[ALISON]:
You’re listening to the Grow a Group Practice podcast. Whether you’re thinking of starting a group practice, are in the beginning stages of a group practice, or want to learn how to scale up your already existing group practice, we have lots of great content for you.

Grow a Group Practice is part of the Practice of the Practice Podcast Network, a network of podcasts seeking to help you grow your group practice. To hear other podcasts like the Imperfect Thriving podcast, Bomb Mom podcast, Beta Male Revolution, or Empowered and Unapologetic, go to practiceofthepractice.com/network.

Hi, everyone. Welcome to the Grow a Group Practice podcast. I’m Alison Pidgeon, your host. I have another Allison on the podcast today, Allison Puryear. She’s an LCSW who started out in solo private practice, and now has a small group practice. And she also works as a business consultant. Her business is called the Abundance Practice-Building. She has started practices in three different cities, she is excellent at marketing and she is an awesome business consultant for private practice owners. I’m so happy that she agreed to come on the podcast, I really admire Allison’s work. And we talk about her group practice and some decisions she made around intentionally keeping it small and what she wanted the culture of the practice to be like. And we also get into talking about the different trends that she’s seen with group practice, not group practice, necessarily, but private practices because of all the changes that have happened in 2020, with the pandemic. And then she also talks about some predictions of kind of where private practice might go in 2021. So I hope that you enjoy this interview. Allison, as always, is just a lovely person to talk to and also has lots of great tips and great insight into our field. And so I hope you enjoy this interview with Allison Puryear.

________________________________________

[ALISON]:
Allison Puryear, welcome to the podcast.

[ALLISON]:
Thanks so much for having me.

[ALISON]:
Yeah, it’s so great to have you here. And I wanted to tell you a funny story before we get started. Because we both have the same first name, I feel like people sometimes get us mixed up, like, I get emails that were meant for you.

[ALLISON]:
That’s awesome.

[ALISON]:
Does that ever happen to you?

[ALLISON]:
Um, I don’t know. I don’t check my emails.

[ALISON]:
Oh, right, [unclear]. But I had somebody email me one time and he was like, um, that thing you were talking on the podcast about? Like, he was like asking, like a more detailed question about how I do this certain thing. And I was like, I have no idea what he’s talking about. And then I was like, oh, he thinks I’m the other Allison.

[ALLISON]:
I love that. That’s awesome. I actually clarify, like, someone checks my emails. It’s just not me. I get forwarded the ones I need to see. But I do have a team member and people aren’t just like sending emails into a void.

[ALISON]:
So, it’s very flattering to get mixed up with you. I should say that.

[ALLISON]:
Oh, yeah. Well, thank you. Same, same.

[ALISON]:
So obviously, we talk a lot about group practices on this podcast. And so I understand you have your own group practice. And so I was hoping you could tell us about that.

[ALLISON]:
I do. And I’ll tell you kind of like my evolution with group practice. I will say, when was it, like maybe back in 2011? Something like that, maybe 2010, I was like, okay, well, I know, we’re about to move back across the country. And what I really want is to get people in private practice. This was like the very like little sweet little bud of Abundance Practice-Building being born. I was like, I know I want to get people into private practice. So what I’m going to do is I’m going to start a group practice, I’m going to get people full in my group practice, and then send them out into the world with the tools for their own practice and a full caseload. And how nice will that be that like they’re just set up and ready to go? And this was a really kind idea. There weren’t a bunch of like, build your private practice people back then, particularly around group practices, but I found one who was like, that’s real sweet, Allison, but do you have any idea how exhausted you’re gonna be? You’re gonna be making less money and working way more hours than you’re currently making. Because turnover like that is just brutal for a business. And so I was like, well, what’s like, what do I really want here, to have a group practice or to help people start a private practice?

And so I jumped into the start a private practice world and went the whole hog there. And was like, yeah, I don’t really want a group practice. It’s not for me, like, I’m focusing my energies here. And then a therapist that I knew here in town that I really respected and that was going through like, maternity leave life change, and the nonprofit she was working out was like, have fun on unpaid maternity leave. When you get back, you’ll be making the same amount of money with more hours. And had a high risk pregnancy and a child that needed immediate surgery upon her six week early birth was like, I was like, you’re awesome, you’re reliable, you’re really good at what you do. Why don’t you come work with me? When you’re ready, like no rush, you have a baby that’s been attached to machines, like, take your time, when you’re ready, come on over. So I kind of fell into group practice, almost reluctantly, except that it was her, you know, like she was amazing. And she was the reason I was willing to do group practice. And now I actually find it really fun. So, I’ve been talking a lot I just realized. [Unclear] story to a very simple question. Um, yeah, so I was kind of like, initially very gung ho, like my business plan that I wrote for that group practice where people were gonna leave with a full caseload was over 100 pages, I was super gung ho. And then got deflated with the group practice piece. And now I’ve been in the game for a few years and really enjoy group practice.

[ALISON]:
Yeah, nice. So what is your group practice now? Like, how many clinicians do you have?

[ALLISON]:
It’s just the two of us, like, I still maintain a very small caseload. And she has her caseload, and we refer out the other folks when she’s full, or when the person’s not within our niche or our skill set, or needs to use insurance or you know, what have you. And so I keep it very small intentionally, because it’s easier for me. Like managing two businesses, my husband also has a business. So that’s three businesses between the three of us and I’m starting a fourth. And so between all these businesses, it’s nice to have somebody I completely trust clinically, I know is going to show up, like, as she needs to administratively. Like she’s someone I completely trust. And I know that in the effort of building a private practice and finding clinicians, I’ve seen so many people take on non ideal employees in an attempt to keep up with the flow of calls they’re getting. But I’d rather just be super, super freakin picky. And if somebody else amazing falls in my lap, awesome.

[ALISON]:
Right. I agree. Yeah, you have to be very picky when it comes to hiring. And do you feel like just having one other person, does that even make it worth your while to do everything that needs to be done?

[ALLISON]:
So I think, to do everything that needs to be done? Yeah. As compared to like, the profit margins are nowhere near what they are in my other business, right? They’re just, they’re not, I don’t think they’re going to be unless I grew it super big, which I don’t have the energy or intention of doing. The profit margins aren’t there. But I know that I am providing employment to somebody I trust. That’s good for her. It’s also really good for our community because I know she’s doing great work. And I know there are other clinicians here doing great work, too. But I get to see the great work she does. And, yeah, I feel good about it. It’s enough money to make it feel like not a waste of time or not a waste of energy.

[ALISON]:
Yeah, yeah, that’s great. So no plans to make it any bigger than it is.

[ALLISON]:
Um, if the right person fell in my lap, yeah. Like, we have the referrals for that, but I don’t, I’m not operating that way right now.

[ALISON]:
Right. Right.

[ALLISON]:
And I think about all the group practice owners who listen, who also maybe want to create courses, or membership sites, or consulting or things like that, the people who are looking to grow beyond their group practice. There’s a choice you have to make, in order to succeed in either. And I think that that’s a really important thing to sit down because you only have so much time and you only have so much energy and you only have so much money. And knowing your priorities is really important. Instead of just going with the flow of I’m getting so many calls, it makes sense to hire more people, to be really intentional about it.

[ALISON]:
Yeah, I really like that point. Because I feel like so many people I get calls from, you know, potential consulting clients, and they’re like, well, I sort of started this group practice by accident, because I was just getting so many calls, I was just trying to keep up with serving everyone in the community. And then because they weren’t intentional about what they were building, you know, things are not running smoothly, or, you know, there’s gaps in how they set things up, or whatever the case may be. So I’m glad you made that point.

[ALLISON]:
Yeah. And I think about how like, so many people think it’s the logical next step from solo practice, like you’re getting more calls than you can take, just hire someone, but it is such a different business. Your day to day is so different as a group practice owner, particularly if you plan to have a larger group practice, than it is as a solo practitioner, that you really need to have great management skills, you really need to keep your mission and your goals for your community and the people that you serve both inside and outside of your business, you need to keep that in mind so you don’t become like, uh, well, my bottom line is this, and I need to make this much money because this is an expensive venture. So that intentionality is so important. You’re right.

[ALISON]:
Yeah. Yeah. And I know we were talking a little bit before we started recording about how you were also very intentional about creating a particular culture in, I mean, in the group, I guess, for your one employee or your one contractor, but how would you describe that? And where did that kind of come from?

[ALLISON]:
Yeah, so she gets paid per session. And so that’s the model I have for that. And I keep, I have a different structure within Abundance, and we can talk about that if you’re interested just because I love leadership. But for my employee, she has a set number of hours that she dictates that she wants to work and I fill that, and if she wants to take time off, she lets me know, I don’t have any limit on the time off she wants to take, I don’t feel constrained by like, well, if she doesn’t see this many clients, my business is suffering. It really is a matter of like, she’s essentially in solo private practice almost for her, like she comes to work, she sees clients and she doesn’t have to deal with some of the administrative stuff.

So I also, it’s very important to me to provide paid maternity leave. And so that’s something else that I provide. She’s actually pregnant right now. And so knowing that I have enough money in the bank for her to have paid maternity leave matters to me. I want her to have autonomy because I fully believe, I know you do, too, that when therapists are taking great care of themselves and their needs are met as much as they can be through the boundaries with their work, then they’re going to be better therapists, they’re going to be happier people. And that, to me, is more important than what the profit margin looks like this month. The profit margin matters because it’s a business. But the way that I have my practice set up, I’m able to really prioritize what’s best for her, what’s best for her clients, instead of just the money in the bank?

[ALISON]:
Yeah, yeah. I’m really glad that you said that. Because that is how I run my group practice as well. Like, one of the things I think that sets us apart is that I don’t tell, even though I have W-2 employees, I don’t tell the therapists when they have to work. A lot of places around here will say, well, you have to work two evenings a week and that’s the requirement. And I’m like, you know what, I get it, you have family responsibilities, and maybe it doesn’t work for you to work in the evening. And that’s fine. You know, like, I don’t put any of those stipulations on them. And I think they really appreciate that.

[ALLISON]:
Yeah, absolutely.

[ALISON]:
Yeah. So there was something that I wanted to circle back to, you said something about, you’re starting a fourth business, I want to hear about this, if you want to share.

[ALLISON]:
I don’t want to share just yet because it’s still like the lawyer situation of getting everything trademarked or copyrighted or whatever. I don’t really know the difference. But it’s therapist adjacent, like it’s for therapists, but it’s not about building a practice and things like that. It’s something to further serve our communities, because there are just a lot of things that we need as a community. So, yeah.

[ALISON]:
Yeah. So when is that going to be launched, so to speak?

[ALLISON]:
Well, if you’d asked me in January, I would have said by September. Who knows, with all the COVID shakeup and everything that’s going on in 2020. So I’m hoping next year, by June, would be my goal. We’ll see. You know, starting, as everybody listening knows, starting a business is never as easy as you might think. No matter what it is.

[ALISON]:
Yep. Yeah. Even if you’ve done something similar before, it’s just, yeah. You run into new challenges.

[ALLISON]:
Absolutely.

[ALISON]:
Yeah. So I know you do probably the majority, I’m assuming the majority of your work time is spent doing consulting.

[ALLISON]:
It is, yes, yes.

[ALISON]:
So what what do you enjoy most about consulting? And who would you say is kind of your ideal consulting client?

[ALLISON]:
Yeah. So what I love most, there are like benchmarks of what I love most. The first what I love most is when early in either of my programs, either the party or the inner circle, there is a moment when the participants really get that they don’t have to settle. I don’t know if you ever had the experience, like, before I had kids, I was like, well, I have to work in the evenings because people work. And then after I had kids, and I had this really, like a nanny, which felt like it was costing an arm and a leg because all the daycares were full. I was like, well, I have to be home to relieve her by, you know, 5:30. So I can’t work in the evenings. And I realized like, oh, I never had to work at 7pm. That was all me. And so when people have this moment of recognizing that they don’t have to settle, that the way they set up their practice can be wholly and entirely what they dream about, and that it’s not entitled, it’s not pie in the sky, it’s like eminent, that’s a moment I really, really love in working with people. And when they’re first voicing, like, well, I want to take four weeks off for vacation a year. And I’m like, make it six, you know, I just love that moment of that recognition that they actually can have what they want.

And then I love that moment when people, if they haven’t had any clients yet, start getting clients, and they’re kind of like, is this for real? Like it’s happening? It’s actually happening. And then the moment when they’re full, and they’re kind of stressed out because they’re like, like, keep accepting these clients because like, I don’t know if they’re gonna keep calling. When they get that point of like, trusting the people are gonna keep calling and even if it did, for some reason dry up, they know exactly how to get more calls again. Yeah, those are like my three favorites.

[ALISON]:
Yeah, yeah, I see a lot of that, too. And yeah, we talk a lot about how to design your business to fit your lifestyle. And I think that’s a new concept for a lot of people. Because if you came from like, agency work, you were just used to being told, like, this is what you have to do. And now it’s like, wait, I get to make it whatever I want it to be.

[ALLISON]:
Yeah, yeah, we have some learned helplessness around it.

[ALISON]:
For sure.

[ALLISON]:
And it does feel kind of audacious to say, like, I’m gonna work, like, no Fridays for the rest of my life. Awesome, let’s work no Fridays, I’m in for that, you know?

[ALISON]:
Yeah. Or like, my goal was to not see clients anymore. That’s what I wanted to do. I just wanted to run the practice and do consulting. And when I tell people I retired from doing therapy, like, their brains explode.

[ALLISON]:
Absolutely. Yeah. Yeah. And you’d asked about my ideal clients, and I didn’t answer you, I just got excited about those [unclear] that excite me. My ideal clients are people, I’ve got two categories, the people who are new or plateaued, like they need clients in their business. They’re often parents, they’re often, like they’ve got some naysayers in their life. And they’re feeling like I don’t know if I should trust this old supervisor who says private practice can’t work. And I should not have a niche and I should take all the insurances. So they’ve got some naysayers in their life but they have this inner belief in themselves, even though it doesn’t feel like it all the time. This like, you know, I know this is possible and there’s no reason this isn’t possible for me. Imposter syndrome rears its ugly head, of course, because they’re human. And so, yeah, those are those are the folks I really love working with. They’re go getters, like they’re, they’re not going to make a bunch of excuses for why they’re not working on their website this week. They’re gonna get their website stuff done, that kind of thing.

And then we’ve got the people who are full and miserable. I also really love working with them. Because, like, I mean, we both know a million people in that boat, right? They weren’t intentional in building their practice. They made some decisions that in hindsight, they wouldn’t have made, and it’s really scary to feel like you’re burning down this thing that has been, on paper, successful, but you’re burned out and you’re exhausted and like you haven’t taken a vacation in a year. So I love helping them trust the process of like, you can build exactly what you want, and yeah it’s scary and so many people have done it. Come in, like, we’re gonna help you with it. So, yeah.

[ALISON]:
Yeah, that’s great. That’s great. One thing I wanted to ask you about since I know you work with so many practice owners is, if you have been noticing trends or how things have changed, obviously, with the pandemic in 2020. And like what you, and I realize this is a big question, and what you might predict will happen in 2021, like in our industry and private practice? I don’t know if you’ve noticed any patterns or have any thoughts about that.

[ALLISON]:
Yeah, what I’ve noticed is similar to like, what we’re probably noticing in life, is that the community that you live in really determines a lot of the decisions that you’re making in your practice. So I live in North Carolina. If I cross the state line, like if I go an hour to South Carolina, I’m going to go from like the land of masks where I live now to like, you know, people are at the kids trampoline park, and nobody’s wearing any masks. And it’s very scary to me, because I live in this community where that’s a thing. There aren’t a ton of people in my community doing in person therapy at this point. But if I cross the state line, because the community that they live in there is more or less like life keeps going on, a lot of people are in person. And so because we’re working with people all over the world, and the party and the inner circle, we’re hearing about what each of these communities is like. And it’s kind of shocking how vastly different they can be. And just like, from a sociological perspective, really interesting, when I can take my own, like fears or judgments out of it.

So I’m seeing, of course, a lot more people online right now than have ever been online in the history of the world. I think there are a lot of people who are like, wow, I want to do this forever. I never want to go back to an office. And I think that, like my prediction for 2021 is that it’s going to be accepted and understood, going forward in our vocation forever, basically, in a way that it wasn’t back in February. So I’m excited about that, for the people who really love to work online. For those of us and I’ll include myself in this group, who much prefer in person, like, I think that there are going to be some, some starts and stops in terms of when it feels safe for people. And I’m really, really, really crossing my fingers on this vaccination, so that it feels safe to do in person again, for me. So yeah, I’m seeing a lot more online practices, many of which I suspect will continue forever. Um, and what that means for office space, like, I know that you’ve rented out space before, I don’t know if you’re still doing that. But I know in my…

[ALISON]:
Yeah, actually, we have some spaces that we were renting, and then I own a building. So I actually gave up all of the rental space and obviously kept the building I own but yeah, shrank the office space quite a bit with the thought that when COVID is over, we’ll sort of reassess if we even need more office space or not. Or if we want to open an office in another part of the state or, you know, that kind of thing. I’m just trying to get myself ready to be nimble, and, you know, kind of respond to the circumstances as they unfold.

[ALLISON]:
Yeah. It’s so interesting, because buying a building has been on our three year plan for the last year. And so we’ve been kind of working towards that. And if you had asked me in February, like, is there any risk in commercial real estate for therapy offices? I’d be like, no, of course not. What a ridiculous question. And yet, here we are, in this situation where so many people have left their offices, and so many people who own buildings or offices are like, okay, how do we pivot from here? It’s still a part of our three year plan. And I still look forward to that experience of buying an office and I believe it will be a good investment. But yeah, it’s just an interesting thing.

[ALISON]:
Yeah, I think that to give you a little bit of unsolicited advice…

[ALLISON]:
Yes, please.

[ALISON]:
I think there’s gonna be a lot of commercial space available. And I think that you’ll be in a really good position because it’ll be like a buyers market since so many people will be struggling to get tenants. So I would definitely like get ready and just be ready, you know, have your financing and stuff kind of lined up or do enough research so that if you do see something good, you would be able to jump on it, in the coming year.

[ALLISON]:
Yeah, yeah, thank you. Any and all advice you ever feel like giving me I’m up for it.

[ALISON]:
Yeah, so any other trends? Like what do you think, I know you don’t work with insurance in your own practice, but what do you think is going to happen with insurances covering telehealth?

[ALLISON]:
I mean, I think we’re already starting to see in some places that they’re putting a cap on that. And I think it’s up to all of us to help advocate even those of us who don’t take insurance, even those of us who are not in those states, to help advocate for those clients and those practitioners. Because this is one of the reasons I don’t take insurances, I don’t like feeling controlled. And I feel like that’s a control move that’s forcing clinicians and clients into a situation they might not be comfortable in, or forcing them into discontinuing care or the clinician having to go to a sliding scale when their slots may already be full. So I feel like that’s something we need to come together as an industry to say like, this is actually not acceptable. Yeah, yeah.

[ALISON]:
Yeah. So what would you recommend to someone who maybe is in a position where the insurances that they’re paneled with are kind of, you know, forcing them to go back into the office, or basically cutting off, you know, telehealth benefits? Like, how do they advocate for that?

[ALLISON]:
I think getting other people involved, potentially getting their license, like NASW, or APA or whomever involved. But I think it takes more than one person and more than one client. I mean, our clients are ultimately like the consumers for the health insurance companies, and they care far more about what they say, than about what we say. And so asking our clients to call to continue their benefits, which feels awful to me that, like, they’re gonna have to take time out of their day to talk to the people that they’re paying money to provide their benefits. But because they’re the ones that the insurance actually cares about, that’s something that is going to be more impactful and less, it’s like our, unless we come in droves, which I think we need to do also, because it’s it’s unacceptable at the time we’re recording this, it would be unacceptable for them to cut off reimbursement at this point, for telehealth.

[ALISON]:
Mm hmm. Yeah. And that’s interesting that you’re hearing that because from my kind of population of consulting clients I work with, I haven’t heard of that happening, at least not right now. And what’s interesting is there were like, 30-some states before the pandemic, who had already passed laws that said that insurance companies had to cover telehealth. So I’m hoping that means that’s the direction, you know, we’re going, even in my own state that legislation was, you know, going through at the state level at like, you know, Fall of 2019. So, I’m hoping now, it’s just like a no brainer to continue pushing the legislation through.

[ALLISON]:
Yeah, well, and I think the idea that people are getting paid less for telehealth also frustrates me, because if we’re saying that it is efficacious, and at the same level as in person therapy, then it makes absolutely no sense to pay a clinician less for that.

[ALISON]:
Right. Right. I agree. Especially because so many of us were, you know, then having to pay additional expenses related to having good telehealth platforms. And then we were still paying for our space because we were locked into leases or whatever. Yeah, yep. Any other kind of trends or predictions for 2021? I kind of put you on the spot.

[ALLISON]:
No, it’s good. It’s good. Another thing that I’ve seen since the pandemic is some agencies being just flagrantly disrespectful of their employees health, and when their clients do have the option of being able to use telehealth, not encouraging or allowing it. I think that’s driven a lot of people into private practice because they were like, well, I’m a high risk category person. I’m not trying to get out and do a bunch of in person therapy when it’s absolutely legitimate for my clients to be able to see me online. I spoke to in like March and April, I don’t even know, probably like 30 therapists who were like I didn’t intend to start a private practice, but I’m clear I’m going to need to because these people don’t care about me the way that I’m going to care about me. So I think that there are probably more private practitioners, my hope is, out there which is a good thing for anybody who’s like oh, no, competition. It is a good thing to have more therapists out there. There are plenty, plenty of clients.

[ALISON]:
Yeah, I’m glad that you brought that up because I saw the same thing actually happen with my own group practice. We got this influx of applicants because a lot of places were forcing the therapist to go back and see clients in the office and they were legitimately worried about their health or, you know, maybe they had a baby at home or you know, taking care of an elderly parent. And that was a deal breaker for them, that was enough to cause them to go look for another job. So, you know, fortunately, because we took the stance of, you know, we’re not gonna go back into the office, or I’m not forcing anybody to go back into the office until there’s, you know, a vaccine or something major happens, that caused a lot of people to want to come work for me, which is good for me.

[ALLISON]:
Yeah, absolutely.

[ALISON]:
Yes. And again, it’s, you know, a win win for me to have them be doing telehealth, because, you know, there’s certain expenses that we save on not operating the office. And then they get to pick their own schedule. And, yeah.

[ALLISON]:
Yeah. Well, and because you’re a good workplace, and you have a good reputation as somebody who actually cares about people, that’s available to you, right? And I think that’s where some group practices and so many agencies go wrong is they lose track of the fact that the people that work for them are people.

[ALISON]:
Right. Exactly. Yeah. Yeah. So Allison, I so appreciate you taking the time today to come talk with us. I know you’re a very busy woman and just wanted to hear, if folks want to get in touch with you, what is the best way for them to contact you?

[ALLISON]:
Yeah, so our website is abundancepracticebuilding.com. That’s probably the best way to get in touch with us.

[ALISON]:
Okay, great. And you have something to give away too, right?

[ALLISON]:
Oh, yeah, we’ve got a webinar that’s free. If you are needing to fill your practice, it’s called ‘Fill your practice without being salesy or spending money you don’t have’ and that’s over at www.abundanceparty.com/fill.

[ALISON]:
Oh, awesome. Okay. We’ll have that in the show notes, too. And yeah, I would say, if anyone isn’t familiar with Allison’s content, she is excellent at marketing and teaching private practice owners how to do marketing. So if that’s something that you need help with, definitely go check that out. Because I’ve always appreciated your perspective on marketing and all the good ideas that you have.

[ALLISON]:
Thank you. I appreciate that.

[ALISON]:
Yeah, yeah. So thank you so much for coming on the podcast today.

[ALLISON]:
Absolutely. Thanks so much for having me.

________________________________________

[ALISON]:
Thanks so much for listening. And thanks again to Allison for coming on the podcast. I know she’s a very busy woman. She was telling me about all the changes she went through this year in her own life with renovating her house and getting a puppy and on top of having a global pandemic and all of those changes. So I know that she has a busy schedule and I appreciate her time coming on the podcast and I hope to see you all here next time.

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.