[ALISON PIDGEON]
I’m Alison Pidgeon, and along with Whitney Owens, we are business consultants for Practice of the Practice.
[WHITNEY OWENS]
And we’re here to tell you about Group Practice Boss. If you have a growing group practice and are looking for ongoing business support, we have a new membership community, especially for you.
[ALISON]
Every month, we’ll be taking a deep dive into topics group practice owners need to know like, how to manage people, how to manage your money and marketing and branding.
[WHITNEY]
For more information, go over to www.practiceofthepractice.com/grouppracticeboss.
[ALISON]
This is the Practice of the Practice podcast, episode number 563. Hello, and welcome. I’m Alison Pidgeon, your host. I’m one of the business consultants with Practice of the Practice. This is our last episode in our five-part series where we are doing live consulting with members of our Group Practice Boss membership community. So today I am talking to Stephanie Korpal. I have gotten to know Stephanie quite well through the group, and she’s just a lovely person who is super motivated to grow her business. She has a practice in St. Louis, Missouri called Marble Wellness, and now she has recently moved and is looking at expanding into the Chicago area. So that’s actually what we kind of talk about in the session, kind of what different options she has in terms of growing the practice in another state or kind of how to manage her practice now that she’s far away and that type of thing. So if you’re in that situation or if you’ve ever thought about doing something like that, definitely listen to this interview. And so I hope you enjoy this interview with Stephanie Korpal from Marble Wellness.
[ALISON]
Hi, Stephanie, welcome to the podcast.
[STEPHANIE KORPAL]
Hi, Alison. Thanks so much for having me.
[ALISON]
Yes. It’s great to talk with you. I know you’re in our Group Practice Boss membership community, so I’ve gotten to know you a little bit but it would probably be helpful if we could start with you introducing your practice, just to give you an idea of what it’s like.
[STEPHANIE]
Sure. And I do want to apologize to listeners in advance. There’s going to be some train noise going by. I haven’t figured out how to cancel that out in the apartment yet, but apologies to all the listeners out there.
[ALISON]
No problem.
[STEPHANIE]
Yes, I am group practice owner. I own Marble Wellness in St. Louis, Missouri, and I currently have three therapists and an admin. I am currently working on hiring my fourth therapist. They’re all W2 employees, we are a cash based practice, and everybody kind of has a different expertise. I started the practice with a singular focus on maternal mental health and kind of increased that a little bit as calls were coming in from a lot of young professionals just dealing with anxiety and depression. So I also have somebody who is a play therapist, someone who is a grief specialist and also has a specialty in chronic illness and then someone else who does couples therapy.
[ALISON]
Nice. That’s great.
[STEPHANIE]
Yes, we offer, we have been back in office, which has been a big help to the community. Most people are calling for in-office availability and then we also offer walk and talk sessions or park therapy. I added that in May, 2020. I kind of say really it was because I needed to get out from behind the computer. So that has been wonderful for a lot of people for a lot of different reasons, but it’s also kind of a unique thing to be able to tell people about when they’re inquiring about our service.
[ALISON]
Awesome. Yes. So I know you have some questions ready for me today for your consulting session so we can jump right in.
[STEPHANIE]
Okay, perfect. So as you know I recently moved to Chicago myself personally. So I kept my practice open in St. Louis. That is because we put a lot of blood, sweat and tears into it. It’s thriving, we keep getting calls, so I didn’t want to touch something that was working. So I am adjusting to being a distance boss and it’s very new. I am in week four in Chicago and last week I was back in St. Louis for work. So that’s all very new. But the biggest thing on my mind right now is about whether or not to open a location in Chicago in that quite, partially the logistics of it, but really just the decision about it is not weighing on me, but I know I’m going to mentally be there a lot until I make a decision about that being a yes or no idea.
[ALISON]
Yes. That’s a great question. And I know we talked a little bit about how to manage your practice from afar. So if you have questions about that, we can certainly get into that as well. But you know, I guess my question for you would be, what is the driver behind wanting to open up another location in a different state. Well, obviously you live there, but besides that.
[STEPHANIE]
Yes. I think my primary consideration for it would be having coworkers myself and being able to see people as a clinician in-person more often. So right now I’m going back to St. Louis a couple of times a month, there’s a set schedule for it just to help with the transition, but that will decrease over time. So this second half of this year I’ll be going back once a month for a couple of days and then I anticipate the time between visits, continuing to grow. I, as a person I’m extroverted and so the consideration of having other people in the office and being able to see clients in person seems like a professionally good idea.
[ALISON]
Okay. So have you thought about how big that office would be?
[STEPHANIE]
Yes, so I haven’t done a ton of research yet, but one of the biggest considerations is Chicago is a very heavy insurance-based area for therapy. It seems from just like very basic takeaways that I’ve been able to gather so far, the insurance imbursement is much higher in Illinois than it is in Missouri so there are just less cash pay practices. So I’m not sure how big I’d be able to grow an office in Chicago because I don’t necessarily want to start taking insurance just to open a practice up here.
[ALISON]
Yes so that’s a really interesting point because you’ve now moved into a geographically different place, but also maybe a very different view or perspective from people on insurance versus self pay.
[STEPHANIE]
Exactly. Yes, yes. And like I said, I haven’t been able to dig around or network too much yet. So I would be interested to see how many cash pay only practices there are. At a glance they’re really hard to find. So I know I’d be able to find a couple clients that I could probably take on for cash pay, but yes, I don’t know how many people, if any, I’d be able to employ, if it would just be one part-time person doing 15 sessions a week, if that even then makes sense for the overhead things like that.
[ALISON]
Yes. And I think you have a couple different options. Would it be helpful to kind of go over what I’m thinking you could do?
[STEPHANIE]
Yes.
[ALISON]
Okay. So I’m thinking you could, I know you like the idea of being in the office and having that like collegiality and having people around, but you could especially now just start out, not having an office and obviously the barrier to entry to start something in Illinois would be really low because you would have to rent and furnish your office and you could just sort of test it out. The other thing you could do too, I don’t know if you’ve looked into what it would take to like register your same business in a different state. But typically there’s a, it’s not difficult, but you do have to go through a process of like registering as a foreign entity in another state a lot of times. So there’s a little bit of paperwork and time that that’s going to take.

But the other thing you could do as well is you could just open a whole different business. Like, especially if you think it’s different enough in Chicago that your practice that you built in St. Louis isn’t necessarily going to translate, either because of insurance or specialty or whatever the reason, like have a whole different LLC. And then you wouldn’t have to worry about like registering as a foreign entity in another state and all of that kind of stuff.
[STEPHANIE]
Oh that’s really interesting.
[ALISON]
Now your wheels are turning.
[STEPHANIE]
Oh yes, because, I mean, that’s completely starting over on the infrastructure because I already know what I know. So our systems would be the same, but that is a website and SEO and completely different phone numbers and different admin, I would guess.
[ALISON]
Yes. Yes, so even if it’s the same business, you’re probably going to want to have all separate stuff anyway, because it’s just going to be less confusing.
[STEPHANIE]
Sure.
[ALISON]
So I mean, it could be the same name, but you’re probably going to have to have all of that stuff separated out anyway. Even the EHR, like just to make it less confusing for everybody, probably have like a whole separate account for the EHR and that kind of thing.
[STEPHANIE]
Okay. Now, would that be worth it just to have coworkers, because that’s, I mean, that to me becomes a completely different clearing hurdle versus just expanding because there, and COVID complicates this, but there are co-working options. So the other consideration I have is you know, as you continue to grow a business, even if you are vocal to being the boss of the business, you have to decrease your client load anyway. The other consideration is, is it even kind of necessary or long-term a good idea if, as I continue to expand in St. Louis, my admin responsibilities and the broader thinking that you have to do as a group practice owner, kind of, as that stuff becomes bigger and more important for me to do. Could I just have a co-working space that I go to three times a week in Chicago and then I do have people around me, even if they aren’t officially my coworkers, because the same people aren’t paying us?
[ALISON]
Yes. For sure. You could definitely do it that way.
[STEPHANIE]
Okay. So would there be any reason for just opening a location of the same business here? Does that seem like a bad idea?
[ALISON]
I think it seems like a bad idea. I think it’s just, there’s different options and it doesn’t necessarily mean one is good and the rest are bad or whatever. I think it’s just a matter of preference and kind of what your goals are, because I mean, if your goals are, you want to have coworkers around your co-working space idea accomplishes the same goal. And obviously that’s a lot less work compared to opening up a whole another branch or a whole new private practice. But I mean, I don’t know what your goals were in terms of your own income or how big you ultimately wanted to grow the practice that you have. And if does it make sense to just grow the practice in St. Louis to that size or does it make sense to have the two locations? Again, I don’t think there’s a right or wrong. I think it’s just what you want to do.
[STEPHANIE]
Well, another thing that I thought would be good to get your insight on, I think I’ve heard you say before that having one location, even just 10 miles away can sometimes feel like completely separate worlds. And so I wanted to get your insight on that too. I mean, the dice is already cast. I’m not in St. Louis anymore, so that has already become a thing. But I did wonder about, wow, two offices in very different cities, completely different states. Is that complicating something?
[ALISON]
I mean, I think if you feel like your model that you have already established in St. Louis is like working really well, it’s running smoothly, not taking up a ton of your time, you’re not constantly putting out fires, then you could look at that as like, “Okay, I I’ve created this really great thing that I know I can replicate somewhere else.” And so I think if you do decide to start something in Chicago, you’ll find that it’s going to feel a lot easier because you’ve already done all of that initial work to figure out like, what EHR do I use? What phone system do I use? How do we do that? Like you already have all that sorted out so you’re just like taking what you already have and replicating it. Obviously, it can’t be exactly the same because it’s going to be in a different location with a different population, but I mean, I think like it’s going to feel like 10 times easier than it did the first time.
[STEPHANIE]
Oh my gosh. Even just hiring therapists, not the first time, it felt worlds different. I mean, hiring the first person was just like, “Oh, am I going to make it?” Just so much to do and it was all brand new and felt so overwhelming and so big that even just by the second, it was like, “Oh yes, I’ve done this before. This is no big deal. Click here, click here, talk to this person. Done.”
[ALISON]
Right. Yes. And I think you have to think about too, like how involved do you want to be in the St. Louis office in the long-term. Like, would you rather have somebody who’s really like running that for you and your attention is running the Chicago based practice?
[ALISON]
Right. And in a way it’s hard to anticipate some of that because I am newer to group practice. I hired my first person in September and then in January. So there’s so much of that, that is still unfolding that even regular patterns aren’t quite established. I think I have a feel for how things are running. But even goals as a group practice owner, I hesitate a little bit to make too many of those because I changed things so much after I feel I’m out for awhile. So I don’t get too attached to something before I even have any clue what’s involved. So even thinking about how big I would want a practice in St. Louis is hard because I don’t know. I haven’t worked in it that long. And then the other consideration becomes, you know St. Louis isn’t a huge city by any means, but there are different, there are even considerations to establishing different offices there, other parts of town there and if that would be a better idea.

And then I just get too far into five years in the future. So I struggle too, to consider like what works best for me, but also what works best for the practice, because in a way that does work best for you and how to plug and play those pillars to your vision.
[ALISON]
Right. Yes. And I think that’s a common struggle of business owners. Like you’ve never done these things before, so it can be really hard to like say today when you’re like six months into it, like, I want my practice to be $2 million a year and I want to have 40 therapists. You know what I mean? Like, how do you know you want that? I didn’t think I wanted that like two years ago and now I have a very different picture of what I want my practice to be. So yes I think it’s sort of like, you have to have some idea of what you want, but at the same time you have to be flexible. And like you said, like sort of, you’re sort of learning as you go and being open to you know, kind of figuring out and not having all the answers right now, but willing to try things. I mean, I think probably too, like you have a sense now of how big you might be able to grow things in St. Louis. Like you said, if you had a different location that was maybe pretty from your current location, would you tap into a whole different population? I mean, do you think there is a good opportunity there to keep growing?
[STEPHANIE]
I do. I filled up my two new therapists from January pretty quickly and that was without too many formal marketing efforts. And I have an admin who’s trained and really sharp. We’ve been able to start to strategize, but our partnerships with doctors and other health professionals in the area and just other marketing and advertising paths. And so I’ll be really interested to see how quickly I can fill this next hire because it’s also just filling one person and so I think once I track how quickly I’m filling all of these people, I might have an idea. There is a population of St. Louis that keeps moving into further west suburbs and as a practice that still serves primarily moms, I’m sure there are a lot of moms who would like to not be driving 25 to 30 minutes for a therapist.

So there is an opportunity to expand out there if we wanted to. It would be doing some networking out there and letting people out there know we exist. There’s a little bit of, there’s not a ton of therapists out there right now, either.
[ALISON]
Okay. Yes. I mean, I think the other reason maybe just to focus on St. Louis is like you said, you already have a sense of there’s a market there, you haven’t reached the end of the line in terms of clients, there’s room to grow in the Western part of the city and there’s not many therapists out there. Like these are all things you probably don’t know about Chicago because you’re new in Chicago.
[STEPHANIE]
Right.
[ALISON]
So it might be harder to get, even though you’ve already started a practice before, you’re obviously going to be at a little bit more of a disadvantage in Chicago, because you don’t know all of those ins and outs of the geographical location and the landscape of mental health services and what’s already available and all of that kind of stuff.
[STEPHANIE]
Yes. Yes. And there are a ton of mental health professionals here. So it’s a pretty saturated market as far as practices go.
[ALISON]
Yes. So what you might have to do then, where you may not have to do this in St. Louis is you’d have to really like hyper niche, is the term where you have to be like, super specific about the population that you treat so you can stand out among the other.
[STEPHANIE]
Yes. That makes sense. So another part of the question, or thing going on in my head is other projects you take on, you see so many group practice owners, you being one of them that, as a podcast or a second business, or they start doing courses online. So especially as you move out of a huge caseload as a group practice owner and have some more time for that and creative energy, that’s something I’m considering as well is, would that space be better to move into instead of a second location in a new city? Because if I did that, if I opened a location here and put effort in, that would preclude me mostly just space wise from other projects, because I just can’t spread myself that thin.
[ALISON]
Right. Yes. I think that, and what we see most group practice owners do is they build up the group practice to the point where the bulk of their salary is coming from what the other therapists are bringing in. And so they’re able to reduce their caseload down to a very manageable number or maybe not see any clients at all and then they start another business or like you said, move into some other type of service type of business. So yes. I mean, I think that you’re already kind of probably on your to that, if that’s something you want to do and yes, you’re exactly right. I think you would need to choose one or the other. Like you either start the second practice location, which is going to be time-consuming for a little while versus you decide to start another business.
[STEPHANIE]
Yes.
[ALISON]
Again, it’s a matter of preference, what seems more appealing to you?
[STEPHANIE]
Okay. Tell me if this is something that is a good idea to keep it in mind or kind of an unnecessary thought process. So the other thing that I realized about what it would look like if I did start a location in Chicago, was that my caseload in St. Louis would have to, well, first it had to drop because of group practice growth anyway, and I just need time back. And then it would have to decrease again to be able to take on anyone new in Chicago, but very quickly here, if I was getting calls in the area, I would have to hire because when you build a solo practice, you can take it on and even kind of go beyond what your, maybe max capacity is for a little while, until you decide to hire. But I wouldn’t be able to do that here. So I guess if you hire somebody really strong, a really talented therapist you don’t have to worry about that too much, but there is something in me that’s like, “Oh, I wouldn’t be the one growing it before I had to outsource some.” That’s not something I need to worry about. Or if there is something to that. Does that make sense, even?
[ALISON]
Yes. Like when you started your practice originally, you had a solo practice and then you grew it into a group practice. And so it was really like, you were probably wearing all the hats, doing all the things.
[STEPHANIE]
Yes. And it was kind of my therapeutic record, reputation that was bringing people.
[ALISON]
Right.
[STEPHANIE]
So not all, but I don’t think, I couldn’t find another talented therapist. I’ve already found several in St. Louis and people are calling because like, “Oh, my friend sees so-and-so at the practice and it’s not me.” But there something that feels very different about starting a location here taking on maybe three or five clients, and then right after that, having to hire, because I can’t go beyond that and I also have St. Louis people still.
[ALISON]
Right. Yes, and I mean, I think it’s just a mindset shift too, like you’re building something that’s bigger than you. Like, my practice is now bigger than any of the individual therapists that are a part of it and even bigger than me. Like it could survive on its own without me. So, yes, I think it’s just a little bit different way of thinking about it, but at the same time, like your values are infused throughout the practice if you have like set that up correctly, which we talk a lot about that in Group Practice Boss, but using your values to run your business and to hire and all of that kind of stuff. So I think even though you’re not personally the one seeing the clients, it’s still like your personal touches on everything, you know what I mean?
[STEPHANIE]
Yes, yes. Well, especially because I would stand out. I do have a pretty good network here, mostly just socially and personally, but you know, at the age I am, those personal relationships can also be professional ones. You know, I have a couple of friends who are doctors here. One of them is married to a pediatrician. So I could start with her for referrals if I wanted to do a maternal mental health niche again. I recently became friends with somebody who’s an MP at a NICU unit at one of the hospitals. So there are resources that I could start to build that our relationships. I just, yes, it’s just kind of something that mentally keeps taking up room in my head space.
[ALISON]
Yes. So, I mean, maybe that’s telling in and of itself, like keep thinking about. It keeps bothering you.
[STEPHANIE]
Yes, that’s a good point. Yes, if it keeps pulling on me then maybe it’s something worth to do or is worth exploring more.
[ALISON]
Yes, and I think it’s, again, maybe just setting it up a little bit differently in that it’ll be its own thing. Like you’ll just be able to hire more quickly, hire a therapist, hire an admin. It won’t have to be you pulling yourself up by your bootstraps trying to do everything from the beginning. It’ll just be its own force of nature, so to speak.
[STEPHANIE]
Right, right. So do you have any recommendations or suggestions of activities, like even just reflecting activities to kind of get at this? Because I do have other ideas you know, as most business owners do, there’s usually a creative something or five in the hopper. And so just again, kind of explore during those in a way so I can manifest those values in my work life. So I can be thinking down the road without getting too focused on five years from now. I also recognize I don’t have to make this decision any —
[ALISON]
Particular point in time.
[STEPHANIE]
Yes, yes. Yes. So in a way that’s beneficial. It’s just, sometimes my brain is also super annoying and can’t let stuff go.
[ALISON]
I am, right now reading the book Rocket Fuel. Have you heard of that?
[STEPHANIE]
I have not.
[ALISON]
It’s about how some people are CEOs, they call them visionaries and other people are what they call integrators. So this would be like your operations person. So the visionary is coming up with the ideas and then the integrators actually like executing the steps necessary to actually carry out the idea. So that might be a really good book for you to read because I felt like it really helped me to recognize that I am a hundred percent a visionary and it’s really the best use of my time and energy to like come up with the ideas and then find an integrator who can carry them out. So that might be a good starting point just to figure out like where is my time best spent. And if you do have other business ideas and you are a visionary, like really focusing on who is that integrator person who could really make it happen for me? Does that make sense?
[STEPHANIE]
Oh that’s really interesting. Yes. Yes. And that makes for an interesting hiring process I’m sure.
[ALISON]
Yes. Because I actually have both, I have an operations person in both the VA company and in the counseling practice now and this is then like —
[STEPHANIE]
Is that new to you in the counseling practice.
[ALISON]
Yes. Just the past couple months she’s been there.
[STEPHANIE]
Okay.
[ALISON]
Yes, it’s been amazing to not have to worry about all those little details because it was like driving me and like we had to like rewrite policies and our policy and procedure manual. And it was, I like kept just putting it off because it’s so tedious to me and she’s like, “I love writing policies.” And I’m like, “Amazing.”
[STEPHANIE]
That’s incredible. I’m so glad you found her.
[ALISON]
Yes, me too. Me too. So I don’t have to write policies anymore or doing anything that I find super boring. So, I mean, maybe that will help you too, just in the role of the counseling practice as well. Like should you really continue to be the, almost acting like the operations person? Should you be continuing to see clients or do you want to cut down on the amount you see clients and then how do you want to spend your time?
[STEPHANIE]
That’s such a valuable question and it’s so hard because there are times you get in a workflow with a bigger idea and it’s like, “Oh, this feels so good.” And I’m just knocking it out and then you look at your watch and I’m like, “Oh no, in 20 minutes I’ve just switched to therapy.” You’re like, “Oh, this is not what I want to do.” And then as soon as I get in that counseling session, I’m like, “I picked the right career for me. I’m so grateful.” So sometimes I don’t even always know what side of the fence to land on and that actually becomes something that can be solved by time blocking and just really looking at how many clients I want to have and really having those ideal clients. But then being able to schedule those project times at a time where I’m not going to have to be pulled away.
[ALISON]
Right. Yes, that’s a really good point because that toggling back and forth is really hard.
[STEPHANIE]
Oh my gosh. It’s so awful.
[ALISON]
Yes. And I think too, I mean, it sounds like you’re the kind of person that just like enjoys a lot of different things and then it’s hard to sort of pick and choose. Like, “I like all of these things,” but that at the same time, there’s a downside to liking too many things.
[STEPHANIE]
Oh my gosh it has been my Achilles heel for a long time.
[ALISON]
Yes. That’s how Whitney Owens is too.
[STEPHANIE]
Yes. I should call her up her support group.
[ALISON]
Yes. You should call her because we’ve talked about that before. It’s funny. So I realized that we are about out of time. So was our talk today helpful? Are there any —
[STEPHANIE]
It was very helpful. It gave me some actual, like very critical points that I should consider, but also some of those, like open-ended things that may help me with the consideration process. So yes, incredibly clarifying for me, even though I don’t have to answer. So let me clarify the thought process I’m going to need to apply to the decision.
[ALISON]
Okay. Excellent. Awesome.
[STEPHANIE]
Yes.
[ALISON]
Well, thank you —
[STEPHANIE]
I want to appreciate your insight and time so much.
[WHITNEY]
Yes, thank you Stephanie.
[STEPHANIE]
Have a good one.
[ALISON]
Yes. Bye.
[JOE SANOK]
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.