The RDtoCEO Podcast
Dive into The RDtoCEO Podcast, hosted by Registered Dietitian and CEO, Eva Haldis, where she shares her journey in entrepreneurship, with discussions on the basics on building a private practice and becoming a confident CEO. The RDtoCEO Podcast is your go-to resource for mastering the art of transitioning from a dietitian to a successful CEO.
The RDtoCEO Podcast
Navigating Your First RD Hire: A Business Coaching Session ft. Samantha Berkowitz MPH RD LDN
In this special episode of The RDtoCEO Podcast, join Eva Haldis as she guides a fellow dietitian, Samantha Berkowitz MPH RD LDN, through a live business coaching session! Listen in as we unpack the complexities of growing a team, and how to plan for it! Eva and Samantha discuss valuable insights into compensation strategies, the benefits of W-2 employment for maintaining company culture, and practical tips for tracking client inquiries and revenue trends. We dive deep into understanding seasonal fluctuations and recommend payroll percentages to ensure your practice's sustainability and growth. Tune in to discover how to build a supportive practice environment where team members can grow, learn, and thrive together. Don't miss this episode packed with practical advice and heartfelt stories from Sam's journey.
Where You Can Find More about Samantha!
www.sammibnutrition.com
On Instagram:
@sammib.nutrition
@nourishingneurodivergencepod
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Affiliate Links Often Mentioned:
Gusto for Payroll - https://gusto.com/h/eva6486
Practice Better- https://practicebetter.partnerlinks.io/evahaldis9298
*Please note that while we strive to provide valuable insights, our podcast is not a replacement for personalized legal or financial counsel. We strongly advise consulting with qualified professionals for specific advice tailored to your individual circumstances.*
Welcome to the RD to CEO podcast. I'm your host, eva Haldis, registered dietitian, who one day found herself a whole CEO of a business. Join me as we navigate the world of entrepreneurship so you can go from being an RD who sees clients in private practice to a confident CEO growing the practice of your dreams.
Speaker 2:Welcome back to the RD to CL podcast.
Speaker 1:Hi everyone, welcome back to another episode. So excited to have you listening today because today is our very first coaching call episode. Obviously, this is it was actually really fun. Well, I won't say it's fun, but it was interesting for me to hear myself back as I was kind of doing a coaching call. I feel like this is one of those calls I'll do sometimes with folks who are just like looking for, maybe, specific things to just talk through. They're not really looking for like more of that long-term work, especially when it comes to hiring. I feel like it's I would say it's kind of like putting a wedding. It's like you set a date and then there's like a lot of like nothingness that happens, and then as you get closer, there's like so much, and so I find that the same way with hiring. It's like kind of hire, somebody go through the process, and then it's really once you're on the team that there's a lot more to work through and talk through. So this is really interesting for me to hear too, just from giving myself some reflective listening on how I talk about things, but also just so fun to get to talk to Sam. You'll hear a little bit more about her story today and we're going to talk through some questions she had around hiring. If you don't know who Sam is, she and I actually know each other a little bit from being in the accountability club that Morgan Sinclair and Hannah Turnbull. Hannah, who I've mentioned on the podcast a few times, is my business coach. They have an accountability club, which I love, and they do it quarterly and basically there's a co-working time and then they do one group coaching call and they're taking a sabbatical break in the next quarter but I believe they're bringing it back in the new year. So if you see that offering out there, I'm sure I'll bring it up again as it gets closer to next year. But Sam and I do know each other from that. But a little bit about her as well.
Speaker 1:Sam is a neurodivergent, registered dietitian, cat mom and culinary enthusiast who offers weight-inclusive care to individuals struggling with eating disorders, disordered eating habits and nutrition related to neurodivergence. Samantha's passion for nutrition began during her undergraduate studies in culinary nutrition at Johnson and Wales University, where she learned about the essential role of food in overall health and well-being. During graduate school at the University of North Carolina, chapel Hill, sam discovered intuitive eating, a philosophy that changed the way she approached nutrition and helped heal her relationship with food and movement and her body. This transformative experience led her to diving deep into learning about non-diet and more inclusive frameworks to help clients develop a peaceful and sustainable relationship with food in their bodies. Samantha's approach to nutrition counseling emphasizes self-compassion, body autonomy and health-promoting practices. Sam's goal is to provide a safe and supportive space for individuals to explore their relationship with food and body and empower them to make a decision that aligns with their unique needs and values.
Speaker 1:In addition to running her private practice, sam would be nutrition, which you'll hear, is going to be rebranded soon. Samantha is also the host of the Nourishing Neurodivergence podcast, a podcast developed to connect neurodivergent folks with tools that were developed with their neuro spiciness in mind, which I love, because I'm all about learning about that. So I will be sure to link some of the places that you can find Sam both her Instagram accounts for her personally and also for her podcast. So be sure to check that out and I'm really excited to have you take a listen, as always, be sure to like and subscribe and make sure you are following along wherever you get your podcasts. So, without further ado, let's get into our coaching call with Sam.
Speaker 2:Hi Sam.
Speaker 1:Hey, how are you Good? It's so great to have you. Thanks for being a guest and a coaching call for the podcast episode. I'm really excited to chat with you today. I'm super excited too. I thought it would be good to start off with you telling us a little bit about your practice and how you've gotten to where you are now and what you're hoping to kind of talk through today in our call.
Speaker 2:Yeah, so right now I am a solo practice, so it's just me. I'm an RD. I mostly work with eating disorder clients, but also neurodivergent clients. So whether they're struggling with eating disorders or disordered eating or more just like navigating consistency of eating and just kind of overall nutrition, just to kind of cater to their neurodivergence and find ways that work for them.
Speaker 2:Right now I'm in the process of rebranding, but my practice right now is called Sammy B Nutrition and part of that rebranding is also because I do want to bring on another clinician in the new year, probably like the end of one. And yeah, I think I went full time my business in March, which is crazy because now it's like the end of the year and I feel like that was also yesterday, so I'm not sure how that happened. And yeah, I was working in clinical for about a year and a half before I kind of took the plunge to do it full-time and that's kind of where we're at today and I know, yeah, we kind of where we're at today and I know, yeah, we kind of talked offline about talking about hiring and kind of some of the more logistical things or just kind of things in that process to kind of learn about and see kind of what I want to do yeah, well, congrats on going full-time in March.
Speaker 1:You know that's always a scary leap for a lot of people, um to and I know and I've talked about it before in this podcast and you know it it sort of I had to like force myself to do it and I know it's a hard thing for a lot of us to really picture going full time.
Speaker 1:So that's really exciting and, yeah, I totally agree, I feel like everything just flies by, like I can't believe it's about to be the end of Q3 and then, yeah, the year is going pretty much over, so I'm really excited to talk about that. Um. So, yeah, we talked offline a little bit about wanting to talk through sort of the logistical process of hiring. Before we do that, though, I'm curious for you, like, because for me and I've said this too on this podcast is like it sort of all happened on a whim and I know, as a fellow neurodivergent person with ADHD, a lot of my stuff is very impulsive. So I'm curious for you, what has kind of led you to wanting to hire and, you know, get started on like the planning process already?
Speaker 2:Yeah. So I think wanting to hire it's so funny because I still remember in undergrad that I was like I never want to be in private practice. Like I interned at a practice that was more like general nutrition Right, and not there's anything wrong with that but it was kind of like there wasn't a specialty, all sorts of people were coming in, like it just it wasn't a fit for me. So I kind of tracked out like all private practice to kind of be like that. And so then eventually, like now I'm here and I think early on the process I was like, oh yeah, I definitely don't want to hire anyone, but I think seeing like one things like especially Hannah, like in that accountability club, like being able to step back from her practice, like temporarily, some of that like less one-to-one client time I love my clients and, um, right now I'm seeing probably like 10 to 15 a week but like that feels good for me. And so like I kind of want to like have someone else so I can like the inquiries are continuing to come in, but have somewhere to send those. Because I also hear like we talk a lot about, like you know, having to or Hannah's talked about having to kind of pare down your caseload when you hire, and so I feel like maybe preemptively doing that because I'm in a good place financially, that like you know seeing where I'm at, or like continuing to grow my case a little bit and with natural overturn, but like kind of not getting up to 25 and then being like okay, like I can't do this now.
Speaker 2:Um, and then just kind of the neurodivergent aspect of wanting like some diversity and work. It's funny because I think on one of your episodes you mentioned, like some of the admins that you really enjoy. And it's so funny because that's how I feel about billing. Like it's just like I could. It's either I avoid those kind of tasks not billing specifically, but like the menial, like tasks or I'm like I could sit here and do this all day. It's a mood, but I think just yeah, like having some more diversity in that work and I like teaching and leading, and so that's obviously kind of a big part of it as well.
Speaker 1:I can totally relate to the wanting to do different things. And, yeah, some of the admin tasks it's like that too for me. Like I'm either like all in, like I have all my tracking sheets, that I'm like I want to be the one that's doing this all, and then sort of once I give it away, I'm like I don't want to touch it, I'm good, you know so, or it's probably just the excitement of it has gone away for me, so it's nice to sort of give it to someone else. But there's certainly like the logistical aspects of being group practice. That's really nice because you can do different things.
Speaker 1:And then there is that other part that you mentioned at the end of like liking to lead and teach and work with people in that way, and I think we, a lot of us, kind of get into that role with clients at first, and then, you know, there's obviously a little bit of a deeper work that we do, especially work with eating disorders.
Speaker 1:But having a team sort of allows us to use some of that part of our brain as well, which I think makes a lot of sense. That the flexibility and the change around group practice seems like it would be something that would be enjoyable for you and exciting for you, and so, yeah, I think that makes a lot of sense. So, with all that being said, I'm curious so far for you what you've sort of tell me what you know or what you've kind of wanting to, or maybe you could start with saying, like what are? This is what I'm thinking of doing. And then here's what I'm curious about if that's you know what, maybe what I would do or what I've seen you know works with well, with group practice.
Speaker 2:Yeah, works well with group practice. Yeah, so with hiring. Even though I just went full-time in March, that was also because I really saw that uptick that I know can be pretty common in our space of after that New Year's kind of die down of people being like I'm going to try a diet or do this on my own I've talked to therapists too and they kind of see that as well and then end of February, like that March time is really big and so that's actually what gave me like why I went full-time because I wanted to ride that wave of like I maxed out what I could do while working a full-time job and so I expect that kind of trend this coming year. So I kind of want to start that process now, because I know I have to build in time for credentialing and so I want them kind of ready for March and so kind of backing up from there. I do want to do a W-2 employee for a lot of reasons, but mostly like I really just want to create a good workplace and work culture, and that's kind of part of it and not kind of doing the contractor thing just because it's quote unquote easier for me, although I don't know if it really is like I feel like it's not that part of all the systems and programs that are kind of available now.
Speaker 2:In terms of like compensation, that's also kind of where I feel like some guidance would be helpful. I think the reimbursement in my state is, I think, higher than most states. They pay fairly well. I'd say like my lowest payer, which is also the majority of my clients, is like just under 140 for a follow-up session. So yeah, it feels really good and has a good margin. But like where is the percentage of like? Because I do want to eventually offer benefits right. So like kind of counting that in of like, not the pay would be like too low, but not like putting the pay too high, so I don't have room to add those in later. Yeah, I feel like I'm rambling a little bit, but that's where I'm at, like right now I'm totally fine.
Speaker 1:Now my brain works too. Yeah, I think a lot of the things you're saying make a lot of sense and certainly I would say it's very similar to my philosophy and approach on hiring and I think it makes sense big picture, especially with the W-2 conversation which I've talked about before here, and I think you're right. I think it's like a lot of people shy away from the W-2 route because it does feel scarier, because I think, just as all commonly dietitians being type A and afraid of getting in trouble for everything, we're afraid of what will happen. But there are so many easy tools, especially with the payroll companies, gusto, but that make it a lot less scary. And I find that a lot of bigger practices that have grown and started as contractors I've seen shift to the W-2 route because it just ultimately makes sense.
Speaker 1:Because what people don't realize is that if they hire somebody who's an independent contractor, you really can't tell them what to do At any capacity. They're basically just coming on to do a task or a job and it's not that we hire people to tell them what to do. But if we want to have a certain company culture and have certain expectations, it's going to be important to hire actual employees and not just contractors. I think you're on a great. You know you have a great page with that. Also, I second and third all the things about March being the busiest. I would say it's our busiest month and I never plan well for it, so it certainly is a really commonly busy month for us in our field, for sure. I think I'm curious too, which we can talk a little bit more. Do you typically track that now, like how many inquiries you get a month?
Speaker 2:I do track that. I haven't really broken it down of like how many per month, but definitely I track like as inquiries come in, I put them in the spreadsheet and where they come from. I need to do more like yeah, like kind of that averaging or like more numbers of it, but I do keep track of it.
Speaker 1:Yeah, I'll send you my tracking sheet that I created and hopefully one day, if I get my shit together, we'll put on my website people to download. But it kind of is a way for people to it'll automatically track it for you. Since you're're already doing it. It was probably very intuitive, but it's good that you're already starting the system of just having that information, because then you can actually see what the trends are, because they are going to just fluctuate. Sometimes they're very consistent, sometimes it's very inconsistent. Last summer was busy, this summer was slow, but March is always busy. So I think that's probably going to be pretty consistent. So I think timing wise is good to talk about. We can talk about, like what that looks like with credentialing and also compensation. Our highest payer pays a little bit under 140. So that's great. That's your lowest, which is really great. What state are you in? Actually, I don't even think I know I'm in.
Speaker 2:North Carolina the payer. I know like these shouldn't be disclosed, so I won't say which payer it is, but it's like, yeah, I'd say 95% of my clients go through that payer and then a couple through another, and then my self-pay rate, which is 150, is kind of in the middle of the two Right, so that gives you a good average.
Speaker 1:And so what I would say with compensation is, especially as W-2 employees, I think I under well, yeah, I didn't really know actually what I was doing. I think I was like I've heard people doing 70-30. And then I was like, well, maybe I'll do 60-40, like a split. And it's simply just from what I heard people doing, especially in like I think more like a therapy world, but not actually knowing why and not realizing they were actually paying independent contractors so they weren't paying any payroll tax on that. And so when we actually think about compensation, the percentages that I've heard and been told from different things and also from my bookkeeper, my business coach Hannah, who you mentioned, and also the Prof First for Therapists book that I reference a lot the range is typically 45 to 60% of your revenue is a good amount.
Speaker 1:I like to go lower because in private practice our biggest expense is always going to be our in-group practice is going to be our payroll. In other companies payroll will not be because it's like the thing that we're quote unquote selling is also the thing that we're paying for, which is our team offering services. And so if you're a business that sells items, that's probably going to be a big chunk of your revenue. It's going towards the materials you need to sell those items versus the people you're hiring to sell that For us it's the money that comes in and also goes out is going to be all in the same sort of. So 45% to 60% tends to be the average. My bookkeeper said 45% is a good one and I have found that it's a good amount as well to sort of stick to that 45%-ish because once again it allows you that long-term vision that you have of being able to offer more things like benefits, because right off the bat it's very hard to do that because you sort of need that excess I don't say it's like excess money, but to want to be able to see the consistency of it but also then, on top of payroll taxes and other things that you're going to be paying for, like your EMR, that you're going to have to pay for them to have access to, you'll have to pay for a payroll system. There's a lot of expenses that come into it. Having that sort of lower end allows you one then to increase that if you want to, over time, offer other incentives and things like that and benefits in the future.
Speaker 1:So what I would say as far as creating compensation structure, if you look at your average and say it's 140 at an hourly rate I'm just going to do take my phone out and do the math that's about $63 an hour. I mean you could probably go a little bit. I would say even maybe like lower than that, cause the other thing that I offer, and a lot of people offer as well, is paying for admin time. So like that's also going to be sort of taken into account there with you know the hourly rate that you may pay for people to see clients. We, you know the hourly rate that you may pay for people to see clients. We also include an admin rate that's lower than our hourly rate that we pay for like meetings that they might do, like weekly meetings with our team and other stuff like that. I'm curious. So far, thoughts, questions, what's coming to mind?
Speaker 2:Yeah, so I was actually thinking about this. It's so funny because, like I'm the person that like does all the number crunching but I'm like, okay, I need someone to be like your heads in the right space. So I have this little like of like the 45 with the from all the different pairs. But yeah, I think, since, like going off the lowest and since that is really the majority of my clients come from that pair, that is really like the average what's coming in per session. So, yeah, 45 of that is basically, like you said, 63. So yeah, it's like a couple dollars under that. So it's like 61. So it'll just say 60, yeah of.
Speaker 2:And then that's what I was thinking about, the admin time too, because like having time that's paid for that isn't reimbursed, like my mind like cannot understand how to account for it, um, because right now obviously it's just me and so I pay myself based on like session, um, but yeah, so that was part of it.
Speaker 2:And then kind of putting like the 60 per hour, like if I bought that times like 18 to 22 clients with like a couple hours of that admin time at, let's just say like 30 for the hour, like that comes at minimum to around like 60k a year and that feels like something that's reasonable, given also like where I live, like the cost of living is really high and so I want to account for that because I think that's something that doesn't get accounted for enough. Like there are other group or not really other there's like one other major group practice in the area and it's just the pay for, like they were saying. I was talking with them at a networking event and they have a lot of trouble getting like in-person asphalt clinicians versus like virtual and they live in other parts of the state because it's just the cost of living is so high. You really need to be able to support that yeah, it's.
Speaker 1:That's such a good point because it's like a lot of people, I think that's the hard thing with group practice and taking insurance in particular. It's like we are sort of at the hands of what the insurance company will reimburse. And so, like I have coaching clients who have, you know, who are in New York and which has a very high cost of living, and their insurance companies don't reimburse that much, you know, as as as I would say, even the other States, and so like it's hard because you still want to like you don't want to like bankrupt your business because of that, but also you have to sort of take into account is this going to be a livable, reasonable wage for somebody working for you? And so I think that's a good point for you to think about. And it sounds like it would be based on where you're living.
Speaker 1:And somebody might live in your state, but not necessarily in the town that you're in, but it's going to certainly impact the type of applicants you get, depending on where they live and what their cost of living is. So it's good that you already have a higher reimbursement, so that's already a good place to start. And it's hard in the hiring process. I mean, I've had to have like very honest conversations with people coming from like salaried residential treatment centers and being like I can't match that. Like, at the end of the day, I'm a small business and as much as I would love to, it's just not where things are now yeah, I'm really thankful for, like um the payer here in North Carolina, because they that was actually.
Speaker 2:It was like the raise they gave us in June. They had increased the reimbursement and it was like almost 18 or $20 more than what it was, which was already, you know, more on the average of, I think, most states. So, yeah, that definitely helps for sure. I think a question I also had like related to taxes, and I work with an accountant so I'm sure they'll help me. But just like thinking about like based on profit versus sales. So kind of use that kind of thing, though the business account I have set up like allows you to create the buckets and assign those percentages. So like all the money that comes in auto like disperses to my buckets. We love that, um, but kind of thinking about like right now I have my tax percentage at 30, but, like then, because I'm not paying all of the taxes on that payroll, like just part, like I guess it's it'll be the same, because I'll put myself on payroll like to make it. Yeah, yeah, yeah.
Speaker 1:I mean, I think what you're saying is like how do we account for the tax? The tax can be the same when you also have an employee that you're paying for and or if you become an employee of your business. Yeah, yeah, so you know.
Speaker 1:Disclaimer obviously I'm not an accountant but, what I'll say is, if you are in, every state's probably gonna be different. But if you are currently not a W-2 employee of your business which it sounds like you're not you're being taxed with the money. That's basically like leftover after your expenses. That's not all that taxable stuff. The tax deductible stuff is accounted for is your personal income basically, and so that's being taxed as your income. And if you then switch and this is where an account can really help, because I think for us it's like we switched over to an S-corp that's going to sort of differ in how you're being taxed once I got to a certain revenue place. But if you hire somebody who is a W-2 employee, you're going to pay payroll tax on top of their paycheck, so it's going to just come out like through their paycheck, basically, like I have in my bank. Basically there's two charges that come out when it's payroll time the portion of it that's their hourly pay and then the portion of it that's like the tax parts. Some of that is deducted from their pay. Some of that is I'm paying on top of that, so it's sort of being paid for the payroll tax side. I'm paying on top of that, so it's sort of being paid for the payroll tax side. Now, if you stay as not a W-2 employee of your business as the owner and you're still doing owner's draws, what's left over will still be considered your personal income. If you add yourself to payroll and become a W-2 employee of the business, there will be a little bit of a different tax, but probably what's left over will still be considered owner's draw because it's still your income as well. So that's where talking to your accountant about the tax structure and how they're doing is going to be important, but that's sort of how it's on a basic level for my understanding where that goes, a lot of people panic about the payroll tax or the taxes that they're going to pay on top of payroll, which is what people, I think, fear.
Speaker 1:The one thing I will say, though, is when you're starting out with hiring, it's not like you're offering a salary pay right away, and if you are, you probably shouldn't. Well, I don't want to say that, but that's hard to do right away. I mean, it's certainly a structure I hope to shift into one day is having a salary structure, but it's hard to do that when you don't already have a consistent amount of revenue coming in, maybe with, like, if you had other employees already. So you're probably going to be charging or paying people an hourly rate anyway and they're probably not going to start seeing a bunch of clients right away anyway. So you're really going to be paying incrementally as their caseloads go up and as you get more revenue. So it'll sort of it's not as much as people, I think, fear and it's not going to be a lot all at once because they're starting out slow as well.
Speaker 2:But using kind of like that 10% of like the gross payroll of like per hour or per like quote unquote session it's only like $6. Session it's only like six dollars.
Speaker 1:So it's me like you know, it's manageable absolutely, yeah, yeah, and I think that's why it's like important to not over like, to be reasonable with when you're setting your compensation and sticking with that lower 45, which is still a good amount of time.
Speaker 1:And the other thing I want to want people to think about when they think about, like, when you're paying somebody. If you end up paying, let's say, $60, which is one great right the other benefits of working for a private practice are there as well. For my clinicians, our goal expectations of weekly sessions is 20 to 24. That's part-time and they're going to be making a full-time salary. So it's like, you know, hourly, hourly, but nonetheless they're going to make you know amount that they would make in a full-time job. They get to see the clients that they want to see. Hopefully they have a good working environment that they like you know those other things. So it's not just how we're paying people, but there's like other benefits of working for a private practice. And still, it's also a high amount that you're paying people per hour, which is, you know, not to be lost in the whole conversation. But you're right, is that?
Speaker 2:it's really not that much, because when people are starting out, they're typically starting out slow and then they're gonna start generating that revenue so that it starts to pay for itself in a way yeah, yeah, because then it also like, if I do the 45 like because you said 45, 60, that gives me like 15%, which is almost like, is it like $20 to like, have and to use towards like the benefits, like things that can also go back to the employee over time.
Speaker 1:Yeah, exactly In the profit first approach which you mentioned, which I've mentioned many times on this podcast. But it's this idea of having buckets and percentages of your revenue and how you're distributing it and also always make sure that there's a profit aspect as the owner of a business, because we do forget about that part sometimes. But the profit first. For therapist book which if you don't have that one I would recommend getting it but in there there's a chart. So if you have the book, you know if someone's listening is on page 57, but she has a really good chart in there.
Speaker 1:That's like target allocations. But then it kind of gives you the breakdown of like when you're, you know by yourself, versus a small group, which is what I would say. If like when you have one, probably like one to three, I what she considers like small versus medium versus large. But you'll see like the percentages shift over time because the more revenue you have also the more peril you have, you know, but the less everything kind of shifts around and so it certainly will give more money as things you know hopefully grow for you to do things like those benefits that will go into your operating expenses.
Speaker 2:Yeah, definitely. Something I've been thinking about too was like so I was just thinking about cause I know we've talked in the past about like I was in a contract position and that's one of the reasons I don't want to do that, but they're like, oh, like in a contract position, obviously I use my personal computer, but, like, if I have a W-2 employee, do I need to provide them with a computer?
Speaker 1:Okay, this would be my other disclaimer of not being a lawyer. What's considered. What I think about is like you have to be able to provide things that they need in order to do their job. My team everybody has a laptop, so I've never purchased one. I know other people that have, and they buy laptops for their employees that are then like property of the company. I, however, will buy I'm like I pretty much for everybody. I've bought like a second monitor because I feel like that makes their work easier. I've bought other things books, other things that they need that are helpful for their job. I think it's a sort of depends Like I remember having a dietitian that was like, oh my God, I know somebody that pays for like their, their employees, like internet, because they're like you know, they work from home or whatever, and I'm like my husband works for like a billion dollar company and is remote and they don't pay for internet.
Speaker 1:I actually put that down as one of our things that I put on our taxes for my business, but so it's like I think about it from like these bigger companies like and my husband's job, like they don't you know they don't offer and provide him with everything, but the main things that they need to do their job. Like, if somebody didn't have a laptop and then like was using like an iPad or something, then maybe I would probably provide them with a computer. But it just, like I would say, sort of depends.
Speaker 2:Yeah, because that's obviously like a large or expense to account for. Yeah.
Speaker 1:Yes, and this is too where I think in doing the profit first method, I think when all the insurance like stuff happened this year with like the change healthcare and like then it impacting other you know payers and just like all this year with the change healthcare and then it impacting other payers and just all this stuff with insurance companies, I was like I don't have a big enough emergency fund.
Speaker 1:If something happened that we weren't getting paid by insurance companies for a month or two, what would I do? And this is really where I think having an emergency fund is really important as a business owner, just in general, because that same thing could happen for you is like your computer might break and then you need to buy yourself one. So that's something that you will want to like consider anyways. I think that's what the nice thing with profit first is when we're putting money aside for profit, it's its own thing, and then at the end of each quarter you're only really supposed to give yourself half of that as like a bonus pay for you as the owner, but the other part of it is really savings for those moments.
Speaker 2:And I for a while was doing like a separate one, but then I just kind of kept it all in my profit bucket for now, but it's helpful to have some extra just in case things like that do come up, and that is something that you can decide to do, you know, if it feels like in line with how you want to do things, but I also know a lot of practices who don't do that, so it just sort of depends I also was thinking like I also don't have to buy like the computer I would buy for myself, for myself, like, yeah, it can be a more middle-of-the-road computer, like I think about you mentioned your husband and my partner works for a big like corporate company from home and yeah, yeah, it's the one I feel like all the corporate companies give like right around the same week because they, I guess, had the same shelf life of like three years, and then that was very much an unexpected, uh a thing.
Speaker 1:so that will happen. I think I talked about this actually in my last episode about like finances of like unexpected expenses I feel for the most part, and group practice certainly kind of throws a run to that but, like, for the most part, there's not a certainly kind of throws a wrench into that but, like, for the most part, there's not a ton of unexpected things Like taxes are the big unexpected ones, or any like penalties if I like I forgot to or like I didn't, you know, do the right thing, like I didn't sign up for the right thing with one of my employees and then I had a penalty that I had to pay to the state, which was my fault, you know. But other than that, there haven't, luckily, knock on wood, been a lot of really big ones, but you never know. I mean, that's always why it's nice to have the emergency fund yeah definitely.
Speaker 1:I mean, I want to come back. I know that you might have other ones, but I want to come back to something you had said earlier about admin pay and how to sort of account for admin time. I think you were like I don't even know what to do with that. What are your, what are your kind of fears or what's coming up around that, or just maybe not knowing what that would mean or look like like.
Speaker 2:Tell me a little bit more, yeah so in my mind I'm thinking like meetings, supervision time, like that kind of stuff, which I know you've talked about before. I think thinking about like also I know different practices structure it differently of like is charting time included in that? Or like should your charting time be like that last five to seven minutes of your session, like a therapy hour type of thing? Um, and just kind of keeping it in check, because that is non-reimbursed time and that's like paying out of the quote-unquote extra box.
Speaker 1:Yeah, yeah, yeah, good question, um, and I think you're right. Like it's, it's something that we have to think about because it's not going to be necessarily like reimbursable money. But that's also why, when setting a pay structure or compensation structure that's a safe amount percentage wise will allow for that like flexibility to add on things like admin time. We, how I have a structure in my practice is um, I pay 15 hours to the clinicians for any client facing time and then they get 30 an hour for admin time. And basically how we do it is like I said, with meetings and all that stuff, the charting things that are like required during a session is under that like $50 an hour that I pay them. So it's like it's included within the pay rate of that 15 hours. So they should be doing their. You know any of that charting stuff? Yeah, exactly, like it really shouldn't take more than five to seven minutes after even you know that can be a lot Speaking for somebody who struggles with their notes. Like it takes more, but it really shouldn't, because I think a lot of times we just think it does Anyways. So that's sort of included as a requirement for seeing a client. What I did to sort of account for some of the extra stuff that happens, like especially working with eating disorders. We do a lot of coordinating of care. Sometimes, like you know, we do other meetings and things like that, so there's certainly other things that come up is I started offering an additional admin time for every five clients they see and this is always like the hardest thing for me to explain, because I do half of an admin time for every five, but it's in increments of five.
Speaker 1:So once they see five clients, they get that half admin hour added on, which is $15. Once they're at 10, they get a full admin time, which is 30. If they're at nine clients that week, it's as if we're going to round down to the five. So we only do that. And the reason I do that is because when I first was going to do this additional admin time, I was like well, why don't I just do it per client? And then I'm like well, that's just a higher pay rate hourly. So it's sort of like you can do one or the other and I think it can sometimes be a math problem.
Speaker 1:I worked with a dietitian. We did a coaching call once and she basically wanted to structure it where she would pay everybody for their one hour client an additional like half hour to that time. So it was like they were going to be paid like 1.5. And we sort of did the math on how I did it versus how she was going to do it and it sort of actually equaled out. So it really just depends on like how you want to do it. You could pay a little bit of a higher hourly rate for clients and then it'll sort of give them some extra and say like that's why this is like a higher hourly rate or how I do it is.
Speaker 1:We do that because as the numbers grow they're going to have more potential. But that doesn't mean that every week that they have more like sometimes things are they might be seeing like 20 people a week, but maybe it's like I don't know, they didn't talk to any therapists that week, right, but they're still getting that additional admin time Cause there's going to be weeks where they do have like a ton of that coordination that happens. So that's how I've structured it to sort of like make up for that. And then anything else really is is the only other times is like actual meeting times, because exactly like what might take me five minutes to do, might take somebody 15 minutes. Like how is that fair If we paid like hourly extra on top of stuff you know for somebody? Like if, like, we were like going to add in more time for something else, like it could? Just, it's, everybody takes different time to do certain things.
Speaker 2:So you're saying, like when they get the increased admin time per like based on that, every five clients they have, that's paid. Like no matter what, it's not like tracked and then paid. Got it Okay, because that was the other thing. I was like I don't want to like deal with more tracking than just the like session tracking, like that's too much.
Speaker 1:Yeah, yeah, that's why it's like for every five and that's why we, you know, I do in this like rounding down kind of way for the increments of five because, yeah, like I said, there's sometimes when things are just really busy and then there is a lot of like emails and coordination all these things, but sometimes there's not right, but they, they still have that time there to sort of have as the buffer, you know, when things are a little bit on the busier end of things.
Speaker 2:Yeah, for sure, cause, yeah, I feel like I'm either coordinating with all my adolescent eating disorder clients or no one.
Speaker 1:Yeah, exactly Right, it's like quiet. So does that answer like your kind of hesitations or questions right now in time?
Speaker 2:yeah, that makes more sense because I also like okay, I want to like think the best of people, right. But also then when you're like tracking, you're like, yeah, how long did it really take? And it's like I don't want that to be like a thing. Yeah, because it doesn't matter down to the minute, like at all.
Speaker 1:It's just like, yeah, keeping it in check, because it's a like an expense, it's not like a reimbursed service and if somebody was like, oh my god, I'm spending so much time on my notes and I'm not getting paid for that time. I'm like, well, why is it taking so long to do your notes? Like, what is it about that? Like, how can we sort of like make that? Not because it really shouldn't. I mean, when I really time myself, it doesn't take longer than five minutes. Ever. In my head it takes like eternity, but when I actually sit down and do it, it's not. So it's sort of like we can like work with people to make that stuff easier. But yeah, that's hard and I also never wanted to be that, that boss. That's like micromanaging every minute that they're working. It's like you know you do the work and see the client and as long as we're like charging for that time, like you're gonna get paid for that time.
Speaker 2:So yeah, I think. Oh, I was gonna say I use like a template too and like I'm actually switching over to practice better, so you could probably tell me better if this is a function or not. But right now I'm using healthy and it pulls it through and so, like you know, I update as needed, but I'm not like redoing the entire thing every time. I'm doing like the I call it like session notes, but like that subjective section the goals, if you've set any and then like, yeah, anything that's changed, and then just like when the next follow-up is, and so, yeah, it really shouldn't take you that long.
Speaker 1:No, yeah, yeah, and practice better. For a long time I didn't even know that I could do this and like when I learned that I could, I was like, oh my God, this is a game changer. Like you can just duplicate your last note and then you basically like link it to the session and then you can change anything. But most of the stuff doesn't really change week to week. That we see with our clients, right, like they're probably still eating the same ways, but we have a section in there that's like for any kind of like major changes and, of course, if there needs to be something that's like checked off.
Speaker 1:You know we've done a lot of like systematizing.
Speaker 1:I think with the first session we go through the actual intake with our clients, so it might take a little time to just sort of like organize it after the end of the session and like close it out, and then the first follow-up note is always the longest because that's when you have to do the initial, where there's like a lot of check boxes, but then after that it really shouldn't take long. So I think it's like also having good systems in place, which a lot of people stress about, like what systems do I need. But so much of the stuff I do now has evolved over the years based on the needs of my team and so, like things that I anticipated like that I would need are different than what they actually were. So I think there's a little bit of like being okay with the imperfection of some of those systems too, and evolving as you go when you have a team which I just wanted to say because I know a lot of dietitians panic about systems and so don't panic, you'll figure them out when you need them.
Speaker 2:Yeah, that's one of the reasons I'm switching EHRs, because I wanted to do that before adding someone, because that's just doubles all the things that need to be transferred. We don't need that. But yeah, I wanted something that I could integrate better with insurance billing. Right now I'm fine with the way I do it, but eventually, as more claims per week, that's going to need to be streamlined, and I've just had all the technical glitches over the last week and I've been taking sessions on my phone through the Healthy app, so it's just. Yeah, it's been a time. So I was just like I was putting it off because it's kind of like a hassle. But I was like last straw and I like did like most of my clients on Friday and just like here's the email, okay, like I'm transferring everything, you don't have to do anything really.
Speaker 1:Yeah, good. Yeah, it is much easier before you start growing and shifting everybody over to a new system.
Speaker 2:Yeah.
Speaker 1:That's good. Yeah, yeah, I love Practice Better. I'll link my little affiliate link that I have if anyone's interested in joining. But I find that one thing I say about Practice Better is like over the years they've made so many changes so it's sort of gone better and better. There's obviously pros and cons to every EMR, but I really do think it's a good one for prior practice and group practice as well.
Speaker 2:I started using it, or I started like setting it up and I was like this feels like high tech and not even like high tech Cause, like I feel like healthy, is very fairly functional, like it's not like super, like clunky, it's just like I guess smooth, like practice better feels smooth, and I've used simple practice before and I like it was good but it felt a little clunky um, yeah.
Speaker 1:So I feel like when I picked it like practice better, it's just like it's like interface, like felt like easier for me to figure out than the other ones that I tested out.
Speaker 2:Yeah, I think I just have to figure out how to find everything, and that's just part of the process?
Speaker 1:Yeah, Well, since we're getting sort of towards the end of our time I know you had a lot of logistical questions I'm curious how you're feeling now and what sort of feels like, maybe looming as something of. Maybe there's anything that you're feeling now and what sort of feels like, maybe looming, you know, as like something of like maybe there's anything that you're feeling still unsure about, or you know what your thoughts are so far.
Speaker 2:Yeah, I definitely feel better thinking through like especially that admin time like compensation piece. I think the only thing that's really looming for me is like actually going through the hiring process and like making that decision. I know you've talked a little bit about this on the podcast before, about like, yeah, if you feel like the interaction is hard, like to actually think about that because you're going to be like one on one with this person like all the time, this person like all the time, but because I've also, like I was listening to a podcast that was like you know, give people that are like not that don't do well in the in the interview, a chance, but basically like not everyone's an extrovert, but also like we also do one-to-one services versus like hiring an incorporator somewhere where it's like just because like their work isn't the same as an interview, but like our work kind of is the same.
Speaker 1:Yeah, yeah, I hear that, Like it's hard to it does feel like I'm being what's the what's the word I'm thinking of.
Speaker 1:Like excluding people that are maybe not outwardly like outgoing or whatever, but I will say it's not necessarily for me. I mean, for me and for you, what might be the type of person we want to work with is going to be so different, you know. And so, like personality wise, I've hired people that have been like shyer during the interviews. Like you know, I've done like individual interviews and I have had done like a group one and I've seen people that are really nervous but it's like certain aspects of like the things they say and how, you know, not necessarily like I can tell when someone's like nervous and like, of course there it's like an interview, it's a nerve wracking thing, but it kind of comes down to like is this the type person that I can lead? Well, and that's my own stuff, you know. But as you grow and evolve like, you want to make sure that like it's, it's someone that you can work with, because that's what's just going to make like your team, what it is, and that's going to be different for everybody, and so it's really just based on like. When I say that like recommendation, like I can see how that can be kind of like maybe ableist is what I'm thinking of, or if somebody comes off, you know, they might have some social challenges like that's, that's, but what that is to me and to you is going to be so different too, you know, and so we really want to make sure that when we're hiring and ultimately, like, you're the boss, you can decide what, what is going to fit for your team, and, as my team has grown, I also think about how that person is going to fit in with the rest of the team and how that's going to like mesh together, cause that is also important for me, so it really does depend.
Speaker 1:A lot of it, though, is the core of it is like not just personality, but it's like values and things like that. Like, I've had interviews where people I'm like tell me about you know your interest in this work, and they'll say something like healthy at every size, which is fine, but that tells me that they haven't actually like really done the work around health at every size to know that it's not, we wouldn't call it healthy at every size, or something like that. So that might be something that dings me a little bit, but have the core values that I do around fat positivity and health at every size and way inclusive care that I'm like I don't, I can't. That's harder to teach, right? Like to like reshape how somebody views like a core value versus like the actual counseling skills and how they do stuff. So if somebody comes off kind of like shy and awkward, like we can still work with that right, it's just a matter of like how that meshes with you and you being their leader.
Speaker 2:Yeah, that's true, because like yeah, I think that's also part of like. What makes me nervous is, even though I do want to hire someone and do this process of like, especially in the kind of space we're in with eating disorders and just like in that, like you know, weight neutral, inclusive space like what someone says to me in interview versus like maybe they're I don't want to say like they're not being truthful, but like I think we've all done a lot of work in the space of like what we think and then unpacking what's really underneath that, um, yeah, and kind of just like with anything like handing something off to someone else. It's just nerve-wracking and that's just part of it?
Speaker 1:yeah, yeah, I had. I had one of my coaching clients recently asked me have I ever like shadowed a session? I actually saw this come up in one of the Facebook groups on private practices. If people have ever like shadowed their clinician sessions, if their retention is not going well, I have not and I don't think I ever will, because it's like how awkward is that. First of all, to like be the boss sitting into the meeting, but there's no way I would be able to be comfortable and like myself if I was like knew I was being watched by my boss.
Speaker 1:This is what I think supervision is so key in doing supervision with our clinicians, because how people talk about clients, how people show up in supervision, the kind of things they say, the kind of questions they ask, the kind of ways that they say stuff is typically how they're also saying it in session. Sometimes they'll be like well, I didn't say it like that. I was like but I'm like okay, so there's, but there's this underneath resentment, that you're that, you're the way that you're saying it to me, that I'm noticing, and being able to give that feedback is going to be really important, and I think that's really where we shift into being leaders and once it's not about micromanaging, it's about like, how do we give good feedback and be like open and honest and help them grow as clinicians, versus like people we want to like I don't know micromanage right, like that just feels like cause it is scary, I mean, of course, but I've found like even newer clinicians I've had that have said things like you know, I just we talked to them about balanced eating or like healthy choice, like they've said buzzwords and I'm like, wait, let me clarify what you mean by that. Like they're going to have to learn and like I don't want to like obviously put our clients in harm's way on. You know, in the process of that, we all have to learn somewhere. You know we're not going to be like the perfect clinicians.
Speaker 1:I've said stuff to clients before. I'm like, why did I say that? Don't say that anymore. I'm like that did not land, we won't use that one anymore. But I really want to also show that to my team. It's okay to make mistakes. We can grow from them. How we say things isn't always going to land with everyone. That's also okay. We want to just come back to one's end the core values of like we believe the same things, we want the same things, and how do we sort of help somebody you know learn that way? And I think this is where, like being you know, doing supervision with our team, makes all the difference.
Speaker 2:Yeah, because that's true. Like sometimes, like even I'm in session, I'm like, yeah, like I'm thinking about something recently and I don't even remember what it was about, but it was like and I was like but I don't want to use the word less, and it was just like. Like I'm like trying to like, because sometimes it's like I don't mean it in this way, but I don't want it to be misconstrued and like being able to like yeah.
Speaker 1:Yeah, I mean, it's hard and you know, and I always say there's been times where and this is nice where I've had newer clinicians shadow my sessions and I've said stuff that I'm like that did not land with the client and afterwards being able to really show my team, yeah, that didn't land.
Speaker 1:I'm just going to not say that I say a lot of analogies and sometimes they don't make sense, but sometimes they make a lot of sense and then repeat those you know, but the other ones, it's okay to let those go, you know, and I think it's okay to like give ourselves some grace, to like learn how to do things, and it does take time.
Speaker 1:That's the other thing that I think Hannah's been really helpful for me too is to recognize that like retention with clinicians takes time and it's really not until like one year in private practice that I feel like people really are, like they have their flow, they have their style, they're feeling more confident and they're able to retain people in a different way than they could month four, you know. So like they might still be new to private practice as well, and so we want to give people the space to also just give them a chance to learn before we, you know, hit the panic button on, like, oh my God, they're not retaining clients If after a year, right, this is where also there's other things we want to put in place, like, are we checking in with people quarterly, like asking them how things are going, and I think that's like the next, that's the next step before hiring or once you're hiring. But I think where you're at, you know, finding people that yeah, you want to work with every day is key and very important yeah, that makes sense.
Speaker 2:And like showing that you can grow like even on my podcast I do that like I will be talking and I'll be like in these two things and I talk about one, I'm like and I don't remember what I was gonna say and like yeah, and like I cut out the long pause of me thinking, but like I leave that in there because I'm like that's just my brain, like that's my brain exactly.
Speaker 1:Yeah, I remember when I first started putting out podcast episodes, I was like editing all my likes and ums and things out. And then I was like, oh my god, I'm talking so fast. And then I realized, okay, this is how I talk and if people want to like listen to my podcast like there are certain people's podcasts that I like listening to just because I like their personality, and like that's who's just going to listen to my podcast, like they don't like it, that's okay. And so I was like I'm going to stop editing out every single like because there'd be one too many, but two. It's just how I talk.
Speaker 1:But it's also been helpful for me to remember like slow down when I'm talking, like I have noticed I talk slower when I'm like recording maybe not so much in these interactions, cause I'm just kind of like being my normal self, not my recording self. But you know, yeah, we want to be ourselves too. I think that's the same thing with our clinicians, right? We just want them to like it's okay to be who they are and that's why it's important to like find someone who's going to be a good fit personality wise for you versus you know, know somebody else yeah 100 all right.
Speaker 1:Well, I think, as, as you know, you're obviously on the right. I think the fact that you're already thinking about these things, do all these things ahead of time, is like amazing, because it's way you know way more than I did before I started. So you know, you can sort of you already have a lot of things at play and like ready to go, even like you guys can see it, obviously because you're listening. But she showed me this like paper she had of like you know, the different pay rates, uh, and the reimbursements and things like that. So I didn't have any of that so like a year ago. So you're, you're on the right page, you're already thinking about these things and I think you already have the things in place of like what do I, how do I want to like make this work environment, and like why do I actually want to do this? It sounds like you have those core principles already kind of in there, and so I think you know. As we kind of conclude, I'm curious what you feel like your next steps will be.
Speaker 2:I think just like solidifying, like the pay, compensation, just like that's what I'm gonna do and, yeah, I think, just deciding when I actually want to post the job and more of that kind of timeline and making sure I'm checking any boxes of things like I need to do before, kind of that process of just like obviously getting my EHR re-moved over and I'm working on rebranding and that will be done this week and so, yeah, just having those kind of preemptive things done.
Speaker 1:Yeah, I think that's great. I think and yeah, like you know, giving yourself some space and and grace, you know you're. You went full-time in March. When did you actually start your practice? I don't know if you shared that.
Speaker 2:So I technically started it like when I was in grad school, because I feel like that was very much when, like the like Instagram boom of like, you can be a nutrition coach and even though, like it was like well, I'm going to be a dietitian, like you know, and now I'm like but you know that's for here and there, but I wasn't really getting anywhere with that because I was I was still in school, I'm like still trying to kind of do all that.
Speaker 2:I'd say I took a break when I started my full time job in a clinical setting in October 2022. I was just like this needs is not a priority, but I liked it. I feel like I really started my practice in like February of 2020. Three, okay, all those years kind of like yeah.
Speaker 2:I was, um, because that's kind of when I was like okay, like I always knew that the clinical position was like a means to an end that's not what I always wanted to do, but I needed to have a job that was paying me and so kind of. I think in February. So after about that like was that like five or six months, I was like okay, like feel comfortable in my job now and I want to focus on this. So you know that that eventually is my job, yeah.
Speaker 1:Yeah, okay, so you've been. It's. It sounds like you've been in practice for about a year and a half now. You know, in this sort of realm, yeah, yeah, I think you're. You know, I think giving yourself some, some time is going to be good to get all those group practice pieces in place of the rebrand and the EMR, all those things that'll be much easier to do when you're still solo versus when you have a clinician. So I think that's a good plan.
Speaker 1:And then, yeah, by the time you're into really your full year of being in practice, it sounds like a good time for you to around that time, like right before to hire. One thing we didn't talk about, which you know just quickly mentioned, is that when hiring with, like with insurance, because the credentialing process does take a little while I try to like, think about, like wanting to have somebody like a position offered and accepted, like at least two months before maybe they're going to start, because you know I usually have people start out like six to eight weeks after. Like, I offer them the position so that I have time to start the crunching process pretty much ASAP, and then, once they're actually starting and like onboarding, we start getting some of the contracts in. So I think you know early Q1, which is what I think what you said was your goal for next year of starting that hiring process. I think that's a good plan if you're feeling like March is going to be sort of that boom again.
Speaker 2:Okay, I was thinking maybe I should post in December to give time for like, just you know, like actually have process.
Speaker 1:I just don't want to feel rushed, because I feel like March is like a really important start date for me, kind of maybe, yeah, a little sooner, but yeah, that makes sense giving that time I think I I certainly feel this pressure all the time for some reason of like, oh my god, it's busy and we don't want to like put people like I need to hire somebody, like I did that last last, uh, like early summer, and it's not the other world. Like I think there's this fear that, like if I give away this client and they're never going to come back, or like this person's never going to refer to me like you know, it's a scary thought to sort of like refer somebody out, but it's easier to do that than to like hire somebody. That's not a good fit, because you're like rushed, you know, and so give yourself time too. So I think that's a good idea, just to give yourself some time and you'll see where things are at too for you, you know, come December and January.
Speaker 2:Yeah, definitely.
Speaker 1:Cool, awesome. Thank you so much for that. I hope it was helpful and thank you for being this. You're going to be the very first coaching call that you do in the podcast, so I'm really excited for the listeners to hear it and I really appreciate you being open to doing it, of course, and I'm excited to see where the practice takes you.
Speaker 2:And.
Speaker 1:I'm glad we're connected in the accountability club so I can see what's going on All right well, thanks again for being a guest and, yeah, I'm excited for all that's to come for you. Thanks, awesome thanks. Thanks for listening to the RD to CEO podcast. Be sure to check out the show notes for any resources mentioned or find more at wwwrdtoceocom. Never miss an episode by subscribing, wherever you get your podcasts. See you next time.
