She has a group practice in Chicago that now has 25 clinicians. Their revenue is incredible and the profit margins are even more incredible. She really knows what she’s doing. She has all sorts of resources for group practice guidance. She has a Facebook group, she has a membership community and she does coaching as well.
She shares a lot of her knowledge with us today. This is a little bit of a departure from our expert series on [00:01:00] testing topics, but a lot of people ask about how to run a group practice and how to start hiring, and you’ll get those answers today.
All right, onto our conversation.
Hey, y’all. Welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Our guest today is a little bit of a break from some of our recent interviews. Today, I have Maureen Werrbach on the podcast. Maureen is the group practice guru experts, I don’t know, what word do you like? What are you?
Maureen: I don’t know, coach.
Dr. Sharp: Coach, don’t sell yourself short. [00:02:00] So Maureen’s going to talk to us all about group practices and hiring and expanding and growing. She is amazing. Like you heard in the introduction, she hosts The Group Practice Exchange. She has a ton of resources for folks who are doing group practice and she’s talked me off the ledge two times so she knows what she’s doing and is really good at this stuff.
So I’m just thankful that you’re here. Welcome to our podcast.
Maureen: Thank you for having me. As you know, you’re my only guest who’s come on my podcast twice, so we have a nice little relationship going here. So I’m really excited that I finally get to jump onto your podcast.
Dr. Sharp: Yeah, absolutely. I know. I like to repay the favor. It’s so good to see you again. It’s hard to know where to start. I feel like you certainly have been doing this for a long [00:03:00] time. You have a relatively large practice in the Chicago area. You have therapists, psychologists, you are doing some testing. You also psychiatric practitioners. You really have mastered the group game, I think.
But I get a lot of questions around group practice and how to expand and when to do it and how to, all that kind of stuff. So we’ll just see where it goes and hopefully pull together some useful information for folks with testing practices.
Maureen: Yeah. So when it comes to expanding, I’ll start from the beginning a little bit and then happen to maybe expanding once you’re already a group, but if you’re a solo practitioner like I was, did you start as a solo practitioner too?
Dr. Sharp: I did.
Maureen: You did. Okay. I know some people who go straight to starting a group so I wanted to make sure. [00:04:00] I started as a solo practitioner and some of the things that … Initially I never thought I was going to own a group practice. I’m pretty introverted. I like to keep to myself. And so if you looked at my history, you wouldn’t have guessed that I would have been someone who was leading and managing other people. You would have guessed I had my own business, though. I was one that likes to do my own things and be in charge of myself.
When I went into solo practice, there was a part of me that, one, realized that there was only so much I could do for the community and for some weird reason that struck a nerve with me that I could only do so much and I realized that there was such a need just in my area, where my main hub is located. Part of me also felt that loneliness factor which a lot of solo practitioners talk about. And [00:05:00] also I had a lot of referrals coming in, and so I knew I could or I assumed I could fill a therapist’s schedule.
I like to stop here because this is probably what most people think about when they think about starting a group practice. And now that I’ve done it, I like to talk to what would I say to my younger self sort of thing. I’d like to say that the best thing to do when you’re thinking about expanding into starting a group practice is getting some business plan in place. I didn’t.
I was lucky enough because I probably wouldn’t have done it for a very long time but I was lucky enough that Chicago, the Department of Treasury, was having a small business plan competition for the city of Chicago. If you won, you were to get some amount of money to help you expand. And so I was like, I’ll do it.
And it really helped me really put together what I wanted my group practice to look like, what I thought it could [00:06:00] look like that would be in line with who I was and what I wanted the community to see in me and my group practice. And that really helped me solidify, one, that if I should have gone the group practice route because at the time I had one person I’d hired already.
So I feel like the thing that people miss most is doing that business plan in the beginning and they wing it similar to how I did. And you’re just going to learn from a lot more mistakes doing it that way. It helps you really figure out what direction do you want your group practice to go. How big do you want it to be? Is it something that you’re wanting to scale in the future?
And obviously a business plan is, it’s ever changing, it’s evolving, it’s not static, it moves but it moves with you as you grow. So mine has changed along the way but I think I would have made a lot more random detours and adjustments had I not had that business plan.
Dr. Sharp: Sure. [00:07:00] I think, at least for myself, I got scared off by doing a business plan because the ones, the templates I looked at didn’t seem like they made sense for us and it was overwhelming. I was like, I don’t know these terms. So what does a business plan look like for someone who’s thinking about building a group practice then in mental health?
Maureen: You can go on the IRS website and they have a template that lists the main things like your business description, your market analysis and your financials. The business plans will all look the same whether it’s in group practice or in banking or in any other kind of line of business.
What I found that a lot of people don’t know about is, yes, you can go on the IRS. If you google IRS business plan template, it’ll give you a template of what a business plan should look like but it’s hard to know what information to put in the categories when it comes to our line of work because some of the terminology just [00:08:00] doesn’t connect with the things that we do.
And so what I ended up doing was, and every state has this. They have business where, what did I go through? I’m trying to think of the name of the website, but it’s like a … For free you can use, your city has people who help small businesses write their business plans. That’s what I ended up using, was a Chicago business association who helps people write business plans and that’s what I used initially. They were able to help me. They didn’t know much about my industry, but they were able to help go into detail of what each piece means.
What I see is that the group practice owners who do write a business plan end up writing a very simple one, that’s one or two pages. A really good business plan requires you to do a little bit of work. There’s a section that’s called market analysis and people usually just write what their marketing strategy is going to be [00:09:00] but market analysis includes going to your local chamber of commerce and asking for statistics on who the people are in your community where you want to have your group practice or where it’s already established.
It helps you know what is … if you’re … I’m just maybe throwing things out in the air right now, but if you’re a child therapist and you want to do testing for children but you find out that later on, because you didn’t check with your chamber of commerce or you can google sometimes, some areas will have the comps on Google, is that you might find out that your average household size is two and the average age is 45 which tells you that it doesn’t seem to be a lot of families there. And if you’re a child therapist, that might be a little rough.
I’m just giving one example, but this is one of the things that really [00:10:00] going in and doing the research on your area which is one piece of the business plan helps figure out what is my community need and can I make that happen because that’s part of what makes you grow a successful group practice is that you’re offering things that are in line with what your community needs.
Dr. Sharp: Right. I don’t know if this is relevant or not, but have you run across any kind of hard data on how many therapists are needed for a particular population level or anything like that?
Maureen: I haven’t, but I like to go from that abundance mindset that we have way more people in the world than therapists so it’s very likely that it’s not going to matter much even if you’re in a very heavily saturated therapist area, but I don’t have any real hard data. I haven’t seen anyone who’s done the work, the back end work, the research even those that are in heavy therapist areas who weren’t [00:11:00] able to be successful and expand and have a group practice.
Dr. Sharp: Sure. The only way that I’ve dived into that was when I was trying to request increases from insurance companies and I did the math around how many contracted providers there were versus children in the school district and stuff like that. And it was way more than I thought. There was something like 5,000 kids for every therapist who was in network with that insurance company or something.
Maureen: Did you use that information?
Dr. Sharp: Yeah, I did.
Maureen: Did you get an increase?
Dr. Sharp: I did not.
Maureen: What?
Dr. Sharp: I know.
Maureen: Oh my gosh. I was waiting for a success story because you know me with those rate increases.
Dr. Sharp: I know. Well, I got that from you. I put a lot of work into that particular one, but it’s like our holdout company. It’s Unite or Optum, and they just won’t.
Maureen: And when was the last time you did it?
Dr. Sharp: Six months ago.
Maureen: Try again. [00:12:00] Optum gave us a huge increase just very recently.
Dr. Sharp: Really?
Maureen: Mm-hmm.
Dr. Sharp: Okay.
Maureen: Very big double.
Dr. Sharp: Double?
Maureen: Yeah, so I would check. I know that it’s likely very specific and it was across the board. If you asked for it, they give it in Illinois. So if you’re in Illinois, listening and you haven’t gotten an increase with United, ask.
Dr. Sharp: Yeah, I know we have listeners from Illinois
Maureen: Yeah, I would try again with them. The way I do it, I know we’re going off topic slightly with the rate increases, but most people give up after they write a rate increase request to an insurance company and they go, oh, okay, they said no. Take it a step further. Probably half the times I will get an increase when I ask for it, but the other half of the time I get a no.
And out of that half, I send another letter saying something along the lines of, I’m going to have [00:13:00] to reconsider my status with you guys. We have X amount of providers that just, financially we can’t work with the rate that you’re giving. I’m a little bit more stern and a little bit more … there’s a little bit more fire under my butt with that second letter, and it’s just usually just a response. It’s not a whole detailed letter, but a good chunk of those will say, let me move it up the chain. It’s as far as I can. I can’t do anything anymore, but let me move it up to my superior, maybe they can do something about it.
I think of it as oftentimes insurance companies just assume that people will give up and so they’ll say no at first and then people won’t ask for it again. Try again.
Dr. Sharp: Sure. I like that. I need that encouragement. I should say, I’ve had success stories too. At the same time that rejection was happening, I got an increase from another panel. That was fantastic and it was really cool.
I did that thing that you’re talking about. [00:14:00] They actually came back and offered something, some raise. And I was like, eh, testing’s really specific and it’s a specialty. Can we get those rates a little higher? We can leave therapy the same, but can you raise the testing rates? And she came back and gave a raise with the testing rates in particular.
And I think that’s applicable for a lot of people listening too, that testing is such a specialty. In a lot of communities, we are in pretty high demand, especially people that take insurance for testing.
Maureen: And oddly enough, testing is underpaid by insurance companies.
Dr. Sharp: In lot of places they are.
Maureen: I’m really actually surprised, when I brought on my first testing person, I assumed insurances were going to pay out more than they do for traditional one-on-one therapy. That isn’t always the case in terms of reimbursement by insurance companies. So I think more than anything, if you have a testing practice [00:15:00] and you’re in network with insurance, requesting those increases often.
And if you get a no, you respond again right away. And then if they say no, again, you wait six months and you request again. You annoy the hell out of them until they give it to you.
Dr. Sharp: I like it. Number one strategy, annoy them to death. All right, let’s dial it back a little bit. So for folks who are really thinking about expanding, you mentioned getting a lot of referrals and you thought you could probably bring someone else on. Is there a way to gauge that for sure? How do you know when you can expand and hire someone referral-wise, business-wise?
Maureen: I like to say that this really can depend on your risk level as a person. There’s going to be people. I was just coaching someone who is starting a group practice. He’s starting from zero, not a solo practitioner. I think that’s higher risk. He hasn’t yet figured out if it’s going to [00:16:00] work. He hasn’t yet got his own caseload where he knows a little bit on how to market himself for whatnot. He’s going jumping right in.
So there’s certain people that are willing to take a little bit more risk when it comes to business and then there’s those that take less risk, which I feel like … and anyone who wants to start a group practice has some level of ability to take risks, otherwise, you wouldn’t own a business. My mom always says, I would never have a business. I just had nothing. I have no willingness to take any risks beyond what I know is 100% possible. So obviously, anyone who owns a business, they have a little bit of ability to go into the unknown.
But when it comes to your specific question, I truly think that you can go the slower risk route, which is what I did. I did one person at a time. Once I solidified that starting a group practice was something that I really wanted to do, that I had the means and the ability to supervise [00:17:00] people and to make executive decisions that maybe not everyone would be happy with.
There’s a lot more than just bringing on someone to work your off hours, which is what a lot of people do initially. I just will bring someone on and they can work the days I’m not there but a group practice is more than that.
And so once you figure that out, if you’re someone who isn’t, not risk-averse but it’s low risk, likes to take little risks at a time, similar to how it was in the beginning, the way I did it and I’m a metrics person, I know you and I talked about that before we went live today, is I like to have metrics that show me if something’s working or not. Otherwise, I tend to be …
I have ADHD so my brain is on all cylinders at all time thinking about this thing and then this thing and then let’s do this. And so for me, I need to have metrics that show me if all of these crazy things that I’m doing, are they working? Are they not working? And so [00:18:00] I think if you can figure out a way to have some level of a metric, whether that be, I get five new calls a week that I can’t schedule because I’m full, that’s a metric. It’s telling you that there’s a need beyond what you can offer.
And I think with hiring your first person, the easiest thing is to have that. Is to just have calls coming in. It doesn’t have to be 100 calls. It can be two calls a week coming in that you cannot fill that you are too full to take. And that, at least, will let you know that you can give that to someone else.
And now there’s a whole other side to the story of making sure that you’re hiring the right person, looking at what kind of calls are coming in. So being risk taker or not, you can hire someone because you really want a Reiki therapist and no one’s asking for it, but you’re willing to market for it. That’s a little higher risk.
Lower risk would be, wow, I have a lot of couples calling for couples counseling. I think my first hire is going to be a couples therapist. The risk is [00:19:00] a little bit less in that you’re more likely to be able to more quickly fill in. And it’s not to say that one is better than the other, but I think it comes back down to what are you comfortable risking? Are you able to be comfortable in higher risk situations, which some people are? Like my coaching guy that I’m telling you about, who’s starting a group with five people he hired all at once.
Dr. Sharp: Oh, my gosh.
Maureen: It’s not impossible. It just means you have to have a certain level of something in you to be able to muster through a longer period of stress figuring out what a group practice is going to look like when you get it plopped into your lap. I don’t think one is any better than the other.
And I do think that as you hire, once I hired my second person, I actually hired them two people at once. And then once I was at then four or five, including me, I was able to hire three people within a month [00:20:00] period. It gets a little bit easier to expand. I look at it as like a snowball effect. Once the snowball is rolling down the hill, it gets bigger on its own.
Dr. Sharp: Absolutely.
Maureen: It’s the beginning parts that most people have the most concern with when it comes to expanding. For me, I always say, if it’s a concern, then why not go the easy route and you hire a person when you have some referrals that you cannot fill yourself? That’s the lowest risk version and you have the metrics to show you that you can do it. You got calls that aren’t able to be scheduled that you’re referring out.
Dr. Sharp: Yeah. I like that you break it down like it’s doesn’t have to be complicated. You basically just track your phone calls for a few months or weeks or whatever it might be to see where they’re coming from and what they’re for. It’s a great place to start.
Maureen: That’s the easiest route. Obviously, if you’ve got [00:21:00] time and you’re a little bit more business savvy, most of us are not business savvy from the get-go, and so going this easy route is just easier. But there’s obviously 100 other ways that you can do it.
I’ve seen success in group practice owners who start physically as a whole group versus starting solo. You then have to have that grit inside to be able to work through adversity and potentially things not going well in the beginning, that’s also a possibility.
Dr. Sharp: Yeah. I wonder, are there any things that you’ve done or things you’ve read or ways that you’ve engaged in personal growth to be more of a business owner to deal with some of those things over the years?
Maureen: Yeah, I think the one thing that I do consistently is because I’m not a business major and I’m pretty introverted, in terms of leadership skills, [00:22:00] it was not my initial. I’m a very nice person. I never yell. So I have all of those great qualities. When I first started my group practice, I didn’t have this innate take charge and lead type of mentality. I am in my own life but not when it comes to …
When I was in school, if I could choose between working with a partner or working by myself, I would work by myself. So I knew my strengths and I knew where I needed to have work done. And so something that I still do and I’ve been doing it for years is reading books on leadership. If you’re thinking about starting a group practice, you should read Radical Candor. It’s a great book on leadership, on how to manage difficulties that’ll come up with interpersonal staff issues.
I also read the book Grit very recently. And that talks more about this innate level of grit that everyone who’s a business owner needs to have to be able to be [00:23:00] successful. There’s only so much that your smarts can do and then there’s this whole underlying level of this grit. It’s like, if you say you’re going to do it, you’re just going to do it. You’re going to figure out how you’re going to do it. And so that book was really good because it just talks about grit as a business owner.
Profit First, obviously, most of your listeners know about that.
Dr. Sharp: I have talked about Profit First book
Maureen: Yeah, most of us are not finance gurus and so we likely as a new group practice owner will pay everyone else first but yourself. You pay your expenses first and you pay your payroll people first and then you pay your taxes and then you’re like whatever I’ve left over, okay. I guess I have $100; I’ll give that to myself.
Profit First was a great book in helping me shift how I looked at money and my relationship to money. So those are the first three books that I’d recommend when it comes to just getting into a leadership mindset and into a business [00:24:00] mindset.
Dr. Sharp: Awesome. I’ll put those in the show notes for sure. I’ve read two of those; Radical Candor and Profit First and love both of them. I thought Radical Candor was awesome.
Maureen: Yeah, me too. It changed how I communicate with my staff and it changed part of the structure of my business because that whole idea of rock stars and superstars, that you’ll have some staff that are rock stars who are just … they’re rock solid in their work and they do their work really well but they have no desire to move up or move forward. And then the superstars are those that do want to move up to move forward. They tend to be the people that leave the practice to start their own practice.
In our industry as group practice owners, tend to not do anything about those superstars and then we get angry because they leave. And so I’ve shifted everything. I have a huge management team now, from site supervisors to clinical director to onboarding coordinator.
I literally, probably since I last talked to you, made a lot of shifts in having more people who are [00:25:00] invested in their business, who do great work, who have certain skills that I was like, I could find a good useful position to help you feel like you’re, that take your investment in my business and give you something special, something different than just a therapist and it’s played a huge role in connecting the therapists and giving them a greater sense of purpose.
Dr. Sharp: Sure. I think that’s super important. I know that’s getting down the road a little bit for folks thinking about having enough staff to even do something like that, but it totally makes sense to at least be looking at your folks in that light, like what might they need besides just doing the work or are they doing the work?
Maureen: I got to say, my clinical director, I had her become a clinical director with clinician number three. I was in my first year. Most people don’t do it but …
Dr. Sharp: I did not know that. I thought it was later on. Okay.
Maureen: No, it was [00:26:00] myself, her, the first person I hired, so she was the second person I hired and then a third person. She only had to manage two people. I knew where my strengths were and I knew where they weren’t. I knew what I liked doing and I knew what I didn’t. I don’t like supervising people. I just don’t. I like to do the business stuff; the metrics, the background, the growth, and the expansion.
I don’t like the day-to-day helping them figure out how to do a note in therapy notes or I’m having an issue with my couple, what other skill can I do? Those are things I don’t want to do. And so from the beginning, I decided, as I hired people, that I would look out for that person that could fit that role. And so when I hired her, she was a clinician for about six months or a year, I can’t remember. It was back in 2012 or 2013, but she was working for a little bit with me and then I was like, I think she’s the one, and [00:27:00] she’s still the one.
Dr. Sharp: That’s awesome.
Maureen: It’s something to think about from the beginning because one of the biggest struggles group practice owners have in the beginning is that they wear every hat. They’re doing the supervision, they’re doing the hiring, they’re doing the staff management, they’re seeing their own clients, doing testing, whatever it is that they’re doing.
Then they’re doing business management stuff, making sure they’re doing payroll and marketing and networking, everything. And so one of the key things that we need to do is to let go of some of those hats and wear the hat that works the best for us, that we feel energized by, that we’re good at and to give those other hats to someone else.
The issue comes up is that people think they can’t afford it. And this is why I like to use my clinical director as an example because I was barely there. We just had three people, and they were still growing at the time. In my head, I thought, if someone is meant to be in a higher level [00:28:00] position, whether it’s a supervisor or clinical director, if there’s something that you can’t do or you feel like you’re not good at when you’re a new business owner is the idea that if that’s something that is their strength, they’re going to be so excited about that, that they’re going to be willing to grow into that position.
So I didn’t hire her to do 40 hours of clinical director work. She did one hour a week. She got paid for four hours of clinical director work a month because we only had two people. They were fully licensed so they didn’t need supervision every week. She was there to be available if issues came up. Obviously, almost every group practice owner can afford to pay one hour of clinical director work a week knowing that that gets taken off of their shoulders so that they can do something that generates more income.
Dr. Sharp: Exactly.
Maureen: Just a little tidbit.
Dr. Sharp: Well, no, I think that’s really important to be thinking about from the very beginning. I talk so much on here about delegating and outsourcing and all that kind of stuff, that we shouldn’t wait [00:29:00] to start doing that, think from the very beginning, like what do I really want to do? What am I not good at? What am I good at? What do I have time for? What do I not have time for? And be thinking about who can do those other jobs for you. And maybe it’s a clinical director, maybe it’s a VA, maybe it’s a biller person, but having that in your mindset from the beginning is important.
Maureen: Exactly. And every time I’ve done it, every time I’ve taken a risk, financial risk, I should say, by bringing someone else on to do something that I could be doing for “free” not really free because my time is worth money but I would feel this way and I’m sure you have and every other new to group practice owner will say, well, if I’m doing it, then I’m saving money because I don’t have to pay someone to do it but your time is worth the most. You’re the business owner, so you got to put a place of value on that.
But every time I made a jump to hiring someone or bringing someone on that wasn’t a clinician because obviously clinicians, essentially, [00:30:00] are not very high risk financially because you pay them for seeing clients, which means you’ve been paid as well. VAs and billers, clinical directors, supervisors, those kind of positions are a little bit more high risk because you’re paying them whether or not the clinicians are seeing clients. They’re there for the most part maybe a VA. Well, even with VAs, you usually pay for a package or a minimum so you have to pay whether you use it or not.
Every time I’ve taken a risk like that and now the risks are much smaller because I’m a large practice and can make additions like this a little more easily but when I was newer, it was a big deal to bring on a clinical director, even though it was just one hour a week. It was a little bit of a risk but every one that I took always yielded in me having more time and being able to use that time to grow the practice in a way that brought in more income.
Dr. Sharp: Absolutely.
[00:31:00] Maureen: I want to put an aside on here. A key thing is if you do hire someone as a support person, whether you’re solo still and you decide to hire a biller or a VA to answer your phones for you or whatever, the thing that makes it worth it because it’s really easy and I’ve heard this a lot where people hire someone but then it feels like their time is still just constantly being used, is that you have to purposefully out loud or on paper, say what you’re going to be doing.So if I hire a VA for five hours a week of something that I was doing, I am legitimately saying what am I going to do with these five hours? I either am leaving an hour early five days a week so that I … Literally am working five hours less or I’m going to say, I’m going to take those five hours and I’m going to blump those five hours on to X day to do marketing only. I don’t know, whatever it is, get my nails done, whatever it is that you want to do.
I think the issue that people have is that they get support but then they replace [00:32:00] that time with menial things that aren’t helpful to the group practice or the growth and still make you feel anxious and overworked. And so when you do make these changes where you’re going to spend money on someone else for support, is that you say, okay, these extra X amount of hours that I’m going to get back, what do I want to do with it? Do I want to use it for myself? And then use those hours, actually leave work five hours earlier, do something that, so you feel it.
Dr. Sharp: Absolutely. Good point. Oh, you’re so right. So let me try to touch on just some basics for folks who may not know, let’s say they’ve decided to hire their first person. I like lists. What are three things they need to think about before they even hire? They know they need someone, now what? What do you look at? What do you research? What’s important?
Maureen: Step 1, have a business plan, but we’ll pretend that that’s not step 1, because I already [00:33:00] brought that up. So step 1A is find an employment attorney and have them draft an employment contract or an IC contract or an offer letter. Don’t …
Dr. Sharp: Can you talk about that IC, employee difference? I feel like a lot of people get tripped up with this, I know it’s a huge thing, but briefly, IC versus employee.
Maureen: An employee is someone that you hire. An independent contractor is someone that has their own business that contracts their work out in your business. So think of a painting company that hires a guy who has his own painting supplies and he doesn’t work for that company. That company will call if they have a project for him to do, and he’ll say yes, I’m available that day. I can do that project. This is my rate, and this is what I charge. And that company will pay that painter, who will then go out with his own supplies and do that work.
An employee is someone [00:34:00] who the employer has more control over. They can say when and where they need to be. They supply them with everything like couches and chairs and pens and papers and testing materials. But going even beyond that, one, there’s a lot of changes happening in several states, California being one of them where they’re essentially writing into law that it’s nearly impossible in our industry to have contractors anymore. So that’s why I say to find an employment attorney because people want to cut corners in the beginning and kind of copy someone else’s contract and then just use it.
But it’s really important to know based off of your personality, based off of your leadership style, based off of your vision for your group practice, is it better for you to have employees or contractors? We’re finding out that in more and more states, as time goes, contractors is really hard to make happen.
And so I have employees, [00:35:00] but my testing person is an independent contractor. All my therapists are employees but for testing, she has her own counseling business. She does her own counseling and testing at her own private practice somewhere. She doesn’t have any set hours. There’s a room that’s available to her two days a week for a certain block of time from 8 to 12. And if she has someone for testing, she comes. If she doesn’t, she doesn’t. She schedules her own appointments. I pay her business for doing that work. She’s not a part of our team and our team culture of therapists who are W-2s or employees.
So with employees, if you want to supervise, if you want to tell them when they can and can’t work, if you want to make them work full time; these are all things that you would need an employee for. If you really want to be hands off and not provide direction, not supervise, not have policies and procedures that they need to follow, allowing them to [00:36:00] come and go as they please and see clients and they have their own business that you can pay and they want to work very part-time, then contractors might work for you.
This is why I say the first step should be to find an employment attorney because they will tell you in your state, what’s possible and what’s not because you may be in one of those states where contractors just doesn’t work but also even if it is possible and something that can work in your state, you talking through what you want from your practice will help them say, that sounds a whole lot more like you need to have employees.
The issue only arises that people have contractors who they’re really treating like employees and if the IRS finds out you’ve misclassified; you can owe a lot of money. There’s never going to be an issue with you having employees who you treat like independent contractors. So if you want to go the safe route, obviously, having employees is safer because you can say, [00:37:00] and this was me in the beginning is I was like, I really want to be hands off. I don’t want to be setting a lot of rules, obviously, as I’ve grown in my business and gotten comfortable with my role, that’s changed.
But there’s no rule book that says if you have employees that you can’t allow freedom or allow them to make decisions on their own. The problem only can arise if you have contractors that you’re treating like employees. There’s never going to be a time where you would get in trouble for having employees who you’re treating like contractors.
Dr. Sharp: That makes sense.
Maureen: So that would be my first tip, is an employment attorney. Don’t use these Facebook groups to ask what’s better. Don’t use the Facebook groups. I feel like my group is the one, if anyone’s a part of that group, people ask it all the time and I wish I could zap that question off so that they can’t ask because it’s a legal question. You need to [00:38:00] have an attorney answer that for you and draft paperwork that fits your state’s rules and your particular …
Even your county or your city, laws change just by counting area. Here in Chicago, just last year, new law went to an effect where if you have employees, you have to pay for sick time, but literally about three blocks away from me is a suburb called Park Ridge. If my practice was over there, I would not be required to … So even just having …
Dr. Sharp: Oh that’s amazing.
Maureen: Yeah. And so it’s really important that you have an employment attorney because she was the one that emailed me and said, hey, just want to let you know, new laws going into effect in July of 2017 it was, and I was prepared in November of 2016 for it that I actually put it in place on January 1st, six months early.
But you don’t get that information if you don’t have an employment attorney. And when you manage staff, whether they’re contractors or employees, I think the biggest disservice you can do for [00:39:00] yourself is not having someone like that, that you can talk to. And most people don’t because they don’t want to spend the money. Attorneys cost money.
Dr. Sharp: They do.
Maureen: As you and I know.
Dr. Sharp: They sure do. I got a bill from my attorney on my desk right now.
Maureen: So do I.
Dr. Sharp: Okay. So step 2.
Maureen: Oh, so then let’s say you’ve figured out who you want to have; contractors or employees. I feel like a second step, there’s like 10 things at step 2 that can happen and not in any particular order but I would say from the perspective of me being a group practice coach, what I tell people to do next is to figure out your ideal clinician before hiring because we were talking about next step before hiring.
There’s a lot of other things like figuring out if you want to take insurance or not as a group and figuring out if you need a group insurance contract, but those things are not as important and you can do them [00:40:00] later, too. If you’re thinking about hiring someone, you want to know who you want to hire. I think a lot of us have it in the top of our heads, like, yeah, I want a fully licensed person to work 10, maybe 15 hours, and are pretty vague.
And then you start interviewing, and more often than not, if you connect with someone because you like them, you’ll hire them. It doesn’t necessarily mean that they’re the best fit for your practice as a culture, personality-wise, needs-wise, which is why knowing what your community needs is important.
I have an ideal clinician worksheet that’s on my website somewhere and it’s free. Anyone can take it. It walks you through some common questions like would you want someone who’s provisionally licensed or not? It’s an important question because you will get 100 provisionally licensed people applying for your position and it’s very easy in the beginning to be antsy and jump in to saying, oh, you know what? I didn’t really want a provisionally licensed person but [00:41:00] why not?
And that’s where I see a lot of people making mistakes because then they see all of the extra work that might come in with a provisionally licensed person that they didn’t think about. And then figuring out what are your non-negotiables? If you want someone fully licensed and not provisionally, don’t interview someone who’s provisionally licensed because you might like them, and then it feels weird to not take them on and you’ll feel the pressure of wanting to take them on.
If you want a couples therapist, don’t interview people who aren’t couples therapists. Make sure to have this job description be directed to a couples therapist. If you’re wanting someone who, like part of mine and it evolved into this, is I have a really heavy emphasis on company culture. And so I want clinicians who want to be engaged in the practice with the other clinicians. I don’t want someone who just wants to see clients and [00:42:00] go home.
You might want people like that and I think that’s important because it’s going to have a different culture. You’re going to have people who are very independent and kind of coming in and going. I wanted a place where when I walked into the office, that people were sitting on each other’s couches and talking between seeing clients.
I wanted a practice where clinicians would want to come to staff case consults. We have a once a month case consult where we get pizza and Starbucks and we just have a good time and connect. You’ll find very easily and I’ve had this happen before where I didn’t put an emphasis on it and then I hired people who never showed up to the staff outings and just weren’t really a part of it and felt like, who is this person? And for me, it was something I didn’t like.
And so that was part of a non-negotiable for me moving forward after I realized that is, I need to make an emphasis on company culture and that I need someone who really likes to connect with the other staff members. If you’re one that likes to close your door between sessions and lay on the couch and relax or [00:43:00] leave the office and not connect with anyone, you’re probably not going to be a good fit.
So the step 2 is really figuring out in detail what are your non-negotiables, I call them, because it’s very easy to find someone who ticks only a few of things that you want, and then for you to be like, that’s pretty good. I’ll still take them. I think the hardest thing that group practice owners have is when there’s a staff issues.
Every person that I’ve ever, businesswise, in any business, the biggest struggle isn’t figuring out a metric in your business. If you have staff, the biggest issue ends up coming with problems relating to staff, whether it’s communicating concerns, whether it’s clinicians leaving a lot, whether it’s hiring people who say they can do something that they can’t do. It always ends up relating to the staff management piece. And so if I’ve learned anything, it’s to know your non-negotiables ahead of time before [00:44:00] interviewing.
And then, I guess, 2A would be to have a good recruiting strategy in place and interviewing strategy. Don’t just interview them once and then make a decision. I have multiple steps. I obviously have other people now that can help me with that. I have a clinical director who can do an interview. Some people who don’t have that use existing clinicians to do a peer interview.
But if you’re starting from scratch and it’s just you, you can still have a multiple-step process. What it does is it lets you get them in different lights. So if something doesn’t pop out at you at one point, it might pop out at the second interview.
So if you’re a solo practice owner still and you’re hiring your first person, and it’s just you, my suggestion is to have something in place that they have to have, they need to give you a resume and a cover letter. I feel like nobody reads the cover letter, but it’s part of can they follow directions, for me. If they don’t send a cover letter, for me, it’s just indicative [00:45:00] of, they don’t fully read through things. I’m probably going to have to tell them things multiple times. That may not be the case but here’s where I don’t like to take risks. So if they can’t follow that, they’re out in that first round.
I then have a Google Form questionnaire that I made that outlines my non-negotiables again because you can put it in your job description and people will be like, of course I can work 20 hours a week if that’s what you want and of course I’m fully licensed. And then all of a sudden, they’re like, well, I will be fully licensed in three months from now. And I’m like, no, you’re not then.
So I have a Google Form that puts stuff from my ideal clinician worksheet or my non-negotiables on there. It says, please confirm you have this license or this license. I put the fully licensed ones on there. And then I put, group culture is very important. If you’re one that likes to work individually and come and go as you please, this isn’t going to be a place that you’re going to be happy at. Can you confirm? You can look mine up, it’s on my group practice [00:46:00] webpage right at the top, but I pretty much list out those non-negotiables.
I list like, what are some of your strengths? Why Urban Wellness, which is my practice. I think it’s important that they’ve done their research and they know my business. If they don’t, I feel like they’re not very invested now, they probably won’t be later. So that’s the second one. And if I find anything in that form that they fill out that doesn’t fit or jive with what I’m expecting, then I don’t move forward.
The third thing you can do is then have an informal 10-minute, very quick phone consult. It’s really meant to check that they fit all the requirements that you’re looking for, but also can they connect with you? For me, I feel like if we can’t connect on a phone call and it’s weird and just not right beyond nerves, obviously we all know that when people interview, sometimes they’re nervous, but if it goes beyond the nerves piece and they’re just like off, you know that [00:47:00] they’re going to have a hard time establishing rapport with new clinicians or with new clients at that first intake.
And so for me, I’m like, if that’s just weird too, then I don’t move forward with an in-person. And then the lastly would be an in person. So having multiple steps to see them in different lights, it would be that part 2A.
Dr. Sharp: Yeah, for sure. I know it sounds like there’s a third step that I want to hear about. I think it’s important to highlight that because a lot of what I hear in the testing group is that it’s just so hard to find people period who are good at testing or good candidates that then we end up in a scarcity mindset and hire people who then are not good fits at all.
Maureen: Exactly.
Dr. Sharp: Desperate, so just holding out.
Maureen: I think the issue, one, is holding out because there is someone that’s good for you. Maybe they haven’t moved to your city yet. Maybe they haven’t seen your Facebook [00:48:00] ad or your Indeed ad yet, but there is someone that’s a good fit. It is so much more painful to be unhappy with your business if the people that you have frustrate you and aren’t aligned with your business. No quicker way will you want to give up having a group practice than having clinicians who don’t fit in with what you are wanting in your practice.
The other thing that I could mention relating to that, especially in rural areas or if you’re looking for someone very specific like testing or EMDR certified or Gottman completely certified, the ones where it just narrows the search down a lot is that you can look at alternatives and I’m going off the cuff here of either hiring someone who can do it remotely, either some practices that do it. It’s a [00:49:00] whole another level of work because you then are employing someone who doesn’t even work out of your practice, but works remotely, maybe an hour away where they’re located.
It also might mean taking a look at what your non-negotiables are and re-reviewing them. There have been a few cases where I’ve seen, truly, based off of them being in this very rural area where there’s like 100 people total in a 100-mile radius, and there’s probably only going to be 10 therapists and you’re wanting one, that you may have to adjust something.
If it’s a case where you’re in a place like that, if you’re in Colorado, no. If you’re in Chicago like me, no. You can step your non-negotiables and hold off and you’ll find someone. But I guess for those listeners who might be in that outlier area where there’s not a lot of people, you may have to shift and look at what those non-negotiables are.
[00:50:00] If you’re looking for someone who’s, let’s say like I said before, EMDR completely certified, could you adjust that to having someone who’s done all the EMDR training and has been doing it for 15 years? They maybe just didn’t pay for that certification but they did all of this pre-certification stuff. It might mean making an adjustment like that.And with testing, maybe you’re looking for someone who can do neuropsychological testing but that’s a lot harder to find, but finding someone who can do regular child psychological testing is a little bit easier. Maybe you make that shift for that reason.
Dr. Sharp: Sure. I think too the hurdle that I had to get over is I found when I was hiring folks that I really preferred a known quantity. I wanted either someone who went to my graduate school program or a friend of a friend or I needed some familiarity but 2 out of my 12 [00:51:00] clinicians just moved from out of state. They saw the ad and they applied and it turned out great. I think it’s just speaking too to being open to whomever may come through the door as long as they are a good fit when you really get down to it.
Maureen: Yeah, exactly.
Dr. Sharp: Is there a third step? Did we talk about the third step?
Maureen: That was the third. I did three for if you’re solo. Still I have a few more steps but that’s for those that are established and have other clinicians working for them, you can then have a fourth step where you do a peer interview where two or three clinicians can do a pre-interview before it gets to you. They’ll definitely get a different version of an interview than you would as the group practice owner.
If you have any management or you have a front desk receptionist, they’re going to be dealing with them. You can always have them do an [00:52:00] interview. I have my clinical director do it and then it goes to me. So those would be just two extra steps that we do.
Dr. Sharp: Cool. Well, gosh, I feel like we’ve covered a lot of ground here. Definitely some stuff around the basics of when to hire and how to hire and what to think about. Other things that you’ve learned from coaching others and doing it yourself that people might forget about or not think about when they are starting to grow and expand and bring people on.
Maureen: One last thing I would mention is marketing. I brought it up before, but I feel like if you’re a solo practitioner, your marketing scheme needs to change a little bit because what works when you market solo might not necessarily work for marketing a group practice. One of the main reasons being when you’re marketing yourself solo, you’re marketing yourself. When you have a group practice, you have to market the brand, the group practice. You can’t market yourself anymore, otherwise [00:53:00] people will be calling to talk to you and you’ll just have a harder time convincing them to go see your clinicians.
And so I think that’s just something that every new group practice owner will have to learn to look at is how they can shift their marketing strategy where it actually markets the brand itself or the group practice itself and not necessarily me, the group practice owner and figuring out what you expect when it comes to your clinicians when it comes to marketing.
I call it the two-pronged approach to marketing, which is, in person, one-prong and digital is the other prong. I focus on the digital marketing mainly. The in person stuff comes more for my clinicians. I pay them to do speaking engagements. They don’t have to market.
If you’re a new group practice, I don’t think it’s a bad thing to require your clinicians to market. It’s helpful when you’re starting group practice. [00:54:00] As you become established, it was something I liked being able to take away as a benefit to working in a group practice. They don’t have to anymore. But when they’re new, I think it’s really important that they learn. You don’t have to carry the burden all by yourself of trying to fill everyone up, and so teaching them to market themselves is that one-prong, that in person prong.
Doing speaking engagements or running workshops outside of your office at other businesses, those are all that one prong of face-to-face. Being a part of your local chamber of commerce is a way that you can do it because you get connected with all the local business owners. And then the second prong is digital marketing and that’s doing things like making sure you have a good website, that it’s optimized for SEO, that you are potentially doing something like Google AdWords if you want or Facebook ads or having a social media account, if that’s what you want. These aren’t all things you have to do but that’s fits in that prong of that digital marketing.
[00:55:00] For me, I find that the digital marketing is easiest because it doesn’t have my face in front of it and so I can do the work without clients seeing me and thinking, oh, I want to see her. So the point I’m at and I think it’s easily doable to navigate that way even as a new group practice owner, is to focus more. People are just on the internet. Most of our clients when they’re calling us, I can see calls through their mobile phone because they found us on our website and called straight through our website.Until your group practice gains traction, you’re not going to have as many word of mouth. And so focusing on that digital stuff is going to be really helpful. And so that’s where I focus my time.
And now I’m at a place where I can pay clinicians a good … I pay them more than double what they make an hour seeing clients to do marketing in the community because we found that community is a [00:56:00] really, you get a high level return on investment by having clinicians go out in the community and do like a speaking engagement. So we have a lot of presentations that we give and that’s that face-to-face prong that I was talking about.
Dr. Sharp: Nice, very cool. That’s a whole topic. We talk with people a lot about, I don’t know if it’s more so with testing and counseling or not, but it seems like that’s a common problem where the practitioner starts out solo, people get used to those reports and that style of testing and then it’s hard to spread that to their clinicians and let the clinicians get referrals because everybody’s like, no, I want your testing.
Maureen: I think with testing; I can see that it would be much more about the person. My daughter has autism. I remember when we were getting her tested when she was younger, I was very specific on who I wanted to see. And so coming from a consumer perspective, I can [00:57:00] see like if someone says, Dr. Jeremy Sharp is amazing at testing my child. It was a great experience, that I would be so laser-focused on wanting to see you.
Just because I’ve had that experience in my own life with my daughter and so I think I can imagine that you have to make sure that your testing psychologists are doing some kind of work in the community, getting themselves known in the community because I can see testing being something that people, it’s connected to a name. And so they need to go out there and make sure that they’re doing something to get their name out there so that people connect with them as well and not just you.
Dr. Sharp: Well, I can say too, at least from my perspective, that’s it circles back to the IC versus employee thing. And that was a big reason that I wanted to have employees, which is because I knew I wanted consistency in our report style. I wanted to [00:58:00] be able to control that. Still, I look at way too many reports that I need to do quality control, so to speak. Even though I fully trust my clinicians, I like to take a look and make sure that what’s going out is what we …
Maureen: What you want. Right. Exactly. I get that.
Dr. Sharp: Well, goodness. You shared so much with us. This is just a tip of the iceberg. Your website has a ton of information. I will link to that in the show notes. You also do a podcast. You also have a membership community for folks who are really focusing on building a group practice and need support around that. We will have links to all of that if people want to check that out.
Maureen: Awesome. Thank you. I had a good time talking.
Dr. Sharp: Good, me too.
Maureen: As usual.
Dr. Sharp: Right, I know. I like this podcast relationship going on here.
[00:59:00] Maureen: I know. Like you said, it’s really is the tip of the iceberg because there’s so much and we’ve been talking for a little bit now and I feel like there’s so much more I could give information wise but hopefully they’ve gotten two tidbits of information that helps them make a decision if they’re thinking about starting a group practice, whether it’s a testing group practice or whatnot.Dr. Sharp: Awesome. Thank you so much.
Maureen: Thank you.
Dr. Sharp: Okay, y’all. I hope that was super helpful for you. Maureen and I ended up covering a lot of topics and I hope that you’re able to distill a few things from that conversation to get you going if you are trying to hire some folks. Like I said, I know the testing piece, but she really knows the hiring and the growth piece. We did not even get into how she uses metrics in her practice but that as a whole other topic that I would love to bring her back for.
[01:00:00] If you would like some testing paperwork to supplement your practice, I’ve put together three packets. There’s a clinical packet, there’s an administrative packet and there is a psychometrist training manual. If any of those sound interesting to you for your practice, you can check them out at thetestingpsychologist.com/paperwork.And if you are interested at all in coaching around the testing aspects of your practice, I would be happy to talk with you about that too. You can find out more at thetestingpsychologist.com/consulting. All right, see you next time.