[JOE]: This is the Practice of the Practice podcast with Joe Sanok, session number 416. Cyber Monday is right around the corner and our last cohort of Next Level Practice is starting on Cyber Monday. Next Level Practice is a monthly membership community where you get in an ongoing support system for mental health clinicians, counselors and coaches who want to start and scale their own private practice. We feature hundreds of trainings, live calls with experts and a robust library full of exclusive online contact and a community that’s so amazing and supportive. I mean, let’s be honest, even if you have a PhD, odds are that you graduated without really knowing how to start your own private practice, let alone one that allows you to grow your impact and your income.
Maybe you’re working for someone else’s practice and you’re struggling under their systems. Maybe you’re working out in the world or nonprofit and making less than you deserve. Maybe you’re working in both arenas and getting dangerously close to burning out, or maybe you already have a practice and it just hasn’t launched how you want it to. I want to invite you to head on over to practiceofthepractice.com/invite where we are going to be talking all about Next Level Practice and you can get access to this cohort. The prices go up in 2020 so I want you to grab and lock down the $88 a month price. Head an over to practiceofthepractice.com/invite to read all about it.
Well, welcome back to the final episode in this series, all about group practice. We have covered a lot of ground with Alison Pidgeon, our in-house consultant around group practice. In episode one she talked all about why do a group practice and then we moved into logistics to start a practice, next we covered moving from me to us, filling up others, and then in the last episode we talked all about managing staff systems, turnover and finances. And today Alison, we are diving into CEO mindset. You ready for this?

[ALISON]: I am so ready.

[JOE]: I feel like we should’ve just had that like [inaudible 00:02:23], y’all ready for this? I hate that song but it just jumps into my head once in a while. So, CEO mindset, like what does that mean? I mean we hear that tossed around a lot. In a private practice. What does a CEO mindset mean?

[ALISON]: I’m glad we’re talking about this because I don’t think we talk about it enough. What I think it means is that you are now focusing on big picture stuff and you are really not involved in the day to day nitty gritty details of running the practice anymore.

[JOE]: Yes. I feel like I’m even transitioning with Practice of the Practice and doing more and more of that with helping you and Jeremy and Whitney and Sam all launch podcasts and kind of having this big picture vision of where we could head and then we have now three people in South Africa that are working for us and you know, we’ve got another state side that it feels like we’re, I’m moving further and further away from just that individual work like I used to be doing. So, it’s fun to be able to look at that big picture stuff.

[ALISON]: Yes, I really enjoy it, and when I look at the big picture stuff in my practice, I am looking at potentially opening new locations. I still want to be involved in the hiring process but really there, and obviously the finances to some degree, I still have to sign the checks and all of that kind of stuff. But really like the day to day of running the practice and all those little questions that come up and different things you know, I don’t really want to be involved in anymore. So, I’m training other people to do that for me.

[JOE]: Now, that’s so awesome. So, when we have someone that has an established group practice, they’re still kind of in the thick of it, what are some of the first steps for them to move towards being more of a CEO?

[ALISON]: I think you have to look at what you can delegate. Again, and that can be hard for a lot of people, but it doesn’t have to happen overnight. It can happen over time and you just have to be really consistent with like, “Okay, this month I delegated this, now next month I have to remind myself, Oh, what else can I delegate?” Because otherwise you’re never going to free up your time to be the CEO.

[JOE]: Yes. I’ve found that if I pay someone on a regular basis, like Sam or Jess where I’ve said you’re guaranteed X number of hours, it then forces me to say, “Okay, I got to fill them up or I’m just paying for nothing.” And so really kind of aggressively thinking about why am I spending my time on this when I should be outsourcing it?

[ALISON]: Yes. So, this past spring I hired a new assistant and I knew she wanted to work 40 hours and I knew I had about 30 hours’ worth of work for her to do. And then I was like, “Oh, what else can I have her do in those 10 hours?” Well, I found things for her to do.

[JOE]: Absolutely. Well, even just like, there was something wrong within Teachable where you weren’t getting your percentage through there. So, every month I’m like manually sending you this money and it’s supposed to be automated. So today I texted Jess, our director of details. I was like, “Can you please get on an email or something with Teachable to figure out why this isn’t happening.” And she took care of all of it. She went through and figured it out and it’s like, that was awesome. I was busy doing podcasts. So that was a much better use of my time than dinking around with this technology to find out why it wasn’t working. And, to me that’s the kind of thing that to just say like this needs to happen outside of my time.

[ALISON]: Right.

[JOE]: So, what gets in the way of people actually doing that? Because it sounds glorious to most people, but the reality is they don’t do it. So, like what stands in the way of people having that CEO mindset?

[ALISON]: I think a lot of us identify with being clinicians and then moving towards maybe seeing less clients or maybe giving it up altogether is really hard because we worked really hard for our degrees and our licenses and you know, moving more into that CEO business role may feel like a big shift for a lot of people. I think too you worry about can I trust these people? They’re setting the tone for the reputation for your practice and if I’m not there every day, how do I know they’re doing good job? And so just like a lot of fear comes up around that, I think too, initially people are afraid to spend that money. They’re like, “Well, why would I pay them to do that when I can just do it? It only takes a few minutes.” But they don’t realize how much having all those little things on their plate just keeps piling up and piling up and creating more and more stress in a lot of cases. I was just talking to somebody yesterday who was having a really hard time with giving up answering the phones, and also he has the money to be able to hire somebody to do it but again, being fearful about spending that money and I was trying to explain to him how you’re ultimately going to increase your revenue even with paying this person because they’re going to keep your schedule full and your therapist schedule full. And I think when you have never done it before, it’s hard to see how that’s going to play out.

[JOE]: Yes. I often talk about how a virtual assistant is almost always cost-positive and that you end up making more money by hiring them than less because they’re catching those phone calls and emails and all that while you’re in session whereas so many people just go through the list of clinicians and if they don’t get someone to pick up the phone, they’ll just move on to the next person.

[ALISON]: Yes. And I see that happen over and over.

[JOE]: Yes, it’s crazy. I remember, I’ve told this story before, but I hired someone before we had the phone forwarding where I had the phone that you had to like call into and enter your code and all that and I just wouldn’t do it. I would go work at the college, totally forget to even call and check my voicemails on this other voicemail. And finally, I hired someone that once a day in the morning and once in the afternoon they would just call the voicemail, check it, and then call the people back. In the first day they scheduled three new intakes. I’m just like doing all this marketing to get people to finally leave a message and then I’m not checking my phones. This is ridiculous. But it was, it just didn’t feel like it was as good use of time as me showing up to do the clinical work. So, the more that you kind of have those people do those things that you know you shouldn’t be doing, the easier it is to grow and scale.

[ALISON]: Definitely.

[JOE]: So, what about exiting? So, you’ve retired and you kind of keep an eye on your practice, but you’re not doing the clinical work. I’ve sold my practice. What do you think that in regards to exiting, retiring, selling? What have you noticed that people that do that do that maybe people that are still within their practices, like compare those two?

[ALISON]: I think they have designed their business to be able to run without them, which ultimately if you want to sell it one day, that is going to be paramount to show the new owner or the buyer like, “Hey, Nick, the revenue here is not dependent on me seeing clients. I can walk away from this and it’s still going to generate the same amount of revenue when you take it over.” So, I think they’ve just, you know, structured it in a way where it’s not dependent on them and they’ve really moved into that CEO role or maybe they even not even in the CEO role anymore and they just have somebody else run, totally running their practice for them.

[JOE]: Yes, I know that in selling it kind of the way that we came up with our prices, looking at the last three years of net income outside of me then valuing the tangible items, like file cabinets or clocks or art couches, things like that and then looking at the intangibles such as a website or reputation or the logo or the professionally taken pictures, like what would the replacement costs be, but then how much also value do we have in it just being around and ranking for different things. And then from that we were able to say, “Here’s what we think that this practice is worth.” But you think about the argument if someone’s going to drop 50 grand, a hundred grand, half a million dollars, whatever the price point ends up being that person has to be able to say, “You know what, that money to buy that practice is worth it more than putting that into consulting or building my own website or figuring this all out on my own that it really needs to be turnkey.” So, I’m with you that you really can’t look at selling or exiting without removing yourself from the equation.

[ALISON]: Right.

[JOE]: Well, so we’ve covered a lot in this series; why do a group, logistics to start, moving from me to us, managing your staff, transitioning to CEO. I want to kind of zoom out from it. What are some things in running a group practice that maybe people don’t notice on the surface? So, it could be benefits like, “Dang, I never would have thought a group practice would do this,” or even just challenges that maybe people don’t recognize before they jump into it.

[ALISON]: What I didn’t realize when I first started was that I’d be able to get to where I am today. Like I probably, since I’ve come back from maternity leave do still work in the practice a little bit. I would say that probably totals about five hours a week and whenever I tell people that they’re like blown away. They’re like, “What do you mean you only work five hours a week?” But I think that to me has been, you know I’m just super grateful that I’m able to do that and then still make a salary and I guess when I started, I didn’t ever imagine I’d get to that point. I just thought, “Oh, I’ll just keep seeing clients wherever and I’ll just be here every day from eight to five or whatever.” And I was able to structure it in a way so that I could really minimize the amount of time I spend working in the practice.
I think the challenges that people don’t recognize is you have to be intentional about setting up the practice in a way that’s going to make things run smoothly and it’s going to make staff want to stay, and, like these things just don’t happen by accident. And what I see happen a lot is people start a group practice without necessarily getting any help or getting any consulting or following any kind of a plan and then, they get a year or two in and they realize they’ve made a mess of things like billing or their staff’s all leaving or, you know. And so that’s what I talk to a lot of people when they’re interested in the mastermind group. That’s one refrain I hear over and over is like, “I just don’t know what I don’t know and I don’t want to start something and have it being an epic fail just because of my own ignorance because I didn’t know how to set it up correctly.”

[JOE]: Yes. It’s like doing renovations on our house. Like I can tear down drywall, I can tear things up. I’m not going to start taking walls down without knowing if they’re support walls and I’m definitely not going to rebuild it or learn how to rebuild it. It’s just like, I don’t want to put my time into things that someone else is already an expert in. So, like, why wouldn’t you just work with an expert that knows how to tell you how to do it?

[ALISON]: Right. And I think too it was surprising to me when I started how quickly we started generating a lot of income. I just had that one office in the beginning and my first kind of full-time person I hired, she and I were sharing the office and she was there when I wasn’t there. And like the second month she was there, we generated like $10,000 gross and I was just like blown away. I was like, never imagined seeing that number coming in on one month’s time. And yes, so it was super exciting. And once you get that first person hired, it’s much easier to add the second and the third and so on.

[JOE]: Yes, totally. Well, I, I’m with you. It’s been so fun to watch you kind of go from that solo practice, that group practice to consulting to now retired. Oh my gosh. So, oh, look at you. Well, I’m so excited about what you’re doing with group practices. If people want to connect with you head on over to practiceofthepractice.com/apply and you’ll see there that we have this big infographic helping you figure out where you might fit best in the Practice of the Practice world. You can connect with Alison through that, you can apply to work with Alison, join her mastermind group. But one thing that we want to talk about is that on December 10th at 2:30 Eastern, 1:30 Central, 12:30 Mountain, and 11:30 Pacific, we are doing a mastermind call/master class/webinar, slash, we’re just helping you learn how to start a group practice. We can call it anything we want but after recording so many of these episodes today, you’d think I’d have this down, but not yet. So practiceofthepractice.com/grouppracticewebinar. If you want to register for that again, that’s December 10th that you can check that out. Alison, thank you so much for doing this series a and working through just all the work you do with group practice owners.

[ALISON]: Thank you. Yes, it’s fun talking about this stuff.

[JOE]: So, if you want to get some extra help from Alison and myself, we are doing a webinar on December 10th at 2:30 Eastern, 1:30 Central, 12:30 Mountain, and 11:30 Pacific. Head on over to practiceofthepractice.com/grouppracticewebinar and you can get all the information about that webinar, register for it, and get some extra help on starting and growing your group practice.
Special thanks to our sponsor, Next Level Practice. For you to sign up for next time’s cohort which kicks off on Cyber Monday, head on over to practiceofthepractice.com/invite. We would love for you to join that community and rock out your private practice. Also special thanks to the band Silence is Sexy. We like your intro music and this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional? You should find one.