Andrew Burdette 00:00:00  The grower Group Practice Podcast is part of the practice of the Practice Network, a network of podcasts to help you grow, manage and promote your business and yourself. To hear the other podcasts like The Practice of the Practice Podcast, go to practice at the Practice Network. You're listening to the grower Group Practice Podcast, a podcast focused on helping people start, grow, and scale a group practice. Each week, you'll hear topics that are relevant to group practice owners. I'm Andrew Burdette, a practice owner, and I love to hear from people. Their stories and real life experiences. Let's get started. Hello and welcome back to another episode of the grow Group Practice Podcast. Today I'm here with Doctor Celia Zinnia, who is a licensed clinical psychologist and founder of Olive Tree Mental Wellness. So welcome to the show.

Celia Zanayed 00:01:00  Thank you. It's good to be here.

Andrew Burdette 00:01:02  Yeah. So I always like to invite guests to give a little background of of how they got to do what they do now.

Celia Zanayed 00:01:10  So let's see. I've always been interested in psychology.

Celia Zanayed 00:01:14  I couldn't tell you why my family did not talk about it. Ever. It was not a thing, but it just always kind of fascinated me how people thought and kind of got into that. And then studying it in school, the only things I really liked for languages and psychology, which was very entertaining because those were the two things that I wanted to work with and eventually ended up studying Spanish psychology. And now I do therapy in Spanish. That was exciting. I actually got to use both of them, and, I really like and find a lot of passion in working with people who've experienced trauma, especially like intergenerational trauma or trauma that kind of passes because of like historical events, societal events, many things like that. And so and I think being Palestinian-American is probably informed that in many ways. So I recently started my own private practice about three years ago now actually coming up on and it's been great, just expanding very slowly, kind of just having my nice small group practice and trying to build a good system within it.

Andrew Burdette 00:02:14  Got it. So it's it's amazing to me how many people roughly three, three and a half years ago started group practices. Because I'm in that camp, most of my local friends that have group practices got started in the, you know, the first half of 2022, I guess it was now, and it's just it's interesting because everyone I know has kind of expanded at different rates and different sizes. And, I appreciate having other having someone else that kind of has done the really slow, deliberate, I want to do this intentional, make sure it feels right as I go along, and I kind of know what's going on. So do you want to talk a little bit about going from solo to group practice and then choices that kind of have influenced how you've structured your group practice and the size that you're at.

Celia Zanayed 00:03:00  Yeah, I, I agree that the intentionally slow growth is I think I think it's something you very much have to commit to in a way. But it's I mean, it's obviously easier in some ways.

Celia Zanayed 00:03:08  You don't have to do the work of trying to find more people and everything, but I really just wanted to find a group practice that felt very calm and comfortable and had people who loved doing the work who were, you know, held themselves accountable to getting the work done and like, you know, maintaining their continuing education and all that stuff. But I also wanted like a safe, calm place for everyone to practice together. And so it's myself and two other practitioners at this point, and I honestly just put out an ad on my website at first to grow. I, you know, I would I think I'd been in practice about a year and it had been going shockingly smoothly. I kind of assumed it would be a lot harder, but like we had talked about like the the time of Covid and telehealth and kind of getting started and things went pretty smoothly for whatever reason. So I thought, hey, why not? This would be great to have someone else to practice with, to consult with, to kind of just continue to grow and provide a space for others to.

Celia Zanayed 00:04:01  Hopefully have a really easy work environment. And so I just added a page to my website and my first employee found me. And pretty quickly, actually, I want to say like a couple weeks, within a month, you know, she'd reached out and talked to her references and everything, and we met up and it just felt very simple. It was it was a good fit. I really liked her style, her energy, just very much so. Someone who is passionate about the work and once it was like ready and open to learn and kind of went from there. So logistics wise, things got very complicated after that point. But but it was an exciting kind of step into figuring out what that would look like.

Andrew Burdette 00:04:39  So I have a couple questions. One is everyone I talk to about hiring always kind of wants to know, how do you really know? Like what's the indicator this is the right person? Is there anything that stuck out about talking to your first hire or even your second hire about you kind of just know that this is the person.

Andrew Burdette 00:04:56  What were the. Were there any things that stuck out? Or do you have a certain kind of metric you use when you interview people?

Celia Zanayed 00:05:03  I want to tell you I had a better system than I did and I did not. I feel like it was truly going off of vibes, but I think I really wanted someone who had a similar idea clinically to me. Not I didn't have the same idea. Like she doesn't practice from the same theoretical orientation by any means, but it's just like the same idea of focus on like intersectionality of someone's identity pieces and someone who really cares. Really. Considering all these factors, someone who's always open to criticism and growth and like feedback as an important part of the practice. But like I had, I just made things up as I went. I think in terms of like, hey, this person seems lovely. They don't seem to. I honestly, this made me sounds terrible. I wanted someone who like, wasn't going to cause drama and make life stressful. I was like someone who's just passionate about the work and was not going to make things really difficult so that the workplace could stay very calm and centered.

Andrew Burdette 00:05:59  I agree that I don't have a way to articulate what the vibe is with people, but, so I'm a little bigger in size practice wise than you are, and there's definitely been some learning curves along the way, because not everyone that I've, offered jobs to or started has stuck around for different reasons. And but everybody had the vibe, right? That's the thing. Like, the vibe was. Right. you know, the checkboxes and the objective stuff on the resume, do they have the skill set and the experience and things like that? All of that was there. But there is something about that gut feeling vibe that I think is worth trusting with people. And, I think it's a book called, Hire Slow, Fire Fast or something along those lines. And I think it has it has really paid off and been to my benefit, really teasing out someone's background in that interpersonal relationship. And do they seem like they could fit into the group of people that's already here. Are they going to have that level of chill that I think we all want is like, you know, managers of people and just people that, you know, are they going to preserve the I want to still come into work in this workplace kind of vibe, you know?

Celia Zanayed 00:07:08  Yeah.

Celia Zanayed 00:07:09  No, I think that's huge. And I think as long as like people are provided the resources to succeed. I feel like most people will do that, to be fair. So like one thing that I found really important was making sure someone was like a W-2, for instance, instead of 1099. I'm sure there are times where it's appropriate or whatever, but for me, it was like, I want someone who knows that they're going to be taken care of, like they're going to get paid, like I'm going to cover their part of taxes. I have like retirement benefits that I offer. I have like a monthly consult group that we meet with to like, really make sure everyone also gets to get to know each other a little bit better and like, spend time together. You know, my first employee, we went out to dinner just to like get to know each other a bit after starting. And it was nice to just talk about life too and like, let them know. Like, no, I care about you as a person.

Celia Zanayed 00:07:54  It's not just like you're not just like an employee here. Like we're going to be professional in the way that we do this. But I did want it to be a comfortable place for us to talk about it, because I think in this field in particular, you kind of do need to talk about some personal things for like counter transference or when things are coming up or when you're feeling triggered by a patient. You have to be able to say like, no, I'm feeling triggered, or here's what's going on in the situation. And sometimes that gets real personal. So I don't think this is the kind of field where you can totally not know the team you're working with.

Andrew Burdette 00:08:23  Yeah. And what I hear about that whole reflection, too, is seeing your staff as people like their very whole person. I know one of my values. I hopefully it's on my website. If it's not, it shouldn't be there. But, you know, what I really want is I want people that can come in and create a work environment that supports them being the best human that they can be.

Andrew Burdette 00:08:46  And while they are spending time in my practice, being a therapist, focus on just being the best therapist they can be and feel comfortable being themselves.

Celia Zanayed 00:08:53  Yeah, 100%. So I think a lot of that gets in the way. Like there's been past work environments where like people are so like especially specializing in trauma work. I feel like everyone is coming into it's such heavy work. So it's obviously going to affect you. There's going to be a lot of vicarious trauma, compassion fatigue, burnout, things like that that kind of come with it. The problem is, when you're used to those environments, everyone tends to get a little, I don't know, restless. Everyone gets a little bit snippy with one another. It just gets to be kind of like tense. And then you're like misreading situations on a regular basis, and everyone's kind of getting mad at each other for no particular reason, and it just gets so pent up and like, angry and whatever it is, and then it becomes a less and less safe and comfortable place to go in and do the really emotionally draining but fulfilling work that it is.

Andrew Burdette 00:09:40  Yeah, I've worked in environments where there's been so much attention to the logistics of things that it's like all the humanity got stripped out of it.

Celia Zanayed 00:09:50  Yeah, and that's always exhausting.

Andrew Burdette 00:09:52  Yeah, it's. I'm just thinking of, like, office space, where it's like, you know, you didn't turn your TPS report in on time or something like that, and you're like, what does this have to do with the sitting with a client that's experiencing this particular thing that they're going through?

Celia Zanayed 00:10:04  I think that's the other benefit of private practice is there's so many fewer, like you're not applying. Well, I'm not applying for federal grants all the time or having to follow a bunch of corporate guidelines. Like I create the guidelines. So that's like the beauty of it is I don't need people to fill out 14 pieces of paper for every patient you see. Or I get to decide if we just take a pro bono case instead of having to take really complicated matters. Like, you know what? Free is literally easier.

Celia Zanayed 00:10:30  I would I would rather help this person out and do it my own way than exhaust myself with this logistic administrative problem. And I think it creates a better balance for work life and makes things feel a lot smoother.

Andrew Burdette 00:10:42  So you mentioned logistics getting really difficult when you added a person. you want to talk a little bit about that experience, and then we can maybe talk about how culture informs logistics, and logistics kind of informs culture. They're kind of two parts of the same system.

Celia Zanayed 00:10:58  Yeah. So I'm going to have to remember now because it's actually been a minute, but I think it's more like when I started off and again, nice lucky easy start. But there was all these like free trials and everything was great. And then the second you are more than one clinician, every pricing agent like triples. So like my electronic medical records, the service I use for storing things like email, the phone number, like all of this stuff that I paid into, I think it's all worth it. It is what it is.

Celia Zanayed 00:11:26  But just everything went up significantly and kind of changed. And then it became like, oh, well, now that you have an employee, you've got to document everything because like now you're held accountable to another person. You need to be making sure you're being fair to them or even just coming up with a contract because I didn't have a contract before that. I didn't need one to hire myself. But once we had, you know, I'd gotten help from a family member and putting together a very intensive contract and then going through it and making sure that it was fair to them. Fair to me, because I think that's also part of that. Creating a culture that's fair to someone is going through and making sure it doesn't say like, yeah, I can fire you for no reason and you have to give me seven months notice for some reason. So I think, like making sure that the policies are fair to both of us is a really important starting off point with that.

Andrew Burdette 00:12:09  One of the things I most appreciate about the attorney that's done a lot of my like, contract stuff, I'm just now starting to work with a North Carolina employment lawyer for the W-2 side of things, as we kind of plan for expansion.

Andrew Burdette 00:12:23  but both of them have really just spoken to the fact that you write all this stuff down for the sake of clarity. So you have a playbook about here's what the rules of baseball are, or soccer and the fields this big and it's definition. So people have a reference. So that should something come up where it's like, hey, actually what I really thought was going to happen or needed to happen was this. And per our agreement. This isn't how this looks. And just talk to that side of things.

Celia Zanayed 00:12:54  Oh, absolutely. And I feel like the ways that that's come up in like, weirder sections that I forgot about is if I offered to like, pay for part of training about something. And then I realized, like as a practice owner, I should probably protect myself from people coming in, getting a bunch of free trainings and leaving. So this idea of like, hey, I'm happy to pay either this much as part of your training or hey, if you end up staying at least six months, the training will be free and don't worry about it.

Celia Zanayed 00:13:17  But if you end up leaving, you know this is how much I'll withhold or whatever like that. So again, just like ways to be fair, while considering how to make the practice one that I can provide resources fairly.

Andrew Burdette 00:13:29  That that specific subject was actually a specific question. I asked the the new attorney to me, that works with a bunch of other group owners about how to protect those onboarding costs, because that's basically what you're talking about. And I liked how she put it. She's like, if you just do a general one, like let's say it's $1,000 if you like, leave within a year. And nothing specific. She's like one. It's really hard to collect that because you have to pay people and then ask for the money back. she's like, it's also not really clear what it covers and what it doesn't. And kind of like you were talking about too, about are we paying for this kind of documentation but not the other? And if so, why is it going to be this versus that and having things sensibly organized in that way? she basically had said that if it was something specific for like, say, eMDR training, since we're talking trauma modalities, you know, you could put that in there and just have something in there that says, hey, for every pay period, I'm going to like withhold $100 toward that.

Andrew Burdette 00:14:29  And then if you stick around for like a year, let's say, then you get the rest of that, you get you get that money return. So basically you kind of withhold it in escrow, and then they get something that's probably going to feel like a bonus, but isn't really a bonus when they get it, you know.

Celia Zanayed 00:14:43  Well, but that's that's a solid idea. Actually I had not considered that. But one of the things for me that I also saw, and I'm just trying to learn from all previous jobs I had basically when starting this, and I was at a site before that was really generous in offering all these free trainings, and it was great, but they weren't actually optional. Like where like you are going to this training. And so for instance, eMDR or like brain spotting, we had a couple of clinicians who went to the training, didn't like it and were like, yeah, I refuse to use this, actually. And the place was just kind of like out of the money afterwards.

Celia Zanayed 00:15:14  So now I'm making it way more collaborative about like, what are you passionate about learning about? What will you actually use and what are the referrals we have coming in so that I can help you guide to who you want to work with without also getting trained in something that like, no one has ever come to us for.

Andrew Burdette 00:15:32  Have you as a practice owner, having some, I'm assuming it sounds like it sounds like based on your story, you've had specific trainings that other places have paid for you, like, say, eMDR and brain spotting and things. So, as you've added people to your team. Have you deliberately picked people that have some of those same backgrounds so that you can say, somebody comes in and you're full and they want eMDR? Do you? Have you intentionally hired other people that have those skill sets and trainings for your practice?

Celia Zanayed 00:16:01  That is my next step. That would be the if I was going to hire someone now. And I mean, I will also say I'm engaged in getting married this year.

Celia Zanayed 00:16:09  So I'm also kind of tired because of the planning of all of that. And I'm very excited way. But, you know, busy with all of that. So my next plan would be hiring someone with eMDR training because my first employee doesn't like it in the second one, like does not have time for that. So it's that would be the ideal. But honestly, I'm choosing more for fit right now. And people who I care about the work the way that I do. I think that would be like a cherry on top. I would absolutely love to hire someone who feels like a great fit and does eMDR, for instance, or does different trauma modalities. That would help, but it hasn't been like a barrier so far.

Andrew Burdette 00:16:43  Cool. I do know from some practice members or practitioners I'm acquainted with that there are grant funds out there to pay for practices that work with certain populations, to do these kind of trainings and I can't remember. I think it's the Small Business Technology Center, the SBC or something.

Andrew Burdette 00:17:04  I get a bunch of emails from all kinds of things, but it's about technology transfer. And I think, yes, I could see. Right. Right. And I'm saying this for listeners out there too that are thinking about it there, there is funding available to fund trainings for mental health providers. And I'm deliberately mentioning this as part of this, because I think it would be cool to get some funds to then pay for people that wanted to do, say, art or Trainspotting or other things like that. And again, like you ask practitioners like, are you interested in eMDR? Great. Let me see if I can get that funded and get you hooked up with, you know, Andrea training or something like that for it. And if you're not interested in eMDR, what are you interested in? And can we get you into that training so that, you know, as a as a business owner, I get to support my team in the ways they want to be supported. That reflects who they are as people.

Celia Zanayed 00:17:56  Well, that's a very cool resource to know about because so far I've just been like, hey, if it's a reasonably priced thing. And so like my first employee has been here I think two years now. So like she's been really consistent showing up like helped out with all the things like just a good rapport so far I don't see her leaving soon. I mean you never know what happens in life, but it's just not feeling like a thing. So I had no problem covering like level one Gottman training because and again we talked about some like terms and conditions, but for the most part I just paid for it because we found a reasonably priced one and called it a day. But it would be nice to not pay for it and get a grant for it. So yeah, I'm very down to look into that.

Andrew Burdette 00:18:31  Cool. So logistics, you talked about how the cost of things goes up notably, I mean, we could get really in the weeds about this? There there are certain hours that adding an additional person are notably more expensive than others.

Andrew Burdette 00:18:49  there are some HIPAA compliant phone systems that are really awesome for one person. And then when you start adding a second person, you're like, oh my goodness, I could just buy them a new iPhone for this amount of money a month, right. And you know, what were some of the choices or lessons learned around going from you to a plus one and eventually a plus to practice for logistics?

Celia Zanayed 00:19:13  I think I have been really, really mindful about protecting my mental health with this kind of stuff. So the funny thing is, even though it was ridiculously more expensive to go to a group practice for some of them, as long as they actually made my life easier and would save me like an hour or two of my time. I just said screw it and paid more, which maybe if I had more like mental energy, I would look into it and try to save more money. And again, right now, since it's a small enough practice, I'm not paying that much like it's an especially again being an all virtual practice.

Celia Zanayed 00:19:41  I don't have a lot of overhead, so frankly, I'm okay to do some of those things and spend more on that. So I think that one was just a I would rather have the peace of mind and not have to think about this maybe ever again, than having to do the research on this at this point. And I've been lucky enough that I've been able to do that.

Andrew Burdette 00:20:00  I actually really appreciate you talking about how does it feel to use on a regular basis. I'm kind of a systems nerd because I used to do tech stuff, and there's a difference between like, buying something cheap because it's cheap, and then you go to use it and you realize, like, maybe it's like an axe or a knife and you're chopping wood and it just doesn't work very well. Versus you buy like a nice tool and then you go do it and you're like, oh, I can feel the difference of this nicer tool, right. Or, or you know, like a Hyundai versus like a Lexus, right.

Andrew Burdette 00:20:33  It's going to be a little different for for how they feel and drive and perform. And I do think The feel matters. And then even down to is this something I even want to go to use? Because if it's a system you hate using, it doesn't matter what it cost. You're never going to go use it. and the other, the other more, I guess KPI, the key performance indicator business metric in there is if it's cost me a little more money, but it saves me a couple hours a month because of how well it works. Well, it's probably paying for itself.

Celia Zanayed 00:21:08  Exactly. And I think the biggest thing that I know for myself is if I am sitting on the phone for hours every week trying to talk to like customer service or trying to talk to different insurance companies, I won't want to do it. And I know me like I will avoid it like the plague, and then I will just not get paid for long periods of time over things that I could have just resolved really simply.

Celia Zanayed 00:21:28  So like, you know what? I will pay more and then I'll take on an extra patient a week. And honestly, that would be way easier than trying to do it to some other way and make myself miserable.

Andrew Burdette 00:21:38  Yeah, It's part of your workplace culture. Do you talk with your staff about how the technology is working for them, and is it? Is it like, you know, is your no template? Not only does it have what it needs, but is it laid out in a way that works for the way people engage documentation, for example?

Celia Zanayed 00:21:55  Yeah. I actually let them come up with their own designs for like note templates and things like that. I did mention like, hey, these are the key things that we need to have in there, but I figured that's more important anyway. I think most of them kind of borrowed mostly from mine and just did something kind of similar. But yeah, like where it just like replicates the. No. At least like the major thing so that you can focus on the actual content as opposed to like patient is a blank.

Celia Zanayed 00:22:18  Year old blank blank blank. Doing this. Who came to therapy for this reason. So the system I think is pretty great for the most part, and we definitely check in about it. So I've got like my agenda set because tomorrow we're actually meeting for our monthly group supervision in person. And you know, like I said, we get brunch, we get coffee and just kind of sit, talk about cases, do all the things. And one of the big things is like, logistically, how is everything working? And, it's mostly fine sometimes, I swear. Systems keep updating themselves and then getting really frustrating with like audio not working suddenly or having to like relog in to telehealth platforms, which patients have been really great about, frankly. But it's just like, sorry, I have to keep asking them or like miming like, okay, get off and then and then just hop back in and we're doing all these like, silly signals to try to make it work. And so that part is annoying.

Celia Zanayed 00:23:08  So we definitely check in about that. And there was a comment recently about like should we actually switch? Might that make our lives easier? But so far it seems like way more work and I'm hoping it's just a temporary glitch.

Andrew Burdette 00:23:20  I for the longest time had a just a piece of paper on my desk next to my computer that just said log out, log in. Because that seemed, you know, to turn it off. Turn it back on. Seemed like it fixed everything right. our, our main telehealth platform sometimes has a weird glitch where it just it'll literally mid-sentence. Just stop doing audio for somebody. And it's always the clinician. It's not for the client, but it's the weirdest thing. And because it's so unpredictable, it's not the kind of thing I can send a tech support to say, hey, when you do this, this happens. It's just randomly kind of thing. do you have any well, are you let me. I don't know. I'm. I'm thinking into, like, systems mode because that's how my brain does.

Andrew Burdette 00:24:03  So I'm trying not to make it all about systems, but, are there systems that if the inconvenience of moving wasn't what you think it is, would you move systems?

Celia Zanayed 00:24:16  Honestly. But it does work. Like for most things. It's just that lately, especially with the actual sessions, like everything else I can figure out, like if it's, you know, this button is kind of annoying or I have to listen to a tutorial. But the problem is, like, I have one patient and she's again, she's lovely. We've worked together for years now. She's like, with it, it's fine. But for whatever reason, her audio. No, she can't hear me. And it's been like six months. She's the only patient at this point that it has not automatically been fixed with one of the updates. We cannot figure out why she has updated everything. I've updated everything. Everyone else can hear me. She's like my last session of the day. So I know it's working and it just it's absolute nonsense and I cannot figure out why.

Celia Zanayed 00:24:57  And so the fact that like half of my patients on some weeks we'll have to like log out and log back in for the audio or the visual to work again. It's it's been getting very silly lately, so I'd think about it. But then my concern is like if one of the biggest platforms is doing this, are all the platforms doing this? And is this just like a part of doing telehealth? And if I had the time to do the research, I'd be asking everyone, hey, what are you using and how's it going? But most people I know use the same platform. So.

Andrew Burdette 00:25:31  As a therapist, I can tell you from experience that having the right EHR air is an absolute lifeline. I recommend using therapy notes. They make billing, scheduling, note taking, telehealth and e-prescribing incredibly easy. Best of all, they offer live telephone support that's available seven days a week. You don't have to take my word for it. Do your own research and see for yourself. Therapy notes is the number one highest rated EHR system available today, with 4.9 out of five stars on Trustpilot and on Google.

Andrew Burdette 00:26:01  All you have to do is click the link below or type promo code Joe on their website. And receive a special two month trial. Absolutely free. If you're coming from another EHR, therapy notes will import your demographic data quick and easy at no cost, so you can get started right away. Trust me, don't waste any more of your time and try therapy notes. Yeah, I, I just came to realize, like, some of it's just part of telehealth and all the different variables that go in there, and some of it's if it's on my end or it's some kind of. Some of the problems are easy to troubleshoot. But then if it's like you're what you're talking about, where I've done six sessions a day, everything worked flawless. And then this one client consistently has an issue. It's usually something on the client's end, and I have no way to troubleshoot it because it's like, why is my AirPods not pairing with whatever or some other thing? It's it's hard.

Celia Zanayed 00:27:01  You know, just having like three backup systems.

Celia Zanayed 00:27:03  I will say that's been kind of helpful because at first it was like, great, I've got my work computer, everything's fine. And then it was like, oh my God, I should have a backup. What if my computer magically breaks one day and I have a hilarious history with computers and like, technology breaking in the weirdest ways around me, where you call it and they think it's all the basic stuff, and then they're like, I've literally never heard of that in my life, is a phrase I've heard so many times, so I don't know if it's a special ability of mine, but it's it's good to have all the backup. So I will say that helps now because like, I just have a backup platform that I end up using with that one patient, and it's like my computer is being weird. I have an iPad as a backup. And then like on the worst case scenario, I use my phone if I really have to. So I will say I do like that flex like that flexibility of, you know, if your car breaks down, there's not that many options.

Celia Zanayed 00:27:46  But if your computer breaks down, you usually can have a backup plan.

Andrew Burdette 00:27:50  My really bad telehealth dad joke is I've never had to troubleshoot a chair because so far I've not had to do that in session. I'm sure someday it probably will happen, but that's kind of been my my like bad joke about technology with telehealth over the years. So as you bring people in, how do you how do you support them with like training and showing them the ropes about how you work in your practice?

Celia Zanayed 00:28:16  I think I'd like to actually come up with a slightly better system for that, just to see where everyone's at at baseline, because I think the hard thing is like, you just really never know. I feel like every training program is so wildly different. Everyone's experience with supervisors is so wildly different. So I think what I'd like to be able to do from now on is like, do more of like an inventory and check in and like be able to rate someone's abilities in a different way, because right now it's just conversationally like hearing how they talk about cases and seeing, you know, are they considering all these factors? so, so far it's a lot of just open conversation.

Celia Zanayed 00:28:49  So like during the group supervision is usually when we'll check in and say like, hey, which things really stumped you? Or you know, which cases? Hey, like, hey, I noticed you get more worked up about these cases or you seem to really hate these cases, like you really love these cases. What's going on there? Is that something that we can work through together? And I feel like as long as we have open conversations about it, which luckily my team is really awesome and we just do it in that way, I think it's been fine. But I do think as we get bigger, if that is the goal, slowly over time, if we find more good fits for the system, it's we're definitely going to need something, I think more structured. And that's why I think growing slowly has been great, because I don't really need a strict structure for the three of us. We just have a conversation and talk it out together and they're both great. So we'll just problem solve together and see what's up and go from there.

Celia Zanayed 00:29:35  I'm going to need a better system if I expand.

Andrew Burdette 00:29:38  Have you thought about expanding and if so, what's one of the things that we talked a little bit about ahead of the episode was just how to stay small and stay sane, being small, because I know when I had just a plus one, it was a lot easier than it was plus two. And then it got to be plus three. Things got vastly more complicated. how's I guess. Are there, like, strengths and then weak points in your system as you think about having a team and maybe adding one more?

Celia Zanayed 00:30:07  Yes, there sure are. some of the ways that I do things are not very efficient for big group practice and just would never work if I had like even three more people, maybe even two more people. Like, I'll manually go through and double check payroll myself. Like, I definitely need to come up with a better system for that and just figure out how to do things. I think in terms of like meeting and I will say I would need a new system for how to divide cases two because like how do you distribute which referrals go where.

Celia Zanayed 00:30:34  Because as far as referrals, most of them do come to me in the practice, and then I'll talk to people and see if they feel comfortable. Like because I do have a waitlist, for instance, even now. And so if that's the case, I'll say, hey, here are the two other lovely people on my team. You know what sounds good to you? And so far it hasn't been difficult. But again, if you do have a lot of people and a lot of them are wanting new cases, I don't have the system set up in place for that yet. I didn't want to. I don't want to have like 400 new cases coming in every week and having to turn everyone away so they would have to like, revamp technically everything, figure out how to be fair to everyone, but also like the people who are really ambitious and taking out all the cases because they want to versus like not overloading someone who's feeling burnt out or maybe has a personal life issue going on.

Andrew Burdette 00:31:19  Are your are your team members fairly diverse and who they work with? one of my friends was talking about the different people in my practice, and they're all very there's like a general vibe.

Andrew Burdette 00:31:30  We all kind of have an interest in, like transpersonal, but not everybody is as interested in, say, transpersonal psychology as the rest of us happen to be. And we all have very different backgrounds, but there's that kind of common vibe there. But for example, like I've got some really skilled trauma people. I've got some people that would just assume work with more life transition stuff rather than trauma per se. So there's I guess for us, it's a little easier to maybe like send people to a certain clinician on the team because of who's coming in and what they're asking for. Do you have a similar experience?

Celia Zanayed 00:32:05  Yeah. So I think trauma for us is like that overarching thing that kind of keeps us all liking and passionate about the same thing. But one of them, for instance, really specializes in like CBT, DBT, act those kind of modalities and is really into that and really likes working with like LGBT populations and immigrants and also like family dynamics. And then the other one really likes working with perinatal mental health.

Celia Zanayed 00:32:29  She's a total specialist in it. Like, we'll work with a bunch of other things is great with a lot of different trauma work. But like, that's her bread and butter for things. So I will say that makes it really clear if we get someone who has any kind of like pregnancy, fertility, anything thing going on. Like she is so excited to take those cases and the other has no problem with that. But for the most part, I think we're all somewhat generalist in the within the trauma specialty.

Andrew Burdette 00:32:54  Got it. Have you. How are you all coordinating the admin without having a dedicated admin person? That's always like an exciting thing to figure out because we back when we were your size and we were your size for, I don't know, probably close to two years. We kind of tried out admin and tried not having an admin. We kind of did some of both. how does that how do you all coordinate that amongst people?

Celia Zanayed 00:33:20  Great question. Currently I am admin and it is interesting.

Celia Zanayed 00:33:25  So it's it's not bad. I will say. Like for the most part, and with the team and the size that they are and just how like self-sufficient they are. It's really not that much work for the most part. But then every once in a while, I swear everything piles up at the same time. Like and I do think I am especially I'll go with lucky and that I've been subpoenaed more than most psychologists I've ever met, and I've not been in the field long enough for that to be a thing yet, I think. But that's okay. So like, I feel like those things are having a lot of like insurance issues come up around the same time since they all show up around the same time. That gets really frustrating and really hard. So recently I actually have hired like a part time admin person who will come in more of like tasks needed. So like as these situations come up and as I'm needing help with, you know, writing certain things, calling insurance companies, whatever it might be.

Celia Zanayed 00:34:13  And that has been amazing and I really am now leaning more towards the idea of that. But since most of my admin stuff is not very much, I'd only want to do it with someone who is like it's fair to them. Like they're looking for really part time task oriented work, and they like just completing a task and then maybe being able to do something else. But it doesn't feel fair to me to hire someone as an admin and like, like, hey, I've got nothing for you to do right now. So you have zero hours this week, but next week you might have five. So that's I think, been my bigger thing is like finding a good fit for that, because I think it's such a unique type of job.

Andrew Burdette 00:34:47  It is I'm really fortunate I get to share my app in person with another practice, and that worked out really well because at the time we started working together a year ago, I only needed about five hours a week. Now. It's very much changed at this point, and they're not only pretty much handling all the intake conversations.

Andrew Burdette 00:35:08  And I've now because I one of the questions I have for you is, what do you like the least? Like what do you, you know, if there's things you could get rid of today. What what what would those be?

Celia Zanayed 00:35:21  Payroll. I think payroll is my least favorite thing on the planet.

Andrew Burdette 00:35:25  That is every group practice right now. I'm serious.

Celia Zanayed 00:35:28  So I wish I had more interesting answer. No, it's just the worst. It's not even that much I recognize that. Like, cognitively, it's not that big of a deal, but it is the worst task.

Andrew Burdette 00:35:38  Yeah, I, I'm in the process of kind of revamping my payroll system so someone else can basically run it. they're already running payroll, but they're not running it independently because we're still ironing out kinks. And, I had to kind of re clarify the compensation to my team. just as a reminder so that nothing changes. Actually, most people got, like some kind of raise out of it, but just the wording needed to be kind of redone because people were reading it very differently.

Andrew Burdette 00:36:08  And so that was not the most fun conversation to have. But as a result of that, like we kind of redid our timesheets. And so today is the first day of running on the new timesheet thing. And so it's been lots of questions. But I don't know. For me there's this pressure of like, that's the biggest deal because the kind of society we live in that's organized around having a job for subsistence, you know, making sure that people get what they have earned and expect to have on a timely fashion. That's a lot of pressure.

Celia Zanayed 00:36:36  Yeah, I think that's basically the big part of it, too, is like the pressure of it is like, I don't want to screw this up. I don't want to screw up even like a little bit. Like, for instance, we did have a problem with payroll recently where for whatever reason, taxes were not taken out of employees, whatever payments for like maybe a month or two or something. So now there's like a ridiculous amount of back taxes that are owed.

Celia Zanayed 00:36:57  And so, like, I hate having to say, like, hey, you owe more than you think you did. Now we have to figure out a payment plan for that, or you can pay it in one fell swoop if you want. But it's just like anything that messes with someone's livelihood is and should be a lot of pressure. But it's like stuff like that that, like, I hate when that happens because it's I know it's not fair to someone and it's just not an ideal situation. But sometimes these things happen.

Andrew Burdette 00:37:21  Yeah. So when you do figure out that really awesome payroll system, like, you're going to like you're going to figure it out and then package it up for the rest of us. Be like, cool, this is the the easy one to do.

Celia Zanayed 00:37:31  Honestly, right back at you, if you come up with something, you just let me know because it's going okay.

Andrew Burdette 00:37:38  I just it is really striking like, I'm fortunate enough to have a lot of other like, great practitioner friends and, and we really are friends and professional and personal as well.

Andrew Burdette 00:37:49  And we're also candid enough we're able to have these conversations about, you know, how are you paying your people? What are you doing? What are you not doing? And just so we we all have this attitude of kind of raising the floor as far as we can lift it up for everybody that works in our field. but yeah, no one's got a good no one has a good payroll system.

Celia Zanayed 00:38:10  Not. Yeah, well, if I am going to casually blame insurance for a moment there because I feel like the rates change sometimes and like sometimes even for the better, but they change and then they don't tell you. And then you have to call like I'm having. Sorry, Edna, but I'm gonna call him out for a minute. Like, not for whatever reason. Right now. They, like, change their rates, but they won't tell me my own rates. They're like, no, you have to fax us at this number to get your new rates. I'm like, they're my rates.

Celia Zanayed 00:38:34  Can you just tell me over the phone, they're like, no, that's so silly, like you. And then you have to call like four different people to figure it out. So then when you know the billing comes through, if it's not coming in through quick enough, it's like, okay, well, how do I pay this person what they are owed without then having to ask for it back later while figuring out blah, blah, blah. So it's just it's nonsense.

Andrew Burdette 00:38:54  Yes. And it's someone that is not willing to float insurance companies for monies owed. So I'm in a pay structure to where people get an hourly, and then they get the balance of their commission because it's a percentage based thing off of payments versus a flat rate, but they only get that after the insurance pays.

Celia Zanayed 00:39:17  So that's wiser. But that's not what I do. I make my life hard and I just kind of guess sometimes. And then I'll like, adjust because I for the most part, I should know ahead of time.

Celia Zanayed 00:39:28  It's just every once in a while that insurance companies do something real weird, and then I end up like crap, but like, it's not too bad because sometimes it's just like, oh good, I owe you more this next time. And then I feel better being like, you get an extra burst this paid period. But yeah, it's that would make more sense. But I do more of like a cut per session.

Andrew Burdette 00:39:46  It does make more sense. And it's also more paperwork every pay cycle because you have to kind of like figure out how many hours do they clock for sessions. They get paid. And then we got to subtract that out. It's just there's there's some extra paperwork on that end of things. And again, if insurance companies just paid like we would assume they would and did it in a timely manner versus some insurance companies in North Carolina, it's like, hey, it'll be six months. You're like, oh, no, that's not okay.

Celia Zanayed 00:40:14  Well, and I think the vast differences between which companies pay so much, like there are some companies that pay literally twice as much as others.

Celia Zanayed 00:40:22  So it's like, is that, you know. How do you factor in how what's fair to someone else? Which is why I just did the flat. Lesson you make a percentage of how much you make. I'm happy to give you all of it. Have a good time. Just. Here's the setup. But then it is hard when you're like, okay, well, then. When you're dispersing referrals, for instance, if some of them have the insurance that barely pays out, you don't want to give too many of them to the same person, because that's not necessarily fair. But you also don't want to take that opportunity away from the patient who they just think they have insurance they don't know. We're not really getting paid for working with them. So yeah, it's not my favorite system.

Andrew Burdette 00:40:56  Yeah, that's pretty bad. Yeah. Pretty pretty bad. so are there any big things you've learned doing the group practice owner experience? I realize that's a very big, broad question. as someone that has learned way more than I expected to in the past couple of years.

Celia Zanayed 00:41:17  I think I've learned I'm very scatterbrained, which is okay for me. I think it's hard to try to figure out how much to have a system and how much to be flexible. I think that's the biggest thing I've learned is I think the way that I work is very like it works for me, and that's great. But that's hard if it doesn't work for your employees. Like that kind of goodness of fit model in terms of, hey, I don't need a lot of like, I don't like being micromanaged is a big thing for me. It's probably why I started to practice, honestly. It's like, I don't like being told what to do. Fun fact so when I have others, sometimes I on the side of not saying too much and not giving as much instruction when someone is actually like no, actually, can you walk this through with me step by step so I know exactly what you are looking for, and then I have to learn how to like, translate what I want and what I'm thinking.

Celia Zanayed 00:42:04  So I think learning how to communicate those very specific things, as the person who actually does have the power now is helpful because in the past, in like past jobs, it was sometimes people would give me leadership positions when I did not have a leadership position, but it would be my job to somehow talk to someone about, like a remediation plan or to talk to them about like how certain things should work. And I actually had no power over how that policy was. I was like, I don't think you want me doing this, but now it actually is my responsibility, which is great in some ways, but means that I have to take responsibility and make sure that this system works for everyone.

Andrew Burdette 00:42:37  Do you? This is something I find challenging at times is I don't it's not exactly people pleasing, it's more just wanting to make sure people are heard and have a voice and acknowledge that. So it's more coming from that place versus trying to make everybody happy. But from time to time, you just kind of have to say, this is what we are going to do.

Andrew Burdette 00:42:56  The end like no discussion. And, I don't enjoy that. I'm worrying. It's something I'm having to do a little more of as we've gotten bigger to just say, here's the direction the ship is going, and I'm going to steer it this way. but yeah, I has that has that kind of dynamic showing up to where you've had to make choices and just say, hey, this is what we're going to do as a group.

Celia Zanayed 00:43:19  And I think the funny thing is the group that I have is truly wonderful. And honestly, I do think there's a good amount of trust in our team. So I will say with them, they're like, yeah, just tell us what to do. And that's fine. Which also throws me off because I'm more used to like a collaborative like, no, let's all decide together and what makes the most sense. And I think in the best way, sometimes they're like, you know what, I don't care, just pick and tell me. So it's not necessarily stressful in that sense because again, it's a small enough group that fits.

Celia Zanayed 00:43:45  And like the dynamic is what it is, that it's not a problem. But again, I could absolutely seeing that being a problem if I actually had to tell ten people, hey, here's what we're doing. Get it together, like get on this plan or get out. Kind of a thing that feels very harsh and unnecessary, but it's probably it actually probably is necessary in certain situations, of course, but I've been lucky enough to not have to deal with it yet.

Andrew Burdette 00:44:10  Cool. Have you run into the experience of being surprised when your staff wants to have a much more strict and clear direction.

Celia Zanayed 00:44:19  Yeah.

Andrew Burdette 00:44:21  Like I didn't know I had to spell this out like I wasn't planning on, but I guess now I need to write up a policy around it, right?

Celia Zanayed 00:44:27  Exactly. I think that is hilarious. Within the big thing that I've learned is like, again, my brain is very like. Doo doo doo doo doo. I'll figure it out as I go. And having people be like, no, I'd love to hear exactly how this is supposed to go is.

Celia Zanayed 00:44:38  Or like, even when they wanted to meet in person, because I meant that in the best way is like, I'm happy to meet with them. They're a great group and I'm happy to like, you know, pay for a meal together and like, spend that time together. I was like, you guys sure like, you want to drive and meet and go an hour out of your way and travel when the whole point of all of us working virtually was that we didn't really have to do that, and they're like, oh, it's so fun to, like, get together and meet. And I was really surprised by that as first, because I felt rude being like, yeah, we all have to hang out once a month. And then they explicitly asked for it repeatedly and I was like, oh, okay, we can absolutely hang out once a month. Sounds great.

Andrew Burdette 00:45:11  Cool. Well, for listeners out there, are there any key takeaways you want to make sure that they remember from this conversation.

Celia Zanayed 00:45:18  I just give it a try. You want to do a group practice thing? I think sometimes the best way to learn is just try things and you never know. And of course, I think you mentioned a really important piece earlier about like getting a consultation group with other group practice owners. And I think that's one of the best things that you can do is just learn from yourself, learn from others, and be ready to take a plunge and see what feels right for you. Because I will say opening a practice has definitely been one of the best experiences in the field so far, and like getting to know these people and being in this role is pretty amazing, actually. Just it's been a really great experience, so I hope others have the opportunity to build a good work life balance for themselves the way that I have.

Andrew Burdette 00:45:56  Yeah. And I'll just add a little note on there that most of your other group owners have just as much imposter syndrome as you do, so they'll be thankful to have someone else if they're like, hey, you struggle with payroll too? Great.

Andrew Burdette 00:46:07  Let's talk about how much it's awful. Maybe we can brainstorm and come up with a better system that works for both. So don't be afraid of your other group owners. They're really not cutthroat competitors, most of them. Most of them are collaborators.

Celia Zanayed 00:46:19  Yeah, most of them are so wonderful. And, like, they just want you to succeed. They want to succeed. Like, I think that's the cool part about being in your own system is there's not a weird competition vibe for the most part. It's like, no, there's plenty of people who need help. And, you know, I'm happy to give you the people that you want to work with. You send the people to me that I want to work with, and we can all do better and better together.

Andrew Burdette 00:46:38  Yeah. Well, cool. If people want to get Ahold of you, how can they find you? And we'll have this link in the show notes like we always do.

Celia Zanayed 00:46:45  Yeah, that'd be great. so the website is probably an easy way.

Celia Zanayed 00:46:48  And they're also welcome to email. So the website being Olive Tree Mental Wellness. Com and then my email being Doctor Celia at Olive Tree Mental Wellness and Doctor Celia being Doctor Celia at Olive Tree Mental Wellness. Com. Probably the best way.

Andrew Burdette 00:47:03  Well cool. Well thanks so much for sharing all your insight and being on the show. And I hope listeners enjoyed this. So thanks for being a part.

Celia Zanayed 00:47:11  Absolutely. It was great speaking with you.

Andrew Burdette 00:47:18  Thank you so much for listening to this show today. We could not do this show without our amazing sponsor therapy notes therapy notes as the best electronic health records out there. You can go over to Therapy Notes. Com and use promo code Jo at checkout. That's going to help get you a couple months off for free. It also helps let them know that their podcast sponsorship is working. Thanks so much for hanging out with us today on the grow Group practice podcast, and we'll talk to you soon. If you love this podcast, please be sure to rate and review.

Andrew Burdette 00:47:55  This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guest are rendering legal, accounting, clinical or any other professional information. If you want professional, you should find one.