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Private Practice Startup Podcast
Episode 163: When to Grow, Hold or Pump the Breaks!
00:31:32
Kasey Compton
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Welcome to the Private Practice Startup podcast.
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Where we help ambitious private practitioners across the globe to brand themselves and grow their dream practices. We chat with successful private practitioners, business coaches and marketing experts bringing you tons of practice building Ninja tips. Visit privatepracticestartup.com for awesome resources, attorney approved private practice paperwork and our signature marketing E course. Here are your co hosts, Dr. Kate Campbell and Katie Lemieux. Hey there startup Ninj. Hi, I'm Nation. Welcome back to another episode of the Private Practice Startup podcast. We are going to be talking with Casey Compton today on when to grow, hold and pump the brakes. Obviously talking all about your private practice. Just a little bit about Casey. Casey has a multi specialty group practice. She's an owner in Kentucky. She has over 80 employees, six locations in 17 counties and growing. That's amazing. Casey's dubbed the systems and processes girl and loves anything to do with innovation and strategy. Just had a baby five weeks ago and she couldn't stay away from business. So we're super glad to have her here with us and you. But before we get started, we hope you guys joined us last week as we spoke with Eric Red and Shawna Roberts. Eric is the co founder of Atto Network. And what they do is they help people scale into a group practice or really build the group practice. They're kind of like that magical unicorn that every therapist dreams of that someone else is just going to take care of all of the business stuff. So you can do what you love. If you're brand new here where you say welcome to the family and we have a gift for you. That is our A to Z cheat sheet. The essentials for building and growing your dream practice. Head over to private practices startup.com. look for the resources tab in there. You'll see it. That will include not only the A to Z cheat sheet, but also five days of practice building emails to help you on your private practice journey. So welcome.
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A
Casey. Hi. You are so good at this. Wow.
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Thank you.
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Because it's so funny. Because it's like I got to make sure I say all these things and I still get a little nervous. I have to tell my body to relax and then, you know. But thank you. I appreciate that. And it's been. Well, we've been doing this now for three years.
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C
Yeah. This is episode 163. So you'd hope that we'd have it a little systemized and down at this point.
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A
Right, Right. Yeah. You worked all the kinks out by now.
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C
Yes.
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And especially after creating our marketing E course. And Kate Edited all of it herself. She really reminded me that I say so too much. So I also listen for those too interesting enoughs.
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And the you knows, awesome would be.
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B
The awesome as the transition.
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Well, I'm guilty of that too. And I was bringing my five year old home from preschool yesterday and she was telling me a story and she was like, so? And she kept saying it. I was like, oh my gosh, she's getting that from me because I do it too. So I'm guilty.
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B
Funny, I'm really curious. And I almost just said it. So I was like, don't say so, but I'm really curious. Like, did you set out to have this massive practice?
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Like, no, no. You know, to be honest, I don't really know what I set out to do. I just set out. I knew I wanted to own a business and I knew I loved therapy. And I just, I just knew whatever I did, I wanted it to be very controlled and very structured and just, you know, like natural feeling. So it wasn't really like I set out and said, hey, I want to have a hundred employees or anything like that. It's just kind of as we built our infrastructure and everything started growing, it just happened so naturally. I can say that now in the moment, it did not feel natural, I'm sure. But now looking back, it definitely wasn't a plan.
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C
Tell us a little bit about your journey from where you started and then growing to the point that you have.
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A
Yeah, so I finished my master's program and then decided I knew going in, straight into that program, that I wanted to own a practice. And so as soon as I graduated, bought a building, opened a practice, saw one client and was like, I'm done. It wasn't the business side that freaked me out, it was the clients that freaked me out. And I just realized I wasn't nearly as clinical as I needed to be. And I really couldn't back up. I mean, I couldn't go out there and say that I was a special specialized in anything because I didn't. And I wasn't even very good. And so I stopped and I went and worked for a couple different agency type places and got a lot of clinical background. And then once I became very confident as a clinician and felt like I truly did have a specialty, then I knew it was time. And so that's when I went back and did it again. And so I did private practice just for a brief period of time and got pregnant with my second child or second daughter, Lennon. And it was a very high risk. Pregnancy. So I was off on bed rest for almost five months and I could not work and I had no income.
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C
Wow.
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Yeah, it was bad. My husband was working three jobs. He was working at a restaurant, serving. He came home every night smelling like bread. It was disgusting. So we really just about crashed and burned. So when I got back and had her and got back into the mode, I was like, I have to have residual income. I cannot do this again. And so that's when I really started looking into group practice and having. Adding clinicians. And then from there it just kind of grew.
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B
Wow. So how much time then between your second child and we know you just had your third. So how much time did you kind of create this group practice that exploded?
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A
This October will be five years. So we've been in it for. We started in October 2015. No. Is that four years? Yeah. So it's not five years yet. So about four years. It feels longer because there was a lot of planning that went into it. It took a while to get contracts and the credentialing and we're insurance based, so, you know, that took a lot of extra time. But officially, when we opened, it was October of 15.
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B
Now when you said that you first started, you said you bought a building and then got into private practice. So when you left private practice, what'd you do with the building?
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That's a good question. I gave it to my ex husband. He took the building and I took the house and so we split them. So it worked out well.
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B
Gotcha.
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He still uses it for his business, so it was fine.
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Nice. Now, did you come from like a family of entrepreneurs or how did you.
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Know my family did not even want me to go to college? Yeah. I remember my grandpa yelling at me one day in his dining room. He was like, you can have everything you need right here in this town. And we live in one of the tiny little town in south central Kentucky where, you know, people are doing really great to make $9 an hour, $8 an hour. The average household income here is about 22, 20, $23,000 a year. That's household. And yeah, nobody in my family went to college except one person and it was one of my siblings. But nobody, I mean, nobody owned a business. Nobody went to college. There was really no nobody that was pushing me to do it. It was just more of me looking at how much they struggled and how we lived. And I just, I was just like, I'm not doing this. So it's kind of where that came from.
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B
That's awesome.
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C
It's great to hear about your story and some of what you've been through and also what you've created in such an amazingly short amount of time. Quite the accomplishments and I know Startup Nation had voted on the particular topic that they really wanted to hear from you today, which was when to grow, hold or pump the brakes. So before we dive into that topic, I think it's perfect time to take a quick break for our sponsor. If you're in private practice, you wear a lot of hats. And some of those hats are totally great. But some like filing taxes and running payroll for example, not so great. That's where Gusto comes in. They make payroll taxes and HR actually easy for small businesses like your private practice. Fast, simple payroll processing and benefits and expert HR support all in one place. Gusto automatically pays and files your federal, state and local taxes so you don't have to worry about it. Plus they make it easy for you to add on health benefits and even 401ks for you and your team. Let them wear one of your many hats. You have so many better things to do with your time. Listeners get three months free when they run their first payroll. Try a demo and see for yourself@gusto.com PPS that's gusto.com PPS There are so many ways to keep your practice organized, but TherapyNotes is by far the best. They're easy to use, secure platform, lets you not only do billing, scheduling and progress notes, but also create a client portal to share documents and request signatures. Plus they offer amazing unlimited phone support. So when you have a question, they're there so you can get help fast. Get started with TherapyNotes today, trusted by over 60,000 professionals. Go to therapynotes.com and enter promo code PPS as in Private Practice Startup and you'll get two months for free. Also, you can listen to episode 54 where we interviewed Brad Pliner and took an in depth view into their ehr. Casey, tell us about when to grow, hold or pump the brakes.
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Okay, it seems like that question gets asked to me so much, you know, because there's really no manual to starting a group practice and you just kind of get in there and you wing it and you do your best. And I know whenever I started I scoured Google for consultants and anybody that could help me and I could find no one. And I don't know if I was just looking at the wrong thing, but I was really interested in someone that could help me know the ins and outs of the group. A lot of people had things out there for private practice, for cash pay practices, but the insurance and all that, I just couldn't find it. And so now it seems like one of the things that I get asked a lot is how do I know what to do next? Or, you know, when should I grow, when should I take that leap, when should I just hold off and when should I pump the brakes? And I've been thinking about that a lot in my own practice. And if people have listened to podcasts that I've been on over the course of the last year, you could probably hear this in my story, because some people have, you know, I know the last time I was on one, they were asking me if I was. If I was going to open any more offices. And I was like, no, I'm good. I don't think so. If you ask me that now, I'm like, yeah, we're doing about six more in the next six months. So, yeah, it's just. It's kind of one of those questions. I don't know. Do you want me to start with when to grow?
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C
Yeah, that sounds great. Let's dive in there.
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A
Okay. This is just based on my experience, and I know it's going to be different depending on what kind of model you have of your, you know, in your practice. There's so many different models that people have, but for the most part, for me was when to grow. When you have the infrastructure or people sometimes will use systems. When you have those systems in place that are not pulling you into the business all the time, when you've got things set to where it really doesn't need your undivided attention, I think that's one time or a good indicator that it's time to grow. If you're not the one doing everything anymore, that's. That's a good indicator that you might be ready to grow. Also, if there's a need. For us, we kind of grew based on the need in our area, and there was just a huge need, and it was very underserved. So we kind of looked at the market and found a population that had not been tapped into yet. And so really we had no competition because we kind of snuck in there and we were the only ones doing it. Now we have tons of competition because people have caught on and they're like, oh, I want to do that too. But if there is a need that you can tap into, and then just to go along with that is when you've created something that no one else has, that's a really good time to grow. And then lastly, it's just, it's more of a common sense when you have the funds. For us, growing doesn't necessarily cost us a lot in overhead. The way that we have structured our company and the model that we use, we can grow without having a major chunk of change in the bank. Some people can't do that. You know, if you're a cash pay practice and you're having to pay two grand a month for Google AdWords to get clients coming in the door, you might not be able to hire five clinicians tomorrow because where are you going to get the clients? So you know, those are just kind of the, just the tip of the iceberg things that I think are good indicators for when it's time to grow.
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B
I'm curious, what need did you find in your community that you guys could.
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Serve that wasn't being served? Yeah, it's so simple. Nobody was working with the medical community. We have a pretty large hospital in our area and a large population of physicians and there was no practices that were working with them. They had no one to refer to for discharge. They had no one to provide assistance to help them determine what kind of medication would be better suited for their patients. Maybe they have bipolar disorder or if it's just major depressive disorder. So we were able to kind of go in there and say, hey, look, we can help you better serve your patients by providing these assessments and then giving you the results so that you can do with it what you feel is necessary. And that was huge because nobody here was doing it. And also at the time, nobody was seeing anyone that had commercial insurance. None. It was all Medicaid. Nobody wanted to touch it. So we kind of opened up those two areas and it just really took off.
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B
That's amazing. I love listening to your story and your ideas and listening to how you grew so successfully in such a short amount of time. And I know that you had referenced in your bio being the systems and processes girl. What are some of your favorite systems tools to really help grow?
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A
Okay, so I really believe that in most practices there are about five core systems, give or take the billing. If you don't do billing. So than there would be four. But for me and the systems, I think the biggest thing is creating a dashboard that works well for your practice and your model and your personality. I've seen some that are very complex and are amazing, but that's just too much information for me. I don't need it. Like, I prefer the very simple, gets the job done, move on. So really I think the Biggest thing for systems is the dashboard and accountability. We've learned that the hard way, too. The dashboard does kind of provide accountability, but you can't really have successful systems or a successful foundation of your company if you don't have accountability.
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C
Before we move on and talk about that a little bit further, can you explain to our listeners what the dashboard is? Because I'm sure some people are wondering, what is a dashboard? I know what it is. I have a group practice. I love my dashboard. I look at it every day. I see all the numbers coming in. It's like the best. And it's all automated, so I don't have to do anything.
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Exactly.
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So tell our listeners what a dashboard is and how that's useful.
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Okay, so think about a car in your vehicle. You look at your dash, and your dashboard is going to tell you things that you need to know in your practice. So if you look at it more concretely, we use Google Sheets. So it's a Google Sheet document. And information populates into that document, whether it comes in an automated form like you were just talking about, or whether someone inputs the data. But what you want to have is certain key performance indicators on that dashboard. So maybe how many phone calls your practice had that day, how many referrals the practice had, how many were converted, how many were scheduled, how like, for us, we do. I want to know how many for billing purposes, I want to know how many claims were sent out, and I want to know how many denials were worked. Because when you have an insurance practice, that aging report is super important. So everything on this screen is going to tell you basically when to grow, when to hold, and when to pump the brakes. Because if you've got, you know, if you've got something that looks off on that dashboard, then that's a good indicator that you need to hold or pump the brakes and go look under the hood of your car or your practice and see what's going on. And I can't even tell you how many times that dashboard in our practice has helped me find major problems before. They could have really taken a bad, bad, bad toll on my practice. And that again, it's just too. It's accountability. So, like, if you're looking at your dashboard and those referrals are down, then who's responsible for the referrals? And then how are you going to check in with them to make sure that this doesn't continue? Or if your denials, if they've not worked, denials in 10 days, guess what? You're getting ready to have a cash flow problem. So, you know, those are things that I look at. They kind of tell me who I need to talk to and what we need to do to get something going to prevent any problems.
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B
Nice. I love that you kind of shared all of that, because, you know, Kate and I really talk a lot about tracking and measuring and how important it is. And usually that's kind of a lot of the, like, the last thing that therapists think of, you know, like, they know that they need a market and they might love it or hate it. And, you know, obviously they want to serve their clients, especially if they're a solopreneur or they are building into a group practice or are in a group practice. But the dashboard and the numbers are so essential. You know, I know that Kate and I have conversations about numbers and. And it really does help you determine, like, what's happening, what's missing, or, hey, what's working. Right. So let's do more of that.
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Well, and it helps you determine where to spend your money. And I can't even tell you how many people I talk to, and I swear they're spending Thousands on Google AdWords a month. And I say, tell me about the system that you have in place to make sure that your calls are getting through and they're getting converted. And then they look at me like I have three hits. And so they're spending the money on the marketing, but they're not spending the time or the money to build the system that's going to support the marketing. So if you're paying people to click and call you, but you don't have anyone answering your phone, you might as well just throw your money down the drain. You're wasting it. And so, you know, that's just a small little example of how dashboard and accountability and systems kind of all intertwine.
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B
Totally. So we talked a little bit about, like. Well, we talked. That kind of really helps you do all the things right. Grow, scale, or pump the brakes. Yeah. What are some other things that help therapists decide what step is next?
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A
Yeah. So, I mean, I guess we could go to hold. A lot of times I feel like people I get come in, they're in that holding spot because they're unsure of what direction they want their practice to go. And I remember whenever I was starting, I met with this financial advisor. I talk about him in almost every podcast. And he told me, he was like, casey, if you don't know where you're going, any road will get you there. And I've kind of lived by that because, you know, everything that we do is intentional. And I think if you don't know where you're going, then you need to hold and you need to figure that out. Now that doesn't mean that you have to know every step that your business is going to take for the next five years. I mean that. But if you know that, if you know that eventually you're going to convert and drop insurances and be a cash pay practice, then everything that you're doing should help you get there. So I think that's a big one. Also holding whenever you need to build up some revenue. And we went through about a year of a holding phase, maybe a year and a half because we were not at a financial point where I felt like I had that security. You know, I wanted to grow, but I didn't want to grow at the expense of something bad happening to my practice. So we held. And even though I could have hired 20 therapists last year and we could have opened up all kinds of offices, it just didn't feel like it was the right thing to do. So, you know, holding for revenue and then the last thing for holding, which I think is probably the most important and my favorite part, this is one of the favorite. This is one of my favorite things I like to do for practices. We do it in a thing called a practice analysis. Hold whenever you have not identified patterns in your practice. So for me, I want to know patterns, I want to know revenue patterns, I want to know hiring patterns, trends. I want to see all that. Because when you have a pattern, what does that do? I mean, that's the best chance you have to predict the future. That's the best chance. Unless you're psychic and I'm not. So, you know, identifying those patterns is major. And you can't really do that when you're growing because then you're going to change it all. So those would probably be my top three things. When you're really considering if you should just hold off nice.
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C
And then tell us about the pump the brakes.
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A
Okay, this one's easy. Pump the brakes when you feel like you are losing your mind. If you're being pulled in every single, into every single system of your practice, if you're being pulled into the office management, if you're being pulled into the building, if you're being pulled into the hiring and you don't want to be there and you're being pulled in all those different directions, it's time to pump the brakes because you cannot, you cannot continue to feed into that. And I'm guilty of it. I've been off for five weeks and I'm so guilty of like getting my hand and all this stuff going on that I have no business messing with. Like, I have a team that is perfectly capable of handling it. But I think I just, like, I get a little bored and then I decide, oh, I can just do this. But if I was actually back to work and I had other work to do, I would be, I would be crazy because I would be in all of this nonsense that I really don't need to be a part of. So if you feel like you're losing your mind or you're overwhelmed or stressed out, you have a system problem. And so you need to pump the brakes and go back and look and look at your practice and open up that hood and see what's going on that you can fix.
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B
As you talk about this, you know, I definitely see like myself in regards to what you're saying. And you're right. Like when I'm involved in way too many things, stepping back and then like looking at like reminding myself what is the most important thing right here, you know, And I have other things that I'll say, like, what are the activities that I need to do to generate right income and go there. I always love systems because I feel like systems are just a feedback loop. And you know, when it's not working properly, it's just an opportunity to be like something's missing here. And it's really about the system. It's not about the person or the team member. Casey, I'm just curious, what role do you have in your, in your team and your company? Where do you focus your talents?
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A
It depends on who you ask. Probably. I, at this point I'm more of the vision and I really use my team to help execute that. So I'm not really involved in any of the day to day. The last piece of the puzzle was payroll and that's gone. And so I really don't have anything else that I have to do. And it's more of just now I can focus on big picture stuff, big idea stuff. What can we do to really take our practice to the next level? How can we better serve our clients? What can we do for our clinicians that's innovative, that nobody else is doing that they would love? So that's kind of where I am at this point.
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B
That's awesome. And who compromises or who makes up your team?
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A
I have a huge team. I went into this knowing that I wanted to do everything in house. And so I just started hiring a bunch of people in house. And I'm really a big believer in having a strengths based approach to running a practice. So, for example, if I hire someone to do front desk and they really suck at the front desk, I'm going to figure out what they're really good at. Maybe they're just really good at, they're just super nice and clients love talking to them on the phone. So I'm going to separate that job out and that's all they're going to do. Now that might mean they lose 20 hours a week because I don't have 20 more hours of things to give them. But everybody in our practice does the thing that they are their superpower at. And so I have about 15 administrative people in the practice and they all do very specific type work.
- [26:44]
B
That's awesome. And I just, I love listening to you and really just again seeing what you've created. And I love that you, you say that. And that's one of the things that we talk about, especially when you are building and growing your business and we kind of focus more on the marketing and talk about that aspect. But I find that a lot of times what we think will work in business is actually usually the opposite, until we really learn that. And, you know, I think kind of going to school and working at places where you're supposed to have to do this because it's part of your job responsibility, whether you loathe it or not, you know, it's such the wrong message. And then when you get into business, it's kind of undoing all of that stuff. So having people in their, in their positions that they absolutely love is, duh, the best thing. Right. Because they're enjoying that your clients are getting the best care. And then it's just this beautiful reciprocal effect for the team and for the business and really for everybody.
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A
Yeah. And then you automatically when you do that, you have this built in accountability. And I swear I thought I was nuts. I really did. I thought this is the stupidest business model ever. And I'm not going to tell anyone I'm doing this because I'm going to sound like a fruit loop, but I went to hear Mike McCallowicz speak in Chicago this summer and that's what he does. I had no idea that's what he does. And I was like, oh my gosh, thank God. I felt so validated because I was like, I'm so glad I'm not the only person that thinks this is a good idea. Because you have so many people to manage. There's a ton of them. But for me personally, I would rather manage the people than manage the individual tasks. So it works. And, you know, I have some clients that have been doing it and they really like it. And so hopefully we're kind of onto something.
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B
Awesome. Well, what do you hope that people take away from your message today?
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A
Yeah, you all told me to prepare for this one, but now I've rethought my answer. I think really just knowing that business doesn't have to follow a model. It doesn't. Doesn't have to be cookie cutter. If you have something that works for you, then do it. And it really should be a reflection of your personality and there's no right or wrong. And, you know, whatever makes you happy and whatever makes your staff happy and, you know, the happier you are, you're going to attract those people back and hopefully have your dream business like you said in the beginning.
- [29:09]
B
Awesome. Well, we so appreciate you being here with us and I know that I could probably spend another, like, hour, two hours with you just asking lots of great questions. And thank you so much for being here with us, like five weeks after your son was born. And you look for those on video or not on video. You guys are just listening audio. She, like, looks amazing and she's here with us. So we appreciate having you with us and we hope you guys join us next time as we talk with. Well, I believe I forgot to write the name down. I think it's. Brandon's going to be joining us, talking about how to utilize Google Maps. So it's going to be stop networking and utilize Google Maps for marketing. So this is interesting and we've never really heard this before, so that's why we chose this topic to talk about Kate.
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C
What about our Brandon Stanton?
- [29:53]
B
So he'll thank you. I forgot to.
- [29:56]
C
And we'll dive into that topic, which will be great. Yeah. So let's take a moment to acknowledge our startup name Superhero Shout out for today's episode. And it's from our colleague, Dr. Andre Caruso. And he says always very helpful and quite awesome people on this podcast. So thank you, Dr. Andre. That's awesome. We appreciate your feedback. And you guys, we're always trying to create content that's really valuable for you and really meeting your needs. Just like today's episode, you guys got to vote out of four or five topics of what you would want Casey to talk about. And this is the one that you guys chose. So we love to hear from you.
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A
Love your feedback.
- [30:29]
C
And anytime we get these little encouragements or emails from you guys, it really inspires us to keep going. So if you love the show, subscribe, rate and review, share with your friends, your colleagues, and definitely if you have a topic that we haven't done yet, let us know. We'd love to be able to support you in that.
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B
So thank you Startup Nation, and we look forward to continuing to inspire you from Startup to mastery. Have an amazing day. Take care everybody.
- [30:55]
C
Thanks for joining us on the Private Practice Startup. Visit the Private Practice Startup for awesome resources, free trainings, attorney approved private practice paperwork, and so much more.
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A
It.