Making the Jump from Solo-Practitioner to Forming a Group Practice
How do you know when it’s time to make the jump to forming a group practice? Many practitioners are impeded by not knowing where to start or wondering if the administrative time and the payroll cost might outweigh the profit. We’ve seen many MHPs (mental health professionals) make that switch successfully by identifying and utilizing apps that are designed to get you there. Before we explain the combination of knowledge and technology required to make this plunge, let’s take a look at some of the factors that you might be weighing as you consider expanding from solo counseling to a group practice.
Why would you do it?
- You’re overbooked! Clients love you and even though you may not have actually fully branded yourself, whatever you are doing is working. Instead of feeling overworked and stressed, spend some time figuring out what that secret sauce is that clients love about the way you do therapy. Hire like-minded professionals you can work with who can provide the bandwidth to add more clients to your practice without you bearing the brunt of those added hours.
- You acquire the opportunity to spread out your overhead costs. There are many therapists who would love to support an existing client base and be relieved of their own need to market, brand, and the accounting and admin that comes with a solo-practice. Make sure you hire the right people because you, as the business owner, are telling your clients that you’ve personally vetted this new therapist.
- You offer or specialize in one kind of counseling. Perhaps you only treat individuals but you keep getting asked by your clients if you can do couples counseling or counseling for kids. Rather than turning them away because you know it’s not your niche, you can add a therapist with those strengths and specialties to your practice without having to refer potential patients out.
To start a group practice the first order of business is to make sure you’ve identified WHY. Is it because you have a good brand that people like and you’re overbooked? Or do you intentionally want to expand? Do you want to diversify your offerings? Do you thrive in a collaborative environment? Knowing your motivation is important and will point you in the right direction for expansion, branding, communications, and networking.
Form the Correct Type of Entity
If you have a solo-practice, hopefully you’ve already taken advantage of the tax benefit of forming an LLC (in some states a PLLC), obtaining an EIN, placing yourself on payroll, and have considered filing as an S-Corp with the IRS. A stellar small-business focused CPA can walk you through the steps and explain to you the tax benefits of filing as an S-Corp.
If you’ve found another therapist who you are going into business with, form a new multi-member LLC (again, this is a great time to consult with a knowledgeable CPA so both owners can make sure they’re minimizing personal taxes) with a new EIN. Don’t let these details overwhelm you! There are plenty of CPA’s who can help you take these steps (we as accountants know quite a few).
Tracking Everything – The Apps
As a business owner, be sure to track everything! There are many practical tools that you can use to keep your finger on the details of your practice. Do your research and choose one piece of software that will handle almost everything an MHP will need to do with clients (scheduling, insurance billing, remote sessions, electronic paperwork, accepting payments, etc). A few that we’ve worked with are ChARM (https://www.charmhealth.com/) and Simple Practice (www.simplepractice.com).
Many of these can connect with an accounting software (Quickbooks Online is our go-to) for income recording. Most also have excel reports that can be exported to do a deep dive into reviewing margins and average billing numbers. Whatever it is you pick, you do need to ensure it can provide that all-important income reporting so that an accountant can take that info and integrate it into the accounting software where all expenses live.
A great accountant can help you build out basic margins tracking based upon billable sessions and pay rates for employees. Whatever you build should be scalable so that what works for 3 people can work for 10. No need to go fancy on margins reporting, Google Sheets is usually sufficient and it can be connected to QBO as well for automatic updating of your numbers. We often rely upon our own internal data specialist to build automatic reports like this for our clients; and though it requires expertise outside of the realm of normal spreadsheeting to build, once it is built, it can be easily run and refreshed as needed. The same holds true for calculating what you can afford for overhead and owner pay once you understand your margins and standard expenses.
Hiring Employees – It’s the Group part of “Group Practice”!
Even if you already have an EIN and have been paying yourself via payroll, odds are you didn’t open up a state unemployment insurance account as business owners are exempt from these taxes (you can’t really fire yourself and legitimately claim unemployment). Most states have online applications that can be completed in 15 minutes and an unemployment account number obtained same-day or within 2 weeks. Make sure you’re also covered with workers compensation insurance (some states have state-sponsored programs, other states you will be required to purchase via private agencies). Once applied for and received, whatever your current payroll system is should be well prepared for you to add new hires into.
If you don’t already have payroll up and running, we would recommend Gusto as a great small-business friendly system that allows 100% online hiring and onboarding of employees. Gusto also has some great articles that can help to give direction on the various state payroll tax accounts you’ll need to apply for depending upon what state you are located in.
To hire good people you need to have a good employment proposition. A large portion of that is going to depend upon how you communicate what you’ll be offering in terms of compensation. There are two fairly common approaches but both are based around fees per session and how much gross profit you need to be left with to pay overhead and to pay yourself (and potentially any other owner).
- Pay a percentage of each session – In this scenario, you hire therapists and tell them their pay will be x amount of the fees they bring in during the month (say a 60/40 split or a 70/30 split). This is a guaranteed way to make sure you can always cover that employee’s salary as they’re only being paid for what they bring in. However, you want to be sure that the balance covers your own overhead such as rent, utilities and other professional fees (like accounting!).
- Pay a base wage and then create a variable compensation structure for fees brought in over that base wage – Guaranteeing you’ll cover everyone’s base salary with this method is a little more risky, but it is a more attractive employment proposition as employees see a direct correlation between more client sessions brings exponentially more pay. In this scenario and as an example you’d offer a base salary at the state minimum for professional positions at $24k. If a billable session is $100, you know they’ll need to have at minimum 20 sessions a month to cover just their salary. Any sessions in excess of those needed to cover payroll go toward paying overhead expenses. Since 20 sessions is considered to be a very low caseload, you can make the minimum 35 or 40 sessions a month and pay a portion of those revenue earnings out as additional compensation (i.e. you get 80% of the session fee for any session booked in excess of your established minimum, or even up to 90% if you book over 60 a month).
While it might seem small, additional perks are a great way to make an employment offer more desirable. Healthcare is always an option to add for full-time employees. As a small group employer you can usually pick a percentage of the monthly premium to cover and then have the rest deducted pre-tax from employee paychecks. An annual continuing education stipend is also attractive ($300 a year) along with additional pay for any time spent team-building or aligning everyone with your brand. Free supervision for those working towards full licensure is also a great addition that doesn’t take up much of your time as an owner, and also gives you an opportunity to train that person on the brand you’re building to pull more clients into the practice.
At the end of the day your practice won’t grow steadily unless you hire the right people who will support your goals and work well with your clients. Take time to interview thoroughly and have a great employment proposition that provides for increased pay and growth opportunities in the future. Above all, make sure you’re hiring people who concur with your mission, vision and values. And finally, when you research, locate, and utilize the tools that will help you minimize time spent on administrative and accounting tasks, you and your team can focus on that which is the most important element of your successful practice; your patients.