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This is the Practice of the Practice podcast with Joe Sanok, session number 412. Well, today on the Practice of the Practice podcast, we have Alison Pidgeon. She is a group practice owner and also a consultant here with Practice of the Practice. Alison, welcome to the show.

[ALISON]: Thank you so much Joe. It’s great to be on.

[JOE]: Yes, you’ve been on like every other counseling podcast recently, but it’s been a while since you’ve been on our show. So welcome back.

[ALISON]: Yes, thank you.

[JOE]: I’m so excited about this series that we’re doing about group practices. We’re going to be talking about why to do a group practice in today’s episode. In the next episode we’re going to talk about logistics to start then we’re going to talk about moving from me to us and kind of filling up other people. Then in episode four, we’re going to talk about managing your staff, the systems turn-over finances, and then episode five, transitioning to CEO and exiting if you want out of your practice. So, a lot of ground to cover today but I just want to hear why did you start a group practice back when you started a group practice?

[ALISON]: I started because, for a few different reasons. One was I was sort of lonely by myself in solo practice.

[JOE]: You just wanted friends?

[ALISON]: Yes, I just, you know, wanted some coworkers to talk to. The second thing was I knew I could make a really big impact on the community by offering really excellent mental health services in that. I wanted to offer something different and that was exciting to me than what was already available in the community. And then I think the third part of it was being able to make money that wasn’t tied to me in the chair seeing clients, and we talk a lot, Practice of the Practice about, you know, building your business to fit your lifestyle and so I think I’ve always had that in mind when I’ve built up my group practice. And so, it, now four years later has become that.

[JOE]: It’s interesting because I kind of did it in reverse order where I was working my full-time job and kept hiring 1099s in my group practice. So, I never had that, “Boy, if I’m not at work, I don’t make money,” because I’d have sick days through the college and all of that. And so, the idea of being in private practice and then being sick or having sick kids or going on vacation, just not having money, that’s scary for a lot of people.

[ALISON]: It’s, definitely your easier income fluctuates a lot more when it’s just you. And I’ll tell you, I just was on maternity leave over the summer. I took a full three months off. I had somebody else running the practice for me and I was able to keep paying myself my same salary when I was working, which was such a blessing to be able to be home with my baby and not be worried about how I was going to pay the bills.

[JOE]: And boy, the consulting clients that jumped into your mastermind, I loved writing you your check this month. I was like, “Dang, look at you. You’re killing it.” So, but I think that that really speaks to not just a group practice but having multiple streams of income that you know, as you level up and have these skills, whether it’s doing a group practice or starting to consult or doing podcasting, that you can build all these multiple streams of income and craft your own lifestyle.

[ALISON]: Exactly.

[JOE]: So, when you first started out the group practice maybe, and we’re going to talk about the actual logistics in the next episode, but what were like the big picture things that you were like, “Boy, I got to figure this out.” What helped convince you maybe that, that, “Yes, I should start a group.”

[ALISON]: I think I had experience working in community mental health. I was a director of an outpatient clinic and so I already was familiar with managing people and I actually really liked that part of the job. So, I had an idea already just from those past experiences what it would be like, but I would say just trying to figure out really simple with just tickle things. Like, how am I going to pay these people?

[JOE]: You know, how do I pay you for working?

[ALISON]: So, that’s something that I like to share now in my mastermind group, like what I do and how I figured that out and mistakes that I made so other people have like a roadmap of what to do and what not to do and that kind of thing.

[JOE]: Yes, absolutely. I feel like for me, the numbers side of it really made it easy too because you’re already paying to rent an office and to look at all the amount of time that you’re not using it on evenings or on a Friday and Saturday to just say, “Okay, if I’m not in here on Friday and Saturday and Sunday, that’s like 20 plus hours. And then if I look at maybe three evenings a week, there’s probably five hours in each of those evenings. So, if I add that in 15 plus 20…,” We’re looking at 35 extra hours a week beyond your own, maybe full-time practice. If someone’s even just charging a hundred bucks a session and works 48 weeks a year, that’s $168,000 gross. And so, say you’re taking home 30% of that, that’s an extra 50K a year. So even for me, just like when I ran those numbers and said, “I’m already renting this place. Why not optimize it when I’m not here?”

[ALISON]: Right. And that’s what we recommend in the mastermind group to use the resources you already have and maximize them and don’t run out and rent a six-office suite right away. Like, just use the office you already have, have somebody work there when you’re not there and try it out and see how it goes.

[JOE]: Yes. And I think that when people think about fixed costs, like, you know, there’s the fixed costs of your rent is the same amount every month, hopefully. and then there’s variable costs such as every person that you add that’s going to be extra Therapy Notes or extra thing, you know, a G suite. Those are the variable costs. There aren’t really that many variable costs until you start to upgrade your office.

[ALISON]: Right? Yes, because typically, yes, rent is one of your biggest expenses.

[JOE]: Yes. So, when people are considering whether or not to start a group, maybe take us through a few of the questions you would have them think through before they even say, “Yes, let’s do it.” Because in the next one we’re going to talk about the actual logistics. But for people that are like, “You know what, I’m a solo-preneur. I feel like I’m pretty good and life is good. Do I really need a group practice?” What should they think through as they kind of consider starting a group practice?

[ALISON]: I think this is a really good point because it’s not for everybody. So, I think you have to ask yourself a few questions like do you like the idea of being a boss? Maybe you’ve never had that experience, and that’s perfectly okay, but does the idea of that, is that something you’re willing to learn? Is that something that potentially sounds like a positive thing for you? Or does it sound terrible? If it sounds terrible, maybe you shouldn’t be a boss. And you’re also going to have to focus more on the business side of things, especially in the beginning. So, if you enjoy the business side of your solo practice, then I would say you’re in good shape then to potentially enjoy the business side of that group practice.

[JOE]: I think, you know, when I look at it, I’m really glad that I did 1099s because the worst parts of my career were when I was a supervisor of people that just weren’t fun to supervise. There’s people I supervised that it was awesome. It was lots of fun and we worked well together, but boy, for me, trying to motivate people that feel unmotivated, like that’s just another layer of hell for me.

[ALISON]: So, when I worked in community mental health, I inherited the staff and it’s a much different thing when you’re, it’s your practice and you actually get to hire people rather than just inheriting people.

[JOE]: Oh my God. I had this, and I’m not going to name where I was working at the time, but I inherited a staff and it was this guy who was retired and he, it was a, I almost disclosed where it was, but he was retired. And then another lady that she was probably in her mid-twenties, well, she started having an affair with him and then they ended up getting married and he was like in his mid-sixties and she was in her late twenties. And it just was like this situation where, and you know, to each of their own, whatever. But it was like my first time supervising and then they weren’t following the contracts and then it just was like, “I don’t want to supervise people ever.” But I think I realized just what you said, that when you get to hire your own team then you have no one to blame but yourself. Whereas when you inherit this like S-show, it’s just like, “What is wrong in this place?”

[ALISON]: That sounds terrible.

[JOE]: It was terrible.

[ALISON]: And something that probably doesn’t happen that often.

[JOE]: No, I mean that team had many a story similar to that, but I think it was more the team I inherited than necessarily the management considering it was going on well before I was there. Well, what other, maybe there’s probably a couple more things to think through. Like what comes to mind for me is I’m not only just supervising, but just like you mentioned the business side of things and I think that when you move into a group practice, you are kind of moving away from some of the clinical work or if you want to keep doing the clinical work, then you kind of got to hire someone to do some of that marketing and branding. What are some other things to just think through before saying, “Yes, I want to jump into a group practice.”

[ALISON]: I think that’s a good point. So, there’s obviously a point at which you have to delegate things and there’s that loss of control and that’s really hard for a lot of people. That’s something else that always comes up in the mastermind group. It’s like, “Oh, I know I need to hire a VA, but I’m really like, don’t want to let go of me answering the phones,” for whatever reason. And so, I think it’s getting in that mindset of like, “This isn’t going to work unless I delegate things.” And obviously that doesn’t happen overnight. It probably will happen over a period of time, but you have to be willing to trust other people with your baby, so to speak.

[JOE]: I think that’s a good point. I’m glad you brought that up because I hear that a ton too around virtual assistants. But even, you know, I worked really hard to build my reputation for my practice. Do I want to trust other people and their clinical skills that I’m not sitting in the sessions watching them do it? I just have to trust that they’re doing good work. Can I take that risk and kind of training people and finding the right people? How do you help people sort through that question because that’s a really common one to say like, “No one can do it like me.”

[ALISON]: What we talk a lot about is the whole hiring process and making sure you’re kind of going through all of those steps so that you’re making sure you are hiring somebody who is going to be a good fit, who does have good clinical skills, who you are going to feel good about, because you know, when I first started out I was like, “Oh, you have a license and you seem nice. So, you should just come work for me.” Well that, you know, in a couple of cases was a disaster and I got much better at asking certain types of questions and checking references and making it really clear what my values are in the business and making sure they resonated with those values. So, we kind of go through all of those different components when we talk about the hiring process.

[JOE]: Oh, that’s awesome. Well, in the next episode we’re going to be talking all about the logistics to start a group practice. Then we’re going to be diving into moving from me to us and managing staff and then transitioning to a CEO mindset. 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.
Also, a special thanks to Gusto who has amazing payroll services. Head on over to gusto.com/Joe to get three months for free. 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.