Things I learned after starting a group practice
I had no clue what I was doing when I started my group practice. In some ways, my naiveté could have been what crumbled my business, but I think it’s one of the reasons why I was able to even start a group. If I had thought about it too much, I probably would have shaken my head and said, “No thanks, I’ll never be able to do this right and succeed.” Instead, I steered straight away and laser focused on hiring someone to fill the days I wasn’t in my office. I mean, how hard can it be???….
Well, first thing, DON’T just hire someone as an independent contractor because it seems easier. That’s what I did. Independent Contractors may work for your practice, but making the assumption from the start can become a costly mistake. When I first started my group practice five years ago, there weren’t Facebook groups or coaches out there (that I could find) that could help you process these decisions. So, I did what any flying-by-the-seat-of-her-pants type of person would do, and hired someone as an independent contractor. I would soon find out I was treating them like an employee, and have to make the switch to employee status a year later.
The second thing I learned is that the systems I had in place when I was solo, and I say systems very loosely here, many of them did not work for my group practice. When you are solo, you can often “wing it” and make policies as situations happen. You can decide not to enforce them either, because who’s going to tell you otherwise? For example, most of us have a no show/late cancel policy. But how many of you, when solo, would waive 50% of them (or more!)? This would create a mess in a group practice if everyone is doing their own thing, or asking you each time what they should do. Another example: taking payments at the time of session. When you are a solo practitioner, you can let one client pay whenever, another at the time of service, and yet another accrues a huge balance. When you start to hire clinicians, this will cause confusion and resentment between you and your staff, because not only will your practice be losing money, your clinicians are looking to you for guidance and they want to get paid (whether or not they hold themselves accountable to taking money). That leads me to my next lesson.
Don’t assume your clinicians will hold themselves accountable for doing all parts of their job. You may hold yourself accountable, but you are a business owner and that’s probably part of the reason why you are successful as a business owner. You WILL have to put a policy in place for doing notes in a timely fashion. You WILL have to have a policy about uploading documents into the EHR, getting authorizations before the time is up, and any other little thing from taking payments to actually checking that clients sign their intake paperwork completely. You’ll also have to check notes (if they are employees) because you’ll find that many clinicians could use some guidance on making good treatment plans.
You will spend a lot more time than you expect answering questions, emails, fixing electronics, delegating, and fixing issues. It never ceases to amaze me at how much time I spend on seemingly small things. Things that I expect will take me no time at all. Things that I assume others can handle on their own. Case in point: just this week, I have spent the better part of 10 hours trying to fix my printer. After buying another new one, spending 10+ hours “troubleshooting” with the printer company, I am now spending $150 for Geek Squad to just do it. Then TherapyNotes went down. No one knew their schedules. My receptionist could barely schedule new appointment. My biller could not balance our books. All eyes on me. This leads me to my last lesson.
Everything is on you. I mean, I knew that going into it. I didn’t expect anything different. But it was a hard lesson to learn some years back that I. AM. LITERALLY. IN. CHARGE. I have to make all the decisions on behalf of the business and all the employees within it. I can’t just cover my ears and close my eyes and say, “La la la!! I can’t hear you!” and hope the problem goes away. Same goes for you. At times, you will wish that your staff could make some of these decisions on their own. And sometimes they should-which requires retraining. But many times, this feeling will stem from a deeper issue of needing to tighten up ship (i.e. your policies and procedures). When many questions get asked, it’s likely because there’s a gap in your policies or an issue with training.
Despite the many lessons I learned, it’s helped me grow personally and professionally. I wouldn’t trade it for any other position in the world. What lessons are you learning?
Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here: LEARN MORE HERE
