Joe Sanok 00:00:00 You’re someone with a vision for your practice, for your side hustle, and for your personal journey. But when it comes to establishing your path and how to get to where you want to be with your practice, things get a little messy. You’re also someone who’d prefer to go in person instead of to groups and listening to everyone else’s story. To me, it sounds like you could benefit from one on one consulting with our experienced practice of the practice consultants from 595 a month and up, you can work with a consultant that will give you more direction and practical, tried and tested tips matched to you and your goals. For more information, visit practice of the practice. Com forward slash apply. Again, that’s practice of the practice. Com forward slash apply. This is the practice of the practice podcast with Joe Sarna session number 117. Welcome to the practice of the Practice Podcast. I’m Joe Stanek, your host, and I am so excited that you are hanging out with me today. Today we are giving you behind the scenes in regards to our membership communities. Joe Sanok 00:01:16 And so a lot of our consultants are doing teachings every single week. every Tuesday, Wednesday and Thursday we have live teachings going on in our membership. So we wanted to give you a little behind the scenes. So we’re going to be hearing from Nicole Ball talking about what to do when referrals are slow, our basics with Andrew, client retention with Ashley, scaling with Nicole Ball, choosing the right project management systems and all sorts of other things over the coming weeks. I can’t wait to dig into this with you. If you want help from one of our consultants, please head on over to practice of the practice.com/apply. I’ll chat with you for 30 minutes to determine if one of our membership communities or consulting might be right for you. Now let’s get started with this episode. Andrew Burdette 00:02:01 Well, cool. I think most everybody I recognize faces. I don’t know if I’ve seen everybody in this particular community board yet, but, I’ve actually seen most everybody at some point. So everybody’s got a group to some degree. Correct. Andrew Burdette 00:02:17 I think because we’re all in the group practice boss realm of things. see, everybody’s shaking their heads. Everybody’s high. At least one person in some capacity, whether it’s ten, 99 or W2. how’s that going for people? But anybody really new to it that’s still freaking out about the fact that you’re an employer? Because having just switched over to like W2 as of two weeks ago and tomorrow’s our first W2 payroll day. just filling out a survey and was like, you know, how many employees do you have? I’m like, oh, that’s a different question. Instead of just contractors and things like that. So, I’m up to two employees, not counting me and my contractor person, but, yeah, it’s different trying to wrap my head around that framing of things, for sure. So, I also let’s see. I’m working with Jen. We’re trying to decide a place in circle. I can kind of just put like a repository of resource kind of things like job descriptions, files, other stuff like that that I can just kind of put it in one place in that way, as these things happen, it doesn’t necessarily get tagged under the event. Andrew Burdette 00:03:17 It can just kind of go somewhere. And as people come in in the different circle communities, just say, hey, you can kind of find this over in this stack of resources. There’s a FAQ section in NLP that I think has a number of different resources and other things, and there’s something else under the lessons. So we’re just trying to figure out where it makes the most sense to have me have like a shared folder of different resource kind of stuff. Speaker 3 00:03:38 Yeah, that would be very helpful because, different, presenters put things in different places and it’s so hard to find. so if, if it can find one place where everything goes, that will be a lot easier. I appreciate that. Andrew Burdette 00:03:57 Yeah. I think one of the things we talked about, maybe for each of us consultants kind of setting up like a consultant, one on one space for each of us and then be able to selectively share things out of that to like the broader communities and things like that, because, you’re right. Like, I mean, Barbara, you’ve been around this community world enough to know that a lot of the same questions can asked as new cohorts come in, because it’s not easily found on circle about what’s already been talked about and those kind of things. Andrew Burdette 00:04:24 So things like job description, examples and other stuff I have already to go. It’s just trying to figure out a place to put it so I don’t have to reupload it like every other week, it seems like, because people ask for it. So so yeah, I guess with that I’ll said I can kind of jump in the slides. I don’t, for those that have seen me, like I don’t usually do a lot of slides, but this seemed like a pretty relevant kind of thing to do slide wise. So let me jump into that and see if I can figure out how to make screen sharing work on this platform. yeah. So let me click over here. So our people seeing slides, I kind of lost. okay. There we go. It looks like it’s sharing so everyone’s can see slides. Right. Cool. so this is basically going to be a little four parter. Today is going to be a little bit dry. we’re going to go through I guess I could slide show. Andrew Burdette 00:05:19 I’m wondering how they go Google thing works too. so basically today we’re just going to go over kind of the recent changes, that went into effect early in March about how the classification and what the litmus test is in terms of, contractor versus W-2 happens to be and how that impacts people in our field in particular. just a very, very super high level view of what human resources is. It really is exactly what it sounds like. depending on what scale company you’re at, it may involve some other things like corporate strategy and other things like that. and then at the end, I’ll kind of share a link to, a checklist of basic compliance things you’re going to need for doing W-2 stuff. And it’s going to there may be some additional things that are required in your particular state. I’m based in North Carolina, and North Carolina is right to work state. It’s in the South. It’s not known for having particularly strict labor laws and things like that. However, you’ve got states like California and Colorado, they have much more stringent labor classification rules and additional requirements to be in compliance in those states. Andrew Burdette 00:06:18 So the checklist isn’t necessarily going to cover those, but we can talk about where to go about finding those kind of things. Also for reference, if people have hands and other things because I’m on a different tab, I guess leave notes and things like that and we can kind of, I don’t know how to necessarily get both things up at once on my one laptop screen. So I will respond to chat questions and things like that. Kind of at the end after I kind of blast through this quickly. Or if you just want to jump in and cut me off and let me know any things that you have going on, that’d be helpful to, Virtual presenting is not the same as being in a room with a PowerPoint, and you can see people’s attention and things like that. So in short, basically what changed March 11th of this year when the new rules went into effect is, basically six factors to kind of test and determine, whether someone is a contractor or an employee, among things. And I’ll kind of talk through as it relates to like our particular field. Andrew Burdette 00:07:15 So the degree to which an employer controls how the work is done. So in our field that would be, are you directing your notes process and things like that, or are you kind of advising them about here’s kind of the recipe of of how I want things done. Do they have roles on client engagement and is it a fixed model or is it something that you know, your your worker? I’ll just use clinician or worker kind of interchangeably. do they have a lot of control over how they interact with clients? How much control are you directing, how they do their job? That’s not the same as like clinical supervision to where you’re going to direct, and advise them on the clinical side of things, this is just on an employment level about how much autonomy do they have to decide how the work gets done? opportunity for profit and loss. I’ll cover a little bit more in depth later on in an upcoming slide. But basically, you know, employees, the part of the thing with employees is that employees are not intended to assume any risk for employment. Andrew Burdette 00:08:11 So costs that might be involved with advertising, cost of EHR, risk factors when it comes to like insurance payments and stuff coming in or not. These types of things are if there’s an opportunity for loss and profit, that’s going to be much more of a contractor thing because they’re functioning as an independent business. the amount of skill and initiative required for the work, all of us, that are hiring clinicians, they’re going to have some degree of licensure and things like that that is independent of the business. So I don’t know that that’s a huge necessarily like determining factor for people in our field or not, the degree of permanence of the working relationship. this one definitely comes up. In general, contracts specify a length of time that you were going to be contracted. A lot of times contractor clauses have things like auto renewals and other things like that. And so for example, under my 1099 model, and even just kind of the arrangement as a contractor with practice or the practice, it stipulates a year with an automatic renewal unless something changes and there’s discussions around how much length of time you would need to give notice under exiting without cause and cause being something that you did, something that would violate the contract enough to be able to terminate things immediately. Andrew Burdette 00:09:25 other things are like in North Carolina and being a work or right to work state or Atwill employment kind of factor, under a W2 model in our state, everything’s kind of listed as at will, meaning there is no guarantee of employment that’s in the job description letter and things like that. so we can talk a little bit more about that discussion wise to people have questions. for basically like how permanent is the working relationship and the assumption it’s for an indefinite period of time. And if it’s for an indefinite period of time without some really fixed and finite thing, that’s going to be much more considered to be a W-2 relationship versus contractor. the workers investment in equipment or materials required for the tasks. I would say pretty confidently, the bulk of people in this project, like in this group, have a practice that has infrastructure with like probably a company phone system, some kind of secured email system, whether it’s Hashmi or Google or some other thing like that, EHR paperwork, other things along those lines, those the availability of that and the expectation of the person using them is going to kind of influence about whether or not the person’s going to be required to invest on their end, to have the materials or equipment needed to do the task. Andrew Burdette 00:10:40 And then the extent to which the service rendered is an integral part of the employer’s business. This last one is really going to be the big determining factor when it comes down to like probably I think is probably has the most weight about why in our field, it would be really hard to say that a second counselor in your practice is somehow not an integral part of what your practice is meant to do, business wise. So, for example, if you were to use electrician or plumbing, if you have an electrician business and you hire electricians, you can’t really classify them as contractors or it gets a little harder around that issue, because the purpose of the electrician business is to provide electrician services. And if you’re hiring additional electricians because you have too much work for one person to do, their performance and job task is the primary reason that you’re in business. However, if you were to say hire an AB in person, you could be AB in person supports the other primary role of the business, but it’s not necessarily the primary reason that you are in business. Andrew Burdette 00:11:38 So I hope that makes sense. And we can kind of talk through that and unpack it a little bit more to, off the Department of Labor. Kind of cite here in terms of facts and things like that. I just kind of highlighted a couple of things. one of the things that really is the big determining factor is this first point here in terms of like economic dependence, for the employer for work. So if you have somebody that is planning to work in your practice full time and this is their primary job, and I realize, like, if they’re technically an independent contractor, they could choose to work elsewhere and we can touch on the new FTC decision about non-compete coming up. toward the end of the discussion. But in short, if someone is primarily working for you, even if it’s their election, then it creates a level of like economic dependence on you as the employer, whether they’re a contractor or not. And that’s a one of the weighted determining factors for W-2 versus 1099, returns to the totality of the circuit circumstances, economic reality tests. Andrew Burdette 00:12:43 So in short, what this really says is like nothing in those kind of six key factors is really weighted higher than the other. there’s an additional one, which includes the investment made by the worker and the employer in terms of looking at the weight of investment on either party staying, that kind of goes into impact. further details of just about kind of, you know, control factors, other things in that kind of six, six checklist thing. And it also, eliminates the, an exercise, right, to control the worker. So what that means, if I’m understanding the legally is kind of side of stuff correctly, is basically even though the employee reserves the right to maybe offer more direction and then doesn’t exercise it. So for example, like you could say to a clinician that’s joining your practice, I have the EHR and these other things and it’s available if you want to use them. You’re kind of suggesting that and probably economically incentivizing them to use your platform even though you’re not dictating it in a way that like an employer would kind of do it. Andrew Burdette 00:13:46 don’t worry, I’m going to make these slides available so people can kind of read through this in detail. But basically some key points about the new law is, and how that litmus test is going to be really levied about whether a person is categorized correctly as an employee or as a W-2 or, sorry, as a contractor. how much flexibility does the clinician have the ability to negotiate rates with, a potential client. So if you’re in a practice and say across the board, our minimum rate for a session is going to be 125 or ranges is going to be 125 to 175 depending. And that’s kind of your sliding scale range. And you’re going to hold all of your clinicians to that standard. That’s going to be something to where you are basically setting the rate for them, and it’s not really up to them to decide if it’s flexible or not. are you assigning possible clients and things like that to your individual clinicians, or do they really have the option to kind of decide? I don’t really want to do that. Andrew Burdette 00:14:42 I don’t want to work Saturdays or whatever day of the week it is. I don’t want to work Mondays. Tuesdays. I only want to work, you know, 4 to 6 p.m. on Wednesdays. And that’s all I’m going to do for you. How much flexibility and control does that person have over their schedule, and whether or not they accept the job offer to work or not, versus under an employee thing, you could say, hey, I want you to work 9 to 5 Monday through Thursday. I want you to see six people a day, and I’m going to kind of direct people your way that I think are going to be a good fit and you don’t really have unless it proves to be a bad fit. You don’t really have much say in terms of being able to reject a referral kind of thing with in-house, the marketing, advertising and networking kind of thing. That’s a really big factor. if you are paying for people’s Psychology Today profiles, for example, or providing the business cards, even having them on your website can possibly get you in trouble about, is that really marketing that you are doing on behalf of this individual, or is it something that is really just for the business and they happen to be listed there? So the advertising marketing test I know has definitely gotten some past practices in trouble, including things like paying for psychology to day profiles and things like that. Andrew Burdette 00:15:52 also, I have like hiccups or something. So apologies if I’m like a little hiccup or something. So that’s what’s going on there. whether or not the person makes decisions about their materials. So my business is still going to be bring your own device type business. So if somebody’s got a laptop that they want to bring in, everything’s electronically based. There’s an agreement about technology use that nothing is going to get stored on any personal property. That’s all fine. I’m also willing to provide my employees an iPad if they really want it. And that way there’s a company device that, is a little more secure and a little easier to administrate. from the standpoint of, like, a business owner with regard to data. So how much of that are you allowing the employee to kind of bring in, or how much are you really providing on their behalf? All my employees enjoy, like a fully furnished office that’s ready to go. It has everything in it. the whether or not the worker makes a decision to rent space. Andrew Burdette 00:16:50 This is one of those things under a 1099 model. And even with my quarter time contractor, they are still going to basically rent free time in the office for when they use it. And previously, up until this paycheck, everybody else basically kind of rented space from the business for the time that they were in the office doing hybrid work. here’s the link here. You can go through and really dig in details. This is a huge, big breakdown of all the things I kind of just superficially covered in detail. And like I said, I’ll link the slides and everything like that to this presentation so people can kind of get back to it. But this will be a really nitty gritty, detailed, explanation for the Department of Labor of of how they are applying the new laws and what the new law really and standards really means. so kind of jumping over. Well, let me let me pause for a second before I jump into the next thing and then see where people are at for questions. I know that was a lot of details. Andrew Burdette 00:17:44 Does anybody have any questions about Department of Labor laws and stuff? It’s really dry. Half of HR is going to be really dry. Just so you know so. Speaker 3 00:17:52 Well I mean it’s it’s dry, but it is you know, I don’t know I’m still a little confused. So I know that, we can put things on the contract and on my 1099, contract. I said, that, the rent, the, ehr that, it is offer and it is already part of their compensation. Can I set that on the contract? Andrew Burdette 00:18:25 You can in my contract definitely has stipulations about your percentage covers EHR phone systems, whatever you happen to do in terms of business infrastructure and things like that, and that was included in their percentage. It also stipulated, and this was at the advice of my attorney, to have something in there that basically kind of said, if you’re going to use office space, you basically kind of are you’re going to be charged basically for the time you’re in the office space under the contractor model. Speaker 3 00:18:55 But it is included on it is included in their payment. How do we do that? Andrew Burdette 00:19:01 No. So the way I, the way I had my contractor stuff structured is EHR phone system and that kind of stuff. So anybody’s ability to work remotely that’s included. Okay. I decided after getting advised about the advertising kind of ability to come back and kind of bite you, and get you in trouble in terms of classification, I change from just paying for contractors like their psychology to day profile to basically saying, if you’re below, I think it was 12 or 15 or something like below 15, you get a $30 a month stipend toward directories if you want to use it that way, but it was just a stipend. And then above 15 they got 60 bucks. And then in terms of office space, basically they people would block out either the Am or the PM kind of block. So half a day and then basically would pay. I think it was one of my offices was $15 per half day I think is how it was structured. Speaker 3 00:19:55 Okay. So just very symbolic. Andrew Burdette 00:19:58 Yeah. Like which kind of notice is like to really do the 1099 thing, right? You have to do all of this stuff that is maybe a little more than symbolic, but certainly has to show to somebody from an outside viewpoint that someone could be in the B in the office space, let’s say all of their appointments cancel that day. That establishes that they have paid for the office space planned to be there, and they’re going to experience a loss because they’re not getting paid for the time to sit there in an empty office as a contractor. And they’re also not, they’re losing money because they pay to rent space that they’re not actually using. Does that make sense? Speaker 3 00:20:32 Yeah. Yeah. And then, just this piggyback on that question is like, if I put it that it is included, on there, right. The E.R. if I tell them that, for example, that they have to use the CTP codes, you know, such and such, and they refuse to, to do that. Speaker 3 00:20:54 are they in their right to refuse, how they’re going to be or is that like a practice, policy or, you know. Andrew Burdette 00:21:06 That’s an excellent question. And I’m smiling because this kind of ties into, like, a conversation we were having among group practice owners locally a couple weeks ago about mixing type provider types within a business, and that’s a whole other conversation. And state laws are very, very, very different depending on what state you’re in. But in short, your question would So to to super quickly recap the discussion in in North Carolina the like the basically I can’t remember the entity that sets business standards, but basically secretary of state. So for most medical practices, most professions you have to have a PLC, which is vastly limited in scope to just counseling, social work, marriage and family doctor, CPA, stuff like that. and that is the business law side of things. And you also have the North Carolina medical board side of things, which is separate and under the medical board specifications, the limit of who can be in your practice as a practice owner is someone in the practice that is a considered an owner, even if it’s if it’s figurative with like a 1% symbolic ownership stake on the PLC articles of incorporation, someone that is able to see someone has to be in your PLC that can supervise any licenses there, per the medical board. Andrew Burdette 00:22:30 And the question you’re asking to me is much more in that what is what is correct in terms of medical billing, because if you submit the wrong CPT code to the insurance and it doesn’t match the service, that’s fraud. So there’s a legal implication there that’s dictated by like the medical side of things. It has nothing to do with EHR. So they would have to and I had things in my contract that basically say something to the effect of you were your responsible for accurately like documenting and coding and billing what you were doing. with the understanding that if it’s found fraudulent or you’re in the wrong, that you have to recover, like I’m going to recover the money from you. Speaker 3 00:23:10 Okay? Okay. Thank you. That’s helpful. Thank you. Andrew Burdette 00:23:13 So it’s kind of it’s required because it’s legally binding that they have to do that for the medical board and CPT codes and other things and practice and insurance etc.. Not so much because it’s necessarily a contract law thing with employment. Speaker 3 00:23:27 Okay, so they can do whatever they want. Speaker 3 00:23:29 And, I just have to kind of, you have to. Andrew Burdette 00:23:33 Trust they’re doing it the right way. Speaker 3 00:23:35 Okay. Andrew Burdette 00:23:36 Yes. And and part of how you can do that, if you’re going to stick with the contractor model is, again, the back and forth kind of thing. So one of the ways in which W2 is actually more efficient is like add people running a time clock now and I can I don’t necessarily have to have them submit a timesheet for all of their billing with regard to like insurance services, whereas whereas under a contractor model they really need to invoice you for everything. Okay. Speaker 3 00:24:00 Okay. Thank you. Andrew Burdette 00:24:01 Yeah. So any other quick questions about that before I jump into like the next section, which is going to kind of superficially talk about what HR is and how we’re all doing this, whether or not we realize it. Joe Sanok 00:24:21 Do you often find yourself overwhelmed by the influx of client calls you receive. Receptionists are expensive, but you can’t afford to let your patients go to voicemail. You care for your clients, so you try to phone them back. Joe Sanok 00:24:36 But more often than not, it’s too late. They’ve gone to another practice. When you partner with well-received, you capture every opportunity. Your calls are answered by professional medical receptionists 24/7, and they can support you with more than just message checking. They offer new patient intake, after hours service, bilingual services, medical appointment scheduling, medical live chat, and so much more. All this at a fraction of the cost of an in-house receptionist. Your patients are well received priority as a practice and the practice listener. You can get an exclusive 50% off your first two months of service. Head on over to well received. Com forward slash Joe to start growing your practice today. Andrew Burdette 00:25:23 so in short, human resources is exactly like what it sounds like it has to do with managing like the human capital that you have in your country or company. key compliance things. employment standards and labor laws are probably the primary thing that they do. If you’ve ever watched the show of The Office, Toby Flenderson, who also happens to be a social worker, there’s an episode where he counsels Michael. Andrew Burdette 00:25:45 That’s a whole other interesting little thing in there. But in short, like, he’s part of why he’s always like the Debbie Downer, I guess, in that that kind of setting is because he’s always having to check Michael about, you can’t do this. It’s offensive and keeping people in compliance and standards and just helping to create a less toxic work environment and hopefully a good work environment. I say less toxic in context with the office. Hopefully you’re not aiming for less toxic and your culture and your company, you’re hopefully aiming for a good one. but it’s basically like, are you in compliance at a federal level or you’re in compliance at a state level? And, you know, knowing what that is, I will say one of the one of the best recommendations I can make is to have an employment attorney specific to your state that you can work with to make sure that you really are in compliance, because HR experts are great. The thing is, they’re still going to default and refer you to someone that’s actually an employment attorney in your state to really ensure that you are in compliance. Andrew Burdette 00:26:42 So even though you could find a really good HR person, even HR people I know locally, you’re still going to recommend to consult with an employment attorney about things like making sure a contract really, you know, follows California law. Let’s say, your job offers and then how you’re training things and your employee handbook and those types of things, you’re actually in compliance with your state. there’s obviously the hiring and recruiting that’s generally an HR thing. a lot of what I say, we’re all doing this anyway, in terms of a small organization is because we are kind of it’s one of the many hats that we wear regardless. So even though this is kind of in the HR world of things, I don’t know that it’s a whole lot different than, just us being business owners and kind of being all of the things because they’re often really isn’t another person to handle these types of things. And even if we are going to outsource stuff, we’re probably not outsourcing much of our HR related things until later on. even my friends at run group practices, probably in the like 15 to 20, staff person range, they’re still the primary excuse me, the primary person when it comes to making final hiring decisions, interviewing people, deciding who’s going to, like, get interviewed in the first place. Andrew Burdette 00:27:54 they may outsource some of the onboarding tasks to like, other clinicians or somebody else to kind of support that, to bring a new clinician into the fold. there’s probably going to be somebody doing the operating things, like checking to make sure that, you know, if they have company property like an iPad or other things, that’s, you know, returned logins and stuff are disabled, those types of things, your HR is going to kind of do basic management of staff. And so that’s going to be your staff meeting kind of check in kind of things. That’s an HR related. Certainly within the HR world, administration of benefits and Payroll is probably the other big area to where we do HR stuff and don’t necessarily think of it or assume it’s HR, but that would be a very clearly, distinctly HR type role. And then the last is keeping employee records. your necessary employee records is going to vary a little bit based on what state you’re in and what individual state requirements there are. But the basic verification that the person has the ability to work as an employee in the United States, so some form of driver’s license or ID card to kind of verify their status and right to work in the state, those types of things are going to be in the employee records. Andrew Burdette 00:29:07 Have there been any performance improvement plans? any of the stuff that relates to that specific employee is going to go in that employee record file. And just for reference, they should be treated with the same, degree of care that we treat our client records in FY and things like that. So you don’t necessarily have to like, hide an employees like email from other employees, but no one else should have access to the employee record except whoever is your designated HR person or does HR tasks. And then you in larger organizations, you’re going to actually probably have a separate HR department versus, you know, what we typically do where it’s generally just us and maybe someone that’s doing administrative support, kind of thing. So in small business, again, basically all of the HR stuff we just talked about in a large company, there’s going to be a bigger emphasis on strategic goals of the company. one of the things that so for, for setting for this HR exam, one of the questions on there was, companies start corporate social responsibility programs for which of the following reasons. Andrew Burdette 00:30:14 And based on my studying, I’m assuming the correct answer is the one I put, which is to gain, economic and political power. So at fortune 500 companies, the role of HR and goals is a bit more like the intelligence in terms of trying to like, you know, stay on that fortune 500 list. so that that added dimension of HR, that scale is not anything that feels particularly great, like at our level. But it is one of those things that trying to help create a work culture that people want to work in, that aligns with your business values and your practice goals and who you want to work with. That would be a way that it kind of features in. Its just maybe less, less manipulative, I guess. Might be a way to put it, or less just, hey, we’re going to try and get you to to drink the company Kool-Aid and be all in for our group practice and do things that way. As you might really be awesomely jazzed about working for DoorDash or Starbucks or something like that. Andrew Burdette 00:31:09 so from an HR side of things, on a small scale, it’s still going to be there. We’re talking like, how do we create culture and employee buy in and workplace satisfaction kind of things. But it’s not necessarily about trying to get people to join the cult of a particular company’s mindset and things like that. the seven principles of HR. So this is kind of like the decision making framework. so like everything you really need to kind of do a needs analysis to kind of see what are my needs. So if you have a wait list with 25 people on it all the time, your needs analysis is probably going to tell you you need to hire another clinician and add to that pool of talent to be able to work with your target demographic and your, your business needs and things like that. top management commitment. This is kind of more applicable in a larger company organization structure, and same with operational support. But in short, if you are trying to make a case to say, hey, we need to actually hire additional people, and this is why we need that, or we need to like, change our onboarding process to make it more efficient or help get our employees more trained up on how to use our EHR and things like that, having, you know, you, the business owner, the group practice leader on board with that recommendation is going to is going to be necessary for you to implement those changes and make decisions about what kind of budget and changes we might want to have. Andrew Burdette 00:32:27 same thing goes with operational support. So do you have an admin team and if so, are they on board with kind of recommending and supporting these changes to make their jobs easier? Are you looking at using a different onboarding tool, something like Therapy Flow, which I’m investigating and we’ll keep everyone posted on. It’s apparently a CRM that’s HIPAA compliant and geared toward therapists, and it’s supposed to simplify the entire intake process. So that would be something that operational support category, critical thinking is do I need to change any of the order of operations for what’s here? Or do I need to prioritize, like, you know, maybe I know what my needs analysis is, or somebody comes to me and says, hey, we need to switch to EHRs. simple practices aren’t working for XYZ, and they’re trying to convince you of it. that critical thinking skills thing is, do I need to? Or is one of these other things kind of out of order? And do I need to get buy in from a particular section of things? the last three are kind of interesting. Andrew Burdette 00:33:21 And this is where like the dynamic from a large company standpoint, if you’re thinking in terms of like ExxonMobil or BP, your most valuable assets are obviously going to be your staff and your talent. which is true, but from the macro HR level, it’s kind of more from a workforce thing, and you kind of have minions and not necessarily like humans. And so I would invite you all as you’re setting up your group practices to really like, consider your employees and the people that work within your overall company like to be really, really, really highly valuable as humans first. And they have talent and skills. But to really take that angle of things that I think is much more in line with therapist’s values versus corporate America values, communication, obviously. How are you communicating the needs of your business and structuring what your vision is for how things to work to people that not only within your company, but to people that work with your company, maybe you have outside assistance like your CPA and bookkeeper, or maybe have a lawyer that you consult with from time to time, or you have other people in the community that, may benefit your business. Andrew Burdette 00:34:26 Like maybe you work with a nonprofit that provides vouchers for care and other things like that. This all falls into that broad communication umbrella. And some of those external, stakeholders would be people that have, you know, let’s say you have a like there’s a nonprofit where we live that helps, the reintegration process for people that are getting released from prison and helping get them reintegrated back into the community. And one of the people that’s on my crew is friends with the person that set that up. And, they’re obviously they’re a stakeholder because practices like mine that are willing to kind of partner with them and help support the people they’re looking to support the most. there’s a vested interest back and forth for that, to be able to get that to work. So that would be an example of an external communication role of things that in a larger company would be officially kind of more of an HR type relationship. And then the last is like employee participation. So do you have people that, support the company vision, support the alignment with how they’re implementing that vision? do you have a corporate culture that really supports the people in it and takes care of them, and isn’t necessarily like trying to get them to where, you know, your company branding from head to toe on all the shirts and swag and stuff. Andrew Burdette 00:35:38 But, you know, or are you creating an environment that people are happy to work in and want to stay in? Because otherwise you’re going back to the needs analysis thing of, I have high turnover and I can’t keep staff and I need to kind of keep them in the fold. So that’s a quick rundown of the seven principles of HR. Other things that kind of. Yes. Speaker 4 00:35:57 Can I interrupt a second. What was that program that you mentioned that you’re looking at therapy something or other. Andrew Burdette 00:36:02 Oh therapy flow. Speaker 4 00:36:05 Yes. W yes. Andrew Burdette 00:36:06 Therapy flow. Speaker 4 00:36:07 Okay. Thank you. Andrew Burdette 00:36:09 Yeah. so yeah, like, I’ll talk more about that probably on circle like later this month. I’m meeting with my app and today we’re going to set it up and kind of see how that’s going. But the idea is it’s not to get too sidetracked. But therapy flow is supposed to be HIPAA compliant, do HIPAA compliant website forms, which you can embed, automate your entire workflow process, track where your referrals are coming from fairly automatically. Andrew Burdette 00:36:35 and do a few other things like automatic reminders. And I think also do a HIPAA compliant newsletter type thing if your email system’s up for it. So I’m excited to check it out because it should automate or kind of like software technologically solve, a lot of things that you might otherwise like, need somebody to kind of manually go in and do. so I’ll do a follow up on that, kind of want to know a little bit more, but yeah. So anyway, that’s, that’s in a nutshell kind of the seven principles of HR. other things that are kind of within the HR domain that maybe isn’t necessarily thought of, as we go about building our group practices. So fitness to work. So what fitness to work is, is let’s say you have somebody that, you discover has a substance use issue and they get a DWI. And this is how you find out. And obviously that’s a they need to notify the board that they got a DWI. But you know, that would be a place where having an HR consultant, for example, to kind of assess is this person fit for work, and if not, when would they be considered fit to work to return? So that’s kind of the fitness to work thing. Andrew Burdette 00:37:37 mediation between employer, employee and employees. and then management. So what I have done in place of having an HR consultant for the moment, while I kind of look for one that I can kind of have, kind of like that employment attorney on retainer type thing is I have two of my friends, both of which one’s a clinical supervisor. The other one did the clinical supervision training with me, and they’re both agreeable that, they’re good friends of mine. I’m like. And they’re good friends because I trust them to call, call me out on any bullshit that I might introduce the people to, so they’ll call me on it. And they’re agreeable that if somebody had an issue with me and as a manager, they can reach out to Sarah or Angela and just say, hey, I’ve got an issue with Andrew about XYZ, and we’ll start that conversation. And it’s built in that, you know, they have a fee that they’ll charge and that’ll be there. But the goal is to not not be a jerk and not end up in that position. Andrew Burdette 00:38:29 But I’ve at least provided third party people that are, I trust to be very, very transparent and very objective. If there’s a need, if there’s a concern about me from an employee, performance management things, are they getting notes done on time? performance improvement plan? documentation quality document. I pick it on documentation because that’s the one that tends to come up the most about where people might need to improve and things like that. And then the last thing would be like compliance and termination. So again, North Carolina, it’s a natural state. It’s really bizarre coming from the contract world because there’s kind of stipulations about what constitutes, cause for termination versus just, like, mutually agreed upon termination, like, hey, I’m going to leave to go do this other job. Here’s my 30 day notice. That’s what I had in my contract. versus with cause, which is like, you punch the client in the face and you can no longer work here. so different states again, are going to have different rules about how you can and, and also depending on the status of your offer letter, whether or not it’s an Atwill thing, whether or not there’s some other kind of more guarantees about some length of relationship or nature of relationship and things like that. Andrew Burdette 00:39:41 And there’s I’m not super familiar, honestly, with the different categories of that, because in North Carolina, Atwill is really the only thing that’s, applicable at a state level. and just because it’s an Atwill thing doesn’t necessarily mean that you are going to be an awful jerk of a boss and just decide you didn’t like somebody’s t shirt one day and fire him or their haircut. so that’s that’s the management style. That’s not whether or not it’s legal. And again, different states are going to have different rules on that. But just having somebody to kind of walk through, am I terminating this relationship with an employee in a in a fair way that’s in compliance and stuff like that. So again, it’s compliance on the front end and compliance on the back end. this spreadsheet, I’m going to link the or put the link in here, but this is basically the checklist I was given, for what to do, in terms of bringing new people on. So as you can kind of see, like there’s a certain things are dependent on others. Andrew Burdette 00:40:38 some of these things you probably already have in place, some of these are going to be mandated by the state. And then also kind of a breakdown of who is the person that’s going to be necessarily overseeing. You’re completing this task versus somebody else. So job description, job posting, your job description and your job posting, you’re going to have a lot of similar things, but your job posting is what the outside world sees in terms of I’m looking to hire a clinician with the following credentials. And the job description is what they’re going to do when they come to work for you. The offer letter is going to be a breakdown of, what’s included, what’s not included. You can absolutely put in something that says to the effect of like benefits or subject to change, you’ll be notified in writing, etc.. So if you’re starting off really small and plan to add in benefits later on, that gives you some leeway to kind of add things in later. Or if something doesn’t work out and you need to terminate a particular benefits offering, that gives you the leeway there. Andrew Burdette 00:41:34 The handbook is really interesting in terms of not all states require it. North Carolina requires an employee handbook, above 15 people. It would be best to have an employee handbook and how the employee handbook differs versus an operations. handbook is your standard operating procedures or how the kitchen works, and the employee handbook is what the relationship is to work in the kitchen. So the employee handbook is really strictly like things like benefits how your time off policy works. what constitutes fitness to work? Is there a dress code, rules around using the office per se, those kind of things. That’s going to be an employee handbook side of things. How to use your EHR and what the workflow is for when a client contacts the business to ask about scheduling and what happens there, that’s going to be more in that standard operating procedure. po so in terms of business, and benefits, Po is a professional employment organization, if I remember my acronyms correctly. And essentially what that is, is it’s a way for small businesses to pull with other small businesses, into a larger pool of benefits so that you can basically let’s take a thousand group practices that have five people in them, a piece that creates a pool of 5000 people if they’re all participating in a Po. Andrew Burdette 00:42:55 And that number of 5000 people means that you can then get a benefits plan based on that group of 5000 people. And so there are I’m not currently working with on I don’t plan on necessarily doing one other things that may factor into like PEO it’s really going to be primarily for things like health insurance and doing a group health insurance plan directly through your business, and the minimum number of people required to have a health insurance plan offering is going to vary from state to state. North Carolina it’s a minimum of 50 employees before you’re required as an employer to offer that. you can do other things kind of as benefits and offer stipends and other things that are not necessarily the same as like providing a company sponsored health insurance plan. But basically, pay would be an option for you to pull your employees, along with a lot of other small business employees, into a large pool and have a more competitive collective bargaining relationship for establishing benefits kind of thing. those can those are usually available through whoever your payroll company is and those kind of things. Andrew Burdette 00:44:00 So you can look at gusto or ADP or I think even QuickBooks has something along the lines of a Po, available through them. things that I would hope that if as a good practice, you already have set up as a business entity of some kind, along with a tax ID number that goes with it, things you will have to do regardless of state, is have unemployment insurance, which is, I think, 1% of wages, at least in North Carolina, until you start having people that are making claims toward that. But basically, you you register with your Department of Employment Services, I think is the is is what it is in North Carolina. I don’t know what it’s called in other states, but you register with the state Department of Insurance or, sorry, state Department of Employment to set up unemployment insurance for your employees. Workers comp policy would be another thing. I know it says yes, technically with three employees. I think that’s a North Carolina thing. I would recommend having a worker’s comp employee regardless. Andrew Burdette 00:45:00 That’s liability against anything happening on site in the role of work performed by an employee. So it’s like general liability for your employees in case something happens to the employee, whereas your general liability policy covers stuff that happens to someone that comes in with the client. So, think of it like slip and fall insurance just for the employees and covers them so that you’ve been not on the hook. you have insurance in case there’s an injury at work. payroll process, benefits accounts, if you’re doing a benefits kind of thing. I-9 employment verification, that is a specific thing that you have to do within 72 hours and verify that the person you’re hiring is eligible to work as an employee in the United States, and you have to physically verify their ID. So acceptable forms of ID would be like a passport or driver’s license. There’s some additional ones in there. But, the employee completes a form and then you complete the form to say that yes, I verify this person’s identity and things like that. If you’ve ever worked a job or remember the last time you went to go work at a company, when they ask for like a copy of the driver’s license and social Security card? That’s what that is. Andrew Burdette 00:46:10 It’s for the I-9 verification. I think there is a way to verify things, but, I don’t know if it’s necessarily limited to 25 or more. it’s mainly one of those things that you get to kind of verify that, yes, this is a legit driver’s license and those kind of things, and then it’s all covered. this is one of those I don’t know that you can actually outsource it either. I’m not really clear on whether or not the I-9 and E-Verify thing is, an outsource ible thing to like an HR person or not. W-4 is the same thing as your W9 just in terms of W-2. So your W-4 sets up tax withholding instructions for your W-2 employee to get the W-2 at the end of the year end. C-4 is the same thing that happens in North Carolina, usually the W-4, and then whatever state equivalent is for that W2 establishment. A lot of that should be included in your payroll system. And I know when I was setting up QuickBooks a couple of weeks ago for my new employees, or the switchover from 1099 to employee, one of the options in there was to have them fill out and complete the tax withholding thing. Andrew Burdette 00:47:17 And one of them was like, I don’t know what to put here. I’m like, I don’t know what to put here either, because I haven’t been an employee in a decade. And I couldn’t tell you even if I did, because that’s tax advice and that’s out of my scope as an employer. a couple last things. Post required notices. This has to do with if you’ve ever been in a company and seeing the like Fair Labor Standards Act and Equal opportunity employer the big giant labor poster. my understanding is you can actually have that available online, electronically. It doesn’t necessarily have to be, conspicuously posted in your office. I mean, if you’re like my practice, we’re in a single room, with kind of some shared space. But the shared space is among other businesses. It’s not all of my business. And so there isn’t really a good, conspicuous place to stick a, you know, a four foot by six foot bulletin board sized employment law poster in my room. so there are some ways around that, report new hire to state agencies. Andrew Burdette 00:48:17 I think this also kind of goes down to, what goes in with the unemployment insurance thing and naming who those are. this is going to vary a little bit state to state. I think actually QuickBooks took care of that. I’d have to I need to go back and look at all the recipe of things. but I do know that at least they’ve been checked off. I’m just not exactly sure if it was done through my payroll system, or if it was done independently through the state registration for unemployment insurance. set up benefits policies and the payroll process system. right now I’m doing very, very limited benefits. I do plan on adding in vision, short term, long term disability in life, $25,000, something like that. this month, coming up in May. and do that through an independent insurance broker. And so once that’s done, that’ll be a either a 50% of all premiums or 100%, depending on the number of like average appointments per week and doing kind of a tiered reimbursement there and payroll preferences. Andrew Burdette 00:49:17 this is all covered in your payroll processing system. So gusto or QuickBooks or whatever you happen to be using and then handbook acknowledgement that’s simply a page in your handbook that you make a copy of that the person receives to say, hey, I acknowledge that I’ve received the employee handbook and had the opportunity to route it before signing this kind of thing for compliance there. So and again, that’s going to be required if you’re required to have an employee handbook. Not necessarily otherwise. So with that I’m going to stop rambling and lecturing and talking. And then we have probably about nine ten minutes for people to ask questions. I know that’s a lot. I’m sure my brain hurts from going through all that because it’s really dry. Speaker 3 00:49:58 It’s just a side note, I try to watch you on old videos on my speed 1.5. It did not work out. Andrew Burdette 00:50:06 No, I talk really fast and even doing this, trying to cram everything, I’m like, I’m talking probably a little faster than I usually do. there’s an author name, I guess, John Hari or whatever he wrote, Chasing the Scream and, a couple other really good books. Andrew Burdette 00:50:23 but similar kind of thing. I usually listen to audiobooks like 1.2 to 1.5, and I had to put his almost a little slower because he talks at a pace like I do, plus a plus an accent. So sorry for talking fast. Anybody have any big sticky questions about how to do this or feel stuck on compliance side of things for switching over to W2? If you are planning to do so, or planning to start with W2. Speaker 3 00:50:52 I guess I have a question. I have. Speaker 5 00:50:56 for 1099, which I’m very comfortable with, and I hired a W2, and I felt like I had to scramble to get everything all set up for her. but the other 1099 are completely adamant that they do not want to be W2 employees. and I’m just kind of stuck like I. Andrew Burdette 00:51:20 So one of the things that I didn’t, spend a lot of time on, but is in the kind of highlights of things there, you can’t opt to be W2 or you can’t opt to be 1099 because you want to. Speaker 5 00:51:35 I have heard that. Andrew Burdette 00:51:37 So it’s not whether or not they want to stay. 1099 if, if by going through the checklist of do they meet requirements for classification as W2, Then basically the offer is you can switch to W-2 because that’s what the Department of Labor or the IRS. And then our state laws are going to require us to do, or you’re going to have to find another place to work. Speaker 5 00:51:58 It’s like I worked so hard to build this practice. It’s just so it just feels like such a bad place to be, I guess to. And I’m in Michigan, which is very 1099 friendly. So most of the new like I’m hiring right now that none of these therapists even get it. You know, when I’m like, oh, we really can’t hire 1099 anymore. They’re like, what? Like lots of places are hiring. 1099 just I’m wondering, like, I don’t know how. I don’t know, I guess it just comes down to risk management then. Right? Like how much risk I’m willing to take to keep my employee for my contractors? Andrew Burdette 00:52:36 Yeah. Andrew Burdette 00:52:36 I mean, so on your end, the the risk, the risk concern is if the IRS realizes you’ve misclassified employees and there’s a form that someone can fill out to say IRS. Can you evaluate a mine employee or not? the risk to you is if you have misclassified people as employees and however long that goes back, you’re going to be on the hook basically to pay all their back taxes for how many? However, since when they started basically, as well as whatever fines and other things like that. by the way, North Carolina was all 1099 up until about mid last year. And then that was when everybody kind of switched over. And part of what came with that was, people seeking work were now expecting employee based versus 1099 base two. There’s very little like people looking for contract work anymore, unless it’s like I’m a full time school teacher and just looking to do five things on the side. Speaker 3 00:53:30 Would the 1099 contractor have to fill it out an application and send to the IRS? saying, you know, I’ve been treated like a, like an employee or, or the IRS just All right. Speaker 3 00:53:45 automatically, when we file taxes. Andrew Burdette 00:53:49 It could be either one. The. I’m looking at the form right now. the somewhere down on this thing is a is a form number, and I’ll drop it in the chat. But basically, if someone’s concerned about being misclassified, they can kind of start here. And then there’s a form on there. also for reference, like I worked a job in California that I was I very much knew I was misclassified and then basically walked into my, like, boss. this was one of those, like, we didn’t just burn the bridge. I, like, nuked it because I didn’t want to go back. It was an awful arrangement, but was basically kind of like, look, here’s what we agreed on, per my contract. And then here’s the stack of everything for the California Labor Board to show all the ways in which you treated me like an employee, but then didn’t pay for my breaks and other things. So what do you want? And this was at like 3:00 in the afternoon. Andrew Burdette 00:54:39 I was like, the Labor board’s in the way home, so just let me know if I’m making a stop after I leave, and they ended up paying something like $6,000 in back taxes for six months. So, you know, it’s some of some of the risk is like if you’re really upset, if you’re not that I’m hoping nobody in this community is mistreating their people just as people. But, you know, if you did have a disgruntled employee that thought they were being, you know, just, you know, mistreated as a ten, 99, then that really opens you up for like misclassification, because somebody is disgruntled and or just is really like really kind of realizing, like, hey, this is the only place they work. There’s a lot of like direction about how I do my job and what’s expected, beyond just what’s specified in the contract. and I think we’ll definitely, in the upcoming ones, talk about how to have a conversation with 1099. So switching over to W-2, and for what it’s worth, all the practice owners here that I’m friends with, I don’t know of a single one that’s still doing 1099 for anybody that’s, you know, above basically five people a week. Andrew Burdette 00:55:44 so even even very limited part time or all W-2 at this point. everybody had conversations starting about this time last year to switch everybody over to W2. I don’t know that I think probably out of 12 to 15 practice owners I know, and that probably was about 150 clinicians over the whole process. and I’m including my practice in this too. I mean, just on this. they maybe had 2 or 3 people that realize it’s not what they wanted. So it’s it’s nuanced and you kind of have to make a conversation, honestly. Like Justine, that’s in my practice and we’re good friends. She’s like me and is like fiercely entrepreneurial and independent. But when I kind of brought things up in January, she’s like, okay. And I’m like, wait, what? She’s like, no, I’m good. I’m like you said, for a year you would. You’re going to push back on this. And she’s like, no, I got you. It’s fine. I’m like, okay, like so, you know, having a conversation and just kind of explaining the differences. Andrew Burdette 00:56:41 And we can kind of we’re going to stack up like what ends up being in the 1099 world and things they have to do for them to really be truly contractors and things like that versus W-2. And, you know, there’s things like they’re my two employees are now my malpractice insurance. And that’s the thing they don’t have to pay for. you qualify for things like unemployment insurance, it’s often generally easier to get financing for all kinds of things, including mortgages and things like that. If you’re a W-2 versus self-employed, there’s a lot of reasons why employees are actually better, even as an employee. And also some of this conversations around it doesn’t mean I’m changing my management style to then be more of a boss and micromanage you. That’s a management style thing. And we’re talking like basically tax and labor classification. So these are conversations that are doable. And and we’ll be talking through how to have those answered. Speaker 4 00:57:34 Can I just ask that when you have that conversation what are the rubs in Pennsylvania that has resulted in people coming to work for my practice as 1099 is, there are a number of really lucrative therapy mills that really have, from my point of view, taken advantage of master’s and doctoral level people by really demanding, you know, 35 sessions a week, as soon as you bump below that, you lose money. Speaker 4 00:58:08 And for 35 sessions a week, they were paying them $35 an hour when the actual going fee from, say, an insurance company for a master’s level was well over 100 bucks. So all of my people are really like, we don’t want to go back to that because they were really, I think, abused. I know that’s a really big word to use, but so, you know, I don’t think it’s a big worry kind of, you know, I mean, certainly I’m not going to pay them 35 bucks an hour, and I don’t want anybody doing 35 sessions a week, but that’s like they had a little bit of PTSD. Yeah, yeah. So if you could just put a nod to that as we move into session 2 or 3, I’d appreciate. there’s one practice in Pennsylvania that had like 500, therapists and Noncompete made it that they can never leave the practice. Andrew Burdette 00:59:03 So so we’ll talk about non-compete, too. That was another thing that just changed, like a week or so ago. Andrew Burdette 00:59:09 non-compete are basically not enforceable in the first place. And, if you have a 1099 contract that says you can’t do the same business outside of things, you can’t do that because they’re not independent. That’s the thing. So the non-compete things unenforceable on principle because you can’t have an independent contractor that’s their own business and then say you can’t do business outside of just my business. You can’t do both. It’s doesn’t work. so I think at my job offer, it’s like, you know, I’m not going to. I basically said, I’m not going to hire you if you’re working in a solo practice for yourself. At the same time, you’re working with me because you don’t need me if you’re doing that right. That’s really just it. And it’s an easy conversation to have about it doesn’t make sense because of XYZ. And same thing if you’re working in a group practice that does the same demographic I do. If you want to go work at like a substance, use IAP or some other thing I don’t do that happens to be a private practice and does that over there. Andrew Burdette 01:00:08 I’m good with that because there’s demographics we’re not going to work with. If you want to work with kids, I’m not going to take kids in my practice because there’s a lot of hassle with that. But, you know, if you wanted to, if you wanted to split and we have that agreement, you probably end up in my friend Jill’s practice anyway, working for her. And we figure out a way to make that work if it was really ideal. But so there’s logistical reasons. It’s not a like spiteful reason. And that spike kind of thing doesn’t, doesn’t play well. So you have people that left because they were being mistreated and exploited. And that happens in employees and contractors both. And that just comes down to like who you want to be as a business owner and not be a jerk. So yeah, we’ll talk through how to have those conversations too. And I realize we’re a little over. So thanks for sticking around and see you next week. So have a good week and weekend. Andrew Burdette 01:00:50 Thanks for coming by. Joe Sanok 01:00:59 Well, thank you so much for listening to the practice of the Practice podcast today. These trainings are available in our membership communities. Now we’re going to be opening up our membership communities more than just when we’re opening Level Up week. So if there’s one that you are interested in, I would love for you to head on over to practice of the practice. Com forward slash membership, where there’s more details and you can get notifications when those open up. So if you are in solo practice just getting going, if you are building and sustaining a sustainable solo practice, next level practice is for you. If you are looking to launch a group practice, group practice launches for you and group practice bosses for all those group practice bosses out there. Our sponsor for today’s episode is well received. Oftentimes, you know, people are calling through all the phone numbers, and if someone answers the phone, those are the clients that actually get in. 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