October 16, 2025 • 22 mins
What happens when therapists abandon group practices en masse? This phenomenon is sweeping across the mental health field, leaving practice owners scrambling to understand why their associates are heading for the exits. At the heart of this exodus lie several critical issues that, once recognized, can be addressed to create thriving, ethical practices where clinicians want to stay.
The financial relationship between practices and clinicians represents the most significant source of dissatisfaction. Fee splits of 50/50 or 60/40 aren't inherently problematic, but the lack of transparency about where that money goes creates resentment. When clinicians generate thousands in revenue but don't understand how their contribution supports the business infrastructure, they question the value of remaining with the practice. Similarly, practices that pass insurance clawbacks to clinicians or make them wait for payment until insurance reimburses claims create financial instability that drives talented therapists away.
Beyond compensation issues, many practices make promises they can't keep. The most damaging is guaranteeing full caseloads to new hires without having the marketing infrastructure or client base to deliver. Therapists who join a practice expecting consistent work find themselves with empty schedules and insufficient income, forcing them to seek opportunities elsewhere. Successful practice owners understand that growth should be organic—adding clinicians only when current therapists are at capacity and there's genuine client demand.
The power dynamics become even more complex when practice owners also serve as clinical supervisors. This dual role requires careful navigation to maintain boundaries and ensure associates feel supported in both their professional development and financial wellbeing. Practice owners must recognize this inherent power imbalance and take extra steps to create safe spaces where supervisees can voice concerns without fear of retaliation.
Building an ethical group practice isn't mysterious—it requires patience, strategic planning, and a commitment to fair treatment of clinicians. Seek guidance from business resources, learn from adjacent industries, and prioritize creating a workplace where therapists feel valued and fairly compensated. The return on this investment will be staff retention, positive word-of-mouth, and ultimately, a thriving practice that makes a meaningful difference in your community.
Ready to transform your group practice? Subscribe for more insights on building an ethical, sustainable therapy business that benefits both clients and clinicians alike.
Get your step by step guide to private practice. Because you are too important to lose to not knowing the rules, going broke, burning out, and giving up. #counselorsdontquit.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 00 (00:00):
Hey, I'm Dr.
Kate Walker.
Welcome to another episode.
Yes, I'm wearing the same shirtbecause we're recording two
episodes back to back.
And this one is about whypeople are leaving group
practices.
It's a thing we monitor theinternet everywhere.
No, not everywhere, but we'reseeing this a lot.
(00:21):
We're seeing from one end,group practice owners are having
folks leave and they can't hireanybody else on.
There's, you know, everybody'sgoing to, you know, this is them
talking, not me.
They're going to Hedway,they're going to Alma, they're
going to whatever all the thingsare.
But then we also hear the otherside of folks saying, hey,
look, this is why I'm leavinggroup practices.
(00:44):
In fact, I had a I looked at athread a couple of weeks ago,
and someone, it was very, very,very well written.
This is exactly why I left mygroup practice.
I've seen group practices uhfail, and um it's just, you
know, we have a shortage in thiscountry.
(01:06):
And the whole mission behindKate Walker training is we want
to keep you in business.
You're too important to lose tosomething like you didn't know
how to do business and all youremployees left you.
So that's what we're focusingon today.
We'll hit supervision a littlebit, but we just finished three
episodes about toxicsupervision, supervisors in dual
(01:27):
role of boss and supervisor,and then associates, how to
speak up to your supervisor.
Uh, but we may still hit alittle bit on, you know, if
you're a supervisor and you owna group practice and your
associates are leaving you.
So, Jennifer, I'm gonna startwith you.
What are the things out therethat we're seeing about why
people are leaving grouppractices?
Speaker 01 (01:49):
Um, one of the biggest ones I see is the fee
splitting.
What does your pay look like?
Um, you know, I I saw a postthe other day, and they were
offering um associates jobs andthey were gonna pay $30 a
session in a group practice.
(02:09):
And and it was just, should Itake this job?
And just no, that's no, that'syou know, when are we gonna
speak up?
But but the biggest one isthese splits, these 50-50,
60-40, 70-30, and and what isthat money going to?
Where where's the transparency?
Okay, you took 40% of mysession rate.
(02:30):
Okay.
Um, but I had 50 sessions, andif it was $40, let's say we had
$100, you know, now we're in thethousands.
What what did that thousands ofdollars go to that month?
Speaker 00 (02:45):
But yeah, and and business owners, you may own the
building and you or you may beleasing the building and you're
on the hook for lease money anduh the overhead, you know, that
to run that business.
Well, have a meeting with yourstaff and explain, you know,
okay, our air conditioner brokelast month, or uh, we got to get
(03:06):
a new copy machine.
But again, how much of that areyou passing along to your
employees or 1099 contractors?
We're gonna kind of use thoseterms interchangeably today.
And how much is it changing?
So are you doing 40% thismonth, and then next month
you're saying, hey, the airconditioner broke, I got to take
(03:28):
50%.
Your contract, your policy, andprocedures should rule when it
comes to payment.
Um, but that's not all.
Um, Jennifer, you want to hitthe whole, you know more about
insurance than I do.
I mean, how can like a clawbackaffect employees?
Speaker 01 (03:47):
Well, some, you know, clawbacks are fun.
Insurance companies want tosay, yes, yes, do your therapy,
but you didn't say some magicalkey phrase in your notes, so
therefore we don't have to payfor that.
And so a lot of people arerunning into this clawback
scenario.
(04:07):
And I've heard some instanceswhere group practice owners are
passing those clawbacks on totheir clinicians and and making
the clinicians, you know, repaythat money.
Somebody's got to repay themoney.
You've got to decide whoseresponsibility is that.
Speaker 00 (04:25):
And if that employee is a 1099 contractor, I mean,
can a business even do that?
Can they pass along a liabilitylike that?
I mean, that's I'm no attorney,we're not attorneys, but I'm
thinking, okay, if I'm trying tothink of a situation where if I
hire someone to come and paintmy house, you know, and they're
(04:48):
in the middle of a job and Isay, Oh, I've got to pay you
less because uh a tree fell onmy car and I don't have any, I
mean, the the painter would say,hey, no, no, this is what we
agreed to.
This is my price.
I'm an independent contractor.
So it's definitely, I'm gonnago back to the transparency in a
(05:08):
second, but the clawback is ahuge issue.
And if you're listening to thisand you're an employee in a
group practice, I woulddefinitely go look at your
contract and say, okay, how willclawbacks be handled?
You may have agreed tosomething you wish you hadn't
agreed to.
Um, but let's get down to theminutiae of insurance.
Um, so pay pay can change,right?
(05:32):
I mean, Jennifer, if a paymentor does it stay the same?
Like if an insurance companycontracts with me to provide
services at $80 an hour, does itstay $80 an hour?
Speaker 01 (05:44):
From what I understand, yeah, it doesn't
change.
But in Clawbacks, it reminds melike, if I if I buy $400 worth
of merchandise at Target and allof it breaks, and I take that
$400 worth of merchandise backto Target and say, this is
broken, I can't use it, and theygive me a refund.
They don't go to all theircashiers and say, hey, I'm gonna
(06:05):
need you to give me this moneyback because they brought in a
refund and we can't cover that.
So it's coming out of your paynext week.
All of you gonna spread it outequally.
You know, it's kind of it's isthat not part of being a
business owner, taking on thoseliabilities?
Speaker 00 (06:23):
I like that example so much better.
And that's true.
I mean, any business is goingto have some sort of equity,
some sort of fun, so thatthey're able to do the things
they need to do to stay inbusiness.
So if you're getting apaycheck, so I'm talking to you,
employee in a group practice.
Can you look at your pay stuband see, okay, these are the
(06:46):
five services I delivered onMonday?
Okay, I had one no-show, so Igot paid for these four, and uh
this was this insurance, thatinsurance, this insurance.
So, Jennifer, if everyinsurance pays at a rate that's
decided upon, I should be ableto look at my pay stub and see
every service I delivered, howmuch paid, and then my split,
(07:10):
right?
Speaker 01 (07:11):
I that's that's what I would um encourage to use as
best practices.
I know that doesn't alwayshappen.
And I've even heard instanceswhere um a lot of group
practices will withhold uh an aclinician's pay until insurance
pays out.
And they'll say, hey, insurancehasn't paid out on your the
(07:32):
first 10 sessions from themonth.
We'll pay them when we getthem.
You know, and if and if that'swhat you're doing as a practice
owner, you're waiting on thatinsurance reimbursement to even
pay your employee.
I don't know that you're gonnaretain that employee because
they're coming to you lookingfor consistent pay.
(07:52):
And if every month I'm like,oh, I made $5,000.
Oh, insurance was behind, so Imade $1,000.
Nobody, nobody can live likethat.
That's not sustainable.
Speaker 00 (08:02):
And let's be let's be fair, okay, especially small
communities, new businessowners.
I mean, if you're hiringeverybody in your practice as a
1099, you know, conceivably youcould do that, right?
I'm I'm only gonna pay you whenI get paid.
And you could have it in yourcontract.
Okay, I get that, and I'mtotally on board with that.
(08:22):
Um, but in a situation whereyou haven't informed the people
that you're hiring that you'renot gonna pay them till you get
paid, or they're used to aregular paycheck, but then oh my
gosh, we had something happen acouple of years ago where I
know insurance something blew upand people were getting paid
and they couldn't pay theiremployees.
And so I'm not saying this isgood or bad because business
(08:46):
owners, you can only do what youcan do, and especially if you
take insurance, I mean you'rekind of handcuffed.
But the the topic of thisepisode is why people are
leaving group practices.
And I'm always gonna comparethis to if you're a physician
working in a big practice.
You know, a physician is gonnaget paid, and the the volume and
(09:09):
the amount of money that willbe in the the kitty, for lack of
a better term, is going to bewhat helps that physician
continue to make what they'regonna get paid, uh, they're
gonna make.
So I know that didn't makesense, but if there's a
clawback, you can bet thatphysician is not gonna feel
that.
The business is going to absorbthat from the funds, from the
(09:33):
capital that they have set asideto handle rainy days, right?
You've heard of a rainy dayfund.
Well, that's what that is.
And so many times businessowners they don't set aside a
rainy day fund, or and this isreal, your rainy day fund runs
out.
And we're coming from Texas.
Texas is number 50.
(09:53):
I get it.
Nobody's getting paid.
And so this goes back toanother episode where I talked
about this.
Business owners don't addpractitioners until you just
can't handle the volume anymore.
I have people who will say,Well, you know, there's this
great LPC and I want to hirethem.
(10:14):
Uh, I told them I could getthem the clients, and so I
promised them that we're gonnado the marketing and we're gonna
get, and I'm thinking tomyself, why are you hiring
somebody if you can't get themclients?
Yeah.
Like where there should be awaiting list.
Okay, uh, Jennifer, you weregonna talk about that.
Speaker 01 (10:27):
So I'll No, you're good.
No, that that's a huge one.
Um I'll g I'll give a greatexample.
There was a company that wasexpanding an IOP.
They're expanding to newstates, they're taking on new
contracts.
Well, they expanded to threenew states.
Went through, hey, we're gonnaget contracts.
(10:48):
They um hired uh two 1099therapists in each of these
states, right?
Because we're gonna take onthese clients.
Um, and then three months wentby, and they one therapist had
two clients, and I think therest of them might have had one.
Well, the therapists ended upghosting the practice.
They just because it wasn't itwasn't feasible for them.
(11:11):
You know, they were guaranteedwe're going to market and then
no marketing was done.
And they guaranteed we're gonnafill your caseload and and no
caseload was filled.
And how long can you expectsomebody to hang around waiting
for you to fulfill promises?
I mean, it's not a marriage.
We all know in marriage peopledo that all the time.
This isn't a marriage, and Ican go down the street or I can
(11:32):
hang a shingle out of my owndoor.
So if you if you cannot makepromises and then not deliver
and then scratch your head andwonder why these people left,
you have to have a clear,transparent plan in place going
into it.
Not just, I'm gonna feel it.
How?
Tell them how you're gonna feelit.
(11:52):
Marketing's a full-time job,isn't it?
Speaker 00 (11:55):
Oh so if you're a business owner, I mean, I want
you to think in terms of like,you know, Shark Tank, right?
If you've got a startup andyou're like, okay, I want my
startup fully fully staffed, allright.
Well, get an angel investor andpay everybody while they're
(12:16):
waiting for their client load topop, right?
And I hope right now you went,Angel Investor, what's that,
right?
That just doesn't happen in thecounseling world.
Or please don't don't do that.
Don't get a loan to do that.
The flip is start your businessand as it grows, because it
will, because you're awesome,and the world needs you, and
(12:36):
your community is going to growto rely on you.
As it grows, then hire peopleto plug in the hours and your
wait list of clients becauseyou're doing such an amazing
job.
We just see so many people,they they want a full staff, a
beautiful web page with all thepeople and all the specialties
(12:57):
first.
And I know for me, Jennifer'snot kidding.
Marketing is a full-time job.
I am on every day just tryingto stay ahead of trends.
Don't even get me started on AIand SEO.
You guys know you can go backand listen to the episode.
So you're a business owner andyou're probably trying to see
clients too.
(13:17):
So just remember what youpromise, if you can't fulfill
that, nobody's gonna stickaround.
And feelings get hurt.
I mean, uh, we that's this iswhen a lot of complaints happen.
Um, you know, I the the moneything, you know.
So what have we talked about?
We've talked about transparencywith money and then
(13:39):
transparency with what youpromise.
And all of that can go into acontract.
But business owners, if you getin a bind, if you turn to your
employees, just like Jenniferwas saying, target looking at
their cashiers and going, heyguys, can you guys give up 10
bucks an hour?
Because we're feeling it.
(14:00):
That's not fair.
And the the power hierarchywhen it comes to supervisors, I
mean, we've had cases where youknow that we've that we've done
consultation and and also, ofcourse, on the on the internet,
where we've got the boss who'salso the supervisor, and then in
(14:23):
some cases holds the visa forthe person who's working for
them who's working to get theircitizenship.
I mean, think about that levelof power if you then as a
business owner look at youremployee and say, Hey, you're
gonna have to hold off on yourpaycheck for a couple of weeks.
(14:44):
I mean, how's that gonna affectthe supervision relationship,
the employee relationship?
And what do you think is gonnahappen when that person's able
to finally leave your practice?
Speaker 01 (14:55):
It's like an abusive relationship.
It really is.
I mean, yeah, and I thinkthat's that's when you know the
sign of a truly good supervisoris when they are aware.
And I don't mean just, oh, I'maware and of its existence.
When they truly understand thepower imbalance that that exists
(15:18):
and they they maintainmindfulness, not just at the
beginning, not just three monthsout of the year, but every day
they take that intoconsideration.
And if you have made it towhere your associate has no
recourse to even bring a concernto you, then then I'm kind of
(15:40):
at a loss for words.
Yeah.
Speaker 00 (15:42):
And when we teach the 40-hour training to become a
supervisor in Texas for LPC,LMFD, and social work, that is
one of the things we really,really try to pound is if you
are going to be a businessowner, first of all, bless you.
You're a special breed, we wantto support you.
And if you want to be abusiness owner and a supervisor,
here are the 10 extra steps youneed to take so that you can
(16:07):
preserve that relationship.
So there's still openness andhonesty, and everybody feels
good at the end.
And you're still colleagues,right?
You're still gonna be friendsafter the thing's over, after
the hours are fulfilled.
Speaker 01 (16:21):
Well, and that the I'll I'll just add one more
thing on that.
If you are trying to build andscale a thriving group practice,
and you're also trying to buildand scale a thriving
supervisory practice, um thereis no better marketing than an
associate that went through withyou and is out there saying, I
(16:44):
had the best supervisor ever.
I was I was paid well, I wastaken care of, I was supported.
If I had an issue, I could cometo that person.
You'll stay full.
You'll have associates knockingdown your door, but I guarantee
you, if you don't take care ofyour associate, they're gonna
tell everybody with a set ofears how awful you were.
Absolutely.
(17:05):
That's a great way to just makesure you either have a bunch or
you have none.
Absolutely.
Speaker 00 (17:12):
So pay, and and remember, I'm not saying pay
well.
I mean, granted, please don'tpay your qualified people, you
know, $30 an hour.
So pay competitively, payconsistently, pay transparently,
and don't try to pass on yourproblems to your employees or
(17:35):
your 1099 contractors.
And if you are going to take itto the next level and be a
group practice, do it the way,do it the right way.
Start with the volume you haveand what you can market.
And as your practice grows,then you can grow.
And then start to shower thoseemployees with good things,
(17:57):
offer them benefits, make themW-2, help them save for
retirement.
Don't be another thing in theirlife that they have to worry
about.
I mean, you've been on jobswhere you have to worry about
your boss.
Don't be that boss.
Be the boss that's going togrow ethically and in a way that
(18:18):
helps your employees do thebest work.
Um, and the resources outthere, right?
I mean, there's the smallbusiness development, uh, which
is practically in every town,the chambers of commerce.
Um, you can get free businesshelp besides this podcast, which
I'm so glad you're here.
But there's so many places youcan get free business help.
(18:39):
Um, I told Jennifer one of thethings I was going to make sure
I mentioned, you know, when Iwas coming up in business, one
of the things I love to do wasto take people out for coffee
and pick their brain who weren'tcounselors, but owned
businesses.
So, you know, hair salon owner,uh, massage owner, like a
massage envy, right?
(19:01):
It's the same model.
You've got people, they'reeither delivering services or
they just got no-showed, orthey're filling out paperwork
and not delivering services, orthey're maybe at the front desk.
How do you do that thatbusiness?
I mean, it can't be a mystery.
We're not the only ones doingit.
So ask questions.
(19:21):
Ask how other people are doingit.
And you won't be able to do itexactly because we have a
medical model, so it's going tobe a little bit different.
But man, there are tons ofsimilarities.
You don't have to reinvent thewheel.
Speaker 01 (19:35):
No, and you haven't done one in a while, I don't
think, but you have tons ofreally great podcasts on how to
scale a group practice, how toscale private practice, all of
those things um you've beentalking about for years.
So there's podcasts on how toscale appropriately and
ethically and at the right time.
Speaker 00 (19:55):
So hey, we'll probably link to those in our
show notes and in the blog.
So go down there, see whatwe'll link to, go there.
Um, and I have some amazingcolleagues here in Texas that
are running group practicesethically, profitably.
They are assets to theircommunities.
I they do advocacy work.
(20:17):
They're just amazing humanbeings.
I'm honored to know them.
And so I will work really hardto get them to be guests on the
podcast, and we will pick theirbrains so that you, amazing
business owner who wants to growyour practice and improve your
community, can do the things youneed to do and not worry about
(20:37):
are you?
I don't want to say, let mejust say making your employees
mad or worry that you don't havethe ethical business practices
in place.
Because I know you want to do agood job.
Um, anything you want to add tothat, Jennifer?
No, that was great.
That's it.
(20:58):
That's it for today.
Thanks for listening, watching,and we'll see ya.
Hey, I'm Dr.
Kate Walker.
Welcome to another episode.
Yes, I'm wearing the same shirtbecause we're recording two
episodes back to back.
And this one is about whypeople are leaving group
practices.
It's a thing we monitor theinternet everywhere.
No, not everywhere, but we'reseeing this a lot.
(00:21):
We're seeing from one end,group practice owners are having
folks leave and they can't hireanybody else on.
There's, you know, everybody'sgoing to, you know, this is them
talking, not me.
They're going to Hedway,they're going to Alma, they're
going to whatever all the thingsare.
But then we also hear the otherside of folks saying, hey,
look, this is why I'm leavinggroup practices.
(00:44):
In fact, I had a I looked at athread a couple of weeks ago,
and someone, it was very, very,very well written.
This is exactly why I left mygroup practice.
I've seen group practices uhfail, and um it's just, you
know, we have a shortage in thiscountry.
(01:06):
And the whole mission behindKate Walker training is we want
to keep you in business.
You're too important to lose tosomething like you didn't know
how to do business and all youremployees left you.
So that's what we're focusingon today.
We'll hit supervision a littlebit, but we just finished three
episodes about toxicsupervision, supervisors in dual
(01:27):
role of boss and supervisor,and then associates, how to
speak up to your supervisor.
Uh, but we may still hit alittle bit on, you know, if
you're a supervisor and you owna group practice and your
associates are leaving you.
So, Jennifer, I'm gonna startwith you.
What are the things out therethat we're seeing about why
people are leaving grouppractices?
Speaker 01 (01:49):
Um, one of the biggest ones I see is the fee
splitting.
What does your pay look like?
Um, you know, I I saw a postthe other day, and they were
offering um associates jobs andthey were gonna pay $30 a
session in a group practice.
(02:09):
And and it was just, should Itake this job?
And just no, that's no, that'syou know, when are we gonna
speak up?
But but the biggest one isthese splits, these 50-50,
60-40, 70-30, and and what isthat money going to?
Where where's the transparency?
Okay, you took 40% of mysession rate.
(02:30):
Okay.
Um, but I had 50 sessions, andif it was $40, let's say we had
$100, you know, now we're in thethousands.
What what did that thousands ofdollars go to that month?
Speaker 00 (02:45):
But yeah, and and business owners, you may own the
building and you or you may beleasing the building and you're
on the hook for lease money anduh the overhead, you know, that
to run that business.
Well, have a meeting with yourstaff and explain, you know,
okay, our air conditioner brokelast month, or uh, we got to get
(03:06):
a new copy machine.
But again, how much of that areyou passing along to your
employees or 1099 contractors?
We're gonna kind of use thoseterms interchangeably today.
And how much is it changing?
So are you doing 40% thismonth, and then next month
you're saying, hey, the airconditioner broke, I got to take
(03:28):
50%.
Your contract, your policy, andprocedures should rule when it
comes to payment.
Um, but that's not all.
Um, Jennifer, you want to hitthe whole, you know more about
insurance than I do.
I mean, how can like a clawbackaffect employees?
Speaker 01 (03:47):
Well, some, you know, clawbacks are fun.
Insurance companies want tosay, yes, yes, do your therapy,
but you didn't say some magicalkey phrase in your notes, so
therefore we don't have to payfor that.
And so a lot of people arerunning into this clawback
scenario.
(04:07):
And I've heard some instanceswhere group practice owners are
passing those clawbacks on totheir clinicians and and making
the clinicians, you know, repaythat money.
Somebody's got to repay themoney.
You've got to decide whoseresponsibility is that.
Speaker 00 (04:25):
And if that employee is a 1099 contractor, I mean,
can a business even do that?
Can they pass along a liabilitylike that?
I mean, that's I'm no attorney,we're not attorneys, but I'm
thinking, okay, if I'm trying tothink of a situation where if I
hire someone to come and paintmy house, you know, and they're
(04:48):
in the middle of a job and Isay, Oh, I've got to pay you
less because uh a tree fell onmy car and I don't have any, I
mean, the the painter would say,hey, no, no, this is what we
agreed to.
This is my price.
I'm an independent contractor.
So it's definitely, I'm gonnago back to the transparency in a
(05:08):
second, but the clawback is ahuge issue.
And if you're listening to thisand you're an employee in a
group practice, I woulddefinitely go look at your
contract and say, okay, how willclawbacks be handled?
You may have agreed tosomething you wish you hadn't
agreed to.
Um, but let's get down to theminutiae of insurance.
Um, so pay pay can change,right?
(05:32):
I mean, Jennifer, if a paymentor does it stay the same?
Like if an insurance companycontracts with me to provide
services at $80 an hour, does itstay $80 an hour?
Speaker 01 (05:44):
From what I understand, yeah, it doesn't
change.
But in Clawbacks, it reminds melike, if I if I buy $400 worth
of merchandise at Target and allof it breaks, and I take that
$400 worth of merchandise backto Target and say, this is
broken, I can't use it, and theygive me a refund.
They don't go to all theircashiers and say, hey, I'm gonna
(06:05):
need you to give me this moneyback because they brought in a
refund and we can't cover that.
So it's coming out of your paynext week.
All of you gonna spread it outequally.
You know, it's kind of it's isthat not part of being a
business owner, taking on thoseliabilities?
Speaker 00 (06:23):
I like that example so much better.
And that's true.
I mean, any business is goingto have some sort of equity,
some sort of fun, so thatthey're able to do the things
they need to do to stay inbusiness.
So if you're getting apaycheck, so I'm talking to you,
employee in a group practice.
Can you look at your pay stuband see, okay, these are the
(06:46):
five services I delivered onMonday?
Okay, I had one no-show, so Igot paid for these four, and uh
this was this insurance, thatinsurance, this insurance.
So, Jennifer, if everyinsurance pays at a rate that's
decided upon, I should be ableto look at my pay stub and see
every service I delivered, howmuch paid, and then my split,
(07:10):
right?
Speaker 01 (07:11):
I that's that's what I would um encourage to use as
best practices.
I know that doesn't alwayshappen.
And I've even heard instanceswhere um a lot of group
practices will withhold uh an aclinician's pay until insurance
pays out.
And they'll say, hey, insurancehasn't paid out on your the
(07:32):
first 10 sessions from themonth.
We'll pay them when we getthem.
You know, and if and if that'swhat you're doing as a practice
owner, you're waiting on thatinsurance reimbursement to even
pay your employee.
I don't know that you're gonnaretain that employee because
they're coming to you lookingfor consistent pay.
(07:52):
And if every month I'm like,oh, I made $5,000.
Oh, insurance was behind, so Imade $1,000.
Nobody, nobody can live likethat.
That's not sustainable.
Speaker 00 (08:02):
And let's be let's be fair, okay, especially small
communities, new businessowners.
I mean, if you're hiringeverybody in your practice as a
1099, you know, conceivably youcould do that, right?
I'm I'm only gonna pay you whenI get paid.
And you could have it in yourcontract.
Okay, I get that, and I'mtotally on board with that.
(08:22):
Um, but in a situation whereyou haven't informed the people
that you're hiring that you'renot gonna pay them till you get
paid, or they're used to aregular paycheck, but then oh my
gosh, we had something happen acouple of years ago where I
know insurance something blew upand people were getting paid
and they couldn't pay theiremployees.
And so I'm not saying this isgood or bad because business
(08:46):
owners, you can only do what youcan do, and especially if you
take insurance, I mean you'rekind of handcuffed.
But the the topic of thisepisode is why people are
leaving group practices.
And I'm always gonna comparethis to if you're a physician
working in a big practice.
You know, a physician is gonnaget paid, and the the volume and
(09:09):
the amount of money that willbe in the the kitty, for lack of
a better term, is going to bewhat helps that physician
continue to make what they'regonna get paid, uh, they're
gonna make.
So I know that didn't makesense, but if there's a
clawback, you can bet thatphysician is not gonna feel
that.
The business is going to absorbthat from the funds, from the
(09:33):
capital that they have set asideto handle rainy days, right?
You've heard of a rainy dayfund.
Well, that's what that is.
And so many times businessowners they don't set aside a
rainy day fund, or and this isreal, your rainy day fund runs
out.
And we're coming from Texas.
Texas is number 50.
(09:53):
I get it.
Nobody's getting paid.
And so this goes back toanother episode where I talked
about this.
Business owners don't addpractitioners until you just
can't handle the volume anymore.
I have people who will say,Well, you know, there's this
great LPC and I want to hirethem.
(10:14):
Uh, I told them I could getthem the clients, and so I
promised them that we're gonnado the marketing and we're gonna
get, and I'm thinking tomyself, why are you hiring
somebody if you can't get themclients?
Yeah.
Like where there should be awaiting list.
Okay, uh, Jennifer, you weregonna talk about that.
Speaker 01 (10:27):
So I'll No, you're good.
No, that that's a huge one.
Um I'll g I'll give a greatexample.
There was a company that wasexpanding an IOP.
They're expanding to newstates, they're taking on new
contracts.
Well, they expanded to threenew states.
Went through, hey, we're gonnaget contracts.
(10:48):
They um hired uh two 1099therapists in each of these
states, right?
Because we're gonna take onthese clients.
Um, and then three months wentby, and they one therapist had
two clients, and I think therest of them might have had one.
Well, the therapists ended upghosting the practice.
They just because it wasn't itwasn't feasible for them.
(11:11):
You know, they were guaranteedwe're going to market and then
no marketing was done.
And they guaranteed we're gonnafill your caseload and and no
caseload was filled.
And how long can you expectsomebody to hang around waiting
for you to fulfill promises?
I mean, it's not a marriage.
We all know in marriage peopledo that all the time.
This isn't a marriage, and Ican go down the street or I can
(11:32):
hang a shingle out of my owndoor.
So if you if you cannot makepromises and then not deliver
and then scratch your head andwonder why these people left,
you have to have a clear,transparent plan in place going
into it.
Not just, I'm gonna feel it.
How?
Tell them how you're gonna feelit.
(11:52):
Marketing's a full-time job,isn't it?
Speaker 00 (11:55):
Oh so if you're a business owner, I mean, I want
you to think in terms of like,you know, Shark Tank, right?
If you've got a startup andyou're like, okay, I want my
startup fully fully staffed, allright.
Well, get an angel investor andpay everybody while they're
(12:16):
waiting for their client load topop, right?
And I hope right now you went,Angel Investor, what's that,
right?
That just doesn't happen in thecounseling world.
Or please don't don't do that.
Don't get a loan to do that.
The flip is start your businessand as it grows, because it
will, because you're awesome,and the world needs you, and
(12:36):
your community is going to growto rely on you.
As it grows, then hire peopleto plug in the hours and your
wait list of clients becauseyou're doing such an amazing
job.
We just see so many people,they they want a full staff, a
beautiful web page with all thepeople and all the specialties
(12:57):
first.
And I know for me, Jennifer'snot kidding.
Marketing is a full-time job.
I am on every day just tryingto stay ahead of trends.
Don't even get me started on AIand SEO.
You guys know you can go backand listen to the episode.
So you're a business owner andyou're probably trying to see
clients too.
(13:17):
So just remember what youpromise, if you can't fulfill
that, nobody's gonna stickaround.
And feelings get hurt.
I mean, uh, we that's this iswhen a lot of complaints happen.
Um, you know, I the the moneything, you know.
So what have we talked about?
We've talked about transparencywith money and then
(13:39):
transparency with what youpromise.
And all of that can go into acontract.
But business owners, if you getin a bind, if you turn to your
employees, just like Jenniferwas saying, target looking at
their cashiers and going, heyguys, can you guys give up 10
bucks an hour?
Because we're feeling it.
(14:00):
That's not fair.
And the the power hierarchywhen it comes to supervisors, I
mean, we've had cases where youknow that we've that we've done
consultation and and also, ofcourse, on the on the internet,
where we've got the boss who'salso the supervisor, and then in
(14:23):
some cases holds the visa forthe person who's working for
them who's working to get theircitizenship.
I mean, think about that levelof power if you then as a
business owner look at youremployee and say, Hey, you're
gonna have to hold off on yourpaycheck for a couple of weeks.
(14:44):
I mean, how's that gonna affectthe supervision relationship,
the employee relationship?
And what do you think is gonnahappen when that person's able
to finally leave your practice?
Speaker 01 (14:55):
It's like an abusive relationship.
It really is.
I mean, yeah, and I thinkthat's that's when you know the
sign of a truly good supervisoris when they are aware.
And I don't mean just, oh, I'maware and of its existence.
When they truly understand thepower imbalance that that exists
(15:18):
and they they maintainmindfulness, not just at the
beginning, not just three monthsout of the year, but every day
they take that intoconsideration.
And if you have made it towhere your associate has no
recourse to even bring a concernto you, then then I'm kind of
(15:40):
at a loss for words.
Yeah.
Speaker 00 (15:42):
And when we teach the 40-hour training to become a
supervisor in Texas for LPC,LMFD, and social work, that is
one of the things we really,really try to pound is if you
are going to be a businessowner, first of all, bless you.
You're a special breed, we wantto support you.
And if you want to be abusiness owner and a supervisor,
here are the 10 extra steps youneed to take so that you can
(16:07):
preserve that relationship.
So there's still openness andhonesty, and everybody feels
good at the end.
And you're still colleagues,right?
You're still gonna be friendsafter the thing's over, after
the hours are fulfilled.
Speaker 01 (16:21):
Well, and that the I'll I'll just add one more
thing on that.
If you are trying to build andscale a thriving group practice,
and you're also trying to buildand scale a thriving
supervisory practice, um thereis no better marketing than an
associate that went through withyou and is out there saying, I
(16:44):
had the best supervisor ever.
I was I was paid well, I wastaken care of, I was supported.
If I had an issue, I could cometo that person.
You'll stay full.
You'll have associates knockingdown your door, but I guarantee
you, if you don't take care ofyour associate, they're gonna
tell everybody with a set ofears how awful you were.
Absolutely.
(17:05):
That's a great way to just makesure you either have a bunch or
you have none.
Absolutely.
Speaker 00 (17:12):
So pay, and and remember, I'm not saying pay
well.
I mean, granted, please don'tpay your qualified people, you
know, $30 an hour.
So pay competitively, payconsistently, pay transparently,
and don't try to pass on yourproblems to your employees or
(17:35):
your 1099 contractors.
And if you are going to take itto the next level and be a
group practice, do it the way,do it the right way.
Start with the volume you haveand what you can market.
And as your practice grows,then you can grow.
And then start to shower thoseemployees with good things,
(17:57):
offer them benefits, make themW-2, help them save for
retirement.
Don't be another thing in theirlife that they have to worry
about.
I mean, you've been on jobswhere you have to worry about
your boss.
Don't be that boss.
Be the boss that's going togrow ethically and in a way that
(18:18):
helps your employees do thebest work.
Um, and the resources outthere, right?
I mean, there's the smallbusiness development, uh, which
is practically in every town,the chambers of commerce.
Um, you can get free businesshelp besides this podcast, which
I'm so glad you're here.
But there's so many places youcan get free business help.
(18:39):
Um, I told Jennifer one of thethings I was going to make sure
I mentioned, you know, when Iwas coming up in business, one
of the things I love to do wasto take people out for coffee
and pick their brain who weren'tcounselors, but owned
businesses.
So, you know, hair salon owner,uh, massage owner, like a
massage envy, right?
(19:01):
It's the same model.
You've got people, they'reeither delivering services or
they just got no-showed, orthey're filling out paperwork
and not delivering services, orthey're maybe at the front desk.
How do you do that thatbusiness?
I mean, it can't be a mystery.
We're not the only ones doingit.
So ask questions.
(19:21):
Ask how other people are doingit.
And you won't be able to do itexactly because we have a
medical model, so it's going tobe a little bit different.
But man, there are tons ofsimilarities.
You don't have to reinvent thewheel.
Speaker 01 (19:35):
No, and you haven't done one in a while, I don't
think, but you have tons ofreally great podcasts on how to
scale a group practice, how toscale private practice, all of
those things um you've beentalking about for years.
So there's podcasts on how toscale appropriately and
ethically and at the right time.
Speaker 00 (19:55):
So hey, we'll probably link to those in our
show notes and in the blog.
So go down there, see whatwe'll link to, go there.
Um, and I have some amazingcolleagues here in Texas that
are running group practicesethically, profitably.
They are assets to theircommunities.
I they do advocacy work.
(20:17):
They're just amazing humanbeings.
I'm honored to know them.
And so I will work really hardto get them to be guests on the
podcast, and we will pick theirbrains so that you, amazing
business owner who wants to growyour practice and improve your
community, can do the things youneed to do and not worry about
(20:37):
are you?
I don't want to say, let mejust say making your employees
mad or worry that you don't havethe ethical business practices
in place.
Because I know you want to do agood job.
Um, anything you want to add tothat, Jennifer?
No, that was great.
That's it.
(20:58):
That's it for today.
Thanks for listening, watching,and we'll see ya.
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