Group Practice - Business Growth or Burnout Multiplied?

Aug 19

Ever wonder if you're the only one silently struggling while running a practice? You're not. This episode dives deep into the raw reality of therapist burnout - and what comes after.

In this episode, we pull back the curtain on our personal journeys through therapist burnout, the emotional toll of leadership, and the hard-earned lessons we’ve learned from building and breaking our therapy businesses. We’ve led teams, scaled services, and weathered some serious storms inside our own group therapy practice models. And we know firsthand how often clinician mental health is sacrificed in the process.

Whether you're dreaming of launching a side hustle for therapists, reimagining your practice, or dying to explore fresh mental health business ideas, this is your space.

In this episode, we talk about:

How we recognized therapist burnout and why we finally decided to stop pushing through

What’s missing in most conversations around clinician mental health, and how to center your own
Why traditional paths aren’t sustainable - and how we started building mental health business models that actually support us
How a side hustle for therapists can offer freedom and purpose when the 1:1 model starts to wear thin
The real-life mistakes, wins, and mental health business ideas we’re exploring now

If you’re holding space for everyone but yourself, questioning whether you can keep going, or wondering if it's possible to run ethical, profitable therapy businesses without breaking down - this conversation is for you.

We’re sharing our stories not because we’ve figured it all out, but because we know someone else needs to hear them.

Subscribe and listen now. New episodes every Tuesday.

WATCH THE FULL VIDEO EPISODE HERE!

[00:00:11] Jennifer Politis: Welcome to the Off the Chair podcast. We are focusing on our second episode today, and that is about group practice. Is it business growth or burnout Multiplied. Everyone loves the idea of scaling, but what if growing your group practice just grows your stress, your liabilities, and your leadership mistakes?

[00:00:32] Jennifer Politis: Let's unpack the promise and the pain of becoming a boss in private practice.

[00:00:37] Colleen Long: This episode dives headfirst into the myth of group practice and the golden ticket to freedom. We'll share the unfiltered truth about stepping into the CEO role, including the emotional weight of managing therapists, the chaos no one prepares you for, and the moment growth. Stop feeling good.

[00:00:38] Colleen Long: Tired of being burned out, underpaid and boxed in by a broken mental health system.

Colleen Long: Welcome to Off the Chair, where visionary therapists talk business burnout and building something better

Jennifer Politis: because to lead, to earn more. Reclaim your creativity and truly change the mental health system. We have to get off the chair and into the role of visionary CEO and change maker.

Colleen Long: I'm Dr. Colleen Long psychologist, entrepreneur, and founder of a seven figure practice I built.

Colleen Long: Broke, rebuilt, and exited. I'm here to ask the hard questions. How do we adapt? How do we survive, and how do we fight back against a system outsourcing mental health to the lowest bidder?

Erika Bugaj: I'm Erica Bugaj, clinical social worker, psychotherapist, group practice founder and doctoral student. I work with therapists who want to build brave values led businesses without burning out, because real growth doesn't just happen in the chair.

Erika Bugaj: It happens when you step out of it.

Jennifer Politis: And I'm Dr. Jennifer Politis, psychologist, entrepreneur, multi-site group owner of a seven figure practice and business coach, obsessed with making strategy simple, sustainable. 0% Bs. I help therapists lead like CEOs and build businesses that work for them, not the other way around.

[00:01:39] Colleen Long: No fluff, no fake success stories. Each week we'll dive into honest conversations about hiring money leadership. Scalable income and leveraging modern technology to build a more innovative, profitable practice. This is off the chair. Now. Let's get on with the show.

I really see our podcast as for two types of people, and I, and you guys chime in here, if you agree or disagree. So I, I see the podcast as being for people that, uh. Are either wanting to own a group practice and are kind of wanting to see like, is this a good idea for me? Or people who you know, already own a group practice and want to better scale, learn how to grow, implement systems, that type of thing.

[00:01:19] Colleen Long: And we can certainly help with that. And then the other type of person I see it for is maybe someone that. They don't, they're not a group practice owner, or maybe they are, but they want to get away from the traditional trade, your time for money format altogether. They're looking for how do I leverage my expertise in a way that I don't feel tied to the chair, and what are the things that other people are doing that are sort of outside of the box thinking that really utilizes that moat that we have as.

[00:01:51] Colleen Long: Trained clinicians with all that education. How do we do that in a way that still feels free and and creative? What do you guys think?

[00:01:59] Erika Bugaj: I agree that at some point in. The many years of sitting in the chair, there is a desire to pivot and to assess what other types of work activities one can do to bring in income instead of the traditional, like we've said, 53 minute, but in seat session. And that's something I think a lot about and. You know, in looking at the future, uh, when I was a young therapist, I saw group practice as a way to do that.

[00:02:34] Erika Bugaj: however, I think I am really at a crossroads with whether or not the group practice helps to fulfill that potential vision or dream. Um, it seemed like a really positive way to add to the good, so. I thought, why not do it? when I first opened my small group practice, my partner at the time was in school and we had a growing family.

[00:03:04] Erika Bugaj: Uh, so it seemed like a very helpful way to increase income. but I definitely underestimated the toll that it would take on me, um, emotionally and financially. I don't think back then, you know, over 10 years ago, I don't think there were as many resources for group practice owners as there are today, as it's become more of a thing, a phenomena.

[00:03:29] Erika Bugaj: So, um, I learned to put a support team together and. I still encountered a lot of unexpected bills. You know, random regulations popping up and tripped a lot over aspects of business ownership that I was unprepared for. I also give myself a lot of grace with that because how could I know what I was in for?

[00:03:54] Colleen Long: I think that's a real reality of what we're facing right now is that we're dealing with, um, some big sort of VC backed tech companies that come in and they do disrupt the field, right? And some for good and some for bad. Um, but where it disrupts the group practice owner is you've got companies that have billions and billions of dollars that can come in and hire your clinicians.

[00:04:19] Colleen Long: At a rate that just would not be sustainable for you as a business, right? So it's really, really hard to staff today's practice and then it really puts us in a position of kind of begging people to stay for us versus being in that leadership role that you really need to be in to make people feel secure.

[00:04:38] Colleen Long: The other piece that I would say to that is there's a great book called the E-Myth, and it's about how, uh, it just starts with this woman who. She bakes pies, and that's all she does. She bakes pies and she's great at baking pies. But eventually, more and more people want her pies, and so she's gotta hire another person to make the pie for her.

[00:04:56] Colleen Long: And then she's gotta hire another person. And then she needs a bakery, and then she needs to market herself, and then she needs someone to do the payroll for all the bakers. And so this person has gone from technician to manager and entrepreneur at the same time, and. In the E Myth, they see those three roles, which is like technician, manager, and entrepreneur.

[00:05:19] Colleen Long: And as a group practice owner, I think we really struggle with trying to balance all three of those roles. And maybe that's where people start is asking themselves, which of those things do they like best? Do they like being simply the technician and or in our case, the clinician? Do they just like seeing clients?

[00:05:37] Colleen Long: They don't wanna deal with the administrative, they don't wanna lead people, they don't wanna do systems. That's the technician piece. And I think that's great. Um, there's the manager piece, so that's the operator, the person that likes to go in and roll out those systems, but isn't necessarily gonna be the visionary.

[00:05:52] Colleen Long: Thinking about like, how do we get those big contracts and how do we. Band. And then there's the, the entrepreneur, the dreamer, the person that really yearns for that creative freedom, um, to create and build something and suspend reality. And when you're in a group practice, I, I, at least for me, that piece became so small. That was the piece I love. That's the piece that feels like oxygen is like, what if we did this and what if we created our own like wellness brand and self-help line? And what if we did a podcast and all of that was gone because I was so busy being the manager and sometimes the technician. What about you guys?

[00:06:36] Jennifer Politis: Yeah, I mean, I definitely agree. I was even thinking, taking a step back in our field before we became group practice owners, I think so many people aspire to be, first of all, a solo practitioner in private practice and a group practice owner, because I do think it was a little bit glamorized at the

[00:06:54] Jennifer Politis: time.

[00:06:55] Jennifer Politis: You know, I remember being in graduate school and talking to my professors, and to be honest, the track was, do you wanna be a professor? Do you wanna be a researcher? Do you wanna work in the clinical field? Do you wanna work at a, you know, agency, college, counseling center, hospital? And if not, or school, or if not private practice.

[00:07:14] Jennifer Politis: And at least at that time, you know, that was 20 years ago. But I remember aspiring and looking at. I had one professor in particular who, she was a full-time professor and she had a side practice and her practice at that time had she expanded it into group practice and I thought, wow, like she has people working for her and she has this other job that's bringing in stable income.

[00:07:40] Jennifer Politis: So, you know, I do think we were kind of, I don't wanna say fed a lie, but we were, you know, that was kind of our role model at the time.

[00:07:48] Colleen Long: Mm-hmm. Yeah. Well, so today's episode's gonna be more about the former, which is, uh, scaling group practices. Uh, you know, this will really hit for some of you that are maybe struggling with, man, what do I do? How do I get better at doing this? Can I get better at doing this in today's day and age? Is it even possible?

[00:08:10] Colleen Long: Is this dream gone? I don't think it is. Um, or, you know. What do I do to fold them? You know, what do I do to say I don't wanna do this anymore? And it's okay to say no and there's great power in No. But for the, just a little second, I want to, I wanna do a career daydream segment. So this is for the second part.

[00:08:38] Colleen Long: So if you. If you were to get off the chair, and I'm sure we've all had those, I know I've had those moments where you daydream about what it is that you would've done differently. Like if tomorrow, Erica, they said you're, we gotta take your license and you can't do what you're doing, what would you do? Dream job.

[00:09:03] Erika Bugaj: I do think that I have an interest in being an educator, um, and whether that's in, you know, the typical higher educational realm, maybe eventually I'll get there. But I do like the thought of, you know, doing more group work. Incorporating some of the clinical skills I've developed over the years.

[00:09:27] Erika Bugaj: One idea that comes to mind is I'm a nature informed therapist, so, you know, maybe working with organizations to bring in, nature-based therapy techniques to teams and two groups, expanding the, the good, By helping more people at once. Uh, I do give talks in the community around therapy, psychoeducational talks, trainings, things like that.

[00:09:55] Erika Bugaj: Um, so I think it would really be a matter of building on that to work with, say. Organizations, companies, corporations, who want to bring someone in to lead their retreat or help with their retreat and help to inspire and maybe also impart some mental health education to their teams.

[00:10:17] Colleen Long: Nice. Nice.

[00:10:19] Erika Bugaj: I do really relate to the visionary piece because I, I like to brainstorm. I feel like I could do that all day long, but. What I'm constantly reminded of as a group practice owner is I'm just one person. It's only me. And you know, growing leadership on the team is helpful, but ultimately you can only spread your yourself so thin.

[00:10:46] Erika Bugaj: So you know, I have to often. Stop myself from doing what you described Colleen. Like, oh, I could do this. That sounds so great. Like, or coming up with these really awesome ideas that inspire me and maybe, you know, our little outside the box of typical therapy approaches or, you know, the typ typical therapy framework.

[00:11:12] Erika Bugaj: Uh. But I would have to, to clone myself. And I've been, I've been making that joke since I started this, um, group practices. If only I could clone myself.

[00:11:23] Colleen Long: Yeah. Well, and it sounds like you really do like the. Clinician aspect of it, you know, even in your fantasies, it's about taking that and still being in that lane, right? Like being, uh, a facilitator of mental health and wellness, but just maybe in a different format. Um,

[00:11:46] Colleen Long: versus like, I'm more like, should I be a soil engineer, makeup artist?

[00:11:55] Colleen Long: Um. You know, and I actually, I, I had a, I'm we're trying to put in a pool and the guy said, uh, it's $2,500 upfront. I'm gonna test your soil. And he just told me when he was gonna be there. He walks in and I'm thinking. What kind of model is this? Like I need $2,500 and I'm gonna go play in your dirt for a couple minutes and he doesn't answer to anybody.

[00:12:23] Colleen Long: It took me three months to get him and he's like the only guy in town that can do it. And uh, I thought that sounds nice. You, you're just with your dirt tools and that's it. You're just like, you don't deal with Aetna. You're not like Aetna. I need copay for this dirt. No, you just, it's $2,500. Right? I don't show up and I'll show up when I wanna show up and you're not gonna rake me over the coals and social media.

[00:12:51] Colleen Long: 'cause no one's look looking for a soil engineer. And so I thought that's a, I'm gonna, can I be a geologist? That was one thought I had. Um, makeup artist after I got my nails done and they charged me more than what, uh, I get paid for 9 0 7 9 1. I was like, could I do nails? Um, so that was a thought. And then, uh, you know, I think the other dreams have been just, uh.

[00:13:21] Colleen Long: You know, working with our baby boomer population and creating like legacy sites for them, but from a psychological bent, like really I love writing. So capturing them in a way that is perpetuated forever online or creating like a glass door, but for employees where you rank your employees. Mm-hmm.

[00:13:42] Erika Bugaj: Uh oh.

[00:13:44] Jennifer Politis: I like it.

[00:13:45] Colleen Long: I'm pretty sure it's not legal, but I'm like, why can you rank your employers but you can't rank your employees?

[00:13:52] Colleen Long: Right? And then if you it's just a one-off, then that's fine. But like if they keep on doing the same behavior, they start to go up there and the algorithm. So I've got all these ideas and the problem is I actually act on a lot of them. So it becomes analysis paralysis.

[00:14:11] Erika Bugaj: Is that a problem though? I mean, that sounds like a plus that you take steps to explore other, other things that interest you. I mean, I certainly have those ideas too. At times. Like for me, I, I've always thought owning an ice cream shop would be like the

[00:14:29] Colleen Long: Ooh.

[00:14:30] Erika Bugaj: you know, way to bring joy into people's lives.

[00:14:33] Erika Bugaj: But from what I hear, it's also not easy. So, um.

[00:14:38] Colleen Long: I.

[00:14:39] Erika Bugaj: And recently our favorite ice cream shop here down the street from our house just closed. So it's so sad we've lost our

[00:14:48] Colleen Long: Yeah.

[00:14:49] Erika Bugaj: So I mean, there's that, and I, I like to cook and I, you know, in grad school, uh, worked in some restaurants and to have thought about that too.

[00:15:00] Erika Bugaj: But, um, I know that's a really tough industry as well.

[00:15:04] Colleen Long: Yeah, that was the cool thing about being in Vistage was you were at a table with a bunch of CEOs or, or, uh, leaders, and you learned that no matter what industry, there's always. Pain points. I mean, everybody, even if you're selling, you know, fire hydrants, you're going through some sort of pain point. Um, and so I think that helped to bring perspective for sure.

[00:15:32] Colleen Long: What about you, Jen? I'm curious what you would do if you lost your license tomorrow or just threw it out the

[00:15:37] Jennifer Politis: You know, I know I am definitely, um, I think for me, I'm over the clinical piece, not in a bad way. I feel like it served me, I enjoyed it for 20 years, but at this stage of my life, I think I'm looking for. I wanna have a more fun, um, I don't know, you know what I mean? I'm 45. I have, you know, two kids that are teens.

[00:16:03] Jennifer Politis: My little guy isn't yet. So I just feel like I'm looking at life through a different lens at this point, and I keep thinking of like, what does my next chapter look like?

[00:16:11] Colleen Long: Mm-hmm.

[00:16:11] Jennifer Politis: So, but I'm like you Colleen. I have a hundred ideas, you know, and I'm looking into running an AI business. I wanna set my three kids up with like their own AI business and I want it to be fully functioning with and, and I'm looking into it and I created an Etsy shop and I started writing a book.

[00:16:29] Jennifer Politis: And you know, I love being in the visionary role, but I definitely feel scattered because. And every time I meet with a business coach or even talk to my best friend, everyone tells me, just pick one thing and focus on it. But I almost can't do that. It's like it, it doesn't sit well with me.

[00:16:50] Colleen Long: right.

[00:16:52] Jennifer Politis: Yeah.

[00:16:52] Colleen Long: I feel like, uh, I'm still, the jury's still out in terms of whether or not that's the best advice. I know that is always the sort of standard advice, right? Any entrepreneur you listen to, they're. You gotta just focus on one thing. You can't be spread thin. But I also think if you've got excellent organizational abilities, you know, you can make time.

[00:17:17] Colleen Long: Like this podcast is one of those pursuits for us, and we've carved out a time every week where we're like, this is the thing, and all of a sudden after a year, it's gonna be this thing that's built. And you're like, how do you do a podcast? You've just made time for it and you've automated it once a week.

[00:17:33] Colleen Long: Right. And I think that's what you do for all of your ideas. You just have to carve out that space. And I think about when I was doing my dissertation, somebody said the greatest way to, or the easiest way to eat an elephant is one bite at a time. And it's like, you can't just be like dissertation, like do my dissertation today.

[00:17:50] Colleen Long: It's like, I gotta do my literature review. You gotta just kind of break it down into these steps. So I'm still of the belief with you, Jen, which is like. I think you didn't have it all. I think you have done your time, you've put in your time, your dues, you've paid your clinical dues, and yes, at 45, tomorrow's not promised.

[00:18:12] Colleen Long: So why not have fun in a way that really leverages all the work that you've put into yourself in

[00:18:20] Jennifer Politis: Yeah, and there are two areas that I think of a lot. I do think of supporting like women business owners in a more fun way, just because I know when I'm looking for motivation, those are the people that I follow and I listen to. And I also love cooking. And again, my daughter loves cooking and we cook a lot together.

[00:18:39] Jennifer Politis: And my daughter would love to have like a YouTube channel and she has in the past. So I think. I don't know, maybe I do something fun and we just cook together. You know what I mean? And we just, um, so yeah, those are the two things that come up quite

[00:18:55] Colleen Long: well. You see these, uh, people like Dr. Mike. I dunno if you've seen Dr. Mike on YouTube, but I've got kids that are the age. They love watching these things. And of course the kids are watching it fascinated. 'cause they're like, oh my God, look, he's dispelling all these medical myths. And he was a medical doctor and he is making way more money on YouTube.

[00:19:14] Colleen Long: Talking about like these ridiculous things that he finds on tiktoks and he just shreds 'em apart. Then he would've as an actual medical doctor and, and we would too, if we got on TikTok and looked at the mental health myths that are out there and broke it down. There's an idea right there. Just, you know, your Dr.

[00:19:30] Colleen Long: Jen and your dispelling these crazy myth. It would kill. Right. So what does that say about when we see these, you know, really serious shootings and people are crying, mental health, mental health, we've gotta have better mental health. We create a society then where the biggest brains in the best minds that have trained for this are rewarded more for that, more for helping those people in prevention than they are on YouTube.

[00:20:01] Jennifer Politis: Yeah.

[00:20:02] Colleen Long: You know, because that's where the brain drain's gonna go. So, um, we, I, I'm totally there with you. I, I feel like the next path is gonna be something with my kids involving them and they, uh, this weekend we're on this app called whatnot. Have you guys heard of that?

[00:20:21] Jennifer Politis: I haven't heard of it. What is it?

[00:20:23] Colleen Long: Oh my God, it is. I almost don't wanna tell you because it's gonna take up. Days of your life, but it's sort of like eBay on steroids. You get

[00:20:34] Jennifer Politis: wait, I heard about this from Gary V. I think Gary V mentioned this

[00:20:38] Colleen Long: oh my god, it's the most brilliant idea. It's amazing. So you go in and you're literally just like hawking your stuff in your house. You're like, glasses, go cup. Go. And then people just randomly jump into your feed and they'll start to bid on all your stuff, and then you, and then it just creates a shipping label for you.

[00:21:00] Colleen Long: And it's very easy and it's, it operates on that intermittent reinforcement principle that Vegas operates on. So every once in a while, you're getting that sale and it becomes addictive. And then the same thing. You're bidding, you just swipe right bid, swipe right. So it makes it so easy. Um, and so my kids got into it and it was really cute to watch them.

[00:21:19] Colleen Long: They're like trying to sell their baseball guards and their Pokemon, but then I was like, wait, can I do this? Because I have a lot of product. So it is, it's really, it's fun. I don't know that it's a big money maker unless you're, you know, really moving product. But, um, it's just one of those things that you're like, okay, these people just made a hundred thousand dollars over the weekend.

[00:21:42] Colleen Long: And that's something that most of our clinicians could hope to make in a year.

[00:21:47] Jennifer Politis: yeah. Well, you know, mentioning that is just like TikTok shop. So we, we just, we have a TikTok account and everyone was telling me, oh, we should have a TikTok shop. And I cannot believe the amount of people that make money on TikTok shop

[00:22:01] Colleen Long: yeah.

[00:22:01] Jennifer Politis: just putting up like our candles, our books, anything we have in the office.

[00:22:06] Jennifer Politis: So I do think stuff's going in that direction.

[00:22:09] Colleen Long: I really wonder if we are not straddling two different zeitgeists where we've got our old school work ethic that are like, you know, I grew up in the eighties. Our parents were like, you go to college, you get your degree, and then you go and then you make money. And it's like, I don't know that college, like I don't know that that path works anymore because I'm pretty sure my son's gonna just make an app.

[00:22:36] Colleen Long: Make way more money and not have to deal with the infrastructure. I mean, that's the biggest part that burnt me out in my practice was dealing with people and all day long as a, as an introvert, having like my circuits fried, managing, not patients, but employees that all needed something that day. So let's, um. Let's get into it. Let's talk about burnout. Let's talk about scaling. and, you know, we'll start off with just why no one prepares you to be the boss in group practice ownership. What do you guys, what comes up to mind for you when you're thinking about, you know, what leadership training or stuff you did, or the gaps that you had to address for yourself as leaders in your practice?

[00:23:25] Jennifer Politis: I think no one really teaches you how, how to lead, and as soon as you become a therapist and then you move into the CEO role. No one hands you a roadmap. You're just supposed to, you have your team, you know, you have a ton of, um, expenses that you're trying to figure out. You have your vision and you're just expected to figure it out without falling apart. And I know for myself, um, one of the worst weeks I ever had, it was like, and I'm not somebody who cries a lot, by the way. Like, I'm pretty, I hold it together. You know what I mean? Not that I'm not emotional at times, but I'm not somebody who like overly cries. And I remember sitting in an office after a horrible, rough, rough week.

[00:24:07] Jennifer Politis: We had like two resignations, a whole budgetary issue that we were trying to get ahead of. We had a tense meeting with somebody and I literally went in the stairwell of my building and I started crying in between calls of speaking to my attorney on one hand, and then my, accountant. And I just remember thinking like, I built this.

[00:24:28] Jennifer Politis: I love this. Why does it feel like it's breaking me?

[00:24:31] Colleen Long: Mm-hmm.

[00:24:32] Jennifer Politis: You know, and I do think part of it was I never grieved the version of me as a therapist, as a psychologist that only wanted to do the good clinical work and go home.

[00:24:44] Colleen Long: Mm-hmm.

[00:24:45] Jennifer Politis: And I think leadership is, is very messy, especially in the beginning. And I think it's not just about what you do, I think it's about who you're becoming during that process of, of the transition.

[00:24:59] Jennifer Politis: And I know we've maybe talked about it briefly before, but like I do think leadership is identity reconstruction, and I don't think anybody talks about that enough. You know, we talk about scaling freedom, building a practice bigger than ourselves, but what happens when the bigger you build your practice just multiplies your burnout?

[00:25:21] Jennifer Politis: What happens when you realize that leadership is less about calling the shots and it's more about taking the hits?

[00:25:27] Jennifer Politis: I mean,

[00:25:28] Jennifer Politis: as a business owner, you're the bad guy all the time. You know, even though I would go outta my way to pay my clinicians, well, I'd fight with my accountant at times and I'd be overpaying them, but they would perceive me as I'm the big, bad guy, not wanting to pay them enough.

[00:25:47] Colleen Long: Mm-hmm.

[00:25:48] Jennifer Politis: Not understanding the financials. And then also I would do, you know, things like trying to make sure they're seeing the exact clientele they want decorating their office in the way that I know they like, like bending over backwards, but it doesn't matter. You do all those things, you're still the bad guy.

[00:26:03] Colleen Long: Mm-hmm.

[00:26:05] Jennifer Politis: So I do think what happens is like you grieve your old therapist self and I do think you kind of resent for a time period your new CEO self. While you're kind of figuring this out because it's like a dichotomy. Like you're just like, who am I now?

[00:26:20] Colleen Long: Yeah.

[00:26:21] Jennifer Politis: I think for anyone listening that is in this stage, you're not broken.

[00:26:26] Jennifer Politis: You're just in this messy middle. And I think that's what growing into leadership looks like. You know, you're not a bad leader because it feels hard. You don't have to burn, you know it all down to rebuild it better. And I think it's okay to honestly change your vision.

[00:26:45] Colleen Long: Yeah.

[00:26:46] Jennifer Politis: your website says something, it's okay to take a pause, change it, change your vision of why you wanna, you know, grow the practice.

[00:26:53] Jennifer Politis: At this point, maybe it's not what you set out to do in the beginning.

[00:26:57] Colleen Long: yeah.

[00:26:57] Jennifer Politis: I.

[00:26:58] Colleen Long: What about for you, Erica?

[00:26:59] Erika Bugaj: Well, I relate so much to what Jen just shared, and um, you know, I think I can, I still enjoy to a degree the clinical work. Um, but in order to make the group practice function, my caseload has to be very small. So, um, you know, I do feel like it's walking a tightrope, kind of, you know, holding a. the rod, you know, you know when someone walks in.

[00:27:29] Jennifer Politis: Oh yeah, they're holding the,

[00:27:30] Jennifer Politis: Yeah,

[00:27:31] Colleen Long: Oh, the cattle prod.

[00:27:32] Erika Bugaj: it just feels very difficult to, to balance it all and to carve out these different aspects. And that's something I've been thinking a lot about lately is being a helper, an empath, a person that, uh, really enjoys working with people one-to-one, one balancing that with the leadership role, the CEO role and.

[00:27:57] Erika Bugaj: You know, having really strong, tough boundaries around the business. It's almost like two conflicting aspects of oneself existing together. And does that work? Is that, you know, possible? Is it something you can do in the long term? You know, I, I'm, I'm not sure, uh, and I still sit with a lot of these questions daily, you know, thinking about.

[00:28:24] Erika Bugaj: Those contrasts in my, the aspects of who I am and the type of work I do right now. Um, it's a big question mark.

[00:28:35] Colleen Long: Yeah, and I think that where I got confused along the way was between the difference between CEO and entrepreneur. Or visionary, whatever you wanna call it. There's a distinct type of person who's cut out to be a CEO and that person usually has an MBA. They've got significant training in systems and operational leadership, and they know they can define for you really quickly the difference between leadership and management. Um, and they know how to fire in a way that. Helps them so that they're not doing everything and they know how to oversee that, right? So to create those KPIs or key performance indicators that they can say, alright, I want you to do this. You're my VP and I'm gonna check back with you in two weeks and make sure that you're doing it. Where, where I went wrong. And to me, one of the examples why I am not cut out to be a CEO is I did a lot of, um, more. Abdicating versus delegating. And I thought abdication was leadership, so I would just be like, alright, cool. So um, I'll pay you all this money and can you just take care of it? Great.

[00:29:52] Colleen Long: Awesome. Um, but I wasn't really sure what we were checking in on. I didn't know what they were supposed to do. I just knew I didn't know how to do it. And. It got really messy as a result. And I remember one of my mentors saying, Colleen, you can't just outsource this stuff. You gotta pull up your sleeves and get ready to get dirty and get in there.

[00:30:16] Colleen Long: And I was like, I don't wanna do that. That's why I'm paying her to do that. I'm, I'm used to, as a therapist, being liked a lot. You know, my, my clients would come in and I would pull out their file and we would just get cozy and I would talk about like. Them for 45 solid minutes. And who doesn't love that?

[00:30:36] Colleen Long: So every, every single person liked me in my business until I became a group practice owner. And then I was like somehow the bad person. Um, and a lot of that came from. Seeing a clinician that was billing us three hours for something that we could only bill the insurance company one hour for. Right? And me having to have this sweaty back conversation, which a lot of CEOs have to have every single day, which is, Hey, I.

[00:31:04] Colleen Long: Could you try to get that done in an hour because we can only bill one hour for that. We can't afford to pay you that. And then them somehow thinking that that's me being stingy or greedy or, or whatever. So I think that's where I really struggled in that role. Um, I remember thinking. I think just through dumb luck, we, we grew really quickly and we're doing really well, and so I thought, okay, well now I'll just bring in my operator.

[00:31:34] Colleen Long: And if anybody's ever listened to EOS, that's sort of, there are two things that they talk about, which is visionary and. Integrator. Those are the two things. Visionary integrator, I, I kind of use those interchangeably, integrator and operator. Um, and I was most certainly the visionary and I thought, oh my gosh, this is brilliant.

[00:31:51] Colleen Long: I need my integrator, I need my operator. Um, so I'll just go find that. And I went through 300 applications. I found someone that was actually. An operator, like they called themselves that they had studied EOS and uh, vetted all the references and had all four of my team watch them, created a blueprint, onboarded them for three months.

[00:32:15] Colleen Long: Thought I was doing the whole thing. Red Cameron Harold, second in command, put them in the second in command, thought, alright, we've got all the guardrails. We're good. And I remember checking in with her. This is about like a month in. And my entire original team quit. I think they were like, we don't like it anymore.

[00:32:38] Colleen Long: Someone's moved our cheese. Right? So my practice manager, my biller all quit. she was like, it's, it's fine, Colleen. I've handled this before I got it. She hired all new people and I said, okay, so you'll meet with them once a week and then just report back to me on how it's going. So every week I would just say, how's the new biller doing?

[00:32:57] Colleen Long: Colleen, I am so impressed with their energy, with our team synergy. I am just, I, I'm so impressed. And I would just walk away going, well, you've done it. You have scaled your business. And now like, there you go. You've just put the right person in and here you go. And then cut to two months later, my husband was saying, have you looked in your bank account and.

[00:33:23] Colleen Long: I hadn't because I had never had to do that. Um, we were always flush. And so I looked in there and we were in danger of not making payroll. And as I looked under this, you know, turned over this rock, there was so much not happening under the surface in terms of, cost control. Cost management oversight of the new biller, making sure the new biller, developing KPIs for that biller, holding them accountable.

[00:33:56] Colleen Long: And I would start to jump into their meetings and listen to what was going on. And I was like. This is all qualitative stuff. There's no numbers. It's all feelings. No facts, what is going on. And I found myself saying that over and over with my person, which was, I need facts, not feelings. And the biller quit a week later.

[00:34:19] Colleen Long: The other person quit a week later. So despite them feeling there was synergy, there apparently was not synergy. And as you know, turnover costs. So, you know, I could tell you a million of those stories. And ultimately that ended up chaining me to the practice in a way I had never been chained to before.

[00:34:37] Colleen Long: Um, and so I think it's. It was a really powerful lesson, one that I'll never forget, and one that I now know. You have to understand how to evaluate who you're hiring. If you're putting in someone, their ROI, their return on investment should be three to five x what you're hiring them for, and they should be able to give you a pretty solid plan on how they're gonna do that.

[00:35:03] Colleen Long: Day one, and my person was working with, they'd hired some creative to work on our logo. That was their day to day. So they're working on window curtains. Meanwhile there's a fire in our practice. Um, and so that just to me, uh, felt like, man, Colleen, you are not cut out for this. There's so much that you didn't know before hiring this person.

[00:35:30] Jennifer Politis: So if you could go back first of all that thanks for sharing. 'cause I feel like, um, I think that can resonate with so many people and I'm sure for you after that whole experience, I'm sure you, it almost, um. You know, had you second guess your abilities and, you know, take a toll on you emotionally of just going through all of that.

[00:35:52] Colleen Long: Yeah. Yeah. I mean, I've got a great clinical director now, and she's like, Colleen, when you. When you hire someone or you or someone leaves, or you let them go, you gotta let the team know. It was such a simple thing. But it just, the way that I'm wired, I think, as an entrepreneur, as a seven on the Enneagram is, you know, there's a lot of great things about that straight, which is you see something, you do something and you, and you get it done.

[00:36:24] Colleen Long: But I don't have. The rollout capabilities. I don't have the fact finder on the kolby. I don't have that. Like, oh yeah, your team's gonna wanna know who this EVP is and what her role is, and, uh, where are you gonna be for the next three months, and all of that. So I think that is the bigger piece is just learning what I didn't know.

[00:36:49] Colleen Long: I mean, there's so much I didn't know, but. Um, where my strengths were and, and where they were not. And for me, you know, ultimately I ended up selling because I realized I don't have the cloth or the DNA for what it takes to be a CEO or a leader. And I do think. There are people that do, they love creating those systems.

[00:37:14] Colleen Long: They love accountability checks. They love the KPIs and the performance, and they love all the operations and systems. But that wasn't me. I, I don't want to have to manage everyone's emotions and have these sweaty back conversations every day, especially as someone that's an empath, that was a therapist and can pick up on everybody's stress.

[00:37:36] Colleen Long: I don't wanna do that to people.

[00:37:38] Erika Bugaj: I've heard this from other group practice owners that it's difficult to hire to scale, that choosing the right person to be the clinical supervisor, to be the, you know, COO you. Those are really important decisions and you know, you could do all the personality assessments and tests and multiple interviews and reference checks, but you know, I've learned from just hiring therapists that you don't really know.

[00:38:10] Erika Bugaj: If they'll sink or swim until they're in the role. And I think that's a really difficult thing about hiring. You know, I've, I have an HR consultant that I've talked with about the hiring process, and I don't think it's an exact science. I've seen people that look great on paper, you know, do poorly in the role and vice versa.

[00:38:36] Erika Bugaj: Those who don't have the best. Resume or, um, experience on paper come in and thrive because they have grit. And that's something I've, you know, done some reading and research about that seems to be a quality that helps therapists in the group practice setting to c to thrive. but I haven't figured out the secret sauce or formula for.

[00:39:03] Erika Bugaj: How to make those hires and have also, I've also been poised where I've had somebody I worked with and. Supervised and mentored and poured into for years and they, you know, obtain their clinical license and are drawn to one of the big online platforms and leave when I think, oh, your position to be a clinical supervisor, I can mentor you further and then it's so disappointing.

[00:39:33] Erika Bugaj: And I, you know, with the types of folks we are as therapists, I think we can't help but to pour into people and to really see, to feel great when we see them succeed. But the disappointment when things don't unfold the way you'd hope is acute and you feel it deeply. Um. So those are things I think about and that I haven't, uh, come to a place of resolve about.

[00:40:05] Erika Bugaj: Uh, though I'm sure there's some business coaches out there who would give me some additional advice.

[00:40:14] Colleen Long: Well, and you would always hear people say. Well, it doesn't matter about money if you've got the right culture, but that's bullshit because you can create, it sounds like you created a great culture all day long. You're pouring into your people and they feel very supported. And at the end of the day, it's about the bottom line.

[00:40:32] Colleen Long: If somebody's gonna pay them 20 more dollars an hour per code, that's what wins.

[00:40:38] Erika Bugaj: that's true. I agree with you a hundred percent on that, and it's sad.

[00:40:43] Jennifer Politis: Yeah, it is sad. What's interesting is, um, when I hired, I hired my COO internally, so she was a therapist that had been with me for a few years and I actually got a lot of slack from it, from like the business coach or if I, or if you read leadership books in what they say. 'cause they say you should bring somebody in from outside. And for me, it was actually the best thing ever because she, first of all, her and I already knew how we worked together. She already understood the culture, the vision that I had set in place. And it was an easy transition because I felt like she had the qualities of being super anal, super organized, um, into all the operations of everything.

[00:41:27] Jennifer Politis: So. She got the big picture and she was able to step into that role and do really well in that role because again, I think she had been working with us for a few years.

[00:41:37] Colleen Long: Yeah. Well, and I actually think that it's better to bring someone from the inside in because they have so much tribal knowledge that takes, it's a lift to let that outside person kind of know that, One of the things that came up for me though, as you were saying that, was that I got really good advice when it came time to hiring my second in command, which is don't call them a COO unless that's the last stop.

[00:42:04] Colleen Long: Right. So there's all these steps that they can go to. They can become practice manager or director of operations

[00:42:10] Jennifer Politis: and I actually did that. Yeah, she was director of operations first and I I did do that. Yeah.

[00:42:17] Colleen Long: Yeah, because sometimes you, and I did that too. I made the mistake of just being like, okay, you're the COO, and it's like they didn't want that title. They didn't want that responsibility. I thought it was something nice and that's not necessarily where they wanted to go. And also, if you start calling it COO, people are gonna expect a lot of money.

[00:42:38] Colleen Long: I mean, a lot of those people that were showing up for these interviews were wanting. Uh, way more than what we could have afforded to pay them. So also, I think how we name it too is really important. And, uh, sometimes growing someone from the ground up with you, I think can be really nice because they, you know, they do have all that tribal knowledge.

[00:42:59] Jennifer Politis: Yeah, but to Erica's point, so many of our clinicians now leave, even though you've supervised them, you've given them all the TLC in the world. So I just think that's just what's happening right now and what we just have to kind of

[00:43:13] Jennifer Politis: deal with.

[00:43:14] Erika Bugaj: And it can be the lore of the higher rate from the large online platform or, you know, some folks do have the, the same similar aspirations. I think that we had to, you know, cultivate, develop, and lead their own team. And, you know, I respect that. I wish I could somehow impart to them everything that I've learned, all the bumps in the road, and challenges along the way.

[00:43:41] Erika Bugaj: But sometimes folks just have to do it for themselves.

[00:43:46] Colleen Long: It's almost like being a parent. You're like, alright, go out there and I want you to see what it's like to be a group practice owner and then you can come back.

[00:43:53] Erika Bugaj: So much parent energy in this role.

[00:43:58] Colleen Long: Yes.

[00:43:58] Jennifer Politis: Yeah.

[00:43:59] Erika Bugaj: Mom at home, and mom at work.

[00:44:02] Jennifer Politis: Yeah, It's your second family.

[00:44:05] Colleen Long: They don't, they, you don't truly appreciate how much work it is to be a group practice owner until you're actually doing it. And unfortunately, I think some of our therapists think we're, we become Jeff Bezos in, in, in, you know, as soon as we become the group practice owner, we just have a million dollars and we're just sitting on a yacht somewhere.

[00:44:26] Colleen Long: And the truth is, you know, I went for a year in debt. Like not pulling, like pulling $0 while trying to pay everybody and working 12 to 15 hour days. Meanwhile, my therapists are clocking out at 5:00 PM They're not thinking about my p and l. They're not thinking about forecasting or how we're gonna do in Q3.

[00:44:45] Colleen Long: They're out, they're living their lives. And I was, I started to become jealous of that. Like why did I think that this was gonna be the next move for me? And I remember like just looking at my husband who would just clock out at five and I'm like. What is that like? You don't have to, you're not worried about anything else.

[00:45:02] Colleen Long: You're just like, you just have one role.

[00:45:04] Erika Bugaj: There is an appeal to that.

[00:45:06] Colleen Long: Yes. Uh, the, the other thing is, unless you've got funding, you know, whether it's a, you've got a trust fund, you're a Nepo baby, you've got some sort of VC check, uh, you don't, you, you're in a prop plane. You know, your practice boots, a bootstrapped practice. Any kind of bootstrapped business for that matter is a prop plane.

[00:45:30] Colleen Long: And the moment that you've got one thing that goes wrong, the whole thing can come down. And when you hire and you're looking at these second in commands, a lot of them are used to being very well healed. Well cushioned, uh, the person I hired was a team of four in a C-suite. So there was multiple rungs of protection before they crashed.

[00:45:56] Colleen Long: There's lots of money in those big corporations where they can focus on what should our logo, oh, I like, like a lighter blue for that logo, you know, versus we're not gonna make payroll girl. I need you to get back to payroll, like cash flow. We gotta focus on that. And you can't go back to the plane and take a nap and put it on cruise control in a prop plane.

[00:46:18] Colleen Long: You've got to be at the wheel a hundred percent of the time. So I think if that, if I could go back, that would've been one of the things that I sort of interviewed people from that lens ends.

[00:46:29] Erika Bugaj: I, I think I do that sort of type of education with my group regularly to say this is a small business, to give them the knowledge that I bootstrapped my practice, that this is not a corporation, you know, I'm not sitting on a secret pile of money here.

[00:46:51] Erika Bugaj: Uh. It, it's kind of, it's, it's tough to, to be vulnerable in that way, but I think it's also helpful and in giving them perspective on, you know, what it takes to, to make this sort of workplace happen.

[00:47:08] Erika Bugaj: I do enjoy pouring into the culture, like we have a weekly team meeting that I'm proud of, but, um, you know, I think it's just so easy. We contend with a lot of projections. I think that's a good way to put it, you know,

[00:47:24] Colleen Long: sounds like you did such a good job as. Um, clinical director, clinical lead, like that was the area that you really looked forward to and thrived. I remember our all hands meetings. I just dread it for weeks before they happen because I was supposed to be the leader and supposed to be like, I don't know, what was I supposed to say?

[00:47:46] Colleen Long: And, uh, it felt very much like there was a divide, even though there wasn't, it felt like. You know, you would kind of get people staring at you in headlights and you're all on screens at that point, and they're just kind of waiting for your next directive and I don't know what the hell I'm doing. So it was, that was the hardest part for me was the, the leadership and leading this team that I was like, uh, I don't know.

[00:48:10] Colleen Long: Just like, don't bill us a lot and keep on doing what you're doing and please don't leave.

[00:48:14] Erika Bugaj: It is being

[00:48:15] Colleen Long: That was my leadership.

[00:48:16] Erika Bugaj: It's it's being in the hot seat, that's for sure.

[00:48:19] Jennifer Politis: Yeah.

[00:48:21] Colleen Long: Yeah. Yeah. That was the hardest part for me.

[00:48:27] Jennifer Politis: I think too, in that role, you have to make a lot of decisions. And I think even if, you know, it's not like I'm an indecisive person, but I felt like all the decisions come to me. So it was kind of like, am I making the right decision? I don't know, but I just had to learn to just like make a decision and go with it and run with it, and that's it.

[00:48:46] Colleen Long: Mm-hmm. Yeah. Yeah. And I, I think realizing nobody knows what they're doing. You know, like nobody knows, like nobody knows what they're doing. Um, so if you're in a group practice, everybody's kind of just going by the seat of their pants and you're building the bridge while you walk it. And so, um, I, I think you're gonna bring your own strengths and then you're gonna have your own weaknesses.

[00:49:08] Colleen Long: And for me, it just felt like, almost like if you're in a marriage, and more often than not, you're fighting. You're like, is this still working? Is this the right fit for me? Right. And that's kind of where it was with me and my practices. I was like, I'm not happy anymore. This isn't, I'm not even looking forward to this anymore.

[00:49:31] Colleen Long: Like, I, I, I found myself delaying and procrastinating and I just felt like. Either I'm burnt out or I, I'm just, I've grown out of this group practice phase where I just don't think I can, I can do it anymore.

[00:49:47] Jennifer Politis: Yeah.

[00:49:48] Colleen Long: but the thing is for sure, if you're doing group practice, and, and one of the things that I think if you're, if, if you're still, if you're still optimistic about being a group practice owner, then

[00:49:59] Jennifer Politis: I know we're really selling it well,

[00:50:01] Jennifer Politis: aren't we?

[00:50:02] Colleen Long: it.

[00:50:02] Jennifer Politis: We're really selling it.

[00:50:04] Colleen Long: but, you know, I think it's, uh, it's not for the weary. I think you have to have a tough, tough skin.

[00:50:10] Colleen Long: Thick skin. You've gotta somehow take that therapist, um, piece that just, you know, you don't, you don't have that filter. You've got that empathy and you've got that. You gotta shove that away deep, deep inside,

[00:50:24] Jennifer Politis: Yeah, and the sooner you do that, the better off you are.

[00:50:27] Colleen Long: The better. And you create, you have to have the systems in place. Not saviors. You can't, like, no COO, no second in command is gonna come in and save you.

[00:50:38] Colleen Long: If you don't have systems yet. You've gotta build these systems, hiring systems, onboarding systems. KPIs, regular reviews, negotiations with contractors. How do we credential? How do we check in with our billing? What's our denied claim rate? You gotta have all that stuff in place, and if you're great at developing that, I'd say you're in the right place to be a group practice owner.

[00:51:00] Colleen Long: But when I say that, if you're like, oh God, that sounds awful, then run as fast as you can because that's what you're gonna be doing. Very little patient care and a lot of systems.

[00:51:13] Jennifer Politis: Yeah, that's very true. I mean, one of the hardest lessons that I had was actually, if I could go back, I would've paused scaling. We ended up doing this later, but at at a more pivotal time, we, we kind of stopped growing and we just doubled down on systems because I was realizing like, we don't have everything like, you know, organized and up to snuff yet.

[00:51:37] Jennifer Politis: Um, but for me, if I could go back, that's what I would do. I would've hit pause at that time and I would've got all of our systems, every process documented, everything automated, and then continue to grow from there.

[00:51:50] Colleen Long: Mm-hmm. Yeah. You can't hire someone to do the job. You don't understand,

[00:51:56] Jennifer Politis: Right,

[00:51:57] Colleen Long: you know, you have to

[00:51:58] Jennifer Politis: and you don't know what you need at that time, like what you need or your company needs or your practice needs at that time, it is gonna change. It ebbs and flows.

[00:52:07] Colleen Long: Exactly. Um, well, and. The, there's a, a great book I'm reading right now called Essentialism by Greg McOwen. And

[00:52:15] Jennifer Politis: I love that book. It's one of my favorites.

[00:52:18] Colleen Long: oh, it's so good. It's so good. So I'm not all the way through it, but um, essentially what I'm getting from it is. You have to figure out, I mean, especially if you're a group practice owner, you have, you have to figure out what things am I gonna do today that move the needle for my company in the right way?

[00:52:35] Colleen Long: Not what things do I wanna do today that I like doing right? Because I could sit on Canva all day and design a logo, but that's not necessarily gonna move the needle for my company. Doing a review and looking at KPIs and understanding cash flow and p and l, that's gonna move the needle. And I wanna make sure that either myself or the people that I've hired around me.

[00:52:54] Colleen Long: Are doing those very things and designing those systems and KPIs so that every week, you know, Monday, those are the dailies for that person. For a down to billing, are you confirming patients next week and making sure that you're getting their copays. So making sure that their time is being spent most effectively in the most essential items that're gonna move the needle for your company, versus just opening their email and being reactive to everything that comes in.

[00:53:23] Jennifer Politis: Right. I mean, now to this day, I typically spend one day a week where I just do the financials. I look through every account. I look through every p and l. I look through every little thing, every expense, but I never did that before, not until someone actually told me I had to really focus on that, and I thought I could focus on it like quarterly or monthly.

[00:53:44] Jennifer Politis: No, I have to focus on it every single week.

[00:53:47] Colleen Long: Yeah. And some every day I know I have a mentor and he, he opens it up every single day and is looking at that. I, I look at it and I'm like, what am I looking at?

[00:54:00] Erika Bugaj: There definitely is a lot to keep track of.

[00:54:03] Colleen Long: yes, it's a lot. So hopefully in this episode, you guys that are practice leaders that have that in your DNA in your cloth. Are thinking, yeah, this, I'm in the right, I'm headed on the right path. I do enjoy that stuff. I do enjoy creating systems. I do like being the leader and I feel like I'm a good leader.

[00:54:25] Colleen Long: I'm good at that stuff, and I don't mind having those, I call 'em sweaty back conversations. I don't mind having those conversations. I like, I like all of that. I like being in control and I, I could be A-C-O-C-E-O. Um, and then hopefully we're saving some people a lot of time that are like, Ooh, I, that I didn't.

[00:54:43] Colleen Long: I think that all of that was involved in group practice ownership, and that's not for me. I thought it was more about just getting a yacht and collecting all my money, counting all my money. Uh, and it's not, I, I don't even have a boat. Uh, so it's, it's definitely not about that. Or maybe there are some people, and we will hopefully have them on as guest, but, um, you know, hopefully that.

[00:55:08] Colleen Long: That as we start to talk about the realities of what that looks like as group practice owner and what you deal with on a day-to-day basis. Um, one, there's less people that are leaving group practice owners that are really good like you, Erica, right? So you've got less people going out with that fantasy. That, uh, that they're gonna just, you know, all of a sudden just kill it on their own because they start to hear the real, the minutia of what you have to deal with every day as a group practice owner. And then those that hear this and it really resonates with them. They're like, okay, I'm on the right path.

[00:55:43] Colleen Long: Like, this is the thing that I feel like I'm cut out for.

[00:55:46] Jennifer Politis: just wanna say if this hits home, you're not alone. And we're talking about this and much more on the next episode of Off the Chair. Thanks for joining.

[00:55:55] Colleen Long: Thanks guys.

Off the Chair Podcast

Group Practice - Business Growth or Burnout Multiplied?

In this episode, we talk about:

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Colleen Long, Psy.D.

Jennifer Politis, PhD, LPC

Erika Bugaj, MA, MSW, LICSW

Episode Transcript:

Scaling Without Selling Your Soul: Building a Business That Loves You Back

Burned Out, Broke, and Brilliant: How We Got Off the Chair