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Hey, y’all. Welcome back to The Testing Psychologist podcast.
Hey folks, guess what? I’ve got a live coaching call for us today and I’m excited to bring you my guest, Dr. Leslie Roberts.
Leslie owns a multi-location group practice in Western Michigan. [00:01:00] And we are talking through this question of how to move from more of a daily operations role as a group practice owner into more of a visionary role. That’s the way that I ended up framing it anyway. Leslie’s question is, how do I do more of what I love in my practice? And so, that’s the framework that we came at this from.
I think there’s a lot to take away here for any group practice owner, especially anyone who is in that messy middle part of ownership where you still got your hands in a lot of the daily operations, but find yourself longing to do something different in your practice. I hope you enjoy.
Now, if you are a practice owner and you’d like some support in a group coaching environment, I would love to help you out with that. The next cohort of masterminds is starting in [00:02:00] July, and that’s right around this time, I believe. I’ve got beginner groups, intermediate groups, and advanced groups running. So any stage of practice development, there is a group for you. You can go to thetestingpsychologist.com/consulting and book a pre-group call.
All right. Let’s get to my conversation with Dr. Leslie Roberts.
Hey, Leslie, welcome to the podcast.
Dr. Leslie: Hey, Jeremy, how are you?
Dr. Sharp: I am doing well. Thank you. How are you today?
Dr. Leslie: Good. Thank you for having me.
Dr. Sharp: I’m glad to have you. Thanks for being here. I always want to acknowledge that there’s a little bit of vulnerability coming on to a podcast, putting your stuff out there and [00:03:00] asking for support. So thanks for being willing to do that.
Dr. Leslie: You’re welcome. This is my first podcast ever, so it’s exciting.
Dr. Sharp: You’re doing great so far.
Dr. Leslie: Thanks.
Dr. Sharp: This is meant to be a coaching call. Let me start and just learn a little bit about your practice or have you share a little bit about your practice? So just tell us where you’re at, what your practice looks like, what you do, how many people are there, and anything else that you feel is important.
Dr. Leslie: Sure. We are West Michigan Psychological Services. We’re a multi-location private practice along the lake shore in West Michigan. We have 3 different offices, probably, I think, 40 providers, 6 of which are evaluators and 3 of which are prescribers. The communities that we’re in along the lake shore is an underserved area in general, and so we aim to provide each location with all the services they would [00:04:00] need for mental health.
Dr. Sharp: That’s great. I either forgot or did not know that you have prescribers on your staff as well. That’s a whole other game to play.
Dr. Leslie: It’s been an exciting and very interesting process. It’s the first time I worked with people in the practice that are outside of my discipline. So I don’t know all the roles. So it’s been interesting to discover them as we go along.
Dr. Sharp: Oh, sure. We brought on a prescriber maybe 4 or 5 years ago and that person has since left our practice. Admittedly, I don’t know that I handled it very well. The different discipline is a lot to learn and there’s practical components, there’s I don’t know if you’d say emotional components as well as far as what prescribers expect or need, and that kind of thing.
Dr. Leslie: There’s a very different level of what kind of support they expect to have because most of them have worked in clinics or other kinds of places. So you have to moderate [00:05:00] that with we want to give you the support and this is a private practice, you got to do a lot of stuff yourself. So, we’re trying to strike a balance but it’s still in the process.
Dr. Sharp: Sure. As it always is, I think owning a group practice. Got you. So you have a pretty sizable practice. 40 practitioners is a lot. I think that’s easily at the top 1% of group practice owners, maybe more. I know that you got a lot on your plate. It sounds like we have relatively similar size practices.
Dr. Leslie: I didn’t realize that. To me, it doesn’t seem that big, but well, some days it feels very big.
Dr. Sharp: Well, I’m guessing that’s part of what we’re going to talk about today in some regard.
Dr. Leslie: Yeah.
Dr. Sharp: Let’s frame the question a little bit. We can meander around and touch on different things, but as we start the conversation, I’m curious what you are hoping to get out of this discussion; what’s top of mind for [00:06:00] you as far as running the practice?
Dr. Leslie: I think for me, one of the big questions that I’ve had over the course of the past year, we’re about 3 years old. We won’t really be 3 years old in office until November. That will be our in-office 3-year anniversary. I had things happening in building before we actually had a physical location.
But coming up on our 3rd anniversary, part of my thought process is so much of my work has transitioned from what I’m good at and love to do to things I don’t necessarily know that I have been great at or don’t always love to do. How to find a balance of that and also do I like doing this?
It’s very different than I thought it was going to be. I really just wanted to not work alone. Before, I worked independently for 10 years and I liked it, but the only social direction I had all day long was my clients. So, I thought, well, let’s be a few of us colleagues and we’ll all work independently in the same office and we all will follow a general set of rules and they’ll never be a problem. It’ll be great. [00:07:00] And so, that’s where the idea came from. And then it expanded quickly. And that’s not exactly how it’s turned out. There’s just a whole lot of things you have to have in place to manage the expectations of 40 providers.
Dr. Sharp: Yeah, I really can’t agree more. It feels like we’re living parallel lives in some way, except that you did it in 3 years versus my 10 or 12 or whatever.
Dr. Leslie: I had a pandemic to help. It really threw things in high gears.
Dr. Sharp: Sure. I think what you’re saying right now, there are probably a lot of people out there resonating with that, and just that idea of let’s bring people together, let’s all do the work we do and have a good time. And then all of a sudden it’s like, Oh, now I have to take on a whole new skill set. Do I want that skillset? Do I like that skill set? Is my job what I want it to be? That’s what I hear you asking.
Dr. Leslie: Yeah. I love the clinical work. I do. I’ve always loved it.[00:08:00] I never seem to have really difficult. I’m in private practice. I test for a living. It’s not terribly difficult. It’s a skill set, but I love it. And I enjoy working with families sometimes during the most difficult times of their life. I know that their child is diagnosed with a major mental health disorder. But I have had a harder time with the managerial aspect of the job, the day in and day out.
And we’re still small enough where I’m the person that people go to. We have a practice manager, and the goal was that was the buffer, right? Here’s your job. It’s to be a buffer. I can do the things I love to do. And then really some of the things I’m good at. I’m good at some of the creating. I’m good at finding different locations. I’m good at going there as a testing psychologist and then bringing people in because we’re really not readily available in all parts of where I live. I’m not so good at day-to-day management of all the things and there’s always all the things every day.[00:09:00] Dr. Sharp: Yeah, all the things never go away.
Dr. Leslie: No. I have learned to think about them. Sometimes as I’m trying to focus like, okay, these are opportunities and challenges, not problems. But man, my mindset is like what problems do I have today? So I don’t know. Maybe it’s me. Maybe I don’t have the right personality style to not get overly frustrated by some of these things.
Dr. Sharp: Who knows? I don’t know you that well. And experience would say that I think, like a lot of people, you have a skill set that has certain strengths and certain things that you’re not so good at, right? And as a practice owner, we tend to think we should be doing everything really well. And that’s just not the case. That’s why in “real businesses,” there are multiple people running companies. Everyone can’t [00:10:00] do everything. So I’m going to stop you from beating yourself up around not having the skills to do it or the personality.
Let’s talk about your leadership team, though. Maybe that is not even a thing in your practice, but tell me, first, how much time are you spending on clinical stuff versus nonclinical stuff running the practice? Let’s start there. And then I’ll take it from there and ask more about who’s helping you.
Dr. Leslie: I think I spend more of my time on clinical work now that I do in running the business. I think that’s part of the issue is that I probably need to do less clinical work.
Dr. Sharp: Okay. Do you want to do less clinical work?
Dr. Leslie: Yeah. I think, eventually. I’m trying to pare down. I do 6 evaluations a week and then had 2 solid days of therapy, but I’m really down to 1 solid day of therapy. Well, when we started, it was just me and two people, and I [00:11:00] need to make a living. We’re a big company, but we’re not… I mean, that’s a whole different discussion of like, there’s not a profitable salary built into this company for me. There I work to make my own receivables like everybody else does. So that is what…
Dr. Sharp: Okay. I’m going to tuck that away.
Dr. Leslie: Yeah, I know that is up for a discussion but I’m at a place where I can do less, but I don’t know that I want us to do less and then do more management or more of the day… The goal of taking on a practice manager was really to have someone to do that. And we have a great administrative team. So about 4 administrators, a full-time billing person, a practice manager, and then that’s it.
Dr. Sharp: Got you.
Dr. Leslie: They’re all incredibly busy all the time.
Dr. Sharp: I bet. That sounds about right for that practice size. Let me get back to the time [00:12:00] question just to be super concrete with it. Even if you had to just ballpark, is it like 60/40 clinical versus admin or practice leadership, is it 75/25? Do you have any idea?
Dr. Leslie: If you take in the amount that I do, a lot of supervision of limited license, which I actually also really love, that’s the kind of work I love doing. I would say, if you put that in the clinical side is 70/30. 70% of my time is doing clinical work, and then another 30% is doing other types of management.
Dr. Sharp: Yes. So let’s talk about that 30%. What is happening in that 30% of the time? When you say management, what is your role in the practice at this point?
Dr. Leslie: I get CC in a lot of emails. A lot of things that I don’t know that people, one of the things my practice manager 1st time when she came on board and she’s been great at this is[00:13:00] she said, Leslie, you have a lot of knowledge. It’s there. It’s up in your head. And if we don’t write it down, her phrases, “If you get hit by a bus, who is going to know how to do these things.” And so we’re working on writing things down and teaching other people these things. But there’s a lot of things I just know how to do that if you haven’t practiced for 20 years, you just might not know that that insurance just happens to be this little thing about this. That might be unique, but not everyone knows it. Does that make sense?
Dr. Sharp: It totally makes sense. Yeah.
Dr. Leslie: So those things just lead to most clinical staff because I’ve hired them myself and work with them, I’ve got a personal relationship with each of them. And so when they don’t either get the answer they want, don’t get the answer in time, or just are not sure who to ask, they ask me.
Dr. Sharp: Yes. I think you’re describing something that a lot of practice owners go through
Dr. Leslie: I don’t mind answering if I had the time. The other thing I recognize that we as practice owners do if in answering it, oftentimes I’m circumventing systems [00:14:00] that other people are trying to put in place to make my life easier.
Dr. Sharp: You nailed it.
Dr. Leslie: But I think us owners all share some of those same characteristics. We want to be helpful. We know our business in and out because we were the first ones to run it. We want to be known as someone who’s willing to get back and follow through on stuff because we’ve all had practices we worked at that maybe weren’t great.
Dr. Sharp: Yeah. I think you’re right on. Are you aware of any feelings underneath there that come up if you were to imagine taking yourself out of some of these roles? What would that be like for you to not be the person for people to go to?
Dr. Leslie: Well, Most days I would say I would love it. I think I would be disappointed if people didn’t. I think I really do pride myself on having a better practice or a practice that cares more or is willing to go the [00:15:00] extra mile more than other places people have worked.
So I think that’s hard, but the truth is, I’ve learned, you can’t establish systems in place and then have lots of side deals. That’s not how it works. And that’s really hard for me. I’ve had to learn that through lots of practice management meetings, and having a really strong practice manager who understands. She has a degree in health management. So she has just an understanding of how to manage things in a way that is much better than me and whatever I said last that I can’t remember.
Dr. Sharp: Right. Oh my gosh. You’re speaking the truth. So what does the practice manager do at this point?
Dr. Leslie: It’s really interesting. We just had a review. It’s a one-year review. And I did this all on myself because here’s the problem. It’s Mother’s day. I want to do this big survey, but the only way I know how to do surveys to ask her how to do it. And I didn’t want to do that because I wanted to figure it. So I put together this nice survey. It took me way too long because I didn’t know how to put together a [00:16:00] survey and I wasn’t going to pay for it. So I had to figure it out.
Dr. Sharp: Of course not.
Dr. Leslie: Anyway, we’ve got the survey and I got responses back from about a 3rd of the staff, which is a 3rd of our providers, which is pretty typical, I think. And I had way too many responses of I’m not really sure what she’s supposed to do. Not that she’s not working hard. She’s always working hard. Everyone always reported on that, but a lot of people are like, I’m not really sure what her role is. We have a whole flowchart of who to ask for what. So this week will be laminating the flowchart and putting it up because it was in an email and people don’t read their emails. I’m learning on the job every day, Jeremy.
Dr. Sharp: What a blessing to learn so much from day to day.
Dr. Leslie: I wish I thought it was more of a blessing.
Dr. Sharp: I’m joking. There’s so many opportunities to learn. And that’s the only way I can frame it and not hate [00:17:00] everything.
Okay. Got you. So theoretically, a practice manager has a pretty large role. Is this person full-time?
Dr. Leslie: Yeah.
Dr. Sharp: Okay. And do you have anything in place that you would call an accountability chart or an org chart where it truly is defined what that person’s roles are and what your roles are?
Dr. Leslie: Probably our flow chart would be. That’s where we put that together where it was literally if you have a question about it and it’s a list, go to Leslie. If it’s this, go to Alicia. If it’s this, go to whoever people are because we have a full-time billing staff. We have administrative staff. We’ve got people who are in charge of specifically scheduling testing versus scheduling for medication management. So we have a significant flow chart that really does spell that out. I don’t know that that’s common knowledge. So that’s one of the things we’re working on is how do we really cement these roles? And that’s both educating people and then [00:18:00] also not allowing them to circumvent the system.
Dr. Sharp: Exactly. So it’s a two-part thing that is related: how do you communicate it and then how do you stick to it? I hear you. It’s super common. I’m just going to keep saying that, but this is super common.
So my question is, if that flow chart was followed to a tee, would that solve your problem here? Like, if you were only doing the things that you were supposed to be doing on the flow chart, would that get you to a different place with your job satisfaction so to speak?
Dr. Leslie: I think in some ways it would feel like it would lighten the load. I think that as an owner, there’s a lot of decisions that at the end of the day, if they’ve gone even through the direct route, I still have to have a say in them. Whether we maintain a contract with an insurance company that now decided they’re not going to pay the rates that are in our contract. [00:19:00] There’s a lot of things that can’t be done without my say that I don’t want to lose that say I also don’t necessarily know the answers.
It’s amazing to me that all of us out there practicing with a master’s degree or a PhD, I mean, 20 years of education and no one has ever made me take a business course.
Dr. Sharp: It is remarkable.
Dr. Leslie: One of the greatest disservices that we’ve ever done in our field is not prepare ourselves for the, I mean, I remember the first time someone asked me for a P&L sheet and I just nodded and smiled and said, I’ll get that to you. And then I had to Google it because I didn’t know what it was.
Dr. Sharp: You’re so right.
Dr. Leslie: And then I didn’t know if I had one as a company. And so there’s just so many aspects that I don’t think that someone who knew about running a business would probably not sweat these things like I do.
Dr. Sharp: Do you have any examples off the top of your head?
Dr. Leslie: Of things I sweat?
Dr. Sharp: Yeah. These decisions feel hard to make.[00:20:00] Dr. Leslie: Decisions about insurance companies even just understanding the contract with them, decisions about but even just an operating budget; when you grow like we’ve grown like we have in the last 3 years, even just getting an operating budget together is really difficult because we’ve never had a set of expenditures that’s remained stable.
Dr. Sharp: Right. And so you are wearing all these hats at this point still?
Dr. Leslie: Yeah. We had a changeover in our payroll. We had someone doing payroll. They’re no longer doing payroll. I don’t have anyone to do payroll. So I’m doing payroll which is so not my skillset. I appreciate that at least when I do it, the control factor is there, there’s not mistakes. And you can’t make a 6-year-old’s paycheck. That’s a really bad plan.
Dr. Sharp: Yeah. It took me forever to give up payroll. Forever.
Dr. Leslie: Well, I gave it up and then I had to take it back because there were mistakes. And that is not how you want to be viewed as an owner, as someone who’s okay with that.[00:21:00] So now, I love it that there’s no mistakes, but I’m still the one running payroll.
Dr. Sharp: Payroll is so brutal.
Dr. Leslie: I know. And every month I’m like, I should not be doing this, but again, will I lop it over my practice manager’s desk who doesn’t have enough time in her schedule for that yet?
Dr. Sharp: Is that person a clinician as well?
Dr. Leslie: She’s not.
Dr. Sharp: Okay. Sounds good. I wonder About the possibility of building out your leadership team a bit more. Have you thought about that at all?
Dr. Leslie: If it was financially not an issue, I would have to practice managers or a building manager at each location. I think we can double our support staff and we’d be fine, but then you have to pick that or do I want to pay people well?
Dr. Sharp: Sure. Which [00:22:00] gets back to the budget question. You say that like it’s a fact. Do you know that for sure you do not have room for a few more leadership hours in your budget?
Dr. Leslie: We didn’t before. We have turned a new leaf where we’re finally, our third location opened in September of 2022. We’re now enough into it. We’re starting to pay its own bills, which is good. And we’re starting to fill the offices enough where I think we’re starting to pull something you would call a profit, which is what happens when everybody has been paid, which is a wonderful concept that isn’t always there. It hasn’t always been there in the past. So that may allow us to really think about that.
The problem is when it’s a new concept, you just want to sit on your account and go, I don’t know what to do. I’m just going to wait and hold out just in case. I don’t know what these operating expenses are. There’s a certain sense of making sure you… I’m somewhat conservative before I want to make big moves that could…[00:23:00] Dr. Sharp: Absolutely. That makes sense to me.
Dr. Leslie: I went to that place and I think this is pretty common thought for small business owners. I finally feel like the other shoe is not going to drop them or we’re not going to hold. I feel like I’m there, but for the first three years, you just hold on tight and hope well, maybe not. Will you survive?
Dr. Sharp: I’m right with you. I heard someone say at some point, I forget who this was, but another practice owner or coach or something, that when you are growing your practice, there is never a point of equilibrium. You’re either understaffed or over budgeted because it’s hard to dial in the amount of admin staff you need, the amount of leadership, so you’re always either growing ahead or falling behind a little bit and it’s hard. I get that.
So when I think about leadership compensation, it tends to fall around 3% of [00:24:00] of your gross revenue could be leadership compensation. And that could be clinicians that you pay extra for leadership roles. It could be folks just on your leadership team who aren’t clinicians, but that’s just a ballpark maybe to be thinking about. I wonder if there is some room in there to…
Dr. Leslie: Well, what you’re saying is it might be beneficial as opposed to necessarily adding on support staff. Maybe there’s something I think about having people who already are in an office location. They’re already invested in that location. I’m one of the few people who travel to all the locations. Most people don’t do that. They’re working in their hometown and that’s where they want to be. And I’ve learned that that’s who I want to hire because they’re far more invested than travel. I’m the only weird one that’s willing to travel everywhere.
Dr. Sharp: Cool. So when I think…
Dr. Leslie: Someone within the organization that already is maybe a clinician who is willing [00:25:00] to maybe for higher percentage of split, do some more leadership stuff and be able to take some of those off my plate.
Dr. Sharp: Exactly. We only have two locations, but our site supervisor, it’s an additional, we say 3 to 5 hours a week that are just dedicated to supervising time, whatever that looks like. So it’s not hiring a whole separate person. It’s not necessarily admin, non-revenue generating person, it’s bumping up somebody who’s already there- a clinician who might want a little opportunity for growth or something like that just to do 2, 3 hours a week to serve as a point person for that site and manage.
Dr. Leslie: Has that been successful?
Dr. Sharp: Yeah, it’s been super helpful. And it’s certainly helped with the problem that you are articulating of people coming to you for everything. So it just adds another [00:26:00] layer.
Dr. Leslie: That’s the other thing I found, Jeremy, is that even in my attempts to redirect everything besides clinical work, clinical questions, I want them all to come to me. I’m supervising people or we have consult groups where there’s other people to talk about issues with. So I don’t need them to. And my practice manager is very clear about being clinical and doesn’t want to be put in a situation to answer clinical questions.
But beyond that, I’ve tried to push everything on location. What I’ve ultimately done is made it so her email box is on fire all the time. And so I think that’s maybe the issue is that maybe there needs to be another set of leadership there that can do something completely off of her plate but not put it back on me.
Dr. Sharp: Yeah. I think that’s true. I wonder about splitting the practice manager role with even a finer detail. So is there a situation where you could have a clinical director [00:27:00] and I don’t know what you call it, an admin team director; somebody overseeing the front office, the billing? For us, it’s the same person. It could be 2 separate people. And then someone doing the clinical stuff, right?
Dr. Leslie: I tried that initially. So back in, all of 3 years ago, we opened our 2nd location. I tried that with some clinical staff. It did not go well, but I think in retrospect, they were traveling from a different city and I think they were invested in that aspect of it. So I think that I just shut it down and was like, okay, well, that’s something that isn’t going to work. It was my first bad idea. I was like, well, I’m not going to do that again. And what I’m hearing is that maybe rethinking that now that we’re established at a different crew on board, there’s practice management to take over some of those things, it might not be a bad idea to re-think that.
[00:28:00] Dr. Sharp: Yeah. The ultimate goal here for me, hopefully, this is what you’re looking forward to, is to get you to a place where you’re really operating in your zone of genius. And so, for me, that is being this visionary role in our practice. So basically, being out of the day-to-day operations 100%.
I actually have 2 roles in our practice that we’ve delineated over the past 15 to 18 months. One is visionary, which is big picture business planning, big relationships in the community, contracts, maintaining our presence, just being the face of our practice out in the world, thinking of big ideas like things we might change, service lines we might add, stuff like that. You’re smiling. So this tells me that maybe this is exciting.
Dr. Leslie: I have like 10 big ideas. There’s only one of me. So they just sit in [00:29:00] my head.
Dr. Sharp: Yes. So there’s the visionary role. And then I also have the owner role and that is separate from being the visionary. And it can be hard to separate those sometimes, but the owner is the stuff that you’re talking about like, does this insurance contract make sense? Or how are the financials looking right now? Or do we have the money to spend on? It’s that sort of stuff. It’s like big, is this going to clash with the values of our practice? Stuff like that.
So I don’t know if that might be helpful to start to think of yourself as playing two roles in your practice at least at this point and carving out time for it. And then, once you identify what goes along with those two roles, then everything else goes to somebody else; literally everything else.
So then it’s who do you want to take on the clinician questions or the [00:30:00] IT support or fixing the printer or ordering the toilet paper or whatever. It’s letting all that stuff go and putting it under these other roles. So that’s where that leadership team is coming from is just like putting the people in place to handle all these things that don’t fit in your zone of genius right now.
You got 40 people. That’s a lot. To just have you in a practice manager and no other infrastructure for leading, that’s a lot.
Dr. Leslie: I think we’re struggling to get the admin support that we need that’s steady, solid, and invested. We’ve had some turnover. Sometimes it’s just a hard time to hire. And so, I feel like right now we’re in a good place. And then I see that we’ve hired people that I think could take on more in their role which is great.
I think we’re heading the right direction, but I feel like it’s a little bit like two [00:31:00] steps forward, one step back, two steps forward, one step back which is hard, but I think you’re right. I think it feels like it’s always too much for the both of us. So then I go back in because I feel like her plate is overwhelmed. I’m like, here, I’ll work on this mailer. And so then I’m working on the mailer and I’m like, I know this is not moving in the right direction, but it’s also got to get done.
And so you’re used to sometimes getting things done just to have them done because that’s how you always did it. It’s hard to move forward. You get entrenched in things again that are out of the role I’d like to be in.
Dr. Sharp: Absolutely. I get it. And I just want to acknowledge too, it’s easy to sit on the sidelines and advise, and thinking about, in reality, it probably took easily 6 to 12 months to make this transition in our practice. And I still will get pulled into [00:32:00] little things here and there, but it’s a lot better.
I don’t know if you’ve heard me talk about, I’ve been doing this podcast series on the Entrepreneurial Operating System. And that is where all of this is coming from. It’s just a business framework that has helped us put a lot of the stuff in place, and it has been a true game changer for us in terms of how to even think about a leadership team, how to build roles for people, how to establish accountability, how to run a meeting. It’s amazing. These things that we just take for granted and probably don’t do very well.
Dr. Leslie: And I don’t think that they’re done very well historically in our field. So we don’t have it. And if you grew up in this field where you did your time in community mental health and you did your time in all the different places, the nonprofits or ever, it’s not like we’ve had great modeling. I’m always surprised at the business world and I’m like, Oh, you mean people do reviews every year? [00:33:00] Never in my entire life have I had some of these things that are pretty standard for other fields that we just don’t know anything about.
Dr. Sharp: Yeah. We’ve been protected from that stuff for a long time. Maybe not protected. Maybe just oblivious.
Dr. Leslie: It feels sometimes like oblivious.
Dr. Sharp: Yeah. And I don’t know if you’re experiencing some of this, but a lot of practice owners, as we grow to a certain point, it’s really this friction around maintaining that small practice culture with the big practice policies and systems that need to be in place, and those sometimes seem to really buttheads with one another.
Dr. Leslie: I’ve gotten some feedback that had people have said, this feels comforting and cozy like a family, but now it feels like a business. And I’m like, we have to be one if you want to work here in 10 years because we had to be around and so we have [00:34:00] to have our stuff together. If we don’t, there’s lots of fair. Everyone’s going to come in and just follow rules that are unspoken because we all have the same method. We all have the same stuff. It doesn’t work. I know because I tried it. It didn’t work for me.
And so I get it. I understand that I’ve got to put systems in place. It makes sense to me, but also I think you’re right. I think that definitely creates some friction with people that are providers, but the other part about that is if I’m ever going to pay better, or we’re going to get to a different place where we can have some of the amenities you might ask me for, we have to be a business that makes money. That’s how that happens. And so, I definitely feel that fresh and regularly and I don’t know that I always respond to it very well. I’m on a different side now. I never was on the business zoning side. So I probably was that person who was like, why does this feel like a business?
Dr. Sharp: Right. It’s a hard thing. I don’t know that I have a [00:35:00] great solution to that other than just validating that this is part of the growth process. It makes me ask the question of whether you’re in it. That’s a question we have to ask ourselves a lot. Are you willing to do what it takes to move to that next level? And like, not do what it takes that puts it on you as like how hard you might work. It’s more like, are you willing or wanting to embrace that new identity as a practice and understand that that will cause some friction as you grow?
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Dr. Leslie: It is far more of an emotional journey than I ever thought it would be. It’s far more of a rollercoaster than I ever thought it would be. And there are times where I have thought, like, I don’t know if I want to be the bad guy all the time or if I want to be the one that people are upset about or complaining to or no matter what I do can’t please anybody, and yet no one has any idea how much I’m bending over backwards beyond what anyone has ever offered to me in a company.
And so it’s very difficult because I feel like probably in our field, we’re really good at wanting to be liked. [00:37:00] I’ve got a great relationship with my clients. I’m a pretty decent testing psychologist, can do some good feedback that leaves me people walking out of the room saying thank you and appreciating. And then I run this company where I don’t think anyone feels that way. It doesn’t feel like anyone feels that way. And it’s a really different dichotomy from the work I’m used to doing. Maybe we just like to be liked and it’s not easy to be liked and be a good owner.
Dr. Sharp: I’m right with you. I think you nailed it. It sounds hard.
Dr. Leslie: It’s a bit uncomfortable and it’s hard.
Dr. Sharp: Yes. I’m just trying to sit with that. I think a lot of folks are probably resonating with that.
Dr. Leslie: I want to be able to explain to people like these decisions are made so that I can be a better boss, that we can have a better place, that we can do the very best that we [00:38:00] can to have a place that you want to work, but if you don’t run a business, you don’t know that. There’s just not a way. I didn’t have any of these ideas. I can remember back to when I was at a private practice and I remember some of the things I said to my supervisor and I have since met with him for lunch and said, hey, you got to hear this.
I tell him some things that had been said to me and I’m like, I know. Sit down. Yep. And he just laughs and smiles because I’ve been there wondering where all my money went, where everyone’s spent, what your bills cost, all the things that have been said to me that but for some reason he’s smiling and I’m not feeling that way.
Dr. Sharp: Sure. Maybe more practice. I don’t know. The sense I get is you are just right in it. There’s no luxury [00:39:00] of hindsight at this point because it’s just happening every day. And that is a really hard thing to sit with day in and day out to have this significant part of your job where you feel like people don’t like you or don’t appreciate what you’re doing or feel valued or whatever it may be. That’s hard.
Dr. Leslie: This has been for me. I guess it’s not harder than I thought it was going to be. It’s just a lot more prevalent than I realized it was going to be. And I have friends who are practice owners and we all in the same boat. We call each other when we’re like, do you got to hear what was said to me this week? And we’re just being willing to support each other and sit in it because it’s hard.
Dr. Sharp: Absolutely. I think finding that balance of being empathic and being able to understand and connect with where your employees are at and being able to then, I don’t know [00:40:00] if it’s transparent or just clear, and say, I totally hear you. And here’s where this is coming from. But it’s hard. Like I said, it’s easy to sit on the sidelines and those are hard conversations and people may leave. We found that to be very true that going through this transition, some folks have left because it just doesn’t fit.
Dr. Leslie: I’ve gotten a little bit better at both understanding that not everyone’s going to be meant going to fit well and then also a little bit better at looking for that on the way in, and a little better about knowing what I’m looking for. So now here I am building up some of these skills that I didn’t have before, but then wondering, what would it be like if I didn’t have a clinical practice. I still love what I do. I don’t know for sure. I never asked you, but do you still have clinical hours?
Dr. Sharp: Yeah. I’m doing [00:41:00] at least 1 or 2 evals a month. For me, that’s 15 to 30 hours a month, I guess, of clinical hours.
Dr. Leslie: Okay. But that’s not a lot compared to what I’m doing at 70% of my job. Was it hard for you to give that, I mean, you didn’t give it up completely. So you still have a portion of it.
Dr. Sharp: It is hard. I gave up therapy many years ago. That was really hard. That was my identity as a psychologist when I switched over to testing and then cutting back on the testing has also been challenging, but I love the business management part, the running the business and the visioning and all that kind of stuff. And so that made it a little bit easier.
I want for you, it might make it a little easier if we get your role dialed in where you’re doing mostly just [00:42:00] visionary kind of stuff versus the other practice management kind of stuff. I don’t know, but it is hard to give up clinical work. It’s very rewarding and it’s concrete. You do it, then generally it goes well.
Dr. Leslie: I’m proud of what we’ve done. I’m proud of what we built. I like the fact that I’ve been able to be a part of building something that’s meaningful in communities that need help. I like all the things that we stand for. I just didn’t know it’d be so damn hard, Jeremy.
Dr. Sharp: Yeah, like you said, we don’t get this education, especially at this level. I just want to validate that.
Dr. Leslie: Do most practice owners stick with it? Do most practice owners find their way through this difficult stuff? You’ve done this for far longer than I have.
Dr. Sharp: Yeah. Do most practice owners stick with it? I think [00:43:00] most do. I don’t know how many are content and profitable. I think a lot of people do stick with it, but I don’t know that that’s always the best choice. There are a handful of folks out there who are running, especially I will say insurance-based practices, it seems really hard because of insurance, right? Private pay group practices seem to do a lot better because it eliminates a big issue that people talk about a lot, which is a compensation, and typically that’s just better in private pay.
But I know plenty of folks who have stuck through it and get to a better place on the other side. And I would say that is absolutely true for our practice as well. It’s a journey for sure, but it’s better on the other side. It’s hard to go through. It’s a hard process.[00:44:00] Dr. Leslie: Yeah. I feel like if I didn’t have to take, if I could be in a place where I could do more of what I love to do. So the length of time you’ve been doing this at some point in time, you pivoted within the practice, but you pivoted to things that you are good at, that you enjoy, that come naturally to you, that are that you’re passionate about. I think that that’s imperative for me. Otherwise, I feel like it’s just slugging them straining. I don’t want to do that. I would just go back and work at a nonprofit, right?
Dr. Sharp: Yeah, exactly. Have you sat down and really reflected and maybe even written a list or a vision or something of what your ideal role would be in the practice? Do you have a clear sense of that?
Dr. Leslie: Yeah, I would open locations. One thing that’s easy to do is be a female testing psychologist in places where there’re people who will [00:45:00] drive on average 30 to 50 minutes to come to any location I have for tests for evaluations. I have prescribers, but I can’t prescribe anything.
So it would be a heartbeat in my time researching, figuring out where other locations to go, driving there, bringing in clientele by doing that, then hiring the right people because I think I figured out the formula to who I’m looking for, to set up these smaller locations in areas that have no… there are areas very close to me that there are no providers. They just don’t exist. Let alone a testing psychologist or prescriber.
And so there are who’s prescribing is pediatricians and they’re prescribing without testing unless they can get you to drive 40 miles and wait for three months. We only schedule out for 2 months. That’s insane compared to other practices. We’re clearly the babies [00:46:00] on the block, right? No one knows about us. So you can get in 2 months.
Dr. Sharp: That’s great.
Dr. Leslie: Yeah. That’s what I would spend my time doing. That and connecting with communities. We’ve got therapists in schools. I would love to spend more time putting more therapists in schools. It reduces a huge barrier that people of low income struggle with as they can’t get their kids to therapy like you and I would do. So that’s another program that I have that I love, but it’s untapped to its potential because it requires time. Getting in schools requires a lot of meetings, a lot of red tape, and a lot of finessing a school before they’ll let you in their building. And so, I just don’t have time to do these things. That’s what I would do. That kind of stuff.
Dr. Sharp: Okay. So that’s great. It sounds like you have a pretty clear idea of how you would like to spend your time.
Dr. Leslie: Yeah. I would not run payroll.
Dr. Sharp: If there is nothing that comes from this call, it’s get payroll off your [00:47:00] plate.
Dr. Leslie: I know. I don’t know how to do it.
Dr. Sharp: I know. That’s really hard. I’m going to come back to something we talked about more toward the beginning of the conversation, which is defining these roles. I would start with defining your role and how you would ideally like to spend your time from week to week. Can be clinical, can be leadership, can be visioning. And then, then the job becomes sorting through all the other stuff that happens in the practice where the people are coming to you for and maybe working with your practice manager to build more of a leadership team in this practice.
Dr. Leslie: That makes a lot of sense. Actually, it is an idea that since it didn’t go well the first time early on, that was really hurtful for me because that was back in the time when everything was very personal. It was the early days where I was going to live or die by this. And it’s just not that. I’m not there anymore. I’ve [00:48:00] grown a thicker skin, but I never even thought about it again. So it would never cross my mind to think about doing that again. So I’m glad you brought that up in a sense because that might be a really nice next step. And I do believe I’ve got providers at each location that would probably take that on and be very interested in and probably would flourish in that.
Dr. Sharp: That’s great. I like it because it gives people an opportunity for advancement which is rare in private practices in our field, but you have the size to do it and create these other roles. It again gives more layers between you and day-to-day operations. And my guess is that it’s going to help things run even more efficiently because people don’t have to wait for you to get back to them or deal with inconsistencies because you said something two months ago to one person and then you forgot and said something different yesterday to the different [00:49:00] person.
Dr. Leslie: And do you think that 3 to 5 hours a week is really good… I mean, does that allow people to take on projects and little things? Because there’s little things that we want to do that never get done. They’re not clinical. They’re not visionary. They’re just like, I don’t know, a mailer that I honestly have wanted to put together. I’ve got admin staff working on that, which is wonderful because we have one that came in that’s got some skill in this area. But part of that, it was just me. It’s not good. And that’s definitely not my skill set.
Dr. Sharp: Right. So for us, the 3 to 5 hours a week has been good just for our site supervisors. I will say, though, those are meant to be mainly clinical touchpoints. So, problems that come up at that site, clinical issues. It could be some logistical stuff like, Hey, we’re out of paper towels. Can you pass the message along to the office person to order more? It’s stuff like that.
But [00:50:00] 3 to 5 hours a week is a lot. You can get a lot done amount of time. And then, I don’t know if there’s room to or a need for more of an admin leadership role- someone to split off and run the financial part or the front office part. I’m not sure what your practice manager would do from that point, but this could help her dial in her role as well and what you really want her to be doing.
Dr. Leslie: Well, there’s a lot of things that like her to do that again. The first thing I probably mean, she needs to learn how to credential because now we have an in house biller.
And so there’s a lot of things that I’d like her to do, but with 120 emails in your inbox every day, it’s hard to get to these things. It’s a lot of putting out fires. So I think there might be moving some of that stuff. It’s true. We’ve got to move it into different places so that she can do the things that I would like her to do that are also getting involved in the community, finding out how [00:51:00] we can get involved in our communities, which is important to me. There is that.
Dr. Sharp: Yeah. And are you meeting with her regularly?
Dr. Leslie: Yes.
Dr. Sharp: Okay. Great. Do you feel like those meetings are productive?
Dr. Leslie: Yes, they can be. I feel like sometimes we get burned out. So that’s been hard. That’s why there’s such interesting because you and I talked about this months and months ago and I find myself in that space again going, okay, we’re both feeling too much burned out. This is a good time to come back to this idea that still wasn’t solved.
Dr. Sharp: Yeah. I’m just spreading the wealth, sharing the love of leadership just to diffuse some of this energy. Makes a lot of sense at least to me. And like I said, I’m not inventing any of this stuff. It’s really just this business framework material that [00:52:00] has been so helpful.
Dr. Leslie: Yeah, it’s just not knowledge that comes naturally when all of your education is in psychology.
Dr. Sharp: Absolutely. So, if you’re looking for resources, if you do books, the book Traction is really good.
Dr. Leslie: Oh, it’s on my list, actually.
Dr. Sharp: Oh, good.
Dr. Leslie: I didn’t buy it or read it, but it’s on my list.
Dr. Sharp: Yeah, of course. So many books on the list. I know that feeling. It outlines EOS really well and gives you the key components and just moves you forward a little bit if you want to start to buy into a system.
But I’m super hopeful for you there. I think there is definitely a light at the end of the tunnel. And at least for me, that really happened when I made the choice to step away and let other people shine in my practice and do the things that they [00:53:00] are good at and wanted to do anyway, and just let go of some of the control.
Dr. Leslie: Okay. I like that a lot. Let other people shine. I never really thought about it like that, but I guess it’s really important.
Dr. Sharp: Super important. You’ve got 40 folks there. I’m guessing there are some rock stars, right?
Dr. Leslie: Absolutely.
Dr. Sharp: So spend a little time thinking about how could they step into other roles and do really well, you know?
So what else? I know we’ve spent a lot of time on this, but I want to make sure if there’s any other open loops with this topic that you want to tackle before we wrap up.
Dr. Leslie: I think that was the big one. I think trying to figure out if I want to do this forever really comes down to am I going to be able to find a way to pivot what I do to things that I know I want to do [00:54:00] because we’re a practice that has a lot of young therapists. They’re new, but I’m thinking more about how I want to work when I’m 50 versus building a caseload of practice right now.
So I’m trying to figure out, like, I don’t want to work like this when I’m 50. I don’t want to have to. I love the clinical work I do, but I hustle in this clinical work. It’s not bad. I just don’t want to do… I don’t want to retire. I just don’t want to do as much of it. And then it’d be great to have a possibility to do the things I really love. And that’s the connecting in the community and the growing of the things that are important to me. I’ve got even other ideas.
Dr. Sharp: This is great. Just like other people can shine in different roles, it seems like that’s where you are going to do your best. I’m super impressed. In the 45 minutes we’ve been talking, you thrown out like 10 great [00:55:00] ideas for where you could take your practice. And that job doesn’t fall to anybody else. That’s another way to look at it. Like, if you aren’t making time to do this and taking care of your practice in that way, nobody else is going to do it. You’re doing your practice a disservice by answering emails about mailers or whatever.
Dr. Leslie: I know. Plus I am not a graphic designer. I can’t even cut and paste very well. So this is just not my thing. But it’s the same thing over and over. You just feel like as an owner that at the end of the day, if it’s not done, it falls on me.
Dr. Sharp: Yeah, for sure.
Dr. Leslie: So I think that’s what you’re saying is the longevity here is that can’t be the case. Otherwise, we get to the point where we’re burned out or ineffective.
Dr. Sharp: Exactly. Yeah, you’re burned out. You’re trying to figure out how to get out of the [00:56:00] practice. People are complaining bottlenecks. The practice goes nowhere because nobody’s implementing the vision. Yeah, it’s all those things.
And I will say this just to address one piece of this that you alluded to that I felt a lot is I did not want to lose connection with people. And for me, I was conflating doing things and being useful to people with being connected to them. There’s a lot wrapped up in, if people don’t see me doing things, what are they going to think? And my identity is wrapped up in this productivity, looking busy and all that kind of stuff. Like, what would people think if I was just sitting in my office for 20 hours a week planning and visioning for our practice?
And so, I’ve had to do a lot of work around staying connected to our staff and that’s just an ongoing. It’s a lot more. Now, that is built into my role just because I’ve[00:57:00] loved it. I love that small practice feel. So it’s a lot more of like stopping by people’s offices and just saying, hey, how are you doing? And posting things in our work chat and little things like that, just making it a point to stay connected.
Dr. Leslie: That’s incredibly important to me to be connected to everybody. And it is hard because I also am really busy doing a lot of stuff. So then I feel like that’s a disconnect. And I’ve also really worked hard to make sure we all do the same. We’re all colleagues. We do all the same things. I do have to find a little way to break from that as well if I’m going to do other things.
Dr. Sharp: Exactly. You’re right on it and now it’s just what happens? What happens now? So, what’s the next step for you after all of this that we’re talking about? Where do you go from here?
Dr. Leslie: I think we’re not ready to make a move yet, but I think that I need to talk to my [00:58:00] practice manager about considering some site supervisor, something that is, I don’t know what we would call it, our supervisor will call it, whatever it would be called a clinical or something that would allow some people take on a little bit more.
We just got an EMR. I know you’re going to laugh at me, but I resisted the EMR forever because they’re all dumb, Jeremy, I can’t say this. You probably endure, but they’re all terrible. I’ve never met a good in my whole life, so I resisted, but you can’t have a multidisciplinary practice without EMR.
So again, my brilliant idea has created a whole big headache for myself. We now are in all in a very easily usable, understandable, affordable EMR. And that in itself is a feat of a transition. So we’ve got some things we’ve really got to get settled first, but I think coming 2024, and I have to, [00:59:00] the whole time, I still have to make sure that I can get an operating budget under control because then I know what it costs to run the company because we’re not adding expenditures right now.
We’ve done that for years in a row, added a location which messes everything up. Now, I can figure out what it actually costs to run the company consistently. And then I think once those things are settled, I think the next best step, as opposed to hiring other practice manager is to promote people within the company who want to take on more of a clinical leadership role. That makes a lot of sense to me.
Dr. Sharp: I like that. I hear you talking about…
Dr. Leslie: I don’t know if you’ve had this experience before, but I feel like a lot of times I don’t really know what to do and then problems will arise and they’ll pile up and then all of a sudden have this moment of clarity, like, okay, now I know exactly what’s going to happen. I see three steps and this is how we’re going to do it and they’re not negotiable to me. It doesn’t happen all the time but when it does happen, I am like, [01:00:00] “This is how it’s going to go.”
Dr. Sharp: Yes. I love the moments of clarity. I think that dovetails with what I was going to say too, which is, I hear you talking a little bit about prioritizing and what is important. And that’s just another tenant that we’ve really moved to is tackling things on a quarterly basis has helped a lot.
So, January, February, March, April, May, June, we split 4 quarters in a year. That’s the duration for any projects we’re working on on our leadership team. And so that gives you an end point. It’s like, we need to be done with this by this date, and it ramps up the urgency a little bit. And then it provides a little clarity to for where you focus your energy, because otherwise, it’s shiny object or putting out fires and you get nowhere mostly and those big projects don’t get done.
I wonder if you’re like, [01:01:00] so we’re in quarter 2 which ends at the end of June. So you got like 6 weeks. Can you in 6 weeks dial in the financial part and the EMR transition and then Q3 is building out or defining more of a leadership team. I don’t know.
Dr. Leslie: I think starting the discussion for sure. And some of this is we’ve got some young staff that are pretty promising, but they’re young, meaning not young as in age, but also young as a licensure. So there’s some people that I would want to really get their feet a little bit more wet in the clinical room before they would. I made all those mistakes before. So, usually, the’re lessons I’ve learned but I got some really wonderful promising practitioners who just really do a great job. I think having that discussion, I think it’s going to just be more of a planning period before implementation probably is realistically [01:02:00] 2024.
Dr. Sharp: Love it. Okay. I like realism. Yeah, that works.
Very cool. I’m excited for you. It seems like your practice has a lot of potential. It’s doing great, but there’s a lot of potential for you to do what you love. That’s the most important thing. If we’re not in a good place, then the practice is not going to be in a good place.
Dr. Leslie: Yeah, I agree.
Dr. Sharp: Thanks for jumping on and having this discussion.
Dr. Leslie: I appreciate all your ideas. It’s very helpful.
Dr. Sharp: Sure thing. I hope so. Well, I’m guessing that so many people out there who own group practices are nodding right along and hopefully take away some similar things.
It’s a tough job. And I just want to say, I’ve been thinking about this throughout our conversation talking about it being fairly thankless. I just want to be super clear. I am very grateful for our practice and our staff. And we have amazing people who [01:03:00] do great work. I always say we have the most amazing staff and it can be tough sometimes to manage all that emotional energy. Good to see you.
Dr. Leslie: Good to see you too. Thank you so much, Jeremy.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcast. And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development: beginner, intermediate, and [01:04:00] advanced.
We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.
Thanks so much.
The information contained in this podcast and on The Testing Psychologist’s website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric [01:05:00] or medical advice, diagnosis, or treatment.
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