Episode 184 | Expanding Benefits in Group Practice to Attract New Clinicians with Carissa Phipps

Maureen Werrbach
Hey everyone, welcome to another episode of the group practice exchange Podcast. Today I have Carissa Phipps she owns small victories counseling and wellness. Am I saying that right? Small Victories wellness services? What the Oh my gosh, guys, you won’t be able to see this, but it’s the cutest shirt ever. I love that with your logo on.

Carissa Phipps
I’m gonna put we had stuff photos taken in them. So I’ll post on the Exchange when when we get the picture.

Maureen Werrbach
Yeah, you were gonna do the awkward awkward staff photos? Is that it? Those are in?

Carissa Phipps
Yeah, they’re real awkward. Oh, that’s so awesome.

Maureen Werrbach
Oh, my gosh, I’m excited to see that. Okay, so we’re gonna be talking about expanding benefits in your group practice with new staff. And I know I recently saw, and maybe it’s not so recently because time is just weird. But you brought on a clinical director, right?

Carissa Phipps
Yeah, we promoted one of our one of our first clinicians, actually to clinical director recently. So I feel she’s doing amazing. It’s terrifying and really vulnerable for me. But she’s wonderful. She’s doing an amazing job. But it’s awesome.

Maureen Werrbach
What did what are the first things that she’s taken kind of off your plate? Or is it a mental thing as of right now? Or is there anything literally that she’s been able to…

Carissa Phipps
So we have, we’re up to about 20 clinical staff now. So now she is the go to for half the staff. So quick clinical console questions, DCF report processing, checking in about safety–like she’s the go to now for half the staff, which feels really good.

Maureen Werrbach
Yeah, I bet it does.

Carissa Phipps
Yeah. And in fall, we’re going to have start a practicum intern program. So she’s taking the lead on, or working with a University near our main office. So that’s really exciting, too.

Maureen Werrbach
Oh, that is awesome. Okay, so in line with that. I want to chat about benefits and what that’s like for you, and what are, how are things going with the benefits that you have for staff? And do you have any plans to make adjustments? Always that time, you know, when people start thinking about that.

Carissa Phipps
Yes, yes. So we are in terms of benefits, we are adding in paid holidays for 2022, which was a big leap. Yes. But like, that’s like one of the number one things that people ask about is how to implement any sort of like paid time off. Like, right, right things to jump through to get that working well. Right, right. Because we do we do have PTO as well. But staff would just take off you to use UTL or PTO for holiday. So my process was talk to my accountant and pray. Like he reassured me like, I can’t stress enough like, as you’re, when you’re really committed to continuously making, you know, upgrading your benefits and adding a new benefits, like having an accountant that you really trust and can chat with about is just, it’s priceless. But so, yeah, go ahead.

Maureen Werrbach
I was gonna say I feel like that’s where I’m at too is that our accountant, she is literally the person I can’t make any decisions until she says, you know, you need to have either this, this type of income or revenue coming in those type of these many clinicians to be able to add this extra benefit. So for those that are winging it, and still not like truly using their accountant in the full way possible, I hope that conversation with Carissa and I will show you that having an accountant that you really, like, implement into decision making not just do my taxes and profit and loss, but like make decisions with me.

Carissa Phipps
Yeah, and I don’t think I knew, really, that an accountant has that role. You know, I’m a first generation college student like I am, like, like most of us are fumbling through the CEO entrepreneur life. So I really didn’t know that that is such an important role in accountant can have. So especially with benefits, so important, like you said, to have someone you click with and trust because you’re really relying on them to give you data to make really big scary decisions sometimes.

Maureen Werrbach
Yes. Okay. So I’m going to take a step back actually, because I forgot about this with you. I want first before we go into forward movement with benefits, tell everyone what the benefits that you currently have.

Carissa Phipps
Okay, so we have, like I mentioned, a lump sum, three weeks paid time off for all full time clinicians. We also offer unlimited paid time off or unlimited time off. Sorry, unlimited, unpaid time off. There we go. We have unlimited unpaid time off with some productivity boundaries within that. We also offer a 401k. With employer match, we have professional development reimbursement. And we have–also offer quarterly trainings with for CEUs, for staff. I don’t think I’m forgetting anything. That’s–in every interview and everything I’m always like, I don’t think I’m forgetting

Maureen Werrbach
And you’ll think later, like, shoot, I forgot this extra that I didn’t mention, is how I am.

Carissa Phipps
I almost like pull up the job posting so you can read the list.

Maureen Werrbach
Okay, so with the–

Carissa Phipps
Oh, I totally did forget health insurance!

Maureen Werrbach
I was gonna say you didn’t mention it. But I was like, I’m not gonna call you out in the middle of the podcast episode–

Carissa Phipps
Please call me out.

Maureen Werrbach
I was like, it sounds, it seems like she would probably have health insurance, like paid time off. And all the other things.

Carissa Phipps
That’s literally probably the main thing we’re gonna talk about today! Health insurance, which we pay 50% of the premium, and then we pay for vision, dental, and life insurance 100%. We are an entirely insurance based practice, I really want to add that in because I think sometimes people think with the benefits that that is really going to hold them back.

Maureen Werrbach
And same! Also insurance based group practice here with all the fun benefits. So okay, I want to talk for a few minutes about the first scary things. I feel like some benefits, like 401k are usually like, the first sort of things that people implement, because it feels low risk. And it’s, you know that it’s 3%, like the person has to match it. And the income is based off of like income like that they’re being paid. So if they make nothing, there’s no retirement matching to pay out, right. Whereas with health insurance, and vacation time, and all that other stuff, those are things that you have to actually be ensuring that you’re saving for because it’s not dependent, necessarily, like health insurance isn’t dependent on how much–I mean, obviously, there’s like requirements of work, but income might not be coming in from insurance yet. And you still have to pay that. So Right. With the three weeks paid time off policy, can you walk us through your thought process of getting to a place of comfortableness with it, because I know that’s one of the scariest pieces, I think even over health insurance is paying for any sort of paid time off, and how to figure out the best ways to do it. I know I do it, because I have salary. So they just have unlimited time off with productivity measures. But because they’re salary, they can take off as much time as they want, as long as they need a yearly sort of session goal. They can figure out how to, you know, if they want to work more to take four months off or work less throughout the year and a half see less clients kind of figure that out. You’re not salaried, right?

Carissa Phipps
No, no, we’re flat rate per clinical hour.

Maureen Werrbach
Perfect. I think that’s going to be relevant to most people, because most aren’t salaried–don’t salary their practices. How are you figuring out, or how do you put together this paid–not the unlimited unpaid, that that people can figure out–but the paid part.

Carissa Phipps
So to start, the first year, we went through Gusto, it was it was super easy to like, look at some plans walks you through it. Very, pretty automated, like they do all that and how I first did it to make that decision, Maureen, was using your spreadsheet for employee costs. And I you know, did did the math and added that in on what it would be per month, and added that into, you know, what, the what profit was coming in from each clinician. And I was just kind of like, surprised, actually, because I didn’t actually think it was doable. At the time we had, there’s five of us. So we were very small when we added in health insurance. So I used the spreadsheet, I looked at the quotes, figured out how much it was going to cost for each clinician per month and added that in and I was like, oh, there’s still money left? Yeah, that’s great. I can do this.

Maureen Werrbach
So how are they, like, how do you track that? Is it, because you said lump sum for the time off?

Carissa Phipps
Yeah, we used we used to be accrued but I’m always looking at ways to change up our benefits that add more flexibility for stuff and don’t cost the company any money. Yeah. And so that was one that you know, regardless of if they accrue it over the year or we just give it to them. They weren’t being able to plan out things and have things to look forward to, which I think is so important for burnout prevention. And so that it was like, okay, well, annually, it’s not going to cost us any more money it but it is going to this flexibility, I think it’s gonna mean a lot to the staff. So we’ve shifted to a lump sum. So at the beginning of the calendar year, each employee just gets their three weeks.

Maureen Werrbach
That’s awesome. And how has it felt? How long have you been doing the the paid time off?

Carissa Phipps
I’ve had it in there since I started the group practice, started hiring employees. But we switched a lump sum about about six months ago, and honestly didn’t hasn’t felt any any different.

Maureen Werrbach
And you’re just paying the flat fee, the same as the flat fee? Or is it a different rate?

Carissa Phipps
We pay, we pay the clinical rate. I want folks to feel like they’re making what they would have made to really be able to take the time off.

Maureen Werrbach
I love this conversation. Because one of the things I see a lot is with group owners is trying to offer benefits, but then doing it in ways that like, it almost is like I can say I’m offering paid time off, but I’m really–

Carissa Phipps
Yeah, I think it comes from scarcity and fear, which you’ve already brought up as an important topic, because we talked about benefits. But we all know right now, it’s not difficult to find clients, it’s difficult to grow and find great staff that are a good fit with your values. And so your biggest investment is retaining and supporting and taking care and attracting staff right now, like that should all be where we’re investing and focusing.

Maureen Werrbach
There was an article I saw recently, I think, in the Harvard Business Review that said, like the app, the cost to and like turnover for one employee on average is around $50,000. If you think about the time it takes to like recruit an interview and hire that person, and you might have like, interviewed five people up till that person to actually hire them. And you got to count the time and the cost related to all the people you said no to to get to that person, along with the time it takes to onboard them and actually have them able to do their work without a lot of micromanagement. And then through the like termination process of like, the work involved with making sure that you’re communicating with that person leaving, making sure that their clients know, and just the loss of potential clients. You know, there’s a high cost and I think a lot higher than people think. So thinking about benefits, I think it’s such a vital thing right now. And not only is it, we have so many clients that are calling, it’s just it’s an employee market right now, where there are everyone’s looking to hire. And so really what’s gonna set you apart, in a lot of ways are benefits.

Carissa Phipps
Yeah. And we we have grown this year, from five to 20. Yeah, in the hardest year to hire. And I really think it is because of our benefits, specifically health insurance. Like you said, there’s a lot of ways ways to have a list of benefits, but they might not be meaningful or be real benefits. And when I when I shifted to a group practice, I really wanted to make it as close to being an employee anywhere as it could be. I think that I saw so many barriers of getting into private practice. And you know, like, if I hadn’t had a partner whose health insurance I could be on, it couldn’t have gotten into private practice. We have these clinicians that are being burnt out in agency work and underpaid and aren’t having opportunities for these different kinds of settings with balance because of the benefits. That is so often what’s stopping them from taking the leap. So that philosophy is really what drove me from the start saying, I have to have these benefits, right? Because it’s a part it’s a part of our model at this point is how can I give my employees the best of both worlds? The security and the stability of being an employee, and then also having the flexibility and the balance of private practice. And even with BetterHelp and all, that is what is going to sustain group practices. Like they can’t provide that, like these tech companies can’t provide that.

Maureen Werrbach
So you see, what is that one? I just saw this article yesterday. Shoot, what is it’s not BetterHelp. Not Alma. I’m going to think of it! Or I’m going to go on Facebook and try to do two things at once as I’m podcasting with you.

Carissa Phipps
If anyone can do it. You can.

Maureen Werrbach
I don’t know when I’m like the spot. Oh–Cerebral. Do you know that app? Oh, it’s like a newer one.

Carissa Phipps
I’ve heard, I’ve heard of it. I don’t know a ton about it.

Maureen Werrbach
I don’t either, except that I see on Facebook all the time, because there’s a lot of famous people that are doing Facebook–

Carissa Phipps
They have these investors and celebrities!

Maureen Werrbach
Though they, to your point, Cerebral was this is this company that hires people, and salaries, them with benefits and all of that. So it was one of those like, okay, and it’s an online like, it’s like a BetterHelp, but they just this week, so they have a $4.8 billion valuation they just opened last year, okay. And salaried all these therapists who can work virtually from home with benefits all this stuff, and just this week, did a test required all their therapists to come on a zoom call, and the owner, the CEO for was on for 10 minutes and said that they’re taking them off salary back to hourly, no benefits, because they can’t sustain it. And it’s like, barely been six months and say, you know, had made this shift to salary. And I think it was like this way to get like, in this is where all these complaints are coming is like there’s people that are pregnant, that are working, who are like they have, they were told they have to the end of the month, and there’s insurance just is not covered anymore. And you know, these people who are like, obviously, relying on this, who now feel stuck with and people who are like in the onboarding process, who quit full time jobs with benefits to get into that position, who are now being too like, in such a vulnerable times of their lives and in the world.

Carissa Phipps
Oh my gosh, that, that is heartbreaking.

Maureen Werrbach
But even more so like kind of goes to your point of these larger companies aren’t going to be able to do this long term, and there’s gonna be a lot of, you know, behind the scenes stuff, you know, we see this with BetterHelp, you have to like be available all day, every day, you have to spend 8 billion hours. They show you the financial piece, that sounds great, but the way to get there is just right, not right.

Carissa Phipps
And I have I peruse a lot of therapists Facebook groups, I’ve never seen anyone say, Oh, I make that 100k that they talk about and the advertisement!

Maureen Werrbach
And work only 20 hours doing it. You know? So you were gonna end with health insurance. But you the thing that you are just starting to offer now is paid holidays. How’s that feeling for you? Is that starting in January?

Carissa Phipps
Yeah, so it’s, it’s starting January, but really December 31. It’s January 1, which was fun. I announced it at our holiday party a few weeks ago, and then I was like, the first paid holiday is my birthday. My New Year’s Baby. Thank you.

Maureen Werrbach
I’m the 27th Oh, gosh, we’re winter babies.

Carissa Phipps
Yes, we are. And so I’m feeling a little nervous. I feel a little nervous. Like, you know, insurance reimbursement processing time slows down this time of year. So like I you know, things are coming in a little less, and we bill every day, but things that I’m just like, Oh my God. But same like I’ve done from the start things to you and the tools you’ve given me. I know how much a paid holiday costs. You know, I know how much it costs. And we’ve got that and we’re fine. So I kind of I know, you don’t pay for it.

Maureen Werrbach
That’s that’s the only thing that I feel like it’s my saving grace for any of the like paid time off, because I save it throughout the year. So when people then use it, I don’t have to take from technical payroll, I’ve saved it.

Carissa Phipps
Right. Right. I think just like my first good comments about my accountant, like just knowing that we have more, we have more–that we the profit that I know that we have each month. We will eat it. I’m not saying that in great words. But you know, here we are. That we just know that the profits there. Yeah. And so we probably honestly won’t really notice it. Yeah. And so I kind of wait, sometimes until that place where my accountant is like, you probably won’t really even notice this. And then I’m like okay! Yeah, so I trust to adjust my accountant to do the math. I do have I have made an additional account for like employee, an employee benefit account that I do want to start saving back into. Which sounds I don’t know a lot about profit first, but it sounds like it’s in in the realm of profit first, then I am going to have a separate employee account and do some additional savings there that will just make it feel better to–even though the accountant can tell me the money’s there, it feels better to see it. Like especially, like, you know, depending on how you’ve grown up like, feels better to see it.

Maureen Werrbach
Yeah, I don’t know why I always just I have this is not a great mentality. But I always have this like feeling of the rug will be pulled from under my feet at some point with anything in my life, anything that goes wrong. At some point, something’s gonna pull. So I have a little you know, where I don’t have a scarcity mindset I have like, I don’t wanna say fear mindset, because I do all the scary things. Anyways, I’m like, I’ll, I’ll figure out how to like, ride through that. But I also think like, whatever the worst is, will probably happen. So I when it comes to like, money stuff, I’m just like, if I can have everything laid out accounts wise, there’s no way I can get screwed, like, there’s no way that I can offer certain benefits or say yes to like, going salary, if I like can control it as much as possible. And for me, it’s those damn Chase accounts, I have about 15 of them. So bad. Every month it’s like transfer 4% here, ttransfer 8% of this one.

Carissa Phipps
I love that though. I love that. And then yeah, you can see it and it feels safe. There’s just so much vulnerability in it. Yeah.

Maureen Werrbach
Okay. So your last benefit that we want to talk about health insurance.

Carissa Phipps
Health insurance, the big one, and most important one, I think.

Maureen Werrbach
I agree. Not everyone uses it, but it’s like the one that is everyone needs, you know?

Carissa Phipps
Yes. Yeah. And even. And I think even the people that don’t need it, they like knowing it’s there. Yeah. Like, because you never know if their partner is going to lose their job, or they’re like they the option there makes them feel more safe, even if they’re not using it.

Maureen Werrbach
Yeah, I mean, I am getting on my own practices, health insurance plans starting in January for the first time ever. So I’m like, well, thanks Urban Wellness for health insurance!

Carissa Phipps
Isn’t it wild those few times where you’re like, Oh, I’m using our benefits.

Maureen Werrbach
Yeah, yeah!

Carissa Phipps
It’s kind of cool.

Maureen Werrbach
Yeah. Yeah, I don’t have to use any of the other ones. I don’t have to have like, you know, use my sick time, or you know, that that stuff I don’t ever use. So is the first time like, I gotta have my executive director. I was like, I don’t know about any of our plans, like from a using standpoint, because I don’t have to use it. You know, I have a person that our broker who does questionnaires each year, unlike what–

Carissa Phipps
Most important word: broker! We’re gonna talk more about that word.

Maureen Werrbach
I’m not the only one. I always feel like I come on, I have all these…I’m so glad I’m not the only person using them. Anyways, so she sends out a questionnaire every year before November, when the new plans come out asking my staff like what, what’s most important when it comes to benefit with health insurance? Is it like, low premium, like order of importance? What are the things so that when we roll out the plans or add additional plans, they cover all of those things, like some people never use it, and would rather have a really low premium with a $80 billion deductible, others use it all the time, and they’d rather have a slightly higher premiums so that they have like no deductible. Other people want certain specialists. So there’s plans that have just like more specialists and all that. So she asked those things to get, you know, again, this goes back to what you were saying at the beginning of, you know, making sure that you’re offering things that people actually want and not just, you know, what you think is important. And again, you know, this similar case of just offering the cheapest health insurance plan that’s going to cost you the least, is not very meaningful if it’s a plan that nobody really wants to use, right? You can’t just for the sake of saying I offer health insurance, if it’s crappy health insurance, that no one wants to use, what kind of benefit is this? So, tell us about your stuff?

Carissa Phipps
Yes. So I mentioned that the first year we used Gusto, which I’m glad we did, it was made it easy for me to see, oh, this is doable. It was really easy. You know, it was easy to work with. Granted, I did not know what I was missing out on with the life of having a broker. Like I had, I didn’t know what I was missing. So a broker is like an angel sent from the heaven of benefits. And I still constantly like I don’t have to charge you know, I don’t have to pay you for this and not paying you like it blows my mind. So, so. Right. So we we shifted to a broker in November, our benefits renewed November one, and it was an amazing experience. Just having someone that can understand, like you said, your employees and your values in terms of plan options, someone that you know, is really hunting and looking around and knows about it, because, you know, we can, it’s we just know it’s its own world like it’s its own world and to have to navigate it alone is really hard and scary. So a broker takes out that mystery, they’re available all the time for you to ask any questions. And we were able to for no additional cost cut our deductible in half. We also were able to offer two plans, whereas with Gusto. I didn’t know this at the time, that once my staff and like I mentioned, I only had five, and I think two or three people enrolled the first time. Once they pick the plan, that was the only plan that we could offer the rest of the year. And it was ended up being the lowest one with the highest deductible. So then every time I’m interviewing people, I felt like I needed to like give them this disclaimer, like, I didn’t choose this plan. I wanted it to be better. Yeah. And but that was the only plan we could offer for a year was this really high deductible, lower cost plan. And so my broker assured me, I don’t know why it’s different, or why it was different, but that I could still offer these two different plan options.

Maureen Werrbach
We have five plans, as we’ve always had three, and then this year, based off of the survey feedback she’s like, there’s actually two additional plans I’d like to add to here. 5 plans holy moly. Yeah.

Carissa Phipps
That’s great. And she was so lovely. She made videos for the staff, she came to our staff meeting. I do miss it being automated, like with Gusto, like, now we have to go in and manually add in, like the deductions. And I have to we have to keep track and like tell everyone Oh, fill out your enrollment form, it’s your time, whereas Gusto would just automatically harass everyone to do that.

Maureen Werrbach
I think I have, you know, the benefits of using something that’s all inclusive comes with costs. Because yes, you know, and in this case, it might be you know, what is more important to have everything all inclusive, that takes less of your time, but maybe isn’t as robust or helpful to your team, or have something like using a broker, but then you have, you know, there’s a manual work.

Carissa Phipps
But then my view is shifting to that and focusing on the benefits allow me to grow to where I have a practice manager and I have a you know, now a clinical director, and I have ways to delegate, we have this master like onboarding checklist, we all have different roles, it’s not no longer just me, which still blows my mind doing it all. But and so when you’re when you’re investing, and those tasks can be delegated, once you’ve grown, and I think it’s because you’re investing in the benefits and being able to grow your staff. So But you’re right, that it’s such a great point about that trade off there.

Maureen Werrbach
I just want to say I had a great time chatting with you, I feel like the way you run your business, I obviously get little snippets in the Facebook group of you know, seeing that you brought on a clinical director, little things like this, but I feel like I’m in awe and really excited to see your values that you have in your business, I think is amazing. It just, there’s not that many people unfortunately, that, you know, get into the business world and, and really make that a priority. You know, I think that’s something that people start with, and then the money thing becomes this like monster that they just focus most on. And so I just want to say I am really happy that I got to chat with you because I feel like it just is nice for other people also to hear that you can have an insurance based business, you can pay your staff well, you can offer a lot of benefits. You can have a culture where you’re working to reduce burnout. And I think like you said and still be profitable.

Carissa Phipps
Yes, it it can happen. Yeah, it is possible. Yes. Most important thing. And it’s so lovely to chat with you to just thank you for this community you’ve built for all of us. And I know you get told this a million times but you know, just you are were such an integral part to so many of us getting to launch off so for you to say you’re in awe is you know, like a weird full circle amazing moment. So, so fun to chat with you. Well, it was so nice to see you. I hope you have a great rest of your day. And thank you for sharing your journey with everyone on the podcast you to see on Facebook and the summit.

Maureen Werrbach
I was gonna say with with the group practice builders the the summit I just finished the because I’ve ignored it for the past year because we just skipped you know, 20 joinery and you don’t want to do a whole virtual thing.

Carissa Phipps
I get it. I get it. Yeah, yeah.

Maureen Werrbach
Just re launched the site with all the speakers and all that for 2021. Fingers freaking crossed like 8000 times over that everything is going to be good for next July. But are you going to it?.

Carissa Phipps
Yeah! And i get to be in the seven figures one.

Maureen Werrbach
You’re in the seven figure realm?

Carissa Phipps
Yeah, we we just hit it like a month ago. We hit it. Our revenue last year was 104,000. And I did 1.2 million this year.

Maureen Werrbach
Holy shit. You guys hear this? 100 and something 1000 to 1.2 million in less than a year. That’s awesome. And I I give a lot of the credit to our benefits. I genuinely really do. Yeah. Wow. It was really nice to chat and I can’t wait to see July. I know can’t wait. Alright, happy holidays. You too.