What are some of the logistics of starting a group practice? Do you need to bring in professionals to help with logistics? What type of things do you need to consider and be aware of?
In this podcast episode, Joe Sanok speaks with Alison Pidgeon about the logistics of starting a group practice.
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In this podcast episode, Joe Sanok speaks with Alison Pidgeon about the logistics of starting a group practice. This episode is part 2 of 5. Be sure to listen to the rest of the episodes!
What logistics do you need to think through before starting a private practice?
It’s important that you find professionals that can help you on this journey. A CPA and a lawyer will be particularly useful in the beginning. You may need others along the way. They will help you review your documents and make sure you’re ticking all the boxes, as well as give you peace of mind that you’re doing everything right.
What also helps is to have an attorney that you already have a relationship with.
Remember, each state has its own way of dealing with things and having these professionals can help you understand and figure it out.
What about accountants and bookkeepers?
These professionals are important to help you go over how you’re categorizing things. If you have different income coming in, it is taxed differently and that’s crucial to know.
Are there any other things to consider?
Yes, think about your different business entities. Make sure you have a separation from your own assets.
It will also be ideal to give each person their own phone extension to allow things to run smoothly.
How do you figure out what type of people to hire?
Think about your vision of the practice. Either hire someone with the same specialties and own that or hire people who offer different specialties to offer your clients more value.
How do you market a group practice?
A hard pattern to get into is to start saying ‘we’ instead of ‘I’. Talk about the other clinicians at events and not just yourself, and be more of a representative of the practice in these events to give other clinicians more referrals.
If your website is under your name, you need to change that. That might lead you to change your website entirely with separate pages for each clinician.
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[JOE]: Small businesses across the country love running payroll with Gusto. Why? Because Gusto automatically files and pays your taxes. It’s super easy to use plus you can add benefits and management tools to help take care of your counseling team. But here’s the thing. It’s almost 2020 and switching to a new payroll provider can be tricky. Fortunately, Gusto can help as long as you get in touch. Now try a demo and test it out at gusto.com/Joe. You’ll even get three months free when you run your first payroll. That’s gusto.com/Joe. It is the payroll system that I use here at Practice of the Practice. This is the Practice of the Practice podcast with Joe Sanok, session number 413. Well, welcome back to this series all about starting and growing a group practice. I’m here with Alison Pidgeon, our Practice of the Practice consultant who is our master around starting and growing a group practice. Alison, how are you doing today?
[ALISON]: I’m doing great. How are you Joe? [JOE]: I’m doing really well. Sorry, just almost dropped my notebook there. So today we’re talking all about the logistics of starting a group practice. Yesterday in the previous episode we talked about why do a group practice. Now let’s dive into just what are some of the bullet points around someone’s like, “Yes, I’m in Alison. Let me know what to do. Tell me what to do around starting a group practice.” What should they think through when they’re just getting going? [ALISON]: Sure. So, one of the things that folks may not have done when they were in a solo practice is finding other professionals who are going to help you with your business and what comes to mind would be a CPA and a lawyer. You may need other professionals along the way, but those are two really good starting points. If you were kind of doing like the accounting stuff on your own, I would say now is definitely the time to get a professional to help you. [JOE]: What would say an attorney that understands employment law in your state do that not having an attorney would do? [ALISON]: Well, I think just having the peace of mind of having them review your contracts, having them review your paperwork. As you grow and get bigger, your liability is going to increase and so you’re going to want to make sure you’re really on top of that and making sure you’re not making a silly error or even a HIPAA violation and it just was something you just, you didn’t realize. So, I think just having somebody who can give you the peace of mind to say, “Yes, this is all good,” or point out things that maybe you haven’t thought about. [JOE]: And I think that, especially when those situations come up, I was so happy when I had my group practice that I had an attorney that I already had a relationship with. We had one of my clinicians that, there was, one of his clients had some pretty severe issues and had made some false accusations against him and the state ended up coming in and doing kind of the investigation and he didn’t get any slap on the wrist for anything but to just say to my attorney, “Hey, these are the things that came up. Here’s what I know. What should I do to protect my business and make sure that I advise my clinician?” It was great to have that person that, from a legal standpoint could say, “Okay, here’s what you can do. Here’s what you should do.” And then whenever any kind of correspondence from the client or from the state came in, I could say, “All right, what do we do now? And did just say, “That’s on my attorney?” [ALISON]: Right. And I think, you know, you don’t want to be in that situation and not have an attorney and then be on top of obviously being stressed out about that whole situation you’re like scrambling to find somebody. And so, yes, that’s why it’s good to establish that relationship early, then they’re familiar with you, your business, and then those things come up and you’re not having to sort of like start from scratch with finding somebody. [JOE]: Well, and I mean that whole ounce of prevention versus what is it? A pound of cure. [ALISON]: Right. [JOE]: You can just get your contracts set up right on the front end and make sure that if you’re doing 1099s or W2’s, you just do it right for your state because, at least what I’ve seen, and maybe you’ve seen different than this, is that each state has its own kind of unique way that it handles W2’s and 1099s and kind of the way that they look at employment law. I mean, we do our best to keep up with it but in the middle of, I remember a couple of mastermind groups ago was when California just came down on 1099s and it was like in the middle of the mastermind group. A bunch of the California people were just like, “Ah, what do we do?” And we were trying to figure it out too, because it was such new law. [ALISON]: Right. I know, I see that too. Like all over the country, there’s, you know, state by state there’s different laws. So that’s why it’s important. Obviously, we’re not lawyers, but on top of that. Just depending on what state you’re in things can look very different. [JOE]: Now, what about an accountant and bookkeeper? You said to kind of engage with those folks. What would you want them to have eyes on, especially as you’re growing into a group practice? [ALISON]: I would say if you don’t already have something like QuickBooks set up or even if you do, maybe just having them look over how you’re categorizing things because a lot of people don’t realize different income and expenses or maybe tax differently. So, for example, if you’re getting a rental income, it’s taxed differently than the income you’re getting to see a client. If you don’t realize that and you’re not separating out that income, you could be overpaying on your taxes. [JOE]: Okay. Now what else? So, I decided I’m going to start a group practice, I talked to my attorney, talked to my accountant. What else needs to be on my hit-list of things to work through in the first couple of months? [ALISON]: I would say definitely if you haven’t already formed some kind of business entity. So again, different States, it might be something different, either an LLC, a PLLC. If you’re in California, you have to have an S-Corp. Just making sure you have that separation from your own personal assets because that’s going to protect you. You’re also going to want to look at your systems that you have. So, some of the systems like EHRs, phone systems, things like that are not well suited for a group practice. So, you may have to go back and choose different systems or do some research into what would work well; like we talk about having a phone system that has extensions because now you’re going to have therapists, you also maybe are going to have an assistant. It’s ideal if they all have their own extensions. So, if you’re using something like Google Voice, you’re definitely going to have to switch to something else. [JOE]: I’m with you where that extension side of it. It’s nice as the owner to not be fielding or having the virtual assistant filling everyone’s phone calls as they come in. [ALISON]: Right? Yes. [JOE]: Now what about figuring out what type of people that you want to hire? So, specialties, different demographics of kind of who they serve. How does that fit into the equation when you’re first getting going? [ALISON]: I think you have to think about your vision of the practice. So, a lot of times what people will do is they’ll either choose to hire people who have the same specialty as them. So, let’s say you’re a play therapist and you only want to hire a play therapist and you’re the play therapy practice in town or you want to hire people who are doing things that are different from you so that you’re offering more of a variety. But also, then there’s this sort of like natural referral process that happens. So, we see a lot of moms in my practice, that’s one of our ideal clients and a lot of times what will come up is that they need couples counseling. So, in that situation, it would be nice to have somebody in the practice that sees couples because then you’re referring that couple to someone in the practice and you’re essentially keeping that business in the practice rather than referring them out. [JOE]: I love starting with what are the phone calls and emails that we’re already getting for specialties that we don’t yet serve and saying, well, I mean, even if we have one person that just says three sessions a week then we can keep that in-house and help those people be able to have even better quality of services. [ALISON]: Right. Yes, because a lot of times people want to stay in the same practice because they’re familiar with the practice and they’re comfortable there, and so, I think they appreciate the fact that they can stay within the practice as well. [JOE]: Yes, absolutely. So, you figure out some specialties to hire, make sure you’re doing it right, legally and accounting-wise. What about some of the beginning just marketing and filling those people up? [ALISON]: I think this is where you have to think about now, you’re marketing the practice as a whole and not just you as a solo provider. So, there’s definitely a lot a lot of things that are different when it comes to marketing a group. One of the things is you have to start thinking about saying we instead of I, and what I ended up doing actually from your advice, Joe, was when I would go to marketing or networking events, I would talk about the other clinicians instead of talking about myself because I wanted to fill up the other clinicians. And so even though they weren’t there I would say, “Oh, Whitney’s great with teenage girls,” you know, blah, blah, blah. So, then I wasn’t talking about myself and hopefully drumming up some referrals for her. [JOE]: Yes. And in the next episode, we’re going to go really deep into how to fill up the other clinicians, but those kind of things of just talking less about yourself and being more of a representative of the practice. I think it’s a big shift for most people as they look at kind of getting started. What else in regards to kind of the logistics of starting you know, one thing we didn’t touch on was any website updates. What kind of things should someone do on their website as they start a group practice? [ALISON]: I would say, and this goes back to kind of naming the practice, if it is under your name, you probably are going to want to change it to something that’s more representative of a group. Because if your name is on the door, then people are always going to ask for you. [JOE]: Yes. [ALISON]: It just seems to be how it goes. [JOE]: Let’s say way harder to sell it too. [ALISON]: Yes. So that may lead you into needing to redo the whole website. So, if the website was, maybe mine was alisonpidgeon.com or whatever, now I have a new name and now I have to create a totally new website and now I have to create separate pages for each clinician and separate pages for each specialty. So yes, that can be quite a bit of work if you are really starting over in that way with the name and everything. [JOE]: Yes. And I think for people that are listening that have a solo practice or even just starting a practice, thinking through naming it something other than your name and making it set up so it’s easy to scale into a group practice if that’s even slightly on your radar. I think that’s really important to think through. When I bought mentalwellnesscounseling.com, I knew that at some point I would want to do a group practice. I just wasn’t sure how to do that. And so, if you can start with that end in mind, it just saves you so much time and money on the other side. [ALISON]: Yes, it’s definitely a hassle to switch things over. It’s not impossible. It’s just annoying. [JOE]: Right. Well, in the next episode we’re going to talk more about filling up those clinicians, transitioning from me to us and kind of how you do that. And then in episode four we’re going to be talking about managing your staff systems, turnover, finances, transition. And then in number five, transitioning to a CEO and exiting if that’s what you want. So, Alison, thanks so much for being on the podcast. [ALISON]: Thank you. [JOE]: If you are looking for extra tips and advice all around starting a group practice or growing a group practice, Alison and I are doing a live webinar on December 10th. It’s going to be at 2.30 Eastern, 1.30 Central, 12.30 Mountain, and 11.30 Pacific. We would love to hang out with you and go deep around starting and growing your group practice. We know it’s one of the best ways to scale up and for you to be able to have multiple streams of income. So, head on over to practiceofthepractice.com/grouppracticewebinar. Again, that’s practiceofthepractice.com/grouppracticewebinar and you can register for this masterclass completely free. We’ll see you there. So, if you want to get some extra help from Alison and myself, we are doing a webinar on December 10th at 2.30 Eastern, 1.30 Central, 12.30 Mountain, and 11.30 Pacific. Head on over to practiceofthepractice.com/grouppracticewebinar and you can get all the information about that webinar, register for it, and get some extra help on starting and growing your group practice.
Also, special thanks to Gusto who has amazing payroll services. Head on over to gusto.com/Joe to get three months for free. 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.
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