Latest / Integrity at Scale™ / The Four Biggest Struggles of Group Practice Ownership (And How to Fix Them)
Transcript
- Okay. Welcome back. Welcome to the first content episode of the Culture Focused Practice podcast. I'm your host, Dr. Tara Vossenkemper, and we are going to dive into the four biggest struggles of group practice owners for group practice owners. I don't know. Same thing. Okay. Okay. So. If you have been in this field for longer than a month, let's say you will probably have run into one or two or four of these things. So I'm just going to talk a little bit about each of the struggles and then I want to talk about some potential antidotes. Yeah, so let's do it. Um, struggle number one, hiring and retention. Man, I don't know what's in the air lately, but hiring Hiring is a fucking struggle. It just is. It's always a struggle. There's like the general issue with it, which is sort of like, um, attracting people and then of course, like the whole application interview hiring process, which I love. And I think you can do very effectively and very well, but then there's also the retention component, but at the base level of that, at like the very, very basic level, what people tend to do that I see consistently is they hire for "skill," but they don't even assess whether or not that skill is there. So if I told you I do X, Y, Z therapy, or I do X, I take X, Y, Z approach, or I do this or I'm this great, like, that's great. I can say anything. I might even be able to talk about it and I might seem competent, so it might seem like I know what I'm talking about. That has nothing to do with how it shows up in practice. So for me, one of the first things with regard to like hiring and retention is that people aren't actually assessing whether somebody can do what they purport to be able to do. That's an issue. So that's one major thing is anytime you are going to hire somebody and they say they do X or Y or Z, have a skills based component, have some sort of skills based portion to your interview process. It adds 20 minutes. You don't need to spend all day having somebody to do something. Excuse me. It could be a 20 minute thing. It could be a 10 minute thing. It doesn't matter anything that helps you assess whether or not They are able to do the thing that they say they can do. That's one thing is basically ensure that the skill is there second. And I would say you, these to me cannot be taken apart. One is not more important than, well, I mean, actually, no, I do think one is more important than the other, but I'm not, I'm unwilling to do, I'm unwilling to hire without both of these things in place. That's what I should say. The second piece is culture. So I refuse, I refuse to bring somebody on who's not a culture fit. Absolutely not. They have to fit with the vibe. So if you're bringing somebody on and whether, I don't know, maybe they potentially they gave you a bad vibe, but they were able to do the thing you wanted them to do, or they, they said they could do the thing and so you hired them anyway, or Maybe, um, the person who normally hires wasn't there that day. And so you're the one that was left deciding, and that's not something you would sell at, or maybe it's your first hire and you weren't even thinking about culture. Or maybe you think they're a culture fit, but you don't actually know how to assess if they're a culture fit. So you have nothing in place to ensure that this person actually is a culture fit. So long story short, when you are hiring. It should be for both. It should. It would be who you if your hiring process included both a skill based component and a culture based assessment, something to try to ascertain whether or not this person that you're going to bring into your life and into your team's life if you have a team will actually fit. So, um, two easy ways of doing that. One is Ask value based questions. Get really clearly defined on your values. Ask value specific questions in your interview process. Two is just always keep it as a filter as you're interviewing this person. But the, and, and three, I guess I said two things, but maybe three things. The third thing is, um, I realized early on that I didn't want to be the only one. I mean, ultimately it's my decision on who to hire or not, but I knew early on, I didn't want to be the only person who had an influence over who joined the practice because it's, it's, it's my practice, but I'm not the only one here. Like, there's a lot of people who are here and who make, make the entity up. And so I need to make sure that these other people also are excited about bringing somebody new into the mix. They're bringing somebody new into the system and that that person is going to, is going to, you know, sort of meld right in. And so even my team now I have, we have a hiring committee at this point, but even early on, I just had people join in on the interview and we debriefed after. And so having almost like a checks and balances for who's joined in the team, especially with regard to culture is a, I almost said it's a power move, but I don't think it's a power move. I just think it's really important for ensuring goodness of fit. So hiring. Struggle. Those are a couple things you can do to really ease that burden is ensuring that you are having culture fit. Join your practice and assessing skills before somebody, before you make an offer. Okay? Second thing that's a huge struggle is that you don't have clarity on roles and responsibilities at the practice. So. It's funny because when you're starting out in group practice land, you are, you're the one building everything. So you are literally doing all of the things, just everything you can imagine with regard to getting this business off the ground and running overseeing people, if you have them maybe like doing billing, still, whatever it is, credentialing people working through HR issues. I mean, everything you are the, you are all of the seats and roles. As your practice continues to grow and your role at the practice needs to start evolving, what happens is that practice owners don't realize, they don't see the roles as clear, distinct things. They just see themselves and it's just like, just imagine, imagine like um, just a blob, just a, just a blob of color and it's sort of like things are melded together and just. It's kind of messy. It's kind of abstract and beautiful, but it's also kind of messy. And so we want to extract some of the color just to say, okay, well, this is purple and we need this much purple and okay, this is blue and we need this much blue. We need to try to tease things apart. So a big struggle, if I'm like circling back now, is that not having any sort of, um, we use an accountability chart because I'm hardcore EOS. So we have an accountability chart, but not having something in place where there are clearly defined seats or roles And then clearly defined responsibilities for that role. So from an EOS perspective, we're talking about, you know, five, like main responsibilities per seat or, or per role, I'm not talking about a position description, which is going to be way more detailed. So when I'm saying seats and responsibilities, I'm sort of like, that's like an EOS lean, of course, in your position description, you would get a lot more detailed. And so you might have up to 15 or 20 different, like tasky things a person does. And then that, you know, catch all at the end, other duties as assigned. But in EOS land, if we are developing an accountability chart, we're saying here's the seat and here are the top five things the seat is responsible for. So when we do something like that, what we also have to then start doing is, and you might've already been doing this, but you need those main responsibilities, that seat, that role, you know, what is it? What seat is needed? What is that person that seat responsible for? But then also you start to develop processes. Well, how does this seat inter interact with this one over here, for example, this is simple, but for example, my billing specialist and my client care coordinator, they have very distinct seats and very different responsibilities, but they are in constant communication because as people come through my client care coordinator and get, you know, set up with a session, for example. There has to be a handing off because my billers and gonna be in contact about, you know, a good faith estimate type things like this is what your, um, co pay as your co insurance or here's details about what you're going to owe for services. There's a lot of these things are separate. Initially again, if you're earlier on, they might be one of the same, but your client carrier, my liaison, whoever this person, your intake coordinator, whatever language you use, they might be doing everything like scheduling, supplies, billing. As you expand and grow, if that is your goal, you will start to tease out seats and have more clearly defined responsibilities for each seat. This includes you. You cannot be in all the seats at once. Well, you can be, but I mean, it's only if you want to. Be like raggedy and run around like I'm running around like a maniac. So number three. So number one, what do we say? Number one is that, um, hiring and retention can be really hard. That's a struggle. Number two is that a big struggle, big, um, struggle of group practice owners is that there are not clear roles and responsibilities. Number three, I'm talking to you is that you're still carrying a caseload. Stop it. Stop it. Get some help. Just get some help. You know, You at some point, I'm saying this like I didn't carry a caseload for years and still try to do it even, you know, up to six months ago, geez, it's hard not to carry a caseload, especially if you love clinical work. It is so hard not to have a caseload. However, you reach a point, you will reach a point if your goal is to grow and expand. And maybe you're saying, shut the fuck up, Tara. I always want to have a caseload. Cool. By all means, if you bake that into your. responsibilities in your seat, then do it. Cool. You can still carry a caseload. I would be very mindful of the balance between the caseload that you're carrying and the amount of time you are needed elsewhere. So that's really what this is about, is if you are doing clinical work, any sort of whatever that caseload looks like, if you are carrying a caseload and you're responsible for X number of clients or patients, then you have not as much time over here to do whatever else might be falling through the cracks. Anywhere from trying to develop processes to trying to create a vision so your whole team can be on board with the direction that you wrote. So that transition from, I mean, it's the E Myth Revisited. I know that's a super popular book. I didn't love it. I'm not trying to bash on it. It's really popular. And it was, it was, it was fine to read. Um, it just is, it wasn't something that I like loved, loved. However, I did love the concept of shifting from working in the business to working on the business. Oh gosh. Was that email or was that someone else? I think it was email. Regardless, caseload is in the business. And so if you're doing something very tasky and technical, like clinical work, you don't have any space and time to think. You can't be thinking about, okay, well, let me take a step up and look down at things and see, okay, how, what direction do we need to go in? How can we get there? You can't do that stuff if you are busy doing clinical work. So, and again, it's about finding your balance. So I'm not saying, you know, don't do any ever again. What I am saying is find a balance where you are able to still work on the business and you know, do working in the business to the extent that you want to for carrying a caseload. Okay, number four. Last one. Oh, this was like a jab in the heart for me to write it down. I hate this one. Not knowing financials or like, you know, being a what's the bird that puts his head in the sand, sticking your head in the sand with regard to financials. I almost said flamingo, not a flamingo. Tara. Come on, Tara. Flamingo. I guess an ostrich or an emu. Maybe ostriches are fast. As a side note, those those motherfuckers, they run like 35 miles per hour. I'd have like a cheetah. You know, it's not like a cheetah fast, but that's pretty fast. You're getting chased by an ostrich. No, thank you. So not knowing financials, don't put your head in the sand is ultimately what I'm getting to. Um, there are some things that you are not going to be good at. That kind of goes back to the roles and responsibilities conversation to just accept it. You can do all the things. But should you like, should you be doing all the things? I will answer for myself. That answer is no, I should not be doing all the things because I'm not good at everything. Plus, I don't like everything. I don't like to do everything. Financials is one of those things in my world, my group practice world. I need them done. I want to trust that they are done well. I want to see my reports. I hate everything about it. I hate everything about it. I hate sending in statements. I hate, I hate it. I hate it all. I just hate doing it still gets done. Not my favorite thing. So you don't need to, some people like this. I've worked with folks who they do their own books. They like maintain their own bookkeeping. They prefer it that way, more power to them. I absolutely cannot. Well, I can't, I can't do it. I would just fuck it all up. So as soon as you can, if you are not good at maintaining your books and you don't know your finances, your financials, that is problematic because you can't stay up on anything. You don't know what's coming in or going out. You can't look at your like monthly profit and loss statements to see. I look at, if you're looking at those, I would look at a percentage based thing, you know, but your monthly and profits state monthly profit and loss statements, excuse me, you can't see where money is going and where. Maybe like you think income is less than what it is or more than what it is. And you can't troubleshoot. You can't be proactive about anything with regard to finances or forecasting or budgeting if you don't have a handle or an understanding of what's happening financially in your business. So if you're not good at that, like me, get somebody hire a bookkeeper. I know a great bookkeeper. You can hire a bookkeeper. You could hire your CPA. If you have a CPA, maybe bookkeeping. I mean, There's a lot of things you can do to help remedy this. But ultimately the struggle is staying on top of financials. And I would say that the ask is that you stay on top of financial. So, uh, that's it for the day. I'm really hoping that this sits home and I am going to ask that you subscribe to make sure you stay up on anything that's coming out. Again, we're talking about all things, culture, EOS, leadership, hiring, retention, people. I feel like. structure. That's kind of E. O. S. This is the cult podcast. Again, my name i and Kemper. If you are in implementing it and using a recent start. This is l This is sort of a recent EOS collective for group practices. So this is for people who are really interested in well that they're currently attempting to implement or integrate EOS into their practice, or maybe they're just trying to get better at it. Go there. It's totally free to join. You can be surrounded by other people who are actively using it in their own practice, including yours truly. And If you really need more support where you're listening and you're like, Oh my God, I have 15 people and I still do everything. Or I like reach out to me. We have, I have another, I have a membership. Go to tarahawesomefever. com. Click on the membership and join. It's practice culture, first membership, a little bit different culture, focus, practice, podcast, practice, culture, first membership. It's a steal. There's a live monthly training every month with either me or an expert, a guest expert. There's a live Q and a every month with either me or a guest expert. So there's a lot more support in that group if you are seeking that. So it has been great seeing you. I hope this is helpful and I will see you next time. Bye.