d never sold a business before. And we had never bought something like this. So a lot of trust went into it. And so there are definitely some things that I would do differently if we were buying in a different situation. So we can definitely touch on those. And things that I’ve learned, you know, from doing that, but, um, so yeah, we first got together and we relied on him a lot to figure out the selling process and having not had a business before we didn’t know. [PORTER]:
We had to learn everything, we had to learn, like, what’s an S corp? You know, and the LLC, you know, the umbrella and everything that falls under there? And like, how do you, what do you even look at to evaluate the profits to know if you’re even getting a good deal? And so we had to go through and learn all those things. And the previous owner, Kirk, was good at providing us with information. But we went and got an accountant and we showed him some stuff and were like, can you help us make sense of these numbers? [KAMI]:
Yeah, before we even said, yes, we took financial information from the business that Kirk had provided us and we took that to an accountant. And we said, you know, help us out. We don’t know if this is good, if this is bad, if this you know what this looks like for our future. And, you know, that was huge in helping us. [PORTER]:
Yeah, and I think transitioning. Because I feel like if I were to build my own practice, I would start with just me as the therapist and me and Kami would build together. But transitioning to a place where you automatically have employees, you automatically just right off the bat have other therapists and medication providers and office staff working for you. It was interesting to work through that too, with the previous owner, and he helped a lot in setting us up where he showed a lot of trust in us. So I think the other people did too. But I think that was a really important part of the process that I didn’t fully understand at the time that I would have put more thought into had I recognized it. [KAMI]:
Yeah, I agree. But, you know, they all had a relationship with the previous owner before we came in, and I put in a lot of thought into trying to make that transition good for them. I wrote a letter talking about our family and that we were excited. And we did like a picnic right after the exchange of ownership, and to get to know everyone and answer questions and Kirk came to that as well. And he also stayed as a therapist with us until he moved to Montana. And so that made the transition better. So yeah, that was interesting. It was also a little bit difficult because the medication management side of things, that’s very unknown. At least it was unknown… Most therapists, you know, you probably have a lot of information on medications. [PORTER]:
No, not really. [KAMI]:
No, [unclear]. [PORTER]:
Probably more than the average Joe, but I never took like a psychopharmacology course or, well, I did take one. But yeah, that’s not enough. So yeah. Being like the boss and managing those took a lot of like, consulting. And, you know, I talked with them back and forth. It’s not like I’m their boss even, it’s almost just like, we’re figuring everything out together with them and having to take their advice. [KAMI]:
Yeah. They have to tell us a lot of things. [ALISON]:
Yeah, there’s a whole different flow of how patients are seen and regulations you have to follow. And I’m sure you know all of this but yeah, I think that it’s great to have psychiatry and therapy under the same roof. But I think a lot of people don’t understand how differently those psychiatry appointments run compared to therapy appointments. Yeah. [KAMI]:
[Unclear] oriented. And so it’s difficult to be a therapist and learn all of those things, and, you know, take on those risks and challenges as an owner, without having any of that background. So that’s been, that’s been challenging. [ALISON]:
Yeah. Yeah, I wanted to touch on something you just said a minute ago about, like, the whole transition to you, you know, taking over the practice, and kind of how the staff reacted to that. And a lot of times, we just, we think about the business side of it, like, oh, I’m buying this business. And obviously, with a service business, a lot of times you’re also buying, I don’t know, that’s the correct way of saying it, but you’re buying the staff, because that’s who’s generating the income, right? But the other side of the coin is the staff may not like that there’s a change of ownership, or they may quit, you know, because they don’t want to work for a new boss, or whatever the case may be. So I would imagine that was something you had to be thoughtful about and really manage well so the staff stayed. And was that your experience? Did most of the staff stay? Or did some people leave? Or how did that go? [PORTER]:
I think most people, thinking back on it, most people stayed. We had, I think we’ve only had two therapists leave. And one was, one guy was great, we got along really well. Really like him, but he just got another job opportunity that was, it took up too much of his time to do this. And then the other therapist, she was a very valuable therapist, and I think that she just didn’t really need us. She didn’t need a group practice, or anything like that. And so from our, yeah, from what we, from my experience, it doesn’t seem like anyone really left because of the change in ownership. Of course, they could have just been nice to us when they did leave and tell us, you know, that it had nothing to do with that. But Kami and I have talked a lot about when we bought it, we had different goals. And we wanted to go a different, like a different path than the previous owner. And so all those employees were very used to the way that he was doing everything and how he was going. And I think that makes change really hard. And that’s what I noticed the most was it was hard to convince them that our vision was a good idea. [ALISON]:
Hmm, yeah. [KAMI]:
I see what Porter is saying. However, I kind of see it a little differently. We have a great relationship with most, if not all our therapists, least from the way I see it, and I still have a relationship with one that left. And she actually had been meaning to leave for a long time and it just wasn’t convenient, until, I mean, it was just a hard thing for her to change because she actually has quite a commute to come in. But she has a big following on Instagram, and she was not in need of help getting clients. And so she ended up, you know, getting her friend’s, being able to rent out her friend’s space, close to home. And it was a good opportunity for her to do that, because of all the changes happening at Amber Creek. And that’s what pushed her to take that next step in her life. So it was good for her.
But everyone who has stayed, you know, we are really open about our vision. And we try to be very communicative about what we’re doing. And, to tell you the truth, we’ve, we’ve changed a lot of things in the year and a half, and, you know, everybody else has gone along, and the med providers, you know, I’m worried about losing them, because they’re really valuable to us. And I think sometimes the changes we make affect them the most, and what we do affects them the most and they’ve been awesome. We’ve just really worked hard at, you know, bringing the team together. We did a Christmas party this last year, I don’t know what we can do this year, but that wasn’t something that was done before.
The practice was led, in a way before that, it was really more of a 10-99 situation. Everyone had jobs elsewhere and they come in to see a few clients or they work for a day. And, you know, what we’re trying to do now is work towards having, and this is where consulting with you came in big help, and we can touch more on consulting too, later. But, um, you know, the value of having full time employees, and, and not having to manage as many people because this was a place of, you know, 10 clinicians, maybe some of them only seeing three clients a week, you know, and so we are working towards building a team that is more full time, while still offering a place for those who need that differently that were there already. You know, keeping that for them, but changing that for anyone we bring on from here on out. And we’ve hired four.[PORTER]:
We’ve hired four so far that have goals of either being full time or at least, you know, at least 10 clients a week. And anyway, everyone’s kind of gone along with us, though, and stuck around. The only people that have left are ones that were ready to leave before we took over. [ALISON]:
Yeah. Yeah, I think that’s great. I think it’s great how you, you know, have a vision for what you wanted the practice to be and obviously, when you come into an already existing practice, and there’s already a culture established and all of that, like it can be hard to come in and make changes and you know, obviously, get the the trust of the staff and you know, all of that kind of stuff, but it sounds like you’ve been doing a good job of, of kind of making it your own and having the staff, you know, retaining a staff, which ultimately is really what you want to do. [PORTER]:
Yeah, we like our team. We don’t want anyone to leave ever.
Thank you again to Porter and Kami for coming on the podcast and talking about their experience of buying a practice and what it’s like to work together as husband and wife. If you are interested in hearing more, definitely check out next week’s episode, which is the second half of my interview with Porter and Kami Macey.
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.