Show Notes

Kayla: Welcome back to the Designer Practice Podcast, and I’m your host Kayla Das.

Have you ever thought about building your own multidisciplinary practice, but you felt overwhelmed by all of the moving parts from setup, hiring, and client retention?

Starting your own multidisciplinary practice is no small feat, but with a little guidance, it can certainly feel less overwhelming. That’s why I’m super excited to introduce you today to our guest, Marco De Ciantis, Chiropractor and long-standing business owner with over 11 years owning and operating multidisciplinary practices.

Hi Marco, welcome to the show. It’s great to have you here today to shed some light on how to start and run a multidisciplinary practice.

Marco: Good to see you. Thank you for the invite and hopefully the little shred of wisdom that I’ve developed over my decade in terms of navigating this field can help out so many others that are part of this family that you’ve cultivated through this podcast.

Kayla: Yeah, and one of the things I get asked all the time is, how do I start growing my practice? Having a multidisciplinary team. So, I think that this episode is so fitting, and I’m so excited for you to share your wisdom.

Introduction

But before we dive in, please introduce yourself, where you’re from, and tell us a little bit about your journey through practice ownership.

Marco: Sure. So, I’m born, bred, raised in Toronto. And in Toronto, I graduated from the Chiropractic College in 2012. So, I did my undergrad and did my chiropractic degree there. And right from the get go, I knew that I wanted to own and operate a practice rather than being, an associate. Not that there’s anything wrong with being an associate, and I’ll probably dive into this later on in terms of the different options when you graduate, what you can do and what you can’t do.

But after I graduated, a practitioner that I was doing research with in the chiropractic college serendipitously was selling his clinic. He knew that I was shopping around. I was able to acquire the clinic and ran it up to about a month and a half ago. Fortunately, I had my identical twin brother, Paolo. And, yes, so Marco Polo, and it’s a great way in terms of never forgetting. Trying to guess which one is which is a different story, but, you know, it always helps with the icebreaker when I introduce myself and for people to remember. We were running the practice together, for the past decade. And that brings me to a different aspect of my life right now where I’m starting a new business and a new venture, but I’m still in the field itself just practicing as a locum right now in Kenora.

What’s a Multidisciplinary Practice?

Kayla: Fabulous. So, I know many listeners probably already know this term, but just in case, what is a multidisciplinary practice? And then also, how does it differ from, say, a private or group practice?

Marco: Multidisciplinary is definitely one of those terms that has a loose sort of a definition, but as long as you have three different types of, wellness or associate allied practitioners in one space treating people, they don’t necessarily have to all treat the same patient, but as long as you have those three or more in one area, then you’re going to be a multidisciplinary practice, which can be used synonymously with the group practice.

However, I think the group tends to be more associated with companies that actually operate as this medical quote unquote group, which offer their services almost as a you pay for medical service, so to speak. And there’s quite a few of those in and around this country.

Kayla: Yeah. That makes sense. And even when I think of group practices, not that I know the definition, but I think of people hiring the same type of professional. So maybe all mental health therapists or all chiropractors. Instead of a multidisciplinary is, like you said, three or more of different type of professionals.

Marco: Absolutely. And I want to delineate between, I use the term allied or associated healthcare practitioners. So, what I mean by that is basically anyone that’s not medical or that’s not dental. And it’s not to cut those out. It’s just colloquial use of that term is you’re referring to practitioners that aren’t medical or that aren’t dental.

Preparing to Start a Multidisciplinary Practice

Kayla: That makes complete sense. So, when it comes to starting a multidisciplinary practice, what are some key areas that therapists should focus on during the preparation stage to ensure that when they open their doors to their multidisciplinary practice, that they have everything ready for start-up?

Marco: Absolutely build your support team. And what I mean by your support team are three individuals. bookkeeper, accountant, bank manager. You can have a fourth one in there, what I recommend as a lawyer, particularly once we’re starting to do your contracts. And usually when I start this way, people like, “Oh, why wouldn’t I think of who should I get the RMT or this practitioner?” We’ll get to that.

But whether you’re graduating for the chiropractic college or the naturopathic college or the osteopathic college. We really don’t get that much in business. You’re doing a doctorate for four years and you’re specializing in doing what you do, not in business. And then you graduate, you have all this clinical information, but it doesn’t mean that you have any business sense or how that does not translate towards business. So, what I learned stumbling out of the gate, and I did stumble out of the gate, was you need a great bookkeeper, you need a great accountant, you need a great lawyer, and you need a good, good bank manager. And the reason being is these are specialists who do this for a living. Yes, you can do your own bookkeeping using QuickBooks. Yes, you can do your own management. But when push comes to shove and you start operating a multidisciplinary clinic, a lot of disciplines get paid differently. RMTs, depending on what province you are, HST, non HST, how they get paid. You need someone else to sideline this to who has that education to work through this because the last thing you want to do is create your own fires and then try to put these fires out. So that is where I would start is trying to get that team together.

And there’s cost effective ways in order to do that, where you can always start with Upwork, for example, and not just name dropping. I mean, you can search for these individuals and pay for certain services. I don’t need to hire a lawyer. I just need someone to make a contract. Okay, I can go on Fiverr or I can go on to Upwork and then just hire someone per contract and that’s cool. But absolutely try not to do everything yourself.

I dabble in the stock market. That doesn’t mean I’m a day-to-day stock trader and I’m going to make all these decisions that make me millions and billions of dollars. No, people spend decades doing that and even then, it doesn’t happen.

Determining When You Need to Start Hiring

Kayla: That’s all really great points. And something that really come to mind is a scenario question because we’re talking about hiring people and having that team set up. So, what if a therapist is thinking about creating a multidisciplinary practice? But they don’t feel like they’re ready. And maybe even sharing maybe your own experience on how did you know you were ready to start hiring and putting money on the table? Because of course, we have to pay these people. How did you go through that?

Marco: With my experience, the clinic that we purchased, so I purchased from a sport chiropractor, and he already had in the clinic a massage therapist, other chiropractors, and a naturopath. So, I was fortunate enough to already have those disciplines there. However, there was some turnaround in the sense of there were certain practitioners who left and you needed to hire someone else. So, for me, it was more pragmatic where the naturopath left within a month. So we needed to hire a new naturopath. The massage therapist was gone, I believe within a couple of months. So, it was more based on the need to replace the service that was already established. So, it’s a bit of a different story with me.

However, push comes to shove, it’s still the same. What are the qualities of the individual that you’re looking for? And that is a really, really, really important aspect. So, you’re not just looking RMT. How do they practice? Is this complementary to the type of practices that is already established within you? So, if they’re only doing cupping or they’re only doing hot stone massage and that’s more spa based and you tend to be a more pain-based wellness, probably already don’t jive. And it’s not that it’s, against using any hot stones. It’s just not quite within the fabric of your practice. So multidisciplinary just basically means those three or more practitioners. How you all practice and the type of care you deliver will really dictate the type of services you’re finding in the specific practitioners you want part of your team.

Kayla: That’s a really good point and it’s really about knowing your specific clinic or your specific practice and what the vision and the values are because, yeah, there could be really great professionals out there but if their approaches or their methodology are not necessarily aligned with your clinic or your practice it isn’t going to feel cohesive to clients or potential clients.

Marco: A thousand percent. And you can get the feel for that when you walk into a place where the different practitioners’ personalities aside that the actual treatment styles don’t actually quite add up. And one way that I’ve been finding that you can key into that is if there’s a lot of referrals within the clinic between the disciplines. That doesn’t necessarily mean that it always has to happen. However, I mean, that’s the benefit of a multidisciplinary crew. You can’t do everything. You’re not Batman with your utility belt, with all the tools and gadgets for every single situation. There’s things that other people can do that you can’t do that will help the patient. Patient centered care, it’s what’s best for them. So, you want to have people there that kind of work similarly together and one of the best ways to view that and if it is working is if those patients are seeing most of everyone or everyone.

Benefits of Having a Multidisciplinary Practice

Kayla: Yeah, and incorporating those benefits. So, I guess that actually brings me to another question is what are the benefits of having a multidisciplinary practice? Why should listeners even consider or think about it?

Marco: Business sense wise, if you’re a solo practitioner, yes, all the clients come to you and then theoretically all the money comes to you. Okay. However, you’re only limited to the room you’re in and you only have two hands in the same amount of hours and days per week as everyone else. So, you’re already at a glass ceiling. You’re already at a finite level that you can’t pass. So having multiple practitioners just increases, frankly, your revenue stream. There’s other people who are working on other people who are generating new money at the same time. And that’s just the business sense.

Clinical sense already comes down to what we talked about. You can’t do everything. And there is no way in terms of absolutely meeting someone’s, in very specific circumstances it can happen. But generally speaking, it’s hard to meet everyone’s health care demands and requirements just on yourself. So having those other practitioners to help you out as a team effort to reach the goals for the patient is a whole another ball of wax. So, it’s that clinical and it’s also that business sense where it can really work out.

Considerations to Hiring and Onboarded Professionals

Kayla: Fabulous. So, when it comes to hiring, what are some considerations when determining which type of professionals or practitioners should be onboarded within a multidisciplinary practice?

Marco: Yeah. Let’s start off in terms of the basics You want to make sure that the discipline whatever the discipline is that they’re fully registered first and foremost and that they can practice. And that they don’t have any sort of other issues like previous suing or anything like that. You want to know that they’re in good standing. So, before you hire anyone, let’s just make sure that they’re in good standing and they can actually do what they say they can do in the place that you’re practicing first and foremost.

Outside of that, it comes with finding people that match not just so much your image of the clinic, but once again, the fabric of the clinic itself. So, where you start from hiring starts from you. And you just said the word not more than five minutes ago. Values and I’m going to mention something that a colleague told me, not that long ago, right down 5 to 10 values of the clinic itself. And there’s a lot of dynamic towards us and it’s very, very subjective. That doesn’t mean you go and Google the values of this clinic, it really means you dive deep into yourself find something that’s really meaningful. Why did you get into this? Why do you want to do this? Why do you want to work with this other person? Get those values write them down because when you’re interviewing someone you want to make sure you’re checking off those values. Yes, they showed up on time. Yes, they are presentable, blah, blah, blah. Yes, they can do this. Yes, they’re certified. Do they match the values? Because in the end, they could have been the top 5% of the class. They’ve already got their experience. But if they don’t match your values, you’re going to find out really, really quickly that tensions can occur. And that’s just outside of anyone’s personality. And the last thing you want is tension within a clinic because patients feel that very quickly. And when that happens, you can have all the best people with you, things aren’t going to get done.

Ingredients to Creating Cohesion Among the Team

Kayla: So, let’s talk about tension. Because there are an array of practitioners with various trainings and experiences that you hire in a multidisciplinary practice, how can a therapist maintain cohesion between the different types of practitioners within that practice, especially if they run more than one clinic across maybe even multiple locations?

Marco: So, what we ended up doing in my previous practice, we had two locations in Toronto. And interestingly enough, there’s practitioners that never met each other. They actually met each other once a year, and that’s when we had our end of the year seasonal party. And it’s like, “Hey, cool, I’m seeing you again, and I’ll see you again next December,” sort of a thing, right? One of our naturopaths, she just had her second child not more than two weeks ago. And she’s in Kitchener, Waterloo, and she’s been working remote for the last three years. So, there’s practitioners that were in the clinic that never met her. And you’re right, how do we maintain the cohesion?

What we did do is start a WhatsApp group, which was only for members of the clinic. So that was a way where day to day. It wasn’t so much about the happenings in the clinic, it was strictly just to keep people in tune with what’s going on in their lives. “Hey, happy birthday” to this person. “Oh, cool. Here’s a picture of my new son,” sort of a thing. Or, “Hey, here’s my cat. And they did this.” And this all really happened, by the way. That’s where we found the cohesion stay together. Not just because of the actual medium that we use, the WhatsApp, but how we utilize it strictly just focusing on our social aspect, not so much on the clinical practitioner aspect.

With the clinical practitioner aspect, we would do clinical rounds once a month where every practitioner will present a case to all the other practitioners, and then we would discuss, “Okay, cool. How would we manage it. And how would we co-manage it?” So, we would have those monthly rounds, up to speed, every single day with WhatsApp, socially, and then we would have our social outings, where it would just be, let’s go paintballing, or let’s go see a movie. That’s already well instilled, but I want to really hit home that you want to have the social aspect and the business aspect to maintain really great cohesion between the practices. And I think that can really not only help with cross referrals. Create a family aspect with people who are working together quite often.

Kayla: I love that you’ve added both points because even when I used to work in organizations, one of the things that often happened is that we would focus on maybe one area and not on the other, right? We would focus on the business side. How can we get more business cohesion? Or let’s focus on taking our lunch hour and doing some sort of fun activity. But it really comes back to having both because you’re going to have different types of people.

And I’m just going to share for myself. I’m more of the business side. I love when we can do more like business, maybe learning or trainings and things like that. But that’s not everyone’s cup of tea, right? Some people want to have that bowling night or that time that they can get together. And by providing both options, you’re really supporting everyone’s personality because not everyone is going to find value in one or the other. So, I love that piece.

Marco: And Kayla, I love how you said the word value and it’s not just so much what you put water into, but it’s also what you cherish. And humans are humans, we’re not all business minded or business is not on our mind all the time, whether you run it or not. And that’s okay. And how people interact with each other is always completely different. And sometimes, they’re more interactive on the business. Sometimes they’re more interactive on the clinical. Sometimes they’re more interactive on the social. Awesome. Doesn’t matter. Get that trifecta going. And with that trifecta, you’re going to be creating the union between everyone.

Kayla: I 100% agree. And this even goes back to those common introvert versus extrovert. And ironically enough, and people probably would not believe me, but I’m actually an introvert. And I know it’s so interesting. Hey, but the truth is, I’m motivated by being really immersed in something, right? For me, it’s like learning or building or even doing these podcasts, right? I do love meeting people. It doesn’t mean that I don’t move outside that, but if I’m going to really be cohesive with others, I love that learning opportunity.

And the one thing we did not say at the beginning of this episode is that we actually met at a Jane event in May. And one of the things that I found, and this really supported me and my personality of an introvert is that we did have opportunities to socialize, but we also had opportunities to learn and to be immersed in the process so that we could get to know each other, but in a way that helps support, again, going for me in that business side, but it really hit both sides. It hit that let’s have some opportunity to connect with people, the social events. We even went across a really long bridge that was super scary.

I know our listeners have no idea what I’m talking about, but there was a bridge in Vancouver that Jane had brought us to. Do you remember what the bridge was called?

Marco: I believe it’s called the Capilano Bridge?

Kayla: Capilano Bridge. Yes, it was. And it was so scary. But anyway, I’m digressing here. But we had those both opportunities, right? So that people, whether they’re extrovert or introvert, they had those opportunities to find value and benefit. And I just wanted to add that in because that’s how we met, but it’s also incorporating those pieces that you’re talking about.

Marco: Kayla, and just to piggyback onto that one, what I loved about that, because there are so many great things and I love Jane as a product, so complete biasness to it. And yes, we both are ambassadors. But that aside, they really knew how to take care of a group. And what I mean by that is, you’re put into a conference, everyone was absolutely lovely. We’re all meeting each other for the first time. There’s vulnerability. And there’s vulnerability in meeting someone professionally and then just hanging out with someone socially. So I loved how we all were just in our own vulnerability, talking about our different businesses, different parts and different growths of our business, and then going to a bridge that’s suspended 140 feet in the air. That was, I don’t want to say rickety, you know, it was very sway-y, and then we’re in another vulnerability, but we’re all sharing it together. And that’s where the strength comes in.

And one thing I just want to mention with this, however many years in business you have, if you think you’re a business tycoon or whatever, there’s no way you’re going to know everything. There’s no way that you’re going to be able to prepare for everything. Please, please, please, please, please, always keep in mind, yes, you build your wisdom. Humility, humility, humility is incredibly important. And gratefulness. You might not be where you want to be. You might not have what you want to have. That does not mean where you are won’t change or that it’s terrible. You’re here and now and it’s always in a transition and businesses. It’s that growth. It is that transition. Keep humble. Maintain your gratefulness because that’s I find internally will really help downstream with everyone that you hire. And Jane is the perfect example, and I’m going to speak for you here, but seeing literally from the tippy top, just to see how heartfelt and humble and gracious they were, like, yes, this is how a business can be. You don’t have to start cutthroat. You can start this and grow and maintain it. That was inspiring.

Kayla: 100% and as listeners know, like you mentioned, I’m ambassador of Jane, but the reason I’m an ambassador of Jane is because of that mentality. They know how to run a business. They know how to support people. And they genuinely going back to that humility, they genuinely want to support. And I think as business owners, whether you’re a group practice, multidisciplinary practice, or even a private practice hiring contractors to help here and there. It’s, what’s important for you, because that really grounds you into what you’re going to do next. Like my values in my business, as well as in this podcast is communication, collaboration, and value-first. And guess what I’m collaborating. I’m communicating, and I’m always, or at least I’m hoping, I’m always putting value-first, right? So, this is why it’s so important, because your values are going to then move you forward into the direction that you want to go.

Marco: Love that. Great point. Great point.

Managing Employees vs. Independent Contractors in Multidisciplinary Practices

Kayla: So, I just kind of mentioned about contractors, so I really want to talk a little bit about the hiring process. So, from your experience, are there differences between managing contractors and employees in a multidisciplinary practice? And do you have any recommendations to help therapists navigate the challenges that may arise when managing either?

Marco: Yeah, absolutely. There’s going to be a difference between the employee and the contractor. First and foremost, what pops in mind is how they get paid is one thing. But outside how they get paid, usually, in terms of employee work, or at least from my lens through my experience, is a longer stay individual. So we’ll talk about the office manager, for example, or the front desk staff. These would be employees as opposed to contractors. It could be contractors, too, or you can have a staffless practice. There’s lots of different ways to operate. However, these ones would be employees, and you’re investing in them as much as they’re investing in you, and you don’t want to turn over you, you’d expect them or hope that they would be there for years.

Contractors can do that. However, it’s more particularly recently in the pre COVID and especially after COVID. There’s a lot of change, or traveling that contractors can do. So six months stint here. It’s a year stint here. So you can have a couple of years, but the investment in terms of how long they’re in the usual place is different from an employee. So temporal pattern is one thing and coming from that the management is a lot different. That doesn’t necessarily mean that because someone is expected or will be there longer, you treat them any differently then a contractor. But it’s more in the background that you know that turnover, things are going to be happening sooner with the contractor themselves. So, this is where a contractor contract really becomes important for you because you know you’re going to be utilizing it a lot more readily than if you’re going to be utilizing it, for example, with an employee. So having your great lawyer, getting a really great contract together is one of those key differences in management right off the bat.

Additional Insights

Kayla: So, whether it’s hiring, managing, running, whatever, do you have any additional advice or insights that maybe you haven’t already touched on that can help therapists who strive to one day open their multidisciplinary practice start moving forward toward that dream?

Marco: I love how you brought this up. So right now, through the Ontario Chiropractic Association, I am an OCA mentor, so I’m paired off with a few students, and then there’s topics that we talk about that range from clinical to business. And just pointly that within this week, there is one student, not student, but he just graduated who’s navigating the territory of being a contractor and getting more responsibility in the business that he’s in. And part of it is he does want to move on to eventually create his own empire, so to speak. So, this was something that we talked to directly.

What I would recommend to contractors who are working or to any practitioner who are working in a place that isn’t their own right now, whatever it may be, however it may be, really dive deep into what you like about the management. And what you don’t like about the management. And those are really, really, really broad categories. It can come down to how the point of sales are collected. It can come down to how patients are booked. How they’re actually generated. How they’re booked with you. All these different aspects. You will find it out very quickly. I mean, you will know in a place, I love this, I don’t like this. Record it. Record it, record it, record it. Write it down. Why you don’t like it. Why you do like it. Revisit it. Every month, notice if it’s changed or not, you’ll start to build a pattern. And I would say, after about three to six months of your own business acumen, where it’s not necessarily now all of a sudden, I’m a tycoon, but I know that when push comes to shove and I start doing this, this is what I want. This is how I’m going to set it up. This is what I’m going to look for. So, when rubber hits pavement, you’re really covering a lot of territory really, really quickly.

Plus, it gives you time to build your team. Let me find a good lawyer. Let me find a good bookkeeper. Oh, you know what? That accountant wasn’t really great. My friend recommended me this one. Let me use this one for a month. Oh man, they saved me way more money. Okay, cool. I’m going to use them. This is part of you. You can start building your team, your business team, right here, right now. No one says that you can’t. Record, use your own experiences here right now, just as you said, to direct yourself in the future. And when you’re guiding your own fate with your own hand, when you’re investing in yourself, that is always a sure bet.

Connecting with Marco

Kayla: Love it. So, if any listener would like to reach out to you to learn more about maybe your own journey as a multidisciplinary practice owner or just really just a chat, how can they reach out to you?

Marco: Absolutely. At this point right now, I’m going to be giving you my personal email address. I am in the midst of creating another business. However, because we’re generating the website right now, I don’t have the specific emails towards that website, which is known as Daphne Health Alliance. However, they can email me directly and it’s all lowercase, marco.g.deciantis@gmail.com. And through that, I’ll be more than happy to speak with you and address whatever it is that we can.

And the one thing I want to, Kayla, to reiterate here, and I say this with my mentor students, with my interns, you name it. I learn as much from you as you would learn from me. Student-teacher teacher-student relationship is always cyclic, and it’s never one sided. So, what I mean by that is, you contact me, you’re going to teach me, teach me, fill me in as much as I can fill you in.

Kayla: That’s fabulous. So, Marco, thank you so much for taking the time to share your insights and your wisdom with us today. It’s been such a great conversation and I’m so glad that we were able to get together and do this podcast episode.

Marco: Thank you again for the invite. I can’t wait till we’re in 3D again. So hopefully, Jane can hear this, and yes, Ambassador Conference 2024. I’m looking forward towards that, and then maybe we can do tightrope walking, or we could do, yeah, we can make that suspension bridge even more suspenseful.

Kayla: Oh, I don’t know, that was quite suspenseful doing it the first time, but yeah, I agree.

So, thank you everyone for tuning into today’s episode, and I hope you join me again soon on the Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

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