Running a Group Practice — Then & Now

January 1st was my six-year anniversary of group practice ownership! So I thought it’d be fun to reflect and share what group practice ownership looked like back in 2017 and now in 2023.

Tune in to this episode to learn—

• How I went from solo practice to group practice
• The story of my first hire & the reality of moving locations
• Expanding the team & bringing on admin support
• Why I think it’s harder to run a group practice now than it was in 2017
• The challenges of a hybrid self-pay and insurance model
• How the pandemic impacted therapy practices

I hope you’ll listen then get in touch to let me know what questions you have about running a group practice! And don’t forget to subscribe wherever you get your podcasts, then share this episode with a friend.

Links

• Follow Brave and Well on Instagram
• Sign up for the Brave and Well newsletter
• Get my workbook — Laying the Foundation for your Private Practice
• Join my Private Practice Circle in Fall 2023 — https://www.braveandwell.com/private-practice-circle
• Join my Group Practice Circle in Fall 2023 — https://www.braveandwell.com/group-practice-circle

Transcript

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Hi everyone, welcome to the Brave and Well podcast. I'm your host, Vanessa Newton. I'm a group practice owner and social worker. I'm also a Latina, entrepreneur, mom, and recovering perfectionist. On this podcast, we teach mental health professionals how to build sustainable, profitable, and values aligned businesses. Here, you'll hear all about decolonizing the business side. Music. To share their stories. Our time together will be raw, honest, vulnerable, and held together by joy. If you like what you hear, subscribe to our newsletter at bravenwell.com slash newsletter dash sign up. Thank you for listening. Music. Hey everyone, welcome to the Brave and Well podcast. I'm your host, Vanessa Newton, licensed clinical social worker, entrepreneur and group practice owner. Today I wanted to talk about, group practice then and now. So the differences kind of between running a group practice and owning a group practice back then when I first started and now. And a lot has changed, a lot is different. And some of it was by choice. And a lot of it was just how life has evolved and how our world has evolved. And I think we've had to shift a lot as a group practice and have gone through many different phases and identities over time. And so I just wanted to talk about that because a lot of times I do business consultation with folks who want to start a group practice. They'll tell me, you know, Vanessa, I really want to start a group practice. I have. This passion of creating a team that offers services to clients and would really love to just, do more of the business side of things. And I think it's important to recognize that running. A group practice today looks very different than what it looked like back in 2018, even when I first started. It's challenging. It's more challenging in my opinion. And I think depending on who you ask and what their experience has been, you'll get a different answer. But I will tell you that for me, owning a group practice now is way more challenging than what it was back in 2018. So January 1st was our six-year anniversary of my group practice, Colors of Austin Counseling. And you know, I launched in 2018. I had been in solo practice since 2015, renting one office in downtown Austin, and had just noticed a huge increase in clients coming to me seeking services, both because I was a provider who was credentialed with Blue Cross Blue Shield at the time and still am. And also I'm a woman of color, I'm a Latina woman, first gen, and I think a lot of the clients that were coming to me seeking services were women of color themselves. And so I just saw a huge need and a huge influx in referrals and, you know, way more than I can manage myself, certainly. But thought to myself, what would it be like if I created a team that was representative of the clients that were coming to me seeking services? And so back then in 2018, when I first launched, we launched as a 1099 contractor model. And so it was a model that I felt like would be a much simpler way to step into, as someone who has never owned a group practice before and wasn't really sure about all of the ins and outs. And so I started as a group practice, 1099 contractor model. I was renting one office space and I hired, my first hire was actually someone I went to undergrad with. And we happened to be in the same clinical supervision group accruing our hours to become LCSWs. And time had passed, we both had gotten our license of course and she became a mom and she reached out to me and was like, you know, Vanessa, I really want to use my skills as a therapist, but I don't wanna go back to agency work. I wanna be a full-time mom. And kind of see clients on the side. And so she was my first hire, and she's still with me today. Now she's a mom of three, and she sees clients part-time for us, and she is a mom full-time. And so remember, we're a hybrid, a mixed model in terms of we take insurance and we do self-pay. So I got her full really fast because so many people wanted to use her insurance, So it was pretty easy to fill. And then I hired a second person. And by that point, it was three of us sharing one office and the person I was renting from was kind of like, you know, Vanessa, this is not gonna work long-term. Have you thought about getting more office space? And I was like, man, that feels like such a big jump. I don't know if I can do that. But started looking around, found a little house close to where I already was and found a colleague who wanted to rent one of the offices from me, which could offset that rent for a little while until I hired more people. And so I took the leap of faith. I signed the lease on this cute little bungalow house, not far from where I was. So I was still kind of in Central Austin by the University of Texas, pretty close to where my clients lived and where my referrals were coming from. And it had four offices, a waiting room, a kitchen, and then kind of a back house, which had like one office space inside of it. We didn't occupy that right away. We just occupied the house, the front house. And as the years kind of went on, well, I think after like a year and a half, We ended up renting the back house because our team was growing and we needed more space. And so initially it was a four office little house and I started hiring more people at that time and was renting out one of the offices to kind of offset the cost. So, you know. Then in 2018, I was the HR representative, I was a billing specialist, I was a client care coordinator, I was the owner of the practice, I was also a therapist seeing a full caseload of clients each week, and I was the visionary of the practice. I didn't have the means to hire administrative support. So I was taking on all of those roles that are crucial to a group practice functioning. When you have people on your team that are counting on you to support them and to ensure that things are moving along, you take on that role. You take on all those roles at the beginning. I don't think you have another choice. This is your business. If you're choosing to start a group practice, then you're choosing to take on all of these roles. And so that's what I did. For about a year, I was all the things all the time. And after a year of being in business as a 1099 group practice, I decided it was time, to hire my first part-time admin position, which was a client care coordinator position, and a digital marketing person. So it was kind of a two-in-one. This person managed our Instagram account for marketing, but they also managed all the referrals that came into the practice and were responsible for matching clients with clinicians and getting them scheduled. And so that really relieved a ton for me. I found this person through a local university. I posted the job posting on a local university job board, and got a ton of applicants because I figured it's a part-time position. What counseling student wouldn't want a job like this? Got a ton of inquiries and landed on this one student who was in the program and just felt like a good fit. And so he was my first hire. And so it was him and I for about six months before I decided to promote one of our clinicians to clinical director, because I found out that I was gonna be having a baby. And so I needed someone to take over my role as owner and director. And so I find that back then, because we were all in person all the time, It was such a fun time. I often look back and I'm like, man, I really wish that we could still do that. Everybody was in person. Telehealth really wasn't a thing. We were having team meetings in person. We were celebrating birthdays in person. We were passing each other between sessions. We were joking in the kitchen and heating up our lunches. We were just in it together. I mean, there was just something about being in an office space with a bunch of people, especially therapists who are doing good work, and having each other close by. And so it was a very collaborative fun space and we didn't have any financial benefits at the time. Like I wasn't at a place where I could offer health insurance or 401k or PTO, we just had the team, right? We would meet as a team. We would do clinical consultation together. We would laugh with each other. And that was the benefit. The benefit was like being a collective team and being able to have each other and know we have each other's back. And so even though I wasn't offering all these benefits, there was still an incentive there, that it was a supportive space. Now, post-COVID. A lot has changed and i don't wanna say that it's bad or it's worst or whatever it's just really different and there are things about. Owning a group practice now that are way more challenging. Then they were back then but it's also all very doable. And it's possible to create a team culture that is just as collaborative, but you have to be really creative and be really willing to go outside of the box and think outside of the box. And so now we're a W2 employee model, right, which is different. We have two office locations that have like, I think, 10 to 13 offices. We sublet several offices to offset rent. We are a much larger team. We're a team of about 16 people. We have a six person leadership team. We have more overhead expenses. We are managing people. We are supporting people in their development as clinicians, as professionals. We are a hybrid model. And so everyone on our team does therapy in person and virtual. And I would say most folks are virtual just because it gives them the flexibility to take care of their home life and take care of their families. And I think the hybrid model really has like, it has made it harder for us to connect with each other. And so we've had to be more creative about the ways that we connect with each other, which is why now we offer restorative offerings where we come together as a team every other month, to just check in and do a yoga class or have some coffee together or have Zoom dates. All of our meetings are on Zoom. So that way we're not, if people can't come into the office, then we're still meeting together as a team versus before we were always meeting in person and now we're just not. We've had to be more creative about the ways that we generate revenue because back then clinicians could see 20, 23, 25 clients in any given week. And people's capacity is different now. They don't wanna be seeing that many clients every week. They can't just like emotionally, mentally, physically, that's not feasible for them. And so in order to generate alternative streams of revenue, we've had to get creative about what are other ways we can generate revenue as a practice, as a business, without putting that burden all on the clinicians. Hiring is much more challenging. I think. You know when covid happened a lot of people took that time to start their own private practice. Especially in texas lpc associates are allowed to start their own private practice and so a lot of lpc associates decided that that's what they wanted to do. You know i think people are just wanting to do their own thing and wanting to do it their own way. Which is great and it's fine, but it's also made hiring more challenging. And we've definitely had to think of other ways to get candidates in. And so hiring back then was so easy. Like I felt like people just were ready and they wanted to join a team and they were ready to work and they were excited and it was, you know, it was just easy. And so now it's just different. But I think that that puts some stress on group practice owners of how can I make this practice, this business sustainable if I don't have anyone who wants to work? And so I think that's just something to be aware of if you're thinking about launching a group practice that you have to be ready to think about ways that you're going to find candidates, and candidates that are a good fit. We know that the economy is not in a great place And so retaining self-paid clients is a lot more difficult. Because clients really want to use their insurance to pay for therapy. They need to because they financially cannot afford to pay out of pocket. So as a practice who does take insurance, while we only take one insurance, you know. Before it was a lot easier to turn an insurance paying client into a self-paid client, and now it's much harder because the economy is so terrible and people can't afford it. And so that has definitely been difficult for us as a business just to figure out how do we still get clients in the door even when they can't pay the full fee. And so I think those are the biggest things that stand out to me. And in a later episode, I'll talk more about hiring, hiring strategies, things to think about when you are offering benefits to your team, whether they're financial or non-financial. But I definitely love to hear more from you all about what you want to hear about, in terms of like the nitty gritty details of running a group practice and owning a group practice because I see a lot of interest in folks who want to do this. But also feel like it's my duty, my calling to be transparent about what, you know, what is, something that can come by really easy and what are the things that you're really going to have to work for. And so if you have any thoughts or questions or ideas around group practice ownership, feel free to send them in. You can go to our website, braveandwell.com, click under podcast and submit your questions there. All right, thanks for listening and I'll see you next time. Music. Thank you so much for listening to the Brave and Well podcast. You can find links and resources from this episode in the show notes at www.bravenwell.com. Music. Then send it to a friend. For free resources, special announcements, and discount codes, subscribe to our newsletter at bravenwell.com forward slash newsletter dash sign up. Music.