Joe Sanok 00:00:00 Using different phone systems and devices to manage your practice is a headache. Open phone makes it simple with a single app that brings your business calls, texts, and contacts into a single place across all your devices. Activate your seven day free trial and get 20% off your first six months when you sign up at Open Phone. Com forward slash Jo again that’s open phone.com/jo. Joe Sanok 00:00:36 This is the. Joe Sanok 00:00:37 Practice of the practice podcast with Jo Sana. Session number 1003. I’m Jo, sound like your host. And welcome to the practice of the practice podcast. We have been doing a series with Andrew Burdette from practice of the practice. He also has his own counseling practice, And he’s a HR professional and he’s just knows so much about group practice and transitioning from 1099 to W-2s. We are going to be chatting through ongoing monitoring of your W-2 transition. If you missed the previous two episodes, we first talked in episode 1001 about why to transition to W-2s. What are some of the benefits? How does it help in regards to the IRS and how you’re doing things? Then in the last episode, we talked about the exact steps, step by step, on what you need to do to transition. Joe Sanok 00:01:30 And then today we’re talking about that ongoing running of a W-2 practice. What are some of the dashboard things you need to know on a monthly basis? What do you need to be aware of as the owner? What should you outsource? All those sorts of things that can get so dang confusing. Andrew, welcome back to the practice of the Practice Podcast. So glad you’re here. Andrew Burdette 00:01:50 Thanks for having me again. Joe Sanok 00:01:52 Yeah, well, I think, you know, the monitoring side of any practice is where a lot of people drop the ball I had a consulting client. It was probably a year ago. We’re still working together. But she discovered that one of her w-2s was 900 progress notes behind, and my jaw hit the floor. That’s. Joe Sanok 00:02:13 Oh, wow. Yeah. it. Joe Sanok 00:02:16 Became this gigantic thing. She’s. You know, that person has since, you know, left and all of that. But, you know, and it was funny because after that I had two other people that had people that had like 500 progress notes. Joe Sanok 00:02:27 And, you know, I think that most of us, we assume that people will do their jobs because we are people that do our jobs. You know, like when I worked at Community Mental Health, I knew that progress notes and treatment plans are supposed to be done in a certain period of time. And I always did it. Like when we were audited, my files were always fine because I’m just a person that follows those rules. And so I think we expect that our staff are going to do, you know, what we expect out of them, unless there’s like miscommunications or things. But like progress notes are like basic things. So, the side of that clinician’s responsibility is one side. But then an owner also, you know, bears a lot of responsibility to, for them or their virtual assistants not having some sort of quality management. So let’s jump into, you know what from an ongoing perspective for for W-2s, you’ve made that transition. You’ve gone through the checklist you just talked about in the last podcast. Joe Sanok 00:03:21 what should like maybe let’s kind of break it up into maybe some categories. Are there certain like categories like 3 to 5 categories that, you know, people need to kind of have eyes and ears on in some capacity. It may be with technology, them actually having eyes on it, an assistant like what categories should we start with? Big picture. Then maybe we can drill into those ongoing monitoring. Andrew Burdette 00:03:42 one thing that I think is really important to pay attention to as part of this in an ongoing basis, and this is just from an accounting and bookkeeping standpoint, is making sure you have somebody that can kind of keep you up to date and double check your books to make sure that the taxes and things are being taken out adequately, because even companies like gusto that are supposed to kind of have everything handled don’t always handle everything great. one of our local group practice owners discovered that for about 15 people, which is the size of her practice. gusto had missed the North Carolina withholding incorrectly, and they caught it before, W-2s went out. Andrew Burdette 00:04:19 But it was one of those that if they hadn’t caught it, then all of your employees would have mistakenly filed incorrect taxes because this thing didn’t come off a payroll. So there’s that kind of things to just have somebody check in quarterly and make sure it’s all happening. And if you need to adjust, and, you know, just from a very nuts and bolts kind of functional thing and then to get along the lines of like what you’re talking about, one of the advantages of W-2 is you get to create a whole lot more culture, culture and workplace culture and workplace environments. A big part of like just HR as a philosophy, as it turns out. And, you know, it’s stuff that we do anyway is group practice owners of like wanting to, you know, are you a really tight group of people. Do you come together as it really structured? Is that the kind of management style that you have, or are you somebody like me that you know, is going to mostly allow people to kind of set their own schedules? And again, if they’re kind of meeting performance standards, then I’m perfectly fine to to allow that to continue to happen versus say, you’re going to work Monday through Thursday, you know, 9 to 5 and see number of clients. Andrew Burdette 00:05:16 It’s not really the style I want to have. so is the culture in place? Are you having people that are feeling like they have the support they need, you’re more likely to have because of the nature of the relationship? being employee based versus contractor based, you are going to find people that are going to want more support and have greater expectations for you as a group owner. So are they getting the kind of hours that they really want? Are they having the kind of take home that they want, for compensation? Are they feeling like they’re getting perks? So things like CEO stipends, a lot of practices around here, it’s very affordable for them to kind of maybe do like a self-care lottery. And so everybody, you know, is eligible to win $100 toward a massage or something like that once a month. And, and those kind of different cultural type of things that really keep the employees engaged and just checking in to see the health of things regarding kind of what you were talking about in terms of notes being way out of sync with when they really need to get done. Andrew Burdette 00:06:16 thinking of the clinical supervisor friend of mine, she’s like, if it’s not documented, it didn’t happen. which for probably a lot of us who are maybe not seeing high acuity people, like there’s less of a safety concern, but there is that. What did I actually do for an entire year with this person when we met once a week, like there’s no record of how therapy went and those kind of processes. So then that would be a employee, you know, performance improvement plan and those kind of conversations. I will say there’s a bigger difference in terms of one of the things I’m still trying to figure out, I guess from like some HR and attorney people. I’m just trying to understand it better. But for the most part, every state’s in Atwill state. And so when you do your job offer and things like that, it’s very clear to stipulate in there this is not a contract and not a guarantee of any kind of employment. And there’s still these kind of things of, you know, wrongful termination and other things like that that still factor into rules. Andrew Burdette 00:07:14 So trying to find a way to still have some cause built in. So cause would be an example of like, you know, you punched a client, so I’m going to terminate you with cause because you punched a client. That’s obviously a very awful thing to do. versus your notes or maybe a week behind. How can we kind of get you in sync and get that kind of behavioral thing, like remediated and kind of back in sync with things? So some of the cultural things are going to be a longer term thing, or the performance evaluations are going to be longer term. And then there’s the nuts and bolts end of things. That’s the very administrative side. Like is payroll deduction happening correctly. Joe Sanok 00:07:49 Yeah. Joe Sanok 00:07:49 And I think that you’re just that kind of DNA of the culture, you know, is so important to to say, what do I want to have my impact be here, you know, through this practice on the people that work here, but then the community and all of that. what are some techniques people can do to really discover that personally as an owner, but then also collectively with their group? Andrew Burdette 00:08:15 I think in many ways this goes back to just as you’re conceptualizing your group, how are you conceptualizing your group? you know, do you have an ideal? Does your group as a whole have an ideal client? Like, are you wanting to work with a certain population? I know one of the groups around here. Andrew Burdette 00:08:32 They’re very focused now on neurodivergent. So autism and ADHD spectrum stuff, and that’s a real big push of who they really want to specialize with and focus on. my group is very big into like mindfulness. And so I want clinicians that have some relationship and practice and experience with that and one want to incorporate that work in with the client work that we do. And that’s not for everybody. Some people just want CBT and that’s great. There’s the CBT center of Asheville’s and other group around here too. so, you know, just group identity, kind of in the same way that you as a clinician have a like ideal client, you probably have an ideal collective client experience for the group of who you most want to work with from a population standpoint. And are you building a group culture around that and evaluating clinicians that are coming in as possible people to join your group, are they fitting into that overall culture you’re looking to create? You know, the other thing too is it’s like, are you wanting to create a very you know, we feel like family. Andrew Burdette 00:09:29 We want to hang out after work and that kind of dynamic. Or do you want relative independence with people? One of the things that I really appreciated, somebody had said in talking through switching over to W-2, they were like, you don’t have to change your management style. You can still be a relatively hands off manager and just work from an empowering other people to do their job and provide the infrastructure to allow them to do it well. And so thinking about those kind of things as you conceptualize your group, I think is a really big, important piece of things. Another part is you may have clinicians that join your practice that just aren’t a good cultural fit. And it’s not that they’re a bad clinician. It’s just you’re the wrong place for them to be. And so are you going to then want to recognize that and help them get rehomed into a different group to where they’re probably going to have greater success and greater comfort, because the culture of that organization functions better for them. Joe Sanok 00:10:31 Something always comes up when you’re running a private practice. Joe Sanok 00:10:35 Well, Augusta’s payroll and HR services can make it a little easier. Gusto was designed for you the small business owner. They take the pain out of running a business automatically calculating paychecks, filing payroll taxes, setting up open enrollment. Gusto. Does it all want more time tracking health insurance? 401 K onboarding commuter benefits offer letters, access to HR experts. You get the idea. With gusto, you can focus on the joy of running your business. It’s super easy to set up and get started, and if you’re moving from another provider, gusto can transfer all the data for you. It’s no surprise 99% of businesses said the value they get for gusto is worth the price. And here’s the best part because you’re a listener, you get three months totally free. All you have to do is go to gusto comm forward slash Joe again. That’s gusto comm forward slash. Joe. I’m telling you, you’re going to love gusto. Get started today. Joe Sanok 00:11:39 Now, what. Joe Sanok 00:11:40 Sort of metrics should people have that they’re looking at ongoing when they switch to a W-2? Andrew Burdette 00:11:46 It’s a good question. Andrew Burdette 00:11:47 I would say having notes that in a timely fashion would definitely be a good metric to start with. and that would be true private pay or not. metrics that come up a lot. are clinicians kind of meeting their target number for the total number of sessions in a week? You know, whether you’re contract or not, part of the the assumed benefit of joining a group is that that referral stream to the clinician is going to be a part of what she was a business owner, really provide for them. so on the one hand, are you kind of meeting what you need to kind of fill up a clinician’s roster and keeping it full and or you kind of getting things directed to them in a functional way. And then the other part of that is client retention, and our client’s actually sticking around with the clinician. And there’s a lot of reasons why that may or may not be happening. I think one of the things we had talked about briefly before we started recording these couple of episodes was, questions I get asked and started getting asked last year from some female group practice owners. Andrew Burdette 00:12:45 what was I noticing? Like, does my gender have an impact on whether or not people stick around or just talking about the difficulties some people run into about filling up a male clinician’s caseload because it’s a male versus, say, having, you know, female therapists with waitlists and stuff. So, you know, retention is a hard thing because, again, some of it’s going to be a modality thing. Some of it’s maybe people are realizing like it’s not a good fit. It could just be that the clinician doesn’t do a great job for rapport building. And that’s the key thing to kind of look at, too. So as an employer and having employees, as therapists, you do have a lot more latitude and discretion to kind of intervene and kind of mentor and train people on how they do the practice of what they do. whether it’s from an official clinical supervision standpoint or from an administrative supervision standpoint around their clinical skills, that opportunity to kind of like train them as much, much more available as an employer because you have more direction and control over the work that they’re performing. Joe Sanok 00:13:46 Yeah, I was just presenting. Right? Actually, right before this recording, to group practice launch and kind of summarizing that transition from launching a group practice, going into being a group practice boss. And, you know, one of the things that we talked about is looking for those outliers. And so, you know, having your front desk staff or virtual assistant, or, you know, billing specialists, whoever you have, let you know if there’s a clinician that is an outlier in specific areas. So one example we talked about is if, say on average, people have one cancellation or no show every other week across the practice. And, you know, you’ve got good systems for reminders. And then all of a sudden one of the clinicians is getting, you know, five a week, you know, we want to look at that and to, you know, look at if the average total sessions is 12 sessions start to finish and then one person has like 2 or 3 and they don’t even make it to a treatment plan, like something might be going on. Joe Sanok 00:14:43 And how, you know, as an owner to even have those conversations during hiring to say, listen like this isn’t to kind of breathe down your neck. But we know that on average, you know, people come about 12 sessions. And so, you know, if out of nowhere your caseload drops where people are leaving early, like, we’ll probably have a conversation, I’d rather you come talk to me and say, hey, I notice people are canceling a lot. I notice people are no showing. You’re not coming back as much. something’s going on. Rather than me discovering that as the owner, you know, I want you as a clinician. If you notice things shift to to know that, to just be aware of. Okay, you know, are things being optimized? Are they running? Well, you know, is there someone that’s hurting your reputation? You know, if you have a bad therapist behind closed doors, you don’t often know that the signs are there where, you know, people aren’t rebooking with them. Joe Sanok 00:15:30 They’re switching to other therapists. They’re canceling late. but I think those sorts of things to think through, like, where are their outliers here? And how do we make sure we protect ourselves against those. Andrew Burdette 00:15:40 Yeah. And again, as an employer versus somebody that has 1099 contractors, you have a lot more room to just kind of intervene and say what I think what you brought up to about having rapport with your employees about, please come to me and let me, let me work with you to try and address any issues that are coming up as you see them. Having that open door policy is really important. I think it’s important whether or not you have contractors or employees. I think it’s important for cardless. But, you know, and then looking at again, if you have that high turnover thing, it’s like, well, you know, maybe we can we connect you with a supervisor, like a clinical supervisor to kind of go over some things. If you happen to be a clinical supervisor in your group, you’re probably tapped into that to some degree, already. Andrew Burdette 00:16:22 But just, you know, is there a way we can kind of address the high turnover rate or the lack of client retention, or maybe drill into, like, why that’s happening? you know, it’s we’re recording this. It’s the start of March. We’re kind of past, like the reset of insurance stuff, through January and February. But having done private practice for five years now with insurance, it’s really common to have people like drop out in January or February because their deductibles reset. Stuff gets more expensive. Maybe they change the insurance companies and you’re no longer in network. there’s a lot of reasons that are not at all related to your clinician that did factor into it, but having that dialogue with your clinician and kind of having a discussion about, can we look at this metric and see what we can do to address it and try and identify what’s within the clinicians control or the practices control and what’s not? All of that really matters. Joe Sanok 00:17:14 Yeah. Well, in. Joe Sanok 00:17:15 A second, I’m going to let you answer that final question. Joe Sanok 00:17:18 And any closing things around that transition from 1099 to W2. but just as a reminder, if you are doing that transition and you’re thinking, you know what, I want to get positioned and wrap that up and do it before the end of the year. You’re going to want to sign up to work with Andrew. We are launching a new consulting program with him that’s that specific around 1099 to W-2s. You can read more about it over at practice of the practice. Com forward slash W-2. It’s only 595 a month, and Andrews Consulting usually is 795 to 995 a month. But you know, this training that he just went to, went through and, you know, just knowing that this is a really big need, we want to get people working with Andrew as quickly as possible, but we are limiting it to only 12 people. that can do the one on one consulting for three months. So, you know, you’re talking $1,600, $1,700 somewhere in there. to do this transition, you’re going to meet with Andrew once a month, or you can split that session into two shorter sessions, and then you’ll have a group session with other people that are in this transition and have that full support of the practice, the practice team behind you, to help you make a solid transition into w-2s. Joe Sanok 00:18:25 And there’s a lot of that that you want to do before the end of the year. So that’s why we’re starting it. It’s going to be going in August, September and October of 2024. so if you want to sign up for that, head on over to practice of the practice.com forward slash W2. Andrew, anything else you want to say about that group or to kind of land this plane of that transition to W-2s? Andrew Burdette 00:18:44 I want to add from, from just being in touch with my other colleagues and stuff like that, you can do this transition at some point during the calendar year. It doesn’t have to be fixed around, you know, January 1st and some other things. so you can, you know, switch it. Like I’ll be probably finishing this up the month of March. So going into Q2 will be fully done with the transition is my plan. I had friends last year that were doing it like May June of last year. Some people did it October, November, so it doesn’t have to be connected to a calendar year. Andrew Burdette 00:19:17 In other words, this is something that you can kind of set up and have it planned to be implemented kind of whenever it best suits you and obviously like check with an attorney and especially an accountant around how that’s going to all go. But, it doesn’t have to sync up with your, December to January rollover. Joe Sanok 00:19:35 That’s. Joe Sanok 00:19:35 So great to know. well, Andrew, that last question I always ask if every private practitioner were listening in the world, what would you want them to know. Andrew Burdette 00:19:44 W2 I think is the future of group practice. That’s kind of after a year of looking at this. I think that’s where everything seems to be headed. That’s the majority of where people in my area have kind of shifted to take over their practices, over to W2, out of the contract model. But I just think this is kind of that future, an evolution of where group practice maybe started five years ago with contractor oriented and now is shifting into that more, I guess adulting cubed or higher level exponent kind of thing of we’re doing more as business owners to really support and empower the people that were, affording the ability to do clinical work. Joe Sanok 00:20:20 So awesome. Well, Andrew, thank you for doing this series with us. And again, if you want to go, hang out with Andrew, learn more about his consulting around 1099 to W-2s. That’s over at practice of the practice.com/w2. Also, if you want to apply to work with Andrew outside of that he has a ton of different skill sets you can read all over at practice of the practice. Com forward slash apply. Andrew, thanks so much for hanging out with us. Andrew Burdette 00:20:45 Thanks for having me again. Joe Sanok 00:20:55 What an awesome series on that transition. I’m convinced you know I don’t have a practice anymore. I sold that in 2019. But to me, that I think that even just from a getting people to apply position to positions, it seems like W-2s are just really getting quality candidates that stick around. You can compete against some of those bigger employers, especially if you’re doing part time salaries or full time salaries. It’s just a lot easier than a lot of that percentage based model. So, thanks so much for hanging out with us today. Joe Sanok 00:21:27 Today’s episode was sponsored by gusto. Gusto is who we use for our payroll solutions. I absolutely love it because it helps do all the taxes and file everything, and I don’t have to worry about having a whole accounting team or bookkeeping team that’s doing that payroll. So tri gusto.com/joe, you’re going to get three months totally free. It’s going to help you with your payroll and so many other things like doing open enrollment, filing payroll taxes, calculating paychecks, all that sort of stuff you can do with gusto. Again, that’s gusto.com forward slash. Joe, thank you so much for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silences Sexy for that intro music. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter cover. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.