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Hi, welcome back to the Faith in Practice podcast. So glad that each of you are here. We’re in the middle of a four-part series on the, ‘How to’s’ of the faith-based practice. So, the first one we talked about was how to know if it’s time to start a practice. The second we talked about how to implement systems into your practice, how to actually start a private practice. Then last time we spoke about how to market a faith-based practice and here in our last one, we’re going to talk about going from solo to a group practice. So how to actually go from solo to group. And I’m going to kind of address this idea of if it’s something that you’re ready to do or not, because not all of us necessarily want to do a group practice.
It’s good to think about what are the positives and negatives of actually starting a group practice and then from there, if you decide that that’s what you want to do, we can talk more about how to actually do that. So, we’re going to start out this idea of solo practice. So, you have gone through this series and maybe you’ve already started your practice and you’re thinking, “Should I start adding clinicians? Is that the right thing to do?” And I think a lot of people don’t take time to think about this question. We see our colleagues grow in group practices, or we think, “Oh, it’ll give me more money. And that’s what I want.” Or, “I don’t have anywhere to refer all these calls I’m getting, ” so we start a group practice and we don’t always think about the reasons for doing it or some of the difficulties that are going to come up. So, I want to get you thinking about that.
Now, some of the positives that I’ve seen in growing a group practice. One of the best feelings for me was once I added my first clinician and I got that first phone call where my schedule was full and I needed someone to refer to. And when I was able to say, “Well, no, I can’t see you, but I have a clinician here that can, that I trust, and I handpicked.” Oh, such a great feeling to be able to refer somebody to someone that I felt really comfortable with and that I was able to make a profit off of them working with that client. You know, I was able to grow a business out of it and I’m able to offer that clinician a space to be able to see clients and get referrals. It was wonderful. And so that’s a huge plus.
Growing a group practice also allows you to get support and help from one another. So, solo can be really lonely, right? I mean, we feel lonely at times and even though we have other counselors to talk to, we’re so busy in our own practices, it can be hard to make connections. And so, when you have a group practice, you’ve got people right there in the building with you or you’re having staff meetings together. So, it’s really nice to be able to gain that support from one another. You’re also able to offer more services in your area because maybe you only do substance abuse and you can add somebody that does marriage counseling or someone who does play therapy and then more needs are getting met in your area. So that’s another plus to having a group. It also allows you to have more connections in your community, so more resources, more referrals, because people know that other person or their name’s popping up on Google more and so then they’re referring to you and vice versa. So, you’re able to make more connections within the community. And then you have a financial benefit of having a group practice as well.
So then now let’s talk about some of the things I want you to consider the negatives of starting a group practice. So, when you have a group practice, you’re going to be working a lot more than people usually think they’re going to be working. Having a group involves a lot of mental energy, and taking care of your employees or your contractors, your clinicians, being able to invest in the work they’re doing and encouraging them. And it just is going to increase the revenue, it’s going to increase the workload within the practice, and so you’re going to be kind of managing that. So, it does end up being some work on your end. And as business owners grow a practice, they’re going to have to scale down the number of clients they’re seeing to have more time for the practice.
So if you’re not into that idea of seeing less clients to actually invest more in your practice, you probably shouldn’t go with being a group practice owner, because if you continue to see the same number of clients or you want to see 20, 30 clients a week, you’re really going to burn yourself out quick. So, think about if you want to focus more on seeing clients, or if you want to see clients and have a business. You’re going to have increased responsibility within your practice and obviously the difference between a contractor and employee will go into, but if you do choose to have employees, your responsibility is way higher, as far as what they’re doing ethically, clinically, but responsibility in general for the work that’s going on in your practice increases when you have more people working there.
You’re also going to have to give direction and time to your employees, so you’re going to have to make, or to your contractors, you’re going to have to make time and energy to be able to help them in maybe case consultations, or they’re going to have questions about paperwork. What should I do in this situation because we know crazy situations pop up in private practice all the time? You’re also going to have more administrative work and less clinical work, which I was already talking about and then just your overall workload increases. So, if you’re thinking, “Okay, well I know all these things and I still want to do a group practice. I’m super excited about helping other people, helping other clinicians that are wanting to see clients and happy about offering them a space for that, offering them clients, being able to make this into a business. I love being an entrepreneur.” Those are all great reasons to be doing a group practice.
So, the question that comes up the most often I have found is the difference between a contractor and an employee. And this is how I narrow it down here. A contractor is someone that signs a contract to provide materials and offer a service to another company. So great example for this is you hire a contractor to do work at your house. So, maybe you’re getting a door put on to your closet, which I have had done and so you’re getting this person to come and put the door on. You don’t decide when they’re coming, you don’t decide their rates, you don’t decide what they wear. You don’t even decide how they put the door on, really. You just pay them to put the door on. So, you are paying them for a specific service and they’re going to do the service when and how they want to.
So, the same thing with, when someone is a contractor at your practice, you cannot tell them the type of therapy they have to do with their clients. You can’t tell them specifics on how to do their notes or tell them what time they have to see their clients. But you can give them some direction with their notes, but ultimately, it’s their choice, how they want to do that and what kind of therapy they want to do. You can’t make them wear a uniform. Not that we normally do that, but that would be a difference between a contractor and an employee. So, with that contractor, you have less hands-on experience with them. You don’t necessarily provide them as much direction as you would an employee. You have a lot less say in the types of work they’re doing with their clients.
And then an employee is somebody that’s hired and paid a wage to work at a company that instructs and oversees their surfaces. So, you’re going to be instructing and overseeing what your clinicians are doing a lot more closely when you’ve got an employee as opposed to a contractor. And that is the big difference here. And so, I even found with my practice, I started with contractors because it seemed like the easy way to go. But as I started to think more about the culture, I wanted to create my practice, I realized that I wanted a lot more unity. I wanted a lot more ability to invest in my employees and kind of educate them and teach them on clinical work and growing a practice. And so, I found that having employees, which is a better fit for my model is I want you to think about the type of culture you want to create at your practice. How involved you want to be as a business owner.
So, some people have found that contractors work a lot better because they don’t want to be completely involved in everything that their clinicians are doing and, so then you do a contract for that. And an employee, you send them a letter and then they start employment at your practice. So those are the big differences. I mean, as far as the financial piece to all this, when you have a contractors, there’s usually some kind of rate that you’ve pre-determined and the contractor will provide their own supplies just like when the guy comes to do your door, he might bring his own screwdriver or his own drill. So, a counselor is going to provide maybe their own toys for play therapy or their own supplies as a contractor and an employee, you’re going to be providing those things for them.
Another difference is a contractor has their own business in essence. So, they can work at other practices as contractors in town and an employee works at your business. So, they don’t necessarily have their own business that they’re working out of. They’re working for you. Contractors also have to pay their taxes on the business that they bring in. And so, they have to pay self-employment tax, which runs about 15% of everything that they bring into the practice. They also have to keep up with their expenses so that they can write those off on their taxes. An employee that works with you, you provide them with everything. They don’t have to write things off on their taxes and then you also pay a portion of their taxes because you’re an employer. And that usually runs about 7.5%. If your practice does grow, you would have to think about workman’s comp and if you want to provide any other benefits, but as a W2 employee, you can provide benefits for your employees when, as a contractor, you can’t really do benefits for employees in the same way that you can for an employee.
So, these are all things that I want you to be considering when you’re thinking about the difference between a contractor and an employee. Also, another thing you do have to do is the liability. And so, a contractor provides their own liability insurance, just like a clinician doesn’t sell a practice, but when you own a practice and have employees, you actually have to provide their liability insurance as well. So, you’re going to want to think about that, because that can get a little pricey when you grow a group and have a lot of clinicians. So, fortunately, you’ve already set up your awesome solo practice and now you’re thinking, “Okay, how do I make this jump from a solo to a group? What are the things that I need to do differently in my practice to be able to start hiring clinicians to work?
The first thing I suggest that you do is to find an attorney. You want to find someone that specializes in employment law in your state because they’re going to be answering all your questions about contractors and employees and the specific laws for your state. I would set up a meeting with that person before hiring to kind of talk about your business, what it looks like, get advice from them, and after you start hiring, you’re going to want attorneys that you can reach out to. So, when you have questions that come up, or an employee quits, or different issues that you might have, you have somebody’s phone number that you can call that knows you. And I can’t tell you how many times I pick up the phone and call my attorney about different things going on within the practice. So, it’s really important that you go ahead and set up that meeting and get to have a relationship with an employment attorney.
You’re going to want to set up how you’re going to do your finances. So, depending on an employee or a contractor, how are you going to pay that clinician? Are you going to write them a check? Are you going to use software for payment? There’s plenty of software out there like Gusto and QuickBooks that you could use to be able to pay and I believe both of those can work for contractors or employees. So, you’re going to want to find a system that works. So, when the clinicians are taking payment from clients, where is that going to go? How are you going to track the payments that they’re getting? And a lot of that can go through an EHR, an electronic health record, but if you don’t have one, then think about how are you actually going to keep up with a system for how they’re going to receive the money and how are you going to receive cash if clients pay cash. And so, creating that system for managing the money, receiving it from the clients and then how are you actually going to pay your clinicians.
And so also with the group, you’re going to want to start thinking about space. Do you have space in your current office to hire? I hear people all the time say, “Oh, well, if I’m going to start a group practice, I have to change locations.” Absolutely not. You do not have to do that. In fact, I highly suggest that you stay where you are until you get through this transition. You are not maximizing office space nearly enough. So, if you’ve got an office seven days a week and you’re in it four days a week, there are three more days that you can maximize that space. I actually have been in the same office in this town, Savannah, since I started and it was three offices and we had three people. Each had our own office and then one of them left. And so, then I took over the second office and started adding clinicians.
I have been at a point where there have been six clinicians in two offices. I know you’re thinking that’s crazy and actually it was a little crazy, but we were able to make it work. So different people were working weekends and different people were working day hours and different people were working evenings. Everyone was part-time and it worked. So, I think you could easily get two or three people into one office depending on what hours people want to work. So even if you only have a single office that you’re working out of, start thinking about how you can add clinicians to be able to use that space. And then as your practice grows, that’s when I’d start considering moving to other space because you want to get the practice up and going before you’re making too many transitions at once. That can become a little bit craziness.
So then after that, you’re going to start thinking a lot more about the hiring process. If you’re going to do a contractor or an employee, getting that paperwork set up and then starting to create a system for hiring. I really encourage you to think through that. So anyway, I want you to start thinking about how you’re going to set that up and if you’re going to ask what kind of questions you’re going to ask, are you going to have an assistant call in advance? How are you going to go about that? How are you also going to find out their skills, their background and their belief system? So as contractors, from what I understand, and this is something you will have to ask your attorney about as well and your state, but at least here, a contractor, we can ask a little bit more from them as far as what they’re doing and meeting with clients in the sense of, we have certain values as our practice that, you know, if we don’t agree with what they’re doing, they don’t necessarily have to stay.
But with an employee you cannot discriminate against based on race and based on religion and based on lots of other things. So, I can’t necessarily talk about that in the interview because that would be discrimination based on someone’s religion. But the things I do ask in an interview is, “How do you feel about working with Christians? So, if a Christian were to come into the practice and want a faith-based perspective, is that something you feel comfortable offering?” That way we find out if this is a place they’re comfortable with or not, but I know some other practices that have contractors who’ll just flat out say, “We are a Christian practice. We only hire Christians. Is that what you want to do?”
So it’s important that you talk to an attorney about the appropriate ways to do that as you’re hiring and as you’re interviewing, but as a faith-based practice, thinking about how do you, how are you going to convey those values and think about that in advance. So, develop a hiring process, thinking about the things that you’re looking for with an employee and do those. Well, I can tell you a little bit more about our process and I will say over time, I’ve changed it to meet the needs. At the beginning, I was doing it all myself and boy, it was exhausting. It was exhausting. And so now I have my assistant a lot more involved and in every area you’re going to find different platforms that work better for getting good candidates, but I have gotten a lot of my candidates through indeed.com and I’ve also gotten some through word of mouth, through Facebook, just posting ads on Facebook, or just posting something that says, “Hey, I’m hiring. Someone tell someone.”
I also put it on the website. I add a page on there about hiring and then honestly, randomly I get emails from people, “Hey, are you hiring?” And I say, “You know, not now, but we’re going to keep your application and get in touch with them later.” So, when I’m in the hiring process, I am narrowing it down to what are we hiring for? Some might have a specific specialty or specific licensure that I’m looking to hire for. So, write all that out. I kind of make a description for what we’re looking for and try to be as specific as possible in that description. And then I have my assistant start weeding through applications as they’re coming in. And so, she’s looking at those first things, finding out is this somebody that meets these qualifications that we’re looking for. And she tries to narrow those down to as little as possible, usually somewhere around five or six and then she sets up phone interviews with each of those people and does about six questions with each one to talk about the things that we’re looking for and finding out a little about their background.
And another thing that we’re adding to our process that I wish I had done sooner was, you know, “Tell me about your relationships with your family, with your friends.” Because I think that shows something about how the relationships are going to be with you within your business; is how do they do in general in their relationships? So, asking about that as well. And then, you know, we ask about how they feel about working with faith-based organizations, with churches, what kind of specialties they offer, how long have they been practicing. Tell me about your experience, all those difficult questions, strengths, and weaknesses. So, once we’ve done that initial 10-minute phone screening, my assistant takes notes and she sends me all those documents, I’ll read through them and we narrow them down to two or three people, depending on how many we’re hiring.
I highly suggest hiring two people at a time when you hire. And I say that because there is a lot of turnover in our field, and I have even found that the times I’ve hired two, one sticks and one doesn’t. And when I say sticks, I’m talking about over a year since that’s been really helpful, because then I’m not stuck without, but then I’m hiring different specialties and different things are getting out there as far as their name and what we’re doing. And so, hiring for two is also less work because I’m training two at the same time. And that’s really, really helpful in my own time. So obviously don’t hire two just because. Hire because you like both people and you would have hired them both anyway, but I have loved hiring two at a time.
So after we have narrowed it down and we’ve done the interviews, the people that we like, we get references from, and then we call, we ask for five references, phone number and email because a lot times you call and you can’t get a call back. So sometimes email is a better way to communicate. And then we have questions that we ask each of those referral sources and references. And so, we ask those questions and then from there we make our decision. I think it’s really, really good to do the references. And a question we always ask that I found helpful is, “When you were working with this person, what was helpful and what wasn’t?” And like, what is something that I need to know as a business owner to help me be better as an owner and as an employee with this other person, working with this other person? So, you get some really great tips in that way.
So that is how to go from solo to a group practice in a nutshell. There’s obviously lots more details so we can dive into other episodes. But those are some of the systems you want to be thinking about and setting up for your group practice and, it’s so exciting to have you all with me today and looking forward to our future episodes together. Thanks for joining me.
Thank you for listening to the Faith in Practice podcast. If you love this podcast, please rate and review on iTunes or your favorite podcast player. If you liked this episode and want to know more, check out the practice, the practice website. Also, there, you can learn more about me options for working together, such as individual and group consulting, or just shoot me an email [email protected]. Would love to hear from you.

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