[JOE SANOK]
This is the Practice of the Practice podcast with Joe Sanok, session number 626.

Well I’m Joe Sanok, your host, and welcome to the Practice of the Practice podcast. I am so excited that you are here today. We are doing these live consulting sessions. We’ve got some great things coming up after this one. The next one is how to get interviewed on podcasts and build an email funnel, questions like should I hire an assistant? Should I start a group practice attracting my ideal client and starting a podcast? So all of these awesome live consulting sessions that I’m doing and really it’s to spotlight the consulting that we do all the time in Next Level Practice and within our communities, whether that’s one on one consulting or mastermind groups or Next Level Practice.

And on November 8th, it’s our last Next Level Practice cohort of 2021. So if you’re interested in that, make sure you head an over to practiceofthepractice.com/invite. Also, we’ve got a bunch of webinars coming up and you can see all of those over at practiceofthepractice.com/100K, that’s the number 100 K webinar. We have Q&A events and all, all sorts of things that are just open to you to come hang out totally for free. So if you’re looking to get to that a hundred K or want to grow your practice or learn kind of what’s normal in regards to quarter by quarter, it’s an awesome webinar series over at practiceofthepractice.com/100Kwebinar.

So this series of people are people that earlier in the year, I did some live consulting with and Michelle Croyle is someone who’s been super involved with Next Level Practice, has been involved in just so many different parts of Practice of the Practice. So I’m really excited to welcome Michelle back. Michelle, welcome to the Practice of the Practice podcast.
[MICHELLE CROYLE]
Hi Joe. Thanks so much.
[JOE]
I’m so excited to have you back on the show, because I feel like I say this every time you’re on it, but you are someone that just shows up for yourself. It’s almost like anytime we have an event for Next Level Practice or for anything you are there and you’re just like diving in and it’s so cool to see the results that you have had from being involved in that community.
[MICHELLE]
Yes. I joined Group Practice Launch as a result of kind of moving in that direction from Next Level Practice. So now I’m happy to be a part of both and enjoying working with Whitney and Alison as well.
[JOE]
Yes, it’s really cool to see how people start with, I’m doing my private practice and then they’re like, wait, I’m really busy. I should add a clinician. And then it’s like, oh, now I have two or three clinicians. It’s just, I mean, to see the change in just such a short period of time is so exciting to see.
[MICHELLE]
Yes. I really was hoping to move into group practice and getting a little bit discouraged because there are so many places hiring right now since the pandemic. An given what Alison told me and suggested as far as a marketing technique that I never would’ve thought of actually ended up with about five resumes where the traditional Indeed that I was doing wasn’t bringing it in. Alison gave me a tip of buying a mailing list of the licensed clinicians in Pennsylvania and sending postcards out from VistaPrint to try to get them in. So like that alone was probably worth a few years of frustration as far as the, because I never would’ve at all thought that way. Then she further said, go ahead and let VistaPrint, you just upload the mailing list and then VistaPrint will send it out for you.

So it just streamlined everything. So now I have two clinicians that I have hired they’re coming on is 1099s. I hope to move them to W2s by midyear, 2022. There’s just reasons that I won’t go into here that it makes more sense to be 1099 for the moment. But it’s just, it’s surreal because I went from trying to get to come on to join the group practice through Indeed and it was crickets. And then that one bit of consulting advice really made a difference. So that’s where I am right now, kind of just —
[JOE]
That’s a great update. How exciting.
[MICHELLE]
Yes. It’s at the beginning of this. So it’s the beginning stages. So it’s all still growing pains and I guess to ask like a question about kind of how to position myself now, I know I’m supposed to, I’ve heard you say it and I’ve heard Alison and Whitney say it about stepping back and not seeing as many clients because you’re going to need that time to work on the business rather than in the business. Also you said in the last consult call about raising my fee and then getting ideally eventually off of insurance panels but either keeping the other people on the insurance panels or raising my fee. So my question was pretty much at this point, I have these two clinicians coming on. I did raise my fee after our last consult call. I really don’t get a lot of people who don’t want to use their insurance.

I mean, everybody who calls in Pittsburgh pretty much wants to use their insurance, but every now and then I will get an out-of-pocket. I can convert them pretty decently when there are people who are open to that idea. So I’m wondering, like, as I set my out-of-pocket rate, does it change how much I set that at, based on what the other clinicians that I’m bringing on their out-of-pocket would be? Like, is there a certain proportion above that, that I should be setting mine at? Or is that just I set it at my fee and if there’s no, because think I’m, the gist from what think you said is I price myself kind of, so I see fewer clients, but I make more money and then the clients go to them. Is that the right understanding?
[JOE]
Yes. I would actually, instead of basing your fee on what your clinicians are charging for their out-of-pocket I would actually set your fee where you want it and then bring them up. So for example, if you end up being $200 an hour and all of them are $100, that looks super weird. Like why are they so far down? So you want it to be typically $25 to $35 lower is where your clinicians are. So if you raise your price to $175, you may want to have them at $145, for example, and then you raise —
[MICHELLE]
That makes a lot of sense.
[JOE]
Yes and then if you raise your rate to $200, now you’re going to raise their rates up to $175. If you go to two 50, they’re going to be at $195. So then as you kind of blaze this trail then they come up with you because if they’re getting a percentage, then they’re making more, or if you end up doing W2 where they get a flat fee, maybe you can have a bigger bonus structure or have more kind of money to put into marketing or other things. So when you do it that way, it’s sort of like you’re blazing the trail and everyone else is winning behind you because you’re able to then charge more and more based on the marketing and all the things you’re doing.
[MICHELLE]
Sounds like a plan. Sounds like a good plan. Then the other place where I’m getting stuck now that I’ve grown to this point, because this wasn’t, I mean, it was in the imagination at the time we last talked, but now that it’s actually happening and people are starting to come on board and we’re getting the clients onboarded for these different clinicians and such, I’m thinking about the future as far as what I want the practice to look like. It’s supposed to be a group practice focused on trauma. That is the heart of this. Is that we would be the go-to trauma specialist first in Pittsburgh, then Pennsylvania. That’s about as far as I’m dreaming right now. But the concept of, I want us to be specialists in trauma.

I also want to personally, whether this is the trauma group or not, but personally I would really like to kind of reinvent how we do trauma treatment, as far as like, I know there are places doing EMDR intensives instead of once a week. You go for a retreat weekend or all day long, things like that. I’m not sure exactly what the programming would look like, but it would be different than the traditional model of one-on-one that I’m doing right now, or that the clinicians are coming in to do. Is that something that I should separate from the group practice, sort of like, that’s my own thing over here, since it’s going to be a whole different kind of product, or is that something that should be incorporated like under the group and part of what we offer as a specialty? How would you
[JOE]
So the question above that question is if you’re launching a new product, when should it be under your practice and when should it be separate from your practice? So kind of the core teaching around that would be, if someone for that product came to your website, would they be really confused? So if they come to your website, so for example, when I had Mental Wellness Counseling, before I sold that, if I was doing Practice of the Practice, the podcast that was aimed at therapists, and one of those therapists came to Mental Wellness Counseling, they would be like, wait, this is a counseling website. This isn’t for practitioners. Or if my counseling clients came to Practice of the Practice, they would’ve been like, wait, no, I’m not looking for this.

But in your case, the kind of person that comes to your counseling website is also the kind of person that would be good for an intensive. So to me, it’s probably more of a menu dropdown of like, what do we do? We do individual therapy, we do group therapy, we have intensives, we have seminars workshops. So over time you’re building out things that that one type of client, that trauma client says, well, do I want to do this really fast and do an intensive, do I want to do this one on one every single week? I’m not sure. Maybe I need to talk to the front desk and kind of sort through with a decision making matrix of what’s the best fit for me. So for me, I think that your ideal client for an intensive is a little bit different than for one on one, but they’re still in the same category of being people looking for trauma treatment. Is that accurate?
[MICHELLE]
Yes. That would be the same.
[JOE]
So with Mental Wellness Counseling one of my therapists offered an intensive outpatient approach where it was four hours a day for five days a week for specifically around, if someone got, say a drunk driving. Maybe they wanted some really like quick and intense treatment around substance use or abuse. So that was as simple as sketching out what was the plan? What was the schedule on a webpage? Outlining how they applied for it, what the steps were, whether or not we built the insurance or gave a super bill for that. If so then kind of, how does that work? If someone’s paying out-of-pocket, what’s the cost? So really, I mean, for us, that was a half day discussion with me and that clinician to sketch out what’s his vision for the program, who’s the ideal client, who’s not the ideal client? When was it appropriate where it was a step down from being inpatient versus when was it not appropriate?

So I think sketching out the vision for it, putting it up onto a page and then having it from your main menu, assuming that you or one of your clinicians has the time to do this intensive, it wouldn’t take too much to kind of put that up on your website and start saying that we have a waiting list right now for these intensives. Apply here. And then have a HIPAA-compliant form and all of that, so that you can say, okay, we just got an applicant. Let’s do an interview with this person to make sure they’re a good fit for this week long program, or however you sketch it out three day program and then book them.
[MICHELLE]
Okay. So now that sounds exciting to me. That leads to another question. So if I am working more on the business than in the business, like that’s the ratio I’m kind of heading towards, this is what I would like to also do. Like, because I think I could see fewer people, I could charge more out-of-pocket it, and that’s more like where I think my energy right now would like to do, kind of more knock it out, help more people, but also limit my hours a week. So I’m just, would it be the right strategy to think, as I’m stepping down on my one to one hours that I should be sketching this out and starting to implement it, or would this be something that you would recommend waiting until after I get my clinician started, get the group really rolling.
[JOE]
I mean, I think that we want to free up your time as much as possible. So I would, especially because you’re in investing in Group Practice Launch, I would say really focus on getting some people that can take the overflow, because if you’re going to step back and you don’t have somebody that can kind of catch those people then that means you’re doing marketing to bring people into your practice but you don’t have the systems to help with that capacity.
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[JOE]
So I would definitely start with getting all of the, getting one or two clinicians hired, onboarded that you’re confident that they can take things off of your plate when needed. Then I would say the thing to be careful about is for an intensive outpatient approach to make sure you’re making more per hour than you would if you were just doing that many counseling sessions, because sometimes what happens is you look at a program and what you’re charging ends up being that you’re actually making about the same as if you’re just doing counseling. So we’d want to look at well, do we want to do more of a group approach? So then you can have maybe three or four people that you do some individual sessions and then you also have maybe a weekly group session or if it’s an intensive maybe people apply for it and there’s like one week where you’re doing some individual sessions, some groups. So you want to just sketch it out to make sure you’re actually going to make more money at it. Or it could just be that, hey, this is something that for you, you really enjoy doing and it would open the doors to more private pay clients. So maybe that’s the benefit of it too.
[MICHELLE]
Yes, that’s what I was wondering. I was wondering if that would be like the thing that sets me apart, as far as freeing up my time, bringing in more income. But I think I’m in agreement with you solidifying those clinicians first so that they, I can funnel everybody into them and then and separately market.
[JOE]
Anytime you launch a new product, you want to see your, and we’ll just call them an audience, but people that are calling you what are they asking for? Are people asking for intensives? If so, maybe your front desk person starts saying we have one-on-one, but we also have some intensives that Michelle’s going to be offering starting October 2021. Would you like to be on that interest list so that when that launches, we can reach out to you and talk more about that program? So then you have some data to say, if I’m going to make this jump, I don’t want to just have zero clients on day one. I want to be full. So even just having a wait list or an interest list, if you have 10 or 15 people that are like, I want to do an intensive, then you can talk to them or have your front desk person talk to them and say over what period of time would you want to do this intensive? Would you want to have Michelle kind of sketch it out or would you want to have some feedback in regards to what it looks like?

We’re developing this program concurrently with the clients that want to be involved. Because you may find out that people say, I really only want to address my trauma for two days in a row and then I’d like a week off and then I want to come back for two days. So then you can at least hear them and then as the professional, you’re saying, how does this fit within the research I’m looking at, within the clinical outcomes, within my training? Because people may ask for something that you’re like, I just don’t think that’s smart. That doesn’t mean you have to do it, but at least getting their feedback on kind of what they would want it to look like.
[MICHELLE]
That makes a lot of sense. I really like that. I really like that a lot. So if I could ask just one more question, and it’s about the leveling up, as far as, so I’ve held onto my office location, but I’ve decided I’m just working from my home office like indefinitely. I just love it. So the people I hired, I gave them the option as well as to what they would like to do, but preferably with some in office and both of the clinicians want in office. So they’re very happy with that. I also, at the same time I have a sub-letter, another therapist who let her office go during the pandemic and just needs it for a couple of days a week. So she’s paying me for office space. So with these people, there’s probably room for one more clinician like later in the evening and then I’ve probably maxed out this space. So I’m just wondering if it makes sense, so I know like the proportion of fees for your office space should be a certain percentage of your overall budget. Is that about 10%? Did I get that —?
[JOE]
Yes. I mean, it depends on the size of practice and kind of how many people you have in there, but yes, you want it to be usually 10 to 25%, somewhere in that range. 25% would be on the high side. I think one of the dangers of having someone subletting and also having 1099s or W2s is if the amount that someone’s paying to sublease from you is significantly lower than say the percentage cut you’re taking from one of the 1099s, some of those 1099s may say, “Wait a second, if I run the numbers for only $200 a month, I could work in Michelle’s office, but I’m giving her a thousand dollars a month because she’s taking this percentage.”
[MICHELLE]
Oh, good point.
[JOE]
So at some point you’re going to want to look at like what is that agreement with the sub-letter and are you giving up money by allowing them to be there? So say they’re using it every Tuesday and Wednesday evening. If you had another 1099 or eventually a W2 in there would you make significantly more than what that sub-letter is paying you? Most likely yes. So I would make sure that you’re starting to have those conversations where that person understands the kind of bottom of the totem pole and that your 1099s or W2s will get priority. And over time that may mean that that person has to be more flexible or it might not even be a fit to have them in the space anymore.
[MICHELLE]
Got you. That makes a lot of sense. So along with that, if I know that, so basically what happened in the office building that I’m in, where I have one small space, there is a suite of three offices plus a kitchen area that is opened up for just about double my amount. I don’t mind saying like my rent is really low. So even at double the amount I’m still well within that like 20% range. I’m just wondering if I’m planning on expanding by adding like four more clinicians over the next year or so, would that be a wise investment to secure now or given the pandemic and there’s so much office space just saying just wait because I don’t have that —
[JOE]
How many offices do you have right now? How many offices?
[MICHELLE]
Just one, just one small one.
[JOE]
And that’s being shared between like —
[MICHELLE]
Three.
[JOE]
Three people? Okay. Then the other office, how many offices was in that?
[MICHELLE]
There’s three.
[JOE]
Three, okay. I mean, if it’s within the budget, that’s not a bad thing to secure, but I just don’t want you to pay for six months or a year of offices just on the gamble that at some point you’re going to have people in there. But oftentimes when you level up in that way and you get the space, you kind of force yourself to start to hire more people quickly. As long as you’re doing that in a solid way that can help you level up faster. So I remember when I upgraded to a four office suite. I went from a one office to a four office and the one office we had, let’s see there’s five, four part-time people that we were all rotating through, so probably doing 30 or so clinical hours between all of us.

Then it was like clear that we needed to get a bigger space and within a year with that four office space, I went from four people to 11people. So it was like, I want to fill this thing up. So there’s this push that when you do start paying for this larger space, you don’t want it to just sit empty. But if we’re saying, well, we just want to help Michelle kind of get growing and we aren’t necessarily going to like get to this mega practice within six months, that’s where you’re going to want to run some numbers and say, okay, if it sits mostly empty, is it worth it to have that? Could we have an agreement with the landlord knowing at a certain date that you’ll be moving in? So I think there’s a lot of factors that I’d want to dig into to just make sure that you aren’t stuck in some five-year contract paying for four offices when you only really needed one or two.
[MICHELLE]
Got you. Okay. Well, Joe, this is really helpful.
[JOE]
It may make sense that instead of having the one office, you just give up that one office and then move to the three office if the rent isn’t that much more.
[MICHELLE]
That what I was thinking. Yes, I wouldn’t keep both.
[JOE]
Yes, I mean, would have some conversations with the landlord, find out different situations and what they think. I mean, right now it’s a renter’s market So you may be able to negotiate something pretty sweet that would help you grow over time.
[MICHELLE]
Okay. I really appreciate that. This is so, as always so much food for thought. It’s exactly what I needed.
[JOE]
Well, Michelle, thank you so much for being on the Practice of the Practice podcast.
[MICHELLE]
Thanks, Joe. I appreciate everything.
[JOE]
What an awesome show.

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So go take some action just like Michelle. The reason Michelle has leveled up so quickly is she’s shown up for herself. She’s done consulting. She joined Next Level Practice and then Group Practice Launch. All these things that are so helpful.

So at every phase of practice, we have a membership community for you. From that moment that you say, wait, I might want to start a private practice, we have Next Level Practice. So you can get on that interest list over at practiceofthepractice.com/invite. We have our last cohort of the year starting on November 8th and that’s going to be an amazing cohort of people that are starting practices. Then we have Group Practice Launch, which one of those just launched recently back in September, we’ve got another one coming up. You can be on that interest list over at practiceofthepractice.com/grouppracticelaunch. Then we have Group Practice Boss, which are people that are owners of group practices that want to be around other group practice owners. So, so many ways for you to get involved and get help and to continue to level up.

So get involved in some way. And if you’re ever unsure, you can just go to practiceofthepractice.com and in the bottom you’ll see a little pop up that says, “How can we help?” Jess, our director of details is there throughout the whole week and can point you in the right directions. If you’re ever confused, if you want to have free podcasts or other things, make sure you head on over there. And if you’re needing any sort of help, we’ve got that live support there for you. So thank you so much for letting me into your ears and into your brain. Have an amazing day and I’ll talk to you soon.

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. This 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.