Episode 128: How To Successfully Grow + Sell Your Private Practice [featuring Nicole McCance]

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Transcript

PATRICK CASALE: Hey, everyone. You are listening to another episode of the All Things Private Practice podcast. I'm your host, Patrick Casale. I'm joined today by Nicole McCance, who is a psychologist, retired, turned business coach for therapists. Scaling to a group practice she expanded her private practice to 55 therapists and multiple seven-figure years three years in a row, sold her clinic in the fourth, and then retired in the fifth. So, she now teaches therapists how to help more people make more money and have more freedom.

Nicole, thank you so much for coming on. You were a part of our summit a couple of months ago. And really enjoy to having this conversation.

And fun fact, Nicole is in Canada. We don't have any Canadian guests, so I'm excited for you to be here.

NICOLE McCANCE: Yes, me too.

PATRICK CASALE: So, tell the audience anything I missed. I hate reading bios. I hate when my bio is read. So, tell us anything that's really important for the audience to know.

NICOLE McCANCE: To be honest, I didn't plan, just like you, to be in a group practice. I was in solo for 15 years, seeing couples, doing EMDR, loved what I did. And then one day, I got pregnant with twins. And I said, "How do I make more money because I cannot see more clients?"

And that's when I became really frustrated with hitting the ceiling in my income. So, guess what I did? I did nothing for two years. And Jackson and Lucas were born. And you know why? Because I didn't know the first step to take. And I wonder if your listeners relate.

So, I didn't want to make the wrong step, so I did nothing. Now I have two-year-olds, I'm working until 7:00 PM. And these chubby little babies, their faces smashed against the glass waiting for mommy. And I just couldn't do it anymore.

And then I turned to my husband and said, "I'm going to hire." And I jumped in, it was a lot of trial and error. But what I did that I think was unique and had me hit one million in our second year, and then, scale, of course, and sell eventually, was I found a business coach because there wasn't a whole lot out there, because we're so highly regulated.

So, I took the aspects of business, and I applied it to our highly regulated field. And it worked. And now I teach people how to do exactly that.

PATRICK CASALE: That's awesome. And I think that's really relatable too. Like, for me, when I started my group practice, it was a situation where I was like, "I'm growing, I'm growing. I'm growing. It's COVID. I'm taking on more clients than I can really handle."

But I'm like, "But I'm working from home. So, like, am I really using that much energy?" Obviously, yes.

And one day, a friend reached out was like, "Hey, would you hire me so I can get the hell out of the hospital system?"

And I was like, "Why would you come work for me if I can teach you how to do this? Like, that's what I do." And he's like, "I just want camaraderie. I want connection. I don't want to deal with the business side of things."

And we've been a group practice for a little over three years. And our retention rates are unbelievably high. I think we hit 1.8 million in revenue this year as a first-year W-2 practice.

NICOLE McCANCE: Yay, congrats.

PATRICK CASALE: Thanks. And, you know, the ability to offer more jobs, to see more clients, to help more people, and for me to take [INDICERNIBLE 00:03:39] back as the person who really is no longer practicing as a therapist.

NICOLE McCANCE: Can I just say, we are so lucky that we get to make, like have a very… the number you just said is a very successful business, your parents can be really proud, and make a big difference that desperately needs the difference on this planet right now.

PATRICK CASALE: Yeah, absolutely. And that's the thing is like when you step back, and you kind of zoom out of your business instead of you're always working in it, because you're like putting out fire, it's like, okay, how can we continue to expand in a way where our business prioritizes people over profit? I want to make sure people are making a good living. It feels like they have a good supportive environment, very different than community mental health or other practices out there. And how do we stay afloat to ensure that if I do decide I want to sell down the road, that that's an option? Because most of those things can happen. And I think you just need to know how to strategize and do these things in order to grow in a way that makes sense.

So, you grew pretty rapidly. Do you want to talk about… a lot of people that I come in contact with are, "Nobody wants to work, nobody wants to apply." I'm like, "I just got a hundred applications over a two-week period. And I can't even go through all of them."

So, I don't think that's true. I think if you make good culture, then people will be attracted. And I think that's all you really have to do. So, tell us a little bit about what your process was like.

NICOLE McCANCE: Yes. Before I do, I just want to touch on that. I do have tons of Americans in my coaching program and Canadians. It does depend where you live. New Jersey, I don't know why they really struggle to hire. You know, other states, I mean, are way easier.

But just a little tip on that, have your job description be a love letter to them. And a lot of people at the top of their job description, they outline all their requirements, which is really boring, and you're going to look like everybody else. What if at the very top you put what's in it for them? I'm going to create your dream job. You know, we offer this, this, and that. And now they're listening, and they're going to apply. So, I think it really starts with a really good job description.

PATRICK CASALE: 100%. And I've done some coaching work with some folks about how to create a job description, because ours is like, do you want to work in a private practice without having to do any of the business side of things? And like, do you actually want four-day work weeks and self-care, and practice what we preach in a profession [CROSSTALK 00:06:21]-

NICOLE McCANCE: Yes.

PATRICK CASALE: …don't? So, if you can make your job description really personable, like you said, like a love letter to the people who are reading it, really showcasing, like, this is a place that is going to take care of you, not the traditional job offer that's like or job posting that's like, "Looking for licensed clinician, this type of experience…" This, this, this, this, bullet point bullet-

NICOLE McCANCE: Exactly. They're skimming over it.

PATRICK CASALE: Yeah, I'm not reading that. I'm just moving on to the next one.

NICOLE McCANCE: Yes. So, I'll get into what I did and how to… and this also relates to how to have a company that is profitable. Yes, we want to put people over profit. But you also want to make a living. We're not doing this for fun or you just might as well stay in solo, right?

And the reason I mentioned the profit piece is then you can sell, then you can sell because they're going to look at those numbers.

So, there's three things, one, you want to build the container, then fill the container, and then grow the container. I'm going to talk about what that means.

A lot of people fill it first, and then it collapses because it's not built solidly. First is systemize. Systemize your operations, then build your team, then grow your revenue. Those in solo practice or even group right now I would just start thinking about what are all the things I do? And write them all down, everything.

Like, when I walk into my office, what do I do? Do I turn on the lamp? Then the diffuser? Then the music?

And then guess what? I always say create and delegate, create and delegate. Then it's replicatable, and then you hire the people, and then they do the things. But start there. Because if you do it the other way around, it can be really overwhelming, because you've got the people and you've got tons of questions.

PATRICK CASALE: Yeah, that's wonderful advice. And I agree 100%. Like, because so often you're just kind of flying by the seat of your pants, right? Like, so many of us in the mental health profession didn't have any business training. So, so many of us are just like, "I don't know, I'm just kind of like figuring it out as I go." Which is kind of okay, because that's been my process.

NICOLE McCANCE: I did that my first year, totally.

PATRICK CASALE: For sure. And you're going to make mistakes, right? Like, that's inevitable.

And then, ultimately, being able to systemize that is so important so that if you had to step away, almost like someone had a manual of how to run the practice. Like, this is how you intake calls, this is how we do scheduling, this is how we do [INDISCERNIBLE 00:08:39]. So, so important. It also helps with onboarding, so onboarding doesn't feel frantic so your new clinicians aren't like, "What the hell did I just step into?"

NICOLE McCANCE: Yes. Can I give you a quick example? So, what you want to do is just put it in the Google Drive, have it be a live document. I love Loom, L-O-O-M. Do you know Loom. Go to Loom, my friends listening. It's because I actually learn visually. So, I'd much prefer a quick video on how I process payment or send a receipt than a whole paragraph.

But during COVID, I actually had my admin quit. She got COVID, horrible story we all went through, you know, our version of that.

And so, picture this, it is a Friday. No, it's a Saturday, a busy Saturday, and it's packed in the waiting room. We have 24 rooms in my clinic. All the kids, all the parents, all the couples are there and my admin doesn't show up.

And I'm on my way to the cottage, I've got my twins all packed up. I've got my mom driving like, and here I am. And most practice owners would have to go cancel everything, and go and they would be sitting behind that front desk.

But because I was systemized, I emailed one therapist, gave him one password, and they're like, "Go." And that was freedom. They're like, "Go enjoy, I got it. I'll read it, like it's all here in a cool, go." And that's the freedom you can get from systemizing.

PATRICK CASALE: That's such a good story, because so many people find themselves in those situations, right? And that's, ultimately, what then says, "I don't want to do this. Like, I don't want any part of the practice I've created."

And that's a shame because we work really hard to create these things, and to employ staff, and to grow our businesses, and to just like, throw in the towel, because it's like, "This is not for me anymore." That feels like really defeating. So, having those foundational steps, super important.

Okay, so from systemizing, where do we go from there?

NICOLE McCANCE: Yeah, build a container, then fill it. So, then that you want to find your dream team. And I would start with hiring a mini-me. I made this mistake a long time ago, because here's the thing, you're in solo, you have a certain brand of who you are, and people expect an experience that is you.

Many years ago, I made the mistake of hiring someone who was my opposite. So, I am bubbly, as you can tell, and she was quite reserved, and just very different. And nobody stayed.

I had given her my whole caseload. I'd moved to a different country, long story, when I was in my 20s, and nobody stayed.

I think it's important to be consistent with your brand, hire your mini-me. It's also just going to be easier. We tend to like people who are versions of us. So, have your first hire, eventually, you're going to hire very different people, but have your first hire be a version of you.

PATRICK CASALE: That's so interesting, because I hear so many people say the opposite of like, find the people who do the opposite thing or have the opposite personality type. But I actually like that perspective for your first hire, because it allows you to kind of say to your clients, if you are stepping away from your caseload, which I did, a lot of my clients were long-term clients. So, I transitioned to my first hire, because it was like, "I trust this person, I can vouch for them, you're not going to have to retell your story when you see them. "And then it allows them to fill up pretty quickly at first as well.

So, you're right, if you have someone who's very similar in personality type, your clients are going to not really notice much of a difference. They're going to say, "Oh, I feel quite in really good hands, getting good quality care here." And then you can start to diversify throughout your hiring process and your team.

NICOLE McCANCE: Yeah. So, after you hire your mini-me, you might need to hire another one, depending. So many of my members have like waitlists.

But then after that, I say, listen to the market. When clients are calling, what is the client inquiries telling you? Are they saying your next hire should be a child therapist? Start tracking that. And then before you know it, you have a bit of a waitlist and go find that person. Are they saying it's an IFS person or a movement therapist, listen to the market. Don't guess. So many therapists just guess, "I think it's going to be this."

PATRICK CASALE: Or they just hire whoever applies. And it's like, I'm just hiring because I know we're getting calls, we have a need to fill. So, I'm just going to hire the first person who applies to this job, because I'm not really getting a substantial amount of applicants or even quality applicants.

Again, that's going back to your job posting, that's going back to your culture, that's going back to your foundation of like, what are we trying to build here, right?

Because, you really want to drive the car, so to speak. Like you want to have control of the vision, it's your business. And so often, it's just like, when I hire some 1099s, whoever shows up and works for me is fine. That impacts your reputation. And I think we often lose sight over that is like, nobody's going to work harder for your reputation than you. So, it's really important to have control over the vision of what you're creating.

NICOLE McCANCE: 100%. Just on Tuesday, I was telling a member, "It's okay to be picky. Yes, that person your old friend back when you did your dissertation applied, she wants to work with you, but be picky. You want an A+ clinic, only hire the A+ people."

This is my bread, I have really high standards and I want you to, I want you to be impressed when you leave the interview. Ask yourself, like, am I so impressed that I really, really, really hope that they want to work with me? And that's the person. And then they get busy, because they're A+ people?

PATRICK CASALE: Absolutely. I think that's so important. And again, circling back to people saying like, I can't find ways for people to apply or I'm not getting enough applications, I think that is, again, circling back to like, what are you doing? How are you posting? What are you offering?

I'm sorry, my mic is driving me crazy right now, so I'm just looking at it constantly. But that's really something to reevaluate. And I think that's a constant reevaluation process. That's not like a set it and forget it. It's more like you said, pay attention to the calls, pay attention to the applicants, pay attention to what's happening behind the scenes.

Like, if you're getting a ton of calls for couples and therapy or couples and families, but you don't have any couple's therapist, make an ad specifically to attract those people or otherwise you're just going to continuously get folks who are like, "Yeah, I work one-on-one and that's kind of my jam." And that's not really filling that void or filling that need.

NICOLE McCANCE: Exactly, yes. So, that is built in, okay? So, first, we're going to… or that's filling, sorry. First, we're going to build the container, systemize. Then we're going to fill the container and we're going to hire.

And now let's talk about everyone's favorite part, which is growing. Growing the actual container, growing your revenue. "What the heck do I do, Nicole? I've got these people. Now what do I do?"

Here's the thing, we live in a world of tech more than ever. Do you have online booking? Allow people to book. Have Book Now on your website and have it everywhere.

I personally get kind of annoyed when I go and someone doesn't allow me just to book online. But your admin could be a bottleneck. Human beings are bottlenecks. They get busy, they forget, they open up an email, and then they get interrupted.

There's that, but there's also that, did you know… pop quiz for you, Patrick, when is the top time where people book therapy in the day? There's a busiest time.

PATRICK CASALE: Yeah, for us it's either early in the morning or late at night. That's when people are-

NICOLE McCANCE: Yes.

PATRICK CASALE: Because they are not working. They're focusing on their needs, so it's like… And, again, bottlenecking, right? It's not even like human behavior. It is human behavior. But sometimes it's just phone tech, sometimes it's just like chasing each other back and forth about like, when is the time that we can talk about a time to schedule a time.

NICOLE McCANCE: And then the client misses the email. You know what I mean, it's not always the admin that's the bottleneck.

PATRICK CASALE: Yeah.

NICOLE McCANCE: It is these 7:00 PM. So, 7:00 PM, according to the online booking stats, people are booking seven or later because that's when they're sitting with their thoughts.

And guess what, that's why I had six admin in the end and they worked until eight. But most people's admin is long gone. Which means here we go around and around the bottleneck.

I would have online booking, allow them to book themselves, and allow them to book with a therapist, not you, you're building an automated practice, and not an intake coordinator. That's how I did it. And it worked really well, because they get to the therapist, they build that rapport, and then that therapist books four sessions, and books a month in a row.

PATRICK CASALE: Yeah, exactly. I agree, 100%. And there are so many ways that you can automate these things. Like, for us, in addition, having abilities for people to text your main line, because so many people hate voice calls. I do. I don't ever call people. I don't really ever pick up the phone when people are calling me.

NICOLE McCANCE: Yeah, me neither. It's always a spam, always.

PATRICK CASALE: Take it easy. Like, our website has so many buttons that are like Call or Text to Get Started. And we get so many text inquiries. And therapists are like so scared of this of like, "But then how do you know who you're talking to?" And my argument is like, "How the hell do you know who you're talking to you on the phone, it doesn't make a difference."

So, like, it's just a way to like, simplify. Make this stuff easy. Make it easy. Think about it, like role reversal, right? Like, as the client experience, you want to call a provider and have it be easy, and simple, and be able to get connected, and not have to, like, hope and pray that someone is going to contact you back. Which that's a whole nother episode.

But like, that's really important, what you're saying, is just make it easy, make it simple, make it straight.

NICOLE McCANCE: Yeah. What is amazing about that you save on admin costs, and you're not paying that person $20 an hour to go back and forth, back and forth, they're booked.

And better, that person just got a dopamine hit. They're like, "We're looking for that…" Like, okay, I have help. I have a call in a few in a few days with a therapist, and they already feel that like a little bit of relief, you know, help is on the way.

PATRICK CASALE: Absolutely. Yeah, I agree, 100%.

NICOLE McCANCE: Now, also, can we talk for a second about the sales cycle? I know therapists just choked because I said the word sales. I totally get it. But let's just talk about this for a sec.

I'd like everybody who's listening to think about how long… and even for you, Patrick, if I go to your online booking, and I need therapy today, because we know human beings wait way too long. By the time I'm on your online booking I need now, I needed it months ago. How long does it take me to book an appointment? If I want to consult right now, when can I get one?

PATRICK CASALE: Are you asking me about time?

NICOLE McCANCE: Yeah.

PATRICK CASALE: Pretty quickly, like same day or within the next day or two.

NICOLE McCANCE: Okay, amazing. And everyone listening, I want you to think really try to allow for your cycle to be only 48 hours, allow them to book within 48 hours.

And please check this, some people think, a lot of my members are like, "Oh, yeah, it's fine." And then they go in there and they're like, "Oh, shoot, so and so's on vacation. She's already booked." They're waiting a week.

And then you want to train your therapist to book them within 48 hours. But what's happening, again, is that therapist is too busy and it's another week. And so you have a sales cycle that's two weeks. And I'd like you to chop that into about four days. And literally, all of a sudden you're way busier just from that small tweak.

PATRICK CASALE: Oh, totally. Yeah. I stress that when we hire people, like, being responsive in this profession is unbelievably important. I think about it like as a client, if I have gotten, like you said, I probably needed therapy months ago, but I've decided today I'm going to take action. The stories that we hear of people not being contacted back, whether it be via email, phone, call, text, etc., and then just reaching out into the void, like people are vulnerable in those moments where they're like, "I need help."

So, if we're not going to react to that or respond to that, you are missing an enormous opportunity to fill your caseload. And it's like, this is so easy, it just feels like second nature to me. Like, where it's like, just contact your clients back. And some people are like, "Well, I hate the phone."

Okay, you can create automated systems that you only communicate through email or text, it doesn't matter, but have a way.

And like you said, a turnaround time, give your clients that expectation of we will get back to you within X amount of hours or days. Don't just leave it open-ended, because then the clients like, "I guess I'm just moving on to the next, like, person that I want to work with." And that's a missed opportunity.

NICOLE McCANCE: Definitely. And, QA it. Get your admin every few days, because again, the calendar is constantly changing. Today, it might look good and tomorrow, there might not be any spots.

PATRICK CASALE: Yeah, exactly. Or, yeah, you could have a clinician who's like, pretty full, pretty steady, and then all of a sudden, seven clients just decide, "I don't need therapy anymore, I'm just going to not show up, or I'm going to move to every other week." And all of a sudden, all these spots open up.

So, you want to have a process too, to cultivate that waitlist or cultivate that process for onboarding so that you know we have this steady stream of referrals coming in. We don't want to just constantly refer them all out. If they are good fits for our practice, how can we ensure that we're just feeding our clinicians a steady stream of referrals and making sure that they're busy, we're busy, and everyone's making money, everyone's helping each other, and it's a win-win.

NICOLE McCANCE: Exactly. So, that's what I mean by grow your revenue. And the best part is you can do it right away. And it's absolutely free. Set up the online booking, making sure appointments are available within 48 hours.

PATRICK CASALE: Yeah, yeah. I think that's really good advice, and really easy to implement. So, for those of you listening, whether you're using TherapyNotes, SimplePractice, whatever EHR you've decided on, just make it easy. And-

NICOLE McCANCE: Make it easy.

PATRICK CASALE: …all you have to do is make it, you know, it just has to be a phone consultation appointment. It doesn't mean you have to wake up and all of a sudden you have three intakes on your calendar. Like, that doesn't have to happen. You still want to do your screening process.

But at the end of the day, take away that pressure of like the client having to contact you, the client having to run around, and like play phone tag. And, again, make your life a little bit easier. You'll thank us in the long run.

NICOLE McCANCE: Yeah. Now, one quick thing, we need an online booking to consult. Here's the bad news, your no show rate on consults will always be the highest. Why? They don't know you, you know, there's no trust there that you actually haven't gone over your cancellation policy. So, it's also important on the back end to have a really good follow-up process.

So, those who booked a consult, they were ready, and for all the reasons they cancelled or no showed, have your admin follow up.

I'll tell you, I really think that was my secret sauce to growing. I became the largest practice in Toronto 24 rooms, 6000 square feet in a short time. And I think it was because honestly, I didn't have the marketing budget of the next guy beside me, the big clinic that was there for 15 years. But I did these little tweaks and one was the follow up. You will be so successful, because you know why? The other clinics aren't doing this. Be the one that does the things the other clinics don't do.

PATRICK CASALE: I love that. Yeah, that's great advice. And those are like, they don't have to take a lot of energy to do these things. It's just about thinking about the communication process, the flow from client inquiry to becoming a client, what's that process look like? And how can we fine-tune that along the way?

And I think, you know, as business owners, we have to tweak, edit, revise, evolve, and adapt, and pivot all the time. So, it's just constantly like analyzing your processes and just kind of thinking about like, what can we tweak? What can we improve? What can we get rid of? How can we make our lives easier? How can we make their lives easier? And then all of a sudden, you have a good system in place?

NICOLE McCANCE: Exactly. Optimize.

PATRICK CASALE: Yeah. So, great advice, Nicole. As we're coming to a close any last-minute things that you want to leave people with or anything that you want to share with them so that they know where to find you if they want to work with you? Please feel free to promote whatever you want.

NICOLE McCANCE: Yeah, so I will share as you know, three years 55 therapists that's a lot. And to be honest, if anybody was to tell me that I was going to do that I'd be like, "There's no way." But it just flows, the snowball happens.

And I still remember when I sold my clinic a psychiatrist approached me, like I never thought I would sell. You have to sign, basically, an agreement saying like, "I won't do therapy anymore."

And I was sitting in my backyard thinking, "What the heck do I do with my life now?" I'm not going to not work, it's just not my personality. And then I said, "What if I take it to my peers? What if I give them my exact job description, exact manuals, marketing plans, and just say, 'Here you go. I know you're busy. And I'll hold your hand and get you to, if you want similar results, and then to sell. Or at least have it automated where you don't have to be there, you know?'"

So, that's what I do now. And if they want to reach out to me, I have a starter kit. It's called Expand Your Practice Starter Kit. It's the first three steps. If you're just like, "I don't know what to do." Kind of like I was, it will be in the show notes, the starter kit.

And also, I have a podcast, The Business Savvy Therapist, where I talk all these things all day long.

PATRICK CASALE: Love it. Was a guest on the podcast, was a lot of fun. And we will have all of Nicole's information in the show notes that you have easy access to that, too.

Nicole, thanks so much for coming on and sharing all this. This is really helpful.

And I hope everyone listening take something away from this, especially, if you're in this position right now.

NICOLE McCANCE: Amazing. Thanks for having me.

PATRICK CASALE: You're welcome. To everyone listening to the All Things Private Practice podcast, new episodes are out every single Saturday on all major platforms and YouTube. Like, download, subscribe, and share. Doubt yourself, do it anyway. See you next week.