The Therapy Business Podcast
We know how challenging growing a therapy practice can be, and don’t think it should require an accounting degree just to run your business. If you own a solo or a group practice, we’re here to help you build a business that creates more time, makes more money and serves more people.
The Therapy Business Podcast
Mastering the Art of Therapy Practice Expansion with Katie May
Katie May shares her journey from solo practice to successfully managing a group practice while emphasizing the importance of strong systems, a supportive culture, and data-driven decisions. Her insights offer essential guidance for therapists looking to grow without sacrificing the quality of care or their well-being.
• Transitioning challenges from solo to group practice
• Importance of culture and support within teams
• Utilizing systems and processes for clarity
• The role of data in managing productivity and performance
• Salary vs. commission: Which model works best?
• Overcoming burnout and maintaining a healthy work-life balance
Work with Katie:
Consulting website: www.visionarytherapist.com
Stabilize & Scale: www.grouppracticescale.com
Austin Group Practice Owners Summit: https://stabilizeandscale.thrivecart.com/visionary-summit-austin/
Our Profit Coaching program is enrolling new practices now.
We specialize in helping therapy practices like yours achieve financial clarity, so you can focus on what you do best—helping your clients and managing your team- while we help handle all the businessy stuff they didn’t teach you in grad school.
To see if your practice might be a good fit, schedule a free consultation at therapybusinesspod.com.
Meet with one of our coaches
*Intro/outro song credit:
King Around Here by Alex Grohl
My name is Craig and I'm the CEO of Desi Financial Coaching. Our goal is simple to help you run a therapy practice that is permanently profitable. If you own a solo or group practice, we're here to help you build a business that creates more time, makes more money and serves more people. This is the Therapy Business Podcast. Today we have Katie May, with Visionary Therapist, joining us to talk about everything involved with owning and growing a group practice. Katie has launched and grown her own therapy practice that has multiple locations and around 20 employees, and has taken what she has learned and been consulting therapists like you into how to grow your business, what systems and processes do you need and how can you successfully grow a thriving group practice. So, without further ado, let's jump into the interview. All right, Katie? Thank you so much for joining me today.
Speaker 2:Yeah, I'm psyched to be here.
Speaker 1:Yeah, so I'm such. I know so well how growing a group practice and how challenging it can be and with our clients a lot of them either they're new to the group practice thing or they're solo and they're wanting to become a practice owner and have therapists under them. It's kind of choppy waters, like not really knowing what to do and how to navigate that. Has that been your experience?
Speaker 2:Yeah, I want to start off by saying I never thought or knew that I wanted a group practice. So that's kind of. The starting point was that I was in solo practice and I just had more referrals than I could handle. I specialize in team dbt so I thought I can't send them to the generalist down the street. All right, fine, like begrudgingly, but also excitingly I'm going to start a group practice, and things really exploded from there. But to your point, my instinct in not wanting to start a group practice was because I knew I could count on myself. I knew what my skills were, I knew what I could do. But having to manage other people felt really challenging to me and it was yeah, yeah.
Speaker 1:I went through the same, the same fears and hiring a team at my business and one of the big pushbacks I hear a lot and I felt too was it's it's my brand, it's my name out there and these, you know, trusting people to represent me was terrifying you definitely need and it's vulnerable once you start imparting that wisdom or creating the systems, all of those things is trusting that other people are going to follow through and actually uphold the quality that you yourself know that you can uphold.
Speaker 1:Absolutely 100%. Well, tell us a little bit. I know you have a couple different businesses that you do, but you have your therapy practice, but tell us about you and your businesses.
Speaker 2:I own a group practice in the Philadelphia area. We have give or take on any day about 20 employees and two locations. Like I said, we specialize in teen DBT so we work with teens and parents and I've really created a solid brand around these services. I published a book for parents of teens around this idea. So really strong brand in helping teens and parents in high-risk behaviors and in the success of growing my practice. Because I started as solo, I went to a little small group practice of four which then doubled in size, then I bought a building, then I bought another building, so things just kind of really grew every single year for me and because I was sharing these successes, it naturally led to me then coaching and consulting with other practice owners to help them develop the practices that supported their lives, that supported their vision and also wasn't so hard in the process like learn from my mistakes and shorten the struggles so that you can see more successes more quickly.
Speaker 1:Yeah, that's so fantastic and you've done amazing things with your own practice and then to turn around and almost pay it forward to other practices is huge. So what's one of the common struggles? When people come to you for the first time, what do you usually see they're struggling with?
Speaker 2:People when they come to my program and I co-lead it with another owner of this business, shailene Kite.
Speaker 2:So when they come to my program and I co-lead it with another owner of this business, Shailene Kite.
Speaker 2:So when they come to our program, what I'm typically seeing is that they've grown beyond the point that they can manage.
Speaker 2:So maybe they started with this little scrappy and strong team. That really was part of that startup vision with them, and typically I and others that I've seen are pretty transparent about we're just starting this thing, we're learning the ropes, but the more you grow, the more you become a real deal business and then the people that you hire into that business have different expectations than employee one, two and three when you are a scrappy startup. So what I start to hear is that employees are quote unquote entitled, that they want more from you, that the expectations are different, that they're pushing back against the system because now, all of a sudden, this power dynamic has been created. Because you're a boss, you have a real business, and so that becomes the struggle point that I see when people are coming into the Stabilize and Scale program because they're like, wait a second, this is not how it was before. I've seen this level of success, but the struggles that come with that success look different.
Speaker 1:They really do and I've felt that, and even working with my coaches right now, it's been what was working for me when I was a solo business owner. Doesn't work when you're growing, you have a team of people, and the number of leads coming in the door when it was just me, it felt like, wow, I've got more people than I can handle, than all of a sudden it's like we need more leads coming in the door so we can get more clients. So it is an interesting pivot.
Speaker 2:Well, and what I see is that it becomes transactional. The mirror is then turned back around for you to look at yourself, because what was required from you as a solo business owner or a smaller team business owner now looks different and it requires you to step into different roles in terms of holding a higher accountability, in terms of being more direct in saying things like I expect this from you, versus like having two employees who are really jazzed and want to do all those things. Sometimes you have team members who don't want to do things and you still need to uphold that expectation, and it becomes this uncomfortable shift in how you show up as a leader and really manage your team and hold them accountable. And that's one of the biggest pieces that I see as struggle is that shining the light of accountability and really holding people accountable in a way that's not overshooting it and being aggressive, but also not sitting back in your chair and letting things happen because it's uncomfortable to address it.
Speaker 1:Yeah which I think is really common to see both sides of that coin I feel like with therapists and this has been my experience with the clients we've worked with I feel like that side of they don't want to come off too harsh or too strong or overbearing or micromanaging. That seems to be a huge trend that I've noticed. I notice it in myself too. No one teaches therapists in grad school how to become business owners and all of a sudden you find yourself in this business owner and manager seat and having to balance making people happy while also making sure that things are getting done and that it's to your standards.
Speaker 2:Absolutely, and I have the thought that if I find myself having to micromanage someone, I've made a wrong hire or I haven't properly oriented them to my expectations and the systems that they need to follow. So I don't like to micromanage. I have very clear expectations and systems that we follow and quality assurance that we have in place like checkpoints for those systems. But if I'm having to manage you to do your job well, you are not in the right job right now and you need to be somewhere else.
Speaker 1:Yeah, fantastic. So when it comes to team members too this is a question I have, I think, a lot of times there's fear for practice owners that their team is going to come in, they'll grow a caseload. Then they'll turn around and go. You know what? I can go make more money on my own and they'll leave. And so there's this fear of I want to entice them to stay. But also, what's that balance? Do I nurture them wanting to start their own thing? Do I try to hold them in? What is your experience with that?
Speaker 2:Yeah, well, it's true is that I mean, I am an entrepreneur. I once worked for somebody else and had the thought I want to do this on my own. I want to be my own boss. I'm otherwise unbossable, so it makes sense anyway that I don't work for somebody else. But there, I think to some extent there is the reality.
Speaker 2:What I teach is that we rent our employees. We don't own them. They're not ours to keep. And so in my practice, we're really transparent about I want you to have a career worth having. I want you to be fulfilled and achieve your dreams, because that's my value system and that's what I want for myself, and if I want it for me, I want it for all of you. And so what that looks like is being really transparent.
Speaker 2:Some choice points I would say, like when pre-licensed therapists achieve licensure. When therapists have been with me, you know, between that three to five year mark, we're having these conversations around like is this still aligned with your goals? What's the next step for you? Is it here, becoming a supervisor? Have you thought about being in your own practice? They're thinking about it, whether or not I say it, and I think there's this fear of like oh, I don't want to put the idea in their head, but I see that as the cost of doing business.
Speaker 2:When therapists leave my practice, they take their clients with them, because we don't own clients. Clients are people with autonomy and so we just need to plan for the onboarding and offboarding process. So you had mentioned leads, like knowing there's enough leads coming in, that if someone leaves with 20 clients and I hire someone new, I know exactly how long it takes to fill that new therapist. So it's really just having your systems and your data that support. People will leave One day. I might leave, so we need to be prepared for those changes. I often look at owning a business like trying to balance on top of a rolling beach ball, and I remember these really distinct points in my career where all I wanted was that beach ball to stop rolling right so that I could finally relax, and then I had this realization that this beach ball is never going to stop rolling. So my job is really to just learn how to balance on top of the beach ball and find my zen within that, rather than trying to stop it Like reality acceptance here.
Speaker 1:Yeah, I think that is really really great advice. I think, as we are even just talking about that, that fear or the sit back and let things happen, and so that confrontation I've seen that that can even derive from fear of pushing people out and that they're like you know, and I don't want to boss anymore, but just nurturing that or leaning into it and just saying, yeah, like you just said, we're renting our team, which I think is a fantastic perspective, because every practice owner started working with somebody, most likely, and we all had that dream. And then there's also people out there who have zero interest in the business side of marketing and lead to all that. They're like nope, I just want to be a therapist, that's what I want to do.
Speaker 2:Yes.
Speaker 1:So finding that balance.
Speaker 2:And I love those people. You know those rock stars that can excel within our practice, and I think it's also like knowing the value that you bring within your practice. We have a really strong culture at my practice. We have consult teams. They have learning opportunities. You know great benefits that you can't always find when you're in your own practice and so knowing the value of your offer for me, it makes me feel comfortable knowing people will leave but we can attract new great therapists too.
Speaker 1:Yeah, I think that's awesome. So you've been talking a little bit about systems and processes and the importance of that. I'm the creative visionary type systems and processes. I importance of that I am. I'm the creative, visionary type systems and processes I. I love them cause I need them, but I don't. Naturally they don't come natural and so luckily, I've hired a team of people who are patient with that and know for a long time it was just what's in my brain is is my process, and so translating that into business itself. What have you seen in that? Is that a common struggle with people? I'm hoping I'm not alone in that. And then how do you help people overcome that, taking it from their brain and turning it into something actionable that can be repeatable across other people?
Speaker 2:You're definitely not alone in that, and one common struggle that I've seen with many business owners is when I hire people in. It's a lot of work to teach to them. But even if I hire people in so that they can support me like an admin or a virtual assistant, there's all this front loading to teach them what's in your brain so that they can do it the way that you want it done. And so when I work with group practice owners, my rule is the rule of twice. So I'm telling them you're not going to sit down and write a hundred page manual of every single system in your practice. You're going to build upon what's already there and do it on an as needed basis. So if someone asks me a question more than once, that's my rule of twice.
Speaker 2:I'm either going to use Loom and record myself doing the process. I'm going to write it out, and then I'm going going to use Loom and record myself doing the process. I'm going to write it out, and then I'm going to add that to our handbook. And so we're building as we go. We're really building the plane as we fly, which is something I think that I do in every area of my life. But you need to be comfortable with that. You know, as a business owner, you need to be comfortable letting things happen and then attending to them. I think in the beginning there's a lot more fires to put out, but then there's not, and so it's okay. So that's my starting. Point is like, breathe. There's a lot of systems to get out there, but they don't all have to be in a nice neat package all at once Because, honestly, if they were, you'd have to change one by the time it's already printed right.
Speaker 1:Yes, so true, so true. And I learned, you know, my wife works in a corporate job and she's like you know, their trainings aren't any, it's not any more cohesive than probably what you're doing. I was like, okay, good, because sometimes it feels super sloppy and I'm just learning as I grow and I've been doing this a while and I've had a team for a few years, but it's still this year. We're still having to implement new systems or create processes that a team member will point out, like what do we do in this situation? Like, yeah, I guess you don't know, do you?
Speaker 1:Because I never told you or never figured that out. So I think that's huge and that's been a revelation for me is implementing processes and systems, because that improves client experience. If everyone is on the same page and knows what to do and when and how to follow up and how to serve our clients, then everybody wins and it's a lot better across the board.
Speaker 2:Exactly, and that goes back to what you were saying about the vulnerability of having people that work for you and represent your brand. So the more specific you can get when you're writing out those processes. I have the process. I have it in a visual form in a video. I have the process. I have it in a visual form in a video. I have the written instructions. Sometimes I have pictures, I have scripts or email templates. So my goal with my brand is always to be cohesive. So I know the experience my clients are getting and I know that sounds like a big, overwhelming burden to have all those pieces but again, they developed over time. So if you write an email and it's a good template, save that template, put it in your Google Doc. So if you write an email and it's a good template, save that template, put it in your Google Doc. Like we're just continuing to build as we go.
Speaker 1:Yeah, that's great. So I want to touch on somebody going from solo to group practice. I don't know how many clients you have who are in that transition phase.
Speaker 2:Do you work with people who are solo now trying to go group? Typically, when I'm working with a practice, they have at least one employee, so they've already kind of made that leap. But the you know where they are in that process differs depending on when they come into the program.
Speaker 1:Okay, perfect. Well, and even I guess if they're that small, they have one person. Sometimes that transition from. I have a full caseload of clients and I'm trying to free up my time. But if we have, let's just say, 50 clients total and I hire someone and they take 20, and I lose 20, revenue stays the same, but my expenses just skyrocketed, that is such a delicate balance. Have you seen that, and what kind of approach or advice do you have in that realm, if anything?
Speaker 2:Yeah, I see that there's these tipping points of when things happen. So definitely when you're just starting, yes, your expenses are going to go out more, but I think that's a natural scaling process, like when I went from 12 to 18 and 18 to 22,. Sometimes there's this inequality in what's going out versus what's coming in. For example, the more employees you have, the more admin support you need. But there's this like weird middle place where you don't have enough revenue coming in to make it make sense for two admin but you need to admin to do the work if that makes sense. So I think, the acceptance of as you grow, there will be periods when profit margin will be lower and that makes sense. But you need to know your numbers enough to know if this is where you want to be at this level and you need this kind of support. What revenue needs to come in to support that. There's a lot of just like looking at the numbers to make it make sense and sitting with the fear of those like middle places.
Speaker 1:Yeah, You're speaking my language and yeah, I think with that profitability, you know I'm reflecting on 2024. This morning, with one of my coaches and I was like, yeah, revenue was up, we grew, but profitability was down. And you know it was a double-edged sword for me, cause I hate that, but cause we're profit coaches.
Speaker 1:But it also came with intentionality, because we knew this year was a year of growing the team building infrastructure so that we could, uh, take on more people Cause we had, um, we do personal finance coaching, our uh, we had, uh, the head of that. She was capped out and was two months out before she could see clients, so we had to bring somebody else in. And so all that to say, I think, just knowing your numbers and that kind of what you're talking about being proactive and having a game plan and just watching it and and being okay with the fact that you're going to have those tighter years and then you're gonna have those years where you're just wildly profitable.
Speaker 2:Exactly, and for me a lot of it comes back to what your vision is as well. So I've talked a lot publicly in the past two years about how I actually downsized. I was bigger, I had three buildings, three locations, way more employees and I was profitable, but I kind of hated my life. It was just more than I wanted, with also having other businesses, having a family, all of these other things. And so when I downsized I was very intentional about maintaining my profits but having less work output going out, if that makes sense. And so I really do think about like you can keep growing and growing and growing, but in service of what it needs to be, in service of your life. So knowing what those profit margins look like at each level is also helpful to be in service of your life.
Speaker 1:So knowing what those profit margins look like at each level is also helpful. Yeah, that's so great, that's that's. I find it so important to look at profit versus revenue. And revenue is just how we're geared, especially as entrepreneurs and business owners. Like we're trying to grow, grow and we're trying to hit that next target, that next target. But revenue is just one, one piece of the puzzle, whereas profitability I would rather have a $500,000 a year business that is just incredibly profitable, versus a million dollar a year business that's not making me as much profit and not putting as much in my pocket.
Speaker 1:So, yes, I think we're speaking the same language and you kind of even touched on time with your family and how it was robbing that, and is that something that you see with people that they kind of quit their nine to five and they start this business and now they are working more hours and not taking care of themselves financially and they're just burnt out?
Speaker 2:All the time. I mean, isn't there a saying around that, like you, quit working 40 hours a week only to work 80, 100. I don't know what the saying is but the concept is there.
Speaker 2:So, yes, all the time, and I think there's a part of that that when you're working within your passion and what matters to you, it doesn't always feel like work, but the flip side of that that I hear from practice owners regularly is like it's hard to shut off your brain. You're on the couch and you're on your phone looking at Google Sheets of how many clients were converted today and it's hard to shut that off because it's always on your mind. You're always working on it. So the balance is hard to come by. I think I've cracked the code, but it took a while and intentionality to get there.
Speaker 1:Yeah, absolutely it's. I feel like I'm always trying to crack the code. I've done really well with shrinking my availability and when I can take calls.
Speaker 1:But then I guess there's always those seasons of where maybe it's on my mind all the time, I'm feeling a little bit more anxious about it, and so I might be after the kids go into bed, I might be sitting down to do some writing or something. But I do have to watch it because, you're right, it can, it can creep in, especially in this day and age where a lot of us have our remote businesses. Maybe they're doing virtual therapy and my office is here and my kitchen is there and there's not a commute for me to kind of decompress.
Speaker 2:Definitely.
Speaker 1:Okay, so for me, data is something I know is important to business. We have different dashboards and things, but with therapists, when you're working with them, what kind? What do you recommend they're looking to or paying attention to? As far as numbers go and data?
Speaker 2:Yeah, so there's different parts of this. I would say we're looking at different departments From the intake department. We're looking at how many inquiries are coming in, how many of them are being converted. I'm also looking at a whole bunch of other information about what marketing stream brought them in, what they're looking for. But the main numbers I would want to know is how many leads are coming in and what percentage are being converted. And then if we're moving that down into our operations department, where what I'm looking for is are my therapists meeting their numbers? Each of them have an expectation to see 20 client hours a week and that matches to a revenue goal. There's a reason for that. So because I say 20 doesn't mean that someone else should have 20. So again, it goes back to like knowing your numbers and knowing what you need to bring in.
Speaker 2:But I like to pause there, because when you implement this, if you are a group practice owner who has never talked about numbers before, and then you start talking about numbers with your therapist, you're going to hear things like you're too corporate, all you care about is money. Things feel different because all of a sudden, that accountability has shown up for therapists. Fight or flight kicks in. They're feeling like, oh my God, now there's this microscope on me and everything that I'm doing, and I like to remind group practice owners that pushback doesn't mean that you're doing it wrong. You get to a certain point in your business where you can't just wing it anymore and you need to know that the people that you're paying are doing the job that you're paying them for and meeting the expectation.
Speaker 2:You know there came a time in my business when I realized that a therapist that I was employing for four hours a week was not making me money. In fact, was sometimes losing me money to have, you know, on the roster. And so these are important choice points for practice owners, and that's when I think they need the most support is when they're making these changes, they're putting accountability in place, they're starting to look at their data and freaking out a lot of the time because it's scary once you start realizing, oh no, like this isn't working or I'm paying people too much, like all of these things that start to come up. So I think having support in those moments is the most critical to help you stick with it rather than fold. And then what's the point of being in business if you're going to run it into the ground because you don't know your numbers or you're not monitoring them well?
Speaker 1:Yeah, absolutely. I think that is so great. It's this counterintuitive thing to our nature which is sometimes and we'll do this with our clients too it's like, let's, we need to step back and, yes, you're, you're clinicians, you're therapists. They're people, they're humans, we care about them deeply. But let's just look at the numbers and how profitable are they being? And it can feel sometimes icky, I think the first time you do it, because you're looking at, like, just them as a number on a spreadsheet. But truthfully, if you don't, then they're not being served well, your team's not being served well. You can't serve as many people if you're not as profitable as you can possibly be.
Speaker 2:I mean, I really look at it as for the greater good, like if we're going to a potluck and everyone's bringing a dish but you didn't bring anything and you're just eating everyone else's dishes, you're not contributing to the greater good, you're just taking from it. And so we want to be mindful of how everyone contributes, so that everyone wins, rather than somebody being a drain while other people overcompensate for that.
Speaker 1:Yeah, ma'am. So you touched on the compensation piece, or making sure you know are we paying people too much, which?
Speaker 1:we've run into that many times we have a whole episode on just titled help, I'm overpaying my clinicians. So, when it comes to paying clinicians, we know there's multiple ways. You know that we've seen commission flat rate, even just hourly or salary. Is there a recommendation that you have that you think is the best way, or is it really just dependent on the practice owner? Yeah, as far as paying clinicians go, how do you approach that? This is one of the biggest fears, I think, when people start hiring clinicians.
Speaker 2:So I actually talk about this a lot. I pay my team on salary and I love it, and I came to that decision because we were previously commissioned. But we do groups and we do individual and I'm not good at math, and so all of those things combined became a lot of payroll errors and a really long payroll process and I just decided that I wanted to simplify things and I moved us to salary. I think there's a lot of fear around that, with good reason. For me it worked because I know how to market.
Speaker 2:I consistently bring new clients into the practice, I know how long it takes to fill a therapist all of these like data points right. So for me it works and it helps me to control my costs. So I know that this is how many client hours I require from each of my therapists, this is what I'm paying them, this is what my expenses are, and it's stable, so they're getting a stable paycheck. But I also know my numbers in a stable way, so that things aren't fluctuating in terms of what's going out. I just know how much I need to bring in to make it work for me. So I really love it and it's not a magic fix.
Speaker 2:I've worked with group practice owners who think, like if I move to salary, it will magically fix that people need to be more motivated. No, they're actually less motivated. You need to find other ways to incentivize them. So I wouldn't say it's for everyone and I wouldn't say there's one right way. I just think that it's what works for me and it's simple. I'm a fan of things that are simple in administration.
Speaker 1:Yeah, and I think when, as we look at numbers, salary is the greatest profit potential, because I think when you get into a commission-based structure, which is the typical how people typically start, and it's easy because you're hiring someone for the first time. You don't have a lot of cash overhead, so it's like hey.
Speaker 1:I'm only paying you if you're working with people and if you don't, then I'm not. But salary gives you the opportunity because I think when that person the clinician they hire gets a caseload of people, the profitability doesn't change. They're still taking 60% of everything that's coming in, where salary kind of gives that overhead some ability for the profitability to grow, ability for you to ask your clinicians and therapists to do other things outside of just clinical hours, which I think is a huge fear.
Speaker 2:Yes, that was. Another benefit is that I wasn't having to think about an admin rate for when I want them to come to a consult meeting or what it looks like for them to write notes. Like everything is this package deal. It just made things so much easier.
Speaker 1:Yeah, man, that's great. So that's good to hear. I don't run into a lot of practice owners who are doing salary, which I am a huge fan of, and so, but also going back to that point of knowing your clinicians, profitability if your salary, that is just increasingly more important because it's not this weighted pay structure. I could pick your brain for hours, but we need to wrap it up here. But first I want to give an opportunity for listeners to get in touch with you, because I think everything you're talking about I know for a fact. There's people out there resonating who are saying I need these systems, I need these processes, I'm ready to scale and grow. So how can people get in touch with you?
Speaker 2:Yeah, if people are interested in the program that I run, it's at grouppracticescalecom and so they can check that out, or my consulting website, visionarytherapistcom. Or my consulting website visionarytherapistcom Love it.
Speaker 1:We'll link those in the show notes for everyone. Kate, thank you so much for joining and just sharing your wealth of knowledge on growing group practices. Thanks for joining us on the Therapy Business Podcast. Be sure to subscribe, leave a review and share it with a practice owner that you may know If your practice needs help getting organized with its finances or just growing your practice, head to therapybusinesspodcom to learn how we can help.
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