Joe Sanok 00:00:00  You're someone with a vision for your practice, for your side hustle, and for your personal journey. But when it comes to establishing your path and how to get to where you want to be with your practice, things get a little messy. You're also someone who would prefer to go in person instead of to groups and listening to everyone else's story. To me, it sounds like you could benefit from one on one consulting with our experienced practice of the practice consultants from 595 a month and up, you can work with a consultant that will give you more direction and practical, tried and tested tips matched to you and your goals. For more information, visit practice of the practice. Com forward slash apply. Again, that's practice of the practice. Com forward slash apply. This is the practice of the practice podcast with Joe Santa. Session number 102. Welcome to the practice of the Practice podcast. We are going to be doing a series between now and the beginning of November, where we are going to be playing all of our level Up week trainings that we did in September of 2024.

Joe Sanok 00:01:21  And we're going to be talking about from empty to overflowing, talking about your branding, talking about Multi-location shifting from 1099 to W2, all sorts of different things during this series. And if you want help from one of our consultants for every single phase of practice, or if you're just not sure where you fit in our memberships versus our consulting, I would love for you to talk with me over at practice of the practice. Com forward slash apply. We can schedule a 30 minute call together and dig into all those different areas that you want to get started again. That's practice of the practice. Com forward slash apply. Now let's get started with the Level Up Week series. Well welcome everybody. today we're doing a panel of group practice bosses of what they did. Right. And maybe what they did wrong, what they could have improved on. and so we're going to just be talking through their level of group practice, kind of what they do. but let me just share a little bit about myself if I haven't met you yet.

Joe Sanok 00:02:18  welcome. Glad you're here. I'm Joe Cenac, and I'm the founder of practice of the practice. And we've helped thousands of therapists start, grow and scale their private practices into thriving practices they absolutely love. we want you to be thriving in grad school. I always heard, you know, we're not in it for the money. Or, was made to feel bad about wanting to make, you know, money and not just struggle. And we don't believe that. We believe that, money is something that you can use as a tool. And if you're a good person, you'll probably use it for good. And if you're a bad person, you'll probably use it for bad. So, we work with therapists all the time, to grow their practices, however that looks. so whether you're in solo group or a larger group. welcome. Glad you're here. we also. I have some guests with us today. We have Emily, Daniel, Christina, Sarah and Matt. and I'm going to, let them each introduce themselves, and be able to just kind of share a little bit about their practice.

Joe Sanok 00:03:11  Daniel, I think, is running a few minutes late. so I'm going to bring him on once he comes in as well. so why don't we start with Emily? You're unmuted. We'll kick it off with you. why don't you just tell us a little bit about your practice, where it is right now, and then we'll dive into some questions.

Emily Runyan 00:03:27  Okay. Thanks, Joe. so I have a group practice in a suburb of Nashville, Tennessee, and, it's two years old as a group practice. we have eight clinicians, seven, therapists and one psychiatric nurse practitioner. And we are a private paid practice. We're kind of a boutique, kind of feel. And, a unique thing about our practices that we are a brain spotting practice. So we treat, you know, kids, teens, adults, couples, families. But we all one of the things that I do for my employees, which they're all employees, is that I paid for them to get brain spotting training so that we are all on the same page with that.

Emily Runyan 00:04:10  And we're, driven by a trauma informed approach in all that we do.

Joe Sanok 00:04:16  And over what period of time did you start your group and how how far are you into that process?

Emily Runyan 00:04:22  Okay, so I had a solo practice in the same area for about six years, and then I'm two years into the group practice. So I'm right at the point where I'm, I've been wearing all the hats and I'm, I'm slowly like in the last six months I've been taking off some of the hats, but I'm still wearing too many hats. But but I'm feeling like, okay, things are things are starting moment and starting to go. And I can probably start taking off more hats as we in the next year.

Joe Sanok 00:04:50  Oh, wonderful. which of the panelists you want to pass it to? We have Matt, Sarah and Christina.

Emily Runyan 00:04:55  Let's go. Matt.

Joe Sanok 00:04:56  All right. Matt, tell us about your group practice.

Matt Fowler 00:04:59  Thanks, Joe. So we are a group practice in Portsmouth, New Hampshire, right on the sea coast, where we've got seven clinicians and one admin.

Matt Fowler 00:05:08  our practice has been around for about two years, so kind of like Emily. I started my private practice, did that for about two years, and then started the group practice. And we've been open for about two years and marketing ourselves as a group practice. We primarily market ourselves to children and families in the area. That's been my niche. That's what I kind of know really well. So I tried to bring people on just in the in the same vein, but we also have a lot of people that have eventually come on into our practice to fill the gaps of, you know, for, for parents that need some counselling, individuals and marriages. But, so we've, we've kind of morphed a little bit into that, even though our marketing remains the same.

Joe Sanok 00:05:46  Awesome. And Daniel, welcome to the panel. we're just I'm just having each person share a little bit about their practice. And so Matt and Emily have gone. So Matt, who do you want to pass it to between Daniel, Christina and Sarah?

Matt Fowler 00:05:58  Oh, pass it to Sarah.

Joe Sanok 00:05:59  All right, Sarah, tell us about your practice.

Dr. Sarah Bren 00:06:06  So, my practice is called Upshur Brent Psychology Group. I run it with my partner, Emily Upshur. we're located in Pelham, New York, which is in Westchester, just outside of New York City. And we we really specialize in kind of treating the family across the family lifespan. So we do a lot of like perinatal and postpartum work with families that are growing. And we do parenting support with parents of really young kids. We see children, adolescents, young adults, parents, adults. we do a lot of family work. so we have 12 therapists with two admin kind of three. and then we have some people that do like hybrid jobs for both therapy and like Mark bang and we have been around for three years. We started we turned three in June.

Joe Sanok 00:06:56  Awesome! And you want to pass it to Christina or Daniel?

Dr. Sarah Bren 00:07:00  Christina.

Joe Sanok 00:07:01  All right, Christina, let's hear about your practice.

Christina Blanton 00:07:03  Yes. So I own connected families counseling.

Christina Blanton 00:07:06  We are a in a small town. We're about 30 minutes north of Kansas City, so we serve a lot of rural populations. So our goal is to provide just really quality mental health care to the local communities. And so we started out as private pay, and now we're moving towards more insurance based just to make it more accessible. And so that way we can reach more people in our community. And so I've been doing the solo practice for about two and a half years. And then actually last year at this level up week is one of our started group practice launch. And we have four clinicians now and one admin.

Joe Sanok 00:07:42  That's incredible. You know I always love hearing that where it's like, you know, you start one of the programs and then it's like, you know, a year later you're a panelist talking about it. That's incredible. Right? Daniel, tell us what you're sorry. Go ahead. Christina.

Christina Blanton 00:07:55  I was just going to say it's it's crazy to see, like, where we're at last year compared to, like, this year.

Joe Sanok 00:08:00  it's so cool, so cool. And, Daniel, tell us about your practice.

Daniel 00:08:04  Yeah. Thank you. Joe. Yeah, absolutely. The practice of the practice has been invaluable. It started definitely with just my office and then hiring a couple of employees to share that office space. And then we expanded the two offices, and now we have our own location, a seven office suite in addition to the two offices that we have. we've got about 17 clinical, employees and then an admin. So, it's been yeah, it's been it's been great. We we are insurance based. so we do a lot of insurance based so that accessibility is important to us. Yeah.

Joe Sanok 00:08:46  So awesome. Well, and part of having everyone kind of introduce themselves is to kind of know, you know, as you listen, those of you that are, participants to to say, okay, I have a question for Christina on this or I have a question for insurance, for Daniel or, you know, oh, I'm in New York, too.

Joe Sanok 00:09:02  Sarah, what about this? so as we look at the next hour together, I just want to frame out a couple things. So, we're going to take as many questions of yours as possible. what we aren't going to do is have. Here's one question, and we're gonna have all five people answer it because we would get through three questions. and I'm sure that we would be able to riff on a lot of different things. so if you do have a question that you specifically want someone to answer that you just heard, please say, hey, Emily, I have this question for you. that's going to make it easier for the overall flow. And if there's not a name, I'll probably have 1 or 2 of them weigh in on it. so there's a lot of different directions we can cover. I'm going to ask a couple questions at the beginning to get us going. And then as we have, questions come through in the chat. please go ahead and put that there. Now, if you have a question that you think needs a little bit of back and forth.

Joe Sanok 00:09:45  Maybe you think there's going to be a follow up question, just virtually raise your hand where you see react at the bottom of your screen. When you click on that, you'll see some reactions. But then at the very bottom of that, you'll see raised hand. That just lets me know, and our team know that you are willing to come on camera, or to at least unmute and to ask your question if it's a little more complex than maybe the chat. So, let's start. Christina and Daniel, I want you to just talk a little bit about insurance. And so, Christina, you said you're in a rural area, you're deciding to move away from private pay. Daniel, you're insurance based. maybe. Christina, talk about that transition, of deciding to take insurance and just some of the nuts and bolts that went into that. And then Daniel would love to hear a little bit more about for you, how does insurance pay tend to work for your practice?

Christina Blanton 00:10:30  Yeah. So with us, we decided to make the transition about a year ago.

Christina Blanton 00:10:34  Just because it is. It can be a lot in marketing to get private pay clients and especially in our area. And so we really wanted to make sure our clinicians can stay full. So that was what made the switch to insurance easier. to help it out, we got a biller because we're like, you know, this is just an extra step just to make it just a smoother transition. And so that has really helped us out to have somebody who can answer those questions. And it's not extra work on our part necessarily. It's more it's minimal work.

Joe Sanok 00:11:07  So really kind of making sure that you have a team of people that know what they're doing, that you aren't starting from scratch.

Christina Blanton 00:11:13  Right? Because billing and insurance is not my skill. So I'm going to hire that out to somebody who can do it a lot better than me.

Joe Sanok 00:11:19  And even if it was your skill, you know how Emily is talking about. She's taking hats off and realizing, okay, like, we got to where we're at because of bootstrapping, wearing multiple hats.

Joe Sanok 00:11:27  But to get to that, you know, ten, 20, 30 clinicians, if that's her goal, you know, you have to start taking those hats off, Daniel, for you with kind of the logistics of insurance. What is that? What does your team look like in regards to that workflow and also that decision to take insurance.

Daniel 00:11:42  Yeah, that was, definitely a decision that shouldn't be taken lightly. It's, it was a lot of work. And, you know, the during the earlier stages, I was doing most of the insurance, and I'm not an insurance guy, so I was there was a lot of learning and a lot of research and a lot of calling, lots of wait time, lots of back and forth calling the wrong number. It's true. It can get pretty frustrating. But, now you know that we got a little bigger. We have an admin. and so pretty much it's just growing pains. it's doable. It's not rocket science. It just takes time. Yeah, but he.

Daniel 00:12:24  Yeah, he handles it so now. So it's good.

Joe Sanok 00:12:27  Yeah. Emily, now you're 100% private pay. tell us how you came to that decision. What do you think are some of the pros of that? What are some of the difficulties that come along with that?

Emily Runyan 00:12:37  Okay, I'm glad you asked. because we are in a transition point actually. So we are private pay. I came to that decision because I wanted to pay our therapist well. I really wanted to foster, you know, excellence in, in treatment and to attract, you know, therapists who wanted to be paid well. and what I'm finding is, I guess, with the community our size, as a suburb of Nashville, it's kind of a smallish town, and it's been challenging to fill the caseloads of our eight clinicians. So, we do a lot with marketing. we Google ads are what we spend the most money on. And I, we hired a Google, a local marketing company who helps run the Google ads, as well as run our website, like the SEO of our website.

Emily Runyan 00:13:27  we market in a local, like little, magazine that's been very effective. also, what's been incredibly effective is me getting very involved in the community. So I'm kind of the face of the of the company. which is called Tennessee Mental Wellness, by the way. And, so I'm involved with the chamber in Gallatin, our city, and, do a lot of like speaking, it with local businesses. I targeted the businesses and do corporate, wellness kind of speaking. And then in the schools, I sit on a committee, a mental health committee of the county. So those things really help to get our name out there. But, I'm seeing now two years in that, you know, I would have thought that our clinicians would all have very full caseloads, and some do, but not all. Oh. Also, I have two part time admins, and one of them, I, they both answer the phones, but, one is also office manager and the other is also, marketing. So she does a lot of our networking.

Emily Runyan 00:14:32  She goes around to, lawyers and physician's offices and distributes flyers and cards and stuff like that. so that's that's what we do. But the transition thing is that we are going to add we're going to keep a private practice, and then I'm going to add a practice that is insurance and start to grow that in the next year.

Joe Sanok 00:14:52  Awesome. Well, we just had a question come in and I'm going to have either Sarah or Matt, kind of field this one. so could, could paying a clinician well be accomplished through a more generous split? Assuming one hires 1099 contractors? I'm actually I should have asked, who has w-2s and who has 1099? So why don't we, if you have w-2s, do a W gang sign. And if you do, if you do 1099, do a nine gang sign. All right. So Matt's the 1099 guy. Daniel's going to probably pop back in here. Matt, why don't we ask you that? like, what are your thoughts? What do we start with? What are your thoughts on a percentage split versus, you know, a flat fee also paying a higher percentage.

Joe Sanok 00:15:37  Like how have you thought through the money side of it since you have 1099 and that's this question.

Matt Fowler 00:15:42  Yeah. So it's an interesting question. You know, I've tried to be able to be really generous to people who in terms of like, you know, experience trying to reward that, people who are, you know, maybe doing a little bit more work for us, maybe more full time clinicians than someone who's a little bit more part time. So we we kind of have a more generous split with those people. But it's really important. The I kind of think of it as our business. If our business doesn't survive, these people don't have jobs, and if they don't have jobs, then we can't support the community. And so it's really important to make sure that we offer a, a split that is really competitive because I really want to pay our people really well. But at the same point in time, keeping that other mission in terms of like keeping the business going at the forefront. So it's a it's a it's not an easy, straightforward question, but I feel like I try to do my best to to make the split feel even for, for everybody that works for us.

Joe Sanok 00:16:34  Yeah. Are you willing to share the split or kind of some of the principles that led to what your split is?

Matt Fowler 00:16:40  So we go anywhere between we usually start off at about a 6040 split for the beginning. And then once people hit a certain percentage of their caseload, if they're full time, just because there's a lot of support that goes on in the beginning, a lot of my time, a lot of things that I, you know, outsource in terms of like, so we do a lot of insurance credentialing to we take care of all of that for our clinicians. So there's a lot of that that comes into it as well in terms of like paying somebody to be able to do the credentialing that's, you know, something that I've just decided to take off my plate. So once they hit a certain level in terms of their caseload, then we bumped that up to about, 65. And then if we have people who come into our practice who are private because we, you know, we're very clinician centered in terms of what they want to be able to do.

Matt Fowler 00:17:25  So we do have people who are private pay, and they're on the higher end around a 7030 split.

Joe Sanok 00:17:31  Awesome. Cool. And, Daniel, you got popped out of the spotlight. Are you W-2 or 1099?

Daniel 00:17:40  Yeah, W2.

Joe Sanok 00:17:41  Okay, that's what I thought I heard you say. I just wanted to make sure. Okay, cool. there's a question for you, Emily. and in a second, I'll show you all, our staff wage calculator, that we're giving away for free. I won't go through all of it, but it's a great way to then run those numbers so that, you know, if Matt's saying, okay, we're doing a 6040 split, where does that break down to? Where you can look at what your profit margins are and all of that? it's something I've used with my own consulting clients that we turned into an actual product that people can use. but the password that I have for it to get into it isn't working for some reason. So I gotta find out what the new password is from.

Joe Sanok 00:18:12  From Jen or Sarah. but while they're looking for that, Emily, how do you separate the private practice and the insurance practice? Will they be in the same location? Will they have the same clinicians and serve both practices? Like how does that work?

Emily Runyan 00:18:25  Okay, so I know a little bit about this. I'm going to be working with, one of your consultants, Joe. Melissa Schneider. Starting Friday, actually. But from what I know, from what I understand, I will need to have two tax IDs. So essentially to separate practices. So I will have two tax IDs. I'll have the insurance practice and then the private pay. And you know the clinicians can work for either practice. We will start at the same location because we have we have rooms still at our location. But I plan to have the the private pay practice stay in Gallatin. And that's kind of like that's what we do. And then the insurance one will be more scalable. I'm finding that the private pay practice really does well because of us being known and me being known in the community.

Emily Runyan 00:19:13  You know, I had my solo practice here for six years and started to, you know, build a good referral base and stuff. So, it, I may consider, you know, scaling the private pay, but the insurance is what I really want to build and and scale that one.

Joe Sanok 00:19:31  Awesome. Cool. I would love to just think about like how do you think about scaling Daniel. So you have a larger practice. You've done that in a short period of time. I think there can be this desire, this kind of hustle mentality that's like, I always gotta do more, gotta do more. Like, how do you know when enough is enough? How do you think through scaling, growing like, just what's your thought process around that?

Daniel 00:19:54  it's funny, we just had, a group consult and that was a, something that we discussed was the the spectrum between, striving and being. So I think that's right on point. When do we say, okay, let's just be a practice instead of, well, I guess, you know, to be honest, I haven't reached that point.

Daniel 00:20:16  That, though, is that one where we had that two offices and we jumped into the seven offices. I mean, that was striving. And I think we had just gotten to a point, Joe, where, we filled the offices were full, our clinicians are just almost right there to being full. so I think the time is now to say, okay, I think 17 is enough. let's cruise this ship for for a bit before we decide on the next step for us. I don't think it's the end, but,

Joe Sanok 00:20:48  Yeah, that makes sense. now, Cristina, if we went back to the beginning of your group practice, like, you know, you just a year ago, you know, decided to jump into this, and, I'll let kind of anyone else also weigh in on this because I think this is an important question. We don't have to necessarily hit all five of you. But if you have ideas, feel free to jump in. after Kristina answers like, what do you wish you had known? Maybe in the couple years before you started your practice? Like, what could you have done even before you launched it? And what have you learned since you launched your practice that you wish you knew earlier on? And then we'll answer this.

Joe Sanok 00:21:19  And then, Ingrid, I see raise your hand. We'll go to you, to to get your question.

Christina Blanton 00:21:24  For me, I think, I wish I would have worked more on my leadership skills and stepping into that role. I think it's, I've always been a great follower. and so stepping into the leadership role was a challenge. But I think going through group practice launch really helped me because, you know, whenever I was going like LaToya, like we had all those meetings with her and like her voice would pop into my head and like, no, Christina, like, you've got to do this. So, like remembering, like, I'm the captain. I'm the captain of the ship, you know, like, I have to be the one who's leading. and I think what I wish I would have done differently is, I think, I wish I would have interviewed better, I think, I wish I would have pushed in the interviews a little bit more, but I would make excuses.

Christina Blanton 00:22:07  I'm like, oh, you know, like, this will just level out. Like it's just interview nerves. Like things will level out. And they never did. They would only get worse. so now what I do is I have my admin. I have a lot of trust in her. She'll do the initial phone interview like it's just the basic questions, and then she'll tell me like, hey, Christina. Like, I don't even know why this person wants to be a therapist. Like, I don't even know what the what they're doing as a therapist. And so we'll pass on those people, or she'll say, you know what? They've got these great skills. And then I do the interview with my husband, who's also the co-owner. and so he sees my blind spots and we look at things through different lenses. And then usually, you know, like we're all in agreement with the next people. So having those checks I think has been beneficial. and then also what's really helped has been just having the group practice launch system, because like that helped me have a system, you know, because around this time last year, we're like, you know, like, let's start a group practice, maybe in February, like, let's begin.

Christina Blanton 00:23:07  And I was like, well, no, like group practice launch is starting right now. Like, let's let's get it done now. so it was a little bit chaotic, but I think, you know, it's going to be chaotic either way. And I'm glad we jumped in. And I'm very thankful for where we're at now.

Joe Sanok 00:23:25  Awesome. Other things that you any of the other four that you wish you had either known in, say, a couple years before you launched, or that you've kind of learned in the years since you you launched?

Emily Runyan 00:23:37  I'll, I'll jump in and say that, I think something I learned in group practice launch was or some somewhere along the way was, having a good admin in place. And so my admin was my first hire. and I now have two part time admin, but, you know, she was so, so fabulous. a stay at home mom turned part time admin turned practice manager. and she was so helpful. You know, I would say, okay, I have these ideas, and, you know, I'm learning all this stuff and group practice launch and, like, help me distill it.

Emily Runyan 00:24:11  at the time, I, I had already spoke to my first who would become my first hire, and I, I knew I'd probably hire her. So my admin came, two months before we started onboarding the new hire, and it was so great. You know, for me to say, I have all these ideas and all my onboarding, you know, processes, and she would help distill it and organize it and help help me with setting up everything, really. She was fabulous.

Joe Sanok 00:24:41  Awesome. We'll get to more of that. Let's go to Ingrid. Ingrid, you've got a question. I just, added a spotlight. So you're with us here.

Speaker 7 00:24:48  Thank you. Thank you, sir.

Joe Sanok 00:24:50  You're welcome.

Speaker 7 00:24:50  Glad to be here. I wanted to follow up and get so, so with Emily and and thank you for answering the question. So I have a group practice right now. It's, ten clinicians, and myself, but I, not doing a lot of, therapy and more, but, we have a couple of couples, couples, therapists, and, as you may know it, there's this big thing with, couples and insurance, and, and and it gets really muddy.

Speaker 7 00:25:22  And so I actually was doing the opposite. So I have a group, insurance based practice. And I wanted to do a private pay for couples. and I actually set up the LLC, I, I did all the, the work, we got stuck with clients calling and saying, but I see you take insurance. We're a different practice all this, but your clinicians are the same. Like, how come. And so it was very difficult to the point where I had to put that on hold. And so basically my, my question or what I'm looking for is is there a better way of doing it?

Emily Runyan 00:26:08  the only thought I have for that is you may want to have a separate website. So you have a website. Oh, you did it.

Speaker 7 00:26:15  With separate websites, separate EMR, Everything was separate. It was just the fact that, for example, let's say I was seeing an individual and they say, oh, we need couples therapy. Okay, so let me there is this service and oh, but but your clinician is in the same practice.

Speaker 7 00:26:35  How come I can use my insurance. And so it became very entangled I think

Emily Runyan 00:26:43  Oh I definitely get that dilemma. And since I'm on such the early side of, you know, having the two, I don't know, I think we would encounter that same challenge, I imagine. And I think we would just try to make it known that, like, we don't take insurance for couples. We just don't. That's just, Yeah, because Tennessee Mental Wellness will be the umbrella practice and then the insurance will be under that. And so but in general, and I think that the insurance practice will also be Tennessee Mental Wellness. But an LLC, whereas the umbrella is an escort. But, yeah. So that just in general our policies to not take insurance for couples.

Joe Sanok 00:27:25  Yeah. It sounds like, next level up week, we'll get an update as to how it goes.

Emily Runyan 00:27:31  Yeah.

Joe Sanok 00:27:32  Excellent. Whatever stage your practice is at, we know using great resources with patients is crucial to helping them get better, faster.

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Joe Sanok 00:29:07  All right. We've got another hand raised. let me add a spotlight there and JP. Ben, welcome.

Speaker 8 00:29:16  Thank you. Thanks for letting me, ask a question. So. And this is for anybody. I'm ready to. I'm ready to hire my first one. I'm going to go to 1099 route. I've got plenty of office space. What is everyone's best place to find clinicians? Is it indeed Facebook? I'd love to hear any and all sources from which you find clinicians.

Joe Sanok 00:29:41  Awesome! Such a great question.

Emily Runyan 00:29:44  Oh, I have something to say about that. so I've used indeed, and I've hired one of one of the eight from indeed. But, two great sources have been, my networking in the community. So I've reached out to I had my admin set up, like coffee dates with kind of early career clinicians or pre licensed clinicians and just, ones that I knew were established in their own solo practice and and just, you know, talk to them, got to know them. And then, you know that kind of that turned into hiring three of my clinicians.

Emily Runyan 00:30:24  so that was very helpful. And then the other thing was I learned this from Elizabeth Carr, Doctor Elizabeth Carr, who's part of practice of the practice sheet. her idea was to have separate web pages for each job description that you want to hire for. So because, you know, I wanted to hire for a, psychiatric nurse practitioner, and then a child therapist, a couple of therapists to separate web pages so that they can show up in searches. the day after I created my psychiatric nurse practitioner, I got an application from one that I ended up hiring. So that was very effective as well.

Joe Sanok 00:31:02  Yeah. Sarah. Matt, what about you guys? You you haven't had a chance in a little bit.

Emily Runyan 00:31:06  Yeah. So can I ask.

Dr. Sarah Bren 00:31:08  What, what types of clinicians are you looking to hire? Because that's also kind of a kind of a factor to consider.

Speaker 8 00:31:15  in terms of their niche.

Dr. Sarah Bren 00:31:17  Know in terms of like master's level, doctoral level, early career, experienced training.

Speaker 8 00:31:25  Mostly early career, master's level.

Dr. Sarah Bren 00:31:29  Provisionally licensed or fully licensed.

Speaker 8 00:31:32  I'll take a provisionally licensed. I even have a there's a clinical supervisor that's just renting office space for me right now. So I think I could have that supervision covered.

Dr. Sarah Bren 00:31:42  Fantastic. So so because when I so our practice does sort of two different ways of recruitment. We recruit for fully licensed, more seasoned clinicians. But we also have a training program. And that kind of our training program, it's post-doctoral provisionally licensed clinicians and also master's level interns. and so for the master's level interns, they don't have a provisional license. So that we're looking to connect with schools. but if you want master's level provisionally licensed, which we also have, but they've sort of graduated up to that point. we didn't recruit for those positions, but, another good place to look for is like, training programs and kind of postgraduate programs. So like if you are connected with your local clinics and your local, hospital systems where you might have trainees running through, they might like their training director is probably helping those graduates find placement and stuff afterwards.

Dr. Sarah Bren 00:32:48  And there's usually listservs that kind of circulate inside of those programs. So to connect with training directors at internship programs, you know, practicum programs and just letting them know, hey, we're hiring. Hey, we're looking to build out and I think a really important thing to you want to speak the language of the clinic director or the you know, they want to know that the people that they have trained are going to be still getting the kind of like quality training and support that they've been kind of giving them. So highlighting this is the supervision. These are the didactic we offer. This is the professional development we offer. How am I supporting these clinicians come into a space where they're going to continue to grow professionally and clinically. You're going to get a lot of, you know, people want to put their students in places that aren't going to just therapy, build them out. And so you can highlight what you're providing in terms of clinical supervision and support. Those directors of training programs are going to be more inclined to be like, oh, I heard about this and pass it along.

Joe Sanok 00:33:49  So I think that's such an important point in connecting with grad schools, because when I had mental wellness counseling, we didn't have the capacity as a private practice to do internships, but I would speak in the classroom about private practice every single semester. And every semester I would have 2 or 3 people come up to me and say, my dream is to work for mental wellness counseling when I graduate. And I'm like, here's my cell phone, let's keep in contact. I can help you with internships, and we can talk about what kind of trainings you want. So then when they were done with their internship, they'd always join my supervision group. And then in there I could kind of foster them to join the practice. And so having this kind of long tail approach of making those connections early on with students, I think is so important. Matt, anything you would add to that?

Matt Fowler 00:34:33  I would say the, the what you do for your own networking too is pretty important. so I've been involved in a lot of the mental health community for a while here in our state, and in particular with our marriage and family therapy community, and doing a lot of a lot of work with them.

Matt Fowler 00:34:47  And I've just found that, you know, not like as you get to know a lot of other people, that it kind of come up into the field. I've gotten to know a lot of other group practice owners, and just through that, people just sort of learn who you are, who your reputation is. So, so yes, we've found a lot of people through indeed. And that's been and that's been great. People also filter through us that way just by our reputation. So I know I've had people who have reached out to me before and they were a fantastic candidate, but just not a good fit for for what we do. And I've been able to, you know, reciprocate that and be like, but there's this other group practice that I know in the area that's fantastic. Let me help you and support them. And, you know, they've kind of referred people our way that are a better fit for our practice. So in networking with people in the area has been has been huge for our practice.

Joe Sanok 00:35:30  So awesome. There's a bunch of comments also that other people on our panel put in the chat. So, you know, things like LinkedIn and other places that you can put that you're hiring. let me share with you just the way the staff wage calculator works. This is something we put together for our consulting clients. so the way it works is you walk through, like, total staff. How many total full time staff do you have? So if you have two part timers, you can kind of do the math on that. What's their average reimbursement rate going to be or what is it. Total sessions. and then how many weeks per year. Then that's going to figure out the annual gross per clinician. and then as we start to add in some of these costs. So thinking about admin, you know, how much do they get per hour? How many hours do they work for? How many weeks? How much does that cost per year? Thinking about a supervisor. So is there a supervisor? Is your time? Is the owner.

Joe Sanok 00:36:14  If you're doing, you know, say, you know, three hours a week working on that. We want to make sure that we're counting that time, you know, as time that you're not just donating to the practice. So say you're making what would it take to replace you as a CEO, not as a clinician. You know, maybe that's, you know, 100 bucks an hour. If we had someone that was CEO level that was running this practice full time. So to then be it'll do all the math for you and then some of the other things that you can add in here are your like annual marketing budget insurance. If there's a percentage, rent it miscellaneous because there's everyone has all sorts of different other things that they would add in. Then what you can do is you can toggle it by hourly or by percentage, and it'll do it for you. And so this all changed then once all those numbers are in there, so then it tells you what is your profit margin. How much are you actually taking home.

Joe Sanok 00:36:58  What's your gross revenue. What's your net profit. How much are you making per clinician with this? So it's a really just important way to think about how we're doing our percentages. Because sometimes we can say, hey, I want to really like help my clinicians, like have a good, you know, living and all these things which are good. We want that for people. But then if you're working 50 hours a week and you're making less than your clinicians, like, that's not okay too, because you're taking on a ton of risk when you're starting a practice. So just really kind of helps you with that. Let's let's dig in to, a few more questions, for from our, community and for the five of you. let's see. So next question. My tax guy told me that being an escort is better from a tax perspective. so anyone want to weigh in on that? I know that I've heard that from my tax person as well. Of course, none of us are accountants or attorneys, but, is that something that, you know, 1 or 2 of you could weigh in on regarding, how you think about taxes?

Dr. Sarah Bren 00:37:58  The one thing I would say And again, I would really I think if this is where it's really important to go find your team because you could spend a lot of time.

Dr. Sarah Bren 00:38:08  I mean, I personally when I started my private practice, I didn't I tried to DIY it and I ended up with an LLC when I need to have a PLC because I have a professional license in my state, you have to have a PLC. So I find that honestly the best thing to do is to really like there are certain things you just outsource and one is when you're incorporating, get a lawyer who knows what they're doing, who can help you figure out what's required in your state with your specific license, with the company you're trying to build, because you can waste a lot of time and money if you don't know what the you don't know what you don't know.

Joe Sanok 00:38:44  So I'm really glad you said that. And even like Tracy's saying in the chat, you know, in California you can't have an LLC. And it's like, yeah, you need to do it right in your state. I filed with, an online filer. I won't say them. and then, I ended up working with an accountant, probably four years after I had filed my LLC did like, you know, TurboTax Home and Business.

Joe Sanok 00:39:06  The first year when we restructured it. It saved me about 15 grand in taxes. It was just like, oh my gosh, that is not worth the $199 I paid TurboTax to do this, to not get any advice. And so I'm with you when you when you have a group practice, it's just worth it to have a accountant that knows it, to have an employment attorney that you can call if something happens, all those different things. So, awesome. Let's see. we have Joe's done some great trainings in circle to help you find your team. Thank you. Sarah. Appreciate that. let's see. So, Daniella says I am more of a coach and educational therapist, so I don't need a license. And I would like to hire a individuals under 1099. Daniella would love for you to, unmute and come on. And maybe if there's some follow up questions, I bet the panel has some ideas around that. If you're willing to to have us put the spotlight on you.

Emily Runyan 00:39:56  Hi.

Emily Runyan 00:39:57  How are you? So, basically, I left the school system.

Speaker 9 00:40:00  I started a practice, like, 30 years ago. I get more people than I could possibly take. I created programs, I just need people filling seats to be able to deliver. And because I don't need a license, and I just wanted 1099 and being bring people in using, profit sharing or something like that would LLC s corp like what would be the way to envision something like that? I'm looking for people to be able to grow themselves, but at the same token, have a platform because I'm finding people in my line of field, they don't necessarily have a process. And so for everything and I just think, I like the way I do things and I, I would like more people to be able to get help because I can't service people wait for months. And it's, it's my lack of, business savvy and understanding how to grow and how to hire, So. But would you be an LLC? Would you do s-corp if you're 1099? You know what I mean.

Speaker 9 00:41:00  And there's no licensure involved.

Joe Sanok 00:41:02  Let me actually jump in here first. And then if, the five of you have extra things you want to weigh in, I want to just clarify a couple of terms. So you use three different terms that have three different areas. So first your LLC for example, that's your business structure. So that's protecting you from a personal lawsuit. And again I'm not an attorney or accountant. Consult your own. But my understanding of it is that, you know, if someone sues my LLC, they also aren't they're not able to sue me personally. So that's your your business structure. what's corp C Corp, you know, sole proprietor. Those are all legal taxation terms. And so it's how are you taxed. So you can be an LLC filing as an S corp, meaning you're paying taxes as an S corp. And that's where that's about the level of my knowledge. And then that's where I'm going to take.

Speaker 9 00:41:48  Oh I get it. Yeah.

Joe Sanok 00:41:49  So so and then the other side the 1099 versus W2.

Joe Sanok 00:41:54  That's the structure of the relationship you have with your employees or your contractors. And so employees are W2 employees. You're paying different sets of taxes. Contractors are pretty independent. So I think for you, and I'd love to hear what the five of you think. It sounds like what you're talking about is having people learn your model, follow that model, and that somehow makes you money. Is that an accurate, quick assumption of kind of what we're talking about?

Speaker 9 00:42:21  Yeah, use my platform in my program, as a way to help guide therapy so that we're all talking the same language and it's done faster.

Joe Sanok 00:42:31  Yeah. So I think asking yourself, how much do you want to manage people? So if you want to manage people, have them follow your ways. Like you have to do it this way. That's a little more W2, if you want them to be able to show up. And sometimes they use what you're saying and sometimes they don't, that's a little more. 1099 I think there's a third option we haven't discussed.

Joe Sanok 00:42:49  And that's you creating a certification program where people go through saying e-course and then they're required to say monthly, do supervision with you or have some sort of annual certification where it's sort of like, you know, the governments have their level one, two, three Gottman certified therapist. You could create something like that, that then they would go just run their own business, but with your model and have fidelity to that model where you don't oversee them. So that's what comes to mind for me regarding Danielle's question. I saw Emily. You unmuted? did you have extra things to add to that?

Emily Runyan 00:43:21  Oh, you did a great job. covering that. The only other thing that came to mind for me was that, from what I understand. correct me if I'm wrong, and it could vary based on your state, but, you know, in a 1099 model, each, contractor really should have their own LLC. Your, your, you know, hiring their LLC. So that's something to consider too. They need to be their own entity that you're contracting with.

Emily Runyan 00:43:47  If you do. 1099 at least in my state.

Speaker 9 00:43:51  Okay. Yeah.

Joe Sanok 00:43:52  Yeah, I think I required when I had because I had 1099 and I actually wouldn't do that if I were starting a practice now just for myself in Michigan. and for retention. But I required people to have an LLC that I paid that I wouldn't pay them directly, I'd only pay the LLC. So that was part of our contract.

Speaker 9 00:44:07  Well, so here's the question. The question is, if you're starting out, the only reason why I wanted 1099 is because, I don't have the money to be able to start supporting having full time. And they get the freedom. They make their own schedules. Just give me a calendar and say this. When I'm available. This is my perfect schedule. but because a lot of people just don't have a process, it's I just want to give them, like a basic process so that the executive functioning is, you know, accomplished faster. So how would you onboard more clinicians if you're trying not to hire them full time, since people who come into my office, I can get the midday day clock for what I do, but most people couldn't get them in until after three.

Joe Sanok 00:44:57  So what you're saying, I don't think is going to be solved by ten, 99 or W2 and you know, any of the five of you can push back. because you can have a W2 that you pay hourly or that you pay as a percentage as long as it's above minimum wage. So, I mean, you don't have to have someone be a full time employee from the get go. You could have someone that's hired it. You get paid $50 per hour. You know, when you're doing this work. All the money flows through the business. We set it up with a W2 with like gusto to have all the payroll done correctly. and then when the money comes in, they get paid in the same way that if someone you know works at an ice cream shop, you know, they're not hiring people full time for the summer, they're getting $16 an hour. So, same sort of model where they're just a part time employee. other other things that you would weigh in on, that comes to mind for the five of you in regards to Daniella.

Joe Sanok 00:45:45  question.

Dr. Sarah Bren 00:45:46  One, One thing I think is important when you're trying to decide 1099 versus W2 is this comes up a lot with like, I think the common misconception is that what you're not, Joe, is that if you have W2 employees, that means that we salaried and you you know, when you have professional license, people will either way. But like if you have professionally licensed employees, there's like piece pay, piece rate pay, which is different. Like that's sort of what we kind of call fee for service. It's not hourly but it's not salaried. It's they're getting a, a piece of the rate that is built by the practice for the work that they do. and that can be W-2 or 1099. That's you can give that kind of compensation model to a W2 employee, and you can decide if it's part time or full time. so our practice typically works by employing all w-2s who start out at part time, and once they hit a certain threshold of cases per week, they can move to full time.

Dr. Sarah Bren 00:46:53  And their the pay is based off of a piece rate pay. So they make a it's the same as a fee split. It's just a different way of describing it. Like they make a piece of the rate and we present it as a flat rate, not a percentage, though it's calculated off of a percentage. So I think people think that W-2s mean they have to be salaried or hourly, and that's not how it has to be. You can have ten, you can have W-2 employees and pay them in this sort of piece rate way.

Joe Sanok 00:47:22  Awesome Daniella, thank you for that question. And you know this this is the kind of conversations that we have, you know, when we're in group practice boss and group practice launch where, you know, we don't ever claim with practice the practice that we have the corner on information, we believe that a community of people is going to be more vibrant and smarter collectively than any single one of us could be. So, you know, even Sarah Sara breaking down, you know, piece rate pay.

Joe Sanok 00:47:46  you know, I had heard that I, she did a better legal description than I would have done and made this webinar even better. So same with the the other five panelists that have joined us. one question, and I see that some of the panelists are putting it in the chat is, what's your favorite business book or finance book? So if each of the panelists, if you could just type that into the chat as to your favorite business book or, money book. So, I want to give each of you, just a chance to maybe give just like a 1 or 2 sentence. just answer to, what do you think makes people successful in group practice? Let's see. Daniel, we haven't heard from you in a while. in a couple sentences, what does it take to be successful in group practice?

Daniel 00:48:31  I think that if you're going to open a group practice, you're going to need, to, to learn leadership, and, management skills, Girls. Unfortunately, I think the hardest part about it.

Daniel 00:48:45  You've got to be ready. and people say this, but, I think the most challenging thing for me was when, I had to let somebody go. Yeah. it was really emotional. and I'm really thankful for my coach, you know, helping me discern, like, okay, like the character or the stick, you know, how harsh, like, am I overreacting? These are all these questions that come up that I had to learn and navigate. where do I set my boundaries? Where can I be more lenient? and, how can I make sure that everyone knows what we're doing, our values, and everyone's on the same page with our values? because it's such a responsibility. Because each, you know, it all comes up in every single issue that goes up the chain. That's going to be the most complex issue for you and you. You have to decide it, and it's never an easy question or else it wouldn't have come to you. and that's just part of leadership. but if that's your cup of tea, then I would say it's very rewarding, to be able to reach out to the community in a way that has just a little bit of influence for good.

Joe Sanok 00:50:13  Awesome. Thanks, Daniel. Who do you want to pass it to?

Daniel 00:50:17  let's pass it to Christina.

Joe Sanok 00:50:18  Christina.

Christina Blanton 00:50:20  Oh, so I think what makes a person successful just looking at my own journey is having a system in place. And that's why we started with group practice launch a year ago and continue with group practice sponsors having a system, and then the consultation piece in there because you don't know what you don't know, and having other people to lean on and help you figure out some of those hard questions that come up and you know it's not something that you've planned for and really, you know, like Daniel said, having to dig into that leadership side and figure out how do I make these hard decisions. And having other people as consultants like can be incredibly helpful. Also, knowing your why because it's nice to do group practice for the financial piece. But I mean, it can be so emotionally taxing and challenging. And if I didn't have my why solidified, I would have given up. because it is hard.

Christina Blanton 00:51:14  And you know, I know it's like it is worth it, for me, because I know my wife grounded in that and just that effort and discipline. I think also, whenever it does get challenging or like, okay, like, this is rough. so systems and consultation and then knowing your why and that consistent effort. I think that's what helps a person be successful.

Joe Sanok 00:51:38  Awesome. Who do you want to pass it to?

Christina Blanton 00:51:40  let's go with Sarah.

Dr. Sarah Bren 00:51:42  I have two things. One is to really be intentional about building your team. You want to really you. It's so much harder to take. Kind of like Daniel saying it's much harder to take away, than it is to just really add intentionally to begin with. And like that goes for clinicians that you're bringing in administrative support, eventual leadership. and then you're outside of your practice team, like your accountants and your bookkeepers and lawyers, like, these are really important, intentional pieces of the puzzle. And having a really solid team that understands what your vision is, what you're trying to do and has buy in into what you're building is really important.

Dr. Sarah Bren 00:52:25  And the other piece that I thought of, because I was thinking about my bookkeeper, who was like, I couldn't run this business without him, is you need to know your numbers. Like you need to look at your numbers. You need to know your numbers. You need to understand what your profit margins are. You need to understand what is coming in and out of the business in terms of your finances. You need to know cash flow. This is like not stuff they teach us at all in grad school. And like, yes, leadership soft skills can be kind of extrapolated from a lot of our clinical knowhow. But business and finance and numbers like you have to kind of be willing to learn that stuff, because even if you outsource it to a bookkeeper and an accountant, you have to understand what's happening to make a lot of these on the fly decisions and to have long term kind of plan for where you're going. So, yes, have a great team that you trust and who gets it and know your numbers.

Joe Sanok 00:53:20  So awesome. All right. Who do you want to pass it to.

Dr. Sarah Bren 00:53:23  I'm going to go with Matt.

Joe Sanok 00:53:24  All right Matt.

Matt Fowler 00:53:26  So quickly I'll I'll echo the intentionality that Sarah just talked about. Like, I think it's really important to be intentional. But then on the flip side of it, you know, it's really important to get comfortable with being uncomfortable. At the beginning, when I started my practice, I saw this and it pops up into my head all the time. It was a it was a meme, and it was of a man strapped at the front of a train, building the tracks as he was going. And I always think about myself in a business every single day. Like some days that's what it is. And so, you know, being intentional is important, but also some days you're you're building the tracks and just trying to keep things on track. So learn to be comfortable with that.

Joe Sanok 00:54:00  Love that. Emily, wrap it up for us.

Emily Runyan 00:54:03  Okay? I echo everything everyone has said, and I'll summarize it like, you know, you are now a business owner, and so your business owner, first clinician, second leader, you know, all the things come secondary to being a business owner.

Emily Runyan 00:54:18  So get very, skilled, create the team. Like Sarah was saying, to be able to get a team, to get skilled at, you know, systems, numbers, think like a business owner. And if you it's a skill that you will grow into. So get the support you need to be able to grow into that.

Joe Sanok 00:54:34  Awesome. If all of you could just go down to react at the bottom and pick a emoji, that to you is your reaction to these panelists. And I'm going to do rocket ships because you're helping us all just like blast off. got some clapping. Got all sorts of things coming in. So awesome. All right. Thanks all of the panelists. Thank you all for joining us. Talk to you all in half an hour. Thank you so much for listening to the Level Up Week series. I hope you are getting so much help out of this. If you need extra help, head on over to practice of the Practice Comm forward slash apply. I would love to spend 30 minutes brainstorming with you as to your phase of practice, and helping you determine whether a membership, community, or consulting is right for you.

Joe Sanok 00:55:25  Again, that's practice of the practice comm forward slash apply. And we couldn't do the show without our amazing sponsors. You know, I wish I had a better online library of evidence based resources to use in my practice and psychology tools is the place to get that. Psychology tools is a smart business tool also, that helps you with productivity and efficiency while giving your clinicians and yourself better quality materials to give your clients. You can get 20% off new subscriptions over at Psychology tools.com/joe and use code Joe 24 to get 20% off of any new subscription. Thank you for letting me enter your ears into your brain. Have a great day. I'll talk to you soon. Special thanks to the band silence Sexy for that intro music, and this podcast is designed to provide accurate and authoritative information in regard to the subject matter cover. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.