Episode 194: Step Back and Let Your Group Practice Run Itself [featuring Nicole McCance]

Show Notes

In this episode, Patrick Casale and Nicole McCance talk about her proven 5-step method for scaling a group practice—perfect for anyone feeling stuck at an income ceiling, burned out, or simply wondering what the next level looks like for their private practice.

3 Key Takeaways:

1. Systemize First, Hire Second: Before you build your team, get everything out of your head and document your systems. As Nicole says, if you don't systemize before hiring, you'll end up as the "chief question answerer"—not a true CEO.
2. Marketing Matters—But Do It Right: Digital marketing (especially Google Ads) is essential, but make sure your website and ads are synced, specialty pages are clear, and hire experts when needed. Don’t waste money on marketing that doesn’t connect.
3. Retention is Your Secret Weapon: Booking clients for multiple sessions and following up consistently (even after no-shows or cancellations) can increase your sessions by up to 20%. Simple steps = big impact.

Whether you're dreaming of scaling, preparing your practice as an asset, or just want more freedom as an owner, Nicole’s guidance offers a fresh roadmap using practical strategies.

More about Nicole:

Nicole is a Psychologist (retired) turned Business Coach for therapists scaling to a group practice.  She expanded her private practice to 55 therapists and multiple 7 figures in 3 years (with toddler twins at home). Nicole sold her clinic in the 4th year and then retired as a Psychologist in her 5th year. She now teaches therapists how to help more people, make more money, and have more freedom following her proven method. The McCance Method: mccancemethod.com

Social Media

• Instagram: instagram.com/nicole.mccancemethod
• Facebook Group: facebook.com/groups/947689352498639
• Podcast: mccancemethod.com/podcast

Sign up Nicole’s FREE Masterclass: How to Build a 7-Figure Group Practice → mccancemethod.com/webinar-free-masterclass-from-solo-to-superteam

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Transcript

PATRICK CASALE: Hey, everyone. Welcome back to All Things Private Practice. I am joined today by Nicole McCance, who's been here before and is now back to talk about her five-step scaling method. And I'm going to let her introduce herself, because I hate intros and she likes them. So, take away.

NICOLE McCANCE: Thanks for having me. Really good to see you again, by the way. Yes, so I built a group practice, kind of, by surprise. And I feel like listeners might relate to that. I know that you do.

I was in private practice for 15 years. Loved what I did, couples all day long. EMDR, love it. And then, I just became, honestly, kind of sick of hitting the ceiling in my income and burnt out. And then, I became pregnant with twins. And I remember thinking, "Oh, gosh, we need a bigger house. Like, I didn't expect this. What do I do?"

PATRICK CASALE: Sure.

NICOLE McCANCE: And I knew at that point I needed to hire. I don't know for you if there was like a moment where you're like, "I need to hire." But guess what I did? Nothing. Because I didn't know what to do.

So, I feel like, if you don't know the first step, you feel frozen. And anyone listening, like, I get you. They were two years old when I finally scaled. But I figured it out with a series of multiple business coaches and was able to scale it with Jackson and Lucas at home to 55 therapists in just three years. And then, eventually, a psychiatrist, not a private equity firm, just to be clear, a psychiatrist wanted to buy it, and they're in really good hands. So, I let it go and sold it for multiple seven figures, 2022. And now teach people how to do that.

PATRICK CASALE: Yeah. It's definitely impressive. I remember your story and like, talking about it, and, you know, I don't think I ever anticipated hiring at all. I never really wanted to, if I'm being honest. And I think the story is a bit different in that regard, because my friend just kept, like, pestering me to hire him during the pandemic. And I was like, "Dude, I teach people how to start their businesses. I'll do it for free."

And he was just like, "No, I want support, and community, and not have to do the business side of things." And I was just like, "Okay, I guess you're going to be the guinea pig, because I have no idea what I'm doing aside from, like, a few checklists that are, like, circulating out there and some other stuff." And I'm like, "I don't know how to be a boss." And here we are, four years later, with 25 clinicians. So, it's definitely been an interesting ride.

NICOLE McCANCE: That's a testament to who you are, that somebody's like, "No, you. I want to work with you." And you're like, "Are you sure?"

PATRICK CASALE: It's daunting, you know, because like [CROSSTALK 00:03:25]-

NICOLE McCANCE: Yeah.

PATRICK CASALE: …responsible for other people's livelihoods, yeah. So, that's one part that I still to this day, present day, do not enjoy. It is like keeping it afloat for everyone else's sake. I'm like, I would rather just be on my own, doing my own thing. So, good leadership team in place makes a world of difference.

Anyway, so you're going to talk about your five-step method to scaling. And I'd love to hear more about that, because I'm sure those who are listening, who are in group practice is ownership, are probably contemplating selling every day. And I think it would be really, there would not be transparency if you were thinking like, "I never think about selling my practice." And I know there's a lot of emotion that comes with that guilt, shame, all the things. But in reality, burnout is real, and group practices are assets.

And I see too many people kind of say, like, I'm just going to wipe my hands of it. "It's either run itself into the ground, or it's not profitable, or I'm just so burnt out I can't handle it." And they let it go. And that's also really unfortunate too.

NICOLE McCANCE: Yes. And this is actually why I put together the five-step scaling method, because when I sold, I vividly remember sitting by my pool retired now. Like, officially, you know, I left my regulatory board and being like, what do I do? You know, I went for a swim, and then I just was like, "Now, what do I do?"

And I really just wanted to help people. And I said, "You know what, I'll give them the map of how I did it so fast." But also, what is different about how I did it is it did run without me, with a good leadership team, and that's really key, and part of the five steps. And then, it's an asset that is revenue generating, that is running without you. And so, a buyer is going to say, "Wait a minute, if it runs without you, then it's worth something."

And for everyone listening, even if right now you're thinking, "Gosh, I couldn't imagine ever selling." Maybe they think that like, gosh, you know, it feels like so far, but build it to sell. Just build it to sell. And that's called freedom.

So, I'll go into the five steps, okay, and then you can ask me kind of any questions. So, the key step one, what you just alluded to is a lot of people just fall into this. So, step one is before you hire, first, systemize your operations. Because what happens? Because step two is hire your dream team. If you hire first, you will not be a CEO. You will be a CQA, a chief question answer, which is exhausting, and that's every day when you're like, "Oh my gosh, this isn't what I chose." So, that's step one. Yeah.

PATRICK CASALE: Totally. Yeah, it makes sense. You know, like, and I think a lot of people do it that way, and I know I did it that way because I didn't expect to do this, and it was figuring a lot out as I went. And I think that leads to a lot of exhaustion when you are constantly not only answering other people's questions but solving problems you didn't expect to have or you know, putting out fires on a daily basis. You're like, "This is not what I had envisioned."

NICOLE McCANCE: Exactly. This is not freedom at all, right? Like, I bought myself a bit of a job. So, and what does that actually mean? So, systemize your operations means getting everything out of your head. That's really key. And we live in a world with Google Drive and Loom, which is a video recorder. If you don't know Loom, Google it, loom.com.

And even as you grow, new questions will come, because as you scale, there's different problems. But here's the thing, the moment you answer it, you're going to train your admin to like, where do you go to find all… Like, you should never answer the same question twice. You create the manuals. And this is what I give people in my program. Like, here's all the manuals, the handbooks, step one.

Step two, and this is the fun part. This is where you hire your dream team. But here's the thing, and I wonder if you feel this, this is a work marriage. Like, be picky. This is your reputation. That you're literally saying, "I met you on Indeed five minutes ago. Oh my gosh, this feels really overwhelming." So, having a certain way to hire is really key.

PATRICK CASALE: Super important. And something I've talked about multiple times on here and elsewhere with Maureen Werbach of The Group Practice Exchange of like, how to hire your leadership team, because too often I see, and I've been guilty of this myself, of promoting people into leadership roles because they're good at one thing, but you don't really have the role defined, or you don't really have the expectations defined, and then you find that the people you're putting into administration are not really the right fits for whatever reason. And it's really hard to walk that back once that's happened. So, really being able to hire your dream team is super important.

NICOLE McCANCE: Yes, and I actually have a six-step hiring model. Do not hire anybody until they go through all six steps. And that includes like a personality test, a strengths assessment, a working interview. We usually just do one step, maybe two, interview, references, you're hired. And hiring the wrong person is the biggest headache. So, that is step two. Then you build your dream team.

But let's get to the fun part, step three. Here's where we attract clients with digital marketing. Now, I love digital marketing because I was so busy, and had no time, and was already burnt out, I didn't really have a lot in me at that point with the twins to go, and network, and do all the things. So, I will tell you, those who have reached seven figures in my program, they all use Google ads.

Now, a lot of people say Google ads don't work. You're just doing it wrong, or your website isn't branded enough, but Google ads, advertising works. That's what every big brand does. You need to advertise.

PATRICK CASALE: Yeah, advertising is crucial, right? Like, if we're sitting here having this conversation and anyone listening, even if you're in solo private practice and you're like, "But it's not for me. It feels salesy. I don't know how to market. It feels like, you know, I don't really know how to do that. I didn't learn that in grad school."

For the most part, I would imagine 99% of us who are mental health entrepreneurs did not learn this in grad school. But you can learn it now, and you can also delegate, and it makes a world of difference.

And what I find to be the biggest issue when we talk about Google ads, and SEO, and web design, Google wants everything to sync up, right? Like, it wants your Google My Business, your Google ads, your website. Everything has to be, like, side by side, syncing up together.

And far too often I see like a really basic, shitty website with no content, no landing pages, Google ads, that point to things that maybe your website doesn't really accurately reflect. And then, all of a sudden, it's like, of course, we're just throwing money into this pit. And it can feel like a lot of hopelessness and a lot of frustration once that happens.

NICOLE McCANCE: Yes. And I think the key is not doing it yourself. Please, you're so good at talking about feelings. You're such an amazing therapist. Stay in your lane and hire a good marketing agency.

I find even, like, something as basic as your keyword needs to go to your specialty page on that thing. So, when I click on anxiety, but you send me to a random page, when you confuse, you lose, I bounce. So, make sure you send them to the matching page, right? Just small things. So, that's number three.

Number four, a lot of people miss, we're so hungry for marketing, but they're not a client yet. They're just at your website. But now is when you want to convert. What is your conversion rate? A good conversion rate with your team is about 70%. Yours is probably going to be higher, but aim for 70. If you're higher high five.

But number four is convert clients with consult calls. I love free consult calls. They should be about 20 minutes. I think because the first 15 is building rapport. I give like a whole script of how to have people move. Because, as a side note, we are selling something that's called sit with your pain. People actually don't want to do that. They don't want to do that, right? So, how do we guide them to actually give them, like, the result that they want?

But the last five minutes is where you book multiple sessions, get the credit card, because I teach private pay, and go over the cancelation policy. So, a lot of people, their conversion rate is low just because the consult call is too short, that's all it is. Add an extra five minutes.

PATRICK CASALE: Yep. Yep. And I think that another issue I see when I was doing private practice coaching is people don't ask for the conversion. It's more like, "Okay, so that's how therapy works." Or, "That's how I work. Okay, let me know if you want to schedule at some point." And that's the end of the phone call. Instead of saying, "Hey, my next available session is on Monday at 10:00 AM."

And I would always teach people to say, like, what email address do you want me to send the paperwork to and get this started? So, really, just being more direct on the call, because they're calling you for a reason. They've reached out to you for a reason, right? They've already kind of done some of the due diligence, and leg work, and heavy lifting, so I think that's important as well.

NICOLE McCANCE: Yes, and I know it's hard for people because that feels pushy or salesy, but here's the thing, what if they're depressed? They lack the motivation, they need you to be a guide, to hold their hand, to literally, what we sell is have a better life. I would sell that all day long. There are people selling things that are not as great, that thousands of things, you know, that we see bombarded with. Like, I feel like we need to take a stand for people to actually do more therapy. Wouldn't the world be different if we pushed therapy more?

PATRICK CASALE: Yeah, it would be helpful if it was pushed more and more accessible to everyone, so it would be different, for sure.

NICOLE McCANCE: Yeah, and number five is retention. Don't forget, guys, retention. You did the consult call. They're now a client. On that call, you actually booked four sessions because I say, if they commit, I don't know if you noticed this, Patrick, but when they committed to a certain day of time, then they just showed up to multiple sessions. Like, they're just way more likely to be retained because they've built their life around that session, right?

PATRICK CASALE: Yeah, I think we also just really struggle as mental health therapists, like, with the scheduling component so it can get really lost, you know, where you might have a session, and then leave it open-ended of like, "All right, let me know if you want to come back at some point or when you want to come back." And then, you schedule other things, and then it becomes like a game of Tetris to fit people into your schedule.

NICOLE McCANCE: Yes.

PATRICK CASALE: And I like having more of a, like, regimented approach to that, because my brain just works better in those settings. So, easier for me, easier for clients to remember, like, "Oh, I come every Tuesday at 4:00" is a hell of a lot easier than like, text me next week and we'll see what we can do, or when I can get you in.

NICOLE McCANCE: Exactly. Cancelation is going to go down. Obviously, the results are going to be better because they've committed. And if you can book even more than four, I find four is like easy to digest when they just meet you, and then you can book the rest of the treatment plan.

But step five, retain clients with follow-ups. Are you following up? We were just never taught that. Like, follow up with those people who no show or cancel, follow up with those people who don't book on the consult that said they were going to check insurance or talk to their spouse. And even follow up with those who ghost you, because they were triggered, they went on that vacation and you never heard about them, or you heard from them again.

And the beautiful thing about this, what I love, Patrick, is a lot of this your admin can do. Your admins following up, not you. Your therapists are doing the consults, because you're building the business in the background.

PATRICK CASALE: Yeah, for sure. No, follow-up is huge. And I think about so often, like, how all people forget that reaching out to a therapist for the first time is a really vulnerable experience, and sometimes that is, like, the step for someone, right? So, they might build up the courage, or they might be in such a bad place that they're finally, like, I'm going to reach out for therapy. And then, they do it, and they're like, "That was really daunting or intimidating." Or like, "Ooh, that was a relief that I did the thing." And ultimately, that no longer feels as much of a priority at the moment. So, following up is huge, and you capture and convert more when you are doing these things, for sure.

NICOLE McCANCE: Yes, 20% more, actually. So, research shows just by following up, you increase sessions, clients by 20% and this is like, not industry-specific. This is just like all industries, yeah.

PATRICK CASALE: Yeah, yeah, no, 100%. So, great steps and strategies. It sounds like you've got a lot of formulas and templates, and steps in your coaching program. So, I always like to hear that, because I think that works well for a lot of people.

Anything that we've missed in this conversation that feels like really important that you want to share with people who are listening?

NICOLE McCANCE: I feel that a lot of people are afraid to be a boss. You know, it's just like group practice is next level. Starting your private practice is, oh gosh, I'm a business owner, but then group practice is, oh gosh, I'm a boss.

And a couple of things for me, it was less intimidating because I was a baby boss, and so I hired baby therapists. I actually started with interns. If you live in California, you can't hire interns, so double check where you live and pre-qualifying, because I just felt like, you know what? Yeah, it was less intimidating. So, know that there's certain ways where this could be easy and just hire one. Just one.

Like, honestly, Patrick, if you were to tell me, "Nicole, one day you would have 55 therapists." I would look at you and laugh. Like, I didn't plan that. It's just one step in front of the other and working with someone who's done it before, because there's 100 mistakes that they will save you from.

PATRICK CASALE: 100%, yeah. And there's a reason the same questions get asked in all of the Facebook groups and all of social media posts, because anyone who's entering into this world, you know, there's going to be a lot of unknown, and uncertainty, and discomfort, so having some support and guidance is crucial.

Yeah, good conversation, good tips, good strategies. And Nicole has all of these downloadable resources and freebies. So, we'll have that in the show notes too.

Nicole, tell people where they can find you on your podcast, and at your website, and everything else you've got going on.

NICOLE McCANCE: Yeah. The best place of finding me, if you love podcasts, which I'm assuming you do, would be my podcast, the Business Savvy Therapist. And if you want to hang out live, I do have a weekly masterclass, How to Build a Seven-Figure Group Practice.

PATRICK CASALE: Sweet, and we'll have all of that in the show notes, so you have easy access to all of those links and information.

And Nicole, thanks for coming on again and making the time.

NICOLE McCANCE: Yeah, thanks for having me.

PATRICK CASALE: To everyone listening to All Things Private Practice, new episodes are out on Saturdays on all major platforms and YouTube. You can like, download, subscribe, and share. Doubt yourself, do it anyway. And we'll see you next week.