[ALISON]: Starting a group practice can be really overwhelming. So, if you’re wanting some help to figure out how to start and grow a group practice, please go to practiceofthepractice.com and click on Work With Us. There you’ll find information about everybody on the Practice of the Practice team, including me. I specialize in helping people grow a group practice, and I would love to work with you. So please fill out the contact form on the website or email me, [email protected].
Hi, I’m your host, Alison Pidgeon. This is the Grow of Group Practice podcast. If you are thinking about starting a group, if you have already started a group, if you are 10 years into having a group practice, this is definitely a great place for you to be. So today I am interviewing Amanda Patterson. She is a group practice owner, but she also does some business consulting in the area of group practice and she is really excellent with marketing. So, there’s definitely a big chunk of the interview where we get into some nitty gritty details about specifically marketing, a group practice. So, if that’s something that’s interesting to you definitely keep listening. And I actually know Amanda personally, I’ve met her in person twice. I met her at Slow Down School in 2018, and then I saw her again at Killin’It Camp this past fall 2019. And I don’t know how else to say this other than Amanda is the real deal. You can just tell that she does her homework, she’s thorough, she is on top of everything related to her group practice. And like I said, she also does some business consulting as well, which we’ll talk about in the interview. But she just does everything at such a high level and I was really excited that she agreed to be on the podcast because she had so many great things to share. So, I hope you enjoy the interview with Amanda Patterson.
Today on the podcast I have with me, Amanda Patterson, she is an LMHC, and she is from Palm Beach, South Florida. She is not only a group practice owner. She owns a practice called Caring Therapists of Broward, but she’s also a private practice business consultant. She helps therapists create business and marketing plans, and she’s the founder of My Private Practice Collective, an online community for therapists in private practice. Welcome Amanda. We’re so glad that you’re here with us today.
[AMANDA]: Thanks for having me. I’m excited to be here.
[ALISON]: Yeah, so tell us a little bit about your practice as it sort of stands today. What’s your practice all about?
[AMANDA]: So, I have a group practice. We’ve had to do a little bit of rebranding because I named it Caring Therapists of Broward and then my family moved to Palm Beach, which is the next County up. So, we’re sort of affectionately known as Caring Therapists of Broward and Caring Therapists of Palm Beach. And so, we have two locations and really, it’s a full-service practice. We work mostly with, let’s say every day issues, depression, anxiety, phase of life issues, and we range from seeing children to adults.
[ALISON]: Okay, awesome. So, I know we had talked a little bit before about how you started out with one business model and then you switched to a different model. And so, can you tell us what the original model was and what was problematic about that and what kind of prompted you to switch to the new model?
[AMANDA]: Yeah. So, when I first started sort of like a group practice, which really wasn’t in essence, a group practice, it was really like a collective, which is funny because now the Facebook group is called Collective. And so, it was four of us that got together that they, the other therapist had said, “I don’t really want to do all of the behind the scenes work, but I really want to see people.” And so, I had then decided to kind of join us together, put us under the umbrella of Caring Therapists at Broward, and I had them rent office space from me. And for a while, as we were just sort of in the beginning stages, everybody acted independently. What I started to see happen is I started to see two things happen. One, I started to see some people really struggle to build a caseload, even though they had all the right credentials, they put up a website, they had Psychology Today, they were maybe doing some things out in the community. Their name just wasn’t really getting out there. They weren’t building as quickly as they would like.
And then what I saw is that my marketing efforts were bringing in a lot of calls, a lot of calls. And so when I started to run the numbers, I realized that renting out to people just didn’t really make sense because I wasn’t going to really make enough income to cover the expenses that it would take to continue doing the marketing efforts, rent out the space. And then I needed additional admin staff to handle things like phone calls and billing, and then the numbers just started to not work out. And I realized that I needed to switch over to sort of like a traditional group practice model.
[ALISON]: So, they were renters but then there were like these other things that you were kind of including in the rent, is that correct?
[AMANDA]: Yes. So, we had a website, they got some referrals, we, they used standardized paperwork at that time. People had the option to sort of use an electronic health record or do paper records. It wasn’t uniform. Nothing was really uniform, but we were still sort of practicing under the umbrella. And then it really, you know, kind of looking forward now it kind of got tricky because I get records review or records requests all the time for therapists that I didn’t have access to their records because they were renters. But because they were operating under that umbrella, a lot of people assumed that we were the record holder. And so that’s just, it hasn’t really created any problems, but it just made me realize that something I wasn’t thinking about that if they were operating under Caring Therapists at Broward, that maybe at some point people would be coming for records or be coming for any kind of, you know, issues that come up when you’re a group practice that I really didn’t have any control over.
[ALISON]: Yeah, I’m really glad that we’re talking about this, because I get this question quite a bit when people want to start a group practice, but they don’t necessarily want to do all the things that come along with it and they want to sort of do a model like what you’re talking about. And I always think like, you know, this could get really messy if you’re not really clear about like what the boundaries are and what’s your business and what’s my business. Is that kind of what happened?
[AMANDA]: That’s, you know, part of what happened was that it wasn’t really clear, was I responsible for giving them referrals or were they responsible? Was I responsible for teaching them some strategies? Was I responsible for encouraging them to write blog posts, which is a very popular way people find us? And so, you’re right, it wasn’t really clear who was in charge of what. And then the other thing is, you know, one thing I learned, by going to Slow Down School about a year and a half ago, was how different things are in different states. I mean, I think that, you know, intuitively makes sense, but until you start talking to other group practice owners or private practice owners from other states, you realize, just really what the difference is. And I would say somebody looking at that model of renters that unless you own your building, it really doesn’t make sense for you to, you’re basically subleasing out, especially in South Florida where we run into two issues.
One it’s very, it’s not very common for private practice owners to own their buildings. There’s not a lot of commercial real estate and any commercial real estate that’s down here is very cost prohibitive. So, it’s not like by charging rent it makes sense, “Oh, it’s going to a mortgage.” A lot of the times it’s just going to rent. So, while that does reduce maybe overall costs for rent, in the long run, it’s not really going to be beneficial. And that’s really another thing that I found.
[ALISON]: Yeah, it’s not like at the end, you’re like, “Well, this helped me pay off the building and now I own it and it’s an asset.” You’re paying rent to cover your rent, basically.
[AMANDA]: Exactly. And when push comes to shove some of the work that you have to do, because you still have to coordinate calendars and you still have, you still are, so even if they’re operating completely separate and your contract clearly outlines that they’re in charge of the record, you’re still responsible for what they do ultimately. And that if there are emergency situations, you need to be there. And a lot of the times the consumer doesn’t really know the difference. They would see the name Caring Therapists at Broward and then for instance, if I had a clinician who maybe wasn’t strong, the reviews could go to Caring Therapists at Broward, instead of going to maybe their own Google page. Not that people generally write negative reviews or anything like that, but it just opens. It’s another way that it’s opened up to liability.
[ALISON]: Yeah. I think that’s a really important thing to think about as well, because you know, they’re under your name, but then you have no control over them at all.
[AMANDA]: Yeah, and that, if they’re just renters, they are supposed to be just coming in and out, and I think, you know, people who, you know, have a rental situation, will provide resources to the people there, but then again, that is, are they bringing their own paper, their own ink? You know, group practice owners will probably all lament on the cost of ink. How much is printed?
[ALISON]: So, was there a pretty hard cap too, on what you were able to generate in terms of income? Was that one of the reasons for the switch?
[AMANDA]: Yes. That was the, you know, one of the main reasons is that there was a cap because there’s only so many hours in the day in terms of when people can rent. Then the other issue becomes making sure that the offices are being utilized to their fullest capacity. And then what it really takes to generate more reviews or more referrals is, a lot of the times what it takes is time. It takes time and money, whether you hit the ground running and you’re hitting off, you know, business cards, making appointments with doctors, going and seeing referral sources or doing things like AdWords, campaigns, and Facebook campaigns, that costs money. And in order to have that money, you know, you need to generate income from whoever it is, whether it’s renters and a lot of the times the rent will just cover rent. It’s not going to cover any of those extras.
[ALISON]: Right. Right. So, the model you have now, tell us about that. Like, do you have employees, do you have contractors, what do you provide for them? What do they do for themselves? All that kind of stuff.
[AMANDA]: So, I have independent contractors now. Florida tends to be a state that is pretty independent contractor friendly. And it really works out well for both myself and the contractors because it allows each of us to have some flexibility around independence and I don’t have to micromanage them. And I don’t need to, you know, be on top of certain things like maybe, as close to like vacations or the number of clients that they see. But at the same time, it allows me to hold them accountable to what’s in that contract. And that gives the contractor flexibility maybe to work other places or to do other things that are on the side. So, I have an independent contractors’ model, we do a split, and that seems to work out really well because it allows me to account for things like rent and for admin costs and for other things. So, the independent contractors obviously get the office space, use of supplies within the office. And we use a centralized, electronic health record. We use Therapy Notes and they get access to that and marketing and our office staff, which we have an in-house person answering the phones and we have a biller office manager.
[ALISON]: Okay, great. And how many contractors do you have now?
[AMANDA]: So, there are 15 contractors between the two locations.
[ALISON]: Okay, nice. So was there kind of a tipping point with your, in your growth where you realize, like you had to change things in the practice? You know, like I’m finding now, I’m almost as big as you are and I’m finding like, it’s at that point where I might need to start changing some structure or some system just because there are so many therapists now.
[AMANDA]: Yeah, I feel like that’s, I laugh because that’s like a consistent thing that’s always happening. It’s like, you know, the more, the bigger you get, the more you have to really create those systems. So, I think that one of the best things that I’ve done and what I would recommend that people do is track things because that’s really what’s guided my business planning. My business planning has been around numbers and referrals and marketing and all of these different types of key performance indicators. I’ve really tracked that and either formally or informally, more so informally initially. And what happened initially is when I was a solo, in a solo practice and I was looking at my numbers I had from, like year one to year two, I had doubled my income, but I realized from year two to year three, I wasn’t going to be able to double my income because as much as you can raise your rates and do these things, it’s really hard as a solopreneur if you’re full to double your rates.
And so, our double, you know, your gross revenue year to year, unless you’re doing something really different and it just, that I wasn’t going to do something really different with my solo practice. So that’s when I decided to do the group practice and we did raise, it wasn’t, you know, 50%, but I did raise my income because I was just doing things differently and I, because I had people now I could refer out some of the different panels or different things. And so, I did increase, but what happened was when I went to look at my numbers again, I realized I had hit a stagnant point. I wasn’t going to be able to grow that much. And I started to see, like the marketing efforts had really kicked in. We were starting to get a lot more calls and people were starting to get full within the renters’ model situation. And I knew we needed a larger space.
Like that’s really what it came down to. It’s that we were operating out of three office space and I was like, “Man, I need to operate. We need a bigger space here. Like we’re not going to be, we’re going to, we’re busting out of the scenes out of these three offices. I need it to move into a bigger space.” And that’s really what drove me to go into a larger space. We went from three offices to six offices. So that’s the main, like the flagship location. That’s the one down in Broward where most of the contractors work out of and then because my family, we moved to the next county up, I really, I’ll call it selfish reasons, opened up a second location because my first location is about an hour from my house and I did not want to drive down, multiple days a week. And so really opened up that second location for me, but what I realized when we were purposeful on picking the location that we moved to is that my second location, which is in Wellington, Florida is not an overly saturated area. It is an area that, we’ve been there three months and we’re getting, just that the volume of calls is very high, which is really, really great. Anybody that takes insurance, the only issue you run into that is that it takes time to grid credential your people. And so that’s been the only roadblock we’ve hit with our second location. It’s just the time that it’s taken to credential new clinicians.
[ALISON]: Okay. So, the driver for opening, the second location was really just your commute and the fact that you moved.
[AMANDA]: And I’m very open about that because you know and, it made sense. I mean, we were, again, purposeful on why we picked that location to move on a couple different levels. I wouldn’t, I don’t think we would have bought a house for instance, in an area that was an hour from my original location and saturated with therapists, for instance. It just wouldn’t have made sense from a business stance.
[ALISON]: Right. So how do you manage the two locations? Like, are you going down so many times per week or is somebody else kind of in charge of the original location or how do you structure that?
[AMANDA]: So, I’m still going down to the original location. And as, again, as things have evolved, I’ve handed over some of the responsibilities for that location, things like, you know, I used to be in charge all the supply ordering, and now I’ve got somebody really in charge of reviewing all of the supplies, in charge of, I still do the ordering, but you know, I’m not looking through drawers, looking for ink anymore, for instance. We brought on somebody and I was using, I actually used Alison’s virtual assistant for a while, but we actually needed to bring somebody in in-house, like somebody, you know, answering the phones in-house and to greet our clients and to manage some of those other things. Again, when you’re the group practice owner and you’re there every day, you’re just naturally doing, you’re eyeballing the place, you’re seeing kind of what is going on, and you’re probably acting as a result of that without even realizing it; just things like making sure there’s water or making sure the coffee is full.
Now, I’ve got somebody who is doing those things I really don’t need to be doing and she’s answering the phones and doing that. And then I have an office manager who does all of the credentialing and really helps the clinicians with any of insurance and billing issues. And so, I’m still going down there. I’m still seeing clients down there and kind of keeping an eye on the place but I’ve been utilizing my staff. A lot of my staff members are interested in taking on other responsibilities. Like I’m having one of the clinicians, work on onboarding of new clinicians because what I found was that if I’m onboarding the clinicians, then they’re coming to me with all of the questions, which is not, which is okay. In essence, I want people to feel comfortable to come to me, but I also don’t necessarily always have the time to answer all of the questions that just come up. So, by having another clinician do that, that kind of alleviates some of my responsibilities.
[ALISON]: Yeah, that’s great. So, it sounds like making the move kind of forced you to look at what you needed to delegate and then you were able to kind of slowly have that, you know, have those tasks given over to those other people?
[AMANDA]: Yeah, and I made a list, I’m a list person. And so, I made a list of all the things that kind of like either I do or somebody does or that needs to get done and put them into categories. And then I’ve been slowly delegating those out based on people. You know, people have different strengths and that’s another thing that I realized that though clinicians, a lot of them want, some people want to just come in and see people and leave. A lot, well, I found my clinicians really wanted a community. They wanted to feel connected to the people. So, one of the best things that happened, and it just sort of inadvertently happened is that we have a little kitchen space. We put a little like, call it a dining room table. It’s maybe a little smaller than a dining room table, but it’s our dining room table, nonetheless and everybody congregates there between sessions. They write notes there, they eat lunch there, and it’s really given the clinicians an opportunity to really connect.
And that wasn’t something, when I was looking for office space, that wasn’t something that consciously I had on my mind. It just happened to be that way. But if you are, look, if you’re a group practice owner looking for space, I would recommend having someplace where your clinicians can congregate and eat lunch together and just generally connect because that’s what I find a lot of people want. It’s that they want to connect. We’re therapists, right? That’s what we do. We connect people to their emotions, we connect people to their communities, and so our, I think therapists want to connect to each other.
[ALISON]: Yeah, that’s great. I find my therapists say the same thing. They want more opportunities to connect with each other, because you’re like in your office all day seeing clients and it can feel like ships passing in the night.
[AMANDA]: Yes. And, you know, trying to coordinate like lunches can be really interesting because it’s like, “Oh, I have sessions. Oh, I’m not in the office that day. Oh, I have to see a last-minute client.” And so, we do try to create that. We did the first year, we did this past year, we did a holiday party and that was really nice. And most people came and it was really good to get out of the office. That’s the other thing like, you know, we’re one, not really one person in the office, but you know, we put our best foot forward in the office and we got to have this holiday party and kind of let loose. And it was really nice and it made me think like, we definitely need to do this on a regular basis.
[ALISON]: Yeah. That’s really important. And I think the staff really appreciates it. So, we talked a little bit about your old model and you switched to the new model and it sounds like things have really increased exponentially for you and you open the second location. Does it feel like the practice grew too fast for you? Was there any issues that you had with like controlling the quality while you were growing so quickly, especially because obviously that model was all new to you?
[AMANDA]: So that’s a very interesting question. I don’t think that we grew too fast again, I’ll just talk about, I hate to like say anything negative about insurance because then everybody jumps on that, but the only issue is again, the credentialing. So, I would say our growth has been inhibited by that just at least initially because it takes three months to get anybody credentialed. So, when we moved into our space in May, I brought on three new people. It took about three months to get them credentialed and so now they’re starting to sort of over the last quarter, see the fruits of those labors. So, I would say the first three months for any clinicians that we’re bringing on is a little slow, just because of the insurance credentialing. We do convert a fair amount of private pay, and you know, we do some other things like substance abuse evaluations or things like that that are only private pay.
So that’s helped us. But I would say we probably would’ve grown if there was like this magic way to just get credentialed like in two weeks. And so that, I think is also helpful because even though I would like growth to be quicker in terms of that, it gives people an opportunity to get acclimated with our systems. It gives people an opportunity to get to know everybody, maybe a chance to do some trainings in order to really get comfortable with their clinical set. So, I make sure a couple of things to make sure that people are a good fit is obviously do an interview with them. I really take recommendations from people within the office or within the community again, because I’ve been in my community for, as a clinician for 13 years. Our practice is well known. I’m all known and I know a lot of people in the area, I went to college in the area. So, all of that is really helpful in terms of being connected to the mental health community.
And so, I make sure that anybody comes in has either specialized training or a specialized niche. And then we, you know, kind of look at what the needs are of the practice. Like I’m trying to think of something we don’t get a lot of calls for. I can only generally think of the things we get a lot of calls for. So, we get a lot of calls for children and teens. So, I made sure anybody that I hired would be willing to work with that population because that’s, we’re in the suburbs. And so that’s what we get. We get a lot of teenagers that are struggling in school or kids, or just, you know the parents want them to work through whatever emotions they have going on. We get a lot of couples counseling and so making sure people have trainings in those things. So, for me, it really goes back to trainings. Do they have the appropriate trainings? And not that just because you have trainings mean you’re a good clinician, but making sure they’re licensed, making sure they’re keeping up on their SEOs, making sure that they’re connected in the mental health community, because that seems to be also something that’s really important. Are they going to conferences? Are they going to networking events and how connected are they to their community?
[ALISON]: Yeah, so just leading into that whole topic about marketing, what do you find has been really successful with advertising the group? I get this question a lot too, because a lot of times people start out with a solo practice and now, they have to switch gears and start marketing a group practice. And it’s kind of a different animal. I don’t know if you’ve found that to be true, but what have you done or what’s helped you with marketing the group?
[AMANDA]: So, we do a lot of marketing just kind of, it’s my thing and is to do a wide variety of marketing. And so, we kind of do three forms of marketing or we do three forms of marketing. We do a lot of community-based marketing and so again, we’re well known in our community. I’ve had meetings with psychiatrists, with doctors, with lawyers, with other therapists, gone to a lot of networking events. And so, we have done that. We also do a lot of social media marketing. We don’t really pay, we don’t. For social media marketing, we just use Instagram and Facebook primarily though we use the other platforms as well. And that’s really just for brand awareness. So, people can be reminded that we exist and we’re here and that we do certain things. And anytime we bring on a new clinician, we share that on social media. Any time we write a blog post, we share that on social media, anytime something sort of interesting happens, we share that on social media.
And so, our social media is well known for that. And we’re in a lot of Facebook groups, we’re on a lot of local Facebook groups like South Florida Psychotherapists and a lot of different groups in. We’ll just go in there regularly and comment and share and just, you know, if we bring on a clinician, I share that in those Facebook groups. If people are looking for a certain type of therapist like, “Oh, I’m looking for somebody who specializes in anxiety in Davie,” That’s like I’m going to share our group practice information. Even if they don’t call, then it just reminds people that, yes, we accept this particular insurance, we do this particular type of therapy and that has been really helpful. We’ve gotten a lot of clients that way. I have encouraged people if they don’t already. If their local community doesn’t have a Facebook group then maybe they would start that because that is a really good way, not only for us to get referrals, but to know who in our area does what. And that’s been really helpful. And then we also do a Google AdWords campaign. We do that in both of our locations and that is really helpful to drive traffic to our website. We use a company to do that. We wrote specialty pages for that. And so, I don’t recommend that anybody does any AdWords campaign without knowing really what they’re doing, because you will waste a lot of money if you don’t know what you’re doing.
[ALISON]: Yes, yes. It can be very expensive and it can be a good return on investment, but you definitely need to know how to set them up correctly.
[AMANDA]: And what, I actually talked to the people that answer our phones and I asked them like, “What is it that people are saying to you on the phones?” And one thing that they’re saying is that they’ve read the blog posts and that they really, really connected to the blog posts. And so while I know a lot of people will say that blogging doesn’t necessarily lead to clients like calling you, I would say while that might be true, it does lead to people getting an idea for your practice, getting an idea for the way that you do therapy. And they’re getting to know you through your blog posts and that has been really, really helpful. I’m an advocate for blogging.
[ALISON]: Okay, great. Yeah. I think I get that question a lot too. Like, “Should I bother with a blog posts?” You know, I think, too with SEO. I mean, you know, the search engine optimization. I think it’s worth it just for that, but I think you’re right. Like people also look at the blog posts and they’re either resonating with it or they’re not. So, it could definitely help convert those clients.
[AMANDA]: Yeah, and speaking of SEO, we’re on the first page of Google. That doesn’t hurt.
[ALISON]: Yeah.
[AMANDA]: That’s really helpful because if somebody searches in our area, you know, just the general like counseling and Davie that we come up, but we’re also coming for what we’ve done our SEO around, which is anxiety, depression, couples, children, play therapy, you know, these kinds of EMDR, these kinds of things that we do out of the office. And that, it’s been a, you know, it hasn’t been one thing that we’ve done. We’ve done service pages, we’ve done blog posts, we’ve done all kinds of SEO around all of those things. Then we did AdWords around them, and then we promote on social media and so kind of works. You know, it works as a system. I would say our marketing is a system.
[ALISON]: Right.
[AMANDA]: And if we’re trying to beef up referrals and we’re going to do more AdWords and more blogging, and we’re going to ask for more reviews on our page. Again, we don’t ask for reviews from our clients, we ask for reviews from our colleagues and people who know us.
[ALISON]: Right. Have you done your own SEO work or did you hire someone to do that for you?
[AMANDA]: So, I did my own SEO, well, I should give credit where credit is due. I use Brighter Vision. They did the initial SEO. So, they’ll go in there, they’ll set up your initial SEO but I went back and did a lot of work behind the scenes in order to make sure that we were really ranking. I went back through and put the city in and keywords and wrote meta descriptions and linked and hyperlinked. And I did a lot of that. I always tell the story. When my husband and I were not married, but when we were first starting to date, sort of in those early years, I was a good supportive girlfriend and I would watch football with him every Sunday. And while he watched football, I worked on the website and I would go in and write, write, write, write, write, and tweak and fix.
If you’re not interested in doing that, or you don’t know how to do that or that you don’t have time to do that. I definitely recommend hiring somebody to do that. SEO is something that you could do on your own. It’s not like AdWords where even me, like I’ve read books, I’ve taken trainings and even taught a little bit about AdWords and I’m like hiring a professional, but with SEO again, if you don’t know anything about it, you’re not going to read the books. You’re not going to listen to podcasts about it. I do recommend hiring somebody for it.
[ALISON]: Yeah, depends on how tech savvy you are. I would say.
[AMANDA]: Yes. And if you’ve ever, Casey Truffo has the book Be a Wealthy Therapist and I’ll always remember the thing that I took away from that book, that there are four types of therapists. And I remember the one, the tech therapist. And if you’re a techie kind of therapist, you’re willing to sit down with your laptop during football games or whatever free time you have in your life and do that, then I would say, go for it. But if you’re more of a, you know, that introverted therapist who isn’t interested in, not that being introverted would make you not want to do tech, but if you are not interested in doing that, don’t do it.
[ALISON]: Right. I know before we got on our call today, you had mentioned about your practice as profitable. It’s insurance-based and I know for a lot of folks they think like they couldn’t ever be profitable with taking insurance. So, can you tell us a little bit about that? Like, is there a particular way you’ve structured the practice in order to make it profitable?
[AMANDA]: So, I am pro-insurance. I think that it’s really important that there are practices out there that do accept insurance, just going to go on a soap box for a moment. And I totally respect when people are private pay for all kinds of reasons. I think that if I lived in an area that, if I lived in Miami, you know, like in a very, or even near me, there’s this area of like Palm Beach Island. For instance, if I wanted to start a practice there, I wouldn’t take insurance there. It wouldn’t make sense for me to take insurance there. It would make it make sense for me to be private pay. I think because my practices have always been in the suburbs and we’ve really tried to meet people where they’re at though, I would say both suburbs that, by practices, I wouldn’t say that they’re straight middle-class; are probably middle class to upper middle class and the area that my new practices is in is more affluent than maybe some of the other areas, but we really looked at like meeting our clients where we were at.
We looked at who do we want to work with? And I would say we work with a lot of people who want to use their insurance. And so, we’ve made work. A couple of ways that we’ve made that work is we have identified what some of the higher paying insurances are and we’ve tried to get credentialed on those. And so that has been helpful. Some of the insurances will pay Medicare rates, which in Florida, you know, it’s a pretty good rate. And so, by being able to accept some of those higher paying insurance panels, it’s been better. I think another thing that I’ve done is really manage expectations with the independent contractors. I’m very transparent. That’s one thing I will say a lot of the independent contractors are really appreciative about my practice. I’m not, I let them know what the allowables are for the insurance, how much they got paid. They know their copays, they know, every single, every two weeks they do a tracking log where they track all of the money that they took in.
I also put in all of the money that was collected by the insurance. They’re able to see everything and they know exactly how much they got paid. And so, they really like that. I’ve learned from some group practices. Again, it’s not bad or wrong, but that they’re just paid a flat rate and then the independent contractor will get paid, let’s say 40 or $50 per session and then they’re like, “I just found out that this insurance is paying out $130 and I’m getting $40.” It doesn’t feel good to the contractor. And so I think that their transparency has helped me to be able to have conversations with my clinicians about how much it really costs to run the practice and what is going to be viable and what’s not going to be viable within the practice and why I might not just order, you know, X amount of supplies or books or toys, or these Amazon, Amazon, Amazon, Amazon, which will bleed my practice. And so really being mindful about where we are spending and knowing what’s going to bring us money and what’s not going to produce money. I knew hiring somebody full-time on the phones was going to be, though that was going to be costly, it was also going to bring us more referrals in because we were going to have somebody answering those calls right away. And with the call volume, it just started to make sense.
So by having conversations and having openness with my independent contractors, it’s allowed me to say like, you know, when my contractor asks for a raise, whether I can or can’t do that, and then I’ll explain to them like where the business is at and what’s going on and maybe what some of the expenses that we have going. And I’m not, you know, it’s not like I open up my QuickBooks and review it with them. I mean, I still do, you know, keep some information privileged, but they also are aware like when I opened, so what happened is, you know, I opened up this first location. It was like, you know, we’re all very excited, it was looking really good. The practice was getting busier and I’m like, “Oh, okay, well, I need to take some of that profit and open up a second location.” And so, they, without really having to say, I think the clinicians have known what it takes to run the practice.
The other thing is that we do focus on volume, but we don’t focus, we’re not just a volumes-based practice. We really make sure our clients feel comfortable and welcomed and have a personalized touch. But when you have an insurance-based practice I’m not going to deny that there’s a certain level of volume that goes on with it. And so, I make sure that my clinicians understand what the expectations are regarding how many clients that they need to see. Part time looks around 15 hours a week and full time looks around about 30 client contact hours a week, which gives them about 10 hours of admin time, whether they want to use that or not. Some people are really quick with their notes and some people like to take longer with their notes. And so based on those numbers, if I have X amount of part time people in an office X amount of full time people, I really look at the different numbers for each office, how much each specific office costs to run, and then just make sure that we’re hitting those numbers every month.
And it has been profitable doing it that way, making sure that we’re competitive with our insurance rates. I sat down yesterday and wrote letters to insurance companies asking for raises. What I’m focusing on this time is not just like, “Hey, we’ve been on the panel X amount of time, and we have X amount of clients, but hey, you know, we’ve got X amount of people trained in CBT, X amount of people trained in EMDR, X amount of people trained in Gottman.” And what I’m learning is that insurance companies really do like evidence-based practices and that’s, we have been pushing for that within our practice. So, it goes back to me hiring clinicians that have evidence-based trainings, then we’re able to ask for more money from the insurance panels or get on higher paying EAPs that only work with clinicians that use evidence-based practices.
[ALISON]: Nice. So, to summarize, it sounds like you have kind of focused on only taking the higher paying insurances and then I’m assuming you’ve really packed out the office space, like have clinician sharing offices.
[AMANDA]: Yes, do not be scared about having clinicians share offices. I have been strategic in that, like for instance, I’ll just call his office too. I know everybody has like these cute names for offices sometimes and I’m such a practical person that I’m like, “This is office one, two, three, four, five, six.” Like, I can’t think outside of that sometimes. And so, in office two, I have somebody who works during the day. She is a mom, she has children, she needs to be home by a certain time. So, she works in the office during the day. The other clinician works at night. She has a full-time job that she comes, works at our office from like four to nine a few nights a week and works on Saturday. Up until our holiday party, they had not met each other because of their offices and because of just, you know, some scheduling things like when we had other office things, they just weren’t there, but they worked. They have put up a sand tray area together, they had worked together without ever meeting each other.
And that was beautiful. It was so awesome to see that. And so, I make sure that the people that are in offices together, that they are not overlapping, you know, in the times that they have similar personality styles, that they have similar or different schedules so to allow for people to not be rushing around office space. And it’s not perfect by any means. You know, there are still times where we’re like, “Somebody didn’t mark in the calendar and now we’re double booked. What are we doing?” You know, these things still happen. It’s not perfect. We still, I was going to say, you know, we do have one low-paying insurance. That’s sort of the bane of all of our existence, except they send us like a ton, ton, ton, ton, ton of referrals. And so, it’s not perfect. When you’re starting a group practice or you’re growing, I would say my practice is still in the growing phase. I look forward to like the stabilizing phase when I’m like, “Oh yes, I can see the fruits of the labor now, but it’s not a perfect practice.”
There are mistakes. There are growing pains, even, like you had asked, what kind of systems do you put in place? Like I’ve had growing pains with just a variety, like EAP, you know, that’s been one of our growing pains that I can talk about; is coding properly in Therapy Notes, around EAP. Some of the therapists forget to do that and then I bill it and they don’t get paid and I’m like, “Why didn’t they get paid?” And it’s like improperly coded. And so, you know, those things are going to happen. And just again, making sure how to have communication, that’s a big one for me.
[ALISON]: Right, right. Yeah, that’s great. I think really just being strategic about how you set up an insurance based practice makes all the difference with whether or not you can turn a profit because I figured out pretty early on that, like I knew, because I had somebody to look at the numbers for me, how much I needed to bring in per hour in order to make money. And then I saw, you know, depending on the insurance companies’ reimbursement rates, that there were certain insurances that if we saw a client for that hour, from that insurance, like we were losing money. So that made it pretty cut and dry then to drop that insurance company because I can’t operate a business that loses money.
[AMANDA]: No, none of us can.
[ALISON]: Yeah. So just switching gears a little bit as we look to wrap things up in a few minutes, can you tell us a little bit about the business consulting that you do and how you help other therapists?
[AMANDA]: You know, it’s funny because I’ve double in this sort of locally a little bit more and I’ve sat down with people and made business plans, made marketing plans, done some workshop, and I’ve never really done anything with it. And I think last year when I sat down and did my new year’s resolutions, which I really don’t do resolutions, I just set goals for the year as I had put on there, like ‘launch consulting,’ and I didn’t really do anything with that either. I think between, I had a lot of stuff, amazing things happen in my personal life, like getting married but anybody that’s planned a wedding knows like you really are not doing too much other, you’re not launching anything, if you’re planning a wedding. And then opening up the offices really didn’t allow me to have time to really launch anything in terms of business consulting.
And I really didn’t want to, I don’t want to reinvent the wheel. Like I don’t want to teach people for instance about group practices per se, because there are like, you do an amazing job, people rave about you, and there are a couple of other people out there that, you know, do that already. That’s not really what I wanted to do and I didn’t want to just, you know, I’ve been as you know, following Joe for many years, like reinvent what he’s doing. And so, it’s just kind of been not something that I’ve really put a lot of energy to until sort of the second half of this year when things really kind of settled down. And I teamed up with another local psychologist, her name’s Dr. Rachel [inaudible 00:44:48]. And we sat down and we looked at the private practice group, that, I have My Private Practice Collective, which has over 12,000 members. And we realized people were asking the same question sort of over and over and over in different ways.
“How do I start a private practice? What business model should I use? Do I need, what kind of marketing, how do I get private pay clients? You know, really those basic questions. I think people really go to private practice groups in order to learn the basics. So, we decided that we wanted to really launch something that helped with the basics. So, we put together at the website, myprivatepracticecollective.com and we have some freebies up there, which I know, if there is going to be a link to that, Steps to starting a Private Practice. Well, most of you listening may have already done that. There are other resources on that website that will be really great for private practice owners just in terms of marketing and, like social media hashtags or some other core ones there, too, but I have really decided that this is the year that I’m going to launch out and really utilize the audience that I already have.
I’m not really competing with other people’s audiences because I have an audience already and they want information. People want to learn about private practice, they want to learn how to build, they want to learn how to put systems in place from the beginning. So, we’re going to be focusing on the beginning parts of private practice. And then Alison, happy to fan off to you people who want to learn about how to start and grow a group practice.
[ALISON]: Oh, that would be great, thank you. And you have a giveaway for the audience, correct? And we will include that in the show notes, but can you maybe give a quick overview of what that is?
[AMANDA]: So, I am giving away steps to starting a private practice. So maybe some of you that are listening haven’t started a group practice yet, and you realize maybe you do need to learn some of those steps. So that’s going to be on there. We go through the basics of what it takes. I think there are some basic steps when you’re starting a, even a private practice or a group practice. They’re very similar. You have to think about the business structure and get your marketing, get your referral sources. So, if you have already started a solo practice and you’re looking to do a group practice, you can also use this list to just modify it to starting your group practice. So, I wish all of you luck that are out there looking to start up your group practice. I think I was really shy to do that sort of initially, because I didn’t want to micromanage people and I didn’t want to like create an agency job for myself, but it’s been really, really fun. It’s been really rewarding. That’s probably the best word to use in terms of starting a group practice because now you’re not, like when you’re a solo practice practitioner, you see your 25 people a week and you impact those 25 people. Now, like last month I didn’t do our key performance indicators yet for last month but I think the month before we did like 500 sessions. I mean that’s 500 individual people because you know, people come, but 500 opportunities during the month to like change somebody’s life. And you know, I had a part in that and that’s really, really, really gratifying.
[ALISON]: Yeah. It’s amazing, excuse me, to see how much of an impact you can make on the community.
[AMANDA]: Yeah, and so that’s what I would, that would be my final thought for everybody, that, you know, you can have a greater impact on your community by having a group practice and you can make money while doing it, which is very exciting.
[ALISON]: Yeah, that’s great. Well, Amanda, I want to thank you for coming on the podcast today. I really appreciate your time and your expertise. If folks want to get ahold of you, what’s the best way to connect with you?
[AMANDA]: So, you can reach me if you want to join our Facebook group. It’s My Private Practice Collective. We’re happy to have you. We’re happy to answer any questions that you have. We do some videos in there and kind of, a lot of people share about the things they’re doing. It’s a really great community, or you can visit my website. It’s amandapattersonlmhc.com and you can find all my contact information there.
[ALISON]: Awesome. Well, thank you so much, Amanda. It was great talking today.
[AMANDA]: Thanks for having me.
[ALISON]: I’m so glad that Amanda shared with us so many great tips about marketing a group practice. I think that is one area where people always have questions or looking for new ideas. So really appreciate the value that Amanda brought to the interview. And I hope everyone is having a great day and I’ll see you later.
Grow a Group Practice is part of the Practice of the Practice podcast network, a network of podcasts seeking to help you grow your group practice. To hear other podcasts like the Imperfect Thriving podcast, Bomb Mom podcast, Beta Male Revolution, or Empowered and Unapologetic, go to practiceofthepractice.com/network.
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