Meet Elizabeth Oldham

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Org or email them partnerships at. Thank you life. Org thank you. Life healing through accessibility. This is the practice of the Practice podcast with Joe Sarna, accession number 1042. Joe Sanok 00:01:28 Welcome, everybody. So excited to have you here today. with our group practice panel. We’re getting started in just a moment here. really excited to have you here and our panelists here as well. we’re just going to make sure everything’s going like it’s supposed to. Looks like it is. So, Welcome. I’m Joe Sana. I found a practice of the practice back in 2012. back in 2012, I had a small side gig counseling practice called mental wellness counseling. I started it, seriously, just to pay off student loan debt? I was thinking, if I can make an extra thousand bucks a month, then maybe I can be able to, you know, pay this down a little bit faster. And so got that going and was supervising somebody that then, he said, hey, can I, can I work with you? Because I was just his clinical supervisor and like, I have no idea. So I had a friend who was an accountant and he said, oh, yeah, you could do this 1099 instead of W-2. Joe Sanok 00:02:25 And I was like, okay, that sounds good. I literally just had no idea what I was doing, and just luckily had a couple friends that gave me a little pieces of advice and just proceeded until apprehended. Well, in 2019, I sold mental wellness counseling to one of my therapists, Nicole Ball. you know, at that time we had 13 clinicians entirely private pay. And then now she has three locations. She has taken it to levels that I had no desire to work on. I just loved doing this podcasting stuff. So I started the podcast in 2013, really to just learn as I was growing my practice and over time, developed into quite a consultant and helping people grow their practices in a variety of different ways. So now I get to do that. I have a podcast that gets about 70,000 listens per month. I’ve written a couple books. one comes out in May through Harvard Business Review. It’s going to be in airports and all over the place. so that’s pretty exciting. I’m also a dad. Joe Sanok 00:03:14 So, we have our panel we originally planned on having three people. Heidi got called into court yesterday for a client issue. and so, wanted to introduce our panel. Let me pull up their bios. Don’t want to miss any of the major things here. so we have Sherri Merriman, who has 20 years of experience in private practice management and health care administration. She’s founded two group practice collectives, Iridescent Care Collaborative, her dream clinic, which gives providers both community and autonomy so independent practitioners can live their dreams within a supportive setting. And then also we have Elizabeth Oldham. Elizabeth is the co-owner and founder and CEO of Transform and Renew plc. She and her business partner, Amy Rhodes, founded Transform and Renew in 2022, with the goal of reaching more clients while making a difference in the lives of their clients. Now there’s a lot more I could have read there, and we are going to, bring these two panelists, onto the spotlight. So let me add your spotlights here. Awesome. Welcome. Joe Sanok 00:04:21 Sherry and Elizabeth. Sherry, let’s start with you. why did you start a group practice? Tell us a little bit more about your practice and why you got it going. Sherry Merriam 00:04:30 I started a group practice because. Oh. Hello, everyone, by the way. I started a group practice because I had a lot of experience in running clinics and in medical education and healthcare administration before I became a therapist. So I knew how those kinds of places ran at least a little bit. And then once I became a therapist and started working for other people’s group practices, I mean, frankly, I thought, well, I can do at least as well as this. Probably better. like probably a lot of us have that kind of experience, and I’ve worked in some okay environments and I worked in some fairly toxic environments. And also, I’m the kind of person I prefer a lot of autonomy. I don’t like people telling me how to decorate my office, or what kind of hours to work or what kind of clients to see, and I wanted to create the kind of space where other people would have that option as well, but yet still be able to, like, live their dream of working in a private practice like group environment. Sherry Merriam 00:05:26 And so I wanted to create a an environment where people could have like the best of both worlds. Joe Sanok 00:05:33 So awesome. Elizabeth, tell us a little bit about you starting a practice. So you’re in a partnership with it. Tell me about how you guys decided on that. you know, how did that launch? you know, some people do that, some people don’t. So tell us a little bit about your group practice journey. Elizabeth Oldham 00:05:47 Yeah, it was really out of necessity. my business partner actually was subleasing from me, and, you know, towards, the as things started slowing down with Covid. we were just overwhelmed. we still had so many requests and had we both had huge wait lists for people who wanted to come see us. so, we started talking about, well, how can we do this better? How can we get more people helped? You know, we’re in one of the fastest growing cities in the United States. and the need is huge. And so, after several great conversations, we decided to partner together, and really, use our different skill sets and our different talents, to do a better job with a group practice. Joe Sanok 00:06:34 That’s a great intro with the two of you. so welcome, everyone that’s here. if you have questions that are just quick questions, just drop those in the chat. and we’ll answer those. This is a panel. So, if questions don’t come in, I’m just going to follow my curiosity and ask these ladies some, some questions about their lives and about their group practice and how that looked. If you ask questions, usually what happens is it’s a little slow at the beginning that we get to the end. We can’t get to all of them. So please make sure you’re dropping those questions in. Also, if you have a question that might need a little back and forth, just virtually raise your hand at the bottom. You’ll see reactions just to raise your hand. That’ll tell us that you’re willing to ask your question and have your audio turned on, and maybe your video so you don’t have to turn your video on. But we will bring you up with the panelists just to ask that question. Joe Sanok 00:07:20 So maybe you want to dig in a little bit. Maybe you want some, just like, how would you think through this situation? This is a chance to pick the brains of some group practice owners. Now, Sheri, your practice has a very clear niche in a lot of ways, and I would love for you to talk about that niche, how you decided on that niche. And just like, like how just how that’s helped you grow the practice faster. Sherry Merriam 00:07:41 Oh, yeah. That’s been a lot of fun, actually. So I’ve been a therapist for 15 years, and from the beginning I have worked with, what I like to call misfits and sensitives. So people who don’t fit into your standard, mainstream society. And so I work with a lot of outsiders, kinky folk, poly folk, science fiction geeks and nerds. people who, consider themselves sensitives or psychics. Activists. you know, also a slightly more mainstream, like health care providers. but people who just maybe would have a hard time feeling like they might fit in with, like, your average standard therapist. Sherry Merriam 00:08:26 I was coloring my hair long before it was, like, fashionable or more mainstream. And so they would see me with my, you know, pink or purple or blue hair and go, that’s my therapist. And I had no. Joe Sanok 00:08:37 Hair in college and had blue hair. My friends called me Madonna because I changed it so much. So I get it. Sherry Merriam 00:08:42 Nice. Exactly. And so I have an ability to put those kinds of clients at ease, you know, very quickly. And so words started getting out in our community. And so I was able to build up my practice really quickly, and I was able to find group practices to work at that, were supportive of that, and then network with colleagues who were also interested in those niches. And so that’s what we really specialize in at our location, is making sure that those folks know that you have a place here. Joe Sanok 00:09:18 You know, one question we got on Tuesday in the Stata group practice panel and some of the other ones, this has come up a few times is oftentimes you start with a vision for the practice yourself. Joe Sanok 00:09:29 And then at some point you kind of got to decide do I stay only in that niche. Or is that something that I have individual clinicians that are kind of known for that super power? and so I think the example was, there was someone that had an eating disorder clinic and they were really well known for that, but then they were getting referrals for anxiety and other things. And she was like, should we stay like this eating disorder clinic or should we brought in? How have you thought through as you’ve grown your group practice, how to keep the DNA of that kind of misfits? that compared to like, you know, if there’s other clinicians you may want to bring in that maybe don’t fit that, like, just how do you keep that DNA? How do you think through niching all of that. Sherry Merriam 00:10:07 That’s a great question. I think that I think I’ve been thinking of it sort of like on the macro level of, like the micro level of my own niche, like maybe these are the people to whom I market, but you’re going to pull in other people who maybe don’t exactly fit within the little boxes that you’ve defined in yourself. Sherry Merriam 00:10:25 But if they come in the door and you hear their story and you think, okay, well, that sounds like fun, that sounds like something that I’m totally competent at and would love to work with. I think when those therapists come with those sort of broader interests and show up and say, hey, I’d love to work here. I love what you’re building. your specialties may not be my specialties, but I’m still going to have something to contribute to consult. And I still love to hear what you want to talk about at consult then that sounds great. Like we’ve had several therapists joining the practice who, come in the door saying, I don’t know anything about these specialties that you’re talking about, but I’m open minded. I’d love to learn more. And then I can handle the folks who come in the door who maybe have these, like, adjacent things or very different things. And that’s been really nice, because then we’ve been able to handle more like family groups and do more collaborative care. And so we’ve been able to, take care of those kinds of things by spreading out a little bit. Sherry Merriam 00:11:24 So we’re not super general broad. We still have very much a defined niche, but we can cover most things that come in the door. Joe Sanok 00:11:35 Okay. Awesome. I think one thing we often talk about in group practice, boss, is people will assume that a specialist can be a generalist, but they won’t assume a generalist will be a specialist. And it sounds like that’s really what you’re digging into there. Elizabeth would love to hear a little bit about as you think about like, those early stages of starting a group practice. Like, what do you wish you had known? What? What, like, like just, you know, what did you do? What do you wish you hadn’t done or wish you had done early on in those first, say, six months? Elizabeth Oldham 00:12:07 There’s a lot of questions there. Yeah. in the first six months, I think, the things we did well was we figured out our talents. read the prophet first book, right away. There’s actually a prophet first book for therapists now, which, I’m starting to dig into, which, you know, is helpful. Elizabeth Oldham 00:12:29 absorbed, you know, your podcast, any other podcasts, anything that was out there for people who had been through it before? we really tried to absorb those things, so we at least knew where to start. things we did poorly in my mind, is our first, 1099 person that we brought on. we were just so overwhelmed. We just wanted someone, just pretty much. And we thought the person was going to be a good fit. and they weren’t, and they weren’t sort of the kind of people that we are, like, they weren’t very motivated. they weren’t very tech savvy. and it just was a bad fit. So that was something that we did poorly. and then the other thing we did poorly is we, picked the wrong person to help us with our credentialing. and so we got some misinformation from that person. It cost us a couple thousand dollars. and, so we won’t make that mistake again. Yeah. Yeah. other things we did well is we looked at like, since we are an insurance based practice is like, who? What are the big insurance companies that are here? What are their big organizations? What insurance do they have? to really make sure we weren’t wasting our time and wasting our money credentialing with companies that we weren’t even going to get anybody. Speaker 4 00:13:53 Awesome. Joe Sanok 00:13:54 All right, so Ryan just raised his hand. I’m going to ask Ryan to unmute and if possible, start video, and then we will, bring Ryan on up here. What’s up Ryan? Speaker 5 00:14:05 Good morning y’all. It’s a little crazy. I’m making breakfast for my two under three right now, so I apologize for any of the robots and Pegasus toys. so I’m in this interesting spot, where I’ve transitioned solo practice into a group practice. I have I have one associate. I have two more associates who are interested and the direction I want to go. I’m kind of burned out on the therapy bit. I’ve been doing therapy now for seven years. I love the coaching. I love the I love the clinical coaching, the mentoring, the supervision part. And so I’m trying to noodle out how do I build a practice that gives my associates enough agency and autonomy to do what they want to do? And then we really are going to focus on the self of the therapist. And how do you enter into this work in meaningful ways? I’ve kind of niched myself in this generalized area of, hey, give me your hardest clients. Speaker 5 00:15:15 and so all of my colleagues in the area, I started in a mental health area, and, so all of my colleagues in private practice when I went into private practice just gave me all of their hardest clients. And I’m wondering, pros and cons. We touched on this a little bit, with you sharing in your answer pros and cons of expanding my niche out, to just really allow my incoming clinicians to to market for whomever they really want to work with and allowing them to guide into that, as opposed to continuing to keep like website and marketing material directed towards what I’ve been doing and then allow them to be complimentary. Essentially, do I change my website? Do I change how we, kind of work the SEO algorithm? All of that fun stuff. I would love your thoughts on that. Speaker 4 00:16:12 Yeah. Awesome. Joe Sanok 00:16:14 How would you to think through that? Sherry Merriam 00:16:16 So I’m wondering, Ryan, is there a theme or a niche that your staff like your your associates have that’s different or or more complimentary to yours. Speaker 5 00:16:28 Not necessarily. No. the guy that I currently have, he’s really great, and he’s stepping into the field kind of just with open hands. What do I want to do? Where do I want to go? we do a lot of work with couples. and he’s he’s wanting to get, his feet wet in that, you know. go ready? And then, the other gentleman is getting ready to hop on board. Wants to also work with couples, so I think I’ll keep that. sorry. I lost my train of thought. so it sounds. Sherry Merriam 00:17:07 Like they both have couples. Speaker 5 00:17:09 Yes, both have couples. however, one of the guys, I. I do a lot of work with men. One of the guys, because of some of his, story, he’s got a lot of pain with men around his dad. And so he has this, he’s eager to try some new things, but he kind of has this pullback. And my website, I tried to really niche into the men demographic because I’m in an area, you throw a dart in any direction, you’re going to hit 30 therapists. Speaker 5 00:17:40 there’s not a lot of therapists who will work specifically with men and are geared towards that. So I’ve found a lot of success doing that. There are parts of that that make him a little bit uncomfortable. uncomfortable is too strong a word. He’s just nervous. Right. To jump into that. So wondering. Okay, hey, do I revamp my website? Do I kind of expand this, to more inclusive male and female type of marketing content to make him feel a little bit more comfortable? Pros and cons? Does that that help guide that? Joe Sanok 00:18:15 one quick thought that I have on that, I remember I had a clinician that was coming in and she didn’t like the office that we had. We had a one office suite. There was four of us. We were sharing it, and I let her come with me to look at all the offices to make sure she was happy. And then and she didn’t even have clients yet. And then we upgraded to this four office suite. It was more expensive than my mortgage. Joe Sanok 00:18:37 beautiful office view of the water. And three months later she said, you know, this just doesn’t make sense for me. I’m an I’m going to just go do my own thing for you to take a percentage. So I would just caution anybody, don’t make business decisions based on trying to keep or please people that are in your business if they aren’t a fit. they’re not a fit. That doesn’t mean they’re bad at therapy. But if like if you can’t see half the population because of your own trauma with your dad, that’s probably some work that you need to go do before you start working with anybody. Because it may be couples, it may be men. So that was one thing that came up right away. Was that story about that person, me literally signing a mortgage for or a rent for five years at a massive loss. So at least initially. But anyway, ended up hiring 13 people though. Sherry Merriam 00:19:22 So yeah, I was thinking something similar, like, I would want you to be guided by your own instincts, Brian, and not by those of your associates. Joe Sanok 00:19:31 Yeah, yeah, if it’s working, I mean, I’d say keep going with that. Elizabeth. How would you think through that, that situation that Ryan brought up for us? Elizabeth Oldham 00:19:39 we’re actually sort of working towards that. So we’re trying to fill in our gaps. So, for example, I don’t like to work with couples. I don’t like to work with kids. but those are areas that, you know, that people are other people are passionate about. So we’re actually trying to fill those gaps with the people that we bring in, people that specifically want to work with couples or want to work with children. and that’s how we’re marketing and our website talks about each individual person. And as we add someone that has that different, skill set, then we advertise it and we blast it out on Facebook and social media that, hey, we’re now serving kids or we’re now serving couples or we’re now, you know, have weekend appointments, you know, whatever the case may be. Speaker 4 00:20:25 I love that. Joe Sanok 00:20:26 The two of you have very distinct ways of thinking about this. That Sherry is definitely more in the we want to really help these, these misfits and have that niche. And then it kind of expands out from there. Whereas you’re saying, you know, each individual kind of has their own superpowers within this collective. Neither one is right. I think looking at your market, what’s working and then you as the person running this, what do you want? So Ryan, if more comes up for you, definitely raise your hand. Again, thanks for being the first one to, to kick that off for us. We have a question that came in in the chat, and then we’re going to go to Shay, who has their, hand raised. So next question is my question is how did you go about building your leadership team? I was small group teaching practice with the idea of transitioning interns to associates to licensed clinicians. My hope is that my licensed clinicians can take on more leadership roles. But what I’m recognizing is that not every licensed clinician is prepared for leadership or want to step into those roles. Joe Sanok 00:21:18 Should I be looking to hire externally or. Dot dot dot. Question mark. What a nice cliffhanger there on that question. All right. Speaker 4 00:21:26 Yeah. Joe Sanok 00:21:26 Elizabeth, let’s start with you on this one. Elizabeth Oldham 00:21:28 Oh that’s a great question again. So my business partner and I looked at our talents. And that’s how we made those two decisions. and then you know, we look for people, we have three things. We look for hungry, humble and tech savvy. Those are our three big things that we need from you to be, because, you know, if you’re humble, you’re teachable. If you’re hungry, you’re going to work hard. and obviously, tech savvy is just we all need to be that nowadays. but for leadership, we just, have looked for people that have that they have that hunger to know more, to grow, to understand. so we have an associate and we are an associate based practice, basically. and one of our associates is very hungry, but humble wants to learn, wants to help. Elizabeth Oldham 00:22:16 just dives in. She’s pretty self driven. and so those are the kinds of things that we have looked for, for leadership. And, and we will be bringing her up as one of our leaders. Hope that helps. Speaker 4 00:22:30 Yeah. Joe Sanok 00:22:31 Yeah sure. How do you think through that. Sherry Merriam 00:22:34 this is something a little plug that I found a group practice leader and group practice boss really helpful for. Because when I started that program, with Joe and his staff, I didn’t have any support at the time. And, man, did I need it. And so I found their guidance and encouragement and accountability frankly, super helpful. And I had a a fully licensed clinician working at my location who had been one of my supervisors at a previous site. She followed me when I opened the group, and she had made it clear that her dream was to run her own group practice someday, and she had demonstrated a lot of like get up and go, a lot of initiative, a lot of skills. And so I approached her and said, you know, I know you want to do this someday. Sherry Merriam 00:23:24 How about sort of a mentorship internship group practice leader gig where I take you under my wing, teach you everything I possibly can, frankly, underpay you to help me run this place while I try to expand what we’re doing here. And, And she leapt at the opportunity. And so now I just try to show her everything, that I can and explained to her, like I cc her on every email I send and try to explain to her every little thing. And I and I love that because then I’m mentoring her on her, you know, next level dream. And, and it’s great experience for her. And she is killer at everything I hand her and it’s a delight to shovel shit, frankly, off to her that I do not have time for. And and I’m getting so much more done thanks to that. And so in so really what worked for me was just watching and listening for people who showed those skills and for people who express that interest. Another way that I got that kind of support was going to our local university, and this wasn’t so much a leadership thing as an admin thing, but I’ll kind of throw it in. Sherry Merriam 00:24:33 is, bef like in our first year, I need I knew I needed some support, so I went to our local university’s, undergraduate psychology program, and I got an intern from there, which was super helpful. And, you know, this was someone who was thinking about going to grad school in counseling psychology. And I was able to, you know, again, mentor and teach and get some great support from somebody who understands social media a lot better than I do. So it was a huge help. Joe Sanok 00:25:02 That’s awesome. I put in the chat that every year we ask three questions from our staff, and the first is, what are you doing that you love? And this is this admin. This is, you know, consultants. And it’s become such a part of our DNA that really it’s a conversation that’s not just like once a year. So if people are feeling things shifting, they just let me know. Second is what do you want removed from your plate? So maybe as a consultant you used to love doing HR stuff with people, and now it just drives you crazy. Joe Sanok 00:25:26 In the same way, you might have clinicians that used to love couples work, but they’re burned out from it. Like, we want to know that because you know, you’re not going to be a good therapist if you hate that type of client. Then third, where are you growing and need training or opportunities? And so we’ve had people say, you know, I’d really like to get into video or I’d like to learn more about operations. Sam, our chief operations officer, started as a conference planner for Slow Down School that was hired for just two months to help with that event. and then she moved in to helping with podcasting, and then she handed that off because she was sick of it to Miranda, who was doing social media. And she moved into podcasting. And then she had to go get training on how to run operations and learn how to use asana and run a team. And so when you find those people, I wouldn’t jump from, hey, you’re a clinician to now, you know, be a whole clinical director, you know, take some steps to say, okay, let’s look at all the elements of a clinical director. Joe Sanok 00:26:14 Give them a few areas of responsibility, see where that’s working. Talk about what compensation looks like and then say, okay, now we’re going to level you up in a few different areas. And then maybe within six months we can have you at a clinical director level. also one thing that I always do with my consulting clients, it’s often one of our very first exercises is just the love hate list. So you as the owner, what do you love doing? Just make a list of all that stuff. What do you hate doing? is it the billing? Is it checking in on people? Is it, you know, when people haven’t done their progress notes in 24 hours, like you’re on their case, like those are all opportunities to say, you know what? We could have our admin follow up with anyone that is at 25 hours overdue for their progress notes. And if someone’s, you know, 36, 48 hours, you know, the owner is going to get notified, you don’t want that. Joe Sanok 00:27:00 That’s the thing. and so figuring out those automations of what you hate, but then what most people miss is on their love list looking at, should you be doing that? So I love writing a 2000 word blog post every single month. Are those 2000 word blog posts like actually bringing in clients is actually helping your SEO? Are we tracking that? And if not, maybe join a writing club and just go have fun writing in a writing club rather than doing these 2000 word blog posts. So even looking at the things that you love saying is this giving me an ROI on that time within my business because I could be doing that thing I love, just not for the business. Do you often find yourself overwhelmed by the influx of client calls you receive? Receptionists are expensive, but you can’t afford to let your patients go to voicemail. You care for your clients, so you try to phone them back. But more often than not, it’s too late. They’ve gone to another practice. When you partner with well-received, you capture every opportunity. Joe Sanok 00:28:07 Your calls are answered by professional medical receptionists 24 over seven, and they can support you with more than just message checking. They offer new patient intake, after hours service, bilingual services, medical appointments, scheduling, medical live chat, and so much more. All this at a fraction of the cost of an in-house receptionist. Your patients are well received priority as a practice. In the practice listener, you can get an exclusive 50% off your first two months of service. Head on over to well received. Com forward slash Joe to start growing your practice today. But Shea let’s bring you on for your question. And then we’ll jump over to the questions coming in in the chat. Thanks for those questions coming in. I’m going to bring Shay on. Hey, Shay. Speaker 4 00:28:55 Hi. Hi, everyone. Hi. Joe Sanok 00:28:57 Welcome. Glad you’re here. Thanks for coming to so many of these. Speaker 6 00:29:00 Thank you. and I appreciate you putting this on for the level up. The last time I saw you. We were at killing at camp in Colorado. Speaker 4 00:29:09 Yeah, it’s been a while. Speaker 6 00:29:11 So my question shut down. Yes. Right after, when Elizabeth spoke. I, I actually had the same experience with my my 1099. and it kind of stifled me after. So coming back in to try to do it the right way, if you will, or, you know, how did you get through that? What did you do different, to regroup and continue to move forward? Elizabeth Oldham 00:29:44 Absolutely. So, we redefined again what we were sort of looking for. The person that we had, brought in initially was retired military and was sort of just working part time. and, and we thought because of his age that he would just sort of be a perfect fit. Someone who still wanted to counsel but didn’t want to do the business stuff. Yeah. And that he didn’t want to do anything, actually. it was it was bad. Luckily, he left without us having to sort of force him. I mean, it was going to it was coming to a head anyway. Elizabeth Oldham 00:30:18 So, but he just pulled the lever first, which was good. and so we really sat down and revamped our questions for interviews and then what we were looking for. So that’s where we came up with the hungry, humble and tech savvy. that’s those are the three things that we look for because those take care of all the rest of it, really. You know, someone is hungry and humble. They’re easy to work with and, you know, and they want to work hard and and so that helped. And then we have just really, been very blessed because we have and I think it’s because in Texas there is a shortage of, supervisors. So we just constantly have associates and students reaching out to us that needs supervision. And so we just started asking them, okay, did you do you just want supervision or are you looking for a site? And if they are also looking for a site and just in that initial conversation on the phone, if it’s a good conversation, then we bring them in and we interview them. Elizabeth Oldham 00:31:22 and so that’s how we have gotten our staff. We actually are on hold right now because we are, we’re just so full. So we are we are waiting on I have three people that I have to call back this week to say, sorry, we’re not offering any more sites, but I can still do your supervision if you’d like. So yeah, but it’s it’s been great. So I think drilling down to what you really want and then making sure your questions fit that. Speaker 4 00:31:47 Okay. Joe Sanok 00:31:48 What’s what’s an example of a question in an interview that you ask that’s around one of those three characteristics. Elizabeth Oldham 00:31:55 we ask about like self-motivation. Tell us about self-motivation, your experience with self-motivation. we ask, what’s our therapist’s superpower? sort of. All of that from you? let’s see, what else do we ask for? those are a couple that, you know, drill down. And we do ask about technology and their experience with, like, electronic health records. So, like this associate. That’s a go getter. Elizabeth Oldham 00:32:19 She used to work at a chiropractic office, so she’s familiar with how all of that works and sort of how claims works and that kind of stuff, which is a real benefit. so we yeah, we drill down with those kinds of questions. Speaker 4 00:32:32 Awesome. Okay. Sure. What can you add to that? Sherry Merriam 00:32:37 gosh, I’m trying to think of I if I’ve had if I’ve been in that situation before, I the closest I’ve come is that I, so I before I opened iridescent this was back before the pandemic. I joined a, I co-owned a group practice. and that was not a great setup. I learned a valuable lesson of don’t go into a business partnership with business partners that you don’t know very well and have no reason yet to trust very much, and you don’t have a very strong relationship with. These were in some ways really good people, and in some ways not great people for me to be in a business relationship with. And, the only way I was able to recover from that eventually, unfortunately, was to leave. Sherry Merriam 00:33:29 So that that was a it was a very different situation though. So I don’t I’m trying to think if I have a good example of like a time when I had to, like, I haven’t actually hired many folks. My situation is a little different. And I saw that some folks had, you know, questions about like W-2 versus 1099. And my situation is a different setup in that I only have one 1099. And that’s my, my admin person. everybody else at my practice, our members, it’s set up as a membership. So they pay me a membership fee in order to get access to all the group practice amenities, including space and, consultation and all of that. Instead of me paying them as a 1099 or a W2. And I set it up intentionally that way so that I wouldn’t be their boss or their employer, or somebody who had to tell them how to do their practice or and, you know, that’s part of my model of like, I wanted to create that best of both worlds scenario of autonomy and support. Sherry Merriam 00:34:28 And we’re two years in. We’re seeing how it works. one of my challenges when I joined Joe’s programs was to figure out how to make it work in a very, like, financially rewarding kind of way because it’s a very different model. And so it it’s, it’s it hasn’t been tested a lot out there. and so we’re working on that and, Speaker 4 00:34:50 But, yeah. Joe Sanok 00:34:51 Teaching people how to do that membership model, that’s. Sherry Merriam 00:34:54 Yeah, that’s the goal. Speaker 4 00:34:56 Hey, thank you so much for your question. Joe Sanok 00:34:58 I really appreciate that. you know, one thing that comes to mind for me, too, you know, I’ve had some bad hires to, similar to if you have a friendship fall apart or, you know, relationship. Not that you need to jump right into a new relationship, but when you have a emotionally intelligent relationship or a friend that does have your back, and the best way to recover oftentimes is to realize that you can have better relationships. And so hiring again, getting good people in there, seeing what that’s like. Joe Sanok 00:35:26 you know, also, I think that normalizing it, like when you like statistically you’re going to have some really shitty hires, you’re going to have people that aren’t a fit. You do your best on the front end, things fall apart, you learn from it, and then you move on. And so I think that when you normalize it, it’s like, yeah, this is part of running a business. And so if you then get really gun shy and worried and stop, like that person has even more power now. And so I would say just push into it more. We have a bunch of questions coming in now. This is what always happens. So we’re going to do one more. Then I’m going to talk a little bit about group practice boss, because you both have referenced that. And then we’re going to dive into the rest of the questions. At what point do you need all caps a leadership team? How do you know when to implement your first leadership role? Sherry, why don’t you kick this one off for us? Sherry Merriam 00:36:11 Well, as far as, depending on what we mean by leadership team, as far as, like, my admin lead that I have right now or any kind of admin support, I would say, like the minute you open doors or decide to open doors in your group practice, because Because one thing I’ve learned from Joe and other coaches is that when you go from being a solo practitioner to a group practice, you have to stop thinking small and bootstrapping. Sherry Merriam 00:36:36 You have to be able to hand off a lot of these tasks. Yesterday I asked my my helper to order sugars. I can’t be the person ordering sugars for the clinic anymore. Somebody else has to order the sugar and And and in the beginning, I was trying to do all that myself. And it was a waste of my time. as far as other leadership team roles, I don’t have a good answer for that. Elizabeth probably does better than me. No. Elizabeth Oldham 00:37:01 I don’t I don’t know that I do, but I agree with you, right? I mean, you have to sort of look at your return on investment if you’re spending a bunch of money calling, you know, returning phone calls and that kind of stuff and not working on your growth or even seeing your clients because we, my business partner and I both still see clients. then you’re not making good use of your time. So having that. Speaker 4 00:37:24 Go. Elizabeth Oldham 00:37:24 Ahead. Sorry. Joe Sanok 00:37:25 Yeah I think definitely. if you didn’t watch Ashley’s presentation on how to get out of the day to day yesterday. Joe Sanok 00:37:31 that recording it’ll be live in a week or so. we’re going to clean them up a little bit. was really good. I think one of the things to decide how involved you want to be, if you if you really want to be a silent owner, you don’t want to be operator, you don’t want to be the clinician. You know, those are really the three roles you have. Owner. You’re just taking the money. You start a business. You’re not really doing much else other than taking on the risk of the business. There’s the operator. So you can be an owner operator that doesn’t do clinical. You could do clinical owner where you’re doing clinical work still maybe clinical supervision, you’re the owner, but then you have someone that does the operations or you can do all three. So deciding for yourself which of those three things you want. And then if you’re paying someone else for that, you know you’re going to be paying them, you know, for operations. So anywhere 40 to 75 bucks an hour, which if you’re billing out 200, that’s great, you know, because, you know, to have someone that’s really knows what they’re doing and operating the business beyond just those things, or having a clinical director that does supervision when you want to be out expanding the business, I think it’s really figuring those things out. Joe Sanok 00:38:27 And then, you know, typically when you have three staff or so, like, you definitely can start to look at offloading one of those if that’s what you want. Next question is how did you make the decision to be a self-pay or insurance pay practice. Do you now or have you tried to accept both forms of payment? Let’s go to Elizabeth first. Elizabeth Oldham 00:38:44 we accept both, but we’re mainly an insurance based practice. we, San Antonio is a large city, but we are not a very wealthy city. And so, private pay only is really difficult. you’re not going to get a lot of that. even with associates that offer lower cost and things like that, it’s still very, very difficult in San Antonio. So you almost have to be an insurance based practice. yeah. So that was our decision. Speaker 4 00:39:17 All right. Yeah, sure. Joe Sanok 00:39:18 Do you have anything to add to that? Sherry Merriam 00:39:20 Yeah. Here in Minneapolis, it’s kind of the opposite. since the pandemic, there’s been quite a short shortage of providers, and so it’s been a lot easier to get a private pay practice off the ground. Sherry Merriam 00:39:31 And so we do it by provider, like each provider gets set aside since we’re a membership and and and not employees, each provider gets to decide if they’re private, pay only what they want to set their rates at which insurances they want to take, if any. And what’s great about that is that if someone contacts me through the website and wants to take it and needs to use their insurance or is willing to do, then I can assign them to providers based on what their capabilities are. Interests are including payment wise, and I really like that we can offer both as far as like to our providers and also to potential clients. Joe Sanok 00:40:10 So awesome. I just put in the chat, also a link to mentira and tire is one of our sponsors, but they’re awesome. They help collect full pay out of network and usually collect 70 to 80% of whatever your full pay is and give that to the client. So the client is really paying about the same as what they would pay with insurance. So that’s something worth checking out. Joe Sanok 00:40:29 So let’s do this one for Elizabeth. so are your staff 1099 or W-2? And how did you make that decision? Elizabeth Oldham 00:40:35 They are 1099. we’re in a state that that’s pretty easy to do. we felt like that was a good way to start. And that’s how most counseling centers in San Antonio work. We are considering, however, changing to a W2. Joe Sanok 00:40:51 Yeah, well, Andrew definitely can help you with that because that’s I mean he’s actually we’re going to be we haven’t announced this publicly. We’re going to be doing this thing starting in, I guess. See when the podcast launches, I think it’s like mid-June. happy to give it to you early, where it’s a consulting package around that 1099 to W-2. And then those people are going to actually be also in a small group that Andrew leads once a month. So you all meet each other and talk through that as well. So, if you’re looking at that, let me know. I can connect you with Andrew. Speaker 4 00:41:16 Absolutely. Joe Sanok 00:41:17 The next question if one hires an employee, then doesn’t the business owner have to pay them unemployment if employee is fired, how to navigate this? That doesn’t happen with a 1099. Joe Sanok 00:41:26 But we’re talking about eventually hiring employees so that they have their skilled and incentive to stay. so since both of you don’t have w-2s, I’m going to speak to this for for one, I’m not an accountant or attorney. I’m speaking from my own knowledge of this subject. So obviously do your own research. in most states, yes, that that is the case that you have to pay unemployment. sometimes you’re paying into in your state unemployment insurance. there’s other ways that you can look at that if you’re talking to an attorney. That’s why I always recommend, if you’re a group practice owner, whether you’re doing 1099 or W-2s or a membership model, that you do have a good employment law attorney because things can shift quickly. I remember in California when there was a court ruling, I think it was when Uber and Lyft were kind of said you were treating these 1099 like W-2s, you need to pay all this money. Then all of a sudden, like, everything switched in California within a month, where basically, if you were a ten, 99 based counseling practice, like you were going to get in trouble. Joe Sanok 00:42:20 And so that’s where having a good employment law attorney is really important. but yeah, there’s lots of ways that you’re setting aside money for that, that you’re planning for that. Next question. What needs to be considered when deciding whether or not to offer clinical supervision to a provisionally licensed contract worker or even a W-2 employee? I am I do know some things that my attorney taught me on that. so for 1099, like a contractor, one thing the IRS does look at is are you providing supervision? So at least in my practice where we had 1090 nines, those 1099 were required to get supervision outside of that contract. And so a lot of them did it with me, but they had to pay for that clinical supervision just like anyone else. So that’s one way that I personally like, legally protected myself and had a wall between clinical supervision and the 1099 relationship. But we’d love to know, how the two of you think through that. Sheri, since you have the membership model, you don’t have to really worry about that. Joe Sanok 00:43:15 Elizabeth, how do you think through clinical supervision with your practice? Elizabeth Oldham 00:43:18 Yeah, so we do do that. And in Texas, we talked about our employment lawyer and our CPA, and they just asked us some questions about what does that supervision entail. Right. And it’s clinical supervision. I’m not telling them when their appointments are any of those things. I’m not telling them what they were to work. I’m not, you know, none of that stuff. So, in that our CPA felt that we were safe, having them as 1099 even though their associates in Texas are called associates. but we do have two separate contracts. So they have a contract for their 1099 stuff, and they have a separate contract for their supervision. Speaker 4 00:43:57 Perfect. Joe Sanok 00:43:58 a question for you, Elizabeth. How does insurance reimbursement work when you have provisionally licensed staff? Have there been any difficulties with this process? Elizabeth Oldham 00:44:07 so in Texas, starting last year, they started allowing for supervisory billing. And then it depends on the insurance company. So some insurance companies do allow supervisory billing, and some don’t. Elizabeth Oldham 00:44:22 So in Texas Aetna allows it, Blue cross allows it and Cigna allows it. these are the ones that I know about. United does not Magellan does not. In fact, it’s specifically in my contract that we cannot do supervisory billing. And I’m thinking of so there’s someone else that doesn’t as well. anyway, so when you file the claim, the claim actually looks like it’s you. It looks like it’s the supervisor. and the supervisor does have to be sort of in the building. They have to be supervising. so in that sense, yeah. Joe Sanok 00:45:02 It really is state to state specific. Speaker 4 00:45:05 This is where. Joe Sanok 00:45:06 I do think that, working with a billing specialist, that 6% uncollected claims to me is so worth it because then they’re putting in that time to make the phone calls to make sure things are approved. And, you know, you’re paying 6% off the top of what’s collected, typically for a good insurance, biller. So they should be able to say, here’s, here’s exactly. Because they know that inside and out, rather than you becoming an insurance billing specialist. Joe Sanok 00:45:30 Sheri, do you have any resources about the membership model you’ve created? we have a question about that. Sherry Merriam 00:45:36 you can find a brief description of it at our website, Iridescent Care. Com that’s for Iridescent Care collaborative. And, if anyone wants to reach out to me and learn more about it, they’re welcome to do so. You can do that through the web form at our website. I know iridescent isn’t easy to spell, so I wore my t shirt. Iridescent care collaborative. Joe Sanok 00:45:56 Wonderful. Speaker 4 00:45:57 Oh, cool. Joe Sanok 00:45:58 We have, Cory joined group practice boss yesterday. Awesome. And let’s see, Donna is thinking about signing up for group practice launch. Wonderful. Donna, if you’re on the fence still, next week, make sure you come to one of my shows, and then we can make sure that, it’s a good fit for you or sign up, and then we can kind of talk next week as well. Awesome. Well, that’s all the questions. We tore through it all. Thank you so much, Elizabeth and Sherri, for being a part of this community for for digging in so much and supporting each other. Joe Sanok 00:46:26 One question people have to ask is how much time it takes to to be involved in group practice. Boss and I want to ask the two of you that in a second. But one thing we say is the 3 to 1. So three times a month we think that you should be, in circle asking questions, supporting people, just getting involved. Because if you don’t have three questions a month, then like, why are you paying for a community? I think we all have three questions a month we could be putting in there, two times a month coming to a live event. So that could be an ask the expert. That could be one of the trainings every Tuesday. You have plenty of access to all those different things. And then once a month going through one of the courses. So we call it the three, two one. I would say from what I hear about 1 to 2 hours a week, in group practice, boss, will be more than enough, but it’s the right 1 or 2 hours. Joe Sanok 00:47:10 Instead of then guessing all these different things. Sherry and Elizabeth, how much time would you say you recommend people put into group practice, boss, to to get the most out of their membership? Elizabeth Oldham 00:47:20 Yeah, that’s about the time. Sherry Merriam 00:47:21 I’m sorry. Elizabeth Oldham 00:47:22 That’s about the amount of time I put in. I try and make, every Tuesday meeting. I try and make that live, if at all possible. and then pick up various things, throughout the month as well. Sherry Merriam 00:47:34 yeah, I agree, and you definitely get out of it what you put into it. And I’ve tried to cherry pick like recordings. If I don’t make something then I try to watch the video later. Those are really helpful. And in the community is great. You can ask anything. Joe Sanok 00:47:49 Awesome. Thank you so much for being a part of the community. In just half an hour here, we have, our next thing that we’re going to be doing. so we’ve covered a lot this week, a total of 14 webinars. we’re talking at 1130 eastern about operations you must master. Joe Sanok 00:48:05 So I’m going to be leading that. We’re talking all sorts of things around pay per click directories, marketing, networking, managing your money. how I think through quarter by quarter and leveling up your practice. So that’s going to be at 1130 eastern. Then we have a little bit of a break. because in the middle there we have our weekly group practice launch meeting, which we aren’t going to make public, and wanted to make sure that those folks could come to everything level up weekend. So then 230 eastern is our next one. That’s growing by 100% in the next year. So how do you double in the next year? so we’re going to be talking through all sorts of strategies around that. And then next week we have all of those Q&A with me. It’s literally a zoom meeting where you pop in, just say, here’s where I’m at. What do you think? Should I join the community? It’s not a hard sell. We honestly have more than enough people that are applying to be in our programs to be working with us, with consulting. Joe Sanok 00:48:52 We want it to be the very best fit for you. So come have a conversation with me. We’ll chat through, all the different things. And, thanks for hanging out with me today. I hope you all have a great day. Panelists. Thank you so much for being here today. Speaker 4 00:49:07 Bye, everybody. Joe Sanok 00:49:17 Also, we could not do this show without our amazing sponsors and we’ve had a bunch of people join. Well received. So if you are overwhelmed by all of the clients that are calling you and you’re just like, I don’t know if I should hire a receptionist or not, getting a virtual assistant company like Well Received is the way to go. They can handle your new patient intakes, your after hours services. Bilingual. They’re 24 over seven. They do the medical appointments, scheduling all the things we talked about around sales. They are experts in. And you can get the first three months at 50% off when you head on over to well received. Com forward slash Joe again that’s well received.com/joe thank you so much for letting me into your ears and into your brain. Joe Sanok 00:49:58 Have a great day I’ll talk to you soon. Special thanks to the band silence Sexy for that intro music. 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