The Practice of Therapy

Gordon Brewer: Well, hello everyone. And welcome again to the podcast and I'm happy for you to get to know if you don't know her already, Nicole McCants. Welcome, Nicole. Yes. Thanks for having me.
Yes. And Nicole has got another, she has a podcast and I'm going to get her to tell you more about that. But Nicole is located in Canada and Nicole is a start with everyone. Tell folks a little bit more about yourself and how you've landed where you've landed.
Nicole McCance: Oh my goodness. Yes. So before I forget my podcast is the business savvy therapist.
If you want to learn how to grow, jump in there. I only work with therapists across North America. So I was in solo practice for 15 years. I loved what I did. I saw couples, I did EMDR, but I don't know about you, Gordon, but I just became not quite burnt out, but like I was getting there. I was actually getting really frustrated with hitting the ceiling in my income.
I had a good life, but I had to see, just to be really honest, like way too many clients. Like way too many clients. And then one day, 2016, I become pregnant with twins. Twins. I'm going from a family of two to a family of four and I live in Toronto and my first thought was, I can't work more. I want to work less.
How am I going to do this? The only way to get the freedom and flexibility I knew was to hire. So guess what I did? Absolutely nothing because I didn't know the first step. There was really no business coach that I knew of back then to help me. So I did nothing fast forward. Jackson and Lucas are now two years old.
Mommy's still working until 7 PM. I remember those moments coming home and just feeling like overwhelmed with guilt. So it was just one fateful day that I decided, okay, I'm going to hire. Fast forward, three years later, I have 55 therapist, multiple seven figure group practice, but I'll tell you what I'm most proud of.
It ran without me. This is what I teach people now as a business coach, because I told my husband, I'm doing this to get the freedom. And then of course, once you build a revenue generating machine, what happens? Somebody wants to buy it. Now I wouldn't have sold it to anyone because I did sell in the fourth year, literally zero to four years this happened, but it was a psychiatrist who said, I will, who, who already sold the like who bought multiple clinics, including one from my friend, but he, he said, I will give them all pensions.
I will give them all benefits. So I did walk away like with the ultimate freedom. And then a year later retired. Wow. Wow.
Gordon Brewer: Wow. And now I help
Nicole McCance: people do exactly that as a business coach. Yeah, that's
Gordon Brewer: awesome. That's awesome. I'm looking forward to learning from you because I'm at that point where I'm looking.
Facing retirement here in the next couple of years, you know, figuring out what to do with my practice and to take care of my employees and that, that sort of thing along the way. So, but yeah, so it, with building a seven figure practice, that's pretty impressive. What, what would you say got you there and how did you manage that many people so quickly?
Nicole McCance: Yeah. I'm going to, there's so much I can say, but I'm going to start with like the three biggest steps that you can do. The first is systemize, please systemize before you hire. Because what happens is I find a lot of therapists say, well, how hard is it? I'll just put a job posting app just thrown on indeed.
I mean, I know about people, but what happens is they hire and they hire, but they're not a CEO. Oh, they're a C Q a chief question. answerer. They're overwhelmed. All the questions are coming to them. So I would guys, what you want to do is write down, grab a Google doc and all of your processes, get them out of your head.
That's how I was able to automate because they weren't relying on me. That is step one. And that is the most important step and the most skip step.
Gordon Brewer: I would, I would totally agree and that people hear this from me all the time on this podcast is the importance of learning to delegate and outsource things.
Because I think as a solo practitioner, we tend to tend to bootstrap a lot. And I know that that was a big mistake I made in my practice early on was, was doing too much bootstrapping. And it's, like you said, like you alluded to with your, with your family of just working all the time and there's coming home exhausted because you were playing catch up all day long.
Nicole McCance: Exactly. But I will tell you, we didn't learn anything about business in graduate school. We know this. Right. Right. Right. What made the big difference for me? The real secret is I got a business coach pretty early. The first year was slow. I felt like I was walking in a dark forest. I didn't really know which path to take.
I feel like we feel that way, like which path actually works, but that was key. I got a business coach early. So she kind of walked me through the things to do. She wasn't a therapist, which is unfortunate. She wasn't regulated because there's a lot we can't do, but yes. So I got a business coach early. And I find in my business coaching program, because I'll tell you, once I retired, I said, what am I going to do with my life?
Right? Like, what am I, I still want to help people. And that's when I said, wait a minute, why don't I give therapists, I'll give them it all. Here's my systems. Here's my marketing plans that got me to rapid success. So in my program, guess who grows the fastest. It's those who hire and admin early on. They double their, their, they double their results because they've literally offloaded the minutia.
So don't be afraid. It will change everything. If you find someone you trust to offload.
Gordon Brewer: Yeah. So what tips would you have for people in figuring out what systems and processes to, to implement and how to implement them and, and that sort of thing. I have some ideas about how I went about it, but I'm curious as to how you do it and how you teach it.
Nicole McCance: Yeah. You want a couple of manuals. One is your SOPs. This is a manual that every therapist will get. It's basically how we do things here. So I know your audience is very, very busy. I know I can hear your inside voice guys. I know you're saying I don't have the dive, like who it's boring. Who wants to do a manual, but what if like, we're so lucky Gordon to live in a world that.
Like loom. Have you heard of loom? This video recording? Yes. So what I would suggest doing is the next time you do a procedure that you send a receipt, that you send a new client email, all the things you do, because guess what? You don't, you do the same thing again and again. Yes.
Gordon Brewer: The next time you
Nicole McCance: do that, as long as you have it in privacy mode, so that you can't see any PHI, do a loom.
And walk, talk the person, your future admin through it as you're doing it. So they really know the way you want to click here, do this, then press this, write this, but even better, you know, our best friend, our new friend, Chad, GPT take that loom. Okay, no PHI in it. Put it in Chad, GPT and ask prompt it. Can you please write out, like transcribe this loom into three procedures, and then you move it over in your Google Drive so you don't actually have to type.
Gordon Brewer: Right. Yeah. I love, right, like I, yeah. Yeah. Yes, I love, I love chat, chat GPT, just with all the different things that it's capable of doing and just really also and I learned this from my friend, Jessica Tapana about teaching chat GPT, how to write the way you want it to write.
Nicole McCance: Oh, my gosh. That's amazing.
Yeah.
Gordon Brewer: Yeah. It's actually
Nicole McCance: scary. It's a little bit scary. Yeah. Yeah, it is.
Gordon Brewer: And I know I was listening to Nicole's podcast before we recorded just to kind of get a feel for her style and how, how she does things. And I know one of her most recent episodes is a mutual friend of ours Kim Tilson who has the Traveling Therapist podcast.
And Kim has really mastered a lot of the AI stuff and that's it's going to be a total, it really is going to be a total game changer in terms of, you know, getting back to that topic of systems and processes. It's going to make it so, make it so much easier for us all.
Nicole McCance: We actually have Kim doing a series for my members on how to market with AI and all the things.
So that is systemizing. But let's talk about where the magic really happens, and that's in the hiring piece. So now it's time to hire. You've done, you've done your looms, like you've got all of your SOPs are written down, and now it's time to hire. I suggest Here's the thing. You were in solo practice.
You're moving to a group. That's why you're listening to me properly, right? People go to you for a reason. There's some sort of experience that you provide them. So me, I'm high energy. That's clear. I'm quite direct in my therapy. And I made the mistake a long time ago, hiring somebody that was the opposite of me, but it was impossible to move my clients over because they wanted a flavor.
Called Nicole. Does that make sense? Kind of like your favorite restaurant. If you go to one in a different city, you expect the same experience. So here's my advice, hire your mini me. They're not all your mini me's of course not, but your first one I think has to be.
Gordon Brewer: Yeah, that's a, that's a good a good, a good point.
And I think, you know, spending a lot of time on hiring, I think is an important piece of really vetting your people on the front end, because again, there's so many mistakes I've learned from with that. Gosh, just of which part of your systems and processes and your SOPs standard operating procedures is, is being able to Define how you want things done and setting that expectation on the front end.
Nicole McCance: Oh my gosh. Because if you,
Gordon Brewer: yeah.
Nicole McCance: It can cost you so much and be like, hand's up. I actually have, because of this, a six step hiring model. It's my proprietary method. Six steps. And I tell people that I work with my members. Do not, this is a work marriage, find your perfect person, take your time and only hire the hell yas.
Like after that interview, it should be like a holy cow. I'm impressed. I hope they want to work with me. Don't hire the people that aren't the A players. So six steps and not, and not until you go through all of them. Should you actually hire the person? Like really I, I underline your point. Yeah.
Gordon Brewer: Right.
Right. Yeah. So what other hiring tips do you have as far as knowing how to hire the right people?
Nicole McCance: Oh, so let's talk about step one of my six step model is actually screening. I don't know about you, Gordon. How many times have you gone on zoom? And within five seconds, research tells us, we know if we like this person, we know if they'd honestly, if they're warm and you're like, okay, they, you know, it's worth an hour of my time.
I've jumped on zoom so many times wasted an hour. So I suggest have your admin, once you hire them, I know you're going to now screen them just on the phone, just, just, and here's what you want to ask. Do you live close to the office? You know, Toronto is a busy place. I thought it would be okay to hire people an hour away, and then it snowed.
And they're like, I can't do this anymore. So now I ask, and I actually stop hiring people over 20 minutes away. Do you live close to the office? Are you okay with evenings and weekends? Ask these questions now, because what happens, you're in the interview, you're absolutely in love with this person. And at the very end of your very precious hour, they say, Oh, sorry, I can't work evenings and weekends.
And you're like, Oh, well, that's exactly what the position's for. So that was a waste. Yeah. Yeah. Ask the hard questions before you share any of your energy and time on Zoom.
Gordon Brewer: Right. And what about in writing a job description, what, how do you go about that?
Nicole McCance: Ooh, I love this question. Two things. Research is now showing us, we have an HR professional in America and a Canadian one in, that does like monthly coaching with us.
So she told me this, which is new. Guess what people are doing. They aren't even reading the job description. They're scrolling to the very bottom. What are they looking for? Money. They want to know what are you paying? What's the compensation? Okay. So just know that there's actually a new law in Canada that's just coming down the pipe that legally we have to put compensation, which is interesting.
Like we can't not put compensation anymore, but so then they're going to scroll back up to the top and they're going to, they're going to want to know more about you. And guess what? Please don't offer the boring job description, which talks about these are the requirements. They just see that a hundred times over hook them.
And what I mean by that is what's in it for them. Start with that. Hook them in and they'll read the whole thing. Otherwise they'll bounce.
Gordon Brewer: Right. Yeah. So yeah. So maybe another way to put that is you tell them what problem you're going to be able to solve for them.
Nicole McCance: I love that. Totally. Yeah.
Gordon Brewer: Yeah. Yeah. Yeah, that's a
Nicole McCance: window with an office.
We offer group supervision, peer supervision. There's free parking in the back. We're on the subway line, like all of this, like, Whoa, okay. This is why you want to work here.
Gordon Brewer: Right. So in thinking about scaling, particularly to seven figures, you want to talk a little bit about maybe how. You kind of structured things.
I know you were talking about being a cash pay practice or just being in network with just certain, certain providers, that sort of thing.
Nicole McCance: Yes. So I, 70 percent of the people I work with are American. I'm your new Canadian friend. I was, I was cash pay, self pay, and I help you be that. But there's a lot of people that join that say, I want to stay in network.
So we build that, but maybe get off some of those panels that are such a headache and paying nothing at least. Okay. So I love that you asked this cause this is step three. So it's kind of like systemize, hire, and then market and bring that in the clients. I love digital marketing because here's the thing.
I was, I was busy. I had babies. I didn't have a whole lot of time to do all the things and digital marketing works while you sleep. It's an high ROI. It's just a matter of knowing what to do. Cause there's so much,
Gordon Brewer: all there's so
Nicole McCance: much I can talk about, but I'm just going to talk about Google ads. Here's why I like Google ads.
We're very lucky that we're one of the places that, that people go to Google to look for therapy. Think of your own life. Maybe you're struggling in your marriage. Okay, fine. You'll go to your best friend to say who helped you in your marriage. Or maybe you can't sleep and maybe you'll go to your family doctor.
But most of the time, the third place you'll go, like the top three, you'll type in, why can't my son, you know, the teacher keeps saying he can't stop. He can't sit in his seat. This is my real life, by the way.
Gordon Brewer: You know, and we're
Nicole McCance: going to Google and then we're. And then we're finding that therapist, you can pay, of course, to be at the top, but a lot of people don't know how to do it successfully.
So my program helps them with that.
Gordon Brewer: Yeah. Yeah. That's great. That's great. So in the, you know, maybe another component of Of all of this is how to, how to price your sessions, particularly with a cash pay, but also I would say with folks that are in, this is mainly I guess folks more in the United States knowing how to price your sessions at a level that when insurance pays their, their, the insurance is going to get their discount, but you can also have a buffer on the other end for cash pay.
Yes.
Nicole McCance: And also what you pay, I really want, this is a really important point. Thanks for bringing that up. A lot of group practices are overpaying their people. Listen up. If you have a fully licensed person, please, I repeat, please do not pay them over 60 percent if they're, if so, this is fully licensed. Okay.
If they're pre licensed, it's 50%. If they're fully licensed, It's 60%. But what happens is we love people. So we were like, sure, you know, it should be fine. But if I help people at least have a 20 percent profit margin, if you give too much of the pie away, what is left for you?
Gordon Brewer: Yeah. Yeah. That's again, another, Great point, because again, that's something I made a mistake in early on in my practice was I was paying too much.
And our, my, my friend, Julie Harris, who's been on the podcast several times, and she's the author of Profit First for Therapists. And she quoted, she used a case example of me of doing exactly what you said, Nicole, of paying your people too much without really knowing your numbers. And really knowing what your margins are and that sort of thing.
And what ended up happening to me was I ended up having to subsidize what I was paying people out of what I was producing.
Nicole McCance: And that's,
Gordon Brewer: that's, that's not sustainable whatsoever.
Nicole McCance: Exactly. And then it's like, why did I do this? This isn't how I planned it. You know what I mean? Julie is a monthly expert in my program.
I absolutely love her. And what she talks about is like reverse engineering coming up with your price, but actually not just coming up with, Oh, well, so and so down the road is doing this instead. How much do I want to keep? What's the profit margin based on? Okay. And how much am I going to pay? And then, and that's actually going to help you build out your session.
Which a lot of people don't know. Yeah, really. Right. Right. Reverse engineer.
Gordon Brewer: Yes. Yes. I love that. And that's that, that is a good way to kind of figure out how much you want to work, how much you want to how many clients you're going to need. Exactly. To sustain the lifestyle and salary you want to pay yourself and all of that is just.
Which is really fun. That's my favorite part. Yeah.
Nicole McCance: Yeah. Yeah. When members come in, we're like, okay, let's talk about like how, you know, how big, what do you want? Like that's the, yeah. Yes. So exciting, that dream building. But if we can talk about profit for a second, because when, at least in Canada, I'm pretty, actually, no, I know in the States too, that when you sell.
Guess what they look at? Profit. They don't look at your revenue. They want to know how much profit you're keeping monthly, which is why I help people know their profit and have it be profitable, especially if you want to sell, which really ties into how much am I paying, right? Because if I'm paying too much, I'm not going to be as profitable.
Gordon Brewer: Yes, yes. Well, it's a, yeah, it's interesting too. And this might get a beginning a little technical knowing what to sell your practice for and how to sell it. How did you learn all of that?
Nicole McCance: Oh gosh. Yeah. So I, My friend sold her practice to this buyer, we'll call him, okay? Psychiatrist buyer. And I didn't just say, I'm going to sell it.
This is my baby. Initially, I was like, no, I'm happy here. I'm during a growth fear. Like we're in a growth period, but I watched her life changed. I watched her get paid because I was also worried, like, is that all going to happen? And so when I was finally like, you know what? I think this is a once in a lifetime opportunity.
I think I'm just going to like go for it. What happens is they go through all your accounting, every single contract. They want to know how long they've been there, what they're being paid, when the raise is coming up. And then they usually say, this is how much we're going to give you. And it's based on, now this is going to be technical, but don't worry.
It's only one technical word. It's called the EBITDA, which is basically an accounting term. It's just profit. So. I, it's not like I walk up to them and say, I want this much, seven figures, they go into my books. Right. It makes sense. Like, it's almost like having your house appraised. And then the appraiser says this, yes.
So my business was quote appraised. And then that's when they said, okay, it's worth this much based on the profit that's coming in monthly.
Gordon Brewer: Mm hmm. Or actually
Nicole McCance: technically it's the profit annually.
Gordon Brewer: Right. Right. Did you, when you transitioned out of owning the practice, did you continue to work for the company for a little while?
Really good question. Yeah. Yeah.
Nicole McCance: Okay. So here's the thing, my friends, you probably in your career will get a phone call one fateful day. It'll probably be an equity company. And they will say, well, this, this is what they won't say. I know nothing about therapy and I'll probably blow up your business. But, but what they will say is, you know what, I'll give you money.
But a lot of the time they want you to actually, that doesn't make, that's not freedom to me. This is what happens. You still do the same work, but I, I, I'm going to invest, but I'm actually going to keep some of the money that didn't make any sense to me. Right. So I really was clear that if I sell, you get it.
I did what's called you call it a stock sale. We call it a share sale here where they bought everything they bought at a 27, 000 square foot, 24 office room. And so they the chairs, the desks, like I literally just walked out the door. But I didn't want to leave my people. So for one year I helped them with marketing, but I, I did one meeting a month.
I just didn't want, yeah, with my own personality, I didn't want to have a boss because sometimes they become your boss and it's all, to me, that's not a sale.
Gordon Brewer: Right. Yeah.
Nicole McCance: A sale is a, yeah, I get the freedom. You pay me and that's it.
Gordon Brewer: Sure. Sure. Yeah. Wow. This is, this is fascinating stuff, Nicole. And I know we could probably talk for hours about this.
But I want to be respectful of your time. Tell folks how they can get in touch with you. Number one, but also just what are some other kind of closing thoughts you might have for us.
Nicole McCance: I get the sense that there's a few people in solo practice that really want this. You want this, but you're terrified, right?
I was too. And I think it's just the uncertainty. So I do have a weekly free masterclass called how to build a seven figure group practice that I would just show up. Let's hang out. You'll learn from me because it's just knowing more and then knowing more, educating yourself helps with the fear because the fear is normal, but.
I can guide you. And then I also have my podcast, which is the business savvy therapist. So if you love podcasts, jump on over.
Gordon Brewer: And so Nicole, I'm sure I will have you back here before too long.