[JOE]:
Between writing notes, filing insurance claims, and scheduling of clients, it can be hard to stay organized. That’s why I recommend TherapyNotes. Their easy-to-use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes today. Just use the promo code JOE when you sign up for a free trial at www.therapynotes.com.

This is the Practice of the Practice podcast with Joe Sanok, session number 499.

499. You’re in episode 499. We are on the brink of number 500. I can’t wait. We’ve been traveling which has been a lot of fun and very interesting. Figuring out the internet, and we’ve been recording with the Leave to Find podcast and sharing our family adventures within that podcast. And right now I am standing in the bathroom of our camper because my wife is road schooling our kids outside. It’s like eighty degrees in here. The Colorado sun is just beautiful, but also making this camper very warm. But having an AC unit on while I’m standing here, I’m literally four inches from the toilet. But it was kind of the quietest spot. And it’s where I’m doing the podcast today. It reminds me of when I first started the podcast and I would go when the family was napping – I was a bit of a nap-preneur – and on Sundays I would go upstairs too but it was not a full upstairs, it had sort of those slanted ceilings. And I would put a blanket over my head because I hadn’t yet got this like wraparound foam thing, and just kick out a podcast at least every week. And you know, sometimes that’s what it takes when you first get going.

Today, I am so excited. We have Rachel Needle who’s going to be talking about what do you need to consider before you start a group practice? What are things to sort through and it’s just so valuable to think about leveling up in that form. So without any further ado, I give you Rachel Needle.

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[JOE]:
Today on the Practice of the Practice podcast, we have Dr. Rachel Needle. Dr. Needle is a licensed psychologist and certified sex therapist. She is in private practice and runs a group psychotherapy practice, Whole Health Psychological Center, and has a continuing education provider company, which she also provides CEs and certification to medical and mental health professionals around the world. Rachel, welcome to the Practice of the Practice podcast.

[RACHEL]:
Thank you for having me.

[JOE]:
Yeah, I’m really excited about this conversation. Let’s just start with, you know, tell us about your group practice and how that got started for you. Was that always kind of the goal? Or did you kind of fall into it? Let’s start there.

[RACHEL]:
Yeah, so my group practice is called Whole Health Psychological Center, and I have specialists in all areas of psychology. And so I guess, a little of both, right? So when I was in private practice – and I went right into private practice, as my postdoc, right, I didn’t do a traditional postdoc – and I was getting a lot of calls from people that needed therapy services that were not necessarily things I specialized in. So I’ve worked with children, but I don’t work with children. So I have in the past, but I, you know, so I needed a good child psychologist. Other areas that weren’t necessarily areas that I was most competent in and that I was seeing clients in. And it was really hard, like, I could name probably fifty therapists in my area off the top of my head, but none that I would say with confidence, I wanted to refer somebody to. In addition, I was at the time, also a supervisor for a masters in mental health counseling program. And I would go visit these sites that students were at, and I was seeing families having to go to like five different places to get their needs met – one for the couple, one for one child, one for the other child – and I started thinking this isn’t right.

So those were the first two things. And then the third thing was, you know, access to services. And when I could find really great therapists, they were typically full pay only, no insurance, and I wanted a place where everybody’s needs could be met, they could get quality services, and there was a range of options, including full pay, private pay at a high rate to, you know, pro bono services, to sliding fee scale, to insurance. So that was all very important to me. I also always knew that I wanted to, you know, I was always a business person. So that was something that was one of the businesses that I was always interested in. So I feel like I was able to meet people’s needs as well as my own needs in this one place.

[JOE]:
Yeah. Now, when you were thinking about especially kind of the money side of it, I think some people will say, well either go private pay or go insurance, because if you’re attracting insurance people, like, no one’s gonna want to jump to private pay, or if you attract all these pro bono people it’s gonna be harder, but you said, you’ve got this whole kind of spectrum of options for people. What for you is the benefit of having so many options for clients when they come in?

[RACHEL]:
I mean, honestly, for me, it’s the idea that I don’t want to turn anybody away. So, you know, we all – and I know that it’s not possible for everybody – but we went into this field for a reason. And for me, it’s really important to provide quality services, to have access for everybody, regardless of their SES, you know, socioeconomic status. And, to me, that is just a personal mission. I am fortunate in many ways, one, I have other businesses that help support me and the lifestyle that I want. And then I also have made the group practice profitable, by still doing it the way that meant a lot for me to want to do it. So it’s possible. We have, I mean, anywhere from my private pay clients, you know, I don’t necessarily slide because I don’t have a whole lot of time, and I’m seeing less clients than I have in the past. So my rate is now $300 per fifty-minute session, and most of my therapists do charge $200 but they’ll slide, and I have a different range of people that I bring into the practice, willing to slide to different amounts. And then for those that are unable to pay, I’m able to pay my therapists to see them, so that they can still be seen. So it’s doable, it can be profitable, you can do all of these things in one place. It’s not easy, maybe, to navigate because you have to set up good systems to make it happen. But once you do, it’s absolutely doable. And I think it flows the same way that a full private pay or full insurance-based practice would.

[JOE]:
Yeah, and what are some of those kind of essential systems that you really rely on to keep things moving forward outside of your own time?

[RACHEL]:
Sure. So definitely a way to track expenses, to track expenses, to track what you’re bringing in. I also, I’m a big fan of putting the people in place that will help you as well as the processes. So the people that, you know, my administrative assistant, my office manager, my bookkeeper, everybody is part of this big package. And, of course, I didn’t start that way. So I get that that’s not always possible to start. But I realized very early on, that you had to spend money to make money. And so I was able to do that very early on. But I think making sure you have a way to track things, making sure you know, in your business plan, how much of each type of client you can bring in, in order to still make it as profitable as you would like for it to be is very important.

[JOE]:
Now, people often have a plan, I need to see X number of clients or, if I’m going to have five or ten people working for me, they need to see X number of clients, and they have the plan. And then they’re marketing, there’s crickets, and their website isn’t converting, and it’s like, well, that was a great plan but it didn’t actually happen. When you see that either the numbers are dropping, or there’s a shift in society, or there’s something that happens, like, what are the kind of marketing plans that you have? And how do you adjust as you go to keep yourself and your clinicians full?

[RACHEL]:
Sure, great question. I think it’s normal, things are going to ebb and flow, in every industry. So if we see that happening, we look at what we’ve been doing differently? Is it a function of what’s going on in the world? Is it a function of something that we changed up, in which case we might want to change back. We look at how we can attract new clients. And a lot of that has to do with putting ourselves out there, whether it’s on the internet, whether it’s through local news, whether it’s through doing writing. So we look at ways that we can increase exposure and make sure that we are appealing to a number of different potential client bases. And in a larger group practice, that’s a little bit easier to do, I think, because we are able to meet all the needs in one place, right? So if somebody comes in and they need a full psychoeducational evaluation, we can do that. If somebody, an older adult comes in, we have somebody that specializes in that. Someone with substance use disorder, someone with traumas, and sex and relationships, right? We have somebody for all of these things. And so it’s easier to do when you don’t have to necessarily turn anybody away.

[JOE]:
Yeah. And so what are some more of those kind of systems? So you’ve got people, you’ve got kind of other systems that are going, like, what does that practically look like? Maybe go through a couple of the roles of how people really are helping you make money by spending money.

[RACHEL]:
Absolutely. So, office manager for instance. Takes a lot off my plate, is able to manage the therapists, for the most part, in the practice. Make changes based on what she sees is happening, like, if it does start to ebb and flow, looking at therapists schedules, scheduling the appointment, dealing with my EMR, keeping track of… she and my administrative assistant keeping track of the money that’s coming in, balancing that out, making sure we’re both in touch with the bookkeeper, the bookkeeper keeps track of, you know, does the profit and loss summaries every month, you know, we look at that together, look at areas that my expenses have gone up or down – if down, how we can keep them that way, if up, is that needed, and has that led to us making more as well? And we continue to sort of meet as a group and make sure we’re on the same page. And if we need to bring… like, recently, I started using different apps like Trello, to be able to keep track of projects that we’re working on, to make sure that things are getting done. When things get done, it ends up equating to having more clients come in, because we’re doing things too that are helping us get our name out there. And that are making people know about our center.

[JOE]:
Yeah, we live by Trello with our team. Even all of our consulting clients, we set up Trello boards with them and our Done For You podcasters, all of that is in Trello. And I love Trello because you can have a template board that you just copy. And so for like Podcast Launch School, as we’re helping people launch podcasts, we have the kind of paint by number already set up as a template and then our Done For You people get access to that. And it’s just you don’t have to start from scratch every time in Trello. So that’s one of those tools that, oh, my gosh, I just love it so much.

[RACHEL]:
Beautiful, right? Yeah. So we find those really helpful. Doing things like setting things up to be automated. So I use the company Meet Edgar to do that. And we actually, we have a great relationship with them. And we have actually, a coupon code for six months fifty percent off with Edgar, which is, I don’t know, ‘collective six’, I don’t think I shared that one with you. But I love being able to use that because you come up with an idea, you put it on there, you don’t have to remember every week to do the same thing. You can add posts to your social media, you can add stories, you can add articles, and everything just gets posted either randomly or as you set it up to get posted. And you know, it takes a lot off your plate, because really, time is money. So you want to do what you can to save your time, because then you’re saving money.

[JOE]:
Yeah, absolutely. Now, what about during COVID and kind of switching to online? How did that go for your team? And as you kind of think forward into 2021, and the future of who knows what pandemics may hit us in the future, like, how did that pivot go to going more online? What are you thinking about as kind of you look into kind of future years and just being prepared for the unexpected?

[RACHEL]:
So we were doing some stuff online already. So we had some clinicians that were already doing online therapy, so it was a lot easier because we had that in place. Also, I’ve been using Zoom for my continuing education company for over six years, I think since, I thought what was the beginning. So we already had that sort of set up and in place. So we were fortunate in that way where we could easily pivot, for those that were not already doing online therapy. For me, one of the biggest changes, well, there’s two, is one, was this push to really expand to going across the country, which I had started doing a little bit and toying around with, but really starting to bring clinicians in from all over. And that was really exciting and something that I just sort of, when this happened, I thought was just the best time to do that. And, you know, again, as part of our mission, I think that making sure that people that were coming in, especially pre COVID, already existing clients, but even new, who had lost their jobs and didn’t have insurance or couldn’t then afford private pay, were still given what they needed and were able to seek services. So figuring out a good business plan that could continue to support something like that.

[JOE]:
Yeah. Now, when you work with people – because I know that you also do some consulting – what are maybe common things that you see people get tripped up on when they’re launching a group practice?

[RACHEL]:
So I think there’s a couple things. I think that not being prepared and not putting the systems in place from the very beginning is a big thing that hinders people’s growth when they start a group practice, and even if it will be sustainable from the beginning. I think I see people – and you know, I mentioned earlier that I really feel you need to spend money to make money – I see people being scared to do that because they’re just starting out. And for some, it’s not possible. I mean, listen, I did not start off with a lot, like, that was not necessarily… I had that idea and that thought from the very beginning, but I wasn’t necessarily able to do that all, everything that I wanted to do. But I think what you can do, you should do. And I see people not being willing to learn. They’ll ask questions, but then when it comes to working with somebody that could, you know, a consultant or a program or something that could help with your expansion, they’re not necessarily wanting to not only just invest their money, but invest their time into that. And those are some of the… those I think are three of the things that could set you up to fail. Certainly, they’re not all a hundred percent necessary, but I think they’re all helpful.

The other thing I think, is, you know, short of being all over the place, I think it’s important to figure out the steps you need to take to be successful in a group practice, and write those down and come up with a plan for each of those things, whether it’s marketing, getting clinicians, and figure out what you’re going to give back in that way. So why would somebody want to come into your practice, as opposed to the tons of other group practices that exist around you? So I think there needs to be that sort of buy in for people. And what’s the benefit of them being with you? So, be able to offer things to the people that are coming to your practice, at least at the beginning.

[JOE]:
Yeah, what sort of things have you seen people do that set them apart from other group practices?

[RACHEL]:
So will you have benefits? Health benefits, retirement benefits? Those are things that you can offer. Will you be just having independent contractors, or are you going to salary therapists? And salary actually can be a win-win, right? A lot of therapists really need and seek that. And for you, you end up likely making more money when you do salary somebody. So I think it’s a win-win. But that’s something that you can offer, if you’re able to. Will you pay their liability insurance? Will you have to give them a budget for continuing education each year? And again, an area I’m fortunate in. I can offer certifications, I can offer CEs, and it’s something I do anyway. So, what do you personally have? Supervision, consultation, will you make a community out of the people that work with you? So, will you have meetings once a month so that people can feel they’re a part of, rather than only seeing people in passing when they’re in the office. So make a community that you’re proud of, and that makes you feel good, and that also is inviting to potential therapists.

[JOE]:
Yeah, I think that idea of, you know, what do you want the practice to look like for yourself? Also, how much community do you want it to be internally? Versus, you know, some places… like my practice, it was mostly people that just wanted to come to therapy, show up, do it and go home. And so that was kind of the culture of, hey, like, we’ll be nice to each other, but we’re not going to hang out for hours after the day is over, and have barbecues and all of that, and so finding that balance of, what do you want out of your practice? Also, how do you then attract good talent, and maybe bringing people in that can do more community organizing, if that’s not your skillset? So I remember, as our team grew, like, I just recognized that figuring out social things to do with the staff was not my forte. And so, one of the people on the team really liked that idea. And so she, for our meetings, would coordinate people bringing food and things like that, and it really added a lot, but it also was something that I wasn’t putting time into, and wasn’t valued as much either. So building out that team, and you know, helping people be able to connect in different ways, it’s just so important to kind of getting to that next level within your practice.

[RACHEL]:
And I think it’s definitely an area I’ve struggled with, on and off, you know, I mean, being really busy obviously doesn’t help that. So having someone that can support you in doing that, like my office manager, but also letting people know from the beginning what the community is like, what the environment is going to be like, what your goals are, what the mission of the practice is, and including that in it, I think is important. I certainly have the therapist that, especially now that we’re doing telehealth, on their own doing their own thing and aren’t interested in that aspect of it. But, we make sure that at least twice a year, we’re doing that. So if nothing else, a holiday party at the end of the year to include the people that maybe aren’t as committed to being a part, or work mostly remotely, but we really make an effort to do that. And you know, that in itself ebbs and flows, where people have their own stuff going on in their lives. Someone starts a family or has something going on in their family? That might mean they pull back a little bit from the stuff that isn’t making them money, which is the relationship.

[JOE]:
Yeah, yeah. Well, as you kind of think about your own leveling up, there’s a lot of people that they just are perfectly content with sticking with owning a group practice. What does it look like for you when you say, okay, this is what I want the next three or five years to look like? How do you evaluate the best use of your own time? What kind of projects are you working on that go beyond the private practice?

[RACHEL]:
So, when it comes to the practice, I’m working on getting new therapists, like I said, really looking to expand more across the country and figure out what that means, if it will just be in the same model I’m doing now or will we add some intensive outpatient programs, and I’ve been thinking about that a lot. And looking outside of just the one-on-one, seeing clients or running the practice, is continuing to build trainings that support therapists in growing and learning in areas that they may not have learned in school. So one of my areas of specialty is sex and relationships. And you know, as a psychologist, we didn’t even get one class on that, unless it was an elective, which, of course, I took, but most people did not. Even area of substance use, same thing. You weren’t required to take the class, I know a lot of masters-level actually are required to take both classes. But doctoral level, it’s not a requirement. So trying to do things to both give back and build my business in that respect. So I’m looking at all of these things, looking at continuing to do more consulting, my private practice collective has a lot of really exciting things that we’re working on in terms of programming and getting things out there. So a lot, I think is going on, and I tend to go in a lot of different directions, I enjoy that. It’s something… it’s just the way that I function best, I think, and thrive. So I’m looking at all of those things as a way of continuing to expand.

[JOE]:
That’s so awesome. Well, Rachel, the last thing I always ask is, if every private practitioner in the world were listening right now, what would you want them to know?

[RACHEL]:
Oh, wow, I wish I knew that was the question now. What would I want them to know? It is possible to do well, and to be financially secure, and then some, as a therapist. It is not something that we learn in school, it is something that you have to either learn on your own or kind of have, and you can get to wherever you want to be. And if your goal is to see one on one clients and not expand in that way, then that is great as well. So don’t be, you know, I guess it’s really important to me that people not be sort of envious or sway in a direction that is not where they want to be. If they’re comfortable, that’s all that matters. So, figure out what it is you need to live, figure out what it is you want to live, and find a way to get there. And it is possible to make as much as you want in this field. So people have to look at possibilities and realize that they can do that, and that it might take some learning, and it might take some pivoting, but it’s absolutely possible. And so that’s the message that I want to always give to therapists, especially, I mean, [unclear] mental health professionals who don’t learn that in school.

[JOE]:
So awesome. And Rachel, if people want to connect with you or your work, where’s the best place for them to find you?

[RACHEL]:
Sure. So always feel free to email me at [email protected]. I have many websites, modernsextherapyinstitutes.com, myprivatepracticecollective.com, wholehealthpsych.com, advancedmentalhealthtraining.com. So any of these, you will find me. You’ll probably find me if you google me as well. I’m open to any questions. I do a lot of stuff also in the media. That’s also a good way to get exposure. If people are interested in learning more about that and feel free to reach out. I always love to support therapists in growing and doing whatever they want to do to get to the place that they want to be for themselves and their families and their future.

[JOE]:
Awesome. Well, Rachel, thank you so much for being on the Practice of the Practice podcast.

[RACHEL]:
Thanks so much for having me.

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[JOE]:
So what do you think? Are you going to start a group practice? If you have any inkling to do that, I would love for you to schedule a time to get a half-hour free consulting call with Alison or Whitney. Both of them are our group practice gurus. They’ll point you in the right direction. We have plenty of people that are applying to either work one on one or in small groups or within their new membership community, Group Practice Boss. But, just talking through it with someone about whether or not it would make sense, do go over to practiceofthepractice.com/apply, it’s a great spot that you can just kind of fill out some information and we’ll give you an honest assessment of whether it’s worth your time and money to do consulting, to join a group, to level up into a group practice. Because, for a lot of people, that’s the defining thing that allows them the time to go after the bigger things that they want to go after. So head on over to practiceofthepractice.com/apply if you’re interested in chatting with Whitney or Alison about starting a group practice.

Also, TherapyNotes is our sponsor today. They are an amazing sponsor. They are electronic health records. We hear from our Next Level Practice people all the time that they love it, that helps keep them organized, the scheduling and support, they have live support. A lot of places they have tech support, or they have a chat, but it’s not someone you can actually talk to. I think that’s one of the defining things about TherapyNotes that I love is that if you get stuck with their system, there’s people you talk to, like, actual people. So head on over to therapynotes.com, use promo code JOE to get the three months for free. Thanks so much for letting me into your ears and into your brain. Have an amazing day.

Special thanks to the band Silence is Sexy for your intro music; we really like it. This podcast is designed to provide accurate, authoritative information in regard to the subject matter covered. It 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.