The Practice of Therapy

Gordon Brewer 0:00
This episode is brought to you by the solo to group practice webinar. It's a free webinar that you can find at practice of therapy.com slash group, and also brought to you by therapy notes therapy notes.com.

This is the practice of therapy podcast with Gordon Brewer, helping you to navigate your private practice journey.

This is session number 183 of the practice of therapy podcast. Hello, folks, I'm Gordon Brewer, glad you're with me, I hope you're having a good start to your summer. And that June is treating you well. You know, as this episode is coming out, I believe today is the summer solstice, Monday the 21st. Or maybe it's the 20th. I don't know for sure. But anyway, it's the longest days of the year. And so it's been nice to be out and V be out late at night and be able to sit on my porch and watch the wildlife come out at dusk and it still be warm enough to do that. And yeah, I just love this time of year, especially in the evenings as the sun is going down. And so kind of mob kind of my routine is my wife and I will get on our back deck and we'll sit out there and have our evening libations and just enjoy the evening with each other and just catch up on our days. But anyway, not to digress too much, I hope your hope your summers are good. And I hope that you're getting to spend some time outdoors because I just as that is the place to be after being cooped up all winter. And after coming out of a pandemic, it's just nice to be out in the out there. So,

in that, as I might have mentioned already, I don't know if I did, I'd be in this particular episode. This is a solo episode, and I'm gonna share with you my thoughts about the different ways in which people can go into private practice. I haven't talked about this in some time. But it really, really kind of, you know, with all the things that have happened over this past year, particularly with telehealth, and just with the kind of upswing of things like these, these online therapy platforms like better help and talk space and those kinds of things, I wanted to share with you just some of my ideas around around those types of things. And really kind of do another dive into if being in traditional private practice would be a good fit for you or not. And so I want to I'm going to be talking about those things. And here in a bit. But before we get to my this particular episode, I want to invite you to go over and take a look at an upcoming c II event. And our it's one that's going to be available kind of on demand over the over this next month. And it's a sea event that has been put together by my good friend, Dr. David Hall over at psych Maven. And it this particular CEO event, and it's a free CEO event is talking about the ethics of business practices in private practice. And the title of this is ethical business practices for psychotherapists is the name of the of the CEO event. And you'll get one one free c kradic. Credit by going to this and if you'll just look down here in the show notes in the show summary, you'll see a link there for that the URL is a little long to kind of mention here. But if you just click on that link, that'll get you to the landing page in teachable where you can enroll in this particular training event for free. And I'm really thankful to my friend, Dr. David hall for putting this together and for just beginning back to by giving people these these free events. And I think it's good for 30 days, once you sign up, you have 30 days to complete the event. So yeah, so be sure and check that out. And again, check the show notes or the or the show summary or wherever you're listening to this and you'll find a link there. The other thing I want to mention before we get to me just talking about the different ways in which we can be in private practice. I'd like for you to go over and check out our sponsor of the podcast. And that is therapy notes. And if you'll use the URL practice of therapy.com slash therapy notes, you can find out more about them. Therapy notes is the leading Electronic Health Record system. For private practices, they are the most one of the most highly rated of the EHR is out there. And they're really specific to mental health. And those of us in private practice, they're who I use, in my practice, they have a patient portal that is really second to none. They also have scheduling and appointment reminders that are sent out to your people. Also there, they will file you through their through their platform, you can file your insurance claims electronically. It's really an all in one kind of platform. Also, they have telehealth available through their platform. Again, I am just thrilled to death with with with this particular EHR, I've had some others. And this is hands down the best that I've ever used. So be sure and check them out practice of therapy.com slash therapy notes. And when you, you can check them out for free, you can try them for two months for free by simply using the coupon code, Gordon, just g o r d o n. And again, you can get to them by going to practice of therapy.com slash therapy notes. And so without any more yapping on my part of in this introduction, let's want you to listen in on my thoughts about the different ways in which we can be in private practice.

Well, folks, thanks again for being part of this particular episode. And as I'm out, I mentioned already, you know, one of the things that kind of inspired me to do this, this particular episode, which is really thinking back at my previous episode with Dr. mnos. And really our conversation around insurance credentialing and being contracted with, with growth therapy, which is the company that he's with. And one of the things that that really got me to think about is it also by listening to some other podcasts, my good friend, Whitney, Whitney, oh, and who has the faith, faith and practice podcast. So shout out to Whitney here, this episode, had someone on where she was just kind of doing a coaching call with them via the podcast and just talking about, you know, starting a group practice. And I was just one of the things that I realized is that, you know, private practice isn't necessarily for everyone. I think it takes a special person, not necessarily better than somebody else, but takes kind of a certain kind of, as my friend David Hall says, intestinal fortitude, to be in private practice, particularly if you go into group practice, or that sort of thing. But, you know, as I think about the number one reason that I hear from people about why they want to go into private practice is, is because of the autonomy that it gives them. You know, being your own boss, and really just working for yourself, is I think, appealing, just because it gives you a lot of flexibility of your time. And you get to decide on how you want to do things within your practice and how you want to run things. But that being said, That's not for everyone. And I realized that there are a lot of people out there that would really prefer to just work for somebody else. In other words, they would like they like the security of having benefits of being employed by somebody of having to some degree, some predictability with their income. They might want, you know, the benefit of having a retirement plan, health insurance and that sort of thing, which can be done within the context of private practice. But you have to be able to be willing to kind of put the work in on the front side. So one of the things I mentioned about this is

as a private practice owner, in a traditional sense of a private practice, of having your own office space of being able to, you know, kind of hang out your shingle so to speak, and have clients come in to see you, you work on getting your own referrals, you run the business side of things on your own, all of that, and maybe even getting growing to the point where you start a group practice, and all of that sort of thing, that takes a certain mindset and really kind of a certain drive to some degree, people that are in private practice, have their own practice, have really need to have kind of an entrepreneurial spirit about them, they, they need to like the challenge of all of that. And so there are some people out there that want to be in private practice, but they just really do not like the challenge of that. They don't like the risk that it involves, and that sort of thing, which is not, which isn't, which is okay, I was gonna say, if you are that way, if you're interested in private practice, but really not interested in growing something big or really kind of starting the next big mental health agency in your community, you don't have to, you can certainly just have a very successful private practice just as a solo practitioner. But that being said, one of the one of the things I want to kind of highlight in this particular episode, and really talk about in terms, excuse me, in terms of the different ways of being in private practice, is just with all the things that have happened over this last year with the pandemic, we saw a huge a huge increase in the use of telehealth. And it's really become very acceptable for for people. Not only on the giving end of that, but on the receiving end of that. So it's very possible to build just a completely online practice, where you do nothing but see people online, that's very possible. So that's one model of being in private practice. But one of the things I want to think about is the other ways in which you can be self employed. And that would be to put yourself out there as an independent contractor. Now, again, this is something that has become become very popular over this last year. And we have seen just exponential growth, with platforms like better help and talk space, and seven cups of teas. And there are several others out there, where they basically provide you a platform, they will also send you clients, and all of that sort of thing. But you're hired as an independent contractor to do those things. For some people that might be very appealing, that might be the way to go. Personally, I like the challenge of figuring out new things, of really kind of putting things together on the back end, and being able to do my own thing and be independent of any sort of thing like that. But there might be people that might not see it that way.

We I had one per tale tell this one to one particular therapist of mine that joined my practice towards the end of last year. And this particular therapist was also doing, doing some side work on one of these particular platforms. And ultimately, she made the decision to just go do completely contractor work, which I was sad to say or go for my practice. But I understood it based on her lifestyle and what she what she wanted for herself. And so she is just doing nothing but contract work online now. And I would say that is that is being in private practice. But here's the thing that you need to know about going that route. And this is something that I really like to make sure people understand. If you are if you are doing nothing but contract work. In other words, you don't own kind of a brick and mortar, private practice that is your own practice. But you just hire yourself out to other practices, either within your town or just online or whichever way you are still self employed. And that's one thing that a lot of people might get themselves in trouble with. If they start down that route where they start doing a lot of contract work for others, and then at the end of the year, those other places other entities will give you a 1099 and it will show Everything that they have paid you for the year, you still have to pay taxes on that. And if you haven't been playing self employment, estimated self employment taxes throughout the year, you could also be stuck with a fine. So it's real important to talk to an accountant if you want to go that route. And even if you want to go a traditional solo practice route, you need to talk to an accountant and really understand the financial side of all of this for you. So, here, here's some ideas I had, though, you know, again, if starting a private practice where you own the business is, might not be appealing to you, just the idea of having to market your practice having to, if you're going to have a group practice having to hire people, being in that leadership role, where you're really dealing with a lot of people, maybe all of that sounds really intimidating, intimidating to you, it doesn't have to be. But if it does sound that way, and you're really your your goal is just to see clients, and to do the clinical side of things, without having to do any of the business side of things. putting yourself out there as a contractor might be the way to go. So I'll just put that out there also, I would say, it might be that just, you don't necessarily have to go strictly the contractor route, you could be employed by a private practice, all of the people that I have working within my private practice, are w two employees, provide them with benefits, they have health insurance, retirement plan, they've also got disability insurance, we've got workman's comp insurance, all of those things that you think about in terms of, we also have a retirement plan. All of those things that you think about in terms of a traditional employee kind of thing might be what you want to do in the context of joining a private practice somewhere. The other thing that a lot of times you have with that which kind of goes back to what I had talked about at the beginning, around autonomy is that you can also get the autonomy of being in private practice. I know for example, in my practice, everyone sets their own schedule, they decide when they want to work, they decide also how many clients they want to see, I don't hold them to any sort of, you know, if they're happy seeing 10 clients a week, and they want to work for me, that is fine, they will do that. If they want to see 2530 clients a week, they can do that. And we'll we'll do that. That's,

again, the way I've got it set up as an incentive base system so that the more the more clients they see, the more rate the higher their rate goes or what they're reading, what they're reimbursed, or they're not reimbursed, but what they're paid for those sessions. So that's a W two model that I use. But it might be that you would find in a practice that has a contract way as hiring contractors. And they have a contract or model and say, you come up with an agreement about what you're going to be paid per session. For some folks that might be more appealing than running the whole business side of things. But you still need to treat yourself as if you are running a business, particularly if you're a contractor. Because you do have to be responsible for your self employment taxes, and you are considered self employed. The other thing that I would recommend for people that want to go, just a full contractor kind of route of being in private practice, where they don't necessarily own the business, but they're hiring themselves out as contractors is to still form a separate entity for themselves form an LLC. And I would say talk to an expert about that, talk to an accountant, maybe talk to an attorney about that. But that would just protect you more, just all the way around by if you're contracting yourself out, you're really just contracting out your LLC. And not to get too far down a rabbit hole on another topic is the there are different ways in which you could be taxed as an LLC and basically it's either be taxed as if you are a solo proprietor, which is called a disregarded in entity or you're taxed as an S corp, which is, essentially you're an employee of your LLC, and you pay your LLC pays taxes, and then you as an employee, pay taxes. Those are basically the two ways to set up an LLC. And talk to an accountant about that, because depending on how much you're making, you might be at a tax advantage to do one or the other. So anyway, didn't want to get too far off on that tangent around taxes. But, again, I guess my point with this whole episode is, is that there are a lot of options for people now in what and ways in which they can be in private practice and have the autonomy that that brings. The other. The other thing I would say is we're talking more about solo practice in terms of either just owning a traditional private practice where you are a sole proprietor or a disregarded entity, you have a space that you see people in, and you handle all of your own stuff in terms of paperwork, and getting referrals and filing insurance claims, and all those sorts of things. That is certainly the most autonomous way of doing this. But maybe a step up from man or a step in another direction with that would be to hire yourself out as a contractor so that somebody else does all of those things. For you, as far as getting your getting your referrals, setting up your appointments for you, all of those kinds of things, and then working as an independent contractor. Again, you still are treated as if you're self employed with that way. And then the other thing I'll mention here is, is to think about growth going into group practice, maybe you're already a solo practitioner, and you're thinking about going into group practice.

If you love a challenge, if you love the entrepreneurial sides of things, if you love leading people, if you are if you love the excitement of growing a company and bringing on more and more people, that's the way to go to start a group practice. Quick plugin for my friend, my friend, David Hall, and I put together a webinar just about going from solo to group practice. And you can still access that by going to practice of therapy.com slash solo to group are no group, excuse me, it's the practice of therapy.com slash group and you can still access that webinar that would that way you can dip your toe in the water around just going from solo practice to group practice. But anyway, so let me recap, try to recap here about the different ways in which you can go into practice, private practice, what I would call the traditional route, where you get licensed, you're, you're licensed as an independent, licensed person, you start a solo practice where you give it a name, you can form an LLC, you lease or buy a space to meet with people in that is, you know, kind of a traditional route. And then you get people get referrals and that sort of thing. And you you begin to work with clients. In that particular model, you have to be concerned about the business side of things. And also with that particular model, you can go the grow, go grow at 10 go the group route. The other ways you can't necessarily start a group practice. But with this particular traditional way of being in solo practice, that's one way of doing it. The other way of doing it is to go to work for another private practice or a private practice as an employee, if they're hiring employees. And that way, you get the benefits of being a W two, and all of that, or you can be just hire yourself out as a contractor where you are not employed by anyone, but you just contract your your services as a therapist to any number of entities, whether it be an online entity or whether it be an in person in entity. All of those are ways in which you can do that. And so, again, that's kind of a contractor model of going of putting yourself out there in private practice, but you do need to recognize the tax implications of that and make sure you're talking to an accountant or an expert about being an independent contractor. In some states, though, I will say this is that they don't allow independent contractors, you've just got to be employed by a private practice. So, again, the cost benefit of that is if you want to go the full blown, private practice, owner route, there's a lot of excitement with that. And you really need to love a challenge, and need to be willing to learn new things. And being able to do that. If you want to just stick to doing clinical work, without having to worry about the business side of things. Find yourself either a job with a private practice or an agency, or hire yourself out as an independent contractor. That works as well. So anyway, hopefully, this has been helpful information for you, of just thinking about the different ways in which we can be in private practice and the different models and ways in which we can run that for ourselves.

Well, folks, I hope that maybe gave you some things to think about just particularly those folks that might be listening, that are in those kind of beginning stages of thinking about going into private practice are learning how to be an independent contractor. In my mind, they're kind of both the same. But there's different ways in which you need to go about that. So hopefully, this has given you some helpful information. And if you want to check it in the, in the show summary in the show notes, I'll have a link there that will get you to the comparison sheet that I put together, that will give you just some ideas about, you know, kind of the pros and cons of the different kind of models you can adopt or ways in which you can go in the context of being in private practice. So be sure and check that out. Also, thanks. Thanks again to my friend, Dr. David Hall. And the fact that he's put together a free training that it will you can get one C for and that is ethical business practices for psychotherapists, and again, if you look in the show summary and show notes, you'll get a link to that. And you can enroll in that. And I think it's going to be be available for the next 30 days. And, again, grateful to my friend, Dr. David Hall at Site Maven, for all the content that he puts out there in terms of just offering a lot of free, great quality stuff for people just in the private practice space. So be sure to check that out. And also, as usual, Big thanks to our sponsor for the podcast, therapy notes. And if you'll get a practice of therapy.com slash therapy notes, and be sure and use the coupon code, Gordon just you are do we and you can try them out for two months for free. Again, therapy notes is who I use my practice. And I can just can't say enough about how great they are. And I've been very pleased with the platform is just so versatile, and there's so much there. That will just make automating your practice and all of that sort of thing just much easier. So check them out, practice the therapy.com slash therapy notes. So this wraps up another episode of the podcast. I am so glad you've joined me for this. If you haven't done so already, be sure and take time to subscribe to the podcast, wherever you might be listening to it. Whether it be on Spotify or Apple podcasts, or Google podcasts or Stitcher or any of the other numbers of places you can listen to podcast and leave us a rating and also a review. I love getting some honest feedback from people and got lots of great guests coming up here in the future. Took kind of a sidetrack here by doing a solo episode but it was just something that was on my mind that I thought was fitting to put in here and so take care folks, have a good rest of your weekend. Happy summertime to you. Take care folks.

You have been listening to the practice of therapy podcast with Gordon Brewer. Please visit us at practice of therapy.com for more information, resources and tools to help you in starting building and growing your private practice. And if you haven't done so already, please sign up to receive the free private practice startup guide and practice of therapy.com. The information in this podcast is intended to be accurate and authoritative concerning the subject matter covered. It has given with the understanding that neither the host guests or producers are rendering legal accounting or clinical advice. If you need a professional, you should find the right person for them.