Why I Only Hire W-2 Therapists (W-2 vs. 1099 part 3)

I've noticed that private practice therapist tend to hire additional therapists as 1099 contract employees. Reasons frequently cited for choosing to hire therapists as 1099 employees is that they don't have to pay the therapists taxes. While it may be more "affordable" to hire therapists as contractors, in my experience, there are also "costs." (For an summary of the difference between W-2 and 1099 employees read part 1 in this series. To hear about my employment tax audit adventure read part 2.)

According to the IRS website, the general rule for classifying 1099 independent contractor is "if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done" (italics added). It also states that an employee is not a contract employee if the services "can be controlled by an employer (what will be done and how it will be done)" and if "the employer has the legal right to control the details of how the services are performed."

In consulting with therapists around the U.S. I've heard about some of the "costs" of hiring 1099 employees. Some of the costs high turnover rates due to the part-time and often temporary nature of contract employee relationships. Some of those "costs" include lack of control over how and where therapy is done, inability to require specific paperwork, inability to require attendance at staff meetings or trainings, inability to request that therapists network and participate in community outreach to boost referrals.

Here are the four main reasons I only hire therapists as W-2 employees:

1) Overall Cohesiveness

My vision for Wasatch Family Therapy has always been to build a cohesive team with a shared long-term vision of providing excellent clinical services to clients across the lifespan from an attachment perspective, not just have a group of therapist doing any kind of therapy they choose.  Now that we have grown into a clinic of 18 therapists at 3 locations cohesiveness is even more crucial. When therapists are hired as 1099 contractors employers are not supposed to tell the contract worker how to do therapy, or make other specific requirements of the worker, such attendance at trainings.

2) Higher Level of Quality Control

If a therapist is going to work under my name and my practice name or "brand", I want to be able to have a say in how, where, and when they do the work.  I've spend over 10 years building trust, credibility, and presence in my region and I want to be able to be able provide mentoring, direction, and training in how my clinical team provides services.

3) Ability to Require Certain Activities

I want to be able to require certain activities from my team members that hiring them as 1099 workers does not allow me to do. We have streamlined forms for notes and documentation in our EHR system. I require each therapist to engage in at least one outreach or networking activity each month in order to create strong referral sources. I require attendance at two monthly staff meetings, and a certain level of professional appearance at the office.

4) Implication of Long-Term Relationship

I am not interested in hiring temporary therapists to provide services. Hiring 1099 workers generally implies a short-term relationship. I am interested in hiring therapists who have a shared vision and who I can invest in long-term, and who will invest in building the practice long-term. I want to build mutually beneficial relationships not just provide services. Hiring therapists as W-2 employees shows a greater long-term commitment to them to build their practice for the long haul. I also allows me to expect a greater commitment from them.

2013 Therapist Blog Challenge

Build your practice and attract more clients to your practice by creating regular content on your private practice website. I'll make it easy for you!

Welcome 2013! I tell my private practice consulting clients is to have an integrated blog on their private practice website and become a regular online content creator. Potential clients are searching online for your services and I want them to be able to find you more easily. Here's how blogging can help.

Why is blogging on your private practice website important?

• Fresh website content boosts search engine rankings/SEO (remember Google is my #1 referral source)
• It add value to your website visitors and give them a reason to come back to your site
• It gives you valuable content to share on social media that direct people back to your website
• It helps you to strengthen your online presence as an expert
• It allows potential clients get to know you and your practice philosophy

Why are some therapists hesitant to start blogging?

• They don't know what to write about
• They think they have to write totally original content
• They think they have to write a "dissertation" (blogs posts only need to be 300-600 words)
• They haven't found their "blogging voice"
• They don't have the "time"
• They're scared

To participate in the 2013 Therapist Blog Challenge:

• Post your practice website link in the comments below.
• Watch for my suggested blog topic twice each month. I'll come up with the content idea so you don't have to. I'll title and number the posts "Blog challenge #1" ... so you can keep track.
• Write your 300-600 work blog article that week for your private practice website.
• Post your blog article link in the comment section on the corresponding post here on this Toolbox blog.
• Read and share other therapists articles.

Pretty easy, huh? So, are you IN? By the end of the year you'll have at least 24 articles on your website!

Blog challenge #1 coming soon....

Remember to post your practice website below and any questions you have. And please invite colleagues to join in. This will be fun!

(c) Can Stock Photo

How To Find Top Student Interns To Grow Your Practice

There is an "it" factor when looking for interns to train in your private practice.

Here's how I've found amazing interns that stay at my clinic even after graduation.

Over the past several years I have trained and mentored many graduate students and new graduates working toward clinical licensure. Working with interns has been a great way to build my practice, leverage my time, and satisfy the part of me that loves mentoring.

Most graduate students who train at my clinic during school are offered a therapist position after graduation which creates a win-win situation -- the student gets a job they're already trained for and I get to add talented and enthusiastic therapists to my team! After interviewing several therapists, I've learned to be very selective about who I bring on at Wasatch Family Therapy.

I recently consulted with a private practice therapist who has a waiting list for new clients. As we started exploring the option of hiring a graduate student to train she expressed some concerns. Her biggest questions were:

• How do you find talented graduates students?
• When interviewing potential student interns, what qualities do you look for?
• How do you know if they're going to be a good therapist and work well with your private practice clientele?

So, here's what I've learned after several years of interviewing and hiring student interns...

How do you find gifted graduate students?

• Contact local graduate programs in your discipline and see if they are  looking for internship/practicum placements for their students.
• Fill out the necessary paperwork to be an approved placement at local schools, even if you're not quite ready to bring on a student. When you're ready to train an intern you'll already be approved.
• Reach out to traditional and for-profit schools. I've found that the for-profit programs (Argosy University and University of Phoenix in UT) are more flexible in terms of internship start times and the number of clinical hours per week required. I have been very pleased with the caliber of students from private, for-profit universities.

When interviewing potential student interns, what qualities do you look for?

• After interviewing grad students for several years now, the biggest "it" factor I look for is likeability. I know that sounds simple, but it's true. If I enjoy talking to them and I trust them during the interview process, then it's likely they will quickly put clients at ease, too.
• I look for people were "born" therapists and just need the formal credentials and trainig in order to actually to all themselves a therapist.
• I look for people who have long-term goals that include working in a private practice setting, like mine, beyond the internship.
• I always ask about their style of handling conflict, feedback, or direction in work settings and discuss several scenarios that might arise in private practice.

How do you know if they're going to be a good therapist and work well with your private practice clientele?

• You don't. There's no guarantee that someone will be an effective clinician. I suggest that you make sure that there is a clause in your contract that you can stop training a grad student that isn't working well with your clientele.
• I often require that interested graduate students volunteer at my clinic for several months before securing a clinical internship. There is such a high demand for interns in my area that we can be extremely selective. This volunteer time gives us both a chance to make sure it's a good fit.
• A 3-step interview process helps screen potential interns before bringing on.  I do an initial interview, a second interview, and a "mock" case presentation at team meeting. While I ultimately decide which intern we will "hire," I trust my team's input as to whether the student would be a good fit.

While it's always a risk bringing on a new student to my team, I find comfort in the fact that the number one predictor of client outcome is the strength of the therapeutic alliance. Generally, if it's easy for me and my team to connect with a grad student in the interview process, it's safe to say that clients will feel the same way about them. Ultimately, it's your practice and your reputation on the line as the owner of your practice.

Have you trained interns in your private practice? I'd love to hear about where you find them, how you screen them, and if it's worked to build your practice!

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(c) Can Stock Photo

Are You Comfortable Asking Clients For Money?

During my graduate school practicum placements I never had to think about the financial aspect of seeing clients. Billing specialists took care of collections. That was their job. After graduation I worked in a private practice setting where I was required to ask clients directly for...money. It was awkward at first to have clients share their pain with me, open their hearts, and be so vulnerable, and then ask them to pay me.

Adding to my money anxiety was the fact that I was charging the same rate as my clinical supervisor and I didn't believe my services were worth it. My supervisor helped me gain confidence by explaining that clients aren't just paying for my time and skill, but they're also paying for her years of expertise. I hadn't thought about it from that perspective before.

My supervisor also helped me to view myself as a professional. Even though I wasn't licensed to practice independently I did had a graduate degree and two years of practicum, and I was licensed to practice under supervision. I had valuable experience, knowledge, skills and tools to help my clients.

Almost 10 years ago I started a solo private practice. Suddenly, I was the therapist, the receptionist, the webmaster, the marketer, and the billing specialist/collections department. I realized that I had to get even more comfortable bringing up money with clients if I was going to build a successful practice. Through the years I've become extremely comfortable addressing the financial aspect of clinical practice with clients. Here are a few things I've learned to help you get more comfortable with money in your private practice.

1) Value your expertise

Keep in mind the time, money, energy, and passion you've invested in your education and training. The more confident you feel in yourself, the easier it will be to accept client's payments and comfortably bring up money issues.

2) Think of money as energy exchange

Money can be such a loaded topic, fraught with baggage from your own upbringing. It may help to reframe money in a more emotionally neutral way, as energy. You are offering your gift of investing energy in the therapeutic experience in order to help your client, and they are offering you their energy resource called "money."

3) Ask for payment at the beginning of the session

I've found that it works best for me to bring up money related issues at the beginning of sessions before delving into deeper therapeutic issues. It's awkward to ask for money after a client shared deep pain during their session.

4) Set firm payment policies and stick to them

Clients will take your lead with money issues. Setting consistent policies regarding payment from the onset of therapy teaches your client what you expect in the therapeutic relationship. If you're anxious about asking for money, your client will feel uncomfortable too. If you're confident, they'll likely respond positively. My clinic policy is that if you are one session behind in payment your therapy is on hold until your account is up to date. Also, we charge full fee for no shows and late cancellations, even on initial sessions, unless there is an emergency.

5) Money is a clinical issue

If you have clients who resist paying you, who "forget" their checkbook, who cancel at the last minute and don't want to pay you, treat the resistance as a clinical issue. Consider how the client's money patterns are part of the larger issues brings them into therapy and address it openly in your session.

6) Write a "money script" and practice it

I've recommended to several therapists I've supervised or consulted with who feel anxiety bringing up money with clients to write down a brief script and role play. Here's an example of the phrases I use in my practice.

At the beginning of the session, before walking into my office I ask, "How would you like to pay for your session today?"

When potential clients ask, "Do you work with my insurance company?" I respond, "While we don't bill insurance directly, I'm happy to provide you with a receipt to submit for reimbursement from your insurance company. You may want to check with them and ask if you have out-of-network mental health benefits."

Do you have money anxiety? What blocks do you have when it comes to asking clients for payment? How have your overcome them? Feel free to post your thoughts and comments below.

photo credit: 401K

Best Of Private Practice Toolbox 2011

As 2011 comes to a close, I wanted to review which posts have had the most views since I launched this blog in August 2011.  It also gives me an idea of which topics are most relevant and interesting to other mental health private practitioners. Is your favorite article on this list?

Here are the most viewed articles for 2011:

1. What I wish I'd Know Before Starting A Private Practice
2. A Day In the Life Of A Private Practice Therapist
3. 5 Self-care Tips For Therapists
4. 8 Real-world Marketing Strategies From Successful Therapists
5. Getting 3 F's In Private Practice Is A Good Thing
6. Multiple Income Streams Soothe Therapist's Financial Anxiety (part 1)
7. Therapist Roll Call: Join The Private Practice Twitter List
8. Why Therapists Need An Elevator Speech (part 1)
9. 5 Free Ways To Market Your Therapy Practice
10. Facebook Pages For Therapists: How To Set Up A Practice Page

I'd love to know which posts have been most helpful to you in creating your dream practice during 2011.

Do you have any areas of practice that you need help with? Please post any specific private practice questions or practice related topics that you'd be interested in hearing more about in the coming year in the comment box below.

Happy New Year!

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