How to Scale Your Therapy Practice to 7 Figures So You Can Sell It: An interview with Nicole McCance
Curt and Katie interview Nicole McCance about her journey to selling her 7-figure group therapy practice. We look at common challenges therapists face in this process as well as ideas and methods Nicole teaches to help others scale their practice more easily. Nicole shares systems, hiring, and leadership strategies. We also look at some important considerations when planning to sell your practice.
Click here to scroll to the podcast transcript.Transcript
An Interview with Nicole McCance
Nicole is a Psychologist (retired) turned Business Coach for therapists scaling to a group practice. She expanded her private practice to 55 therapists and multiple 7 figures in 3 years (with toddler twins at home). Nicole sold her clinic in the 4th year and then retired as a Psychologist in her 5th year. She now teaches therapists how to help more people, make more money and have more freedom following her proven method. The McCance Method: mccancemethod.com.
In this podcast episode, we talk with Nicole McCance about scaling your practice
Nicole McCance scaled her practice and then sold it. We dug into her systems and thought processes in creating a sellable group practice.
What do therapists typically get wrong when growing their group practices?
- New group practice owners often don’t have their systems written down
- Unreasonable expectations of the difficulty in hiring clinicians
- Not knowing which path to take regarding marketing and other group practice decisions
What is Nicole McCance’s model for growing a group practice?
- Systemize your operations
- Build your dream team (with your first hire being your mini me)
- Attract clients with digital marketing
- Converting clients using free consults
- Retain clients with follow ups
“[On how to move one of my clients to another therapist in my group practice:] When I said ‘I, with your consent, I will bring the new clinician up to speed and give them your file.’ There was something about not having to start over that had them say yes…’I’m going to oversee everything, but let’s touch base in three months and make sure your treatment is going well.’” – Nicole McCance
What are important steps to get your practice ready to sell?
- Your branding must not be your name
- You will need to be able to sell your clinicians and move clients into their caseloads
- You need to move into the role of CEO and not get stuck in the clinician role
- Take the time you need to make that transition
What should therapists consider when deciding whether to scale their practice to a group?
“If you’re not going to be a good boss, don’t be one. But sadly, the bad bosses don’t know they’re bad bosses….If you don’t like change, don’t do it. Because growth is change…If you’re not…okay with a bit of chaos, this may not be for you, because as you’re building there’s a lot of moving parts. Some people thrive in that, and some people are like, Oh my gosh, that sounds awful.” – Nicole McCance
- If you’re feeling isolated, find a community
- There are a lot of steps, systems, and processes that you’ll need to develop (or purchase from someone else)
- If you don’t like change or don’t do well with pressure, don’t go into group practice
- You will need to have the ability to read the market to guide hires and growth
- Focus on excellence and service needs, not growth for growth’s sake
- Build a culture that supports your clinicians and helps decrease clinician turnover
- Figuring out how to pay your clinicians may be more complex than you realize
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Nicole McCance’s website: mccancemethod.com
Nicole’s podcast The Business Savvy Therapist
Nicole’s Free Masterclass: How To Build A 7-Figure Group Practice
Culture Code by Daniel Coyle
Relevant Episodes of MTSG Podcast:
Becoming a Group Practice Owner, An Interview with Maureen Werrback, LCPC
Seeking Purpose Beyond Accomplishment: An Interview with Kasey Compton
Don’t Take Tax Advice from Therapists: An interview with Julie Herres
Making Every Therapy Practice Profitable: An Interview with Julie Herres
Don’t Forget to Pay Yourself and Other Money Planning Strategies: An interview with Carla Titus
What Is It Like To Be a Medicare Therapist? An interview with Gabrielle Juliano-Villani, LCSW
Building Your Treatment Team in Private Practice: Essential Networking Skills for Therapists
Therapy for Executives and Emerging Leaders
Smarter than SMART: How therapists can improve goal-setting with clients
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that we do in our practices, the things that we do in our profession. And over the years, we have had a lot of discussions about scaling up your practice, and some of that is advice that I have put into my own practice. Some of it is stuff that I’m still doing. And one of the great things about having a podcast is that sometimes we just invite friends along who are really just guised as, Hey, what should we be doing with our practices? We are very glad to be joined by Nicole McCance today. She’s a retired psychologist and business coach and talks about scaling up your practices. And I know I have questions as my practice continues to expand, but hopefully this is something that applies to everybody who’s looking at going just beyond that solo work. So thank you very much for joining us.
Nicole McCance 1:07
Yeah, excited to be here.
Katie Vernoy 1:08
We’re glad to have you, and we’re excited for this conversation. The first question that we ask everyone is, who are you and what are you putting out into the world?
Nicole McCance 1:17
Oh, I love that question. For about 15 years I was in solo practice, and truly loved what I did, EMDR and couples, and felt in my soul that I would do it until the day I die, and that I was put on this earth to do this work. And I don’t know if you resonate like we’re so lucky, aren’t we, to make a good living and help people. And then one day, 2016 I became pregnant with twins, and I remember thinking, Oh, gosh. Like, this is amazing, but I live in Toronto, we need a bigger house. Like, what am I going to do? I’m already seeing all the clients, and I’m hitting a ceiling in my income. I cannot see more clients. I will burn out. And then I had the next thought, Wait, maybe I’ll hire. But here’s the thing, there was no coach doing it, so I didn’t do anything for two years. Fast forward, Jackson and Lucas are at home waiting for mommy every single night at 7pm and I’m so guilty and so exhausted, and this is not the motherhood that I chose. So, it was that catalyst that I was able to grow my group practice in three years to 55 therapists. And the thing I’m most excited about is that it was automated. I told my husband, I’m going to do this, but I want to be home, so I want it to run without me. And then guess what happened? If you have a revenue generating machine, somebody wants to buy it. And a psychiatrist approached me and said, I will take better care of your team. I will give them pensions. I will give them trainings that you can afford because I’m a conglomerate and you aren’t. And at first I said no, because this was my team. But then I said, Wait a minute, when does this happen in life? So I decided to exit and sell for multiple seven figures, and then the piece of the puzzle, and then, who am I? I’m not a therapist anymore. I don’t own a clinic anymore. And that’s when I said, Wait, what if I take it to my peers, what if I give them every single step that I took that got me to rapid success, and I’ve dedicated my life to that now. I do one specific program that is six months and it is booming because it’s a huge gap in our market for this.
Curt Widhalm 3:16
We start a lot of our episodes asking about what are some of the mistakes that we see people making, as if other people have already made them, we can avoid them as well. So when people are looking to move from that solo practitioner taking on some employees, what are some of the things that you see people usually run into.
Nicole McCance 3:33
The very first thing is they underestimate how hard it is to hire. They’re like, Oh, how hard is it? I’ll just throw a post up on Indeed, I’ll just be a boss. And then it’s not so the biggest thing is, is that it’s not systemized. Everything is in my head, and now this new person has 100 questions, and I’ve become the chief question answer, not the chief like CEO. I’m now at CQA, and it’s overwhelming. So, I tell people, let the first step be, take everything out of your head, like the little things: How to deal with the insurance? How to what is your cancelation policy? You know, how many buttons do I click to book? Put it into a Google Drive so they go there and not to you. Way less overwhelming.
Katie Vernoy 4:18
So, it sounds like you’re a systems gal, which I love. I am as well. So, I’m excited to dig into this. What were the first systems that you realized you needed that you didn’t have once you started getting actual clinicians? So not just like, Hey, how do I do my practice? What are my policies? Those kind of things. But there’s other systems which you actually are an employer.
Nicole McCance 4:37
100% yeah. I think that the very first thing towards freedom, because I help people work a little bit less so they can be with their kids, or whatever they choose, was an admin checklist. So I actually had what to do to open the clinic. We had 24 rooms, 7000 square foot office, and I wanted to not be there, so I literally had, first you open the door. Then you turn the salt lamp on, then you turn the Alexa on, then you turn the lights on, then you open the storage. Like, literally, right? They just, they just got really good at it, and didn’t have to lean on me. Number one, number two is actually an onboarding process. And what’s beautiful about that is one, everybody is treated the same. It’s standardized. They’re trained the same, and now it’s apples to apples, because you’re like, Well, I know, at least I train them the same, so if they’re not performing the same, at least it wasn’t you, or at least it wasn’t your training.
Curt Widhalm 5:29
For me, I have recognized that as my team has expanded. I’m not anywhere close to 55 my team’s at like, 10 right now. But as we have expanded, I’ve recognized more that when I do hire somebody, it’s okay, here’s what your first week is really going to look like, and it’s going to get into the fold, and it’s going to be here’s how to log in, and here’s where the keys are, and here’s how you fit yourself into the schedule. So it is something that I looked at it from, just kind of from the employee perspective, is how many questions am I going to have, and how many answers can be just provided before those questions even get asked?
Nicole McCance 6:09
Yes, and they tend to be the same questions again and again, which is beautiful, which is why we have a really great FAQ. And now with AI, my goodness, like we can have a manual that is actually a vent. Need to get smarter and smarter. Our manual will be talking to us soon, guys.
Katie Vernoy 6:26
How do you use AI to create your manual?
Nicole McCance 6:28
Well, okay, I’m just learning AI, like we’re just new friends, but there’s something called GPT. I mean, this is a whole podcast episode, but anyway, there’s ChatGPT. Obviously, we all know that, but there’s a GPT, have you heard of this, where you can create your own GPT and put all of your knowledge in this GPT. So you have your own chat GPT for your group. So rather than a manual where you control F, you put the question no different than chat GPT, and it spits out, this is how you do you know, this is the exact way that we bill. Yeah.
Katie Vernoy 6:31
I love that. So it’s basically an app, kind of.
Nicole McCance 7:08
Yeah, but it’s just in ChatGPT, yeah.
Katie Vernoy 7:10
That’s perfect. I love that. So, so you did this out of necessity, right? Or, I guess, necessity, but also your values. You wanted to be home with your twins. You wanted to do that. But you were kind of creating it as you were going along. You didn’t have a guide. What was that process like for you, and how have you refined it as you’ve continued forward and then helping others to scale?
Nicole McCance 7:34
Great question. I kind of felt and Curt, I’m gonna ask you, because you’re I didn’t know it’s with another group practice owner. Growing with no business coach, I did get one in my second year, which was the year I hit seven figures, which I’ll talk about. I felt like I was walking in a dark, dark woods. And there were all these paths, like you can do SEO, you can do Google ads, you can do this. But I didn’t know which one, so I’d start doing one, and I’d fumble and trip, and then I’d be like, No, I guess I’ll do this. I felt completely lost and confused. Do you feel that at all? As a group practice owner?
Curt Widhalm 8:04
I’ve been fortunate enough to be surrounded by some really good other friends who are also group practice owners. So a lot of times I just end up having, like, group text messages with these people, and it just kind of Hey, how have you ever done that? And fortunately, we’ve all been really supportive of each other. So I don’t know that everybody is necessarily walking into those same kinds of friendships over and over again, and I would imagine, without the support of them, that I would be in that very dark part of the forest that you’re describing here.
Nicole McCance 8:33
Yeah. And so because of that, finally, I did find a coach. She was not a therapist, which was the hard part, because we’re so regulated, there’s so much we cannot do, and most people don’t know that. Yeah, that was the key to me, though. For me, is I found about four coaches, and I took all of the knowledge in the general industry and I applied it to ours.
Katie Vernoy 8:53
So you had to do a lot of extrapolation. What is it…
Nicole McCance 8:57
A whole lot. But I…
Katie Vernoy 8:58
…big differences?
Nicole McCance 8:59
I’m an ideas person, so I actually loved creating it all. The major differences is what we can’t do. We can’t take testimonials in Ontario, and it’s very similar to California, highly, highly regulated. I would say California is the most regulated, next to New York.
Katie Vernoy 9:14
But we can do testimonials now. We actually help to fix the ethics code. So.
Nicole McCance 9:19
In in all, I don’t know if that’s in all states…
Katie Vernoy 9:21
No, just California.
Nicole McCance 9:22
Okay, oh, wow, that is amazing. I need to, okay, we’ve got a lawyer on like, in my program, we have lawyer HR account with all those people, so I need to look into that. But we can’t message people in the DMs. Like, there’s a bunch of stuff we can’t do. So I put together a program where first I help them systemize, then I help them hire, then I help with, like, what marketing actually works. Which is, and I can get into my five step scaling method, because there’s, like, there’s a way that you want to do it, and in a certain order, just like you wouldn’t go to the dentist and they would pull your teeth out before the anesthesia.
Curt Widhalm 9:58
Let’s take these steps and then maybe Katie and I can also talk about, I’m sure that there are plenty of other differences between the Canadian mental health scape and the American mental health scape, and see where our questions are as as Yankees on this.
Nicole McCance 10:15
Actually, yeah. So not really 70% I have 200 people in my program right now, 70% are American, yeah. So I run two coaching groups, and all the experts are American, but we’re fully so I can answer that, now it’s easy. We’re fully private pay, so the insurance companies don’t run our lives. Thank God. It’s very like everything’s out of network here, so they pay out of pocket, yeah, and then get reimbursed after.
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Katie Vernoy 10:39
So talk us through the steps. What are the things that you’ve found work again and again for folks to scale their private practices?
Nicole McCance 10:47
Yeah. Step one we’ve mentioned is to systemize your operations. Please do that first, or you might hate your life. It feels really overwhelming when you have this person who has all the questions. After that, number two is build your dream team. This is where you begin to feel the freedom, where you’re like, Oh, wow. And I actually suggest your first hire be your mini me, because I made the mistake of hiring somebody that was my opposite. But people expected an experience like me. I’m high energy, I’m quite direct in my therapy, or I was. And so that’s where you build your dream team, and I have a six step process, because you want to get that right. And then number three, this is the fun part, is attract this is where you attract clients. And I’m a big fan of digital marketing. Why? Because it works while you sleep. There’s, you know, there’s, I can get into that more. I’ll just walk through all four quickly. Four is converting clients using free consults. I think that people want to talk to, they want a sample, you know, of the therapist before they book. And then number four, or sorry, number five, which a lot of people are not doing, is retain clients with follow ups. So, if they know show they’re depressed, they they might reschedule in three weeks because time flies. But if you just reach out to them, they’ll probably book. And then you help more people, and then you go.
Curt Widhalm 12:11
So, it sounds like part of this is at first having a really good identity for yourself and really kind of knowing who you are, so that way you can find that mini me that ends up being there. And I’ve seen a lot of people who are starting to hire that first other clinician who might be somebody that they just get really, get along really, but with, or kind of trying to maybe branch out their practice, as you’re describing, of somebody that, oh, you’re providing services that I don’t. So one of the things that I ran into in my practice was my practice was named after me to start with, and it was a great idea, and it was great branding for me. And then when I hired new people, and people called in and they said, but we want to work with Curt. And so helping to move the the group identity from just kind of you as the solo practitioner, as you start hiring employees, what do you suggest for people to help elevate some of the clinicians that they bring on, whether it be the first person or the 56th person? That kind of helps to reinforce that Yeah, this experience is coming from all of us, not just from me as the figurehead.
Nicole McCance 13:20
Yeah, yeah. My I think a lot of us have our practice is our name same, exact same. So I start from the that’s the tough part when you start a group. Or at least when I work with people, we actually have them change the brand and remove themselves, because if I would have kept my practice in my name, I wouldn’t have sold. They told me that very clearly, because I’m not there, right? So it was called the Toronto Neurofeedback and Psychotherapy Center, and they bought it. So if you ever want to sell, just do the branding. And I would do it early, but that’s such a good question, because it’s so common, how do you, quote, unquote, sell your fabulous clinicians? You know that they’re great, but everybody thinks you’re better. Supervising really helped. I would supervise them, and I would share that they’re trained by me. You don’t, you’re not going to see me, but you’re going to feel that I’m there. You’re going to feel like, there’s two clinicians working on your case, because I’m reading the notes, I talk about your case every single week, and guess what? She has a better rate and better hours and a lot of that, they were like, Oh, wow. And would you like a free consult? And once they if you can get them on the console and they feel the warmth and feel the competence they usually book.
Katie Vernoy 14:31
I’m so glad that Curt asked this question, because I think I want to ask another one for him. How do you mentally and emotionally let go of having clients for yourself?
Nicole McCance 14:43
Forever? Or just like letting them go?
Katie Vernoy 14:45
Letting them go, they want to see you, you’ve now sold them on this other person. But there’s, I think, and I’m giving Curt a hard time. A lot of…
Curt Widhalm 14:53
What Katie is trying to describe is that as my team has grown, I still love the clients and the client work that I do. And I face the challenging balance out of I know that I should be spending more of my time managing, supervising, doing the things that are the boss, sorts of things. But I also love seeing my clients, and I love seeing the people that I’ve been working with for years. And there’s also a little bit of the scary, what if my income drops? Because my rate is a lot higher than many of the people who work for me. So…
Nicole McCance 15:30
Yeah.
Curt Widhalm 15:31
…that’s the question that Katie’s asking is, how do you get Curt to stop being so much like Curt?
Nicole McCance 15:36
Yeah, you know what it is, Curt, it’s not just you. It is really hard, especially like these people, you’ve known exactly for years. Couple of things. One, doing it really slow, giving them lots of notice. I gave them a year, and some of them were like, no, not happening. I’m like, I’m going to be slowing down. They’re like, No, you’re not. They were just like, refusing the breakup. What made the difference? This was really key. When I said, I with your consent, I will bring the new clinician up to speed and give them your file. There was something about not having to start over that had them say yes. But what helped me was I did a follow up three months later, Curt. And I don’t know if that would help you. I knew, you know what, why don’t we, I’m going to let you move over. I’m going to oversee everything, but let’s touch base in three months and make sure your treatments going well. As a boss, that was actually great, because I got the inside scoop of how it really was, because then I saw the person for another it was a full session, and I had to do that with a few people three times. So it was like, you know, a letting go. A year of letting go.
Katie Vernoy 16:43
How do you not take new clients when they want to see you?
Nicole McCance 16:46
I think that the little selling script that I just shared, we just moved them over. So that was easy, because I was doing all the training. But what was really key I was with you, Curt, I was seeing clients because I wanted my business to feed itself. I took the money invested in Google ads, right? And then I took my own clients, and they paid for my lifestyle. Now I’ve got these twins, like I I did see clients for oh gosh, like, at least the first year, year and a half, something like that. But then this beautiful thing happens, is profit. And so when there was enough profit that I was like, Oh, now, now I basically, as the profit increased, I decreased my client load. That’s how it went. Oh, I can fill my bank with this money coming in from the business now, coming in from the group practice, and slowly knock one client down, and then another one, and slowly reducing them. So it’s the answer is, it’s gradual, right. And then it doesn’t feel scary.
Curt Widhalm 17:44
So, Katie, my my 10 year plan is to start introducing this to my clients now, and…
Katie Vernoy 17:52
His 10 year plan, oh, that’s the best. So switching gears. I wanted to talk a little bit about making the decision to scale to a to a group practice. Because I’ve chosen again and again not to and so I’m really curious about the thought process of deciding this is how I’m going to increase my income. Because to me, it sounds like just a crap ton of work.
Nicole McCance 18:16
Oh, that’s so interesting. What part? Because to me, it felt like less work because there was no ceiling now, my income. I didn’t only make money when I was sitting in front of somebody.
Katie Vernoy 18:26
Sure, I think for me, it was I’ve been an employer before, and it’s a lot of work, and there’s so many personalities and making sure you hire the right person, setting yourself up as an employer, making sure that you’re paying folks, having to make sure that you have marketing available and clients available for them, so that they’re not coming in and not making enough money and leaving. I mean, there’s just so many difficulties that I see, you know, and I’ve talked to a lot of group practice owners about this, there’s just so many difficulties and so much responsibility that it feels a lot more stressful than just raising my fee and seeing fewer clients as an individual practitioner.
Nicole McCance 19:01
Yeah. And I think that some it’s like, a I’m, like, built to be, I’m a builder. I love innovating, like, I can’t, not, you know what I mean? Like, I could sit on my hands, yeah. So I think that I would say the people in my program, they it’s just like in you, or it isn’t in some ways, but that’s why I have a system. Because you are right. The pressure is real. The pressure is real, like the buck stops with who, with you. You’re the owner. Which, and partly that’s why I wanted to create something where I will give you my I actually give them my manuals, my marketing plans, my contracts, everything, the onboarding, the checklist, because I want to make their life easier. I think that’s the hardest part, too, is oh my gosh, and I have to put all the processes together and not doing it alone. I was lonely. I didn’t have a community, and that was hard. My poor husband, I would bring things to him, and he’s like, doing a great job. He didn’t really know what to say.
Curt Widhalm 19:57
What are some of the signs that somebody isn’t ready to take this step? I know there’s a lot of people who kind of get into building their practice. They are looking at lifestyle changes. They’re looking at income sorts of things, wanting to make passive income kinds of things. But what are some of the things that you’ve seen from people who are maybe on the fence and should stay on the fence, or should maybe take a step back?
Nicole McCance 20:23
Yeah, I think that I was going to say, if you’re not going to be a good boss, don’t be one. But sadly, the bad bosses don’t know they’re bad bosses. Yeah, I think if you don’t, I love change, if you don’t like change, don’t do it. Because growth is change, and everything is new, and it can feel like a lot. I’m kind of biased, because I love this stuff. So, you know, when you love something so much you’re like, everybody should do it. But I think that if you don’t like change, and you don’t deal well, well with pressure, and if, if you are, do you guys know the Kolbe, Kolbe assessment? No? K-O-L-B-E?
Katie Vernoy 21:01
I’ve heard of it, but tell us a little bit about it for our listeners who haven’t.
Nicole McCance 21:03
It’s so good. So it’s basically a strength assessment, but it tells you how you get things done, how you naturally work. And I’m a quick start. So I love spontaneity. I love not, I love uncertainty. And so if you’re not a Quick Start where you you are okay with a bit of chaos. This may not be for you. Because as you’re building there’s a lot of moving parts. Some people thrive in that, and some people are like, Oh my gosh, that sounds awful.
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Curt Widhalm 21:31
I’m guessing that you didn’t go from your first clinician to your 55th clinician as you were growing your practice out. How do you continue to make those changes, or make those desired kind of continue to grow? Or is there a place where you were ever just like, oh, this is just good enough, and I can just stop here?
Nicole McCance 21:54
50 was good enough. 50 is a lot. And you know what? I did not go into this thinking, I want to build something big. It’s interesting. Do you ever have that in your life where it just evolves, like something another thing opens and before you know it? I literally felt like it was happening to me, that it was meant to be, that it was like pulling me with it, which is such a beautiful thing. To answer your question. I listened to the market. Your next hire should not be a guess. It should be what your inquiries are asking. Do you have a child therapist? And we’re hearing a lot of that, that’s my next hire. Do you have a couples therapist, family therapist? We also did neurofeedback, brain spotting, EMDR. We did autism assessments, all the things, we ended up because we were so big. But I was listening and I was tracking, and then I was informed on my next business decision in terms of hiring.
Katie Vernoy 22:42
So for yourself, it sounds like you wanted to create something to help get you more time at home. And yet, I’m also hearing that there were certain, I guess, forces that was that were pulling you along and getting you to a place where, I mean 55 clinicians, seven figures, all of that stuff. I mean, it feels like that becomes really huge and becomes its own goal. So, I’m just curious about your thought process around having it get so big and and what mindset changes you needed to have along the way, going from one clinician to 10 to 20 to 50, right? Like, what are the what are the things that shifted as you got bigger and bigger?
Nicole McCance 23:23
I think that be, I became obsessed with excellence, and I’m a bit like that in my business coaching program; really listening to the market, really knowing branding, really wanting to help people, and then you grow. Do you know what I mean? Rather than being obsessed with growth, I was like, very doing my research, like, really, like neurofeedback. A lot of clinics aren’t doing that, but I know it helps with ADHD. We did a brain ADHD brain training program. So I think it was more of like a way of being than a thought process where this attention to excellence and what was needed, and then this snowball effect happened. And I love marketing. It’s actually social psychology. I love social psychology. That’s why I love couples. And so it’s like, how do we get people to actually activate them? Like, how do we what is marketing? It’s activating somebody to take an action. That’s all it is. And so how do we activate them to take an action, to actually help themselves? Because nobody, we avoid pain all day long. You know, secretly, nobody wants therapy because it can feel painful. And so all of that was my obsession. And then as a result, I grew.
Curt Widhalm 24:38
One of the concerns that I hear from people when they’re talking about growing their practice is, what is it about trusting people and hiring them on; what if I make bad hiring decisions? What if these are people who are going to ruin my practice put me liable for bad things that they potentially do? As much as we would love to say that every clinician out there is the best intentioned person in the world and is going to do no harm. What if I get the one bad one who’s out there and they totally ruin everything? So how do you improve your hiring practices to get the best people? How do you ensure your managing is done in a way that helps to minimize some of that risk and helps you to sleep at night.
Nicole McCance 25:24
Yeah, you will hire the wrong person. You will. It’s just a matter of time if you grow that much. And when I say the wrong okay, so you said ruins everything, I that is, it won’t happen. The sky actually won’t fall. It won’t implode, like I had probably about five people leave, even though I had a really good process to keep the clients in house ethically, they can choose, of course, we give them all the things. And I will say, though, as a silver lining here, most people wanted to stay because they just loved coming. Do you know what I mean? They’re like, Oh no, we this is the place that we come and you’ve got another person, so let me talk to that person. But I did make mistakes, and I hired the wrong people, for sure, because I, unfortunately, I hired people if I liked them in the interview. And so I teach people don’t do that. I have a whole six step process. Like I believe you should be giving them the Kolbe, a personality test, a working interview, a screening process, an interview, there’s six steps, my friend, the references, all the things, and they still, people aren’t honest in interviews. They still might not be the right fit, but I’ll tell you this. I remember vividly one particular person full time left, and I remember thinking, I felt I don’t know if you’ve ever felt this as a group practice owner Curt: betrayed. Like, oh my gosh, I really try so hard. Like, how could you leave me? Really I thought that. And I will say I was also nervous about the income, because I’m like, Oh no, you know, that’s a big deal, but it didn’t make a difference. Please hear that, my friends listening. It, I don’t know how or why. I think it was, you know, we were bringing in the right people for marketing. But in the end, I didn’t implode, and you don’t often the people will leave. It’s it’s there, typically, there’s about a 20% retention rate in most jobs, by the way, or, sorry, attrition, attrition, yeah, so you can expect 20% to leave and you’ll still be okay.
Katie Vernoy 27:20
I know that some of the things that are going on in the larger marketplace, some clinicians who are in group practice are joining, you know, like the the online therapy companies and and there’s also those folks are competing with group, large group practices. Some of them are gaining purchase. There’s there’s a lot of stuff that I think group practice owners, especially when they’re first starting out, there’s a lot of challenges that they face, you know, in addition to the 20% turnover or attrition rate. What are the things that you’re saying as you’re working with group practice owners? What are the big challenges they’re facing, and what suggestions do you have for them to create a sustainable business in this changing marketplace?
Nicole McCance 28:04
I think that what sets is going to set you apart from the tech company, you know, all these other conglomerates, is that they this community and culture. Now we hear about culture all the time. People always want to know, like, what do I do for culture? Do I do a games night? Do I take them out for dinner? Do we have this, all this extra things? But here’s the thing, there’s an amazing book called The Culture Code. I don’t know if you know it.
Katie Vernoy 28:30
Yep.
Nicole McCance 28:30
So good by Daniel Coyle. Read that book, and the number one thing is that they feel connected and psychological safety, that they really know that you care. I teach people how to do 90 to every 90 days, do a check in, and I actually give them a questionnaire. How happy are you rate me as a boss, zero to 10. Please. Rate me. Rate the admin. Maybe there’s stuff in the front desk, you have no idea, and they’re dying to tell you, like, I rate the admin a three, and that’s a combo. But more than that, know their goals, know their personal goals, not just their career goals, and if you can help them reach their goal within your larger group practice, why would they ever leave?
Curt Widhalm 28:30
That sounds like stuff that I try to do, and I am always impressed when other people have had my ideas before me, and it backs things up. I hear a lot from people who are interviewing just about living in a high cost of living area. My practice is in Los Angeles. I know Toronto is very much another high cost of living area, especially for early career clinicians and trying to be able to support them. How do you handle a lot of the conversations around the realities of getting paid. It sounds like you, you said that your practice is all, was all private pay. Not all of the practices around America are, many of them are insurance based. So how do you handle kind of supporting people into getting into kind of that professional level of things when it does really come around being able to afford existing as a early career mental health professional.
Nicole McCance 30:07
Yeah, we give them, I’m not sure if you’ve tried this, but you can ask for more money through insurance. Good luck to you. But it does work some of the time, like, there’s a way to do it, and we get, I found out the way, like, what to say and so, and actually it takes multiple times sometimes, that’s fine, just be persistent. And I really help people do private pay. We have a little mantra, private pay is the way, that’s our little mantra. But the only thing about that is there’s marketing dollars you need to invest in order to make that happen. As opposed to insurance, they’re coming your way for a lot less, right? So, I find a lot of people though, it’s like knowing what to do to bring in more private pay. It’s because, literally, what is it like, 30% more, or even more than that…
Katie Vernoy 30:50
Or 50 or 100% more.
Nicole McCance 30:52
Oh my gosh, and then way less admin. It’s like, I love the 80/20 rule, the Pareto principle, that you’re literally saying, like, what is actually profitable here? Okay, can I release the the low paying ones at the very least? Can I release the that insurance and really focus on maybe, you know, these clients, they pay faster, less admin, less headache. So I would trim the fat there. Can you let go of the least paying at the very least, and then can you focus more on private pay and do the marketing networks, digital marketing, Google ads, SEO, things like that.
Katie Vernoy 31:27
What would you say is an ideal setup for how you compensate your clinicians and the types of benefits that you’re able to to provide at different levels of scaling your practice?
Nicole McCance 31:38
If you’re doing 1099 contractors, you don’t want to pay them more than 60% if they’re fully licensed, and 50% if they’re pre licensed. If there’s an employees, you’re basically just this is where it gets a bit complicated for my therapy brain. But you’re doing the same thing, except factoring in payroll costs, benefits, all of that. And that can be I would give yourself 15% so now you’re looking at paying this person 45, do you see that? Because you’re keeping the rest to cover all the extra things.
Katie Vernoy 32:10
Sure.
Curt Widhalm 32:11
Where can people find out more about you and all of the wonderful things that you’re doing?
Nicole McCance 32:16
Well, if you love podcasts, I also have one. It’s called The Business Savvy Therapist. I would love to see you there. I also have twice a week a free master class called How to Build a Seven Figure Group Practice. If you want to learn, I’d love to see you.
Curt Widhalm 32:32
And we will include links to those in our show notes over at mtsgpodcast.com. Follow us on our social media, join our Facebook group, the Modern Therapist Group to continue on with these conversations, and until next time, I’m Curt Widhalm with Katie Vernoy and Nicole McCance.
… 32:46
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