Episode 178: How to scale your practice...AND FAST!

Scale Your Therapy Practice Fast: Clinicians, Clients, Cash & Space

 In this episode, Julie walks you through the four critical systems you need to grow your therapy practice quickly and sustainably. You’ll learn how to recruit clinicians before you need them, attract a steady stream of clients, plan for cashflow dips, and optimize your office space.

By the end, you’ll have a clear roadmap to coordinate all four factors—so your practice can expand without burning out your team or your bank account.

Listen for solutions:

• If you’re hiring more clinicians but are worried about cash flow, you’ll learn how to budget and finance growth.
• If you need a reliable client‑generation system, you’ll discover the metrics and processes to track.
• If your office feels maxed out, you’ll get practical tips to squeeze more value from every square foot.

Highlights:
00:00 – Julie opens Therapy for Your Money and today’s growth topic
00:32 – Introducing Profit First for Therapists book
00:45 – The four pillars of fast scaling: Clinicians, Clients, Cash, Space
01:25 – Building recruiting systems and runway planning
03:19 – Why you must start hiring months before you need capacity
04:23 – Factoring team attrition into your hiring goals
05:00 – Budgeting for clinician recruitment ads (Indeed, LinkedIn, ZipRecruiter)
05:59 – Setting up client‑attraction systems (ads, referrals, tracking)
07:48 – Speed of response: converting inquiries in 24 hours
10:01 – Planning for a temporary profit dip during rapid growth
11:39 – Financing options: owner’s pay, lines of credit, loans
14:00 – Maximizing physical space: shifts, weekend hours, telehealth
15:46 – Knowing when to add locations or telehealth roles
16:53 – Integrating all systems for efficient, profitable expansion
17:46 – Key takeaways and next steps for scaling success

Need Help Growing:
Need a tailored growth plan? Visit Green Oak Accounting for free guides and tools. If you found this episode helpful, share it with a colleague or leave a review!

Links and Resources

Money for Therapists Practice Startup - https://www.greenoakaccounting.com/startup

GreenOak Accounting - www.GreenOakAccounting.com

Therapy For Your Money Podcast - www.TherapyForYourMoney.com

Profit First for Therapists - www.ProfitFirstForTherapists.com

Profit First Academy - www.ProfitFirstForTherapists.com/Academy 

Podcast Production and Show Notes by Course Creation Studio

Transcript

Episode 178: How to scale your practice...AND FAST!
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[00:00:00] Julie Herres: You're listening to Therapy for Your Money, a podcast about all things, money and finance for therapy practice owners. If you want to feel confident and in control of your financial life, then you've come to the right spot. I'm your host, Julie Herres. I'm an accountant and the owner of Green Oak Accounting.

[00:00:17] Julie Herres: My firm specializes in working with private practices across the US and my team and I have worked with hundreds of private practice owners. I'm on a mission to share all the best practices I've learned along the way. Because I want you to have a profitable private practice.

[00:00:32] Julie Herres: My new book, profit First for Therapists is available at most online retailers. You can get it in paperback, audiobook, or ebook as well. Go check it out.

[00:00:45] Hi there and welcome to Therapy for Your Money. Today we are talking about what it takes to scale your therapy practice fast. This, uh, topic was a suggestion from a listener, so thank you for sending in your suggestions. I always really [00:01:00] enjoy, uh, talking through the things that you ask for and recommend.

[00:01:04] So I want to jump right in today and talk about. The main things that you wanna consider when you want to scale, period, but definitely that are gonna be very important if you want to scale fast. So there are four things that are going to really make a big difference when it comes to scaling or that are going to either slow you down or speed you up.

[00:01:25] And really this is a, a, a question of all ships must rise at once, right? If you have just one and not the other. It's going to be difficult to scale, uh, if you have two and not the third or the fourth, right? You can, you can see where I'm going here. So those items are clinicians. You need clinicians in order to scale clients.

[00:01:48] Uh, you need clients also in order to scale. Right? If you have clinicians, but no clients, that's not going to work. Vice versa. If you have clients, no clinicians, that's going to be challenging. You need cash. Uh, you [00:02:00] need enough money to make sure that you're able to scale, that you're able to pay your new clinician, that you're able to spend money on advertising to fill your new clinician's caseload, right?

[00:02:12] Cashflow is definitely, uh, a big deal where you might be okay if you're hiring one person, but what if you're hiring. Five clinicians at one time, right? You can kind of see how, whoa, that's a big drain on cash flow. And so the cash you have available definitely is a very big and important consideration because you can't run out of cash.

[00:02:31] You've gotta pay the team members that you have. Um, cash is an important consideration for. Fast growth. Um, and then the last item is space. So physical space, this one is not going to apply if you have a mostly virtual practice, but if you mostly see clients in office and that's how your team is set up, there is a point where you cannot add a single additional clinician without adding more space, even if you're using it very, very efficiently.[00:03:00] 

[00:03:00] Okay, so we've talked about the, the four pieces that are really critical and important. Let's dive a little bit deeper in each one of them so we can talk about how you can make sure that your practice is successful and that your growth is successful by, um, aligning really your systems for each one of those.

[00:03:19] Item number one is clinicians. So you are going to need to have decent, uh, and I would even say good systems around recruiting. That means you have a very specific process, you know, uh, how much you need to spend or how many people you need to interview to find one good clinician that's going to be a good fit on your team.

[00:03:41] You also want to know how much time it's going to take you to get them fully credentialed. Uh, and if that is 90 days, then if you need someone in July, you need to start interviewing them, not just 90 days before you need to start interviewing. 60 days before that probably. [00:04:00] Right? So you're looking at a, a five month runway possibly.

[00:04:03] Right? It will differ for each, um, differ for each, uh, practice, but that's a really long runway, right? So if you are. Just waiting for someone to leave to replace them, and then it's taking you from that moment, five months to replace that capacity. You could actually really easily end up in a situation where your practice is shrinking instead of growing.

[00:04:23] So you wanna have strong systems around. Recruiting, you're probably, if you're growing fast, you're probably always recruiting, uh, whether you actually need someone or not. Um, but also you wanna consider attrition of your existing team. That means, uh, if you have a team of 10, there's a good chance that one or two of those people will resign at some point this year, regardless of if you've done everything right.

[00:04:50] Uh. In 2025, people just aren't staying 10, 15, 20 years at the same, uh, company, right at the same job. And so you can, you should go in [00:05:00] expecting that you will lose team members. So that means if you wanted to add three net new positions for the year, and you're expecting two people to leave, you need to plan on hiring.

[00:05:11] Five people, that's going to be a new hire every two to two and a half months. And so I want you to think about that because it's going to look very different from just hiring three people in one year. That's just one hire every four months, right? Your cadence is going to look very, very different, uh, between those two.

[00:05:33] All of these factors are really intertwined. So when it comes to hiring clinicians, I also want you to think about what kind of cash is needed to. Uh, put out ads to recruit free ads, uh, haven't been working in in many, many years now. It's a very competitive hiring landscape for, uh, practice owners. And so you're going to need to put to spend some money on, uh, indeed or LinkedIn or wherever it is that you recruit.

[00:05:59] Um, and [00:06:00] that has a really tangible. Dollar amount associated with it. So if you're hiring a certain number of people per year, you probably have a general idea of how much it's going to take you in Indeed Ads or ZipRecruiter or whatever you're using in order to get enough applicants in the door. To hire one, one single person.

[00:06:19] And that's going to depend on the markets. Um, and on your, you know, how many, how competitive it, it is in your area for jobs. Um, and so there's no magic answer, but there's a good chance that you're gonna need to spend a, a few hundred to a few thousand dollars on ads just to be able to recruit one single person.

[00:06:40] Item number two is clients. You absolutely need to have enough clients coming in the door if you want your practice to grow. And so I want you to think again about systems. I'm saying that word again. I'm gonna say it a few more times. You need to have good systems around bringing in new clients. That means you're going to have.[00:07:00] 

[00:07:00] Systems around advertising. So you know what you need to do to kind of turn the faucet on or off, or really, you're never turning the faucet off, but what do you, what levers can you pull to increase the number of. Uh, potential intakes coming in, or just callers or, uh, outreach coming in. Uh, I want you to know what that, what that takes.

[00:07:21] And so that's usually going to, again, require some cash. It's going to require some spending. You're going to spend money on, uh, Google ads or print ads or, uh. Pounding the pavement, talking to referral partners, but there's some cash required for that typically, and that dollar amount is often going to be very different between a practice that is just in maintenance mode, where let's say you need, uh.

[00:07:48] 25 new calls per month in order to just keep your clinicians full. If you have a handful of clinicians, right, 25 calls versus trying to fill three new [00:08:00] clinicians caseloads, that's not going to be enough. Right? 25 inquiries is not going to be enough. So you know, you need to scale that number way up to get your.

[00:08:11] Three brand new clinicians full and keep everyone on your existing team full. But then that new normal, right, once everyone is full, to just keep everyone there is going to be different as well. It's likely going to be well over 25, um, contacts per per month. And so that maintenance spend is one thing when it comes to advertising.

[00:08:33] But I want you to think about how am I going to turn that faucet and increase spend in order to more quickly fill my brand new clinician? And there's usually going to be a formula that, again, is just gonna be different for every practice. But if you are tracking these metrics, you are going to quickly get a sense of, okay, this is about what it takes, uh, as far as time for us to fill a new clinician.

[00:08:59] This is how many. [00:09:00] Um, calls or outreaches we can expect within with this specific dollar amount that we're spending on ads, right? So you're, you're, uh, building systems, you're tracking what is happening so that you know what it takes, again, in, in dollars upfront to get new clients in the door. And again, when you're scaling.

[00:09:20] You're going to spend money on a regular basis, right? You're not really ever turning that faucet off because even if you get referrals as a baseline, if you are scaling fast, uh, that is not going to happen just with word of mouth. You're going to need something more to supplement that, but also something that you control.

[00:09:39] Right, you can control your ad spend, whereas you can't necessarily control if the doctor around town is sending people your way and you can maintain that relationship and nurture that relationship, but there's a lot less control. So spend money on the things that you, uh, you do control. You also wanna make sure that your intake process is dialed in [00:10:00] because if you are, uh, getting a bunch of calls or a bunch of inquiries and it's taking your intake person three or four days to get back to people, those, um, those potential clients are probably not good leads anymore three days later.

[00:10:15] Uh, right now what we're seeing is speed of response is really, really, really critical. And so. If, for example, you're spending a lot of money on advertising and you're actually get getting a hundred inquiries a month, and that is only converting 25. Clients, there's probably a problem in your intake process, but if you're not looking at that, if you're not measuring that, then you might not know, right?

[00:10:39] And you're spending way more than you need to on ads because your intake process is broken, it's not working. So you want that system to be working as well so that you can convert, um, a good number of cl of potential clients into actual clients. All right. We talked about clinicians. We've talked [00:11:00] about clients.

[00:11:01] Let's talk next about cash. Again, when you're scaling quickly, one of the biggest risks, um, that I find for practice owners is running out of money. It is almost always more expensive than you, you think it will be because of the things that we've just talked about, right? You're spending money on a lot of different things and.

[00:11:20] Maintenance versus growth mode is going to cost different levels of money. So I want you to think about what kind of cash flow do you have available and how are you going to pay for these things? Uh, it's po if it's possible for you to just take home less. That's a great way to, uh, to, to, to pay for those things, right?

[00:11:39] Maybe you're in a two income household and you don't really need to take. Your, um, you know, your profit home, then maybe you leave it in the business and you say, temporarily for this specific amount of time, for six months, 12 months, whatever you decide I'm going to be taking less money home on purpose intentionally, because I really want to scale [00:12:00] this practice.

[00:12:01] That's great. That's a decision that you and your household can make if you have that available. But if you actually need every single dollar of the cash that, that your practice is currently generating, I want you to think long and hard about like, where is that money coming from? How are we going to do this?

[00:12:17] Uh, that might be adding a line of credit, it might be a loan, right? There's, there's, it may be just you seeing more clients temporarily. There's a lot of ways that you can do this, but I always prefer for you to go in having a plan, uh, because if there is no plan, then. That's just more likely that you will end up in a, a financially difficult situation where you are not paying yourself what you needed to or what you need to take home.

[00:12:43] Uh, the practice is struggling because you're trying to take on the same level of cash as you did before, and it really, the practice cannot afford it right now. Right? So in those, in those, those times of scaling, and especially with fast scaling, um, you're almost always going to [00:13:00] see a drop in profit. I, I say almost always really, it's pretty much always in my experience, uh, but there is going to be a temporary dip in profit pretty much every single time.

[00:13:12] That's a very normal part of the process. But if you're not expecting it, if you're expecting that, you'll just cruise control and always make the same amount of money that you did while you're hiring, you know, five new clinicians and training and doing all that, that's unlikely to actually happen. Uh, especially if you're expanding in a fast way and you're adding, for example, multiple locations at a time that is very, very cash intensive.

[00:13:35] I want you to think in advance about how you're going to pay for those things. Like how is that going to be, uh, financed? How are you going to structure those, um, rent agreements. So that you don't run out of, of cash and put your, uh, practice in a difficult situation. My my, my personal mantra is that you are responsible for the survival of the business, right?

[00:13:59] As the [00:14:00] owner, that is your. First responsibility, yes, you have responsibility to your clients, to your team members, uh, to yourself, to your community, all of that. But your, your, your first priority has to be the survival of the business because that is what serves all of the other things. And so if you are, uh, walking into fast growth without a plan for how, how you're going to pay for this, that can ultimately be the demise of, of elevate practice.

[00:14:26] And I have seen that unfortunately happen, happen before. Uh, and so. Prepare your cash position so that you know what you need to do. And then our last factor was space. And I kind of alluded to that. Um, when you are growing and growing fast, I want you to again, have a system around evaluating your space.

[00:14:45] Like how many time slots available in one single day do you have, if you're using your space really efficiently, you're likely not giving each person on your team an office. Right? Especially if they're seeing 24 clients. A week 25. Right? Something like [00:15:00] that. Um, that's really. Four full days a week, that leaves a lot of time, a lot of hours, that that space is completely unused.

[00:15:09] So when you are in a scaling mode, um, it is rarely worth it to do that. You wanna use your space as efficiently as you can. That might mean having a morning or a daytime shift and an evening shift. That probably means having some weekend shifts as well, right? Where there's a combination of those things where you are.

[00:15:25] As you're hiring team members, you are putting them in specific time slots. It's not just, hey, whenever you want, right? They are. You are assigning them time slots that they have these offices available so that you are maximizing that space and getting the the most out of it. That's also going to help you really control your costs as well, because you're using that space so efficiently.

[00:15:46] Then if you were tracking it that carefully. When the space starts getting really, really full, you know, like, Hey, if I hire one more person, there's really nowhere else to put anyone else. It's probably time to start looking at [00:16:00] new spaces, right? Or additional, additional space. Maybe you're adding a new location or something else, or adding telehealth positions.

[00:16:08] Um, but ultimately. If you were in person and seeing clients in person, there is eventually a cap to how much, uh, how many clients you can have based on the space that you have available. Right. It's unlikely that you're seeing clients at 2:00 AM although that that might happen somewhere. Uh, right. But you, but you probably have some restrictions on.

[00:16:27] You know, 7:00 AM to maybe 9:00 PM Monday through Thursday, and then some, uh, slightly, um, restricted hours on, on the weekends as well, right? You're maybe not seeing someone in like 7:00 AM on a Sunday, or maybe you are right? May, maybe, maybe that's, uh, that works for you or for your team. Um, but those, uh, those time slots are, are going to be much harder to, to recruit for as well.

[00:16:53] All right, so we've talked about the four items, clinicians, clients, cash and space. And now that we've [00:17:00] talked through all of them, you can see how it really is necessary for all of those to, um, work together for all those systems to, to fire all at once. Because if you have clinicians and no space or clients, but no clinicians, if you have a potential space and no cash.

[00:17:19] It's going to be difficult. It's never going to be perfectly even where all the things are happening exactly at the same time. But when you're thinking about scaling your practice and scaling fast, I want you to think about these four really restrictions that you have and figure out how you're going to make your systems all work together and all, um, support each other so that your practice can scale quickly, efficiently, and profitably.

[00:17:46] That's all for today. Take care.


[00:17:51] Julie Herres: The information contained in this podcast represents the host and guest general opinions and should not be construed as personalized accounting and tax advice. [00:18:00] Listeners should consider all facts and circumstances before applying this information and seek appropriate advice from an accountant, financial planner, lawyer, or other professional.

[00:18:08] Any info provided does not constitute accounting, tax, or legal advice.