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Episode 179 | 10 Things to Consider Before Starting a Group Practice



  • Episode 179 | 10 Things to Consider Before Starting a Group Practice 00:00


Hey Group Practice listeners! In this episode I’m going to be talking all about 10 things you need to consider when thinking about starting a group practice. So this is for all of you who do not yet have a group practice, and are in that contemplative stage of trying to decide if starting a group practice is right for you!

In this episode I cover:

  • The importance of a business plan
  • Slow, intentional hiring
  • The value of a business attorney
  • And other tips I wish I’d known when I first started!

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.

Do you ever wish for a financial therapist who could relieve you from the last few months’ bookkeeping, talk you off the edge when you’re running into issues with Quickbooks, or help you work through a profit plan for growth? GreenOak Accounting does just that! GreenOak Accounting is an accounting firm that specializes in working with group practices. Their value goes WAY beyond bookkeeping; they can help you get on track for financial success. Schedule a free consultation by going to


Maureen Werrbach


Welcome back to another episode today I’m going to be talking about 10 steps, or 10 things you need to consider when thinking about starting a group practice. So this is for all of you who do not yet have a group practice, and are in that contemplative stage of trying to decide if starting a group practice is right for you, and what those initial things you want to be thinking about are.

So I apologize, I have a little bit of a cold today, so I sound more raspy than normal. But setting up a group practice can really feel overwhelming. And since most of us don’t come from a business background, there’s a lot of decisions we initially make as a group practice, when we’re first starting out that we make a little bit in the dark. And as new and established group practice owners end up realizing, there’s no manual or template that really outlines the best practices that are available to us when we’re starting a group practice. And that’s because they can vary so much in how they’re set up, what their trajectory looks like, how large they get, how many locations they have, whether it’s independent contractors or employees, whether it’s multidisciplinary or a niche group practice, whether there are other offerings, aside from counseling, like having a Wellness Center, or providing medication management, there isn’t really a one size fits all solution, which makes it even harder initially to figure out how to actually get started. But there are some basic first steps that every practice owner is going to consider and think about, and some common themes that are relevant to any group practice owner who is thinking about starting to bring on that first person. So that’s kind of what I want to go through here.

So one of the first things that you really want to be thinking about is your business plan. I know, business planning doesn’t feel like this super important thing. And a lot of people have a kind of a faux business plan in their minds. But what’s really great about having a business plan not only for making sure that you’re on the right path as you grow your business, but especially initially is it helps you kind of map out what you want, how you want it to look. And it helps you make sure that you’re taking the right path every step of the way, that it’s leading you in the direction that you want it to lead you. And this is by far the most skipped step by most new business owners, because typically, we want to be doing things that are like literal, like that contribute to the actual physical growth or starting a business. And a business plan doesn’t in theory feel like a something that’s actually going to help you move forward in a literal sense, right. But it actually does.

And so most of us typically have a bunch of thoughts that are floating around in our heads. And we go by those things versus writing these things down on a business plan. If you go online, you can easily find a business plan template, there are some specific structures that you’re going to want to kind of go through to have a solid business plan. And so if you go online, it’s really easy to find a template. The SBA has a good templates, we at The Group Practice Exchange have one that is based off of a typical business plan, but kind of guides you around specific questions related to group practice ownership that relates to each section of a business plan. So it kind of caters specifically to our industry. But that’s my first suggestion is to just start writing a business plan. And think of it as a living document that you are going to be editing every single year looking at seeing if it still aligns with how you’re feeling at that time. It’s a living document that can always be changed. But it’s definitely a great starting point, when you’re thinking about what you want your business to actually look like.

The second thing that you really want to be thinking about is being legal. And from that standpoint, that’s probably kind of one of the more expensive items initially with starting a group practice. And a lot of people will skip out on this and try to use Facebook or their peers to get manuals, contracts, offer letters, all of those kinds of documents from other people in an effort to save some money. And here’s where I think it’s really important that you invest financially in legal support, because not only does every state have different laws around employment, around how to even set up a business structure legally. You don’t want to be using other people’s manuals or offer letters or contracts because you don’t know, one, whether they’ve used a legal attorney or someone legal to look through those documents, but also how they’re structuring their business might look different from how you want to structure yours. And also, depending on the attorney that they used, you can always find another attorney who can give you complete opposite feedback. And so you really want to make sure that the documents you’re using in your business, from a legal standpoint, have been built, or at least vetted by an attorney that you trust. And so it’s really important initially that you have someone that can make sure that your business is set up as a legal entity in your state.

And then in terms of figuring out whether you want to hire someone as an employee, or contract an independent contractor, making sure that in your state, that you’re making the right decision around which one is best for your business, and where you want it to go, and that it aligns with your state’s laws. And then if it is employee, there’s obviously employment law that comes into play. And so you want to then make sure that you’re setting your business up in a way that will support an employee relationship, if that’s the route you’re going. And so it’s really important not to skip on having legal support, because you’re going to be using that person for the rest of your business’s life.

You know, I use my attorney quite often, and my business is very established. But anytime we’re bringing a new discipline in, or anytime there’s a new employee related issue, we will go to our HR person or our employment attorney, to make sure that the decisions and thoughts that we have around whatever issue is coming up, that we’re going about it from from the legal lens, appropriately. And so having legal support is really important. Along those lines is an employment attorney. So there’s a lot of in the legal sense, there’s legal for your business structure, which usually is a business attorney, and then legal from an employment structure, usually an HR person or an employment attorney, is what you’re going to want to have.

And along those lines, you want to think about who you actually want to hire. So often, new practice owners will hire friends or people they like, or people that have similar qualities that they do when they’re looking to hire because they are really eager to just get started. And the easiest thing to do is to bring someone in who we know, or someone who’s very similar to us, because it feels safe, and like what we know. But you really want to make sure that you’re thinking about who your ideal clinician is just like you know who your ideal clients are as a therapist. Knowing whether you want someone who is a contractor or an employee, not only is important for you to know this, but it’s important for you to make sure that the person you’re bringing on knows that they’re getting into that specific relationship, that they’re coming in, in an employment relationship, or that they’re coming in as a contractor, and that that relationships going to look different. You’ll want to know if this person is going to need to work a certain amount of hours, are they part time or full time? Do they have a certain niche? Do you want some multi specialty? Are you gonna want them to do telehealth or work in the office? Is there going to be some extra requirements outside of seeing clients, maybe administrative work or doing trainings or doing testing, or marketing or networking or writing blogs? You want to think about all of those things before you bring that first person on so that when you’re talking to potential employees, they know exactly what you’re looking for, so that they can make an informed decision about whether or not that position is right for them.

You also then want to be thinking about putting together a recruiting and interviewing a hiring and then onboarding strategy. You want to make sure that this purse first person that you’re bringing on feels like they’re being supported from the beginning, all the way to feeling secure in their role. And so recruiting, how you’re figuring out where to look for someone is the recruiting strategy, what is your strategy behind where you’re looking for people? And what’s important for you, and this is why it’s important to know who your ideal clinician is, because it will guide you on where to recruit to find that ideal person.

Then your interviewing strategy, right? Being intentional about what kind of questions you’re asking what you’re going, what you want to get out of the interviewing. Are there certain questions? Is there a certain feedback that you’re looking for? How are you going to make sure that you’re getting the information you’re looking for from the interview process? You want to make sure that you have a strategy. Part of my strategy is based off of the book The Ideal Team Player, which is that you I look for employees who are humble hungry and smart. If you aren’t aware of this book, it’s a great book to read on hiring and employee relations and making sure that you have the ideal team player on your, you know, team. But making sure that you know what strategies you’re going to have for interviewing people so that you feel confident in taking the next step, which is hiring.

And then making sure that you have a great hiring strategy, What documents do you need from them? What first steps do you need them to make to get on boarded? And then an onboarding strategy, which for me, is those first 90 days. How am I making sure that they’re feeling supported in those 90 days? How do you ensure that they’re, you know, crossing their T’s and dotting their I’s, making sure that you’re supporting them and getting to know the other staff that might be on your team, getting to know your policies and procedures in your business, making sure that they know how to use your EHR and the different technologies that you have in your business, and ensuring that they are, you know, able to schedule an appointment, do an intake, do their notes appropriately, kind of following through on all the parts that their role plays, and ensuring that they’re doing it appropriately so that they can be successful in their business or in your business.

You also then want to be thinking about the insurance process. Are you as a solo practitioner right now someone who’s fee for service? Or do you accept insurance? Is this something you want to continue, or something you want to add in your group practice? It’s really important to be intentional about whether or not you’re accepting insurance in your group practice and what that looks like. And not just doing it kind of haphazardly, where either you’re a fee for service and your third therapist decides they’d like to take insurance and you think, oh, okay, why not? You know, I’ll have you just take insurance, because there’s a lot of rules that are different from insurance to insurance. And it can get pretty messy. And you want to make sure that it aligns with your business plan. And so taking the time ahead of time before you bring someone on to think about, is it important to me to accept insurance or not accept insurance, and be really clear on that. Not that you can’t change your mind later. But knowing that you’re being intentional about that decision is really important.
You’ll also be then needing to update your paperwork and your website to reflect a group practice versus just yourself. And these are kind of like the logistical things, there are certain things that need to be added to your intake forms when you’re a group practice, because there’s communication between in between staff members, where as a solo provider, information is going to you and there isn’t need to discuss in your intake paperwork, how information is communicated within your business, because it’s just going to you. But when you have a group practice, you want to make sure that your potential clinicians know that if they are seeing you that the other employees in your practice have access to certain information, because as a group practice, information that is in the group practice is available to everyone in the group practice, right. And so just making sure that your website and your paperwork reflect the change in information and how information is handled, that that’s reflected in your intake paperwork so that clients know how their information is being used and being communicated within the practice.

You’ll also want to be thinking about your marketing strategy. Because up until now, until you hire that first person or contract that first IC, your marketing, essentially yourself, but when you start a group practice, you are going to be marketing a group practice because the group practice becomes the brand, not you. And so the strategy that you use to market yourself and your group practice is going to be very different. If you continue the marketing strategy you use, you’re just going to be bringing more clients in who want to see you. And that’s one of the difficult pieces of starting in group practice is getting new clients to not want to see you. And so paying attention to how you want to intentionally expand your marketing strategy so that it focuses on the business as a whole versus you yourself is going to be an important distinction you’re going to need to make two more things I think I have in my head.

The next one is accounting. Don’t let accounting go to the back burner. Again, this is one of those expenses that don’t feel really pretty, but it is so important that you have an accountant who takes care of your finances on a monthly basis. I know as a solo provider, you might have someone quarterly or once a year doing your accounting. When you have a group practice you really need to have someone who is doing your profit and loss statements and accounting every single month. So you have a pulse on your finances and can course correct quickly if something goes astray. And then lastly is making sure you are aware of HIPAA, now I know as a solo provider there that we need to be aware of HIPAA and ensuring that we’re HIPAA secure. But it takes it to a whole new level when your group practice because of communication between staff members communication that staff members have that you don’t have full control over. And so making sure that you use someone like Person Centered Tech is a great company. Roy* and Liath are amazing and really are just like the leaders when it comes to HIPAA and technology. And they’re a great resource to use to making sure that you’re setting your group practice up for success and safety when it comes to HIPPA and technology.

So those are my, I think, 10 I kind of winged it a little bit but my 10 tips that you need to be thinking about and considering when you’re in the process of starting your practice. I hope that was helpful, and I’ll see you next week!

*This episode was recorded before the recent passing of Roy Huggins. If you would like to share what Roy meant to you, please do so on the memorial page set up for celebrating his life.

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

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.

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!

* 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.

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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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