[JOE SANOK]
This is the Practice of the Practice podcast with Joe Sanok, session number 680.

I’m Joe Sanok, your host, and welcome to the Practice of the Practice podcast. I’m so excited about this Group Practice Launch discussion we’ve been having over the last eight episodes. This is number nine. So if you missed the first two episodes, it was first me, Alison and Whitney, talking about why 2022 is a great time to start a group PR practice. In the second episode, we talked all about how easy it is and went step by step through starting a group practice.

Then there were six interviews that Alison and Whitney did with people that have started group practices. Then today we’re just doing story time. We’re going to be talking about our group practices, how they launched, maybe asking each other questions that we’ve never thought to ask one another about our group practices. We’re going to just dive right in. So Alison and Whitney, welcome back to the Practice of the Practice podcast. How are you doing today?
[WHITNEY OWENS]
Doing good. Thanks for having us
[ALISON PIDGEON]
Great. Thanks for having us on again.
[JOE]
I’m so excited because right around the corner, we’ve got our first cohort of 2022 for Group Practice Launch. So a lot of people signing up for that, getting ready for it that are on the interest list. It’s all aimed at people that want to start a group practice. If you want to read about that, go over to practiceofthepractice.com/grouppracticelaunch. You can read all about it. The doors open soon. So you want to make sure that you are ready for it because we only open that up twice a year and it’s a six month program. It’s very linear step by step. We’ll talk a little bit about that today, but first I want to hear about your group practices. Why don’t we kick it off with Alison? Tell us about your starting of your group practice back in the day.
[ALISON]
So this is definitely one of those stories where a really a beautiful thing comes out of a really a tough situation. I had worked in community mental health and was the director of an outpatient clinic. At the time had two very young kids, a baby and a toddler and my baby kept having recurrent ear infections. So we were constantly running to the doctor and eventually he got tubes in his ears and he’s fine now, but it was very stressful at the time. I just showed up to work late one day because my son was sick and it just hit me like a ton of bricks I can’t do this anymore. I’m not doing a good job at work. I’m not doing a good job at home.

It just didn’t feel good all around. So talked to my husband about quitting and starting my own practice and that’s what I did and realized very shortly after that, that it was pretty lonely. I really liked my director position. I liked being a boss and so decided to start hiring people and of course looking back now, it was such a great decision, but obviously in the beginning it’s some trial and error and having to encounter a learning curve with growing a business and being the boss and all of those kinds of things. But it’s definitely like outside of having my kids and marrying my husband, it’s the best thing I’ve ever done in my life.
[JOE]
Oh, that’s awesome. Whitney, you can ask questions also to Alison. Alison, what were some things you really screwed up at the beginning?
[ALISON]
I definitely hired some people who weren’t good fits and then I had to work pretty hard on being assertive and realizing that if somebody wasn’t a good fit, obviously giving them an opportunity to improve. But at the end of the day, I’ve had to terminate some people. That was really difficult. It’s probably the worst part about being a group practice owner. So yes, well, lots of tough lessons there, but definitely learned how to avoid that in the hiring process now. Fortunately all this staff we have is amazing. I couldn’t do what I do without them.
[JOE]
What were some things that were maybe, or at least successes that boosted your sense of wait. I’m actually a real business owner, because I feel like when you’re starting, especially with hardly any business training that we get, at least I felt like a fraud for a while. Were there times when you thought okay, I feel legit.
[ALISON]
I think when we started to have five to six counselors on staff and we really started to make a name for ourself in the community, we got our foot in the door with some of the doctor’s offices and they started referring people to us and I started to get good feedback just from providers and referral sources about the services that their patients were getting. Then I felt like, oh wow, this is really gaining some traction and Move Forward was recognized for it’s name and not just me because before it was me and the practice name was me and all of that. So that was exciting.
[JOE]
Whitney, what about you? Why’d you start a group practice. When did it start? How did it keep going?
[WHITNEY]
I started the group practice in 2018 and really the reason was my wait list was so full. I remember sitting at this desk and having a little post-it note of so many clients and then the phone ringing and I’d feel super overwhelmed; how am I going to meet all these needs? What am I doing? Then all of a sudden I was like, oh, I guess I could start a group practice. I had to think about that for months and then did a consulting call with you and you told me to do three things. One was join a mastermind group. The other was hiring an assistant, actually told me to do several things, raise my rates, but joining the mastermind group would mean starting a group practice.

So then I was like, oh, I guess I can do this. I still wasn’t sure like Alison has talked about that imposter syndrome is so real, but having a supportive group of people that believed in me and could walk me through the steps. Okay, I’ll do it. Just like Alison said, there’s been some ups and downs along the way, some mistakes that have been made, but that’s what prompted me to start the group practice, was just the need of mental health services in the community.
[JOE]
Yes. What were some bumps that you hit early on?
[WHITNEY]
Well retaining clinicians was the first one. I hired two people at the beginning and both of them were gone within eight months. One of them ended up leaving because she had applied for another job at the same time with the government and they had fantastic benefits and the governments slow sometimes in getting back to people. So then she heard back five months after she started working with me and was like, this is such your great offer. Then the other one ended up starting her own practice. She was a 1099. I got her completely full and then she went and did her own thing. That’s actually what prompted me. That was one of the reasons I switched to the W2 model at that moment and knock on wood I’ve had a much better clinician retention ever since then.

That was one of the things I wish I had, started with the W2 model, but I didn’t really know and didn’t really know what I wanted yet and what people I wanted to hire yet. So some of that’s just figuring out what you want and that’s part of trying on the group practice stuff and figuring out what your culture’s going to be. The other thing that I should have done or earlier that we’ve talked about is hiring an assistant. I didn’t hire an assistant till I had two clinicians. So then I’m answering the calls for three people. That’s crazy. So I was really happy when I got an assistant.
[JOE]
Yes, yes, for sure. I know for me when I started my practice, it was just like a side gig to pay off student loan debt. So I would see people after my foster care supervisor job and then after working at the college. I might scoot out of there at 4:15 and have a 4:30 appointment, but I’d work through lunch at the college and was doing that. Then I was a supervisor for this guy, Steve, and for his first two years he said, “Hey, could I work here too?” I was like, “Sure, I don’t really know how to do that, but I’ll get …,” I knew the term 1099 and so got a 1099 contract.

It was great because I was seeing people Monday through Thursday till 6:00 or 7:30 after my full-time job. Then I was like, well, sorry, Tuesday’s and Thursday, Steve has the office, so I can’t see you then. We got to switch all over to Monday Wednesdays. Then I had another intern at the college that was like, so I heard that you, actually, no, I spoke in her class when she, her first semester in college, her first semester in grad school. She came up to me after class and said, “I want to work at Mental Illness Counseling.” It was like, this was just a side gig at the time. I’m like, how do you, wow. So she interned at the college and then she became my second 109.

A third one knew me through a school that my daughters were going to be going to. That was actually an interesting situation because up until that point, I had a single office that we were just all three sharing and we were all part-time, but it was bringing in almost as much as my full-time job. Then this fourth person tipped us over the edge where it was just like, we didn’t have enough space and time in this single office suite. So I started looking for a four-office suite, knowing I wanted to grow into something much bigger.

It was like, I knew what my budget was, but this new person was like, this isn’t a nice enough office. This isn’t a nice enough office. I don’t want to work in this office. I gave her a lot. I mean, she had just joined the practice. So I upgraded to this out of my budget, four-office suite with a view of the water and signed this five year lease and look at how much I’m going to pay over five years. I’m like, this is almost the cost of my house and it’s all just rent.

Then within two months she’s like I talked to my accountant and this just isn’t working for me and she quit. It was like, I learned an important lesson there of letting other people make my business decision more than me. Obviously you need to let people have feedback, but it was a gut punch. But then it was also a motivator where I have this four-office suite and it’s three really part-time people. Let’s amp this up. So within a year I think I had seven part-time people, within two years I think I had four full-time and then we were at 13 total. So it really forced me to use that space as much as possible
[JOE]
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[ALISON PIDGEON]
So what was the best part about having your group practice, Joe?
[JOE]
The best part, there were many best parts. I do remember doing the open house at the four-office suite and there’s this local musician, her name’s Miriam Pico. We did this event, Pico and Pinot where we had wine and Miriam Pico was playing. I just love hosting unique events and so, we probably had a hundred people that came through this four-office suite that it was three part-time people, super part-time and just the buzz that came from that was a lot of fun. I think that just, I remember when I left my full-time job and that was the only place I had to go and it was entirely my aesthetic. It was entirely my feel. It was my hours that I wanted to work and to just have that freedom to purely make my schedule if I wanted to come in at 10:00 or at 7:00 or whatever, I think that, and to know that it wasn’t based on my own time, all the time. The money wasn’t based on just me showing up. But whenever I would open my door and see three doors shut and be like, there are three sessions going on right now, I can go for a walk and there’s still money coming in, that was awesome.
[WHITNEY]
Totally agree with you on that. It’s so nice to see that there’s income coming in that doesn’t depend on me. So if I need to do something for one of my kids, or I’ve got to take a trip to care for a parent or whatever that is, it’s so great to not feel that pressure. I’ve actually, even this year, a couple of people who’ve had COVID, practice owners or solo practice owners and the struggles they’ve had to face because coming back from COVID, it’s a slow process of being back in the office and takes a while to see clients. So what a gift to have a group practice with the work can continue, so does the income, even though you’re not there.
[JOE]
Well, and it feels to me it felt like more of a professional business to have support staff and have the billing correct and all those things rather than just, when it was just me, not that there was zero accountability, but if I didn’t get my progress notes done, nobody knew. If I didn’t bill, nobody knew, but if we don’t bill correctly or collect when we have that large of a practice, all those flaws start to stand out. Now, when do you feel like, Alison, when did it feel like you had maybe leveled up within your group practice and did you know it was happening or was it more of a realization like, oh wow, we’re at a point that I didn’t realize we were going to be at?
[ALISON]
Yes. I think there was a few times that happened. One was when I went on maternity leave and 2019 and I was able to leave for three months and still make my same salary. The practice ran without me. That was huge to know that I really could walk away and the practice would be fine. Then I think another time was when we probably hit maybe around 20 clinicians. We in 2020 got super close to grossly a million dollars. Then it just felt like I was at this whole another level and I needed this whole other level of help in terms of a CFO and more admin staff and more of a leadership team in the practice and things like that.
[JOE]
Whitney, what about you? When did you hit things that or maybe knew levels that really represented a lot to you?
[WHITNEY]
That’s a good question. I just feel like it’s been such a gradual process, like leveling up all the time. I can’t think, I definitely felt a lot of concerns when I went from eight to nine clinicians. I can’t explain why. For some reason that eight to nine, I think I sat at eight for a long time during the pandemic and things slowed down and everything. So when I went up to nine, that did it for me. Also as I’ve expanded with space, taking on more space makes me feel like, oh, I’m taking up, I mean more within the community. That’s a difference with different parts of the country, doing consulting is. There’s some parts of the country that functions super well with telehealth. Then at least here in Savannah, no one calls and wants telehealth. Everyone wants to come in person. So I’ve got to create more and more space to be able to provide for that. That’s another thing that feels like I’m leveling up each time I keep, I have an upstairs, then I got it downstairs. Then I got another building. It’s just moving forward.
[JOE]
I know for me, I think it was my second year after I left the community college. I made more for my take home than had the college president. It was just like one of those moments of knowing how much he made and thinking if I stayed within that system you’re always going to make less than the college president. The vice presidents don’t make more. So within 18 months, be like, I’m making more than this college president locally, just from this idea that I have on the side or not on the side, at that time it was my full-time thing. To me that was one of those, it represented a lot to make more than the college president had.
[ALISON]
That’s awesome.
[JOE]
So the last question I always ask is if every private practitioner in the world were listening right now, what would you want him to know? You’ve been able to answer this question a few times in these recordings. Alison, why don’t you kick it off for us?
[ALISON]
I think if you’ve been thinking about starting a group practice, like I said, in the beginning, I feel like this is just my life’s work, is this practice and the impact it has on the community and being able to provide jobs for people and know they’re being treated well, and know they’re happy. We have a Zoom staff meeting and I just see everybody’s face and I’m just like, I employ all these people. And just knowing that they’re satisfied and they feel they’re treated well, just means so much to me. I tell people a thousand time % it’s well worth it. Whitney, and I always say we won’t sugarcoat the fact that it is a lot of work, especially in the beginning. But I think once you get past those initial startup phases, it’s absolutely been amazing to be a group practice owner.
[JOE]
Yes. What about you?
[WHITNEY]
Well, just to echo, I love what you just said, Alison, you said it so well. I feel the same way about my employees, but the other thing is just that owning a group practice is fun. I have fun with my people. We have inside jokes. Even though we’re recording this here in December, we are going to the fanciest restaurant in town for our Christmas party. It’s like, I basically just do all the things I want to do and use the company money to do it. I bring all my friends along. So that’s what I really love about having a group practice, all that support and fun that we have together.
[JOE]
So awesome. Well, thank you so much for being on the Practice of the Practice podcast today.
[WHITNEY]
Thanks.
[ALISON]
Thanks Joe.
[JOE]
Well, Group Practice Launch is launching. Make sure you head on over to practiceofthgpractice.com/grouppracticelaunch. If you want to launch a group practice in 2022, this is the program to sign up for. Another one doesn’t start for six more months. So you’re going to want to jump into this thing, jump in and start that group practice. By the end of it, you’re going to have your first clinician hired. You’re going to have all those systems set up. You’re going to have support from other individuals that are starting their practice and from Alison and Whitney. So make sure you sign up for that over at practiceofthepractice.com/grouppracticelaunch.

Also, we could not do this show without Therapy Notes. Therapy Notes is the top electronic health records. If you’re coming from another EHR, they make that transition super easy. They’ll import all of your clients’ demographic data free of charge during your trial so you can get going right away. Just use promo code joe at check out to get three months totally for free over at therapynotes.com. No strings attached. Remember telehealth is included in your subscription. Make 2022 the best year with Therapy Notes. Head on over to therapynotes.com/joe, to be able to use that and use the promo code [JOE] at checkout.

Thank you so much for letting me into your ears and into your brain. I’ll talk to you soon.

Special thanks to the band Silence is Sexy for your intro music. We really like it. 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.