055: Hiring and Compensating Additional Practitioners

Ronda Nelson: Well, hello again. Welcome to another episode of the Clinical Entrepreneur Podcast. I’m your host, Ronda Nelson, and we are going to be talking about something today that I think is super important. It’s a question I get asked quite often and it is, “How do I hire someone else in my practice? What are the things that I need to be thinking about when I’m considering bringing in another nutritionist, health coach, or chiropractor? Whatever it is, what would be the benefits, what are the pros or the cons, et cetera?” I want you to see better business and financial growth for yourself personally. There is an advantage of adding more practitioners in your office and we’re going to dive into it today. 


I want to encourage you to keep an open mind and think about the fact that it might be a viable option for you. I’m going to give you a few pitfalls, things to look out for, some things to consider, and then you can decide moving forward whether that is the right decision for you. If you’ve ever thought about adding someone to your practice, it probably made you feel a little like, “Whoa, yeah, I don’t know if I’m ready to have somebody else in my space. How am I going to afford to pay them? How do I compensate them? I don’t even know what to do.” If you felt like that, you are not alone because most practitioners have that same kind of gut feeling. As I mentioned though, bringing someone in when you’re at the right place in your business, and that’s a key point- you need to be at that right place in the growth trajectory of your practice before it makes sense to bring someone in. Even if you’re not there yet, keyword: “yet”, you can still be mulling this around and formulating a plan for when you do get there.


I think at the end of the day, what I’m always interested in is what’s the experience for the patient? I’m currently working with a group of doctors on the East Coast and they have multiple offices with multiple practitioners in each office. One of their goals inside the office is to always be cross-referring. In other words, if someone comes in to see one of the chiropractors in the office, they want to make sure that that chiropractor is referring to the acupuncturist, and the acupuncturist is referring to the massage therapist, whatever is appropriate for the patient. That cross-referral continues to build revenue and they work off of each other, and that’s a key factor here. It might be a good idea for you to consider bringing in a health coach or some kind of nutritionist that can help you manage some of the pieces of your business at a little lower rate of pay that you don’t necessarily love doing.


You might be able to hire someone that you could train into your methodology, your way of thinking, but they have to have some kind of background before they come in obviously. Now there’s a two-four, right? You’ve got somebody who can help with diet and lifestyle and then you can provide those qualified services according to your degree or specialty. But when we think about inviting someone into our space, it’s a little scary because they’re going to see your mess. However, when you hire correctly and you bring in that health professional, they’ll be able to help you and can bring in their own ninja skills, but they can also bring in some added insight about, “Hey, have you ever thought about doing it like this?” 


And depending on how you structure it as the business owner and CEO of your practice, you guys really can work together as a team. Now, one of the things you want to look out for is an attitude. When my kids were little, there were a few things that I absolutely would not and will not ever tolerate, ever. If you lined all four of my kids up, they would all give you the same answer because I told them a thousand times or more, I will not tolerate attitude. For me, that’s a deal-breaker. If a practitioner were to come, or even an employee wanted to come and work with me, and they started copping an attitude that’s an automatic disqualify. Not all secondary ancillary practitioners are going to have an attitude, but I always like to throw that in because it does happen. 


Before you decide to bring someone in, there are a few things you need to consider. Number one, is your practice bursting at the seams? We need to bring in someone that’s not going to take away from what you have, but you want to have your practice booming. You’re busy, you need some help, and you’ve got the space to be able to accommodate someone else. A question to ask yourself is: is your practice bursting at the seams? Number two, are you ready to have someone else in your space? And I hope after we’re done with this podcast, you’re going to say yes to that. Number three, do you feel prepared, or as prepared as you can be, with your business systems, what you’re going to compensate, any kind of benefits, and your business core values? You want to set them up to succeed. You don’t want to invite somebody into your mess, and I don’t want you to not take this step if you’re ready because you think that you’re a mess. Everybody’s a mess. I’m a mess. We’re all messy because we’re growing and growing means messy things happen. It’s just the way it is. Just think about if there are things that you can do now that’ll help you prepare for bringing that person in. Do you have a steady stream of revenue, or is it seasonal or fluctuating? Because that can be something that another practitioner is not going to want to get involved in if there’s no kind of a predictable type of income. 


Then lastly, and I think most importantly because after all, we are running a business here, will this person increase your revenue bottom line? Are they going to drive the bottom line? 

Because that’s why we do it. This is a business. We are hiring because we have a business and we’re here to make money. That doesn’t mean that we’re not serving patients but we are here to make money. Bringing someone else in, they’ve got to drive your economic engine, your bottom line. Now, what do we do first? First of all, we’re going to get down to the basics, down to the details here. You’re going to get clear about the type of practitioners you need. Is it someone else just like you? Or as I mentioned, is it a health coach, a nutritionist, a massage therapist, a physical therapist, or acupuncture? Whatever it is, who is this person that you need? And then, will they add value to your overall patient experience? In other words, will they help your patients feel better, get faster, better results? If the answer is yes, then you’re golden. 


The second thing, this practitioner that you bring in should help reduce your workload and allow you some breathing room to focus on growing your business. Because I know, I’m a clinician, I’m just like you, I know what it’s like. You see people all day and the last thing you want to do is sit down to balance a bank statement. If you’re going to bring someone in, let’s see if we can get them to free up some time for you so that you can focus on business growth. Another thing to consider is having your core values well established. Make sure those core values are solid. When you know what your core values are, you’re going to be much better equipped to be able to share your vision. I do have a podcast episode about that, it’s podcast number 44. It’s all about why having core values is essential and I break it down to make it super simple. 


All right. The third thing we want to think about is what you’re going to pay them. You’re going to have to do a little research on what your market can bear. What they pay in San Francisco is going to be different than what you’re going to pay in the middle of Iowa. The next thing I always recommend is treating this person as if you would any other employee. Make sure you’re vetting and screening them to make sure they’re going to fit in your culture. You want to put them through your hiring process, make them take personality tests, get testimonials from the people that they’ve worked with if they’ve already been in practice. This is where you need to become a stalker. You go on social, you find them, and you stalk them. I have had more people that looked great on paper and they interviewed well and as soon as either myself or one of the ladies on my team go stalk them on Facebook, nope, not having it. I’ll see a post that doesn’t represent me or my brand, and it’s okay if they want to do that that’s okay, but I know that that’s not going to be a good fit for me. That is not going to work for me. 


Now, what do we pay them? After you do a little bit of research, see if you can figure out what the going rate in your area is for that particular type of practitioner. And then we need to determine if we bring them on as a W2 or 1099, and there are pros and cons to each one. I’m going to break those down for you and give you my perspective about this. Think about a 1099. The pros are that you don’t have to deal with payroll taxes and they do have to provide their own insurance. There are a lot more cons. The cons are that they have no obligation to you. They technically, as a 1099 employee, can set their own hours. 


They can just decide, “Nope, I don’t want to work those hours. I only want to work nights,” or, “Hm, not going to be in today. I’m busy. I got to go to the dentist,” and you already have patients. An independent contractor can kind of just be independent, as the name mentions. A lot of practitioners try to use this model to get away from paying payroll taxes but I would never recommend that. My favorite is to bring them on as a W2 employee. I’m going to give you a third option here in a minute. With a W2 employee, now they’re a full-on employee and you control their schedule. 


Now, they do have an obligation to do what you’re asking as the CEO and the business owner. They’re going to fall under employment guidelines and they’re often much more invested in your business and your practice because there’s more at stake. Your business is paying their payroll taxes. You may be providing some benefits, which I recommend. You’re paying half their Social Security and Medicare taxes. 


You do have to provide performance documentation, so regular reviews, and if something is going on that you’re not liking, you do have to do those performance reviews where you say, “Hey, look, you know, this happened.” You just have to document it, have them sign it, go through all of that if they’re not a good fit. I believe that a W2 employee should be given some kind of a benefits package. This goes back to you needing to have enough revenue coming into your practice that you can pay for that. I do think that you need to pay for their malpractice insurance. That needs to be a part of their employment with you. I think you need to give them some kind of a stipend or an allowance for them to get their CEUs, and it might only be $1,000. Don’t be putting in your feet in the dirt just because you heard me say $1,000, but $1,000 or so, something like that, $1,200 a year for them to get their CEUs. 


I would give them a week’s paid vacation after the first year because you don’t want to give it right away. You let them work for a year and then you give them a week’s paid vacation. I also like giving personal days and I usually recommend giving about three personal days. The CEU days don’t count against personal days, like if they’re gone doing CEUs then they’re not doing anything personally. Be sure that you check with your local government and your state to make sure there’s nothing else hidden in there that you have to provide them. For instance, I have a business in Washington state, and about two or three years ago they passed a law that mandates employees to give one week of paid sick leave every year whether your employee uses it or not. Just be sure that you check paid family medical leave, anything like that. 


Again, your cash flow has to be sufficient enough that you can support them. What you pay them compensation-wise is up to you, but here’s my advice. It should mimic the real world. Let’s just say the average salary is $4,000 a month, that’s $1,000 a week. Don’t pay them $6,000 just because they ask for it and you don’t want to say no. Start with the average salary and then work backward if you need to. It needs to be fair and it has to be inspiring for them. Then if you’re not sure what’s fair, ask them and see what they say. I’m going to go through a couple of examples but my recommendation is that you bring them on, put them on a salary, not hourly, if you have enough work for them full-time. If you don’t have full time, then you can put them on a salary but that salary is a minimum of X number of hours, or you could pay them on hours. I think it depends too on what’s their experience and their pay certainly would be influenced by that. Have they already owned a practice? Are they bringing a patient base with them? 


If they’re bringing a patient base with them, that’s going to be worth more in the compensation department. Maybe you set them at a lower fee for the first month, and after you see what kind of patients they bring in. After a month you could start them at a lower pay grade and then bump them up and go to that higher pay once you see that they’re actually bringing patients in. Then, does the person you’re looking at give you some kind of assurance that they can build up a patient base on their own? Or are they completely depending on you to bring in all the leads? There’s a big benefit for practitioners to join an existing practice because they don’t have to do all the upfront work. The value for you is that they’re going to bring in their knowledge, their expertise, and hopefully, a patient base that they can bring in with you. When they’re the right person, they’re going to fit within your core values, they’re going to fit right into your team seamlessly, and you’re not going to have any worry about it not being a good fit. 


You’ll want to adjust their compensation every single year. You can start them out as a 1099 for the first three months just to make sure that it’s a good fit because it’s really easy to let somebody go that’s a 1099. I think that kind of allows you to have the best of both worlds. Now, as far as compensation goes, just like with your team, you want to adjust every year. That’s going to compensate for the amount of revenue that they’re increasing. 


When you are seeing patients and have that type of model, I love the salary plus a bonus model. It’s my absolute favorite and here’s why. I don’t like just bonusing the practitioner, I like everybody to get a bonus. Let’s just say in your situation if you’re going to bring in someone, you most likely have a front desk person. Well, I’m going to go out on a limb here and say that that front desk person is pretty dang important to the way that your practice is running. You would be in big trouble if you did not have that front desk person. I think the front desk person should be in on the bonus as well. What I love about this model is that it promotes cohesiveness in the team. In other words, everyone is working together for the same goal. Everybody’s trying to get that revenue up because when you hit that mark, then your front desk person gets a $200 bonus and your practitioner gets a $500 bonus or whatever you decide. 


Now in two months, your revenue is $40,000 a month and that includes supplement sales and fee-for-service, like the whole thing. From the very beginning, you were making $30,000 a month, now you’re at $40,000 a month, that’s $10,000 in additional revenue. You’ve got some hard costs in there like your supplement costs, your cost of goods, et cetera, but I’m pretty sure you’ve got enough money to give a little bonus out here and it makes them work hard. Everybody works together. As your revenue increases, your profit margin increases, and as this happens, you want to have a way that you can communicate to set those goals and stay on point.


Once your practice is up and going, you absolutely shouldn’t even hesitate about bringing in another practitioner because the change it can make for you is dramatic. Not only for the revenue side but just having someone else on your team that you can share cases with and at that weekly meeting you can talk about your insights. At the end of the day, remember, you are running a business, my friend. You are the leader. You are the CEO. This is your business. And it needs to go your way. But having someone else in there as a co-conspirator in this alternative wellness space can make such a difference in the trajectory and the speed at which your practice can grow. Ultimately, the goal is to get you out of the clinician chair, like take the clinician hat off a little bit more often, put on your CEO hat so you can begin to strategize how you’re going to direct your business.




Ronda Nelson: Well, my friend, I hope that provided you with some inspiration and guidance around adding another practitioner to help you grow your business and create a better, more cohesive experience for your patients or clients. If you would like more business tips on how to grow a profitable and thriving practice or you have a question you are just dying to ask, I would love to have you inside my free Facebook group. It’s called Grow Your Wellness Business and that’s where we talk about all things business growth for health care clinicians like you and me. So, that’s it for this week. Next week, I’ll be back with another episode of the Clinical Entrepreneur Podcast. Don’t forget to join me over on my Facebook page or Facebook group, Grow Your Wellness Business. And until then, grow your business like a boss.




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