Maureen: I opened my group practice six years ago next month. It was before Facebook groups and easy access to other group practice owners. I pretty much hired my first clinician on ignorance to practice building and excitement. I missed that whole fear of failure step and jumped right in. I think this really helped me just start it.
My ultimate goal behind starting a group practice was the idea of bringing together a group of therapists in a family-style type of practice, where collaboration and a mutual mind for social consciousness would allow us to give back to the community. It wasn’t until about a year later that the reality of having staff hit me and then I hit the pavement running and immersed myself in learning about group practice building, effective strategies to running a successful business, and improving my leadership skills.
Jennifer: Looking back, what would you have done differently when you opened your group practice (if anything)?
Maureen: I started by having independent contractors. I switched about a year later to employees when I realized what it actually means to have independent contractors. Being in an area where the norm was to have independent contractors, I went off of following the lead rather than researching what it means to have independent contractors myself.
My desire to have a family-style, collaborative group practice didn’t align with that. My desire to offer benefits, supervision, and staff outings didn’t align with that. And so I made that hard change, which was scary at the time.
I would have also put my mission, vision and values for my group practice out there. It sat in my head and played a role in who I hired, but that didn’t help my staff see my vision, mission and values and align themselves to it. Interviewing and hiring staff has evolved so much for me since the start of my group practice.
Jennifer: What specifically do you provide to your independent contractors i.e. office space etc.?
Maureen: I have 20 therapists as employees. They receive the full benefit of my group practice, from access to my Practice Manager/biller, receptionist, financial benefits, supervision, and more.
I have two independent contractors who perform services outside the scope of what our office provides (therapy). One does medication management and another does psychological testing. These are adjunct services, so having independent contractors made sense for me. They receive a space to use when they are in the office and access to bill through our EHR.
Otherwise, their materials, how they do their work, scheduling their appointments and all other aspects of their work are done independently. They don’t get supervision like my employees do. They don’t get access to my receptionist or biller like my employees do. They cover their own malpractice insurance and are expected to fill their own slots. My practice does not market them, and any calls that come in requesting their services gets forwarded to them to handle. It really is a business contracting their work to another business.
Jennifer: What are the most challenging and rewarding aspects of managing independent contractors?
Maureen: What’s most challenging comes from my need to have things streamlined and organized. All of my policies and procedures are followed by employees at my practice. The independent contractors have more flexibility, more control in their work, which sometimes doesn’t align with how I would do things.
There’s also time when they are full, and because they are contractors, they can’t work full time. It limits how many clients they can have and means that I have to go through the interviewing process again to find another contractor to help.
Despite some limitations and challenges, there’s reward as well. There’s less of a time and energy strain on me because they are expected to do their business independently. Compensation is also easier because contractors can’t receive benefits. So you could just cut a check to them and be done.
With my employees, I have to have a payroll system, calculate sick time, vacation time, bonuses, pay life insurance and short-term disability policies, health insurance premiums, and more. These all take time and effort to do each month, something that I don’t do for independent contractors.
Jennifer: If you could give someone starting out advice when it comes to hiring other therapists (either ICs or employees) what would you tell them?
Maureen: Find an employment attorney first. Don’t just hire independent contractors because it is easier or cheaper (it actually isn’t cheaper, you just adjust what you would pay them by about 10% to account for taxes). Just because others have independent contractors doesn’t mean that the vision for
your group practice aligns with having them. And if you think you will just switch to employees later, that idea itself is telling you that you should just start that way. The IRS and your state both have guidelines for what constitutes an independent contractor so having a good employment attorney will help you navigate those entities and their expectations with you.
Visit www.thegrouppracticeexchange.com to get more group practice building help, resources, and access to coaching with Maureen Werrbach, LCPC