The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome again to the podcast and I'm so glad to have back with me Jamey Schrier. Welcome back. Jamey
Jamey: Gordon, i'm so glad to be here right before we were talking and catching up and it's been too long
Gordon Brewer: Yes. Yes. Well, Jamey like I said has been is no stranger this podcast He's been on here before and and what I like about Jamey is he brings a unique Perspective in that he's comes from the physical therapy world rather than the mental health therapy world, but there's really There's a lot of similarities But Jamey is a start with everyone for those folks that don't know you Tell them a little more about yourself and how you've landed where you've landed.
Jamey: Well, yeah Well, I started in the private practice world myself as you mentioned, coming in the industry of physical therapy Jumped right into private practice a couple of years after school and made pretty much every mistake possible that we all make being very smart clinicians in our respective fields, but not understanding the business.
Of our industry. Mm-Hmm. After many years of of trial and error and spending lots and lots of money and lots of time and making mistakes, I finally figured out a few things and was able to create a practice that really operated day in and day out without me there. My job was to support the team, monitor the metrics, and create, look for opportunities.
And that was 2013 where I was able to do that, and then people started reaching out to me. First in physical therapy, now we've expanded to pediatrics, mental health speech and language, and other allied health care. And now 11 years later, we've helped hundreds and hundreds of private practice owners build a business that allows them to really make, not just make more money, but have more control of their time.
And have a better, more fulfilled life while still impacting the people they want to impact.
Gordon Brewer: Right, right. And I know as you and I were talking about before we started recording you brought up just a really interesting topic. So you've got my curiosity up, but that is the death of private practice.
So, what do you mean by that? And, and what's on your mind with all that? The
Jamey: death of private practice. Well You know there, there's a lot of things happening right now in our world. There, there's a, there's a lot of uncertainty. There's a lot of things affecting, especially if you're an insurance base affecting the reimbursements of things, the things are supposed to be easier with technology and I just think things are getting more and more complicated as we get EHRs and stuff like that, and it's, you know, the schooling is out of control, you know, spending.
Six figures in your academic schooling, learning this amazing craft to try to help people. And, and yet you're, you're coming out, not making the money that you want, not enough in this case mental health practitioners and psychologists and such. And but with a massive need. So we, we, we are coming to this kind of head that there's all of these challenges and problems that we're facing.
And there's a lot of people thinking that the small private practice, it's over, like, it's, it's done. And I'm one of the people that are saying that, yes, it is, if we don't do one thing, and that is, we need to start taking seriously what we do as business owners. You see, Gordon, no one made us go into business for ourselves.
We could have worked for someone. We could have been an employee, but we chose to go into business. And yet from what I've seen out there and what I've, the people I've spoken to, and I've spoken to hundreds and hundreds and hundreds of people. I speak to people every single day. We don't take seriously learning the craft of business.
We know the craft of our profession. We know we can help people. Why? Well, because we put a lot of time and money and effort into it. But most people were like me. I started my business and the only thing I really did is spent about 12. 95 on a book. My first book called The E Myth. And thinking I know about business because I read a book and struggled for years.
So that's where we are right now. We're, we're on the cusp. If you add in technology and AI, there is huge movements happening. And that's going to affect our industry, all of our industries as well. So this idea of the death of the private practices, you can no longer just be good at your craft. Because guess what?
Everyone's good at their craft. Now, you may not think that Gordon's any good compared to someone else, but you know what? From the outside people looking in, Gordon, you're trained. You do what you do. People are going to want to come to you. But if you want to actually build a business. If you don't want to be trapped by working 40, 50, 60 hours in it, if you want to actually make money and have something to sell, you and I were talking about at some point, all of us need to sell this thing, then you have to build and operate a business and having being good at what you do.
That's a given. The other part will decide whether or not you survive. And because the margins are so darn low now, so many people are not making anywhere near the profit they should be making. By the way, that should be at least 20%, if not higher. Most of those middle class people won't be around. The bigger people will be around because they have leverage and they have money.
The tiny small people, they'll be around because if it's just them working, There's really no overhead. They basically are self employed and they're giving themselves a job, but it's the people that have 4, 5, 6, 10, 15, 20 clinicians working for them, trying to figure out how to appease them, create the systems.
Understanding the key metrics, the marketing aspects of it, the organization of it, the administrative, that takes time and know how. And no matter how good you are helping someone that's going through some depression and anxiety, that doesn't translate.
Gordon Brewer: Right. That's, that's the my thoughts on
Jamey: that.
Gordon Brewer: Yeah.
Yeah. And the other thing too is being able to recognize that the way you did business when you started is not the same way that you do business as you grow. I mean, I'm. just even in my own practice, I'm recognizing that as I was sharing with with Jamey before we started, but the people that listened to the podcast are aware of this.
You know, last year I went through just the death of my wife and all of that, that was around that. And so, you know, naturally my business kind of took a little bit of neglect for me. I mean, I wasn't, didn't have my thumb on things as. As closely as I should have. And, you know, I was making a profit, but I didn't, so I didn't, wasn't too worried about it.
But when I started looking at the numbers and really looking at. In particular, our collections, boy, we had a huge leak, a bunch of leaks in our collections and where the money was coming in and just missing, missing a lot of stuff. And so it prompted me to. Change the system for which we were doing our collections and the way that we did it.
And bottom line is, is I, we hired a billing company to take it out of ends house and, and outsource that so that my intake person, my admin person could focus more on Client care and being able to get them, you know, scheduled and all of those kinds of things. So yeah. So yeah. So what are, I guess maybe my, my thing maybe hopefully this leads to another bit of bit to our conversation.
What do you see, Jamey, are the things that people really need to know or be able to hone in on well? Yeah, to make your business work. Well,
Jamey: you bring up a good point. When you said, you know, the way your business starts out, assuming it grows isn't the same way it ends up, which basically means that there are different levels.
There are different stages or phases in a business in the life of the business. Think of it as a child. Right. You don't work with a child, the same child doesn't think can operate the same at different levels, especially in the teenage years, having 2 teenagers and the business, the same thing. So, when you 1st, start out and start building your business, you're basically a small 1 person operation.
And you can generate, you know, maybe a couple of hundred thousand dollars. Then you add on someone and maybe you can generate another hundred or 200. So around that 400, 000 mark, as you start to surpass that, your business begins to change the needs of the business, begin to change the complexity of the business, begins to change prior to that.
Your focus is what generate clients. And take care of them. That's pretty much it. And collect for your services. There's not a whole lot of complexity with that. You have to do it. But then what happens is, well, now you actually have done it. You're busier. What happens when you're busier? Well, you don't have time anymore to go out there and build relationships and build referral sources.
And because you're busier, you have to hire. You have to hire admin to help you, and you have to hire other clinicians. So now what happens, now you have literally other human beings working for you. But, you still have your clients that you treat. So what do you have to do? You have to sacrifice more time.
It's all you have. So then you work longer hours trying to manage and oversee people that you think, think and operate and work just like you, but they don't. You're the owner. There's something about you. You have that entrepreneurial thing inside of you. They don't have that necessarily. And the mistake so many of us make is we think they do.
And then we're surprised where they leave at five o'clock. And you're like, well, the client is a little late, don't you want to stay and work with them or you're sorry, can't work with you. And then, you know, they start to do things where you don't have systems and processes in place. There isn't any type of organizational flow to the business.
So that's a whole nother level of complexity. And so many people never get out of that 400, 000 to about 900 to a million. That's like the next point, but if you are fortunate enough to put some systems in place and to learn how to delegate and to stay on point with some of your metrics, as you found out, you start to rise above the million dollar mark, which is a natural inflection point to that stage three business.
And that stage three business can be anywhere from a million to 2 million or, or thereabouts. And in that stage. The stuff that you did before isn't going to work now that stage needs management. Organization. You need to tighten up things. You as the owner need to start removing yourself from some of this admin jump that you're doing, that you're being trapped in the business.
And as you begin to do that, your business then continues to grow. So those are the most common three stages. And of course you have then the next stage that goes to 5 million, the next stage that goes to 10 million and above.
Gordon Brewer: But most
Jamey: people never get out of Most people don't get out of stage two, a million dollars, but if you're fortunate to get to a million, then it becomes a little easier because if someone leaves, you're not hit financially as hard as if you had 600, 000 business and one of your therapists left full time.
I mean, that could be a couple of hundred thousand. All of a sudden a third of your business is gone.
Gordon Brewer: But if you have
Jamey: 25 therapists and you're doing two and a half million, you're not as. You're not as impacted. So how you handle each part of your business, how you think about your business is very predictable.
So when we first look at a client, the first thing we want to know is where you are at. So we have people take a quiz and I'll, I'll share with that later because I want to know where you are in your business, not just financially, but where you are with what you're doing in the business, where you are with the number of staff, people that you have.
Clinical people versus admin, because I can guess right away the problems you're having Gordon, they're so consistent mental health, physical therapy, you know pediatrics, it's the same. And in fact, it's the same in any business. It could be lawyers, it could be doctors, it could be accountants. It's it's it's the challenges of money is really what it comes down to.
In order for you to make that kind of money, you need people beyond yourself. And the minute you have people, that's where the initial complexity comes in that 400 to a million.
Gordon Brewer: Right. Right. I've just I'm almost finished with it, but I'm listening to the book and you're probably familiar with it.
It's 10x is easier than 2x is is the title of the book. And it's really exactly what you're talking about is, is that what gets you to two times bigger, isn't the same thing that's going to be able to get you to 10 times bigger. And it really has to do with being able to learn how to delegate well, to hand off those tasks that you don't do well yourself and, and give them to people that can do those and you get your return on your investment tenfold by doing that.
Yeah. The magic
Jamey: of that book and Dan Sullivan. So a funny story. I was one of Dan's students. 20. Oh, wow. 20 years ago, almost 20 years ago, 18 years ago. I was involved in his, his program for many years and I learned a lot of these, these concepts and frameworks and then I applied it into this medical community.
So very familiar. I was, I was there when he actually came up with that concept. He was kind of playing with it. Didn't know what to call it. He called it the 10X concept,
Gordon Brewer: but the
Jamey: idea isn't about going 10X. I always thought because, you know, sometimes I see things literally, it's like, I got to go 10X. I'm, I'm at a million dollars.
I gotta go 10 million. I don't want to go 10 million. That's, that just sounds like a headache. It's not about going 10 million. It's about what you just said. It's about getting out of your head of trying to work harder. When I tell people, well, we help you make more by working less. It isn't because that's what I want.
It's that's what actually works. And the reason that works is because you run out of time. So you can work 80 hours a week as some attorneys do, and you can make a lot of money. You charge a bunch of money, but you, you can't have both. Like either you're working a ton of hours, making money, or you're not working and you're not making money.
Well, in our field, a lot of times. As owners, we're working a ton of hours and we're still not making that much money. So we don't even get the pleasure of actually making money. So what do you do? You have to leverage. So how do you leverage? You need help. And this is where we're in. This is where some problems come in because as very smart, very talented, very capable people as we are very smart, very smart.
We don't think people could do it as well as us. So it makes us difficult for us to let go. Well, if we don't let go of things, then we just keep holding on to stuff on our plate and other people aren't as busy. We're busy as hell. And they're almost like watching us. I don't know if that's ever happened to you.
It's like, your, your schedule is packed and your staff is like, can I go home early? I don't have a lot to do. You're like, Wait a minute. This is, this is the wrong picture.
Gordon Brewer: Yeah. Yeah.
Jamey: But when we do learn, and it's a, it's a learned skill when we learn actually how to properly delegate starting with things that we don't like, and we're not good at.
That's where we start. We don't start we like. We don't start the stuff we're really good at. We start with the stuff, typically the administrative junk. The stuff that we just do out of habit, but we don't particularly want to do. That's the things that we really want to focus on. For me, one of the first things that I delegated was bookkeeping.
Now, if you know me, you would be like, Jamey, how the heck did you do bookkeeping? And the answer is, well, I really didn't. I was off every month by thousands of dollars. I didn't know half the stuff I was doing. I didn't know how to reconcile. I didn't have the patience for that. And it just put me in a hole, my bookkeeping was really, if there was money in the bank, I was in a good mood.
If there wasn't money out in the bank, I was in a bad mood. That's not a great way to run a business.
Gordon Brewer: No, no,
Jamey: so but anyway, so these are some of the really key things. That all of us, me included, I had to go through the same thing of letting go and delegating. And then the other really key thing I can share with your audience is making sure that your staff as you grow, does not have any confusion about their role, what the company is about, the values of the company, And what's expected of them and what they can expect from you if every one of your staff understood those things that I just said, your business would explode in a good way.
But I've talked to so many staff people because we do some leadership training as well with some of our clients and their teams. Without the owner there, and the question that we always ask is what's confusing? Where's the friction? And they invariably say, I'm not really sure what I'm expected to do.
Like, started doing this, and now the job has. Kind of changed and, you know, I said, well, what about your job description? And you're like, well, 80 percent of that doesn't even apply anymore. Well, don't you have regular meetings? No, not regular meetings. Well, don't aren't you clear about what's, you know, your, your targets or KPIs?
No. Doesn't the owner support you and help develop you as a. No, they're just really busy.
Gordon Brewer: Yeah.
Jamey: So these are all the clues that if we have owners fix them, not only will retain people, we'll create more productive, better people that are in line with our vision.
Gordon Brewer: Right.
Jamey: I know I make it sound simple because in my mind it is what's not simple is actually doing it.
And you growing into this role as this type of owner, this type of leader, that's not easy to do. But what you need to do is not complicated, like
Gordon Brewer: right,
Jamey: you don't need to do a million things wherever your business is focused on those areas.
Gordon Brewer: Right, right. And I, and I think it's one of the things that I know for you and I both doing consulting with people and, and helping people in this journey is that we can sit here all day and tell you what you need to do.
But I think it's, it's important to invest in the how. By getting help from others and not try it. Like you said earlier, not trying to do too much of it alone or trying to bootstrap too much. And I'm notorious for that, doing that. I mean, it's kind of like, Oh, here's a problem. Let me figure out how I would, how I would fix this rather than saying to my admin.
Here's the problem. You fix it. I mean, that's really like a who,
Jamey: who, not how mentality. Yes. Yes.
Gordon Brewer: Exactly.
Jamey: Fix the problem versus how can I do it?
Gordon Brewer: Right. But when you are used
Jamey: to doing things Gordon on your own. You know, and this starts back in our school days, our academic world, we're taught you do it on your own.
We're not taught collaboration. That used to be called cheating back when I was in school.
Gordon Brewer: Yeah.
Jamey: Now maybe they're talking about collaborate, but we're not, we're not taught that in our upbringing.
Gordon Brewer: And
Jamey: then all of a sudden we open up a business and it's all about collaborative, think about this. It's about collaborating school.
They call that cheating. It's about failing school. It's called failing in business. It's called learning, right? Asking for help, right? In school. I mean, asking for help. I mean, you're not as smart as this person's not asking for help. Like you're less than. In business. And, you know, I had as big as ego as anybody.
It wasn't until I hired my first coach, you know, when we're talking about Dan, like, I'm like, wow, this is actually making life easier on me. Like that was a hard concept to take is making this easier for myself. It doesn't have to be so darn difficult and taxing. That was a tough thing for me to overcome.
And now looking back, I realized. Why, because in school and, and growing up and stuff, it's like, I had to work my butt off to get the result me and me alone.
Gordon Brewer: And now I
Jamey: realize I can collaborate with people, learn from people that have been there, learn from other coaches and experts and stuff like that. So, we, we, we sometimes due to our ego or whatever, we, we make it really difficult on ourselves because of, you know, the fear of collaboration, the fear of getting help, or maybe the fear of, well, what if it doesn't work for me?
And I'll feel worse than I do now, or, you know, what if I don't get back the money and that investor, whatever the stuff that's in our head, but the reality is, if we don't learn these fundamentals of business, there will be a death of the private practice.
Gordon Brewer: Yeah, for
Jamey: sure. They'll start to disappear because of the squeeze that will happen.
The margins aren't there. We're working our butts off. We're not getting that work life balance and there'll be the really small people. And they'll just be the larger companies starting to see that with the consolidation that's happening.
Gordon Brewer: Yeah, but it doesn't have to
Jamey: be that way. It doesn't have to, we just have to step our game up because I believe in Main Street and I believe in, you know, we are the people that make this happen.
The VCs, they'll come and they'll go.
Gordon Brewer: They'll come
Jamey: in when the market is hot. Right now, mental health is hot. Lurk it up, scoop it up, get a bunch of money in it and then move on. Right? That's what they did to PT. Now mental health is the next big one.
Gordon Brewer: Yeah.
Jamey: But but us? The mom and pop, the small private practice that are doing anywhere from 500, 000 to 234 million.
All we have to do, cause there's not a lack of people that need our help. We just got to step our game up and create more of a business. That delivers amazing care also creates a profitability that doesn't kill the owner doing it.
Gordon Brewer: That's all we
Jamey: have to do. And we'll be just fine.
Gordon Brewer: Right. Well Jamey, I've got to be respectful of your time, but you've got some resources and things that you can provide listeners with.
Tell them about that.
Jamey: Yeah. So the biggest thing to do is just become aware of where you are. The solution is in the problem. Right. So I developed a practice assessment, a practice quiz that we have everyone take and it's very informative. So and you'll have it in your show notes, but you take the quiz, we're going to ask you a bunch of questions.
It'll take about 5 minutes to do. And then based on your answers, you'll get a report saying all the things that are going on in your business. And exactly what you can do. So this, this quiz and the reporting was based on my, you know, I've been in this industry now, 28 years. It's based on all of my experience personally in my own business.
And then having worked with hundreds of people over the last 11 years. So it's really eye opening and allows you to get clarity and clarity is a big thing. So I would recommend start with the quiz. It's free. It takes five minutes and it'll give you lots of information. And then from there you can then determine what the next best step for you is based on whatever.
Whatever it says.
Gordon Brewer: Yes. Great. I'm glad we reconnected and hopefully we'll connect again here in the future and be sure and check his things out folks. And what's your website Jamey
Jamey: practicefreedomu. com the letter U. And
Gordon Brewer: then you can
Jamey: find me at Jamey Schrier all over social media. I give away lots of stuff there. Lots of things. Like I just believe in giving all of that away. So no one knows. So no one is questioning what to do. It's really about having the accountability and the, and, and someone there to help you do it.
That's really where the magic is.
Gordon Brewer: Totally agree. Well, take care and Jamey, we'll talk to you again.