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Episode 116 | Infrastructure for Scaling to 7 Figures with Amanda Patterson



  • Episode 116 | Infrastructure for Scaling to 7 Figures with Amanda Patterson 00:00


Hi Group Practice Listeners! In this episode, I’m talking with Amanda Patterson all about group practice infrastructure and scaling to 7 figures.

In this episode we cover:

  • Admin roles needed to promote growth
  • Compensation structures and scheduling
  • Bringing on additional leadership roles
  • Expanding offerings

This episode is sponsored by TherapyNotes. TherapyNotes is an EHR software that helps behavioral health professionals manage their practice with confidence and efficiency. I use TherapyNotes in my own group practice and love its amazing support team, billing features, and scheduling capabilities. It serves us well as a large group practice owner.

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Maureen Werrbach

Hey everyone, welcome back to another episode today. I’ve got Amanda Patterson, with me, she is a fellow group practice owner out in Florida and we’re going to be talking about how to scale from around the $500,000 mark to getting to the seven figure mark and what kind of infrastructure and things you need to have in place to get there. So Amanda, how are you?

Amanda Patterson 

Hi, Maureen. Hi, everybody.

 Maureen Werrbach 

Um, tell me a little bit about your practice. I know you and I talked for a few minutes beforehand, but for those listening, give us a little background on your practice and where it’s at and the size and all that fun stuff.

Amanda Patterson 

So I’m in South Florida. I’ve got two locations, one in Davie, Florida, which is in Broward County, which is probably about 40 minutes north of Miami. And then I’ve got a location in Wellington, Florida, which is about 20 minutes west of West Palm Beach. And it is an insurance based private pay based practice. A little bit of both but mostly an insurance based practice. We have 15 clinicians between the two locations. And we’re thinking about expanding in the Wellington office in our North office. Our South office has six offices and the North office has two offices.

 Maureen Werrbach 

Okay. So what is making you think about kind of the seven figure mark as like a benchmark for you?

 Amanda Patterson 

So, I’m like a visual person. I think as I started to see the numbers rise, like when I first moved into the larger space down in Broward, we had this number that we needed to reach in order to really afford the office and afford everything that went along with it. And then, like we hit it the first month, we moved into the office and then you know, our income has just been rising month to month and then a year later, between the two offices, we’ve more than doubled that amount. So it’s just been like fun to watch that and as I’m thinking about okay, this is doable now, right? Like, now that I can see the numbers. It’s, I realize like there are some infrastructure, things that I need in place in order to get there.

 Maureen Werrbach 

Yeah, I was gonna say in reading your application for for this episode, the seven figure market and one of the things that I was thinking about was with Mike Michalowicz and how he talks about numbers and making, you know, goals around making sure that they’re not arbitrary. And I was like, I wonder how many clinicians she has. Because you mentioned infrastructure, which I thought was interesting, because I don’t think a lot of people talk about infrastructure, when they think about growing, they think mainly about like, what do I need to do to get to seven figures?

And your question had the piece of infrastructure in there so it’s interesting that you say that you have around 15 therapists, because I was thinking, I bet you she’s like, somewhere between 10 and 20 therapists that, that she’s asking this question. Because I feel like one of the things that was going to be my suggestion, and that I’ll talk about here is, is that infrastructure would need to be in place to ever get to like a seven figure scaled, group practice.

There’s obviously ways to get to seven figures staying at the size that you’re at, whether that’s increasing prices, diversifying services, not necessarily needing to add more clinicians. But when it comes to adding more clinicians, I found that it was somewhere around the 20 therapist mark for me. And it seems like when I talk to other large group practice owners, they all have a very similar story that they tell whether it’s around 15, 20 or 25. But right around that mark, where they realize that they need to put a specific sort of infrastructure in place. And what it is, is putting together teams, which obviously isn’t really needed when you’re much smaller than that. And so it’s interesting that you were saying you’re at 15 people because I was like, I bet you she’s right around that.

And so that would be my biggest suggestion.

I found that my ability to scale was much easier and much more streamlined when I put in teams in place. And that can look different for everyone. For me, I have a leadership team because I have multiple locations. And you do too. So it might make sense to have a think about a leadership team.

For me how that looks, I have a clinical director that sort of manages all the locations. And then we have site supervisors at each location, and they manage all the clinicians at that site. And my clinical director, kind of leads that leadership team.

So and then, obviously, having an administrative team. And this is something I did actually, probably within the past year or so, and it’s made such a big difference. What kind of admin do you have? I’m assuming you’d have some sort of admins.

 Amanda Patterson 

So I have a full time phone person and then I have an office manager slash biller.

 Maureen Werrbach 

That is similar to where I was literally until about a year ago. I had a full time person who did the phones, and then my mom who everyone knows does our billing and is our practice manager. She makes sure all the money is in order. She’s part time. And that was all I had. So one full time on partners. So like 60 ish hours of work administratively.

And last year, I realized that we were sort of stunted in. We were continuing to grow, but I felt like it was just a harder process than it needed to be. So we took the leap and hired. We have now 1,2,3, almost four full time people altogether. So we have one full time phone person, one part time person who does 20 hours just doing benefit checks and communicating benefit checks to clients. One person who just does around 20 hours of submitting claims and rectifying claims, and then my mom who just oversees them and make sure that if they have any if they need any help.

Like if there’s like with COVID hitting we had a lot teletherapy problems and insurance claims that just weren’t paying out. So then she was able to jump in. And then we have a full time admin who supports both the phone person when phones get heavy and the back end.

What we did was as we rolled each person in, we trained each of them to be able to support and know the other person’s role. And what we noticed was, you know, admin, come and go, just as everyone, you know, all kind of job types do. But what would happen was I would have to go back to answering the phones or my mom would have to go back to, you know, doing almost full time work if a billing person left and so what was nice was they all learned how to do each other’s role, which took me and my clinical director out of ever having to be a part of that.

So I’ve said this before, but we’ve had we probably have around 20 hours of extra work a week that technically we don’t need. Like between all the people, there’s around 20 hours of extra time. But what we found was that that time allowed us to actually tighten up some systems.

We never have documentation issues because we have enough admin and admin time that they’re not busting their butt, like answering every phone call that they don’t have any extra time, they know are able to look through everyday part of their one to one of their their jobs is to check the previous day’s clients and make sure that all their credit card on file is up to date, that a new release of informations are up to date, all that kind of stuff.

So even goes above and beyond, which I think is really important for scaling because, as you know, at 15, it’s it can be a big headache compared to having to clinicians, if I’m notes or if they don’t have credit cards on file, and that just like exacerbates as you get to 20, 25, 30 clinicians. So my biggest feedback for just getting to the the size that you’re kind of talking about is, is having teams in place that can support each other so that you can kind of do what you need to do.

 Amanda Patterson 

So I have a question about the clinical director and maybe the site supervisors and teams because I’m an independent contractor. So we do a split. Like I’m kind of stuck around how to pay them like, and how to know like, how many hours to allot and those types of things.

 Maureen Werrbach 

So I will say when it comes to leadership, if you have clinical directors, I would look at in what ways you can lead and I know every stage is a little bit different in terms of whether they’re more stringent than the IRS guidelines or less. So I check with an attorney and in that regard, but is that what I’m thinking is obviously the level of supervision that you know, my practice is doing, you wouldn’t be able to do with independent contractors like mine are, you know, doing audits and supervision and we sometimes have provisionally licensed people that they’re supporting. So it’s a little bit different in that sense. And we have a lot of team meetings and just because we are a family feel so there’s a lot of connection, just because that’s possible with employees. So my question in terms of leadership is what would you be wanting before I guess, go too deep with your contractors when it comes to leadership support?

 Amanda Patterson 

I’m definitely thinking about having a clinical director because I’m an hour away from my one location. And I’ve been going there three days a week and that I would like to stop. It’s a little far and you know, some of our other goals and plans, and then my other offices eight minutes away, so I’m looking to shift my home base. And there’s just you know, things that come up in that office that because it’s a larger office, there’s more clinicians, they’re more, there’s more going on that I think that the clinical director just would need to support. Even if it’s just things like, you know, a lot of the times people forget the fax number or forget how to log into the fax or just like some of those smaller things, and the larger things like the team meetings and the audits and that kind of stuff.

 Maureen Werrbach 

Okay, so your question is around payment, compensation? 

Amanda Patterson 

Like how do I compensate that person?

Maureen Werrbach 

Well, first, I’ll say you probably want to check and see if you can have a contractor in that position, it’s likely probably going to have to shift at least that specific role.

Amanda Patterson 

And what I was thinking of to an employee, yes,

Maureen Werrbach 

Only because you’re really going to want to direct how they’re leading the team. And obviously that puts some level of control in your hands. That being said, most people in our industry start off by, are you you’re paying you said commission, right? Yes, is that they have a separate rate that they’re paying for leadership. So that’s how I started. It’s it’s lower risk, and it’s easier to keep things separate.

One of the things that I don’t suggest, which is something that I did do a lesson that I learned and a large group practice owner here in Chicago, who has since sold her practice, had given me this feedback. And it was a kind of a lesson learned on my end, years ago, is that if you pay your leadership team or if you pay, I mean, anyone who’s commission based for seeing clients and just pay them a higher commission, which is something I did, I initially paid my clinical director, we’re 55% I think I did, like 65%, right, with the assumption that she’s going to do X amount of hours of leadership.

And this was, I mean, she’s been a clinical director for, I don’t know, seven or eight years now. So it was in that first year or so that I was I’ll just do a higher commission and what that really does is it incentivizes seeing more clients not doing the leadership work, right. Because it with time it if the, it’s just part of how we are thinking is that someone who gets paid a higher commission will just tie the commission to the clinical work and feel like they’re not being paid, even though in theory they are, they’re going to feel like they’re not being paid for the clinical work. So it really incentivized her to work a lot of client hours, which then made me feel bad having her giving her more work on the clinical side because I knew how many clients she was seeing.

So we shifted out of that probably a year into it. And after talking with this other group practice owner who had, you know, been around the block a few times with us and said that it makes the most sense to separate the pay so we went back to paying her regular clinical range for seeing clients just as she does. Just as everyone else my practice has, and then I paid her an hourly rate of like, I can’t remember now because it’s she’s salaried now. But have probably I did I my, my goal was it to be a higher rate than what she makes seeing clients because I felt like the leadership role, obviously as a higher role than being a clinician and has more responsibility. So I wanted that to the compensation to be higher. So I think, at the time, because again, this was a lot of years ago, I did around $10 more an hour than what kind of the combination of her commission was for an hourly rate, and then set that up for her as a clinical director.

And at the time, we knew because we kind of practiced it, so I knew what I was giving up time-wise and I had at the time, I think it was like, literally, again, I had her become a clinical director. When I had three people. She was one of three I already knew from the beginning I wanted to support. So I know it’s a little different for you. You’re bringing someone when you already have 15 people or you’re bringing someone up, but I would think about the time that you’re spending on that, and just have like a month or two of grace period, and then where you meet back up.

So my suggestion is, let’s say it’s, you know, takes you around 10 hours a week or five hours a week of whatever leadership stuff that you’re doing that you’re going to hand off, I would start with that. And how I set up was I did a monthly package like I paid, you know, $2,000 a month, and it came out to the $65 or whatever it was an hour times 10 hours a week times four, right to just do a monthly package. And I asked her to track her time, and sometimes she was a little bit lower, but because I was doing a monthly package like that, for the supervisor hours. She was still getting it even if she was a little lower, and even if she was a little higher. We obviously accounted for minimum wage, but her pay was higher than a clinical wage, so there wasn’t anywhere on that end. Then after a couple months, we redefined the timeframes because we were able to see, you know, obviously how I do things and how fast it is, for me is different than someone else. And we did that for, I don’t know, five or so years, it worked perfect. It didn’t incentivize her to see 8000 clients and incentivize her to actually focus on the leadership part as well.

And then, a couple of years ago, we switched to salary because her role is mainly clinical director, she just does 10 hours of client facing work a week. That’s obviously the easiest route but it’s the most highest risk even in times like now when you know, you could potentially have clinicians not seeing a lot of clients. But that would be my that would be my suggestion. It is the lowest risk, but also keeps the role separate enough where you’re soon to be clinical director. We’ll be prioritizing both the client facing and the Leadership facing work. 

Amanda Patterson 

And then as I’m promoting this person, would you recommend doing site supervisors at the same time? Or kind of like rolling over her? You know, I say her but could be a him but it probably will be her considering my two male clients are brand new and are clinicians, our clients. And what I bring on site supervisors right away are kind of let it roll out having her see how that goes. I mean, I know it might be a personal preference.

Maureen Werrbach 

I guess if you’re asking what I would do, and you can do whatever you want, is, I probably would roll this position out first, because you’re going to want to iron out the kinks in terms of what she you know, to be able to pair out what her role is going to be versus the supervisors, the site supervisors. I think with two locations, one clinical directors is enough to be able to manage all of that It also allows her then to grow in that leadership place. If you bring on the supervisors–not that you can’t do this–at the same time, there could be this feeling like they’re kind of growing in leadership at the same time. And, you know, obviously, you want the clinical director to be able to lead the leadership team, but if she’s growing in leadership, at the same time, she’ll feel more like a peer in that regard.

Again, not that it’s a bad thing, but I think it’s something that you’d have to think about in terms of maybe, you know, doing leadership training separately with her so that she feels like she can actually lead the leadership team without feeling like she’s learning with them.

But again, I think because you’re at two locations, I brought on site supervisors two years ago, when I brought on my third location, because that’s when I felt like she she can’t drive around between three office locations. And so that was kind of the marker for me. That on top of the fact that I wanted to be able to have growth opportunities for my team. So I would say that it would be easiest for you if you started with just that one. And then it’ll, it’ll help you kind of define what you want your site supervisor positions to look like. And then it also offers her the the time to be able to grow in leadership first before you bring them on so that she can support you in training those those new leaders, site supervisors, if you do go that route.

So, I feel like in terms of infrastructure, if that’s what you’re focusing on is, is the team’s leadership and back end, because as you know, you know, being insurance based as well, is that I’m sure it looks really different now at 15 clinicians than it did when you were at two or three and the same is going to be true when you get to 20 and 25.

One of the things that I In talking with other large group practice owners that I was mentioning earlier is another piece of it is that every 10 or so new clinicians that get brought on the dynamic the field, the struggles of the group practice shift a little bit. And you kind of go through these like ebbs and flows. So also with regards to finances even so you might notice that the first five people that you hire, there’s not much like you’re at 15. So I’m talking about now five more, and five more five more, but that between 15 and 20, you might find that there’s very minimal amounts of financial growth on your end, or profit growth. But then between clinicians 25 and 30, there might be a big spurt and then you might find that clinicians 30 to 35. There’s very small growth, again, financial growth, profit growth, and then between 35 and 40. There’s a spurt again, and it accounts for things that like this, like if you’re on clinician number 15, and you decide to put in a structure in place that includes more robust administrative teams so that they can actually handle that, that growth that’s going to come up instead of, you know, proactively instead of reactively. And also with the leadership team, it’s likely that the first few clinicians you now hire are just gonna end up covering the cost of that growth, which is kind of how this kind of goes throughout your future growth in clinicians is, the more clinicians you have, the more administrative and leadership support you need. So does that make sense?

You’ll have people you hire, there won’t feel like there’s any financial growth, but there’s gonna be a lot more leadership needs and support needs. And then all of a sudden, you’ll notice that there’s a handful of clinicians who bring on and that’s where the profits show up. And that’ll continue on as you grow. And I remember thinking that was just something that might be unique to me. And in just, you know, this era that we’re in where we get to talk to all these group practice. owners and peers online, I’ve been able to see and talk to other kind of larger group practice owners who all had the same experience. So makes a lot of sense.

But it’s something to be aware of, I think just because it can be initially frustrating. And you might think, you know, I’m doing this grows, and I’ve hired five, six new people, and, um, I feel, you know, financially a profit wise, not any better off. But we have all this extra work that we need to do for those five or six people. It’s just normal. That’s just part of the the growth the growth piece. 

Amanda Patterson 

Yeah. And in terms of like the percentage like I’ve been doing it the same percentage for the whole time. What do you recommend normally, the split before when you have independent contractors?

Maureen Werrbach 

I’ll say across all of the US the standard for contractors seems to be 60%. That’s kind of industry standard for employees is 50%. And I’ll say and this is for therapists. So I know if you have med management, it’s going to look a little different. But for therapists, psychologists, counselors, social workers, the industry standard is 60% for contractors and 50 for employees, with people wavering around 5%, above and below that point. So there’s obviously practices that have been placed at 45%, up to 55%. I’m at 55% with benefits, and there’s contract group practices that have contractors that pay between I’ve even seen 50%. So I guess with contractors, the spread is a little wider, but the standard is 60. But I’ve seen it all the way up to 65%.

I find that the larger you get, the easier it is to pay a little bit more. And that’s, I think, you know, something that I see struggles with smaller group practices that I coach is that they feel like they can’t compete benefits wise, with larger group practices. And this is one of those reasons is that you know, typically As a group, as any business grows, the profit percentage goes down in what the business makes, but because, you know, the, even if the profit percentage goes down, because the amount of income that’s coming in is so much larger, the profit number is still much higher. And so there’s a little bit more flexibility and being able to, you know, increase compensation or add benefits if you’ve had employees. I know there’s not many benefits you can do with contractor. So typically, it would be increasing the actual compensation, but I wouldn’t suggest doing it unless you feel like you’re not doing the industry standard. Or you feel like the, the rates that your clients are paying are such a rate and your operating expenses are so low that your profit numbers are just higher than where, like the average group practices are.

Amanda Patterson 

So my rate is higher than the end district standard. And the other issue around that is that in Florida, like our private pay rate is decent, but for the most part, our insurance rate is pretty low. And so if I even consider doing maybe 60% initially, it’s really not comparable and competitive with working at an agency or, you know, people who just want to do private pay practices. So we’ve recently got some raises from into some insurances. So that has been really helpful. And we’re pushing but you know, some of the, like, BlueCross and BlueShield, I think, as you know, will not negotiate with most, you know, practices and they have a very low rate. We’re at 60%, it would be like 36, you know, dollars or 30, you know, $35 or whatever it is. And then when the contractor has to pay taxes on top of that, and those kinds of things, it’s just not really sustainable. But at the same time, what I’m learning is that if I want to grow and have a Clinical Director and have more admin staff that the rate that I have, unless everybody’s full, then it’s not really allowing me to do that. So I feel a little bit stuck between those two things because I feel like the contractors are happy with their rate. But in order to provide more admin staff or even a clinical director, I’m sort of stuck between those two things. 

Maureen Werrbach 

Yeah. I mean, you have a couple of options one is that you bring on someone sort of similar to what I did with my clinical director in the beginning. I brought her on and had her to very minimal amount of work just a few hours a week until as my group grew and I had enough profits to be able to support her to do more. And for me, I found it I I liked that option because I didn’t have to jump right in and just bring some hire on full time. As a clinical director, or even part time, I mean, she was a super part time in the clinical director role, it allowed her to ease into it.

For most people just the ability to to be promoted is enough. I know a lot of people think you know, who’s going to want to be a clinical director for a couple of hours. Again, it’s a promotion with the idea that as the practice grows, so would her position and so 99% people are going to be excited that they’re being asked for that sort of opportunity and are going to are going to be willing to grow and partially mold that position with you.

So one option is to continue to grow and every extra clinician you bring on if you if you don’t reduce, let’s say you don’t reduce anyone’s rates allows you to have a slightly more profits to cover the cost and growing or to you can bring on any new person you bring on is just added different rate. And you know, they don’t need to know, and if they are if they do find out you can always say it’s like for whatever reason they talk you can say there was a point to where we added administrative people to support this growth including supporting you not needing to do x, y, & z. and in that we need to we needed to these people were grandfathered into a rate. And that’s the way it is. I mean, it’s just sort the way it is. And then the other option is maybe diversifying services within your practice and looking at. So this is something that we’re we’ve been doing for the past year, it’s just taking a really long time is offering what we’re doing is just an example, is offering CES so we have like a training program, where my clinicians actually can get paid more than their hourly rate seeing clients but I know that I’m kind of decent at selling courses and stuff.

So my thought was I can pay my clinicians $200 an hour to make a make up an hourly fee on their area of expertise. And so they’re being paid more than they would at, you know, hours are around $65 an hour for seeing clients. So a whole lot more. And then it’s up to me, obviously, it is a-whole-nother business venture. So, you know, it’s going to take me probably a year or so to actually see profits from it. But then, you know, potentially, how I have it set up is I have a whole CTE course set area, and then I have one, that’s for businesses.

So like leadership, conflict resolution, so now I’ve seen but corporate sort of trainings, diversify services, and obviously the level of profits is up to me, right? If I can get in front of a lot of corporate clients and sell these and license them, then the $200 that I paid the clinician for that have a webinar or training or whatever could be. I mean, the profits can be however high I can get them to get. I guess long story short,there’s a potential for you if you if those other two options don’t work is maybe adding a different service that is in line with your business that makes sense as part of your vision. And that allows for you to have higher profits so that you can support things like this leadership teams and such.

Amanda Patterson 

Yeah, I think one thing that we’ve talked about a lot is doing groups that’s been an area that we just haven’t done anything yet with it. But there’s definitely I think interest one in the community and two some of the clinicians are really interested in doing the doing groups which you know, in line with what we do already.

Maureen Werrbach 

Yeah. And then if it fits with your vision and what your group practices about them, that makes sense. I talked to you know, Katie May, right. Oh, of course. Yeah. I was going to say talk to her because she’s the person that can help you do that. Groups I cannot, for the life of me is not my strong suit. So, but I think that’s a good option in terms of being able to, you know, increase profits without necessarily reducing clinician pay.

But obviously, that is, I’ll say, the last option is, you know, going back to class and I’ve seen so many group practices have to do this. So, it’s not, you know, it’s not a fun discussion to have, but it’s not something that’s unheard of or not been done before is is reducing their pay by 5% or whatever. And in just saying that this, you know, this is part of the growing pains of a business ownership is, you know, over delivering or over giving and not that’s not being a sustainable method for how your practices run.

I don’t know. When I when I think about that. I always think what what are my other options, I always look at that as like the last resort, if I can bring on new people at a lower rate. Knowing now I’m kind of course correcting, I would probably prefer to do that. Or offering diversified services, whether that’s through speaking engagements, and in the community or offering continuing education or things like that, where you can have a larger profit margin that can kind of offset sometimes the really good pay, you’re giving your clinicians so that’s the thing that they gave out.

Amanda Patterson 

Yeah, but I’ve considered. I don’t want to, I don’t think anybody ever wants to reduce pay, but I’ve also thought about reducing pay, like for part time, people who they want space and they may be you know, contribute some but they’re not full time and it just doesn’t necessarily make sense to pay them the same rate as full time clinician. So that’s also been something I’ve seen people do. And in I think, yes, of course, like that’s the last one for me in my business like, that’s a last resort. But it’s just it is like a funny spot to be in sometimes where you want to grow, and then you, you know, also need money to grow. And then you also, you know, it’s like, what comes first? Yeah, the chicken or the egg sometimes.

Maureen Werrbach 

Yeah. When are you planning on growing?

Amanda Patterson 

Well, I was planning on growing the week that the pandemic hit. So I’m not now we’re not sure, I’m going to try to do like a hybrid system where half online half in person when this all fully goes, you know, rolls out. And so I don’t know that I’ll need a larger space up here yet, but I just added two clinicians one is getting full and the other one just literally started last week, so we’ll see where that goes. But when we all try to go back into the space, there’s, it’s, there’s not going to be enough space. We’ll have to work it out amongst ourselves while we can, but I will probably need a larger space, I would say by August or September. Again it’s so hard to know what’s going on because everything is so up in the air.

Maureen Werrbach 

Yeah, yeah it’s interesting to see the decisions that businesses especially you know, group practice owners are making and it’s so far reaching between the two ends of the spectrum from group practice owners that are closing locations to ones that are expanding right now and opening locations so it’s interesting to see. It’s kind of this fun piece for me is just observing how different we can all run our businesses and how successful we can be doing it so differently which is I think pretty cool.

Amanda Patterson 

Yeah, I agree. I’ve seen people like on on both ends are like closing their business and I’m like, oh, my goodness, like I that’s definitely like a scary place to be. But we’re lucky like our referrals have picked up especially in the last two weeks and referrals have picked up I put the AdWords back on and started, you know, ramping up some of the efforts to drum up referrals. And we’ve seen that’s been good. So that’s why this is like the perfect timing for this coaching call because I’m starting to see like the light at the end of the tunnel. We’re going to go back to the office, eventually things are going to continue to build, I’m going to need a larger space, I could add additional clinicians and I know I need the support.

Maureen Werrbach 

Yeah, and I wanted to sort of end with this but I think not only does looking at teams–and I didn’t actually even finish my thought before because I sometimes go on tangents but–including in the team is looking at things like marketing. You could potentially have clinicians a team or it can be a single person team with you.

Some of my teams are just me with another person. Marketing team, onboarding team, someone that’s onboarding new clinicians, we have that and that’s a lifesaver for me. It’s one of my superstar therapists who just is amazing at everything she does. And it’s like, oh, if we could replicate you, if you have a clinician who you think if I could just replicate you 100 times and have 100 versions of you. As a clinician, that’s probably the perfect onboarding coordinator. And that’s what I thought of with with my one therapist is she just does her notes on time. She has a good system, she charges cards at the beginning of is that like, the things that she’s just so on top of it and has helped mold all the new therapists that come in are essentially learning exactly what I’m wanting out of, you know, upcoming clinicians. So it’s really great.

But in doing this, I think it also does a second benefit, aside from supporting you and allowing you to be able to focus on the growth part is that it really provides all these opportunities to your clinicians, which I think group practice owners don’t think about because they feel like the limit is higher. clinician, and then they’re a clinician, that’s it. And that breeds, people coming and going and starting their own thing or finding a place where they can continue to grow. And so I find that the second benefit to it is that you’re, you’d be able to provide opportunity to opportunities of growth for clinicians in your practice, or, you know, administrative people in your practice, to be able to, you know, kind of step into a role that they might not otherwise be able to have, which I think is pretty awesome.

Amanda Patterson 

Yeah, I definitely think that keeps people engaged in the practice and excited about their practice and then less likely to leave. 

Maureen Werrbach 

Yeah, I agree. Do you have any other questions?

Amanda Patterson 

I have one more question. Who actually pays your clinicians like who reviews their timesheets, who reviews? The you know, we use TherapyNotes I think you do to like who reviews that to make sure everything is done and because I’m still doing that. And I know I need–I know, I saw you shake your head like–I know that has to go to somebody but who does that? 

Maureen Werrbach 

So mine is the practice manager. My mom, who does all of the the money related stuff? I would assume in most businesses in our industry, it’s it’s going to be a practice manager of sorts that’s doing it. If it’s not the group practice owner, it only just makes the most amount of sense as having someone you could also. So I know I use Green Oak Accounting for my accounting and bookkeeping and I have the CFO package. And I almost positive part of the CFO packages is doing payroll. So there’s also accountants out there that will do that work for you. So if you have an accountant or bookkeeper, it’d be worth asking them if that’s part of their scope and being able to do it.

I know with mine, it is a part of her scope and she uses Gusto, knows TherapyNotes and all that fun stuff. So if I didn’t have my mom who has been doing it for a million years Now I would definitely have my accountant do it. It just makes them most logical sense next to a practice manager who or someone who’s in charge of the administrative side of your business would be then an accountant or bookkeeper person doing it. Okay, perfect.

Amanda Patterson 

Yeah that’s it that’s a wrap!

Maureen Werrbach 

It was really good talking to you and seeing you sort of face to face.

Thanks For Listening

Thanks for listening to the group practice exchange podcast. Like what you heard? Give us five stars on whatever platform you’re listening from. Need extra suppor? Join The Exchange, a membership community just for group practice owners with monthly office hours, live webinars, and a library of trainings ready for you to dive into visit www dot members dot the group practice exchange dot com forward slash exchange. See you next week.


Here are the resources and guides we recommend based on this episode

therapy notes

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Meet your host


Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here:


The show

The podcast is structured so that you get practice building tips in small doses, where an episode can be listened to (and a group practice building lesson can be learned) in a single car ride.

Episodes are structured into categories: coaching sessions where I coach a group practice owner on a specific topic, tips of the day by yours truly, real talk where you get to be a fly on the wall while an established group practice owner and I talk about the highs and lows of ownership, and trainings done by experts in the field.

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* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.

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