Welcome back to The Designer Practice Podcast, and I'm your host, Kayla Das.
In today's episode, Bree Chrisman, founder and CEO of BossCo will share strategies to maximize your existing practice resources.
Hi Brie. Welcome to the show. I'm so glad to have you here today.
Thank you so much, Kayla. I'm excited to be here.
Brie, before we dive into today's episode, please introduce yourself, where you're from, and tell us a little bit about your business journey and BossCo.
Thank you. So again, my name is Bree Chrisman. I am the founder and CEO of BossCo. We are an operations management and growth strategy agency solely for mental health, private practice owners. So I've spent the past 15 years in operations and project management. In 2020 I started BossCo. Started off as a lot of industries and then because of referrals we kept seeing more and more therapists, and it turned out that 90% of our clientele ended up being therapists.
And we kept seeing all of these amazing clinicians, people doing life changing work, burning out, closing their doors, going out of private practice into something else. Not because they weren't good at therapy, but because the business side was running them into the ground. And so we focus primarily on the back end of the business. Things like systems and processes and expenses and leadership. So the owners can run their practice with confidence, increase profit, get their time and sanity back without piling more on their plate, which as we know, therapists don't really get any business advice, business classes or anything in all of the schooling that you do. So we are trying to bridge that gap.
Amazing. And I know today we're really gonna be focusing on profit versus revenue. So what's the difference between focusing on revenue versus focusing on profit? And from your experience, which one do practice owners tend to focus on more?
That's a great question. So revenue is the money coming in. Profit is whatever is left over after everything, everyone gets paid, expenses get paid, all of that. So you do have to remember, profit is two parts. Profit equals revenue minus expenses. So you have to remember to look at both things.
They're definitely not the same thing. In my experience, most practice owners obsess over revenue because it feels more exciting. Ooh, I got a new client. I upped my rates. It's measurable. It feels just super exciting. We hit 500,000 this year or something like that. However, if you're spending $450,000 to get there. You're exhausted, there's nothing left over for you. It defeats the purpose of having your own business. And of course we know having your own therapy practice is to support clients in the way that you want to support them, but we have to make money too. And that's part of being in private practice.
So on Instagram, we always see a lot of the Instagram therapists where they say, oh, I made X amount of dollars last year. That's their revenue. That's not their profit. You don't know what the backend looks like, and that's where the comparison game comes in.
Profit is where the breathing room is. So that's what allows you to hire support, invest in better systems, take a vacation without your computer, without panicking, without having your client messaging on. And that's the difference we really focus on. Revenue is super exciting, but profit is what keeps you in business long term without the stress, without the burnout, and to be able to make the impact that you wanna make.
I love that. And when we think of revenue versus profit, would you consider taxes as a expense?
Yes, I would. It's something that is mandatory in your business, it's part of your overhead. In the US we typically say, keep 25 to 30% of your revenue back for taxes. And so that's expenses.
No, I love that because often for many of us, depending on how you pay your taxes, sometimes people will pay quarterly or monthly, and some people will pay at year end, and we can forget about the taxes, right? It's oh, I still made a profit because, I only had to pay this for my practice management software. I only had to pay this for my office space. But then at the end of the year. Here's your tax bill, and you're like, never really considered that. And even when they pay it, it's not always considered as a part-- like taking it away from the profit.
It reminds me of that meme. I can't remember what show it's from. I think it's from Schitt's Creek to be honest. And it's oh, it's tax deductible. What? What does that mean? I don't know. It's tax deductible. And so just because something is tax deductible, you still have to pay taxes on other things as well. And I am by no means a finance expert, but I do know that.
Absolutely. No, I love that. So you work with group practice owners who already have strong revenue. Where do you typically see profits getting lost even in the most successful practices?
Yeah, it's a great question. And we work with group practices mostly, but we do see some solo practices. And to be honest, they're all the same issues. It's just on a different scale. So the big profit leaks tend to be in three different areas. Team efficiencies, that would be unclear roles, duplicate work, having highly paid people doing low level tasks. My favorite example to use is if you are, say your hourly rate for clients is $250 an hour.
If you are sending one email, say it's a lead email and you're typing it manually every day, it takes five minutes, five minutes a day, not a big deal. Five minutes a day, five days a week. Times, say 50 weeks. Say you take two weeks vacation, that's almost 21 hours. A year that's over five grand of your time that you're taking just to write that five minute email. Every day if you gave that email to an admin person, say you're paying them 20 bucks an hour, that's only $420, which is not a big deal. It is, $420 is nothing to blink at, but. It's still a lot of money, or you can template that email and even automate it and potentially, and get that down to $50 max.
So that's a huge thing that we talk about is, a lot of times in therapy you can't automate things because of HIPAA, but the things you can do it's mostly automated with some manual in there. And so Having people doing those, having your top therapist who's bringing in 250, $300 an hour, cleaning the break room, or, ordering Diet Cokes for the office. That's not what they should be doing. Those tasks are necessary. They're needed, and they are part of the quality of the environment you're creating. But it doesn't mean that person has to do that task.
I love that and actually, it makes me think about, even new practitioners may say you know what? I can't necessarily afford, say an administrative assistant or a virtual assistant or whatnot. But I love that you mentioned about templating, right? That's actually something that I do all the time. Usually you're gonna have the same types of emails that you send clients all the time, whether it's reminder emails, although hopefully your practice management software does that for you, that you don't have to do that. Or, follow ups regarding getting paid if you don't have a credit card on file.
Every time you start having a different type of email that you know is gonna show up Again, save it on a Word document. That's what I do even with my podcast, and you probably have known being a guest on this podcast, it's very obvious that it's a template.
And I get it to you super quick because it's the same one that I send every guest, but I just put the unique information in, like the dates or the links or the podcast title, whatever. And you can do that with your clients as well if you can't afford somebody in your practice right now.
Yeah, absolutely. And having a template doesn't necessarily mean it has to be impersonal either. The templates that you send me, they're super personal. I can tell that you put a ton of care into it. You are super friendly. And a lot of times it doesn't have to look like a template either. I know it was a template just because I'm in the business and so I've seen them left and right, but that doesn't mean your clients see it. You can have a template for following up on leads. If somebody reaches out to you via a match service or something like that, you can have those template emails. And if you use something like Google Workspace you can put in template emails in there. So all you have to do is have a couple clicks. Switch out a clinician name, switch out a first name, hi X, Y, Z, and then you're gut and it takes 30 seconds versus five minutes. And there's a whole different podcast, but we could also get into the difference of the executive function. It takes the decision fatigue of switching tasks from each individual piece and going back to those unclear roles and duplicate work, making sure people are working in their zone of genius and zone of excellence versus, just because their body means that they're working. That's not conducive for anybody. It's not productive for anyone. So that's number one.
Number two is tech bloat. If you are paying for software that no one uses, if you're like, oh, this could be great, this project management tool will get everybody on track and then nobody uses it. You should probably use it. You paid for it, you implemented it, but a system doesn't work unless everyone works the system. And if you're not using it, then just get rid of it. If no one's actually gonna use it, there's no point in paying for it.
And then also, if you're stacking tools on top of each other that overlap and function, figure out how you can minimize that. If your EHR has telehealth and it's maybe an extra like $15 a month per clinician, that could be a lot cheaper than having Zoom for healthcare. That's insanely expensive. So you're not only saving costs, but you're also optimizing and having everything in one software. So it's one less thing you have to train new people on. That's one less thing you have to keep track of for your passwords and everything like that. There's so many different things you can do to solve the tech software, squirrel brain, and all of that, and looking at getting rid of the things that overlap. Looking at if you're paying monthly or yearly, getting those expenses down. And then just getting rid of the stuff that you're not using.
I love that. I've recently just had a business coaching client who was working on an online course, and they told me that they have been paying for a course platform for two years and have no course on there. And that is something that I like to teach people is that whether you're buying a practice management software, an online course software, an email marketing provider. If you are paying out of pocket for this, is do that closer to when you know you are about to need it. So if you're gonna create an online course, develop the online course, then pay for the platform. Similar with a practice management software if you are starting your private practice that shouldn't be the first thing you buy. You should have it before you start, but you already know you're gonna start in two weeks, right? So now you're gonna pay for the practice management software so that you can set it up and that you can get it ready. But we often think we need these systems first, but really we need to have that clear plan, that clear idea, and even the back work created before doing it. And then you're gonna save yourself money.
Yeah, absolutely. And I have a client who's grandfathered in, they're not a therapist client, they've been with me for almost five years. But we do webinars for them. And so when there's a month that we don't do webinars, we just drop down their Zoom membership. So that way they're not paying for it. And that is one good thing about doing month to month. If you're doing something like that, it's yes, we need it, but we don't need it every month, so let's just drop it down.
And I'm very much a firm believer of free is for me. So if you can do something, you don't need all these super fancy, gadget newfangled things like, I don't know about in Canada, but in the US doxy.me. So having something like a backup that's free having, I know in the United States, I know I keep saying that. That's my frame of reference unfortunately for Canadian listeners.
Being able to use Google Workspace with just HIPAA compliance, we're able to utilize some other features that can be all inclusive if you don't wanna pay the hundreds of dollars a month for an EHR or EMR. There's so many different options and you don't just have to go with whatever the latest thing on Instagram says. Yes, it might look shiny and new, but do you actually need it? And if you have something that works for you right now, then just. Don't touch it.
And I do wanna give a disclaimer to Canadians is when we're talking about HIPAA and PIPEDA, HIPAA is the US privacy law, whereas PIPEDA is the Canadian privacy law. And even though Brie is referencing different platforms. Here in Canada being PIPEDA compliant, one of the categories is that information is stored in Canada. So even though Brie might be giving some resources, which is going to be really helpful to our American listeners, I do want to say to Canadian listeners is that some of these resources may not be privacy compliant here in Canada.
Yes. Thank you for that disclaimer, Kayla. I wanna make sure that any advice I'm giving is just strictly advice to take and then make sure you're doing your own research and making sure that it is compliant for you wherever you are, whether you're in the US, whether you're in Canada or in Australia or Europe, everybody has different privacy laws. So making sure that whatever software you use is compliant, not just from a healthcare privacy standpoint. If you have a group practice and you have employees making sure you're compliant with employment laws and all of that as well. It's like as a therapist, any advice you give, it's not medical advice. So definitely love that disclaimer.
For the third profit leak reactive leadership. It doesn't sound like a profit leak because it's not time equals money, but it is so important because like we talked about a little bit earlier with the decision fatigue, if you're putting out fires constantly, instead of running a plan, it's not only going to make you be in a reactive mindset and be able to put you in a place where your executive function is shot and your decision fatigue is shot and you are not in a clear mindset to where you can support your clients and to support your employees and your family, and your friends, and all the other roles that you have, but when you are reacting. It leads to expensive mistakes. It leads to, knee jerk reaction sometimes. And when we spot those leaks, we're not shaming anyone.
It's about making sure that, there's always gonna be fires to put out. You're running a business, it's just gonna happen. But minimizing those by creating a plan, creating boundaries, creating systems, even small tweaks in those areas can put thousands of dollars back into your business and hours back into your business as well. So those are the ways that you can create some quick wins for yourself.
I love that. And I think you were alluding to this, but I just wanna also highlight it. It's that also reactive leadership can impact poor work culture. And in my therapist hiring course that, I have for therapists, I do talk about that and I talk about if we are constantly reacting instead of trying to build that positive work culture and planning and having transparency and all of those things that our staff need to thrive, there's going to be significant turnover. And even though we might not see it right away.
Turnover is so costly because you've just spent so much time training people, then you have spent so much time hiring more people. Along the way you've probably invested in your staff. And then you may even lose clients depending on, where that person goes if they want to stay with you. All of these types of things. So even though it may not be as easy to see on paper of how costly it could be. Again, reactive leadership is one of the things that can create a negative work culture over time.
Yeah, exactly. And so when we talk about reactive leadership versus proactive leadership, and that's again can be a whole nother podcast episode, you could get to a point where you're end up micromanaging and you are big brothering, as we like to call it, and you are creating not necessarily a hostile work environment, but an environment that people don't wanna work in. And if you're reactive all the time, it's probably not the person you wanna be. So then you're negatively affected, which your clients will pick up on and your employees will pick on. And they're negative and their clients will pick up on it. And that just snowballs so fast.
And it's really creating those expectations and the boundaries ahead of time to make sure you can have that open door policy. You can have the boundaries that can set you up for success. And frankly, as far as the profit leaks, think of how long it takes potentially to get a full caseload. We're talking four to six months in a good market.
And so that's four to six months that you're carrying this person and their liability insurance and all of their software and everything that you and payroll that you're paying them without any money, you know, without any ROI return on investment.
And to what you said, Kayla retaining employees is so much cheaper than bringing on new employees. And so having that more proactive leadership and having the boundaries is so important because then you are able to retain people better. You're able to create that positive work environment.
Absolutely. So some people think making more money means adding more clients or staff to their practice, but you focus on increasing profit without adding more. What does that look like for you?
So increasing profit. Most people think you need more clients, you need more staff, you need more marketing. And that is my favorite myth to best because it isn't always the answer. You think if you add more clients, you add more marketing, that's adding more to your plate. Yes, it means you are potentially bringing in more money, but it also is bringing in more expenses. And so if expenses are coming in, like we just talked about with. Bringing on new employees it's expenses, so your expenses are probably gonna go up more than your profit for the time being. Same with marketing, if you're running ads or something like that, it's gonna be more expensive upfront. So what we do is we actually help practices make more from what they already have. We help them maximize the resources they already have, whether that be software. Or people or time management skills, things like that. So that could mean refining your billing process. So claims get paid faster. It could be training your admin team to solve problems before they reach you. So really creating more of a hierarchy in your workforce, that could mean really creating a more vertical organizational chart. And obviously we don't need an organizational chart in a more corporate way, like typically what people see. But as the owner, having a practice director or an operations manager, having the admin team knowing what needs to be brought up to the next level versus what they have the autonomy to handle themselves makes the productivity way higher. It frees you up for more higher level thinking, which means growth which means bringing in more clients or anything like that. Focusing on the bigger problems, the bigger solutions.
It could also be replacing underused software tools with one that does a better job, less cost. It also could just be I think we talked about it briefly earlier about working in your zone of genius and your zone of excellence. If clinician A over here is a super type A loves making sure that the inbox is like inbox zero and she's doing social media and she can do it. She's good at it, but it takes a ton of her brain power. And then clinician B over here, maybe they're more creative and a little chaotic, but they're the one that is making sure all of the client charts are complete. Let's switch those tasks because honestly, both of them probably hate their lives while they're doing those tasks. It's not in their zone of genius. And so switching them, one, they'll be more productive. Two, they'll love what they're doing more. And three, they're gonna get it done faster, which means it's gonna be cheaper to do. And that also gives them the empowerment that they need to be an effective employee, be an effective clinician.
They're not gonna be wanting to just get to the next day. They're probably gonna get done on time. And then if you are giving them tasks that they love. They will do more for you. They will like their job. They will love what they do, and it will really be beneficial for everyone.
Absolutely. So if a practice owner is hitting record breaking revenue, but still feeling broke or burnt out, where should they look first to turn that revenue into real profit.
That is a fantastic question. Payroll, definitely the biggest expense for any practice. If you are doing a commission based, if you're doing a flat rate it doesn't matter. It's gonna be your biggest expense. But if your ratios are off, and we see this all the time with newer practices where they start off and they're like, yes, I want to be the person that pays people a livable wage and a fantastic rate, and then they realize, oh shoot. I forgot that I have to pay those taxes at the end of the year and their ratios are off. It will eat profit so fast, and that doesn't mean you can't pay a fantastic wage. But you do have to make sure that first and foremost, your overhead is covered. And that includes taxes and all of the things.
But looking at your payroll ratios is definitely the first thing that you should do. And then after that, review your expenses line by line. This is what we do on a regular basis. We typically do it quarterly with our clients. Last year I did this with one of our clients where we went through her last 13 months of bank statements.
And the reason we do 13 is just to catch those pesky yearly payments that you might miss if you don't go back another month. By just switching some of her softwares to yearly billing, getting rid of a couple that were somewhat duplicate. I think we had one software we got rid of and then it made us have to do a few things manually, but it ended up being cheaper and because we had a standard operating procedure for it, and it was mostly templated, it was really easy to switch to manual.
And then we looked at a couple other things. We saved her $3,000 a year just by that one expense audit. And so you'll be shocked at what's still being charged and what you can do to find money. It's basically like your own personal money tree, being able to look through all your expenses.
And then finally look at your own role. If you're spending 80% of your time on admin instead of leading your team, your business is gonna feel harder than it should. And it's amazing how wild this comes up. Even in multimillion dollar practices, if you work harder, then you're gonna burn out harder. Everyone says work harder not, or work smarter, not harder.
What I always say to my husband, honestly, do I wanna hire a nanny, like a babysitter for today? Like my kids are off school for some random reason. Do I wanna hire a babysitter? I'm like, what tasks am I doing? Am I just doing like mundane admin tasks that just have to get done and they need my brain?
Can I delegate those to other people? People that's part of their job. That's what they love to do, it's great. And sidebar, as an owner, you are not above any task. Like you should be able to do every single task. Just as good as everybody. Maybe not just as good as everybody else, 'cause that's why you have other people on your team, but you need to know how to do it. And no task should be beneath you. But that doesn't mean you have to do every single task.
So a lot of times if I have a higher level thinking I have an audit or something, I have a consult call. Okay, I can make X amount of dollars per hour today. So if I wanna pay someone $25 an hour to watch my kids, that is a no brainer.
I can bring in way more if I have my full brain than trying to like mismatch, try to be half mom, brain, half work brain. And it's really easy to do for clinicians because you do have that hourly rate and you can say okay, is this a $200 an hour task or is this like a $20 an hour task? And so that can be really helpful when you're starting to learn to delegate effectively. And that is really one thing, once you start freeing yourself up, yes, you will be paying people to do things, but your brain will be freed up to do things that will bring more money in faster.
Amazing. So Brie, you offer a comprehensive practice audit. Can you tell us what it is and how it can help listeners?
Yes, this is one of my favorite services that we do. It's basically like a full physical for your business. You go to your doctor once a year, you get everything checked, your blood work, all the things. That's what this is. We go through your operations, we go through your expenses, your systems, your leadership structure, your team roles. Really identify exactly where you're losing money, where you're losing time, where you're losing sanity, and creating burnout. And really figuring out how we can support you and set you up for growth and for sustainable scaling. And scaling can look like a million different things.
It can look like, okay, I wanna open a new practice location in two years, I want to go from 10 clinicians to 25, or I want to keep my small team and take a month vacation once a year because you need those systems in place for that too. And so from there we do a long form that you fill out. We do a 90 minute deep dive q and a audit where we just talk back and forth about your business and you can vent and you can share all the things that are frustrating you, the things you wanna do, your goals, the things you're excited about, the things you hate in your business. 'cause we all hate those few things in your business. And then we create a prioritized action plan that tells you what to fix first, what to fix second, and so on. So it's prioritized. It's a 90 day action plan.
We focus on the small things that'll make the biggest impact first, and then the big things that'll make the big impact and so on and so forth. And then you still get, those things that'll be low impact, but they're still impactful. But it's a way that you can get a ton of information, but in bite-sized pieces that isn't overwhelming.
A lot of practice owners that we work with walk away from it saying I finally know what's going on in my business. It's so helpful and knowing what I need to do next. And we set it up where you can do it all yourself. We give you the plan and we give you enough information where you can actually take it and run with it.
We had someone a few months ago she was like, this is amazing. I'm gonna do all this stuff. And then about a week later she came back to us and she was like, can you guys just do it for me? And so we do the implementation for it as well. But we wanna make sure that you are self-sustainable.
The last thing that we want is to make you dependent upon us, so we wanna give you the tools so you can succeed on your own. But we're here to help you as a safety net if you need us.
Fabulous. So to sign up for Brie's Comprehensive Practice Audit, check out heybossco.com, or you can simply scroll down to the show notes and click on the link.
Brie, thank you so much for joining us on the podcast today to discuss profit versus revenue strategies to maximize your existing practice resources.
Thank you, Kayla.
This was a great conversation and 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.
