[JOE SANOK]: Starting a private practice does not have to be that hard. It can seem that way. It can seem daunting at first. There’s so much to keep track of, so many different things. Do I file an LLC or an S-corp? Do I just do a DBA? Do I start a bank account? All these things that just seem like a foreign language and we don’t learn it in grad school. We don’t learn it unless we just pick it up here and there. That’s why I started Next Level Practice. Next Level Practice is the community for starting a private practice. So, from that moment that you think, “Hey, I might want to start a private practice,” all the way till you’re at a hundred thousand dollars. That’s what is covered in Next Level Practice.
You get access to over 30 e-courses, access to experts every single month, like Dr. Julie Schwartz Gottman, who we’re having soon. We interview her and ask questions and get to know these experts in our field that maybe we’ve looked up to for years. And honestly, they’re just regular people that want to help you out too. So, if you want access to a community of people, that’s going to give you the right information at the right time, I want you to sign up for this cohort. This cohort opens on February 15th and it’s only open for four days. These spots usually fill up. So, you’re going to want to make sure that you’re on that waitlist over at practiceofthepractice.com/invite. Again, you can sign up on the waitlist over at practiceofthepractice.com/invite. I look forward to seeing you in there.
[JOE]: This is the Practice of the Practice podcast with Joe Sanok session 531. Welcome to the Practice of the Practice podcast. I am so glad that you are here today. We have an amazing series going on right now, where I’m talking to people from Next Level Practice, our membership community. And they’re asking me a question and I am just giving them free consulting for 15 to 20 minutes, really diving in and showing you just what kind of the Next Level Practice community is but even more importantly, how you can just learn from what we’re talking about. Well, today we have Anisha Shaw who has been in private practice for over 12 years. She’s been inspiring hope, healing, and happiness through individual marriage and family counseling, Anisha. Welcome to the Practice of the Practice podcast.
[ANISHA SHAH]: Thank you so much, Joe. It’s my pleasure to be here with you.
[JOE]: Yeah, well, you are one of our most active members in Next Level Practice. I feel like any meeting I host any ask the expert, it feels like you’re there. You are involved. You are on the Facebook group. Maybe tell us just a little bit about your practice and how it’s grown, how it’s developed, and then we’ll dive into your question.
[ANISHA]: Sure. Again, I’m very grateful for this opportunity, Joe, to just kind of talk to the world, just how Practice of the Practice has been such a huge help for me to grow my practice to where it is right now. So, I have been part of Practice of the Practice for a while now, for over two years, and I try my best to be engaged and involved. So, I do appreciate that recognition and I wish I can do more. But for that very reason because of being part of the Practice of the Practice group, my practice has just grown exponentially since we last spoke, Joe. It’s really at a full time right now. I average over 30 clients a week and it’s been a mix of private pay as well as insurance.
And I offer individual marriage and family counseling here in the McKinney area in the North Dallas metroplex. And it’s really been a pleasure working with and helping clients from all different walks of life. And I really enjoy what I do, offering people the help that they need, especially during the pandemic. I mean, the calls, the emails that I get, it’s just sometimes overwhelming, but I do my best to get to each of them and give them the help that they need. So, really Practice of the Practice has really helped me with the marketing side being able to run my practice in an efficient way. So, really thank you and your team.
[JOE]: Oh, it’s so great to see you from where you were to now, 30 clients a week, and I know that your heart of just helping people to know that there’s that many people in your community that are going to help because of us supporting you, but even more, the hard work that you’ve put in.
[ANISHA]: Absolutely.
[JOE]: Well, so, what’s your question for kind of how to get to that next level. So, you’re at 30 clients a week, you’re doing well, what’s the question that for you feels like that next level?
[ANISHA]: This is some, I mean, originally my goal was to get to a group practice level, but right now kind of where I’m at in my practice, I’m just so like content at the moment, just because I worked so hard to be here. So, I really want to enjoy this and bask in this and really soak in this because I’m just so grateful and humbled to be in the place where the demand of my services are in a place where people want to come seek me for their needs. So, as you know, my husband and I, we were, you know, we talk often about what’s the next thing for us as a family. And we look as a possibility to be relocating internationally, probably in Europe, more Lisbon, Portugal, Spain area for his work, and as a way for us to explore Europe.
So, we are looking at how, you know, first of all, is there a possibility for a US licensed based counselor to continue to practice seeing clients internationally? And I mean, the sound of it is very exciting for me, but at the moment I’m just so lost on how could that even become a possibility a year or two from now when we look at the possible move, relocation. So, that’s what I wanted to kind of talk to you and see what ideas or suggestions you would have on kind of how to navigate and help take my practice at an international level from the local McKinney community.
[JOE]: Yeah. Well, what an awesome thing to be thinking about, I mean having been to Spain once and been to Europe multiple times, the idea and appeal of living internationally just sounds awesome. So, that’s so fun that you’re dreaming that way. And as you probably know, you know, we’re living out of a camper right now during pandemic, just enjoying national parks and being on the road. So, there’s a lot of similarities in regards to preparation for that kind of endeavor. Now, when you ask your question, are you thinking, how do I maintain my current client load in my current state? Or are you looking at expanding into other countries as well? Like tell me a little bit more about your ideal client, because also we’d have to think about time change. Are you okay getting up really early or doing clients really late, if it’s back in the States? So, take me through some of that.
[ANISHA]: Yeah, at the moment, I mean, right now, of course I’m licensed in the state of Texas only, and I’m still trying to find information on what that means with my current licensure, even can I practice with my current clientele? I’m sure if I were to tell them they would be devastated if I were to move like today and tell them, “Hey I’m leaving. So, of course I’ll them stranded, but it would be great to be able to work. The U S time zone, I guess, I know I have to think about my sleep schedule and work hours and stuff. But just, I don’t know what limitations we would have, like the US license, first of all, can I even see clients, my US clients, if I move. I understand if a client moves out of state then you can’t see them.
So, if, as a therapist, I move out from Texas, what that looks like. So, I’m open to the idea, but if it, I don’t know that license comes in the way, then I’m okay to start seeing people just international. So, that is one, I’m okay to see my clients here from Dallas or US, which I would think pretty much just within Texas, because that’s kind of what my license limits me. So, that would be great if I can. And two, I’m open to like seeing client, you know, people across different countries, because I am born and raised in India and would love to help our people from the South Asian countries, people in Europe, anywhere. But I have just kind of no idea of what each countries, I don’t know, licensure requirements are and what legal rules or regulations are there. And of course I’m ethical in my practice. So, kind of wondering how to play those out accordingly.
[JOE]: Yeah, well, I mean, the first thing I would start with is, for one I’m not an attorney or an ethics or licensed expert. And we don’t even try to, because every single state has, you know, three to five licenses plus pre-licenses, just for us to keep up with all that. We just can’t. And so, I always recommend, especially around licensure that you do have an attorney in the state that you’re licensed. And so, if you don’t I would say definitely find one that understands mental health law. So, they may not even be in your town. There may be, maybe you have someone from a different town to get that kind of expertise. But I’d say it’s worth it. So, I would start with that.
I would also start with that, you know, most of our ethical boards, they look at not just the actual light of the law, but also the intent. Like what’s the intent? It’s that you want to keep seeing your clients in the state that you’re licensed. So, my understanding from listening to Online Counseling podcast and Clay Cockrell, who has you know, started onlinecounseling.com and done the Online Counseling podcast for years, he’s a friend of mine and also someone that’s done a ton of webinars on this. My understanding from him interviewing hundreds of online counseling experts is that international law is such that you can provide services across the globe. That’s the current understanding I have in regards to what Clay has transmitted.
So, he’s actually used India as a huge opportunity because of how few counselors there are there. And also the access to the tech there in regards to online counseling is immense. And so, I actually think it’s really good that you’re thinking this way. So, I would start with that. There’s tremendous opportunity. There’s actually, from what I understand, very few barriers other than especially the state laws. So, you’re not going to move to Spain and start seeing people virtually in New York. You still need to follow those laws, but you still could see people in Texas because that’s where the client lives. So, Clay actually, every year spends quite a bit of time outside of the pandemic in Mexico, especially in the winter. And so, he maintains all of his clients, even before the pandemic online from Mexico doing that counseling.
So, I mean, to me, the bigger question is two years from now, do you see yourself doing 30 sessions a week? Is that even where you’re headed? Because yes, we can talk through, how do you do this internationally? How do you do SEO good for other countries, or how do you connect with local places? You know, one of the biggest tips that I’ve heard over and over is to connect with US because US embassies are almost always looking for therapists and they’ll each have their own individual, like Friday resources thing, or here’s the ex-pat newsletter. There’s a lot of ex-pat communities and US embassies where, you know, if you’re stationed in Germany or Spain or Ireland, and you get in a fight with your spouse and you don’t have anyone that knows that world knows online counseling, and also has kind of been approved by either the local embassy or the local ex-pat community, you know, that’s going to be really helpful. But I want to go back to, do you see yourself doing that much counseling in two years?
[ANISHA]: No. No. I’m looking at just part time hours, because of the lifestyle that we want to have there. So, it’s just something because I’m passionate about, and it would just, you know, I can’t see foregoing myself away from counseling at all. So, it would probably be at a part-time, you know, about a few hours, four to five clients or something like that five days a week, three days kind of condense and see. So, that’s kind of what my husband and I, we were looking at that. It would be just kind of big for me to have something to do, and this would feel in line
[JOE]: And from an income perspective, would you want to make the same amount or more than you’re making now? Or is it sort of like, “I enjoy this work. I don’t need to focus as much on the income.” Would you want to make the same amount, but work half the time?
[ANISHA]: Yes. Well, it doesn’t have to be the same amount, but you know, just, I don’t know whether how insurance works. And so, I would think it would be like cash fee, like a private fee option, but I don’t know, but income wise, yeah. I mean, it’s part time, so work less. But if I’m able to still kind of bring in the amount that I do now or close to, that would be great, but there’s no barriers there because it’s just something that I enjoy doing. So, I’m not bound by having a certain amount of income because we’ll be in a better place financially by then, and also be working remotely. So, we would just supplement each other’s income, but it’s not like it’s only dependent on my income at that time.
[JOE]: Okay. So, a couple of things then that come to mind. So, in my opinion, moving towards attracting that ideal client right now. And so, if we think about it, if you’re thinking Spain you know, there are six or seven hours ahead of the United States, probably I think eight ahead of Texas. And so, then you think about, well, what time would I want to do it? Well, you’d probably want early morning US so that it’s not too late for you or later evening, which is depending on if you’re more of a wanting to work from say, you know, four to 10:00 PM a couple of times a week, or would you rather work from say, I don’t know, 5:00 AM to 10:00 AM. It’s really, I mean, so, being able to start to attract those clients that want non-traditional hours, maybe also clients that would want weekend times, the more that you can have a really long runway where you can start to have that momentum of those kinds of clients. As well, I would say you want to be able to maximize your income and if you’re entirely insurance-based, that’s really hard to do. And so, I would start to, are you taking insurance right now or are you private pay?
[ANISHA]: Yeah, I do both. I have a —-
[JOE]: I mean, I would look at the insurance companies you’re on and say, you know, if you’re on three and one of them pays low and they’re hard to work with, and you don’t get that many clients from them, it might be worth moving away from some of the more difficult to deal with insurances so that you can maximize the private pay. And then also, I mean, to look at well, what are the kind of ancillary services that you’re skilled to do? I mean, you help marriages, you help family, you help all these areas. So, is there an opportunity for say a membership community for ex-pats? Is there an opportunity for a membership community for people that work online or a membership community for people that want to help their kids in a certain way? And then it may be that you have a podcast or you go onto other people’s podcasts and you start to build services that are beyond that one-on-one work.
Because the problem that we get into is you start a practice, you’re like, “This is brand new. I don’t know anything about business,” and then it grows. And then you’re like, now what? And then, you know, we’ve given ourselves a high paying job where if you don’t show up, you don’t get paid. And that’s the same as a job. A business on the other hand makes you money, whether or not you show up. And so, Practice of the Practice, yes, there’s those things that I have to do. I have to do this podcast. I can’t outsource all of that. I have to do some consulting or things with Next Level Practice, but Next Level Practice, for example, as a membership community, I have to show up for just a couple events a month and then the team creates everything else.
So, the business makes money whether or not I show up for the most part. And so, we want to kind of start to think that way of, well, what are other opportunities? If you know, you’re going to live internationally in the next two years, what are some pain points? How are people talking about this and doing some exploration around what resources are out there and what gaps are there in the market? So, for example, with the RV lifestyle my wife and I have kind of been looking at different full-time RV communities. Now a lot of those communities are very evangelical. Now, if you’re not an evangelical, that makes it hard because you don’t maybe speak that same language and things like that. And so, looking at gaps in those communities, like, you know, we’re more kind of, nature-based, enjoy ecology, we care more about that than maybe the spiritual side as we’re on the road. So, that could be an opportunity for us to start a community like that. So, looking for those gaps in the communities that could then build some passive income beyond just your counseling, I think that would be worth looking at as well.
[ANISHA]: Very true. So, would this be like you’re suggesting in the, because this is all I would be online. So, now you’re talking about like country specific or just besides [inaudible 00:17:58] online?
[JOE]: I mean, I would allow yourself to go down some rabbit holes to see what’s out there and to see if there’s extra passive income. In other calls, it was actually Elizabeth episode, who was right before this one, she’s in a similar spot where she’s full and she wanted to do maybe some coaching, but, you know, we really talked through kind of her time and saying, is it worth it to have a group practice? Like if you’re this full Anisha, I would say it might be worth exploring having a small group practice because if you know you want to cut your time in half, but people are still coming to you, it may be worth it to start looking at, “You know, if I had one or two people that were doing five to 10 clients a week in Texas or at least Texas licensed that could be a significant amount of income that comes in passively.” Let’s actually just run some numbers. How many referrals a month do you think that you’re getting in general that maybe you can’t take now that you’re full?
[ANISHA]: I mean, I get about one, two, three a day. So, let’s say in a week it would be what, about at least a minimum of maybe five to 10?
[JOE]: So, in a typical month, we’re looking at 20 to 40 or so referrals?
[ANISHA]: Probably, yeah.
[JOE]: Are you turning most of those people away or are you trying to fit them? Like how, what’s happening with those people?
[ANISHA]: I try to fit them in, I would say at least 70% because my, you know, there are weeks where I range up to like 35 hours a week. So, it keeps pretty full. And then I’m also in a place in counseling where a client is done so there’s an opportunity for a client who wasn’t a weekly basis. Now they’ve moved to every other week or follow up phase like once a month type thing. So, I have gaps open up like that because everybody’s at a different place in their treatment. So, that [crosstalk] to kind of feel in kind of more struggles. And once in a while I get areas of expertise, which I don’t feel I’m good at, or it’s not my area. So, I refer them out to somebody else. But for the most part, —
[JOE]: Yeah, so, if you are down to 15 sessions a week and we are saying, “Hey, you really don’t have time for this because you’re choosing from a lifestyle perspective to do 15 or so sessions a week,” that 20 or so referrals a month, you known would either have to get referred out or go to a clinician. Is that accurate?
[ANISHA]: Yeah.
[JOE]: Okay. So, if we say 20 a month on the conservative side times 12 months, so 240 sessions a year or 240 new clients per year. Now say 60% of those converted into actually coming weekly accounting for drop-off. So, that’s 144 clients being seen in a week amongst a bunch of clinicians. So, let’s say we had 144 sessions a week times, I don’t know if your billing insurance is $70 a session or accurate amount.
[ANISHA]: Yeah.
[JOE]: Or you can take more than that?
[ANISHA]: It would be a little more between, closer because I generally just do the higher paying insurances and my session, yeah. So, we’re about at least —
[JOE]: So, what would be a range or so of how much you would get per session if you were having someone?
[ANISHA]: Yeah, so it would be ranging from 75 to like 90, kind of that.
[JOE]: Okay. So, if we did times 85 a week or I’m sorry, 85 per session for all those sessions and then we did that time say 48 weeks, so that means this is just lost opportunity. That means that if you had every single, if you had 60% of the people that call you get paired with a clinician beyond yourself, that would be $587,520 in income coming into the practice. Now you’re not going to take all that home. You have to pay these people, but say you took home 35% of that. Alright, let me just, I did times 0.35. So, that would be an extra $205,632 per year.
[ANISHA]: Hmm.
[JOE]: So, an extra $200,000 working 15 hours a week. So, that’s just where I think at least thinking about a group practice, talking about a group practice. Even if you just add one or two people, maybe you don’t want to have a 10 person online group practice. Okay. That’s fine. 200K that’s too big, but to at least dip your toes in it, learn about it, educate yourself, talk to Alison and Whitney. That might be really a way to say, you know, is this something that’s worth spending my time on because I know I can then live a better lifestyle. It’s not based just on my own time. And you then can put all that extra effort into building other passive income things such as membership communities for ex-pats or things like that.
[ANISHA]: Hmm. I see. Wow.
[JOE]: So Anisha, what are some of your big takeaways or things that you want to take action on as a result of this conversation?
[JOE]: Well you know, definitely you’ve given a lot of good pointers here on what else I should start thinking and exploring. I think one of the big takeaways, or definitely to kind of start wrapping my brain around the possibility of what would it be like though, I wouldn’t be here physically, but starting off with a group practice, looking at some membership communities. I think that’s something that is easier. That’s something that I can start exploring. And also looking at kind of US embassies around, kind of Europe and kind of looking at newsletters that I would start joining, getting more information. So, I think this is more of a lot of information gathering and exploring that I see that I could be looking at as my next takeaways.
Awesome. Well, and if you’re listening to this and you’re thinking, “Wow, I am kind of where Anisha is. I want to level up in that way,” we would love for you to reach out and talk with me, talk with Alison or Whitney, to see if starting a group practice would be worth it. We’ll run the numbers with you. We’ll say, “Here’s the ROI on your time and your money.” I mean, if Anisha starts a group practice, even if she makes 25% of that 200K that’s, $50,000 a year extra. So, even if she doesn’t go as big as we were talking, the opportunity is there with her referrals.
So head on over to practiceofthepractice.com/apply. You can fill out the application there. Whitney, Alison or myself, we’ll have a conversation with you. We’ll talk about kind of what our advice is. And we’re super low pressure. We want you to have the best fit for yourself. So, head on over to practiceofthepractice.com/apply. If you are in a similar spot as Anisha.
Anisha, thank you so much for being on the Practice of the Practice podcast today. And everybody thank you for letting me into your ears and into your brain. Have a wonderful day.
[ANISHA]: Thank you, Joe.
[JOE]: 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.