Solo Practice Vs. Group Practice the How | Therapist Practice in a Box

Running your solo therapy practice over time has become easier. You have your administrative systems. You have your referrals sources in place; marketing is effective, your caseload is full. You are only working the hours and days that suit you and the family well, and you have created a wonderful office space to work in. Then a call comes in, and you can’t take that person even though you might really want to. Then a second and third call comes in, and now you are starting to think well maybe I should hire on an associate or two. You look around your office and think I can have this new person here when I am not here or if you add a new wall you can create a new office space. However, what else do you need to do or consider before you pull the trigger?

There are many times in our lives when we are at a particular crossroad. Moving from a solo practice to a group practice is one of those times. As you begin to think about the possibilities take time to visualize how this arrangement might work for you. Are you excited about the possibilities? Is this just the next step in your business plan? Think this through because this decision will cost you time, money and energy. However, the rewards can be phenomenal. A group practice can be a great decision for your business if you plan ahead.

Here are a few points to consider if you are planning to move from a solo to a group practice.

Space Considerations

Does your current office have enough space to accommodate another person?
Could you use your current office space and coordinate different days or hours?
Are you okay with others with others using your space?
Will the landlord and your lease allow for employees or Independent Contractors (IC)?
Can you add a wall or extend your current office?

Employees Vs. Independent Contractors

Do you want licensed or unlicensed staff? Depending on your state you may not have a choice. In some states clinicians that cannot practice independently must be employees.
Do you want employees or Independent contractors?
When you have employees, you direct their work, you can require certain hours, days, particular paperwork, billing procedures, scheduling of the staff, dictating what is appropriate office attire or what isn’t and you will pay employer taxes.
When you have ICs you do not direct how they complete the work, manage them, you hire them to perform a service to the clients, and you receive a portion of their pay. The IC is responsible for their own self-employment taxes. To determine if you should have employees verse independent contractors take a look at this publication by the IRS. (Please look at this part carefully, the IRS has made it more difficult to hire IC in recent years)

Money

Employees will cost more money upfront to the business because you must pay the employer taxes, this usually happens through the payroll service.
Independent Contractors often cost less because the IC is responsible for their own taxes.
Insurance cost will increase. (Malpractice, general liability, workers’ Comp) Plus you may need an umbrella plan for yourself. Speak to an insurance agent.
Know your base costs now, how much will it cost to add another person? What is their expected revenue? What will be the business’ profit? (projections are fine)
Do you need a bigger office? What are associated cost expected to be? Will you be paying for the utilities?
How much additional revenue can you expect? Is that anticipated amount worth it?
Will you have construction costs?
What payroll service will you use?
How will money be turned in and kept track of?
Who will handle billing?
Will you need to hire phone services, administrative assistant, HR specialist or a Virtual Assistant (VA)?
How much will you pay the clinician?
How much will marketing for more clinicians costs? Who will pay those costs?

Clients

Will you refer only overflow clients?
Will you pay more if they bring in more clients to the business? How many new clients would you like them to bring in?
How will you handle client care it if the staff person leaves the business?
Who does the client belong to?
How will client scheduling work within your treatment rooms?
Will the staff answer the phone or will staff member each have their own number for clients?
How will you handle clients that are suicidal and will you need to be notified?
How will you handle complaints?

Staff

Create a job description of what you want in your therapist.
Will you hire someone with the same specialties or different ones or a combination?
Are there types of clients you do not want in the office?
Documentation how, what and timing of it, what is your requirements? Will they use an EMR?
You will need time to train staff, so if you have a caseload more of your time will need to go into administration.
What personalities do you work best with?
Will you require your staff to market?
Will you require staff to blog?

Misc.

Create a detailed marketing plan for multiple clinicians
Have a policy and procedures manual in place
Develop a written contract between you and each staff member. Have a lawyer or HR specialist review
Know what documents are required for each employee (State & Federal)
Who is responsible for the office cleaning? Will you hire someone?
Know you and how you like to run your office and be able to communicate that to your staff.
You want your office to have a consistent look and feel
You are the owner and therefore are responsible for everything in your office, everything. (leaders always take responsibility)
You are a leader or want to become one; this may take time and you must become educated on leadership
Talk to a CPA to determine the best tax structure for your expanded business.
How will you keep track of time worked for employees?

The above list although not exhaustive will get you on the right path. I have found that my group practice has been a wonderful experience and profitable too. Do not be discouraged because it looks too hard, like anything else there is a learning curve. However, with a little time and patience having a group practice can be a rewarding experience. If you need more information take a look at my blog on solo practice vs. group practice. What are you waiting for? Let’s get moving.