Show Notes

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

Imagine what it would be like if you had a seven-figure group practice?

You might be thinking about the freedom and flexibility that you’ll have to spend much more time with your family. Or perhaps it’s to plan a three-month trip traveling across Europe. Or maybe it’s simply to prepare and plan for early retirement.

Whatever the dream is at this moment, it may feel a little out of reach, but it doesn’t have to be because in today’s episode, Nicole McCance, retired psychologist, business coach, and the owner of the McCance Method, will share her own story as a group practice owner. And she’ll share with us how she grew a multiple seven figure group practice.

Hi, Nicole. Welcome to the show. I’m so glad to have you here today.  

Nicole: I’m so happy to be here. Thanks for having me.

Introduction

Kayla: Before we dive into this episode, please introduce yourself, where you’re from, and tell us a little bit about your own practice journey.

Nicole: Okay! This is so exciting. I am Canadian, I’m in Toronto. And I’m sitting here in front of you as a retired psychologist, and If you were to ask me that I’d be saying that out loud, even five years ago, I would say, no way.

So let me just rewind five years. If I can, I was in solo practice, 15 years, doing EMDR couples therapy, and I was burnt out. I don’t know about you guys listening, but I was seeing way too many clients. And then 2016. I become pregnant with twins and all of a sudden my life is going to double but I can’t see more clients. What am I going to do? We need a bigger house. But I just, I can’t. It’s not quality care if I fit anybody else in my schedule.

So, guess what I did? I did absolutely nothing. You know why? Because there was no guide. I didn’t know the first step to take to go into a group practice. So I did nothing. And I find a lot of listeners probably relate to that where they’re like, I don’t know what to do. So, I’ll just wait. And then two years went by.

Jackson and Lucas are born. They’re two years old now. And mommy is still working until 7 pm. And these poor babies went to bed at 7:30 and it was just one day that I just couldn’t do it anymore. This is not the mom that I thought I would be. I’m talking to my clients about having this great life, but I’m exhausted and I’m only spending a half an hour with my family.

So, I hired, I took the first step and I hired and then fast forward three years. I now have 55 therapists, a multiple seven-figure huge group practice, 24 rooms, 7, 000 square feet. And a year later I sell it to an amazing psychiatrist who took such great care of my team. And then a year later, that’s five years now retired as a psychologist.

Kayla: Wow, that’s fabulous. And I know people can’t see you, but even the using the word retirement is a really big word because, you don’t have to say your age, but you are quite young to be retired as a psychologist. And a lot of people think that they need to be 65 or 70 to retire. But you realized what was right for you and you moved forward with that.

Nicole: Yeah. If I could just say though, I still remember the day that I retired because I think that ambitious therapists are listening, right? Probably that’s who you attract to this podcast. And I remember going, “Oh no, what do I do now? What do I do now? This is my identity. This is all I’ve lived and breathed. I went to school for all of this, right?” And that’s when it hit me. Wait, what if I give it to my peers? What if I give all my systems that are replicatable? And now I’m a business coach. So semi-retired, we can call it.

Difference Between a 5-Figure vs. 7-Figure Group Practice

Kayla: Fabulous. So, if you were to highlight one key difference between, say, a five-figure group practice to a seven-figure group practice, with the exception making more money, what would be that one difference that you would highlight? And what I mean by that is, what’s the most important thing a practice owner needs in order to move themselves forward towards that seven-figure mark?

Nicole: So, let’s say somebody has a couple of therapists now and they’re wanting to scale more, right? That’s kind of what you’re asking. It’s like, I have a small one and how do I take it to the next level? Well, I think the biggest thing is growth. So, in order to take it to the next level, you need the clients flowing in.

But also, my position had to change at the beginning. I could get away with seeing the clients doing the supervision and wearing the CEO hat that was three hats. And it worked because I created a systemized, maybe we can get into that later, practice, which is really key. So, it wasn’t a mess. Everything was running. It was a self-operating practice.

But when you move up to a seven figure, you need to only wear one hat and do it really well. And at that point I had to stop seeing clients, stop supervising and wear the CEO hat because there was this tribe of 55 therapists that needed a leader, like with a vision driving the bus.

Kayla: I love that you connected it back that you need to wear one hat because I think in society, we’re always thinking that “I got to do more. I got to do this. I got to do that.” And the truth is the more we do, the less we do.

Nicole: Yeah, do well.

Kayla: Do well, yeah. And I think that it’s really important to highlight that at some point you need to step back and think about, “What is it that I want for my practice and what hat do I need to wear?” because if you continue to work in your practice versus on your practice, there’s only a max amount of money that you can make.

Nicole: You got it. You got it. Exactly. And the CEO role, it was exactly that. Making the time to work on your practice, which is hard. And I think that joining a community or someone who’s done it will really help you because it is easy to fall back into the seeing client trap. Of course, that was my old programming. And sometimes I would come from scarcity and say, I’m just going to bang out a bunch of clients because I know that’s guaranteed income, to be honest. You know what I mean? And I see people falling into that because it’s nerve wracking. “Like, oh gosh, okay. I’m going to take off these hours and work on the business, but I don’t see the money coming in right away. Like I can with clients.”

Kayla: And I could totally appreciate this. And for anyone listening, this is a pre-recorded episode, but by the time that this episode goes live, I’ll actually have my first child. And with that, I’ve been having some of those scarcity mindsets too. It’s like, “Oh, well one to ones, even though I have five passive income streams into my business, the one to ones are my primary source of income.” So, as I’m going into maternity leave, I’m like, “What do I do? How do I manage this?”

And sometimes when we think about that CEO role, it’s, okay, “So how do we start putting these other passive income streams into our practices?” And when we’re going back to group practice, that’s hiring other individuals, right? So that you can take maternity leave. So that you can retire. So that you can do whatever that dream is that you need to do.

Nicole: Oh, I see my members taking like their third child. They finally took an extended mat leave. Like it’s just so beautiful what can happen. And I think the key is connecting with people who were a little bit ahead of you to remind you like this is possible. Like that was big for me. Otherwise, you’ll go back into your old habits always.

Managing Self-Doubt and Fear

Kayla: Agree. So, for many private practice owners, thinking of the possibility of even building a seven-figure group practice feels like this impossible feat, especially when that fear and self-doubt sets in. How did you overcome those fears and doubts and even emotional roadblocks that showed up when you started your group practice, but then growing it into the seven-figure business?

Nicole: Yeah, I think fear can stop us. So, two things, one starting small. For me, it was helpful to just say, I’m going to hire help. I think I would have freaked out if I said, I’m going to go to 55 that happened gradually guys. I really want you to hear that. That was gradual.

Just doing the first step, just focusing on I’m going to hire help. What does that look like? Looks like an admin. Looks like one therapist. And I hired an intern. I found a person newer, a therapist new in their career was less intimidating. I’m a baby boss. You’re a baby therapist. This is perfect. So that helped me with the small steps and picking my first hire to be a newbie just like me. And we could grow together.

Kayla: I love that. Yeah, fear often stops people, but thinking that it doesn’t have to be this big thing. It’s starting small, having those stepping stones, those baby steps that can help you move towards that.

Nicole: Yes. The other big thing, and this is so key, I’m so excited to tell you this, that I learned that successful people do it scared that fear doesn’t mean I have to stop. I can be afraid and still act.

And I have this vivid memory of being in my hot tub with my husband and being like, you know what, babe, most people won’t do it scared. I think if I’m the one that could act and still be afraid, I think I’m going to win. And I ended up being the biggest clinic in the city.

Kayla: That’s an amazing insight, and I would agree with you 100%. And I always say fear shows up because we truly care about something, and there’s uncertainty. So, when we really care about whether it’s our success, whether it’s indirectly like financial income for our family, whatever it is, that’s important to us, so fear is showing up. But the other piece to it is that uncertainty piece. Of course, we don’t know what’s going to be on the other side, we’ve never done it, we might have seen other people do it.

But yeah, I would agree with you doing it scared is the way moving forward. And there’s actually a book, I don’t know if you’ve ever heard of Do It Scared by Ruth Soukup. It’s my favorite book. And, I don’t get paid to advertise for her. I just absolutely love her book. And that was one of the pivotal things that help me start moving forward in my business, not necessarily go into private practice because I didn’t know about her book at that time. But all the time when I’m doing something, I’m like, yes, I got to do it scared because that’s the only way forward to start doing the things that we haven’t done before.

Nicole: You got it.

Solo Practice vs. Group Practice

Kayla: Now, this question might be a little nuanced, but what are some of the key differences between, say, a private practice or a solo practice and a group practice, whether it be structurally, financially, or operationally?

Nicole: Right now, if you are in solo practice, in some ways it’s easy. It’s just you and there’s no one to lead. You know yourself. The downfall is of course that there’s no growth opportunity because for me, the most frustrating part was the ceiling. There was a ceiling and I only made money unless I was sitting in front of someone. And I don’t know about you, but I would be resentful some days of my calendar. If I’m really honest, I would look at my calendar. And I wasn’t resentful at my clients. I was more resentful at me. There I did it again. How did I squish all these people in? And then it was a sunny day and a Saturday. And here I am telling people to live the greatest life where I’m wishing I was outside. So, there’s that piece.

But I think the biggest piece people want to start to do in their solo practice is. Or I guess the easiest part is you have a flow, you know your systems, but they’re all in your head, right? You know how to use Jane app and all the things, but they’re all in your head. So, the biggest difference is getting everything out of your head and onto paper. Or not to paper, but like a Google drive. And then that way, when you hire, they can read it and they’ll have the videos and then they could run with it.

Kayla: I think that’s really important to highlight is that more operational perspective is that you have all of how you run your practice in your head, but it needs to be available for when you do start hiring people so that they don’t feel like deer in headlights, right? As you go into the CEO role, you won’t be available to be supervising 24 hours a day, 7 days a week, because that’s counterintuitive to the role. So having these on paper, having these policies, these procedures, these operational standards can really help educate people, whether they’re new therapists coming out of school, or whether they are seasoned therapists, they know what to expect.

Nicole: Yes. Mostly though, I would do it for yourself. Here’s the thing, you’re going to get no questions if they have a place, there’s a frequently asked question sheet. First of all, they were trained really well. A group practice will set you free. Absolutely set you free, but only if it’s systemized.

My favorite thing is create and delegate. So, create the manual and then delegate it to your admin. They’re going to keep it live. They’re going to keep it updated and then questions will not come to you. Because can imagine the same 55 people asking the same question all day long, I would be answering questions, but I wasn’t, I wasn’t because they were fully supported and guided via manual.

Systematizing Your Practice

Kayla: Let’s talk a little about that systemization. Like how do you systemize your practice or how did you systemize your practice?

Nicole: Oh my goodness. You want to systemize everything. And honestly, that’s why I was able to sell. There’s no way if it was a big mess, nobody would want to buy it, but it was a revenue generating asset. And that a psychiatrist was like, “Okay, yes it’s going to run without you. So, I’ll take it kind of thing.”

The very first thing I did, and I suggest people do is create an operations manual, every little thing. And this might feel overwhelming because I know people are listening. They’re very busy. They’re ambitious. And they’re probably thinking, “Nicole, I don’t have the time.” Nobody has five hours in their day to sit down and write a manual, but here’s what you do. Use Loom. I love Loom. Google that L O O M. It’s a screen record video. And the next time you process payment, send a receipt, send a new client email. Record it now, obviously put privacy settings on and then toss it in a Google doc. And before you know it, everything related to clients, appointments that systemized.

And then I systemize all my onboarding, my hiring, and that’s what I give all my members now. Because it was all written down. Right? So literally. What’s beautiful about that is I would do it, do it well, but then I could have my clinic manager take it over and then I would even have systemized if a therapist left. There was a process that how we handled the clients, et cetera.

Kayla: I love that. And I heard you say members, and we’re going to talk a little bit about you and your business in a little bit, but you do have services that you help other practitioners start and grow their group practices.

Nicole: Yes, I help them go from solo to group practice or take their group practice to the next level, to the seven-figure level. Yep.

Kayla: Amazing. I just wanted to highlight for anyone that was like, what does she mean by members? So, I wanted to highlight that.

Key Considerations for Building a 7-Figure Group Practice

So, when it comes to building a seven-figure group practice, what are some key considerations listeners should think about or prepare for before they start growing their practice?

Nicole: Build the container before you fill it. So, here’s what I mean. Back to systemizing. Don’t hire first, please don’t hire first because I think naturally, they’re like, “Oh, I need help. Okay, great. I’m going to put up an Indeed post.” Again and again. Oh my gosh. My members have said, “Oh, I wish I met you earlier because I’m paying too much or I hired the wrong person.” It’s really hard to go back on those mistakes, like we tweak them and you’re good moving forward and the lessons are learned.

But first build a container, a solid foundation. You’re in your solo practice right now. So just start taking note of all the processes that are happening. They’re happening. You just have to document them. That’s number one.

Then to fill the container. That’s when you hire your dream team and they’re welcomed. And there’s clarity. There’s less anxiety on their first day because they’re like, “Wow, there’s a process for everything here.” I had people say that it made onboarding seamless. And I think that matters. Joining a group practice is a lot for a brand-new therapist. So, to have it just super organized makes them feel really, really welcomed and comfortable. So, they could focus on what matters, which is therapy.

And then lastly, grow the container, which is marketing, of course.

Kayla: I love that and this is like a side note and it might be a little bit irrelevant, but I used to run organizations before going into private practice. The number 1 thing that causes people distress or concern in their job is lack of communication and clarity.

And when we’re able to have, going back to systemization, whether it’s in video form, whether it’s in paper form, whether it’s in transcripts doesn’t even matter. But as long as it is written or available to people, they have that clarity, right.

And going back to onboarding, when they are on boarded effectively, they feel more confident. They feel more clear. And even though you yourself may have not have done a lot of verbal communication, all this work that you put behind it, did that work for you?

Nicole: Exactly. Yeah.

Steps and Strategies for Building a 7-Figure Group Practice

Kayla: So, what are the steps or strategies that you recommend for any listener who wants to start building a seven-figure group practice?

Nicole: The first thing I would do is just let yourself for a moment dream. You’re probably driving. That’s where I list all my podcasts. Who would you hire? Like just allow yourself to go there because sometimes fear, of course, we talked about that stops us, but just for a moment, visualize it, just fantasize.

And here’s who I really want you to hire is your mini-me. Hire a version of yourself, replicate yourself. We’re so lucky in this industry that we truly can clothe ourselves. And what I mean is let’s say you see couples– or I’ll talk about me. So, I’m high energy, clearly. I am quite directive in my therapeutic approach. So, I had to make sure that my very first hire was that because my brand is that. I attracted people who were expecting an experience like that. Same with you.

And I’m actually made the first mistake years ago. I had moved it. Long story. I’d moved to Russia in my twenties and closed my practice. It was years and years ago. And I made the mistake of moving all my clients to a therapist that was nothing like me. And guess what? None of them stayed until I got back. And they’re all like, we’ll come back to you. Why? It’s like, when you go to a restaurant, you expect an experience, right? And they were expecting like, “Oh, okay. This is going to be the flavor that I’m used to.” And it wasn’t. So, hire a mini me.

Kayla: I actually always thought about the opposite, like hire someone that doesn’t necessarily have the same skills or knowledge or experience as you. But I can totally appreciate what you’re saying because, especially when we’re thinking about the therapy world, people gravitate towards therapists that resonate with them. And it doesn’t mean that everyone resonates with everybody. And my specific clientele in my therapy practice, I work with a lot of people in leadership positions. And it’s because I was a senior leader and I talk like them. So as a result, referring out to someone that may not necessarily be like me, they might not necessarily feel as connected, understood or even just resonate in general. They might not even be able to label it in any way. So, I love that you highlighted that because that made me think a little bit too.

Nicole: So, I want to dig into that a bit because I do think after that you should hire the gaps and hire the people not like you. But the thing is most people hiring a group practice, why are they doing it? They’re doing it for more time and flexibility. So, if you want to start moving some of your clients over, it’s going to be way easier if it’s a mini me, right? Number one.

Number two, the retention rate is higher because they’re a lot like you. So, it feels really easy for the clients. And of course, you’re going to handhold them. But to your point, I totally agree with you, Kayla, that after you hire your mini me and they’re full, they’re going to feel quick. They’re going to probably take some of your load off for you. Thank goodness. But then hire the person who sees children and does the availability that you don’t have and sees the couples and the families. And like you, you can be the one stop shop if you want.

Nicole: Yeah, I appreciate you adding all that in because yeah, I think that’s all very valid. But I think going back to the mini me, yeah. It’s something I didn’t consider, but it is important for all those things you listed, for your brand, for your clients. Just to make it even easy, especially if this is your first hiree, if you know this person is like you, well, it’s going to be a lot easier to feel confident enough to pass on clients and to pass on work because you already know that you resonate with what they do.

Nicole: And you’ll probably like them because you like you. You’re like, Oh, you’re amazing. Because you’re just like me. We tend to like people like us.

Additional Insights

Kayla: A hundred percent. So, do you have any additional advice or insights for therapists and coaches who are interested in starting or growing a seven-figure group practice?

I think the biggest stressful point, because I have you all on my Instagram and I adore you and we talk all the time and you tell me kind of what’s stopping you. The biggest one is the clients, “Nicole, I don’t know. Will I actually be able to get the clients because I just don’t want the pressure of the therapist and they’re not full.”

Here’s what I suggest: what I did to get to seven figures in just three years was relied on digital marketing. Why? Because it works while you sleep. The networking is great, but the only thing about networking is that it’s high in effort and time, which you don’t have. And it’s a bit of a roller coaster. So you do lots of networking. They remember you. And then you stop and they’re human beings and get busy. And guess what? They forget about you until you do it again. And it becomes this exhausting roller coaster. You’re not here to work more. Relying on things like Google ads, SEO, a website that converts. And actually, knowing how to do those things well. Connecting with somebody who can show you is the key to the success.

Kayla: Agree 100%. My business is completely online. So, I’ve been doing mostly digital marketing really since the very beginning. And I would agree with you 100 percent like digital marketing works. Now, of course, you want a strategy. We’re not going to talk about marketing strategy in this particular episode. But in saying that it works. And it’s because a lot of people are looking for therapists now on Google. They’re looking for you on their computer. So even though networking, and I think that it’ll always be a place for networking, but like you said, it takes a lot of time, a lot of patience and sometimes not a lot of reward, depending on how that relationship is going.

Nicole: Just yesterday, my coaching program, I do coaching on Tuesdays and we were chatting about I’ve spent two grand on a booth at the women’s show, like all the things like a lot of us have done it. And the thing about that, it’s hard to measure.

What I love about Google ads, you can measure the return on ad spend. So you know exactly like, okay, I did that and it made this. And I’m going to do that again. I’m going to double the amount that I do that. As opposed to I talk to a bunch of people and I’m exhausted after a women’s show and I don’t really know how many converted.

Nicole’s Free Resource

Kayla: 100%. So, I know you have a free resource for listeners. Can you share a little bit about what it is and how it can help them?

Nicole: Yes. As I said earlier, I felt so lost. And if you do too, it’s because we learned nothing about business in graduate school. It is not your fault. I have a starter kit for you. It is called Expand Your Practice: The First Three Steps. I said earlier, I didn’t know what the first step was. So, I did nothing. I’m going to give you the first three steps. They’ll be in the show notes.

Kayla: Fabulous. So, to download Nicole’s free resource, Expand Your Practice Starter Kit: The First Three Steps, check out kayladas.com/nicolemccancefreebie.

Nicole, you also have a podcast as well. Can you tell us a little bit about that?

Nicole: The Business Savvy Therapist. Yes. Come and listen. Every Tuesday there’s a new episode. I think we were like number four and business podcasting in Canada. So, I’m super grateful. It’s a lot of fun. Thank

Kayla: Well, congratulations. That’s one of my goals is to get up on the top someday.

So, if you are interested in checking out Nicole’s podcast, the Business Savvy Therapist, check out kayladas.com/nicolemccancepodcast

And as Nicole said you can simply scroll down to the show notes and click on either her starter kit link or the podcast link.

Nicole, thank you so much for joining us on the podcast today and giving us some great tips and strategies for growing a seven-figure group practice.

Nicole: Yes. And if anybody wants to hang out after you can find me on Instagram, nicole.mccancemethod. There’s over 40, 000 of us hanging out over there.

Kayla: Fabulous. 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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