7 Figure Counseling Practice Presentation ACA 2014
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How to Build a 7-Figure Counseling Practice, Presentation for the 2014 American Counseling Association (ACA) Conference. By Anthony Centore Ph.D.
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7 Figure Counseling Practice Presentation ACA 2014
- 1. Building a 7-Figure Counseling Practice Anthony Centore Ph.D.
- 3. Someone willing to work 80 hours a week to Avoid working 40
- 5. We needed new rugs
- 7. Can I be an Entrepreneur?
- 8. Cons PROS
- 16. A note on rugs
- 17. What it takes to succeed in Private practice
- 18. A tale of 2 counselors
- 19. Brian
- 20. Emma
- 21. Advantages
- 28. un-catch 22s
- 30. CFM
- 31. Who’s story sounds more like you?
- 32. Not a solo practice
- 33. Group v. Solo
- 34. Go solo
- 35. Simpler
- 36. 6 Figures
- 39. Go Group
- 40. Sellable
- 41. Fly wheel
- 42. Freedom from the couch
- 43. less isolating
- 44. SHOW me the money
- 45. SHOW me the money
- 46. SHOW me the money A counselor will bill about $75 per session
- 47. SHOW me the money A counselor will bill about $75 per session 36 sessions a week = $2,700
- 48. SHOW me the money A counselor will bill about $75 per session 36 sessions a week = $2,700 48 weeks a year = $129,600
- 49. SHOW me the money A counselor will bill about $75 per session 36 sessions a week = $2,700 48 weeks a year = $129,600 A psychologist will bill about $95 per session
- 50. SHOW me the money A counselor will bill about $75 per session 36 sessions a week = $2,700 48 weeks a year = $129,600 A psychologist will bill about $95 per session = $164,160
- 51. SHOW me the money Just therapy, without: Psychological Testing Medication Management Group Counseling Court Appearances Other Ancillary Services
- 52. SHOW me the money 7.7 Counselors, or 6.1 Psychologists to earn $1,000,000 in Revenue!
- 54. But Wait!
- 55. Revenue is not Profit
- 56. SHOW me the money Therapist Compensation 55-70% of Total Revenue
- 57. SHOW me the money Therapist Compensation 55-70% of Total Revenue ~ $300,000 - $450,000 left
- 58. What can you buy with $450,000?
- 62. 1.08 ct. platinum, fancy vivid blue diamond
- 63. 775 sq foot apartment, with one bath, in Brookline, MA
- 64. Take That, Austin Powers
- 65. Not so fast
- 67. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15%
- 68. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7%
- 69. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5%
- 70. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3%
- 71. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8%
- 72. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity)
- 73. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3%
- 74. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3%
- 75. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3%
- 76. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1%
- 77. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1%
- 78. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1%
- 79. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1%
- 80. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1%
- 81. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1%
- 82. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5%
- 83. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5% Dues & Subscriptions: 0-.5%
- 84. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5% Dues & Subscriptions: 0-.5% Insurance Audits: 0-.5%
- 85. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5% Dues & Subscriptions: 0-.5% Insurance Audits: 0-.5% Meals, Entertainment & Gifts: 0-.5%
- 86. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5% Dues & Subscriptions: 0-.5% Insurance Audits: 0-.5% Meals, Entertainment & Gifts: 0-.5% Furniture: 0-.5%
- 87. Operational Expenses Credentialing, Billing & Credit Card Fees: 7-15% Rent & Parking: 3-7% Reception & Scheduling: 3-5% Office Expenses, Supplies & Postage: 1-3% Admin Salaries: 0-8% Marketing: 0-5% (once at capacity) Research & Development: 0-3% Clinical Supervision & Professional Development: 0-3% Software & Electronic Medical Records: 0-3% Accounting, Bookkeeping & Legal: .5-1% Travel: 0-1% Bank Fees: 0-1% Phone, Internet, Electric & Gas: 0-1% Unemployment, General & Professional Liability Insurance: 0- 1% Recruiting: 0-1% Computers & Equipment: 0-.5% Dues & Subscriptions: 0-.5% Insurance Audits: 0-.5% Meals, Entertainment & Gifts: 0-.5% Furniture: 0-.5% Maintenance & Cleaning: 0-.5%
- 88. Net Profit
- 89. -25% to 25%
- 90. Results May Vary
- 91. Results May Vary 1) Take home the same in solo practice
- 92. Results May Vary 1) Take home the same in solo practice 2) Only money they keep is what they produce
- 93. Results May Vary 1) Take home the same in solo practice 2) Only money they keep is what they produce 3) Highly profitable, and self-sustaining
- 94. Results May Vary 1) Take home the same in solo practice 2) Only money they keep is what they produce 3) Highly profitable, and self-sustaining 4) A combination of self and team best *Sellable & Real Estate
- 95. Getting to Black
- 96. Built to Sell
- 97. Starting with the End In Mind
- 98. Reasons to Sell Include...
- 99. Relocate
- 100. Career Change
- 101. to Liquidate!
- 102. Retirement
- 103. Think You’re Too Young?
- 106. QuickTime™ and a H.264 decompressor are needed to see this picture.
- 108. Do you know what your Business is worth?
- 109. EBITDA, MULTIPLE OF REVENUE, OWNER BENEFIT, Cost of Starting from Scratch
- 110. Recoup investment in 3 years, and make a living along the way
- 111. 12 ways to build Value
- 112. Brand
- 113. Grow Far Beyond SOlo
- 115. “Potential co-operative marketing with other health related professionals in same location. Potential to expand professional referral network, expand hours/days of operation or add complementary services. Huge potential to leverage social media marketing for targeted local advertising.”
- 116. Consider an Earn Out
- 117. Finance the buyer
- 118. Focus on New Clients
- 119. Which would you pay more for?...
- 120. A practice with four clinicians performing a total of120 sessions per week, and 8 new client inquiries per month. A practice with two clinicians, performing a total of 60 sessions per week, and 80 new client inquiries per month.
- 121. Credentialing
- 122. Committed Staff
- 123. A psychiatry practice is being purchased from an absentee owner/manager. A few weeks before the close of the sale, the new owner begins working in the practice and begins to implement some basic rules of operation for the administrative staff. They revolt! The staff destroys documents, cancels appointments, refuses to answer the phone, and creates a hostile work environment (they were also, as it was later discovered, stealing from the company). The new owner has no choice but to fire the entire staff, and hire a new administrative team.
- 124. A buyer of a counseling practice discovers that the previous owner has overpaid his clinicians by compensating them heavily for completing basic administrative tasks the previous owner did not want to do. The new owner realizes that the practice cannot survive without the clinicians forgoing their administrative duties (along with the extra cash-cow income). The counselors do not respond well to receiving what they perceive as “a cut in pay”, and several leave the practice. Revenues drop by over 40%, and the practice doesn’t recover for over a year.
- 125. Assets
- 126. A good lease
- 127. A BAD lease The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive.
- 128. A BAD lease The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive. The lease is non-transferable, and the landlord wants a 20% rent increase from any new tenant/owner.
- 129. A BAD lease The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive. The lease is non-transferable, and the landlord wants a 20% rent increase from any new tenant/owner. The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer.
- 130. A BAD lease The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive. The lease is non-transferable, and the landlord wants a 20% rent increase from any new tenant/owner. The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer. The space is simple TOO BIG for the practice.
- 131. Honest & Open
- 132. Desirable Location
- 133. Finish Strong
- 134. ...And letting go.
- 135. Building the team ...is tomorrow
- 136. Building the team ...is tomorrowFinding
- 137. Building the team ...is tomorrowFinding Recruiting
- 138. Building the team ...is tomorrowFinding Recruiting Interviews
- 139. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees
- 140. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees Avoiding Nightmare Counselors
- 141. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees Avoiding Nightmare Counselors Why Practices Lose Their Best Clinicians
- 142. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees Avoiding Nightmare Counselors Why Practices Lose Their Best Clinicians Offer Letter / Contract
- 143. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees Avoiding Nightmare Counselors Why Practices Lose Their Best Clinicians Offer Letter / Contract On-boarding and Training
- 144. Building the team ...is tomorrowFinding Recruiting Interviews Contractors v. Employees Avoiding Nightmare Counselors Why Practices Lose Their Best Clinicians Offer Letter / Contract On-boarding and Training Creating a Pipeline
- 145. Creating Culture
- 146. Zappos
- 148. Contractors
- 152. Not a luxury
- 153. Tina Fey “Don’t hire anyone you wouldn’t want to run into in the hallway at three in the morning.”
- 154. Starts with hiring But doesn’t end there...
- 155. Things that worked
- 156. Things that worked
- 157. Things that worked
- 158. Things that worked
- 159. Things that worked
- 160. 1) Respect and gestures of caring
- 161. “Thriveworks, at its core, is its team of people…We work to engender great loyalty in the team members of Thriveworks and hope that we are successful in developing and maintaining their loyalty to the point that they elect to stay employed with us for life.”
- 162. 2) Community
- 163. 3) Mission
- 164. 4) Progress
- 166. Thriveworks Rank System Level 1) Assistant Clinician Level 2) Fellow Clinician Level 3) Senior Fellow Clinician Level 4) Associate Clinician Level 5) Senior Associate Clinician Level 6) Senior Clinician Level 7) Distinguished Candidate Clinician Level 8) Distinguished Clinician Level 9) Magna Candidate Clinician Level 10) Magna Clinician Level 11) Summa Candidate Clinician Level 12) Summa Clinician Managing Clinician Clinician Emeritus / Emerita
- 168. Spend Money to Make Money
- 169. We got Nickels Holding up a Dollar!
- 170. QuickTime™ and a H.264 decompressor are needed to see this picture.
- 171. We got Nickels Holding up a Dollar!
- 172. 1) Your office building
- 173. 2) client experience
- 174. 3) Medical Billing
- 175. 4) your clinical staff
- 176. 5) Giving back
- 177. 5) giving back
- 178. 5) Giving back
- 179. 6) Advertising
- 181. big blind swing
- 182. No Tracking
- 183. “Only half of my advertising is working.”
- 184. “The problem is I don’t know which half!”
- 185. Awful social media
- 186. bad headshot
- 192. technical bio
- 193. Spamming
- 194. guest blogging
- 195. bad website
- 196. bad website “Counseling for individuels, couples, and Families”
- 197. dingy office
- 198. dingy office “You can tell whether a business cares about its customers by how nice the bathrooms are.”
- 199. dingy office “You can tell whether a business cares about its customers by how nice the bathrooms are.” How are your bathrooms? How are your waiting rooms?
- 200. no advertising at all
- 201. i’m about to blow your mind
- 203. The Final 10%
- 205. How’s it possible?
- 206. The Last 10% is the HARDEST
- 207. Odysseus
- 208. What’s your 10%?
- 209. Are you quitting at 90%?
- 210. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room”
- 211. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room” “We don’t answer the phone, but most clients will leave a message”
- 212. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room” “We don’t answer the phone, but most clients will leave a message” “My notes are for me. My records don’t need to be great.”
- 213. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room” “We don’t answer the phone, but most clients will leave a message” “My notes are for me. My records don’t need to be great.” “I don’t want to accept credit cards. Clients can write a check”
- 214. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room” “We don’t answer the phone, but most clients will leave a message” “My notes are for me. My records don’t need to be great.” “I don’t want to accept credit cards. Clients can write a check” “That old armchair was my great aunts. I don’t have time to refurbish it”
- 215. Are you quitting at 90%? “Clients don’t need wi-fi in the waiting room” “We don’t answer the phone, but most clients will leave a message” “My notes are for me. My records don’t need to be great.” “I don’t want to accept credit cards. Clients can write a check” “That old armchair was my great aunts. I don’t have time to refurbish it” “I haven’t dug into new research in years. The most important thing is the relationships with my clients”
- 216. obsession
- 217. Be 10% obsessed
- 218. Space
- 219. Space White glove clean and organized
- 220. Space White glove clean and organized No more Poland Spring
- 221. Space White glove clean and organized No more Poland Spring Hallway should smell better
- 222. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING
- 223. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler
- 224. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours
- 225. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book
- 226. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL
- 227. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training
- 228. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program
- 229. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program Measure treatment outcomes
- 230. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program Measure treatment outcomes VALUE
- 231. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program Measure treatment outcomes VALUE More value to clients
- 232. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program Measure treatment outcomes VALUE More value to clients 1st/10th appointment gifts
- 233. Space White glove clean and organized No more Poland Spring Hallway should smell better SCHEDULING Intake process simpler Sessions in 24 hours Never double book CLINICAL More positive psychology training Professional development program Measure treatment outcomes VALUE More value to clients 1st/10th appointment gifts Most desirable place
- 234. 10% is 100%
- 235. THE end