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Are you a married couple trying to navigate running a practice together? What makes a group practice a good place to work? How can you navigate disagreements about business decisions?
In this podcast episode, Alison Pidgeon talks to Peter Wyngaard and Dr. Susan Danielson about running a group practice as a married couple.
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Meet Peter Wyngaard and Dr. Susan Danielson
Collaborative Health Center (CHC) is a group practice in Livonia, Michigan that offers treatment for a wide range of mental, emotional, and relationship problems. Founded in 2016 by Dr. Susan Danielson, CHC is a comfortable place for therapists, clients, and their close ones to work together to improve their lives one step at a time.
Susan’s husband Peter joined CHC full-time in 2018 to help it scale, growing the practice from 6 therapists to 13, and increasing gross revenue by 300%.
Visit their website.
In This Podcast
- Susan and Peter’s group practice
- Growing dramatically in a short period of time
- Full time vs Part-Time
- Putting time into and taking time out of the business
- Navigating disagreements about business decisions
- Things that have helped Susan & Peter to work so well together
Susan and Peter’s group practice
Susan is the clinical director of the Collaborative Health Center and her husband, Peter, is the practice manager and does all of the operations and most of the admin. Susan has been in private practice since 2013 and a couple of years later was at full capacity. She hated turning people away so started thinking of expanding. Not only did she want to expand to better serve her community but she felt isolated so also wanted to build a practice that was a great place for others to work.
Through training, internship, and residency, Susan has become a specialist in eating disorders and discovered that there is a shortage of therapists comfortable with working with eating disorders. Growing her practice would mean that she could train and offer consultations to clinicians wanting to learn and work with people with eating disorders, and also at some point would have enough people to run and attend groups. In 2016, Susan opened Collaborative Health Center, hired two independent contractors, and have since grown and are now up to 13 clinicians.
Growing dramatically in a short period of time
Susan went around looking for office space and found a place that was great and met all of her criteria but it had a whole bunch of offices so filling those offices was one of the drivers. The other reason for growing so fast was due to word of mouth. After Susan and Peter hired their first therapist, she shared her experience working there with her colleagues which cascaded into another five therapists joining the practice over the next two years. Susan had really wanted to have a place where people wanted to work so spreading by word of mouth was a clear indication that they were doing the right thing.
Full time vs Part-Time
Ideally, they would like everyone to work full time with them as it makes things like office space assignments, routine, and monthly staff meetings easier but the downside of that is that you end up excluding a lot of very talented people who enjoy working at different sites. Susan and Peter do have a few full-time employees but also have a number of employees who are part-time.
Full-time employees are often more invested and easier to manage. Two of their employees who left early on only worked one day a week and Susan and Peter realized that this just didn’t work, so they decided that from then on if they hired part-timers it would have to be for at least three days a week.
Putting time into and taking time out of the business
Susan and Peter love to travel together and they usually go to somewhat remote places forcing them to take a break from the business due to connectivity and timezone realities. Right now, due to the pandemic, not being able to travel, it has been a bit harder to have boundaries. The business is now at a place where they can take weekends off so they have started to do that but it is definitely still something that they are working on.
Peter agrees that it has been hard for him to navigate as, throughout his life, when he commits to something he goes all in and often has trouble with boundaries. Peter knows that the amount of effort and effort that they have put in is all temporary. One of their primary goals is to set the business up so that it can operate without them so that they can reclaim that time and pursue other things. Peter has created a role for himself where he wants to design and create business systems that can be operated effectively by someone else in a cost-effective way so that they are serving their clinicians well by offering them a very competitive split. A couple of the benefits that they have from their well-run business is that it is less expensive to run and there are fewer mistakes.
Navigating disagreements about business decisions
Susan thinks that having a roadmap or some guiding principles around their goals and objectives has been really helpful. When they come upon a decision and are trying to decide where to go with it, they look at their goals to see what decision would be in line with one of those goals. If it still feels off to one of them then maybe that’s an indication that they need to either adjust an existing goal or add a new goal.
Peter thinks that because they both have clear responsibilities, they tend to defer to each other regarding decisions relating to the areas that they are responsible for. A big part of it is having clear roles and having comfort and confidence in each other to do their jobs. A really good exercise that they have done together was defining their vision, mission and values for the company. This has been another thing that they have often used to bounce a decision off of to make sure that it aligns with those.
Things that have helped Susan & Peter to work so well together
- Having clear, defined roles with little overlap so there is no inherent conflict there.
- There is a lot of trust between them and they like spending time together.
- There is an existing way of dealing with conflict. The same skills involved with conflict resolution as a couple apply when running a business.
- Intentionally finding time to work on projects together that need both brains.
- Realizing from the beginning that the business required a diversity of skills, approaches, and perspectives which they both contributed towards.
- Their strengths and weaknesses really complement each other.
- Dr. Christiana Awosan Started a Group Practice That Addresses Racial Trauma | GP 24
- Register for the Pivot Your Group Practice Intensive 2020
- Email Whitney: [email protected]
- Email Alison: [email protected]
- PoP Group Practice Owners Facebook Group
- Free resources to help you start, grow and scale
- Work with us
- Consult With Alison
Meet Alison Pidgeon
Alison is a serial entrepreneur with four businesses, one of which is a 15 clinician group practice. She’s also a mom to three boys, wife, coffee drinker, and loves to travel. She started her practice in 2015 and, four years later, has two locations. With a specialization in women’s issues, the practices have made a positive impact on the community by offering different types of specialties not being offered anywhere else in the area.
Alison has been working with Practice of the Practice since 2016 and has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
Thanks For Listening!
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Green Oak Accounting is the accounting firm I use for my own group practice. I started working with them in the beginning of 2020 and I am so glad I did. Julie and her team are super impressive. They’re always on top of things. When COVID-19 started, they were super helpful with navigating me through the whole process of getting SBA loans. They really helped me to navigate all of the changes that were happening and how it was affecting the finances in my practice. What I love about them is that I felt like in my practice, it had grown to the point where I really needed a sort of CFO perspective, that Chief Financial Officer perspective, to help me make business decisions based on my financials and I feel like that is what they provide. So if you are running a group practice and you’re feeling like it’s hard for you to make business decisions because you don’t have a professional and expert to look at your numbers and help you figure out what decisions to make in your business based on that, definitely check out Green Oak Accounting. You can go over to their website greenoakaccounting.com, you can schedule a free consultation to see if they would be a good fit. They can do everything from bookkeeping to payroll; they can set up profit first. They also do budgeting and forecasting. So, I am so glad that they are sponsoring this podcast because it’s such a great service and I have really benefited from it.
Hello, and welcome to the Grow a Group Practice Podcast. I am Alison Pidgeon, your host. I hope you’re all doing well. Obviously, we’re living in kind of strange times with COVID-19 and just to give you a little bit of a window into my life, we’re all still living at home the vast majority of the time, and we’re trying to work from home. My baby just turned one, and it was all the feels to see him grow up, and smashes cake. And he’s definitely the last one and so it was… it’s bittersweet to see him growing. He’s talking now and he’s starting to walk and it’s just so fun to see them growing and learning. But you’re also not ever going to have a baby in your house again. So that’s what we’ve been doing lately, and I have been recording this podcast in my basement. We have an office down here and so when I’m down here, my husband’s upstairs with the kids. But unfortunately, you can still hear the baby when he cries, even though I tried to have the background noise be as nonexistent as possible, that isn’t always the case. So that’s what happened in this interview today. You can probably hear the baby talking in the background or crying or what have you, fussing. So just to give you a heads up about that, that is my life. So, it’s better I think to put the podcast together than not at all.
So, I am really happy to share this interview with you today. I have been working a lot lately with couples who are running practices. It seems like since COVID-19 started, there have been a fair amount of spouses who maybe have gotten laid off or their hours are reduced and so they decided to help their partner with their practice. And so that’s been really fun for me, to get consulting clients who are looking at sort of combining their strengths and figuring out how to optimize their spouses already existing practice. So I had reached out in my Facebook group, and if that’s something that you’re interested in, we have a free Facebook group for people who are either looking at starting a group practice or are already group practice owners, it’s called POP, as in practice of the practice, Group Practice Owners, so if you want to look us up on there and answer a couple questions to join, that would be great.
So, I had just posted in that group and my guests today volunteered. They are a married couple – Peter Wyngaard and Dr. Susan Danielson – and they run a practice in Livonia, Michigan called Collaborative Health Center. They have developed a thriving group practice. They offer a treatment for a wide range of mental, emotional, relationship problems. And they really pride themselves on being a comfortable place for therapists’ clients and their close ones to work together to improve their lives one step at a time. So, Susan’s husband, Peter joined Collaborative Health Center full time in 2018, to help it scale. And he helped to grow the practice from six therapists to thirteen and increased their gross revenue by 300%. So they have grown exponentially in a very short period of time and I asked them a lot about how they set up their practice but also how they work together because I think that’s especially challenging, to work with your spouse, because you’re with them at work and then you’re with them at home. And you have to navigate the professional relationship and working on the business, combined with the personal relationship and being at home with them. So, I really appreciate Susan and Peter being so open about just their relationship and how they navigate all of those things. And we do talk about that quite a bit in the interview. So, I give you Dr. Susan Danielson and Peter Wyngaard.
Susan and Peter, thank you so much for joining me today. Welcome to the Grow a Group Practice podcast.[SUSAN]:
Thanks so much, Alison. It’s great to be here. [PETER]:
Yeah. So, what I was hoping we could kind of start with is just for you to introduce yourself and your practice and describe for us what your role is in your group practice. [SUSAN]:
Yeah, for sure. I am the clinical director of Collaborative Health Center. And my husband, Peter does all of our operations and most of our administration. But Peter, you could probably describe it better than I can. [PETER]:
Yeah, I’m Peter, and I’m the practice manager. So, whereas Susan is clinical director and deals with everything clinical, case… weekly case… what do you call those, Susan? The case reviews? [SUSAN]:
Case conferences. [PETER]:
Case conferences, etc. I do insurance, billing, and all of that kind of stuff. [ALISON]:
Okay, nice. So why did you start the group practice? [SUSAN]:
So, I’ve been in private practice since about 2013 and a couple years into private practice, I was at capacity and turning people away and I just hated doing that. And so, I started thinking about what it would be like to expand. And I didn’t have a sense at that point of how far I wanted to expand but definitely thinking, not only as a way to better serve my community, to have a larger practice, but also doing therapy all day… ironically, we spend all day with other people and yet it does feel kind of isolating, I think, because we are there in a room with one other person all day long. And so I decided that what I wanted to do was to build a practice that was a great place to work, a place that I would have wanted to have worked as an independent contractor, so that I would have more colleagues and we’d be able to serve more people. But that didn’t come down to me just adding additional sessions onto my week, week after week. I also sort of accidentally, through my training and internship and residency, ended up as a specialist in eating disorders, and I love it and have learned that there is an absolute shortage of therapists who are comfortable working with people with eating disorders. And also, a shortage of – I don’t know about in other parts of the country, but certainly in this part of the country, we have a shortage of therapy groups that are available. So I started thinking that if I grew the practice, I could not only have a place where I could be training and offering consultation to clinicians who wanted to learn how to work with people with eating disorders, but at some point, we would also have a critical mass such that we would have enough people to run groups and also attend groups. And so that was the vision there. At some point, Peter and I… so anyway, so that was in 2016. I expanded, I opened Collaborative Health Center, hired two independent contractors within a couple of months, both of whom are still with us. Within six months I’d hired another three. One is still with us, the other two left on good terms and we learned, I think, a lot about – from them – just sort of about what the profile of the clinician would be that would be a good fit for us, at least at this time. And then we’ve just sort of grown since then. And we’re now up to twelve clinicians – thirteen including myself. [ALISON]:
Wow, that’s great. So, is everybody still an independent contractor? [SUSAN]:
They are. I am an employee and Peter’s an employee, but other than that everybody’s independent contractors. [ALISON]:
Okay. Nice. So yeah, it seems like you grew it pretty dramatically in a short period of time. Was that something that you had always been planning? Did it sort of organically happen that way? Like, what was your thought process behind that? [SUSAN]:
Well, it’s funny, we… Part of it was that when I went around looking for office space, I had a couple of criteria and found a place that was great, met all the criteria, but it had a whole bunch of offices. And so, I was like, well, now I got to fill these offices. And so that was, you know, I think that was one of the drivers there. The other was just that we ended up with this sort of cascade because there was a therapist who came upon my job posting and she really connected with it and liked it a lot and came and met me and it was clear that she’d be a good fit. So, she joined us. And then she shared her experiences of working with us with her former colleagues. And then one after the next sort of reached out to me. And so, we then… how many followed her, Peter? Five? [PETER]:
Yeah, over the course of the next two years, five people. Yeah. [SUSAN]:
And then one of them had another colleague that they’d know… or no, I think just a friend. And so, it ended up sort of word of mouth, which was fantastic because that’s exactly… we really want to be a place where people want to work. And so, spreading by word of mouth is, I think, sort of the biggest indication that we’re kind of doing the right thing. And so that happened really quickly. So, the next five or six just sort of cascaded in. [ALISON]:
Wow, so you just really capitalized on that word of mouth phenomenon that happened, and you decided to make it work because you had good people who were applying for jobs. [SUSAN]:
Right, exactly. And ideally, we’d like everybody to be full time, we’ve decided that the full-time clinician is sort of the easiest for us to work with, because, you know, they’re very invested. It’s much easier when we’re figuring out office space assignments and all of that. It’s easier to have everybody available for you know, a routine, like, a monthly staff meeting. But the downside is that it ends up excluding a lot of people who are very talented, but really enjoy working at a couple of different sites. And so, we do have a few people who are full time. We also have a number of people who are part time who work. We have one gentleman who works for us part time and then works at a substance abuse IOP part time. And that’s a really good fit for him. He’s a great resource for us. There are not thirteen full time therapists, but we have, I don’t know, there are probably six that are full time, Pete? I’m just guessing, but… [PETER]:
Yeah. Somewhere around there. Sure. [ALISON]:
Yeah, I think that’s great. I find that to be true also. The full-time people are more invested. And it’s kind of easier to manage, especially when you have less therapists to manage. [SUSAN]:
Yeah, yeah. The two people who left early on, they were with us one day a week and we just realized that that just didn’t work. So, when we were then hiring even part timers, we decided it’s gotta be at least three days a week. [ALISON]:
Yeah. So something you had said a minute ago is something I kind of wanted to dive into a little bit deeper about, you know, there was this word of mouth phenomenon that happened when all these therapists started applying to come work for you. So, what do you think it was about how you were running the practice, or the reputation that you had developed among the therapists, that you think caused that to happen? Because obviously, word got out that this is a great place to work. So, I guess I’m wondering, like, what you did or how you set up the model so that therapists were seeking you out to come work for you. [SUSAN]:
Yeah, I think it’s a combination of things. So that happened after Pete joined the practice. And I think that… we were reminiscing about a trip that we took to Mendocino, California before he joined, and I was just in the process… I think it was like, the month before I was kind of launching this new company. And he was asking me questions like, you know, what is the average session pay? And I was like, oh, I don’t know. And he was like, well, but surely you can figure that out. And I said, well, I don’t know. I mean, they’re all different. They all pay different amounts. They’re all I… I just, I go in, I see my clients, I leave, I get paid. I had never considered sort of tracking anything and keeping track of, you know, data and then making decisions based on data. That was just a really foreign idea to me. I go in and I see my patients and I leave and if there are more patients then apparently I should have more clinicians and then they come in and they can see more patients.
And so, he started me thinking about the systems that we could have in place. And I so I think the combination of the very systematic, data driven way that he runs the business side of our practice and the administration side of our practice, combined with the training that I have, means that we have a place that is… and also just like sort of my personal preferences, we have a place that… what I’ve heard from a lot of the clinicians is that our physical location is a very comfortable, warm place to be. And they have full confidence in the clinical side that I run, and they have full confidence in the management and administrative side that Peter runs. And a lot of folks are coming from companies that were sort of thrown together much like mine was in the beginning, where we’re just… because I didn’t go to business school. And neither did Peter, but the feedback that I’ve given my graduate school is that they told us in the beginning that 90% of us go on to run private practices. And yet we didn’t get a single class on how to run a business. And so I think that that’s how a lot of us end up in this business is that we end up, especially those of us who are sort of driven and entrepreneurial, where we end up running a business, and yet we have no idea what we’re doing from a business perspective, and from a systems perspective. And that is felt by people, by the clinicians that are working at these practices. And so I think that it’s, as I said, I think it’s a combination of my clinical training and my approach, and Peter’s approach, that combines to have it be a place that’s very comfortable to work and that they have confidence in, so that they don’t worry about what’s going on behind the scenes. They have complete confidence.[ALISON]:
Yeah, that’s great. And I think too – we were talking a little bit before we started recording about how your philosophy, and mine actually in running my own practice, is that the therapist should really be the priority. And if you take care of the therapists, then they’re going to take care of the clients. And so, it sounds like you took that approach, and it’s felt by the therapists that you really are there to support them in every way. [SUSAN]:
Exactly. And we really want them to feel fully supported and free to do what they enjoy doing and what they are trained to do, which is to deliver high quality therapy services to their clients, not to be managing a lot of the sort of business side of their private practices that they kind of end up doing, either if they’re on their own or if they’re working in a place that they don’t have confidence in. [ALISON]:
Right. Yeah. And I’m curious too, Peter, what your background is or what you were doing before you joined the practice, and what was your thinking, I guess, as a couple behind you coming on board? [PETER]:
Yeah, I’m an engineer. I graduated with a bachelor’s in electrical engineering a long time ago. And I’ve had a career mainly in software development, software product development. What I was doing just prior to joining Susan, I had spent about a decade in cancer diagnostic development, looking at the cancer genome and understanding what genetic aberrations lead to cancer and then creating diagnostic tests to detect those genetic aberrations. So that was a really rewarding and fun thing to do for a while. But, so leading to my joining Susan, we had that wonderful trip to Mendocino where she was brainstorming starting this business, and I was just asking business one on one questions, you know, I mean, let’s sketch out what a P&L would look like, you know, what are the expenses to a business like this? And what is the income? What profit do you need to have to take home, to pay your expenses, to be able to do this full time? And it was funny because as Susan mentioned before, it was kind of hard to get those… Susan didn’t have those answers off the top of her head. But I sort of helped her over the next couple years, like setting up QuickBooks. I’m trying to think what… oh, I helped her select an EHR. We chose TherapyNotes after evaluating a few of them. So, there was a couple interventions in those first couple of years, even though I was still working full time doing other things.
I think the decision to join her full time happened in two steps. Susan was growing quite a bit and in December 2017, she hired an assistant because it was getting to be too much for her to have her full-time career as a clinician and then full-time career as managing the practice. So, she hired someone to do that and also at the same time, we had been using a third-party billing service that was taking 7% of gross revenue to do insurance billing. And we were looking at taking that in house, you know, the practice was growing to that point where it sort of made sense to, hey, if we’re hiring somebody to do all this other stuff that we’re paying 7% over here, why don’t we see if we can do this ourselves? So, it started really with that project to bring all the billing in house. And I also started helping to manage the person that Susan had hired. And then sort of by the middle of 2018, this is about six months into Susan had hired this assistant, and about three months into we brought billing in house successfully, I think we just looked at each other and said, you know, I think hiring an assistant was too early. We weren’t ready. We didn’t have our systems designed and really locked down in a way that someone could step in and sort of operate them. I think we probably would have needed to hire a much more experienced person to walk into the little bit of a void that we had in terms of guidance. And Susan certainly wasn’t there every minute of the day to help answer questions because she had her practice. So, there was that going on, sort of realizing that we probably didn’t make a good hire and we weren’t ready.
I was between jobs. I had just come off a year of consulting for a health system in South Dakota and was looking at other options and so the time was just sort of right. It also really helped me get a better picture of the finances of the company. And realizing that there was a path to us growing the business in such a way that it could pay us both a salary that we can live on, and probably some profit to save for retirement. And so, we decided to give it a go and decided to see if we can, you know, number one, can we work together effectively and still have the marriage and relationship we want? And number two, can the business be professionally rewarding and provide financially for our family? And I think by mid-2019, I think the answer to those questions were yes, we can work together effectively, and still have a great marriage, but we need to be mindful to not allow the business to dominate our relationship. And number two, the business and our work is professionally rewarding, but we’re gonna have to continue to grow in order for it to be financially sustainable.[ALISON]:
Yeah, and I wonder too, when you were talking about you coming on full time, Peter, into the business, was that a hard decision that you kind of wrestled with for a while or was it just, yeah, of course, this makes sense. Let’s do it. [PETER]:
I think it was easy for me. I think Susan had some reservations. [SUSAN]:
Well, I remember you asked… it was a great question because I wrestled with it a little bit. I mean, I knew on the one hand that for the business, there was no better decision than to bring Peter on. I mean, he’s incredible. And so, I knew that he would make a success of anything that he touched. And so that part of the decision was a no brainer. What is best for CHC? Well, what’s best is to have Peter working for us. And he said, okay, well, what are you nervous about? And I said, well, I’m afraid that you’re going to get really frustrated with me, and I’m afraid that we’re going to spend all of our time at home working on the business, because there’s always more to do. And so I think that those have been things that, yeah, we are wired very differently, but it’s one of the reasons that we make such an effective team and so focusing on the diversity there being a strength, I think is really helpful. But we definitely, yeah, that’s, you know, we approach things very differently and that is a strength. It’s also one of our challenges. And then yes, the boundaries between our personal life and our professional life, that it’s… as you know, Alison, I mean, there’s always more to do when growing a business.
And we have to be careful. I mean, we’ll be sitting having a conversation about anything, and it will slide into conversation about the business, which can be really useful, and we can have these great brainstorming moments and these great aha moments. But it’s definitely something that we have to, that we’ve been sort of staying on top of. And how do we have weekends that aren’t dominated by the business? And how do we have time away that isn’t so dominated by the business? But I think we do it pretty well. It’s a work in progress, but, yeah, I think we do pretty well.[ALISON]:
Yeah, I’m glad you brought up that topic of boundaries because I feel like that would probably be something early on you recognize like, okay, maybe we need to make some parameters around this because, like you said, you might end up spending all your personal family time talking about the business and that would probably be exhausting. So, did you have any sort of concrete boundaries around, okay, this is business time versus this is family time, or how did you work that out? [SUSAN]:
I think… one of the things that Peter and I really love to do together is to travel, and often internationally or to sort of somewhat remote places where, because of connectivity realities or time zone realities, we can’t be super available and responsive to the business. So, it’s a forced break from it. Obviously right now, not being able to do much traveling, I think it’s a little bit harder. So, I honestly think that the last few months have been a lot more challenging with these boundaries that I’m realizing, because we haven’t had these forced boundaries. I think we have started to have more, you know, sort of conversations around like, okay, the business is now to a place where we can take weekends off, so let’s do that. And so, I think it is definitely… that is still something that we’re working on, especially during these times, as I’ve said, that we don’t have this sort of forced distance from it.
*start of commercial snippet
Hey, Alison, this sure has been a crazy year.
It sure has Whitney. [WHITNEY]:
So what were your goals for your practice going into 2020? [ALISON]:
Well, I had a lot of them and then I threw them all out the window back in March when COVID started but then I realized that we might be in this for the long haul so I got back on track with accomplishing my goals in a different way. But wouldn’t it be nice if someone created an event to help group practice owners meet their goals? [WHITNEY]:
Yes, it would. You mean if they did an event like “Pivot Your Group Practice Intensive 2020”? [ALISON]:
Yes, I like the sound of that. [WHITNEY]:
So do I. Let’s do it. [ALISON]:
Yeah, so Whitney Owens and I have put together this awesome one day virtual workshop to help you figure out how to continue growing your practice, even among COVID-19 happening, and still meet your goals for the year 2020. We will be doing a deep dive into fixing all the problems in your practice, and also helping you come up with creative ideas to continue to scale, make more money and work less hours. [WHITNEY]:
So, the registration will be closing on August 5, so make sure you register by then. We’re going to keep this limited to only 20 spots so that you can get the most out of this group and the most out of working with the two of us as your consultants. So, the link to register is in the show notes. If you have any questions, please follow up with us by email [email protected] and [email protected] and we look forward to working with you on August 14.
*end of commercial snippet [ALISON]:
Yeah. What do you think, Peter? Is that something that’s hard for you to navigate or has that been a work in progress or…? [PETER]:
Yeah, it’s always been hard for me to navigate. I mean, throughout my life, whenever I sort of commit myself to do something I go all in and often have trouble with boundaries. So, I don’t think this experience is any different for me personally. And for Susan and I, you know, there’s another piece of this too, which is that I know that the amount of effort that we’re doing right now, or the amount of effort that we both put in, the amount of time we spent last year, the year before, I know this is all temporary. One of our primary goals is to set this business up so that it can operate without us. Not so that we can walk away from it necessarily, although that would be a choice at some point, but more so that we can reclaim that time, so that we can do other things, you know, Susan has other things she wants to do. And I’m sure there’ll be another adventure for me at some point.
So that helps mentally, to know that like we’re not… I haven’t created a role for myself that I’m going to be stuck in for the next three years or five years. I’ve created a role for myself where I want to design and create business systems that can be operated effectively by someone else in a way that’s very cost effective, so that again, we’re serving our clinicians well by being able to offer them a very competitive split. So that’s one aspect of having a well-run business is that it’s less expensive to run. The other aspect is that it’s run well, there’s less mistakes. You know, going back to the question you asked before about why did these five or six clinicians come from this other place? One common complaint was, you know, billing was always messed up. And patients would also complain about that. I get calls often asking for statements and I hear comments from folks who had been working with the other practice before about how the billing was always a mess, and they were always having to double check it so. So those are the two benefits to having a well-run… at least a couple benefits to having a well-run company. And I know that my role right now, even though I’m spending more time that I’d want to, is to replace myself. So that helps.[ALISON]:
Yeah, I think that’s really smart. And I think a lot of practice owners don’t think about setting up their business in a way that they can start to move themselves out of doing the day to day, which is what I’ve done in my own practice. So yeah, I think you’re exactly right. You see the light at the end of the tunnel, so it’s easier to put in the long hours now knowing one day this practice is going to largely run itself and then I’ll be able to, you know, do something else that I enjoy, or have more freedom with my time, or whatever the case may be. So yeah, that’s great. So, I’m curious too, like, when you have a disagreement about a decision in the business, is there one of you that’s kind of like the ultimate decision maker, or how do you navigate those types of challenges? [SUSAN]:
Yeah, that’s a great question. So, one of the things that we spent some time with over the winter was working on our sort of goals and objectives for 2020, with exactly that in mind. So, let’s say that we come upon a decision, and we’re trying to decide, where do we go with this? Well, let’s look at our goals and objectives and see what would be the decision that would be in line with one of our goals. And if we identify what the decision would be, and it still sort of feels off to one of us, then maybe that’s an indication that we need to adjust one of the goals, or add a goal or, you know… so I think that having a kind of roadmap or some guiding principles has been really helpful for exactly that, for making various decisions along the way. I don’t know, what do you think, Pete? [PETER]:
Yeah, I think also… I’m trying to think of a big disagreement we’ve had that we could use as an example, to think about how we resolve conflict, and I’m struggling to sort of think about one, but I think the other thing is, is that we have pretty clear responsibilities. You’re the clinical director and I’m the practice manager. So I think we defer to each other, I mean, I know I certainly defer to you on any decision making around any kind of specialties we should add to the team, the types of clients and issues they’re dealing with that are appropriate for our practice, and those that aren’t, I mean, those kind of decisions are yours. And I think that you’re happy to allow me to make decisions about how we design processes, what software or systems we purchase to implement those processes, I think you largely defer to me. So, I think that’s a big part of it, just having pretty clear roles and comfort and confidence in each other to do our jobs well. [SUSAN]:
I think that’s right. I was just thinking about, what might be the things that sort of span the two lanes, and something that we’ve been working really hard on is identifying what is the profile of the clinician that is ideal for us, and it has to work from both sides. So, it has to feel like a good place for the clinician to be and it has to feel like a good fit for us. And occasionally we have come upon a clinician who’s been really interested in working with us, and seems like a wonderful person, sounds like they’re a great therapist, and yet we decide would not be a great fit because of some of the goals that we’re working on or working toward. And because of what we would need from them just in other ways, and I think that is something that… but even then I think that we can each recognize what is the right decision for the business, even if we personally don’t like making it. That it’s like, I acknowledge that this is the right decision, and it’s an uncomfortable one, and I don’t like it, and it feels icky, but it’s the right thing to do. Yeah. And I think, largely, yeah, that it’s about we each I think really have our area of expertise and we do defer to one another and when there is something that spans the two, that I might have one vote, he might have another vote, and yet, then we sort of look to our goals and look to what we’re trying to do and then the decision is clear, even if it’s the kind of an annoying one to make or an uncomfortable one to make. [ALISON]:
Yeah, yeah. Yeah. So, it sounds like you do some work ahead of time to determine what your shared values are for the business, but also what the goals are. And then when decisions come up that need to be made, you sort of go back to those and then that helps sort of guide you through that decision-making process. [PETER]:
Totally, and not just the goals that we’ve set, but also another thing we did last year, ahead of thinking about 2020, or thinking about our goals and our 2020 objectives, was defined vision and mission and values for the company. And that was a really good exercise, to try to distill down, you know, distill that stuff down. And I think that’s another thing, that we often will bounce a decision off of our vision, but more our mission and values, and make sure that we’re remaining aligned to those. Because those were defined really from the heart, and independent of any one decision or any one situation or problem we’re dealing with. It’s just like, what do we really believe in? What do we want this place to be and how do we want to run it? And I think that’s really helpful. [ALISON]:
Yeah, I’m glad that you brought that up, because that’s something I actually tell my consulting clients to do, is to write down their mission, vision, values for their practice, because yeah, I think we can get distracted by maybe an opportunity that comes up and that seems great. But then if you have those things in writing, you can sort of, like you said, check back to see like, oh, wait was this really part of what my overall vision for the practice was? And really kind of check yourself before you start spreading yourself too thin trying to do a bunch of different things. So yeah, I’m glad that you brought that up. [SUSAN]:
One of my fears has been that I feel this nervousness inside of me, or hesitancy, as we think about expanding even further, and we have brilliant timing – I think we were a month into our new expanded space when COVID hit. So, we have this lovely space that we barely got to start using. And it’ll be there for us, you know, when we return, but one of the things that I was nervous about as we were expanding is that, you know, I was like, what’s gonna be lost if we get to be a practice of twenty clinicians? What’s going to be lost? And as Peter and I talked about it, I was comforted, realizing that, right, that’s one of the roles of, that’s one of the purposes of having really clear mission, and vision, and values is that as long as we’re making decisions that are in accordance with those, the practice should feel the same, whether we’re a practice of three people or forty people. Of course, there are going to be some things that having a staff meeting of five versus twenty, yeah, that’s going to feel different. And yet, if all the hiring decisions, and all the growth decisions, if every decision is rooted in and true to the mission and the values, it should still feel very similar to how it felt as a much smaller practice. And that helped me reconcile, like, okay, we can grow without becoming the dreaded corporate. And that we can because of something that a lot of our clients and clinicians say, you know, they just love the feel of the practice. So, when we were working on the mission and the values that sort of, what is that? What is the feel of the practice? Let’s put that into… let’s operationalize that and make sure that we maintain that. [PETER]:
Or let’s articulate it and make sure that everyone understands. And that’s part of culture, right, this thing that you’re saying, which is, you know, the feel of the practice and why patients and clinicians say that it feels good. I mean, that’s our culture and it’s part making sure that everyone’s clear on why we’re doing this, and how we’re going to do it. But also, operations, operational excellence is a big part of that. And that’s often the thing that gets affected negatively when you grow. Systems that aren’t designed to scale start breaking and some of that trust and some of that culture can go away. If all of a sudden, you know, people are realizing that they’re getting paid much later in the month than they used to be, or there’s a lot more billing errors, or patient benefit checks are being done incorrectly so that all of a sudden, patients have three sessions and realize they have a $500 bill because their insurance wasn’t going to cover it. I mean, those sort of things can really erode away the good feels that you tried so hard to create, because now the company can’t be trusted anymore. [ALISON]:
Right. So, it’s so important to have those tangible and intangible things that really contributes to the culture. Yeah, that’s great. So what was interesting for me lately is that I’ve been working with, I think I have four different couples now who are consulting clients who, it seems like because of COVID, one of the partners got laid off, or their hours were reduced, and so then the other partner had a practice and they were like, well, now I have this time to help you fix the practice, or expand it, or whatever. So, that’s kind of why I wanted to find a couple who was already running a practice, because it seemed to be coming up a lot lately. So, I guess I was just wondering if you had any tips for those couples who maybe are newer to working together, like how to manage again, kind of the marriage/personal side of life versus running the practice together? That’s a good question, right? [SUSAN]:
That’s a great question. Um… [PETER]:
I don’t think we put a lot of effort into it, is why I find it’s gonna be difficult to answer this question. I think we enjoy spending time together. And for me, I mean, certainly I enjoy our time off and our travel where we get to spend a lot of time together and we’re not talking about the company all the time. So, I guess I do enjoy that probably more – it’s more relaxing and fun. But I also really enjoy building this together with Susan, so, I don’t… tips – I’m just trying to think, what are the tips? I think another thing that was really important was, again, this idea of, we don’t have a lot of overlap in terms of strong beliefs about how the practice should be run administratively versus clinically, you know, so there’s not any inherent conflict there, really. And there’s also a lot of trust. I think that I trust Susan… So, I think you almost want to come up with like a compatibility check, right? I mean, I think if these things are already in place, you know, like spending time together, have an existing way of sort of dealing with conflict, whether it’s conflict just being a husband and wife and living together, those same skills are applicable to conflict resolution when you’re running a business, having clear and distinct roles – you know, that goes a long ways towards right there just avoiding difficulty. [ALISON]:
Yeah, I was gonna say it sounds like you’re not obviously working side by side every day, all day together. So that probably helps too, like, you have your stuff you’re doing, Peter and you’re off doing it. And then you’re probably seeing a lot of clients, Susan, or doing supervision, and so you’re not literally together all day, every day. [SUSAN]:
That’s true. But actually, that is something that we’ve been really intentional recently about is, you know, if I’m seeing this client, and that client, and then here’s a question that comes in about a referral, and I’m sort of putting out clinical fires – I mean, that’s a little dramatic, but if I’m like attending to clinical issues here and there, it often is difficult to find time… at least for us, it doesn’t happen without intentionality that we have time to work together on the things that we do both need to work on together. And so what I’ve recently done is to carve out time, so I have moved clients off of one day a week so that that’s a day that Peter and I can work together on stuff because, otherwise he ends up waiting on me for some things that I haven’t gotten around to because it’s not stuff that I enjoy doing. I’m trained to do clinical work. I enjoy doing clinical work. That’s why he was so needed initially, because there were a lot of administrative things that weren’t getting done as well as they should have been. And so, I think, finding time to work on projects together that really need both brains, that’s one tip, one recommendation that I would… at least, I think it’s important for us. Because otherwise it just doesn’t happen. Because of exactly that which is that like, I’m off doing my thing, and he’s doing his thing. And if they’re sort of siloed projects anyway, that’s fine. But if they’re not, then they end up just not getting done. [ALISON]:
Yeah, so I think that’s really good advice, to make time to work on the business intentional, like, you’ve carved it out into your schedule, because I think a lot of people are just like, oh, well, when we have time, we’ll have a meeting about X, Y and Z. Well, you never really have time. You have to make that time. [SUSAN]:
Or you do have time, but it’s like, that’s the weekend. And then that gets into the boundaries question, that it’s sort of like, yeah, if there’s something that’s really urgent that needs to get done, it will find a way of being addressed because one or both people is going to feel the urgency to address it. But then if there’s not carved out shared working time during the workweek, then it’s going to creep in, it’s going to present itself as urgent during non-working time. And then we’re spending our family time doing this other stuff.
And I think also recognizing that… and I don’t know how it’s happened with these other couples, but one of the reasons, as I said, that it became so obvious that there was a role for Pete is that there is this whole side of the business that I’m just not good at, and he is very good at. And so, realizing that, of course, from the beginning, it requires this diversity of skills and approaches and perspectives. And so, you know, what are the… so, let’s assume from the beginning that we have very different skills, otherwise we wouldn’t both be needed at this company. And so then, let’s telescope out a little bit and predict like, okay, so given that these are our differences, what might be some challenges that we can anticipate and how can we prepare for those ahead of time? How will we approach them? How will we manage them when they arise? Because they probably will, and they will probably arise when we’re already feeling frustrated and tired and you know, so what are some things that we can anticipate and how will we manage them?[ALISON]:
Yeah, so it sounds like your strengths and weaknesses really complement each other. And that’s probably one reason why it works so well. [PETER]:
I think that’s right, like, I think if we didn’t believe that the business was stronger because both of us are in it, I think it would be harder. In other words, I think if Susan was just managing me, and I wasn’t adding anything beyond just getting stuff done – making sure that insurance claims are submitted and new clinicians are credentialed – if that was all I was doing, I think it would be harder. But I think because we both add something important to the business, it sort of makes it a relationship of equals, which is something that we strive to… I don’t want to say strive, I don’t think we struggle at all, or strive, I think that’s the way our marriage is. And so, the fact that that translates, that we have a similar relationship of equals in the business, I think, makes it work easier as well. [SUSAN]:
Yeah. And I think also the boundary piece also of like, we can have a professional disagreement, and close the door on that and then have our evening together as a married couple. And I think that that’s also something that’s really important, is to not let the struggles as coworkers leak into the marriage. [ALISON]:
Right. Yeah, I think that’s a great point. Well, Susan and Peter, I so appreciate you taking the time to talk with me today and for sharing about your practice and your life and being comfortable sharing about how to navigate running a business while being married to each other. I think that was super helpful for a lot of other couples in our audience who are also running practices together. So, if anybody in our audience wants to learn more about your practice, or maybe get in touch with you, how would be the best way to do that? [SUSAN]:
Yeah, I think the best way is to go to our website, which is collaborativehealthcenter.com. And you’ll see there are lots of ways to get in touch with us through the website. It’s probably the easiest, don’t you think, Pete? [PETER]:
Yep, absolutely. [ALISON]:
Okay, wonderful. Well, thank you so much again. [SUSAN]:
Thank you, Alison. [ALISON]:
If you are a married couple who is trying to navigate running a practice together, I hope you found that interview helpful. I hope to have a few more couples on in the future to talk about this subject because I think it’s interesting how people navigate their relationships when they’re working together and married at the same time. So again, thank you Susan and Peter for being so candid about how you build your business and keep your relationship strong as well. Before we wrap things up, we are a relatively new podcast – we launched right when the pandemic was starting. And so, our launch got a little lost in all of the craziness that was happening in the middle of March. So, if you have listened to this podcast and you would like to leave a rating and a review on iTunes, I would really appreciate it. And if you have any ideas about the podcast in terms of topics, or maybe you think you would be a good guest, please email me, it’s [email protected] I really want to make this as valuable as possible for potential group practice owners and current group practice owners. So, if you have ideas about content that you would like to hear on the podcast, I would love to hear from you. So, hope you’re all having a great day and I will talk to you later.
This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.