Episode 235 | The Top 10 Mistakes That I’ve Made as a Group Practice Owner

Maureen Werrbach (00:00:01) – You’re listening to the Group Practice Exchange podcast, where the business development resource for group practice owners, where we talk candidly about business ownership and leadership. I’m your host, Maureen Werrbach. 

 

This episode is sponsored by Therapy Notes. Therapy notes is my favorite EHR, and it’s one that I’ve been using in my own group practice since 2014. They’ve got everything you need to be successful in your group practice, and they’re constantly making updates and have live support. If you want two free months of therapy notes, go to therapynotes.com/r/thegrouppracticeexchange. 

 

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Maureen Werrbach (00:01:20) – Hey everyone, welcome back to another episode of TGPE. So today we’re going to dive into the nitty gritty of group practice ownership. I’m really excited about this one. So hold onto your hats because we’re doing something a little bit different today. We’re going to take a stroll down memory lane and talk about the top mistakes that I made as a group practice owner. I know I’ve done this once before, a couple of years ago on the podcast, and so I felt like it’s time to make an update. So I’m no stranger to the challenges that come with running a group practice. And trust me, I’ve made my fair share of blunders along the way. So let’s kick things off with what I am saying is my first mistake. And that was neglecting the vision, the visionary role, a topic that I’ve explored a lot lately. It was one of my earliest mistakes. It was not giving enough attention to that big picture. I got caught up in the day to day operations, and I lost sight of the long term vision for my group practice. You know, as I say, hindsight is 2020, and looking back, I realize the importance of setting a clear vision and steering the ship in that direction. I would say it took about six years as a practice owner to allow myself to reflect more deeply, and why having a vision but not dedicating time to researching, forecasting, and spending time in the thinking space is a valuable part of bringing a vision to life.

 

Maureen Werrbach (00:02:37) – When we don’t spend time intentionally being visionary, we lose the gift of being able to see those things before they sort of hit a square between the eyes. And oftentimes it’s then too late to course correct. Or at minimum, course correction comes with a lot of pain. Mistake number two was assuming that team collaboration or workplace culture will extend to new locations. So mistake number two for me was a biggie. I overlooked the power of collaboration within my team, specifically that it would cross over seamlessly into new locations that I built. I know I’ve touched many times on the significance of creating a positive workplace environment. It’s really important to me. It was one of the main reasons why I first started hiring people, because I’ve had my own experiences with not feeling valued and important in the workplace. Unfortunately, I learned this lesson the hard way. A cohesive team is the backbone of any successful group practice, and I wished that I had prioritized fostering collaboration from the get go at each new location. Luckily, I learned this lesson quickly after building my second location, and I was able to fix my problems for all of my following locations.

 

Maureen Werrbach (00:03:52) – Each location is like a new business, and most of the things don’t translate over to additional locations vary seamlessly, especially culture. Even locations that are close to one another really need to be treated as its whole own entity, with a plan for its marketing growth and workplace culture. Mistake number three assuming that the benefits that I offered are the ones that staff value early on, the first benefit I decided to offer staff was retirement matching. Because of my own money story from my childhood, I sort of feared not having enough money at retirement and thinking like, what happens if I have to work forever? So I’ve always prioritized saving for retirement. For this reason, when I realized that I was able to offer benefits, the first thing I did was offer retirement without asking for feedback, because I assume that retirement matching was the gift that keeps on giving in the good way, meaning that even when they leave my practice, the money that I contributed as a company keeps growing for them. Little did I realize that once I offered retirement matching as the first benefit, that nobody would take it.

 

Maureen Werrbach (00:05:02) – I don’t know if it was because I had a young group of clinicians at the time, or if the economy at the time sort of put them in a position where they really needed to keep all of their money. But nobody took it. And I felt like they undervalued me as a business owner and didn’t appreciate what I was offering. Now, all these years later, I can definitely separate my thoughts from reality and know that it doesn’t necessarily mean that. But at the time it was really difficult to experience. I quickly learned that an easy antidote to this was to ask for their feedback before offering something. I know it’s simple, but I think because when I was an employee a couple of decades ago, employees really didn’t have a voice. And this is starting to change, at least in how I operate my business as a business owner. And it’s so easy to get feedback and offer benefits that are not only valuable, but also affordable to you. Mistake number four not prioritizing anti-oppression in my personal life and in the workplace.

 

Maureen Werrbach (00:05:59) – So it wasn’t until I would say around 2019 that I actively pursued working on myself, beyond reading an occasional book on anti-racism or anti-oppression, and I misguidedly assumed that if I worked on Anti-oppression that it would naturally pass down to my business because the business and I are all one, right. That obviously was wrong, because of course a business can’t be anti oppressive without its employees doing the work as well. So over the years since 2019, I’ve come to learn how much harm I’ve caused by operating a business without being a safe person to so many individuals. Since 2019, when I began to actively weave anti-oppression into every facet of my life, including how I communicate about pretty much anything at work. I learned how much more systems of oppression are just drenched in the US workforce. So once I began to actively work on myself and how I show up and begin to hold everyone on my team accountable for the same standard, so much change happened not only in my life, but in the business. From operational changes to shared power and decision making accountabilities, policy changes that take Bipoc staff, neurodivergent staff, LGBTQ staff, differently abled staff and all other marginalized groups into the forefront of consideration, the better and more vision aligned my business became also attracted the right staff to come work with me because again, at the end of the day, my business can’t be anti oppressive, which is my own core value.

 

Maureen Werrbach (00:07:36) – It can’t be anti if my team isn’t willing to do that work as well. Mistake number five is around people pleasing and a lack of boundaries. I want to say I’m a recovering people pleaser, but I think that would be a lie. I’m definitely 90% better and have learned so much about myself. That helps me not make decisions from that. People pleaser part of my brain, but for many years, a lot of decisions I made were from that people pleasing lens. I hired the wrong fit clinicians. I kept staff for much longer than I should. I promoted people who are not good for leadership, especially at my practice. I overpaid staff, which right now is still a legacy that lives on to this day. But I’ve learned to accept. I used to take every criticism way beyond the needed just consideration to debilitating overthinking, to the point of trying to give every person, every single thing they needed a bigger desk. Sure, different artwork on their walls. Okay, asking my mom to build them furniture because they know that she knows how to build furniture.

 

Maureen Werrbach (00:08:40) – Okay, fine. Fancy snacks in lieu of the ones that we had. Sure, the list goes on, but you know what happens? Nothing. Nothing happened. Staff didn’t get to a point where they stopped asking for things, and I only got more resentful of some of their requests that they had, and also had less money to invest in the real, important things in the business. Mistake number six was having no accountabilities. Now, I want to say that I’ve always had accountabilities, even though secretly I know all along that I had job expectations, but I never really held people accountable for following through. I’d just peep into rooms and have discussion after discussion about issues that certain clinicians or admin were having. Sometimes they’d get resolved, oftentimes not. I then read this book, Radical Candor, and realized the huge disservice that I was giving my team by not holding them accountable in a radically candid way. I then read traction and started my own leadership team on it. And then I created the accountability equation to change some of the things and add components that were missing from that method.

 

Maureen Werrbach (00:09:48) – Although accountabilities came with a lot of stress initially, because people are naturally resistant to change in the workplace, we can think workplace trauma and untrusting leaders that have created a culture of distrust and resentment. But once we all knew what we were accountable for and they agreed to those accountabilities, the more likely they were to actually meet them and be emphatic about it. Mistake number seven was poor ideal clinician awareness. I’ll say I rectified this one quickly as soon as I realized the problem, but it took a long time for me to see that there was a problem. I wasn’t a business school graduate. I had no previous experience on hiring before I hired my first therapist. Like so many of you. I hired so many clinicians back in the day that were not a good fit, some that luckily realized it themselves, some that stuck around for a while, did great work, but culture wise were not a fit for the vision of the business. It wasn’t until I did some visionary work and sat down to create an ideal clinician.

 

Maureen Werrbach (00:10:48) – It started off by looking at the few therapists that I had at the time that I would. I wish I could replicate. I know you know that that feels like we all, even if we are a small practice, there’s usually 1 or 2 people in the practice that we wish every new hire would be more like. So I looked at what do they have in common? I also started asking other leaders in my practice to help me in the interviewing and hiring decision making. Having multiple brains, deciding this really helped me not hire for the wrong reasons, and we held each other accountable. Mistake number eight was not striking a work and life balance before burnout. So in the summer of 2019, I burnt the fuck out like to a point that I wanted to sell all my businesses and live under a rock and never see anyone again. I went on a one month vacation to Costa Rica that summer. I ended up buying land in Costa Rica that I could build a house on, and I ended up living the most peaceful and rejuvenating month ever.

 

Maureen Werrbach (00:11:49) – I then came home and not one minute later felt burnt out, and that lasted for another four years, literally until earlier this year, almost a year ago. I was so confused as to why I was still burnt out after taking a whole month off. You guys, I didn’t answer an email. I didn’t do a minute of work and I still was burnt out. It wasn’t until the beginning of 2023 that my burnout lifted. I learned that for me, vacations don’t cure burnout. Weekly hangouts with friends don’t cure burnout. Trips and hobbies don’t cure burnout. But checking yourself. Can I notice that much of what I was doing in my business no longer came from the heart, and came more from what others wanted of me, or for financial reasons? Although my revenue grew year over year since I started my business over a decade ago. I had a whole year of minimal or no profit the first year post-Covid. Overpaying staff having no accountabilities and less productivity led to it, and it forced me to work more from the lens of generating revenue.

 

Maureen Werrbach (00:12:55) – Then, from the heart, it wasn’t until I realized that that it wasn’t about the trips, but about engaging in an intentional life, purposeful and not having a life that directed me, that things changed. I’ve since cut out the things that I don’t like doing. I’m okay with rest, like a lot more rest, and I’m on track to being able to open a business that is heart based, values based, and not revenue based. Mistake number nine was inadequate financial management. This one feels really self-explanatory at this point. If we reference mistakes three, five, six, seven, and eight, you’ll know why. Mistake number nine is inadequate financial management. And the last one, mistake ten, is not having a clear system for the coaching to termination process. So not only was this difficult for me, but it proved even more difficult once I had a leadership team in place with a handful of supervisors in charge of performance and the accountability of our team, I learned the hard way how each of them had like a different process for supporting staff when they were not meeting expectations, which led to staff getting different feedback, some of them getting pips quicker than others based on how comfortable that supervisor was, which felt unfair to me and confusing to staff.

 

Maureen Werrbach (00:14:12) – Once I created a system for when to coach, when to pip, and when to terminate, it made it not only easier for supervisors, but it was a transparent process to our whole team. All right, so there you have it. My top ten mistakes as a group practice owner. And the beauty of mistakes is that there are like lessons in disguise. Each misstep has shaped me into the business owner I am today. And I’m grateful for the growth that’s come from a lot of these experiences. You guys probably know this if you listen to other podcasts, episodes or have come to a Q&A of mine or training. I love making mistakes because I see every mistake as an opportunity for growth. And so I don’t have like the shame and anxiety and some other places of my life. I definitely don’t have it when it comes to making mistakes in my business. So as we wrap up today’s episode, just remember that running a group practice is a journey filled with twists and turns. So learn from my mistakes, but also embrace your own.

 

Maureen Werrbach (00:15:10) – After all, it’s the bumps in the road that make the ride worthwhile. I’ll see you next week. Thanks for listening. Give us five stars on whatever podcast streaming service you use and I’ll see you next week.