7 Figure Counseling Practice Presentation 2015

BUILDING A 7-FIGURE

Counseling PracticeAnthony Centore

Ph.D.

BECOMING AN

ENTREPRENEUR

SOMEONE WILLING TO

WORK 80 HOURS A WEEK

TO AVOID WORKING 40

HANDS ON

ENTREPRENEURSHIP

WE NEEDED

NEW RUGS

LOW TYPICAL MOMENTS

CAN I BE AN

ENTREPRENEUR?

CONS PROS

CONSDifficult

PROS

CONSDifficult

Risk

PROS

CONSDifficult

Risk

Work

PROS

CONSDifficult

Risk

Work

PROSFlexible

CONSDifficult

Risk

Work

PROSFlexible

Creative

CONSDifficult

Risk

Work

PROSFlexible

Creative

Own Boss

CONSDifficult

Risk

Work

PROSFlexible

Creative

Own Boss

Financial?

A NOTE ON RUGS

WHAT IT TAKES TO

SUCCEED IN PRIVATE

PRACTICE

A TALE OF

2 COUNSELORS

BRIAN

EMMA

ADVANTAGES

ADVANTAGES

Clinical Experience

ADVANTAGES

Clinical Experience

Business Acumen

ADVANTAGES

Clinical Experience Community

Reputation

Business Acumen

ADVANTAGES

Clinical Experience

Investment

Capital

Community

Reputation

Business Acumen

ADVANTAGES

Clinical Experience

LuckInvestment

Capital

Community

Reputation

Business Acumen

CONSTANT FORWARD

MOVEMENT

UN-CATCH 22S

PROGRESS > EFFICIENCY

CFM

WHO’S STORY SOUNDS

MORE LIKE YOU?

NOT A SOLO PRACTICE

GROUP V. SOLO

GO SOLO

SIMPLER

6 FIGURES

HIGHER PROFIT MARGIN

MORE TIME COUNSELING

GO GROUP

SELLABLE

FLY WHEEL

FREEDOM FROM THE

COUCH

LESS ISOLATING

SHOW ME THE MONEY

SHOW ME THE MONEYA counselor will bill about $75 per session


36 sessions a week = $2,700



48 weeks a year = $129,600



48 weeks a year = $129,600

A psychologist will bill about $95 per session



48 weeks a year = $129,600

A psychologist will bill about $95 per session

= $164,160

SHOW ME THE MONEYJust therapy, without:

Psychological Testing

Medication Management

Group Counseling

Court Appearances

Other Ancillary Services

SHOW ME THE MONEY7.6 Counselors, or

6.1 Psychologists

to earn

$1,000,000 in Revenue!

$1,000,000 IN REVENUE!

BUT WAIT!

REVENUE IS NOT PROFIT

SHOW ME THE MONEY

Therapist Compensation

55-70% of Total Revenue

SHOW ME THE MONEYTherapist Compensation

55-70% of Total Revenue

~ $300,000 - $450,000 left

WHAT CAN YOU BUY WITH

$450,000?

1.08 ct. platinum, fancy vivid blue diamond

775 sq foot apartment, with one bath, in Brookline, MA

Take That, Austin Powers

NOT SO FAST

OPERATIONAL EXPENSES

OPERATIONAL EXPENSESCredentialing, Billing & Credit Card Fees: 7-15%


Rent & Parking: 3-7%



Reception & Scheduling: 3-5%




Office Expenses, Supplies & Postage: 1-3%





Admin Salaries: 0-8%






Marketing: 0-5% (once at capacity)







Research & Development: 0-3%








Clinical Supervision & Professional Development: 0-3%









Software & Electronic Medical Records: 0-3%










Accounting, Bookkeeping & Legal: .5-1%











Travel: 0-1%











Travel: 0-1%

Bank Fees: 0-1%











Travel: 0-1%

Bank Fees: 0-1%

Phone, Internet, Electric & Gas: 0-1%











Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%












Travel: 0-1%

Bank Fees: 0-1%


NET PROFIT

-25% TO 25%

RESULTS MAY VARY

RESULTS MAY VARY1) Take home the same in solo practice


2) Only money they keep is what they produce



3) Highly profitable, and self-sustaining



3) Highly profitable, and self-sustaining

4) A combination of self and team best

*Sellable & Real Estate

GETTING TO BLACK

BUILT TO SELL

STARTING WITH

THE END

IN MIND

REASONS TO SELL

INCLUDE...

RELOCATE

CAREER CHANGE

TO LIQUIDATE!

RETIREMENT

THINK YOU’RE TOO

YOUNG?

AN “UNSELLABLE

BUSINESS”

DO YOU KNOW WHAT

YOUR BUSINESS IS

WORTH?

EBITDA,

MULTIPLE OF REVENUE,

OWNER BENEFIT,

COST OF STARTING FROM

SCRATCH

RECOUP INVESTMENT IN 3

YEARS, AND MAKE A

LIVING ALONG THE WAY

12 WAYS TO BUILD VALUE

BRAND

GROW FAR BEYOND SOLO

DON’T LEAVE POTENTIAL

UNREALIZED

“Potential co-operative marketing with

other health related professionals in same

location. Potential to expand professional

referral network, expand hours/days of

operation or add complementary services.

Huge potential to leverage social media

marketing for targeted local advertising.”

CONSIDER AN EARN OUT

FINANCE THE BUYER

FOCUS ON NEW CLIENTS

WHICH WOULD YOU PAY

MORE FOR?...

A practice with four clinicians performing a

total of120 sessions per week, and 8 new

client inquiries per month.

A practice with two clinicians, performing a

total of 60 sessions per week, and 80 new

client inquiries per month.

CREDENTIALING

COMMITTED STAFF

of the sale, the new owner begins working in the

practice and begins to implement some basic rules of

operation for the administrative staff. They revolt!

The staff destroys documents, cancels appointments,

refuses to answer the phone, and creates a hostile work

environment (they were also, as it was later discovered,

stealing from the company). The new owner has no

choice but to fire the entire staff, and hire a new

administrative team.

previous owner has overpaid his clinicians by

compensating them heavily for completing basic

administrative tasks the previous owner did not want to

do. The new owner realizes that the practice cannot

survive without the clinicians forgoing their

administrative duties (along with the extra cash-cow

income). The counselors do not respond well to

receiving what they perceive as “a cut in pay”, and

several leave the practice. Revenues drop by over 40%,

and the practice doesn’t recover for over a year.

ASSETS

A GOOD LEASE

A BAD LEASE

The practice has a 5-year lease in a bad location. The buyer would prefer to move the office, but breaking the lease will be too expensive.

A BAD LEASE


The lease is non-transferable, and the landlord wants a 20% rent increase from any new tenant/owner.

A BAD LEASE



The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer.

A BAD LEASE



The lease terminates within a year, and the landlord plans to raise the rent more than 5%. Or, the landlord isn’t interested in committing to new lease terms at the present time, creating a big ol’ question mark for the buyer.

The space is simple TOO BIG for the practice.

HONEST & OPEN

DESIRABLE LOCATION

FINISH STRONG

...AND LETTING GO.

BUILDING THE TEAM...is tomorrow

BUILDING THE TEAM...is tomorrowFinding


Recruiting


Recruiting

Interviews


Recruiting

Interviews

Contractors v.

Employees


Recruiting

Interviews

Contractors v.

Employees

Avoiding

Nightmare

Counselors


Recruiting

Interviews

Contractors v.

Employees

Avoiding

Nightmare

Counselors

Why Practices

Lose Their Best

Clinicians


Recruiting

Interviews

Contractors v.

Employees

Avoiding

Nightmare

Counselors

Why Practices

Lose Their Best

Clinicians

Offer Letter /

Contract


Recruiting

Interviews

Contractors v.

Employees

Avoiding

Nightmare

Counselors

Why Practices

Lose Their Best

Clinicians

Offer Letter /

Contract

On-boarding and

Training


Recruiting

Interviews

Contractors v.

Employees

Avoiding

Nightmare

Counselors

Why Practices

Lose Their Best

Clinicians

Offer Letter /

Contract

On-boarding and

Training

Creating a

Pipeline

CREATING CULTURE

ZAPPOS

COUNSELING PRACTICES

STRUGGLE

Contractors

Contractors

Rogue Clinicians

Contractors

Rogue Clinicians

Psychiatrist

Contractors

Rogue Clinicians

Psychiatrist

Owner-clinician

NOT A LUXURY

TINA FEY“Don’t hire anyone you wouldn’t want to run into in the

hallway at three in the morning.”

STARTS WITH HIRINGBut doesn’t end there...

THINGS THAT WORKED

THINGS THAT WORKED

THINGS THAT WORKED

THINGS THAT WORKED

THINGS THAT WORKED

1) RESPECT AND

GESTURES OF CARING

“Thriveworks, at its core, is its team of

people…We work to engender great loyalty

in the team members of Thriveworks and

hope that we are successful in developing

and maintaining their loyalty to the point

that they elect to stay employed with us for

life.”

2) COMMUNITY

3) MISSION

4) PROGRESS

Thriveworks Rank System

Level 1) Assistant Clinician

Level 2) Fellow Clinician

Level 3) Senior Fellow Clinician

Level 4) Associate Clinician

Level 5) Senior Associate Clinician

Level 6) Senior Clinician

Level 7) Distinguished Candidate Clinician

Level 8) Distinguished Clinician

Level 9) Magna Candidate Clinician

Level 10) Magna Clinician

Level 11) Summa Candidate Clinician

Level 12) Summa Clinician

Managing Clinician

Clinician Emeritus / Emerita

YOUR PRACTICE,

YOUR CULTURE

SPEND MONEY TO MAKE

MONEY

WE GOT NICKELS HOLDING

UP A DOLLAR!

WE GOT NICKELS HOLDING

UP A DOLLAR!

1) YOUR OFFICE BUILDING

2) CLIENT EXPERIENCE

3) MEDICAL BILLING

4) YOUR CLINICAL STAFF

5) GIVING BACK

5) GIVING BACK

5) GIVING BACK

5) GIVING BACK

6) ADVERTISING

10 BIGGEST MARKETING

MISTAKES

BIG BLIND SWING

NO TRACKING

“Only half of my advertising is working.”

“The problem is I don’t know which half!”

AWFUL SOCIAL MEDIA

BAD HEADSHOT

TECHNICAL BIO

SPAMMING

GUEST BLOGGING

BAD WEBSITE

BAD WEBSITE

“Counseling for individuels, couples, and Families”

DINGY OFFICE

DINGY OFFICE“You can tell whether a business cares about

its customers by how nice the bathrooms

are.”

DINGY OFFICE“You can tell whether a business cares about

its customers by how nice the bathrooms

are.”

How are your bathrooms?

How are your waiting rooms?

NO ADVERTISING AT ALL

I’M ABOUT TO

BLOW YOUR MIND

EVERYTHING IS

MARKETING

THE FINAL 10%

HOW’S IT POSSIBLE?

THE LAST 10% IS THE

HARDEST

ODYSSEUS

WHAT’S YOUR 10%?

ARE YOU QUITTING AT

90%?

ARE YOU QUITTING AT

90%?“Clients don’t need wi-fi in the waiting room”

ARE YOU QUITTING AT


“We don’t answer the phone, but most clients will leave a

message”

ARE YOU QUITTING AT



message”

“My notes are for me. My records don’t need to be great.”

ARE YOU QUITTING AT



message”


“I don’t want to accept credit cards. Clients can write a

check”

ARE YOU QUITTING AT



message”



check”

“That old armchair was my great aunts. I don’t have time

to refurbish it”

ARE YOU QUITTING AT



message”



check”

“That old armchair was my great aunts. I don’t have time

to refurbish it”

“I haven’t dug into new research in years. The most

important thing is the relationships with my clients”

OBSESSION

BE 10% OBSESSED

SPACE

SPACEWhite glove clean and

organized


organized

No more Poland Spring


organized


Hallway should smell better


organized


Hallway should smell betterSCHEDULING


organized



Intake process simpler


organized




Sessions in 24 hours


organized





Never double book


organized





Never double bookCLINICAL


organized






More positive psychology

training


organized







training

Professional development

program


organized







training


program

Measure treatment outcomes


organized







training


program


VALUE


organized







training


program


VALUEMore value to clients


organized







training


program



1st/10th appointment gifts


organized







training


program



1st/10th appointment gifts

Most desirable place

10% IS

100%

THE END

Healthcare

7 Figure Counseling Practice Presentation 2015