[WHITNEY OWENS]: Welcome to the Practice the Practice podcast. We are doing a bonus podcast takeover here with myself, Whitney Owens, and —
[ALISON PIDGEON]: I’m Alison Pidgeon.
[WHITNEY]: All right. So glad to be here with you guys. Today, we’re going to talk about how to launch group practice and I’ve got the group practice guru, Alison Pidgeon here to answer all of our questions and I’ll be filling in as well. So Alison, can you share a little bit about who you are and your work with Practice of the Practice before we get started?
[ALISON]: Definitely. So I’m Alison Pidgeon. I own a group practice in Lancaster County, Pennsylvania, which is about an hour and a half West of Philadelphia and we have 24 clinicians currently. I just hired a chief operations officer, so I function really as the CEO at this point, which is very exciting. We specialize in women’s issues. So it’s been awesome building the practice over the last five years. And I’ve been working with Practice of the Practice since 2016, helping people go from a solo practice to group practice and now we’re doing a lot more with helping group practice owners who are already established kind of helping them get up to the next level and make their practice more efficient and help them design their business to fit their lifestyle.
[WHITNEY]: Yes, we launched Group Practice Boss just a few months ago and it’s been awesome. Like we’re getting such positive feedback as group practice bosses are living their dream and having the kind of practice that they want and growing and expanding. So we’re going to talk about how to launch a group practice today and then share a little bit at the end about some other things that we’re going to be doing. But just to give you a little bit about me, Whitney Owens, I’m also a consultant with Practice of the Practice. Alison and I work really close together in helping group practice owners.
I also have a practice in Savannah, Georgia. We just added our eighth clinician actually this week, our first intern, so I’m really excited about having that option for people who want cash pay practice. So it’s good to have the option of a lower cost for people who can’t afford to do the higher phase. So looking forward to that but let’s jump in here with starting a group practice. How do you kind of talk to people about that in the first phases or when they’re wondering about starting a group practice, how do you talk to people about that, Alison?
[ALISON]: Yeah, I think the way I think about it is like in three broad phases. So the first phase would be setting up the foundation of the group practice because you don’t want to just start hiring people and not have good systems and processes in place to make sure everything is running smoothly. So we look at, are you needing to set up a phone system that has extensions or do you need to hire a virtual assistant? Do you need to change your office space? Do you need to change your insurance coverage? All of these things kind of like set up a really solid foundation for the group practice. The second phase is really all about hiring. So there’s so much that goes into hiring, especially clinician you know, from the job posting to interviewing, screening people, onboarding them. So that’s really the second phase, because that can be quite the process.
And then the third phase is okay, now I have the foundation set up, maybe I’ve hired at least one or two people, I now I need to make sure things are running well, right? Like I need to track data, I need to make sure I understand how to manage finances as a group practice because it is quite different, I need to make sure that the people I have hired are happy and are going to want to stay. So how do I create that really positive culture that they’re going to be happy working there? So that’s how I like to think of it. So just to recap, like phase one is the foundation, phase two is the hiring, and phase three is like, let’s make sure everything is running as it should.
[WHITNEY]: I love how you just broke that down. You make starting a group practice sound easy, but a lot of steps at the same time. So I love that, and especially the first phase, because I don’t know about you, I feel like a lot of people will say, “Okay, I’m getting a lot of calls. I’m going to start a group practice,” and then they’ll just start hiring. And then they go back and they’ve totally missed the first step there. Do you seem to find that as well?
[ALISON]: Oh yeah, definitely. And then that’s when people call me and say like, “Oh, I hired this person and it’s not going well,” because they didn’t have anything set up on the front end to make sure that it would go well.
[WHITNEY]: That’s right. Well, can you talk a little bit about phase one? Let’s go into some details on each of these. What are some of the things, obviously there’s lots of things with the setup. Maybe talk about what are some of the things that are the most common issues going solo to a group practice with systems that you found to be issues?
[ALISON]: I’d say that a lot of times when people start out in solo private practice, they kind of you know, just sort of cobble some systems together because they’re like, “Well, it’s just me. I don’t want to spend a ton of money on X, Y, and Z.” So they might be like keeping track of their expenses on a spreadsheet instead of using QuickBooks or maybe they’re using like paper charts instead of using an EHR. And if you’re going to hire people, you really need to have systems that are going to work well for you and work well also for having multiple providers, because you know, a lot of times we solo practice owners will be using like their own cell phone for the phone. Well, that’s not going to work anymore, because you’re going to need like an assistant to answer the phone. Every therapist is going to need their own extension. So now you need to get like a real phone system with a phone tree and extensions. So these are the kinds of things that people don’t think about or, you know, they start to think about, “Oh wow. Now I have to like formalize all these things.” And it gets a little overwhelming for them.
[WHITNEY]: Yeah, I agree. The phones is a huge one that I have to help people with on those first phases. The other thing I see is, I call it the dream team, but getting your accountant, your attorney and your consultant in line. You know and a lot of people miss those or they don’t understand how important that is.
[ALISON]: Yeah, for sure. I think it’s so important to ask someone for help, who’s already been there, done that, because I see so many people who just think like, “Oh, I can figure this out on my own. I built the solo practice. I can certainly figure out how to also form a group practice.” But I always tell people it’s a very different animal and you can’t do all the same stuff that you did to build the solo practice for the group practice. So it’s always good to ask for the expertise of somebody who’s already walked the walk so to speak.
[WHITNEY]: Yeah, and when you’re adding people, you don’t want to bring them into chaos. You want your new clinicians to feel like you’ve got it together. And obviously none of us are perfect, but if you’re bringing them on and the phones are complicated, if you’re bringing them on and it’s hard to take notes, like they’re not going to want to keep working for you. So you want to have those systems as simple and smooth as possible because then they’re going to want to stay with you.
[ALISON]: Absolutely. Yeah, absolutely. So, the second part of phase one is really looking at hiring an assistant. And I feel like everybody thinks that I’m telling them this in the wrong order, but I’m not. You should hire the assistant before you hire the first clinician. And nobody believes me and then they just do what they want and then they come back later and say, “You were right.” So definitely hire the assistant before you think you need them because what we find, especially in my virtual assistant company is that people wait way too long to reach out for a virtual assistant and by the time they actually get one on board, they’re like drowning in work and totally overwhelmed and don’t even have like the time or the bandwidth to train the assistant. So that’s why we recommend having the assistant in place first, before you hire the clinicians,
[WHITNEY]: It definitely made that rookie mistake; had two clinicians hired and finally was like, “I can’t keep taking these calls anymore,” and had to make some changes.
[ALISON]: Yeah, for sure. I would say too the third piece of the foundational staff is just like making sure you have the right insurance. You know, obviously it’s a different kind of insurance policy to insure a group as opposed to a solo practice. Just understanding what your insurance policy covers, making sure you have the right kind of coverage, making sure you have the right kind of policies and things in place, just so that you can be sure you’re minimizing your liability as a group practice owner, as much as possible. You know, like we in my own practice just looked at like all of our policies and procedures and are trying to like tighten things up. It’s important obviously on a number of levels, but definitely in that minimizing your liability legally is also really important
[WHITNEY]: Yeah, with the insurance, it’s getting that billing figured out, you know, and you don’t want the billing to go through you because then everything’s responsible for you and all your clinicians. And if someone’s not making payments or an insurance, you got to go back and find them and you want to make sure that you’ve got someone else doing your billing for you, or you’re going to have a huge headache.
[ALISON]: Yeah, for sure. And I think too the question of office space always comes up. There’s always like this “chicken or the egg” problem of like, “Should I go out and get office space now because I know that I’m going to be hiring more clinicians. Should I just wait? But then what if I grow my space and then I am stuck?” I think, unfortunately there’s not like a pat answer for that, but that’s always something that we get into conversations with people about, and their own circumstances and goals and all of that have a lot to do with making that decision. But I feel like that’s always an important thing that comes up in the course of when somebody is starting a group practice
[WHITNEY]: Most definitely. And especially with tele-health growing and growing, it’s even more of a conversation that’s happening.
[ALISON]: Yeah, I feel like with the prevalence of tele-health now it’s even more tough to make that decision, because like there’s so much uncertainty around, “When are we going to go back to the office? Is insurance going to keep paying for telehealth?” And all of that kind of stuff.
[WHITNEY]: So let’s talk about the second phase. Let’s hire people. The exciting part.
[ALISON]: So there’s so much to this from like deciding, do you want contractors or W2 employees? How are you going to pay them? If you’re having W2 employees, are you going to have benefits? And you know, setting those up and writing the job posting to try to get obviously the best qualified candidates. Where do you post the job posting? How do you find these people to hire? How do you make sure you’re getting somebody who’s the right fit for your culture and somebody who’s going to be easy for you to manage as the boss? So there’s just like a lot that goes into even just the pre-hiring process and then there’s actually the hiring process, which I have found over the years that it’s better to kind of have that be multiple steps because it will really help you to vet out like who is really going to be a good fit versus who’s not. So I do like a screening call and then we do an interview. Sometimes we do a second interview. I know you have quite the process to Whitney. Do you want to share what you do?
[WHITNEY]: Similar one. We do a screening for anyone that applies that we think looks like a good fit. And fortunately, this is why you need to delegate and have assistance because I’m not involved in any of that. My assistant goes through all that, she knows what we’re looking for and she does the screenings. And those are like 10 minute calls. I bring up the story, because I think it’s hilarious. One time when I was doing a screening before the assistant, this was a while back before she was doing it, I had set up this, you know, 10 to 15 minute phone call and this was to prevent me from doing too many face-to-face interviews and the girl gets on the phone and she sounds out of breath and I’m like, “Is everything okay? Is this a good time?” And even though we had scheduled it and she was like, “Oh, this is perfect. I just sat down to get my nails done.”
It’s like, “Seriously, you sat down to get your nails done? You might not be the best fit for the practice.” But boy, imagine if I had done an in-person interview and so you can really get a lot from that screening process, and then she screens those and she fills out questions, she puts them in a Google Doc and then the ones that she loves, she sends me those. I’ll look at the answers and we kind of talk through it and then I do two or three face-to-face interviews depending on how many people I’m hiring. Then we also integrate the Enneagram into the hiring process because I really want to make sure that the team’s well rounded and the types of people that I work with. And so we make that a part of it as well.
[ALISON]: Nice. That’s cool. So I guess the other part of phase two would be the onboarding process. So, how do you train this new clinician? What are your expectations of them? How do you communicate that? How do you make sure they’re as prepared as they can meet and see clients and be successful in your practice? So that’s a whole another thing, especially if you have brand new systems and brand new processes, you know, working out all of those kind of kinks in the system.
[WHITNEY]: Definitely. And it’s always changing right? Based on different laws and different people. And I’ve even noticed as practices grow, it’s like you have to change things. You have to really nail down your policies better. You can’t be so fluid as you’re growing and you have to have better systems in place.
[ALISON]: Yeah, for sure. It’s interesting too, how I have realized over this last five years of growing my own practice that you think, in the early stages, you think you set up the system and you’re like, “Oh, this is how it’s going to be.” But then I realize very quickly like, “Oh no, like things are always going to change because we get bigger or because some insurance thing is going to change or whatever.” So just as an example, like my therapists have always done their own billing. So they like actually submit the claim to the insurance company and now we’re hiring a biller because the volume is just getting so great that there’s just more room for error. So yes, it was like the first time we’re actually going to have our own in-house biller.
[WHITNEY]: That’s so exciting.
[ALISON]: It is.
[WHITNEY]: Yeah. I mean, I don’t have to worry about that as a cash pay as much, but you’d be amazed how many billing situations come up with a cash pay practice. So I used to have to do all that and oh, it was terrible following up with all of that. So now I have someone else that does it and she’s in-house and it’s great. So what about that third phase?
[ALISON]: Yeah. So the third phase, like I said is, you probably have at least one person hired. Hopefully you have an assistant in place and now you have to make sure things are running smoothly, your staff is happy. Do you have a handle on the budget and the financials? I know I was surprised when I had my early stages of my group practice, like the increase in the number of transactions that were coming in and out of the bank account and how much more like overwhelming it was for me to look at that. And then I realized like, “Oh wow, I really need a bookkeeper because like this is getting to be a lot.” So, you know, having an understanding of a budget, especially like how much can you afford to pay clinicians versus how much should you be spending on overhead? You know, all those kinds of things.
Obviously, if you’re not a profitable business, you’re not going to be able to keep your doors open very long. So that’s something that’s really important to me to talk to people about making sure they’re really thinking through the financial piece and making sure they’re leaving enough to pay themselves a salary. Because what I see happen a lot of times is practice owners will just hire people and think, “Oh well, they’re covering their overhead. So great.” Like, you know, perfect. It’s all working out and it’s like, “Well, that’s nice, but they should also be generating a profit for the business and also a chunk of what they’re making should be going towards your salary because otherwise you’re working a whole lot for free.” So just making sure like those numbers are in line is so important so that you, as the practice owner, aren’t getting burned out by working a lot and not making any money.
[WHITNEY]: It is so true. And that is one of the biggest mistakes. And you probably see this too, when people call for consulting and they’ve already added three, four, five people and they’re not making any money yet and it’s because they didn’t set that up right on the front end. And so you don’t want to make those mistakes on the front end. You want to really invest in your practice when you’re launching it so that you can do it the right way. You know, another thing with this last phase is kind of managing those KPIs, those key performance indicators, like managing your intake calls and how are they converting. Before, when you were solo, you were just picking up the phone and you knew everything, but now you’ve got someone else answering the phone and someone else getting those clients scheduled and those referral sources. So creating those systems and processes for tracking the referrals and tracking the calls and monitoring client retention. Are those clinicians keeping the clients that you’re sending them? There’s so many of those steps that you want to have in place to make sure your practice continues smoothly.
[ALISON]: Yeah, we do a big training on that topic because I feel like it’s so important and people don’t always know like what should I even be looking at? And a lot of people don’t realize when they have an EHR, a lot of the EHR’s will generate nice reports for you. So like as you’re entering data, they’re aggregating the data and you can very quickly run a report and people don’t even realize like, “Oh, I can run a report and see how much money is missing that we didn’t collect yet.”
[WHITNEY]: Definitely.
[ALISON]: So it’s those kinds of things that just you don’t know what you don’t know. So it’s just important to pay attention to because you can really prevent small problems from becoming big problems.
[WHITNEY]: Yeah. So it’s pretty nice to have some consultants help you along the way, huh?
[ALISON]: Yeah. You know what? I always tell folks that I talk to when we get on the pre-consulting calls that I obviously work as a consultant to help other people, but I’ve always had a business consultant in some form or another. Like my first business consultant was Joe and over the years, depending on what I was working on, I’ve invested money to work with different consultants. And I mean, I see it from my own business. A lot of people ask like, “Well, how did you grow your business to 24 clinicians in five years?” And obviously there’s a lot that goes into that, but a big part of it is having that consultant who has a fresh set of eyes and an objective viewpoint who can say, “Well, how come you’re doing it this way? Or what if you did it that way?” Or, you know, I can go to and say, “I have this problem and I can’t figure out how to fix it,” and they have an idea for me. So I’m a big believer obviously in being a recipient of consulting, as well as helping others through consulting.
[WHITNEY]: Yeah. So Alison and I were talking, this was actually really a little bit more her brain child and she brought me in on it. So we like working together, but just that we wanted to create a membership community for people who were starting group practices. We understand that when you’re so low, you need that help in this transition, obviously we’ve talked about that, but a lot of times it’s kind of expensive and maybe you’re not ready to invest all that money, but you’re wanting the support. You’re wanting the documents, the step-by-step process. So we are creating a membership community for people that are starting a group practice and it is called Group Practice Launch, because we’re going to help you launch your group practice.
So we are doing a six-month membership community through Facebook with the teachable platform. We’re going to help you walk through all these steps. And the cost of that group is 250 a month. And that’s it and we’re going to get you all the way to the point where you’ve got at least one or two clinicians hired in that six month process. And maybe Alison, could you talk a little bit about the financial benefit because I know some people are probably going to like, “250 a month?” But maybe you could kind of share what’s the financial benefit once you hire somebody?
[ALISON]: Sure. I think it depends obviously if you’re an insurance-based practice or a self-pay practice, you know, if you hire someone and in yourself pay, you’re probably making a profit much sooner than insurance-based practice. But yeah, I think I always tell people the story about how when I first started out, I had one office, I had like one very part-time person and then I had somebody who had come on and was working up to full-time. And by the second month between the three of us, we were generating like $10,000 out of that one office and I was not working full-time either. And I was just like, “Oh my gosh, I’d never thought I’d see this amount of money in my life in one month.”
So I think it can be pretty significant. And again, I think if you have it set up correctly from the beginning the money that you put into it is definitely going to come back to you, hopefully three, four-fold. There’s something I shared, I think it was at Killin’It Camp. I originally started in solo practice. This is back in almost six years ago now in the beginning of 2015. And I remember I took $3,300 of my own money to start the solo practice. And that’s the only money I’ve ever put into the business of my own. And this past year we made almost a million dollars.
[WHITNEY]: Yeah, you did.
[ALISON]: So, if you could take $3,300 in five years later, turn it into a million dollars, would you do it? I think the answer would be yes.
[WHITNEY]: Most definitely. It is amazing how fast you can start turning a profit. So even if you hire two people and making a very small amount on each one, that’s better than what you were doing six months prior. And so I’ve even found, with people I’ve consulted with even the ones that do individual consulting, a lot of times, by the end, they’ve already made, if they really hustled, they’ve already made what they’ve put into the consulting. Would you say it’s the case for you?
[ALISON]: Yeah. And actually we designed the group to be six months because you can really go through all those phases in six months time and that’s a relatively short amount of time. So like what you said at the end of that six months, you could already start seeing more money coming in.
[WHITNEY]: Yeah. So Allison, do you want to talk a little bit about what the group, kind of the format of Group Practice Launch?
[ALISON]: Yeah. So all the things that we talked about, all the topics are things that we’re going to cover. And so there’s going to be different topics every single month that we’re going to go through and the group is a closed group. So if you want to join, you have to join at the beginning, go through the six months, and after the six months you’ve graduated. And then you can go into our other membership community, Group Practice Boss, which is for more established group practice owners. So if it’s something you want to do like I said, you’ll have to either join when we start or you have to wait another like six months to join. So we’re going to be guiding you through those topics. There’s all kinds of training videos in the teachable, there’s a paperwork package, all of my documents that I used when I had contractors, all the documents I use now that I have W2 employees. Those are all in there and for you to use and take and modify as you wish. I wrote a workbook.
So yeah, lots of different things in there. We’re going to be doing live webinars every week. So if you really need to ask questions or figure out how to apply the material that you’re watching and reading to your own situation with email, we’ll be available to answer your questions. Obviously the group as well. So what I love about the other membership community, Group Practice Boss is, you know, the community and seeing people help each other and share ideas. And I always hear great things from the members about how every single time they come to a meeting or talk to another member, they get a really good idea. So I think that’s a really cool part of it too.
[WHITNEY]: Yeah. It’s really amazing how I think even about masterminds, I’ve made some of my closest friends, you know, in the professional community and I think the same will go for these membership communities. You can make your closest relationships professionally that will really take you for years and be able to grow together. So to give you all some more details about Group Practice Launch, like Alison said, you’ll have the Facebook membership community and the teachable platform with so many courses and resources. Like we pretty much over the years have put everything together you would need to start a successful group practice.
So all that’ll be there for you. And then in addition to that, I want you to go to our landing page, it’s practiceofthepractice.com\grouppracticelaunch so that you can learn more about what we’re offering. There is an opt-in there for the email list. That way you can get first access to the group and get more information. We have a ton of emails that’ll come your way with lots of details about this group. And so you won’t miss out on all those. So as well, we are doing an early bird special. So this group practice launch will open March 2nd and we will have it open for one week so that you will join the first cohort and then after that it will be closed and you won’t be able to join for six more months. So don’t delay in starting a group practice. If you’re thinking about doing it now is the time. You don’t want to miss out on the finances that you could make in that six months and how far you can go.
So the early bird special is only going to be on March 2nd and third. And if you opt into that email list, you will get access to that. So you will save $200 total by doing the early bird. So you’re getting about $200 a month in payment instead of the 250. So you can end up saving a good amount of money by doing that. So opt into that email list and then you’ll get all the information. If you have other questions, concerns, Alison, and are happy to answer those. You can just shoot us an email. It’s our first name at practiceofthepractice.com. And Alison has one L. Or you can go to the Practice of the Practice website and there is a Live chat there, and you can get more information or you can email us at [email protected]. Is there anything I missed there, Alison? Did I get it all out there?
[ALISON]: Yeah, no, I think that was great. I was just going to mention too, like, I’ve run a, start a group practice mastermind the past few years, and that has been a great experience for me to really understand what people are looking for in terms of, you know, what are the common questions people have and what are the common things people struggle with? And so that’s really where all the material has come from for the teachable that we’ve put together. So probably all the common questions that you’re wondering about we’ve already put together material for, and this new membership community is actually going to replace the mastermind groups. So if you’ve ever thought about joining a mastermind group in the past this is now going to be the option because we think it’s kind of the best of all the worlds.
And then Whitney and I get to work together as well. So then you get both of our perspectives of different practices. Whitney has a faith-based practice and I don’t, she does self pay, I do insurance. So we definitely have lots of different experiences. And it’s always fun to work together and to help the group with whatever goals they have.
[WHITNEY]: Awesome. Well, I’m excited. I’m excited about the community and what I just love is when people get done working with us, seeing them have a group practice that they are happy with and they have more time to do other things that they love and have more money. It’s a real honor to be able to see people coming out on the other side. So we hope that you will join this community and so that we can help you do just that. So head on over to Group Practice Launch within Practice of the Practice. All right. Thanks for being here, Alison.
[ALISON]: Yeah. Thanks Whitney.
[Outro]: Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.