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[ALISON PIDGEON]
Do you need help building your brand? Feel like you don’t even know where to begin when it comes to marketing your practice online? Whether you’re a seasoned clinician with a website in need of a refresh, or you’re fresh out of school needing your very first therapist website, Brighter Vision is the perfect solution., from building a brand and designing the perfect website to reflect that, to helping you rank higher with search engines. They’ve even created tools to make online marketing simple that are specifically for therapists.

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You are listening to the Grow a Group Practice podcast. Whether you were thinking about starting a group practice or in the beginning stages, or want to learn how to scale up your already existing group practice, you are in the right place. I’m Alison Pidgeon, your host, a serial entrepreneur with four businesses, one of which is a large group practice that I started in 2015. Each week, I feature a guest or topic that is relevant to group practice owners. Let’s get started.

Hi, I am so glad you joined me today on the podcast. I have a great interview for you, but first I just wanted to say that it’s been really fun to get feedback from people who’ve been listening to the podcast. If you would give us a rating wherever you listen to podcasts, that would be super helpful, and will help get the word out about the podcast for your colleagues. And if you want to share the podcast with a group practice owner friend, I would really appreciate it.

So today we’re talking to Lindsay Keisman. She is a multi-location insurance-based group practice owner in Illinois. She also has a business where she does executive coaching on leadership and business, and it’s called Leading Your Practice. She is a big advocate of work-life balance. She’s a mom of three boys, so she understands what it’s like to have to be present at home and also kick butt at work. She supports people to help them find the right balance between making a living and making a difference without sacrificing what matters most. So Lindsay and I had a great conversation about hiring for leadership positions in your practice. This is something that I get asked about all the time and Lindsay is definitely an expert on this and I hope you get a lot of value out of this podcast interview.
[ALISON]
Hi Lindsay, welcome to the podcast.
[LINDSAY KEISMAN]
Hey Alison, thanks so much for having me.
[ALISON]
Oh, I’m so glad that you’re here. So could you just take a minute to introduce yourself and your practice and your consulting business for us?
[LINDSAY]
Yes, sure. So my name is Lindsay Keisman and I have a group practice in Northern Illinois, a two location insurance-based group practice. I think I started that in about 2016 and we’ve grown each and every year bringing on more and more clinicians. In addition for the last three years I do business consulting on group practice development, and then more specifically leadership development through my consulting business, which is called Leading Your Practice.
[ALISON]
Nice. And how many clinicians do you have between the two locations?
[LINDSAY]
We have 13 clinicians and have been desperately attempting to hire all year, but it’s been a little challenging to get anybody to hire this year, which I know I’ve heard across all the Facebook groups that I’m in, that that’s a challenge many of us are experiencing. So I’d love to have like seven more, but I can’t find them.
[ALISON]
Yes. They’ll come, I’m having the same issue, but it’s got to turn around here at some point.
[LINDSAY]
Yes. That’s what I keep on thinking. I’m crossing my fingers and spending lots of dollars on Indeed sponsorship.
[ALISON]
Yes. Well, I’m really interested to talk to you today about adding leadership position to your group practice because that, we were just talking before we started recording, that’s the question actually both of us get asked all the time and there’s kind of a lot of moving parts to that. So maybe you could just sort of start out, maybe just giving us like kind of an overview of leadership positions, like what do you mean when you’re talking about that?
[LINDSAY]
Yes, absolutely. So like Alison said, I get this question a lot. And I think when we’re talking about leadership, I think the most common roles that I see in practices who have developed their leadership team are usually something like a clinical director. The titles may change slightly, but clinical director or a site director, if you have multiple locations or a site supervisor and also a practice manager, so somebody who’s in a nonclinical leadership position. And even as a larger businesses kind of expand, I’ve even seen leadership roles where there’s a practice manager and there’s also maybe an intake manager. I’m using the most boring titles them, because I’ve seen some really creative titles, but those are the most common ones that I see people needing and reaching out for. And I think the big question is always why bring on leadership? Do I need leadership or do I need administrative support? Do I need third party support or am I ready for that right now?
[ALISON]
So is there a particular way that you help people to figure out the answers to those questions, like when they’re ready and what should that position be and which comes first? Do you get more of a clinical director person in place first or a practice manager?
[LINDSAY]
Yes, I do. You know, it’s usually through a, it’s a combination of why, why. So I like to start with why, which is a little bit of an Assignment Cynic reference for anybody who’s read that book, but start with the why. And I think I hear a variety of things from people, either they’re overwhelmed or they feel like they’re dropping the ball or they’re juggling too many things or maybe they hate a certain part of the job and dread it every minute. I’ve also had people reach out to talk about how they’ve got somebody in their practice who is eager and interested and might be a really good candidate for a position. So they’ve kind of got somebody in mind already and they’re wondering, should I take the leap right now?

And I think on the flip side, I’ve also talked with people who will say, “Gosh, Lindsay, I just realized I’m not very good at being assertive or I get nervous talking to people if they’re behind on notes or they’re not working the number of hours that they committed to.” And and that’s a combination of, “Okay, well, how can I support you to be awesome at having those difficult conversations and also saying, well maybe there is an opportunity for somebody else to take a role that you don’t necessarily love?” So I think the why is important because it can really determine do you need leadership support? Do you need administrative support? Because when I hear people sometimes say they’re just so overwhelmed and I’m still answering the phones and I’m still doing the billing and I’m still doing all of the things for the website and all of my social media. And they’ll say, “I think it’s time for a clinical director,” I’ll say, “Well, have you considered hiring an admin or a virtual assistant, or maybe it’s time to find an organization or a company that is awesome at social media and just take that pay for their service because they’re going to probably do it better, anyways, instead of having somebody in-house?”
[ALISON]
Yes, so it sounds like it’s kind of a combination of the person’s goals, what their circumstances are, what they haven’t already delegated. So there’s not like a cut and dried answer. It kind of depends on various factors.
[LINDSAY]
At least I think so. I mean, I guess what I’ll say is the larger you get, I think there is a point where it becomes really clear that we need additional support. Personally, I know Alison and my journey, I would have loved to have a clinical director sooner than I got one. And my big mistake was I hired wonderful clinicians who are rockstars, not superstars, which referencing a book there. So rockstars are people that are fantastic, great, they’re good clinicians and they don’t necessarily have leadership ambitions or anything other than to just work at a great place and do a great job. But superstars are people that if we don’t give them an opportunity above and beyond what they’re doing right now, they may seek out their own opportunity or to kind of move on to an organization that can offer them a leadership possibility. So I didn’t have any great candidates to put into a clinical director position and I had to really intentionally hire people that I thought had that potential. And I did make that my focus and about six months in, with one of my hires, I asked her to be my clinical director and I’ve never looked back and it was the best decision I’ve ever made. It gave me the most freedom to live my life, love my family, and be available in all arenas of my life.
[ALISON]
Yes, that’s awesome. Can I just ask you, if you recall what the title of the book is, where you use the term rockstar and superstar?
[LINDSAY]
Oh, is that in, I think it’s Radical Candor.
[ALISON]
Yes, that’s a good book about leadership.
[LINDSAY]
Radical candor by Kim Scott is her name.
[ALISON]
Yes, that’s a great book about leadership.
[LINDSAY]
It’s a great book. Oh my gosh. It’s one of my favorites and it really helps also with assertive communication, which I mentioned earlier. But yes, that’s a great book. And if you’re like me and you prefer to listen to books it was pretty good to listen to on Audible.
[ALISON]
No, go ahead and finish.
[LINDSAY]
I was going to say, I like to read with my ears, not my eyes.
[ALISON]
Yes. I know a lot of people who do that, then you can multitask.
[LINDSAY]
Yes, for real.
[ALISON]
Do you think there’s a certain point at which you have like a certain number of clinicians or you’re doing a certain volume of like sessions per month or something like that where it’s kind of the tipping point where you’re like, okay, now I need this clinical director in place?
[LINDSAY]
When it comes to, I guess what I’ll say is, I don’t want to assume that we only are talking about a clinical director because it has a little bit to do with what you enjoy doing. What I mean by that is I think somewhere, and this is me personally, I think the vast majority of people I’ve worked with and my own personal experience would say somewhere around seven to eight, certainly needs some additional support. I don’t know if you would agree. What that support might be, could be a clinical director, it could be somebody who just does clinical supervision of provisionally licensed people. It could be an admin, could be a practice manager because, I’ve worked with a lot of people who love to do the training. They love to do the clinical contact with their clinicians, but they hate everything else. They hate looking at benefits and doing payroll and answering the phones and answering the contact forms. So I think it depends on a combination of what you love and what you hate and what’s available to you. But at seven or eight, I think that any one of us would be burnt out if we were still doing it all.
[ALISON]
Yes. I think, now I’m trying to think back what point I kind of hired or promoted my clinical director. And I think it was maybe when I had five or six clinicians and what we did was we just started out, like she was the person in charge when I was on vacation. That was kind of how we tried out, like, “Does she like this? Did I like it? Did it work out well or not kind of thing?” And then slowly over time I just kept giving her more and more responsibilities. But yes, I mean, I just think like, even just having somebody who could be in charge when you’re on vacation is huge, because then you’re not worried about, “Oh my gosh, is the phone going to ring? What if there’s an urgent problem? Are you going to interrupt me when I’m sitting on the beach with my family?” You know what I mean? Like you want to be on vacation and you don’t want to be thinking about work. So I think that’s the other great reason to have somebody who either is a clinical director all the time, or at least somebody who can be in charge while you’re gone.
[LINDSAY]
Yes. Well, and I think, back to what I said is I think I made some mistakes in my hiring. I mean, if I could have done it at five or six, I think looking back would have, because for me it was too long. And also being a multiple location practice owner really contributed to that because I had to be splitting my time and two different places and locations with two different sets of inventory needs and building needs. And when I look back at all of that, it was a big thing to manage. And when bringing on leadership, I think we’re able to slice off a piece of our pie and say, “Hey, this is your territory now and it’s so great.” And then when we’re gone on vacation, we say, well, now you’re going to take over all the rest of the pie now. And then she’s the only one calling me when I’m on the beach. Like she really has to be in a pickle in order to give me a ring.

So, but yes, I mean I think kind of back to the point I was saying is one of the things I love for people to do is when they’re like, I need more, I just don’t know what is really simple. or a couple of weeks or a month write on a piece of paper, love, neutral, and hate. Make three columns and write down all the things that you do. And do you love it? Do you hate it or do you feel kind of neutral about it? And I think if possible, let’s get rid of all the stuff we hate and find somebody who’s got natural talents and interests in the areas that we don’t. And it doesn’t always work out perfectly. Sometimes financially we need to make a different choice. Sometimes we don’t have a good alternative for the things that we hate to do. But then I say, look into that neutral category and do your best, never to give up the things that you love, because we should be in this business to be able to keep the things that we love.
[ALISON]
Yes, absolutely. I’m glad that you brought that up about really looking at what your strengths are and the strengths of your team, because it’s just sort of silly to make somebody do something that’s like something they hate or aren’t good at what. Like there’s no reason why you have to force it. Like it’s okay to not do it or give it to somebody else.
[LINDSAY]
Yes, absolutely. I mean the clinical director that I ended up hiring, she loves training. She loves supervising. She’s had so much history doing it. And I’ll be honest training is in my love category. I really enjoy it but what we realized is that I have some clinical expertise that isn’t necessarily her biggest area of expertise. So I really love working with couples and she loves working with teens and adults and doesn’t necessarily love couples. So it’s been neat to design something where I still facilitate a peer consultation group for our couples team. And that’s been able to kind of fill that hole in my heart that I didn’t want to give up, and yet she does pretty much everything else when it comes to kind of supervision. And that freed up so much time in my life. And like you, I’ve got three kids and I’ve got a bustling life and I want to be present with them. And it’s really amazing when you have a leadership team or a leadership person that you can 100% trust after that training period.
[ALISON]
Absolutely. It makes a huge difference.
[LINDSAY]
Yes. I think the other big question that I get asked all the time as well, how do I afford it? You know, I can’t imagine affording it right now and well, if I answer the phones or if I do all the supervision that’s better because I’m saving money. And I think that’s a mindset shift that so many people need to make. And I think they wait too long. I think people get to the point of burnout before they go, “oh gosh, I got to make some decisions here.”
[ALISON]
Absolutely.
[LINDSAY]
So part of what I like to do is just share how I look at the different roles, some options for how to pay for them. And Alison, maybe you have a different model than I do, but I can talk about the ones that come up most frequently the, and I think when it comes to admin support I think the traditional feedback of, “Hey as therapists, we can generally make at least probably around a hundred dollars an hour on average, depending on where you are it could be higher, it could be lower.” So we don’t pay admin a hundred dollars an hour. We don’t pay third party providers, whether it’s an accountant or a social media person or some virtual assistants answering our phones. Generally we’re paying an admin rate anywhere from 13 to $25 an hour, depending on where you live and if we’re paying a professional, like I know I pay my accountant, who’s more like a external CFO for me, about $700 a month.

And she does a lot of work for me, but I know that I could see seven clients in a month and that’s done. It’s over? So I think when it comes to leadership, it gets a little more complicated because we generally are paying them a higher amount. So that logic doesn’t always work out perfectly. So the admin is, I think fairly simple. You should do it, everybody should do it sooner than they think they should with admin.
[ALISON]
Yes. What we find is that they always, if they’re good and they’re doing their job well, keeping schedules full they’re bringing in over and above the salary that you’re paying them, it’s always a net positive. It’s a total no-brainer in my opinion.
[LINDSAY]
Yes, absolutely. I have three different admin people on my team. And when I look at how much I pay them at the end of the year, I’m like, I don’t even, I’m like, great. I’m going to give them a raise, because I love them and I never want them to leave. I know that they bring business in and they keep, my biller for instance without her we could easily lose money. Being an insurance-based practice having a biller I think is really important.
[ALISON]
Sure. So how do you kind of manage bringing on somebody for a leadership position, typically when you start out, I’m guessing they still have somewhat of a caseload and then in addition, they’re doing these other leadership responsibilities. Is that kind of how it works financially?
[LINDSAY]
Yes. Yes. So I have seen a couple of different models, so where we pay somebody hourly, we pay somebody a stipend or you move them salary. And I have some preferences and I I’ll explain why, but I like to talk about them all. Hourly is I think when, like, for example, when you said, “Hey, can you be in charge while I’m on my vacation?” that’s a great example of if you’re in a smaller practice and your needs for a clinical director or a site director or multiple site directors, if you’ve got multiple locations, your needs may be pretty infrequent. You know, maybe you’re only looking at a couple of hours a week, or maybe you’re only looking at a couple of hours a month. And I think when we’re doing that hourly could potentially make sense because we don’t know if we’re going to need you three hours this month, or if we’re going to need you 15 hours this month.

When you do that, the tricky part is that I think in general, most great clinicians will at least want to make no less than they could make seeing a client that hour. So going back to simple math if you’re making an average of a hundred dollars an hour and let’s say you’re doing a 55% commission split, you’re not going to offer them $25 an hour for their clinical director work because they’ll say, “Well, I’d rather not maybe.” They wouldn’t, maybe they’d just love the extra work and the title, but I don’t think that’s the right way to do it. So we’ve got to pay people their value and what they’re worth. And I think the major disadvantage, at least from people that I’ve seen that do this, is that mentally they shy away from asking their clinical person, their clinical director to do stuff because they always think, “Well, it’s going to cost me, let’s say $75 or a hundred dollars an hour to have this person do it. Well, I’ll just do it instead.” So I think that that one is good for smaller practices, but can get people in trouble real quick.
[ALISON]
Yes, I think so too, in terms of , you know, you can always put a cap on, “I’m giving you these tasks to do, and I think it’s going to take about 10 hours a month and if for some reason you go above the 10 hours, you have to let me know,” kind of thing. So then you can budget, especially in the beginning when you’re not quite sure how much time things are going to take. So you know like that person’s not going to come back to you and say, “Well, I spent 50 hours a week, I mean, 50 hours a month, this month,” and you thought they were willing to take 10 and now it’s very different, different paycheck.
[LINDSAY]
Yes, exactly. And I think that’s, I’ve seen the stipend model kind of work that way like, “Oh, we anticipate approximately this. It may be less some months, it may be more some months, and this is the stipend you’re going to get.” You know, I’ve seen that model work for some folks but also along the way, they’re seeing clients too. And one of the things, depending on what you’re asking them to do is that they may be ambitious and eager people and they might still want to see 25, 26, 27 clients a week. And the clinical director stuff could potentially be the last priority in their week. And I know for me, I didn’t love that and so I do a salary model and part of the reason that I like the salary model is because we’re not counting how many hours or what you’re doing, and I can go ahead and say, “Well, this is how many clients I want you to see.” So the question is, well, how do you afford a salary, and I mean, I think that hiring clinical leads or site directors is easier than hiring a practice manager because they can oftentimes self-fund either all or most of their own salary.
[ALISON]
Right. That’s what I do in my own practice.
[LINDSAY]
Yes. So my clinical director, when she got started, I required her to work, to have 18 hours of availability for clients, with the goal being to maintain an average of 15 client hours. And with the math, that’s specific to my business, which is higher than the hundred dollar an hour average that I was mentioning earlier I was able to offer her a really nice salary, a title, give her PTO and benefits. And all of that was really attractive to her. It was really attractive to have the title, to have variety in her work, because people also really appreciate, maybe not just being client after client. She loved it. And the quick math for me is taking your average that you make and if you’re not doing the statistics to figure out what the average reimbursement is in your practice, you should.

But let’s say it’s that a hundred dollars an hour because it’s just easier to do that math when you’re listening. You know, I take a hundred dollars an hour times, let’s say 15 clients a week or 20 clients a week. We’ll do 20 clients a week. So you make $2,000 a week from that position or from her or him and then what I do is I take that instead of times 52 weeks, I take it times 48 weeks. So $100 an hour average times 20 clients a week would be $2,000 times 48 weeks. And the reason I picked 48 weeks is that allows me to give paid holidays and three weeks of PTO.

And I look at that and that math comes out to $96,000 a year. And that means I have $96,000 a year to play with to offer a salary. And depending on where you live, where you have the cost of living, what the expectations are in your area, that might not be enough, or that might be plenty. And I look at that and go, great. This is how much is self-funded for that position.
[ALISON]
Yes. That’s a really helpful way to look at it. I’m glad that you went through the math, because I think that’s the piece that a lot of practice owners don’t understand. Like they just sort of assume like, well, I can’t afford somebody in a leadership position and it’s like, if you do the math, you might be pleasantly surprised.

Yes. Well, and the way that I thought about it, when I wanted to offer her the position, I thought, “Okay, I’m going to hire.” And this was before COVID and before the hiring was so difficult. I thought, well, all I have to do is hire one more person, get them up to the numbers she was seeing, and then my profit should be identical. And when you say it like that, you’re like, oh my God, what am I waiting for? So in my case I live in kind of a suburban to rural area. It’s fairly affordable living in my area. So I didn’t offer my clinician the full amount that she was self-funded for. I took a little bit off the top for the cost of her benefits. You know, the cost of some of, just having her there. And I gave myself some breathing room to be able to give her nice salary increases for a couple of years.

And then what will happen, which has happened is since having her, I was able to hire a lot more people because she was a part of it. She was reaching out, she had connections, I had connections. She was able to train them faster than I would be able to. So my business has actually become significantly more profitable because of her and if I have to pay her $120,000 a year to retain her long-term, I’ll do it because at this point she’s brought in that kind of profit to my business.
[ALISON]
And I think that’s such a good point that like it’s probably freed up enough of your time that you can continue growing the business. And I’m hope hopeful that you were less, maybe less stressed out or less overwhelmed.
[LINDSAY]
Oh my gosh. You know, I got to be honest. So I had my two locations, I did have a virtual assistant doing the phones and everything, and I did have a biller. And I’m not one to have a lot of anxiety. I’m pretty, kind of cool cucumber type of personality. And it wasn’t until I started having heart palpitations where my body was telling me, Lindsay, you are working too much. And I was working probably 55, 60 hours a week. And I wish I wouldn’t have. It was too much at once and I’d never recommend exactly the way I did things. I wish I would’ve done them sooner. And that’s what I’m so passionate about, like, don’t wait, don’t wait. You know, you’re going to kill yourself and your family’s going to feel disconnected from you when you’re never, and even when I was working those 55 to 60 hours, Alison, I don’t know about you, but I’d be at home and my brain would still be at work or I’d have my computer on my lap.

And that just felt yucky to me. I didn’t have kids because I wanted to be with my computer on my lap when I was around them. And so ultimately all at once I hired a full-time administrative person, I increased my billers hours and I started hiring for the clinical director position that ultimately I offered to somebody six months later. Now I see eight clients a week and I probably work about 15 hours a week including those eight hours clients. So ultimately I probably spend about six or seven hours a week on my business and eight of those hours in my business, because I personally like to keep my skills up and stuff. I’m not sure that I’ll ever completely give up clinical contact with clients because that’s in my love category. Remember that love neutral? So I’m like, I got to make space for this because I actually do want to be a therapist. So I think it’s so important to do those things before your body tells you or before burnout really takes over.
[ALISON]
Right. Lindsay, this has been such great information. And then I know you said you have a giveaway for our audience. So do you want to tell us about that?
[LINDSAY]
Yes, yes, I do. So one of the things that, you know I work with some people who are kind of at the beginning stage and also people who are dreaming and scheming and business planning for the future. So my giveaway is I have about 12 or 13 organizational charts where you can sort of look at how different leadership is organized in multiple practices that I’ve worked with. And the way I recommend using it is just to see if any one of those seems like the vision that you have for your business and then work backwards and say, “Who should I hire first?” So you can get that at my consulting website, which is leadingyourpractice.com and then backslash Alison.
[ALISON]
Oh nice. Yes, that’s awesome. I think that’s super helpful because that’s actually, I made an organizational chart of my practice because I got asked that question so many times, like what does that actually look like? So that’s great that you have different examples. I think that’s super helpful.
[LINDSAY]
Yes. Yes, the same thing people ask. I’ve just worked with enough people at this point where I started keeping track and there are so many unique ways to do things. I’ve seen them simple and I’ve seen people who get to the point where they have operations directors, clinical directors, training directors, intake directors. And for those of you who are interested in really scaling your business in a large way, I think if you can do it more intentionally and know what you want and what it’ll look like you’ll get there faster.
[ALISON]
Awesome. So if people want to get in touch with you, what’s the best way for them to contact you, Lindsay?
[LINDSAY]
Yes. So you can definitely contact me through the website, leadingyourpractice.com or you can send me an email, which is [email protected] and Lindsay is spelled [L I N D S A Y].
[ALISON]
Awesome. Thank you so much, Lindsay for taking the time to talk to us today about leadership positions. It’s such a good topic, and I really appreciate all your expertise.
[LINDSAY]
Thanks so much for having me, Alison. It was really nice to connect.
[ALISON]
Thank you again to Brighter Vision for being a sponsor of this podcast. I’ve had a Brighter Vision website for five years now and I love it. I would recommend it highly to anyone. And if you want to get the discount that we mentioned earlier in the beginning of the podcast, go to brightervision.com/joe.

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This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.