All Things Private Practice Podcast for Therapists

Episode 132: From Therapist to Boss: Leadership Roles in Group Practice [featuring Lindsay Keisman]

Show Notes

In this episode, Patrick Casale talks with Lindsay Keisman about the intricacies of transitioning from a thriving therapist to an equally triumphant business owner.

Key takeaways:

  1. Leadership Transition - Navigating the transition from individual contributor to effective leader means understanding that it’s not an overnight change. This requires intentional development, clear communication, and alignment with the responsibilities of the new role.
  2. Mentorship is Vital - New leaders need more than just how-to books on business ownership to thrive; dedicated mentorship time and real-life guidance from those above them are instrumental in shaping a leader's ability to navigate complex business environments.
  3. Importance of HR and Leadership Knowledge - Understanding HR practices and leadership dynamics isn't just helpful; it's crucial in setting up a resilient culture and fostering a safe and structured work environment in group practices.

If you are in a leadership role in group practice, developing a good business sense and being a strategic and proactive leader is vital to business success and developing solid relationships with employees built on supportive guidance and mutual respect.

More about Lindsay:

Lindsay Keisman is a business and leadership coach focused on helping people become amazing leaders in their business. Lindsay is also a therapist and owns Pivotal Counseling Center, a mental health group practice with 3 locations in Illinois. Lindsay has a double masters in Counseling and Organizational Psychology, and is also certified as a Senior Professional in Human Resources. Lindsay is a mother to 3, enjoys spending time with her husband and extended family, and volunteers for causes in her community. Lindsay is known for helping clients design businesses that allow them to do what matters most to them. Business should exist to build a beautiful life, not become the ruler of your entire life.

Get a 10% discount on your first package of 1:1 coaching with Lindsay if they mention this podcast.


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A Thanks to Our Sponsors: The Receptionist for iPad & Freed!

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I would also like to thank The Receptionist for iPad for sponsoring this episode.

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PATRICK CASALE: Hey, everyone. You are listening to another episode of the All Things Private Practice podcast. I'm joined today by Lindsay Keisman. She is a business and leadership coach focused on helping people become amazing leaders in their business. Lindsay is also a therapist, owns Pivotal Counseling Center, a group practice with three locations in Illinois. She has a double master's in counseling and organizational psychology, is also certified as a senior professional in human resources. That's the most interesting piece to me, because we're going to talk about group practice ownership and leadership today.

And we were just talking about HR and all the things that people don't understand or get wrong when they're starting a group practice. And I would love for you to talk a little bit more about why that feels like such a passion area for you. And if I missed anything in your bio, please feel free to add to it.

LINDSAY KEISMAN: Yeah, yeah. No, you did great.

Yeah, HR was never something that I thought like, "Gosh, that's a career I just can't wait to get into." And I don't think that maybe anybody in the HR field, you know, graduates, high school or college thinks that.

But as most of us know, when we start our businesses we are instantly having to face questions about what kind of paperwork do I need? And what are the legalities of this or the other? And that's true when you're a solopreneur.

But when you start to hire people, whether you are hiring, you know, making the decision between independent contractors and employees, and I know in our field a lot of information out there is having people migrate to the employee W-2 model, what then everybody says is you should talk to an employment attorney. Which by the way, I don't know what your employment attorney costs, but mine costs about $425 an hour. And while I really love our conversations and like him a lot, I try to only talk to him when I need to. So, yeah.

So, HR become became kind of an interest area for me, mostly because I think it's a practical reality that we have to know more about in our businesses. But the why, right? Like, if we go to like a Simon Sinek for me, right? It's always like, I want him to be the boss of people, because I had a lot of not-great bosses, I had one or two stellar bosses, and I couldn't believe how much of a difference it made.

And one of the common things about the bosses that I had that were great were that they had awesome values about making work a great place to be. And at the end of the day, HR should be about keeping the business owner safe, but also making work a safe place to do the work that we do.

So, I really actually like it all. And I know there's a lot of nuance and nitty gritty details, and every state's different, every, you know, county is different than you got to follow the federal government. But the spirit of it, I think, is all good things.

So, hopefully, that answers your big conceptual question for me?

PATRICK CASALE: That is a big conceptual question. And you definitely, yeah, answered that.

And I think you had mentioned before we started recording that you're a solopreneur for all of six months. Like, it sounds like you kind of knew this is where I want to go, I want to start a good practice, I want to be a great boss.

And yeah, I think most people listening to this can resonate with like, "Oh, yeah, I've had quite a few shitty bosses in my life and it's been terrible." Like, because work then becomes laborious and it feels like an extra stressor.

So, trying to become a great boss, here's the thing I see a lot from group practice owners who want to be great bosses. They may have the best intentions, they may have the best values, but they don't have the best implementation strategies or they don't necessarily understand the leadership structure or how to develop leadership within a team.

And I think that goes into creating a culture where it feels like a good place to work when you have cohesive, solid leadership in place. But also leadership opportunities for those who are like, really excited about growing within your structure.

So, can you talk a little bit about the leadership side of this? Because I think HR and leadership go hand in hand. And I think that there are both, like, critical pillars of the foundation of owning a group practice and being a group practice owner, in general.

LINDSAY KEISMAN: Yeah, I agree. I mean, I think what's interesting about the journey in group practice is the one thing that all of us experience, is that we all have to start off hiring the first person. And, you know, then from there, probably, the number one mistake that I see people making is that they don't really quite know where it's going. And they don't even know what they don't know at that point. So, I see why it's a mistake that's made.

It's not like, and I say this all the time, like, if I sold my business, move to another state, and decide that I'm going to be a group practice owner, again, I would have a completely different game plan, approach, and everything.

But by design, we're learning along the way. And unless you're fortunate enough to sell a business and repeat the business the better way, the second time, which most of us won't have that opportunity to do, we are evolving along the way.

And one of the things that is true of all therapy practice owners is that we're therapists, and usually, we're good at building connections and relationships with people. What we're bad at is holding them accountable. We're bad at boundaries, sometimes.


LINDSAY KEISMAN: And that's more so true in that initial building phase, because I hear people say things like, "Oh, it's our…" Like, they'll say their business name… Like, my business name is Pivotal Counseling Center. They'll say, "Oh, like, we're like a little pivotal family, right?"

And I'll be like, "Nope, no you're not. You're not a family, because there is this weird authoritarian structure that maybe you're ignoring, but one day, you can't ignore it anymore."

So, at some point, and I'm sure you've seen this, Patrick, right? Where it's like, a year or two when people are getting their ducks in a row, as the way I like to call it, they're getting their policy and procedure manual done, maybe they started off with one kind of employment contract, and now they're migrating to something different. Maybe they've had a really bad experience that has caused them to go, "Holy cow, I need a lot more things in writing and a lot more, you know, accountability."

Or maybe they're financially not making it, because they set it up wrong. And at the end of the day, they're realizing, "I didn't set this up and do all of this work just to have, like, good buddies to share a space with. I did this to make a living."

So, it's like, then they do the hard work, then you have to go through this horrible transition with the employees that kind of knew you as something different as you are yourself evolving into a new creature, which is a little bit more boss-like than pure.

And that to me is like phase one. And when people get through that, like you said, they talk about, "I want to bring on a clinical supervisor, I want to bring on a practice manager, I want to bring in a clinical director."

And the bigger practices, sometimes it's multilevel clinical leadership, supervisors, clinical directors, maybe they have training programs, maybe they take postdocs or something, and they have training directors, maybe they're large enough where they have practice managers, and then multiple billers, multiple people, or even the bigger ones that will have dedicated marketing people, or dedicated social people, or something like that.

And it takes a lot to go from I was a therapist and I got a master's degree in counseling, and I'm a really kick-ass therapist to I'm a really kick-ass boss. And I know how to help, A, setup the right structure with organizational design to be successful, put the right people in the right seats, which is also really challenging, and then help those right people in the right seats become the best version of themselves that they can be in that role. That is nothing that we get taught in school at all.

So, yeah, so then once again, kind of a big answer. I could deep dive more into any one of those phases. But those are kind of the phases that I see business owners getting into depending on how large they scale, depending on their finances, depending on their market.

And sometimes, you know, I hate to say this, but sometimes people just get lucky, right? Like, sometimes they happen to hire a therapist along the way who just had some really amazing skill sets who could naturally step into a role and they didn't have to do much to make it succeed.

And then there's other people that they never had the right people. Maybe they're a seven-person team, and they look at the people underneath of them and they go, "I'm going to have to hire externally for some of this."

And then that becomes its own whole thing too, because now you're hiring a brand new face, who's going to come in and have authority over people that are used to dealing with you, the business owner, who may have been a little too nice is usually the case. So, yeah.

PATRICK CASALE: That's so true. You just made so many good points. I'm like, trying to collect my thoughts on where I want to go with that, because, one, I was definitely that group practice owner who was like, "Oh, I'm just going to start this group practice." I did it against my will. Kind of my friend kept pressuring me into hiring him. And I was like, "Dude, I help people all over the world start their practices, I can do it for you for free."

And he was like, "No, I just want to work for someone. Like, I don't want to do anything else."

And I was like, "Okay, well, I don't know anything, and you're going to be a guinea pig. And I'm just going to be honest about that." And despite being very entrepreneurial mindseted and really good at a lot of these things, you're right, we didn't learn hardly any of this in grad school. I would guesstimate conservatively that 98 to 99% of us did not learn a single thing about business ownership in grad school, if you went for a clinical program.

And I was definitely that owner who did transition from taking a practice from 1099 to W-2. So, year one was like, not chaos, but definitely flying by the seat of my pants, figuring things out as you go, learning from all these mistakes. Then we introduced like policy or companywide transition to W-2 last January. We had about 14 contractors at the time, we now have 22 therapists right now, at this current moment. We didn't lose anyone to that transition. But there is definitely a big mindset shift from like an autonomous contractor community to an employment model.

And I noticed myself, like, realizing like, I always look at myself as a mentor and a coach instead of a boss. But I also try not to be a friend. So, it's really this hard balancing act.

And a lot of therapists I talk to really struggle, like you said, with that balancing act, with becoming the CEO or the boss, with having to make hard decisions sometimes when it comes to personnel, and policy, and procedure. So many people want to give the world away.

But I talk with so many group practice owners who are like, "My company is bleeding. Like, I am not making money. We are a sinking ship."

And then, if you review the behind-the-scenes, it's a cluster [INDISCERNIBLE 00:12:35]. Like, it's like what is happening. Like, where are the policies? Where are the procedures? How are we hiring? What are we offering.?

So, you made a lot of great points, but I want to focus on the leadership side. You said like, something that stood out to me, a lot of people, even if they have leadership qualities or tendencies, they're not trained necessarily to come into a leadership role or capacity. And if you, yourself, as the owner of the practice also don't have that specific training or skill set, it's really hard. Because I see a lot of people, like, this person is a really great clinician, and maybe an internal supervisor, clinically, I'm going to put them in this clinical director role.

But then if you don't give them, like, guidance and expectations, and help them kind of create their day-to-day, and their workflow, and their expectation, they can be floundering, and it can really feel like a disjointed, like, really uneven process.

So, can you talk a little bit about like, okay, we get these leaders, we pinpoint or identify the people either within the company or outside externally, and we want to bring them in. Developmentally, what should we be doing here in terms of like, how do we set people up for success?

LINDSAY KEISMAN: Yeah, okay. I'm going to rewind from where you're at for just a second and say that like, before you get to developmentally you need to know what you want that person's role to be.

So, for instance, when you talk about the, like, transcending from clinical supervisor to clinical director, I'm going to talk from the lens of, like, an ambitious young person who's excited about becoming a clinical director, right? Like, here I am, maybe I supervised a couple of interns, maybe I'm supervising some provisionally licensed people, I'm really enjoying mentoring them and having them become the absolute best clinician that they can be, right?

And as a clinical director, I can spend more of my hours doing that. But I can also look into, like, trainings that we could all do together. And I could make sure that as a whole team that we're, you know, clinically excellent. And maybe I'll even make some connections in the community, and niches, and do all those things, right? That's where their mind's at, okay?


LINDSAY KEISMAN: Now, here's the business owner, the business owner is like, "Fuck, I really want to stop having to chase people after their notes, right? Like, I have to put somebody on a performance improvement plan and I don't want to be the person that's got to have that conversation and meet with them a week later to talk about whatever's wrong with them. Their client retention is not good, but they're likable." You know? "They're always a week behind on their notes, but they've always got an excuse." Right? "This person is fantastic, but why do they take a 12-week leave of absence every year?" Right?

Like, those are the things that I feel like as an owner we're, like, looking to just take off of our plate.

So, I'm going to go back to before developmentally, right? Like, I find that clinical supervisors are probably really good at being clinical supervisors, and would be really good at all that clinical stuff, whether you call them a supervisor or director.

Being a manager and leader of people, and making sure that your job description really is well thought out so that you know what that looks like, and that you're actually interviewing and making sure, even with a staff person who says, "Yes, I'm ambitious, yes, I want this." It's like, okay, but this is what it looks like, right? These are the hard conversations that you're going to have to have.

I've met many owners who actually want to hire because they know they aren't having the hard conversations. And by default, they're setting up that brand new person to walk in as the bad guy, right?

And so what I want to say is, let's say you've got somebody through the door that says, "No, I really do want to take on more of this managerial stuff. And I understand that there's some policy writing, standard operating procedure writing. I understand that there's boring, you know, trainings on HIPAA compliance that I'm going to have to do, and sexual harassment from the manager's side of things that I'm going to have to do, and that there's going to be complaints, and that no workplace ever has a team of humans that are all operating at 100% peak efficiency, and they all love each other, right?"

All right, assuming that person knows what they've got to do coming in the door, that's step one, is making sure that you're on the same page with what the heck this role is actually going to day-to-day look like, because the worst developmental problem that you could have is somebody that really doesn't want that job. And so what they do is they only focus on the things that they love.

PATRICK CASALE: Yeah, absolutely.

LINDSAY KEISMAN: So, but let's say you get them through the door of let's say, they're new. I'll talk from the lens of like, pretend it's somebody who's never had a management job, because I do think it's wonderful if we can hire people who've worked in different leadership positions, let's say at an external agency somewhere, you know, especially, if it was a larger setting, like let's say a hospital setting or a larger residential facility. Those places oftentimes have that, you know, hierarchical structure, they have HR, they have legal, they have all these people that do these things.

And so, while they were learning how to be a manager, they were likely supported, and grew without even maybe realizing the skill set that they grew. But if you're dealing with a blank slate, I think the thing people want to do is be like, "Let's read a book, you know, and you'll become an amazing leader."

And that's a great… don't get me wrong, I'm not saying that book reading isn't a place to start. But it's the most passive way that you can support a new leader taking out on their role. No different than, you know, when we have clinical supervisors, we're supposed to do supervision of supervision, you should do the same thing with management, okay? New leaders should have dedicated time with a higher-up focus on nothing other than mentoring them in their management role, period, right? Or making sure that they're not going to do anything really awful, like something illegal, right?

But we're also saying, "Tell me what you're struggling with? Here's this issue? How are you going to approach it? We're doing all the same things that we're taught to do if we are supervisors of supervisors, right?

And believe it or not, what I always say to people is like, let's say you sucked at it. Like, let's say you're the practice owner that you had… And I use notes, because this is the issue that every practice owner I've ever met has at least somebody on their team with this issue. Like, if you have somebody with notes, that's problematic. And you yourself sucked at holding them accountable, the good news is, is like you can still support somebody better and even admit that, "Yes, this is hard. Yes, I can empathize with you. Here's why it matters and how can I, you know, help get you there?"

So, I like the weekly meeting, okay? First and foremost, the people that… And I think because owners were burned out at that point when we bring on leaders, like, we are ready to let stuff go. And that is incorrect thinking. When you hire somebody into a role, you should expect your workload to increase for a period of time.

PATRICK CASALE: Yeah, absolutely. I just want to emphasize that so badly, because I think it's so easy to just be like, "Let's bring this person on. And that person is going to take away all of these responsibilities. And I can step back, and I don't even have to check my phone or my email."

And while that's wonderful, and like, pie-in-the-sky thinking, that is certainly not the reality, especially, in the immediacy. So, I just want to emphasize that, for sure.

LINDSAY KEISMAN: Yeah. And, you know, for me, it's like, whatever energy you spend into shaping and molding this, like, creature that will make your life easier will come back to you twofold, right?


LINDSAY KEISMAN: It's like the same thing. And I like to make parallels between the clinical world. Like, I actually prefer having interns over hiring somebody provisionally licensed, because quite honestly, I feel like I can train them exactly how I want them to be trained. And they don't come in, and I don't have to unlearn them anything that they learned in their, you know, nine or 10-month practicum, where I'm like, "Oh, no. You know, that's not how I want it done."

So, for me, it's like, you can take this person, and you can really, like, craft and mold them into exactly what you want them to be, which isn't necessarily a replica of yourself, right? Sometimes when you're hiring, going back to hiring, and depending on the size of your business, so, for me, for instance, when I decided to expand my business, and I decided that I needed a second clinical director, okay? I have three locations spanning multiple counties. And I really needed somebody that could be in that other community, right? You know, what I looked for was I looked for somebody that was dissimilar to me and the clinical director that I had. So, I put a lot of intentionality into not only what is this job description, but like, what are we missing as a larger team? Like, what could we have to bring to the table personality-wise, right? That is different than what I bring and what my other, you know, higher-level leadership people bring.

So, there's so much intentionality in the designing of things. And I just feel like people go too fast, or they pick what they have right in front of them. And I'm always like, pump the brakes, pause, let's not design something, it doesn't work, you waste time, you screw around your people, they're not used to what happened, you just changed it, now you're changing it to something else.

It's like, pump the brakes, spend just a little bit more time on design, talk with good colleagues, find a coach, do whatever you need to do to say like, what am I not seeing? And what am I not thinking about? And how can I make sure I think about it and see it before I take an action? Will make so much of this developing the person easier, right?

But back to that, the weekly meeting, I do actually think books are great, but I think books are useless unless they're followed by really meaningful dialogue. So, I don't believe in book reading unless you're going to book read with them and really talk about it.

So, for me, I actually do have some things I make all my people do. First of all, I make all of my people go through an HR one-on-one class, because it's the law. You know, like, if you're going to be, let's say interviewing, you can't be like, "Hey, you got some kids? Are you pregnant now?" Right? Like, you can't do those types of things.


LINDSAY KEISMAN: So, like, I like to just start off with like, "Hey, let's start with like, what you're not allowed to do. And not because I said it, but because you're just not allowed to. Let's start with that really terrible, boring, HIPAA security compliance officer training."

I don't know about you, I'm still the HIPAA Security Compliance Officer for my team, but I make my leaders take that class. I make my leaders take the sexual harassment for manager's classes. I start with legal, I start with education, and then tweak from there.

I go through our policy and procedure manual. And I tell the historical relevance for why we ended up with that policy and procedure. And all the iterations beforehand and why those iterations didn't work.

PATRICK CASALE: I love that.

LINDSAY KEISMAN: That's in that weekly meeting. It's a little bit, like, me deciding what we're talking about, and then coming to me, and asking whatever they need support for. If we're book reading, if we're listening to a podcast, if I'm having them, you know, read an article, it's not just, "Hey, read this by." It's, "Hey, read this. Let me tell you why I thought this book, this podcast, this article was so freaking profound that I want to you to absorb it. But I want to know, what did you take away from it?" Because I want to know if they're taking away what I'm taking away.


LINDSAY KEISMAN: And then another thing is organizationally, I believe in feedback. So, you should have some sort of what we call 360-degree feedback tools, right? Which means that you're getting people that are doing an assessment of their manager, both the people above them, the people that are pure level to them, and the people below them.

And I know maybe that feels a little icky and corporate for some group practices. But I promise there's ways to do it, even if it's conversational, even if it's, you know, just a quick little write up, a couple questions, or if you're going to use a more sophisticated instrument, and have, you know, an external consultant come in, all of those are options, but how the hell do you expect people to grow if people can't be real about their experience with the person? Yeah, those are couple-


LINDSAY KEISMAN: …of little ideas I have for that. I could keep going.

PATRICK CASALE: These are great points, though. But that's another point that I just want to re-emphasize, because I think so often, well, one, I love that you're talking about this from a perspective of like, very much intentionality, right? Instead of reactionary, which I think a lot of people are in reactionary mode, when they're growing, when they are, like, doing other things, when their attention is, you know, allocated elsewhere, it's very easy to just be like, I just need to react to what's happening in front of me, then it gets chaotic.

The weekly meeting, I love it. I'm actually meeting with my leadership team tonight for dinner. I'm going to introduce that idea, because-


PATRICK CASALE: …I think that's good. I'm just never around, because I travel so much for retreats and my other business. But that's neither here nor there. Great idea.

But I love the idea of like, going through this with them, going through this with your staff, instead of just saying like, "Here, do this."

Because I am not here to do this type of human. If someone says, "Read this, take this training, do these modules." I'm never going to do it. It's just not how my brain works. It's not how I operate. So, I really love this.

And I think the feedback piece is so important, because so many of us tend to shy away from it. Because it's like, "Oh, I don't want what's on the receiving end. I don't want to know that my staff are unhappy."

But people keep quitting. Like, you have to know this stuff. And you have to have some sort of way for your staff to feel like they can safely communicate their day-to-day and their work experiences, and your leadership staff, and how people are experiencing the culture. I think it's really important.

And it gets overlooked so many times, because I hear friends, colleagues, etc., "I don't want to have these conversations, they are too hard. I get really emotional, I get really triggered, they feel really personal or offensive."

And it's like, you're an employer, though, you have to be able to support your staff in this way. And I think that is the only way to grow. So, I just want to say thank you for mentioning that, because it's really important.

LINDSAY KEISMAN: Yeah. Well, you know, it's interesting, too. And in our field, many of us in school took like a Myers Briggs or, you know, we've taken some of those things. And there's some really neat, you know, instruments out there that corporate world uses all the time.

And, you know, I think about some teams I've worked with that were scaling up and something was not working, right? And there's so much to think about. But I think about this one team in particular that I utilize one of those instruments, and it's called The DISC. Lots of people have probably heard of it, D-I-S-C.

And, you know, the leadership team was, like, you know, only two of them, like everybody was an S and there was like an SC kind of person. And I was like, "Well, you know, this is part of what's happening."

And I think about that intentionality, right? What that person did I think was they were attracted to people that were very much like them. And those were the people that, you know, ended up in these leadership positions, which is fine, but you have to know that about your team, right?


LINDSAY KEISMAN: And I would always say, "Hey, you need somebody." Because they were the people that are like, "Oh, I don't want to like hurt their feelings." And I'm spending a lot of hours and time talking about how we're going to talk about this so that the person has the most optimized emotional experience with me.

And I'm sitting there, and I'm like, "Dude, the person's not doing their job, they're not showing up, and you're paying them. Like, take a deep breath. That's the conversation you need to have, right?"

And it's tricky. And this is where, like, I always say, like from the HR lens, my favorite thing about HR, and I think it's something that every business owner can use, is to remember that if you give anyone special treatment, you have set a precedent.


LINDSAY KEISMAN: And so if you are going to have your feelings all over something, right? Like, "Oh, but their circumstances are so terrible, and so hard, and we want to be so supportive of them, right?" It's like, okay, but what happens when somebody else has similar circumstances, but maybe they're not as likable on the team? Or maybe they're a little bit of a grump, but they do the job? They get the work done? Are you going to… and I'm going to use air quotes here, "discriminate" against them, right?

Because it's considered discrimination if you give it to one person with similar circumstances and not to another without having a very good reason.

And so I always like to say this, like, sometimes why I start with the legal stuff and the law is that can be really comforting to an emotion-centered person, which lots of us as therapists are emotion-centered people to be able to fall back on. There's a lot behind this. There is a procedure behind this. There is a reason for these things. There's a why that we can't do these things.

And if you can get good at conversationally speaking to that, then you can feel more comfortable than just coming in and saying, because there's this feeling of like, well, what you're going through doesn't matter. And that's the message I'm sending to you, because you just need to come to work and do your job, right?

PATRICK CASALE: Right, absolutely.

LINDSAY KEISMAN: And it's like, there's a better way to say it. And I feel like when you have kind of HR, the law of policies, procedures on your side, it's easier to do it for you. And it's certainly easier to support a brand new leader or an emerging leader in making that transition to say, this is how you say it, why you say it, and why we can't do anything else here.

PATRICK CASALE: I love that. Yeah, that's perfectly said. Because, again, going back to a lot of us who are therapists, who are in the helping communities, who are probably emotionally-centered people, it can get really challenging if emotions are dictating all of your business decisions and all of your organizational decisions. And I think that it is just a really important point.

And, you know, I'm just thinking about what you're saying, like sending people to HR one-on-one, all the trainings, right? Like, I imagine just from conversations I have with colleagues and people I coach, that a lot of people are not doing those things. Like, that's not on their radar, it's not even something they know to think about.

So, I'm really happy that you're mentioning, like, this logistical organizational side and the legal side, because it's not like the sexy side of being an entrepreneur, right? It's the side that is probably the most crucial, however, in terms of like, protecting all of the work that everyone is doing and ensuring that it's done well, and people are protected, and just have their businesses safeguarded, and also their employees safeguarded too, to make sure that they're being treated well and within that scope. So, thank you for naming all that. I really appreciate it.

And this has been an awesome conversation. I feel like we can have like, spin offs of a lot of these topics. So, I just want to appreciate you bringing this, like, mindset, because we definitely have a lot of leadership convo on here, but it focuses more on, like, the mindset piece. I like the practical, like, pragmatic piece as well, and I think they have to tie in and go hand in hand.

LINDSAY KEISMAN: Yeah, I agree. And, you know, while I think that that mindset stuff is so crucial, and the shift from, you know, employee or solopreneur into these mindsets needs to happen, I think that our experience is that we do get stuck in that now. I have to write this up now. I have to do this now. I have to decide why I'm doing this.

And, you know, the best advice I can give anybody is, once again, start with what's required of you. Like, I find it so simple to start with what's required and to build from there.

And you can do that. I'm an insurance-based practice. You know those horrible insurance contracts that everybody gets in the beginning? Like, I read those, because I want to know why does this one want my notes done in 24 hours and this one says 72 hours? And what policy am I going to establish because of those differences? And why? Right?


LINDSAY KEISMAN: And what am I signing? And what does it really require of me? And I don't want to sound disrespectful. But I know in this age, especially, with electronic signatures, how many times do we never read a terms and conditions of something? We click the button, and we sign it away?

And I think, you know, the one thing I do love from Ed, my employment attorney is, you know, he's funny. He always says, "Lindsay, it's my job to cover your ass when you're being an idiot. Or when somebody's, you know, trying to get money out of you, and you're not being an idiot." And I'm like, "Okay." I'm like, "Well, let's idiot-proof my business." And it's one of the things that he says.

He said, "You know, I don't know why people pay me $425 an hour to read something that they could read."


LINDSAY KEISMAN: And it's like, it's that practical logistical stuff. And I'll be honest with you, it's like, it's the way down on the bottom barrel of the things that I love to do in my business, right? It's like right next to like, printer problems, or I like networking, and mesh Wi-Fis. Like, it hangs out there. It's like, "I don't really want to do this." Right.

But I also really don't want to pay somebody $425 to do something that I could set aside a weekend and really intentionally build and think about what makes sense. So, yeah.

Yeah, businesses are cool. I love leadership. I love HR stuff. And I feel like it's one of the, like, areas where you can never stop learning and growing. And every amazing employee that I've ever had has taught me a lesson. And every leader that I've developed has taught me vital lessons.

And, yeah. I'm very grateful to their journey and my journey, and what it takes, because once again, we didn't learn about this in school. I went and got, you know, a degree in organizational psychology where I did get to learn about some of this. And what I, once, early in my career, thought was just intuitive and natural, I have really come to learn was actually because I had formal education.


LINDSAY KEISMAN: And there was a way to educate yourself. I'm not saying go get an MBA. I don't think we need to do all of those things. I'm saying that we tend to avoid the things that are uncomfortable and not intuitive for us. And that as business owners, we're not allowed to do that. So, yeah.

PATRICK CASALE: That's a great mic drop moment, so…


PATRICK CASALE: I think that that's a great point, too. So, I really have appreciated this conversation. I've learned a lot honestly. And I think this is such an important piece. If you are in group practice ownership or thinking about going into leadership or group practice ownership, this has been a great conversation. So, thanks for your time. Tell the audience where they can find more of you and what you've got going on.

LINDSAY KEISMAN: Yeah, yeah. Thank you. So, my website and business name is called Leading Your Practice as far as my consulting side of things. So, I'm your traditional coach, to be quite honest with you. What I prefer is the high-touch one-on-one experience with people. So, I really enjoy coaching people for a myriad of reasons, starting their business, scaling their business. I do executive coaching as well. So, sometimes I even work with high-level leaders in larger practices to enhance their skills. So, not necessarily the owner, but maybe like a second in command. So, I really enjoy that.

And for a fun side hustle, I also do some retreats with a wealth coach, Lisa Marie Robinson. So, we do those and we kind of pair everything I talked about here today with also some wealth and money mindset on her part. So, we've got some retreats coming up as well, which you can also check out on my website.

But other than that, I am sure I'll see somebody at a conference somewhere and I would always appreciate people coming and saying hi, because I'm extroverted as hell and I love to talk about this.

PATRICK CASALE: Love it. Thank you so much. And all of Lindsay's information will be in the show notes so you have easy access to all that stuff that's coming up. Really great conversation and thanks again for coming on.

LINDSAY KEISMAN: Yeah, thanks so much, Patrick. I appreciate it.

PATRICK CASALE: 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. We'll see you next week.


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