Episode 161 | How To Know If Group Practice is Not For You
WITH MAUREEN WERRBACH
- Episode 161 | How To Know If Group Practice is Not For You 00:00
Hey Group Practice listeners! In this episode, I’m talking through the top ten reasons owning a group practice might not be for you.
In this episode I cover:
- Solo vs group considerations
- Things to think about before pivoting to group practice
- Top reasons owning a group might not work for you
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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Hey, welcome back. Today I’m going to be talking about how to know if having a group practice is not for you. This is a question that came inside the Exchange Facebook group. And I’m really excited to dive into some of my thoughts around the top 10. These are just things I wrote down–top 10 ways or reasons that owning a group practice would not be for you.
So the first thing is that came to mind is not wanting to lead.
If you’re someone who doesn’t like to lead whatsoever, you’re probably not going to love owning a group practice because you essentially will lead a team of people. That doesn’t mean that you can’t grow in your leadership skills. I don’t think I was naturally born to lead a group of people. I am a naturally independent person. And I can lead myself really well and take risks and make important decisions when it comes to myself. But leading a group of people wasn’t something that was natural to me. So it’s not that it has to be something innate, inborn and natural to you, to lead. But if you don’t want to lead, if you don’t like leading, it’s probably going to be really hard to run a group practice long term.
You don’t want to make less money at all ever.
Now, if you’re a solo practitioner and you’re making X amount of dollars, a lot of group practice owners, I’d say probably 90% will make less money for some period of time after they start to hire people. And that is for a variety of reasons. One, the initial cost investment to renting a larger space that allows for new staff to come in; the extra costs to just having that employee or contractor there’s going to be costs associated with each hire, and some unseen costs to your time, which might not be literal dollars, but is metaphorical dollars, because our time is worth some amount of money, right. And so you have to think about the time that you invest as a business owner to recruit and look for people to interview them, to hire them, to onboard them. And a lot of the upfront costs of having an attorney write up offer letters or contracts and manuals, there’s a lot that goes into the initial phase of bringing on your first few people. And ongoing but there’s definitely initial cost to the first few people that you bring on when it comes to the documents and the legal stuff that you’ll have to communicate with your employment attorney on as you get a grip on how you want your business to run, what it’ll look like what that will mean for those people that you bring on. And you’re definitely most likely going to make less money for some period of time. For some it’s longer than for others. But you’re likely to make less than you were as a solo practitioner for some amount of time until you get your bearings and your staff are working the amount of hours that they’re supposed to be working and seeing the type the amount of clients that they should be seeing.
There’ll be a point where that levels off. And then there’ll be a point where you start to actually make a little bit of income from leading and managing a group practice. But if you’re not wanting to make any, any less money at any point, it’s probably going to be hard to own any kind of business. And you’ll see this also not just when you first start hiring, but also, as you expand, there are times group practice ownership does not have the highest profit margins, just by nature, because we’re hiring professional level, you know, master’s, doctorate level staff. And so pay is higher than in other types of employments. So profit margins are naturally lower. And so you’ll find that as you expand, depending on what your expansions look like, you may be paying for a build out, you might be paying for, you know, the furniture and all that fun stuff. And depending on how much you grow, there’ll be points of time where when you’re expanding, you take home less, again, to offset those costs of building out and growing. And so if that’s something that doesn’t appeal to you, and isn’t something that you want to do, group practice, ownership might not be great for you.
You don’t want to manage staff.
If you don’t want to manage staff, this is probably one of the biggest reasons to not start a group practice. Because whether you have a partner, or someone else who is going to manage staff on your behalf, if maybe managing staff isn’t your thing, there will be times where you have to make important decisions on your business, that are going to affect your staff. And even if you’re not the direct person to managing the staff on a day to day basis, there’s going to be points in time as a business owner, especially in the beginning part of owning a group practice where you’re not fully removed. You know, there’s obviously potential as a group practice owner to eventually get to this place where the business runs itself. And you have a leadership team that runs the business and you are more, you know, of a kind of a silent group practice owner because you have leadership that is managing it. But that’s going to take years. And up until that point, even if you have a partner, who is their role is to manage the day to day and yours is to manage the you know, financial and visionary aspects of the business, you’re still going to need to connect with your staff or hear about staff related issues. And if that’s not something that you want to lead on, it’s not going to be a great fit for you to be a group practice owner. It’s just a natural part of business ownership. And most of us will say that it’s an uncomfortable part of business ownership and leadership. But it’s it definitely gets easier with time, especially if you’re willing to do the work to to learn about how to lead better.
It gets it gets better, definitely you up this goes into my next point is you aren’t a good leader. And I want to preface by saying you aren’t a good leader and you don’t want to work on it. If you’re someone who doesn’t like leading and doesn’t have that leader mentality, where you care personally about the people that are on your team, and you want them to do their best, if you can’t lead in that sort of way, you’re going to have a revolving door of staff coming and going, you’re going to have a business where you get a lot of negative reviews on Google. And it’s it’s going to be a trying business to have.
That being said, like all things, there are areas of strength that we have in there are areas of growth opportunity that we have as well. And so leadership might be one of those areas where it’s a growth opportunity for you. And you just need to be willing to do the work to become the leader that your business is going to need from you. But if that sounds like something that’s not on the table for you, and not something you want to do, maybe. And you know, most group practice owners or business owners aren’t thinking in that way. But what I will hear which is, to me rings, a very similar bell is I’ll hear group practice owners that are starting off say I just want to hire a couple of people who work when I’m not working, do their thing and come and go. Now there’s obviously models out there where you can have staff who are maybe are practitioners, I should say, who are maybe renting an office space from your office, right? You don’t have any personal or emotional attachment to the work that they’re doing. And they’re their own business owners that are just renting a space. But even if you have contractors, their work and how they navigate the therapy world or whatever service they’re offering for you directly impacts the your business, your reputation of your business, and by definition requires you to know manage in some sort of way, that person.
Now obviously, with contractors, there’s less hand holding and less management. But you still need to be able to lead in a way, that contractor and it with employees even 10 times. So you’re going to need to be able to step up and lead, have uncomfortable conversations, make executive decisions that maybe not everyone on your team is going to love. And if you can’t do that, and you’re unwilling to make that decision to make hard decisions, business ownership is probably not not going to be a good thing for you.
You’re in it only for the money.
Now, I mentioned a few points ago that there’s going to be times in the beginning for sure. And as you expand where you aren’t making more than what you were prior to being at the stage that you’re at. So like I said, if you’re first starting off in your group practice, it’s likely that you’re going to make less for a certain period of time. And if that’s not something you want to do, it’s probably going to be really hard to own a group practice and really enjoy it. And the same is true for any growth phases, there might be points where you need to grow. And because the profit margins aren’t astronomical, it’s likely that your own income will dip as you do build outs and expand. And if you’re not willing to do that, that might cause you to not be able to grow in the way that you want to. And so thinking about income, if the only reason that you are wanting to hire staff is that you can make passive income, which it isn’t passive I’m air quoting, passive, it’s not passive at all. You’re not gonna love owning a group practice if all if it’s only about the money, because you’ll get resentful of the fact that the profit margins aren’t as high as you’re thinking. And you’ll be resentful every time there’s conflict with your staff, anytime, you need to make a hard decision. Anytime someone is upset with a decision you make, you’re going to become resentful. Because you don’t have a vision and you’re don’t have a set of values that your business is living through, you’re just in it for the money. It’s going to be really hard to enjoy your business and whether through the struggles, because you’re you’re tying your desire to own a group practice with income and not with the personal aspects of it.
You’re prone to burnout.
If you’re a person who’s prone to burnout, I’m not saying you shouldn’t have a business, but it’s definitely something to think about. Because it is really easy to overwork yourself as a business owner. And if you’re a solo practitioner, you probably know this already. But it is so easy to get to burnout as a group practice owner when you’re managing staff, uncomfortable feelings, angry clients and not just clients that might be angry with you that are your own clients, but the clients of every staff that you have in your group practice. And so if self care is really hard for you, and burnout is really easy for you, it might just be a place for you to pause if your practice ownership is something you want to do. And see how you can work on creating boundaries in a way that allows you to be able to step back when you start to see burnout coming because I think most group practice owners that you will talk to will say that they’ve either been in a stage of burnout or gotten close to it. And if it’s if it’s something that you’re kind of struggling with right now at the moment, I would say hold off on bringing on any people at this moment until burnout feels like it’s far away from you. And if you’re also someone who’s just prone to burning out more easily because you overwork yourself or whatnot, it might be worth looking at either how you can make some shifts, so that doesn’t happen. or bringing on a partner who can share in the workload. And in the mental workload or potentially keeping it small.
You have a hard time with control.
If you want to control everything that is happening, which is much, much easier to do when you’re a solo practitioner, you can control your policies and procedures because it’s just you you can control where how many clients you see and when you take days off, because it’s just you. There’s a big amount of control you need to let go of and throughout the years, you’ll see that that is even more true than however much you’re thinking you need to let go right now. There will be many people that you end up leading from administrative staff to clinicians who come and go to the clients that those staff members are dealing with. And you won’t be able to control the outcomes of how your team members do the work that they do, you can obviously provide coaching and support them. But oftentimes, it’s after the fact. And if mistakes and staff who are angry or clients who are angry is something that you have a hard time dealing with, and will either create resentment or anger from you, because they’re not doing it your way and the way you the way you do it. business ownership that includes leading a team of staff might not be what might not be good for you. You need to get to a place to truly lead a team of people in a kind of healthy way where you’re not resentful. You need to be able to let go of some control, except that people do things differently from you. And that people will make mistakes, and that things won’t always go according to your plan, because you’re involving other humans in that plan. And those humans based off of their upbringing and their history and how they navigate the world and see the world is going to change your expectations and what the outcomes of how your business ends up being run, it just will not be exactly how you thought it was. And to really enjoy and be good at leading in a business that employs people, you’ll need to get to a place where you accept that things don’t happen always the way you want them to.
Number eight, you don’t have a vision, and you don’t want to create one.
This kind of goes back to this, I just want, I just want to make more money, I just want a business where I can have like some passive income. And, again, it is definitely not passive. But to if you don’t have a vision for where you want your business to go, it is going to feel like it’s balancing on a teeter totter at all times, it’s gonna feel unsafe, it’s gonna feel like unpredictable. And it’s–I don’t know about you guys, but it would be anxiety producing for me to have a business that doesn’t have a vision, a place that it’s moving towards, that all of your staff members are aligning with. Again, you’ll feel this sense of unease and like, you don’t know where the business is going. But your staff will also feel that. And like all the great authors, business authors out there, one of the best ways to have a good workplace culture to retain staff longer to have people doing their best work is that they are tied to that vision. They are connected to the values of your business, and they want the best for your business because they align so well with that. And so if you don’t have that, you don’t want to make that.
And usually, group practice owners I see that are like this are the ones that really want to be hands off, and not provide a lot of support to their team members and just are either really busy doing their own clinical work and are just wanting to offer a space where they can make some passive income by referring overflow clients to them. This will create a space where staff are coming and going where clients are unhappy, but there won’t feel like there’s any accountability on anyone’s part because the employees will feel like it’s on you to fix and you will feel like it’s on them to fix because you may be pay them so well and you expect them to be hands off. You need to be able to really have this vision that creates the space where your staff and team members and clients and community all feel a connection to it or those that are at least going to participate in it, feel a connection to it. It also gives you a sense as a business owner of knowing where you’re going so that you’re not aimlessly walking around, so to speak with your business.
Number nine, you don’t like change, you’re resistant to change.
You don’t like to pivot if you refuse to pivot. If you don’t like change, and it causes you major anxiety and you resist it every step of the way. Owning a group practice is going to be really tough, because it changes constantly if if the pandemic hasn’t taught us anything. The only thing it’s taught us is one of the biggest things it’s taught us is that we the businesses that really were thriving through this were the ones that were willing to pivot take some risks. And so it’s really important as a business owner of any kind is the ability to pivot, to embrace change, to know that everything in business is changeable and should be looked at through a magnifying lens on how it can be better and how can be changed and if that’s not, you know, that just isn’t isn’t something you like doing I think owning a group practice with a whole team of people is not going to be fun.
And then lastly, you’re a people pleaser.
Now, I want to end this by saying, if I’m a people pleaser, it’s something I struggle with as a business owner. And it doesn’t mean that I shouldn’t own a group practice. But it definitely starting off is something to note, because it can cause a lot of strife internally. It can give you the feelings of wanting to just let go of the business. And there’s been plenty, plenty of group practice owners who have thrown the towel in on the group practice and gone back to solo work, because of this need, internal need to people please and realizing that you’ll never succeed, you’ll never succeed at pleasing everyone. And a lot of group practice owners have done it at the detriment of their business to a point where they’ve had to close it down and go back so low either because of finances because they’ve overpaid and under delivered, or because they spent all of their time trying to please all their staff. And it created so much chaos within their businesses that the group practice owner got burned out. And so I want to end with a lot of us are people pleasers. And it doesn’t mean that we can’t be business owners. But it’s definitely something to think about when you’re thinking about bringing on your first staff–of the impact that your people pleasing this might have on the business, your mental health, your connection to staff, and how you can set those boundaries within yourself so that you can manage that people pleasing part of you in a way that doesn’t, you know, create a detriment to the success of your business and the relationships in your group practice.
All right, those are the 10 top ones I was thinking of, but there’s probably so many other reasons that it might not be a good fit for you to own a group practice. And I love this question because most of us look at why starting a group practice or owning a business is a good idea or hiring that first person is a good idea. We don’t think enough critically about why it might not be a good idea. And so I really appreciate this question from Jamie in our exchange Facebook group, and I look forward to answering some more questions next week.
Thanks For Listening
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Here are the resources and guides we recommend based on this episode
Group Practice Start Up Checklist
This neatly organized checklist helps you follow the yellow brick road towards group practice startup. No more confusion. No more wondering what to do next. No stone is left unturned here. Grab your free copy today!
Recruiting & Hiring Your Ideal Therapist
Whether you’re a seasoned or a new group practice owner, one thing we all have in common is the overwhelming, sometimes painful process of recruiting, interviewing and hiring of therapists.
* I am an affiliate for some of the businesses I recommend. These are companies that I use in my own group practice, and make recommendations based off of my experience with them. When you use some of these companies through my links, I receive compensation, which helps me continue to offer great free information on my podcast, blog, Facebook group, and website.
Meet your host
Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here:
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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