Welcome to the Voice of Counseling from the American Counseling Association. I'm Danielle Irving, and joining me today is Alena Scigliano, licensed psychotherapist, author, speaker, narcissistic abuse expert, founder and CEO of Coastal Light Counseling. Alena is here today to talk about building a thriving business and expanding your solo practice into a group practice. Welcome, Alena.
Thank you for joining us. So let's jump right in there.
You began your solo practice in 2016 and expanded into a group practice just a few years ago. What were some of the deciding factors that led you to this decision?
Well, it's funny. The course of my business probably progressed in a different way than most. Going into grad school I knew that I wanted to start a private practice right away, and it was towards the end of grad school that somehow I just randomly had the thought, okay, I'd like to have a group practice, and was actually thinking about starting it before I was looking into, okay, can I own a private practice before I even have my license? And so I was talking to someone about that and they suggested that I take some time to get some experience in the profession first. And so at that point I decided, okay, I'll go through my residency, I'll get my license, start my solo practice then, and then two years in, that was my arbitrary time that was based on when I can start supervising. And so two years in was my plan to start the, or expand into the group practice, and that's pretty much what I did.
And I'm sure everyone's experience in progress may have some similarities and some differences, but how did this transition look for you from solo to group practice?
Well, it looked like more work, that's basically what it was, more time, more work. Solo practice was a lot of time and energy putting into things like knowing, making sure I knew all the HIPAA laws and insurance, and I really like to do things by the book and not risk violating any laws, our ethics or committing insurance fraud. And so that requires a lot of knowledge to make sure you're doing that, especially when you're on your own. And so I had to take the time to learn all of that stuff, which really does take an incredible amount of time. And I was able to build on all of that knowledge from solo by going into group. But at that point then it went beyond understanding the intricacies of owning just a private practice and all of the pieces that go into that, billing, credentialing, insurance and patient care and customer service and websites, EHR, all of those pieces, it went into, okay, now I'm an employer and I need to be able to lead others.
And so there was that whole piece that really took it up such a big notch. And now I'm looking at needing to know employment laws, IRS. It just really makes it extra complicated. And so I think when I talk to people about the idea of owning a private practice or a group practice, I highly stress, okay, just make sure that you're not just willing to, but that you'll enjoy putting the time into learning everything that you need to know to make sure that you're doing everything properly.
Absolutely. And you spoke a little bit about learning, billing, insurance. Can you share a little bit about the type of systems that you have in place regarding billing insurance or electronic health records that help you manage the different complexities of your group practice?
I immediately signed on, well, I did my research first and chose SimplePractice back before I started in 2016. And I absolutely love SimplePractice. It's total plug for them here because I just really enjoy their company. I like the customer service that they provide and the interface. I think if anything, the biggest thing for me was the interface. I wanted it to feel and look nicer. And so that was really the reason why I went with SimplePractice over others, but they've definitely worked hard on improving things over the years. And so that's been a huge part of making my life easier in terms of providing not only a service to patients, but also expanding and bringing in other practitioners because of everything that is offered between the integrated telehealth, which actually wasn't even there when I started using them, to everything for billing is in there. Anything for insurance, it's a click of a button to submit insurance claims, click of a button to create an invoice and charge patients.
We can keep their credit cards in there and have AutoPay, scheduling. All I've always done where I have the integrated widget on my website, so patients go in there and schedule directly. That's one of the things that has been unique about my business model is the automated-ness of it, for lack of a better term. And so funny backstory, sorry, I have ADHD, and ADHD people tend to be telephone averse, so we don't actually really answering the phone very much or making phone calls. And so I wanted to design my system to where I didn't have to answer the phone. Also, I'm in session during the day, and it's not really feasible to answer the phone, and I didn't want to have to spend a lot of time calling people afterwards. So that's where that came from.
I also just wanted things to run automatically on their own without having to bring in administrative support. And so that's where all of that automation came from was because that's just my personality, and so it fit that really well. So the entire business model has really been built off of that in terms of, you go onto the website and we have multiple Google forms to gather information from new patients and asking them all the details that we need to know in order to figure out, okay, which therapist within the practice will you be the best fit with? So I make sure that each of my providers has approximately, sometimes they're one or two more, but typically has three specialties. I want them to love what they're doing and be excellent at it.
Therapists can address a lot of different issues, but we can only really be excellent at working with a few. And so to me that's really important. I want my therapist to be excellent at their job, and not just that, but when we're working with the things that we love doing, we're excited about our job, we feel joy every day during our job, and I want them to feel joy. I want them to love working and not have the stresses that come from dealing with issues or the types of patients who almost drag them down emotionally. So that's been, these are the various factors that have gone into how I've set up the systems. And so we match patients with the therapists that fit them best. If we don't have anyone who fits them, I don't have people come in and say, you have to work with everything that comes in. We will refer them out. I'd rather send someone to somewhere else where they can get that excellent quality of care than take someone on and not be able to provide them the best care possible. Did that answer your whole question?
Yeah, you absolutely did. Very insightful. And what I'm also hearing from you is that you're providing a supportive work culture at your practice. Can you share a little bit more about that? And I know it's a bit different as you transition from solo to group practice, and it's no longer just you. There's other professionals, a team working alongside you and also virtually. So can you speak a little bit to providing that supportive work culture?
Yeah, absolutely. That is probably the most important aspect of owning this practice to me, is providing a place where, as I said before, where the therapists can love working and find joy in their job.
So it sounds like you are also providing a supportive work culture at your practice. Can you speak to that a little bit? I know you've transitioned from solo to group practice and it's no longer just, you now have other professionals and a team working alongside you and also virtually. Can you speak to that supportive work culture that you've created at Coastal Light?
Yeah, absolutely. So that is a really important part of what I feel like I'm doing in terms of owning this business and owning a practice as not only providing a place where people can come and get fantastic counseling services and with a focus on what their experience is like, but for me, providing a fantastic experience to the people who work for me and making sure that they love working, I would say coming to work. But we do have a building, but only a few of them actually use it. So it feels like coming to work is now getting on the computer, but I want them to love working. I want them to love what they're doing. I want them to be able to have balance in their life between work and home. In fact, I do the opposite of what I have heard other practices do in that I have a limit to how many sessions they can have a day. So it's limited to know more than seven sessions a day.
And we also have an extra 15 minute break in between each session, so that way they get, so we have 55 minute sessions, and that way they get a full 20 minute break in between each session and they can take care of themselves during that time, whether that is having that time to complete their progress notes, which then allows them to not have the anxiety of having progress notes hanging over their head at the end of the day or the next day, and they can go grab a snack or say hi to their family or make a phone call or just rest in between a session. It gives them time to decompress and transition.
And not only does that help them, but that helps them be there in the best way possible for each patient because they get to restart, refresh, and just be present for the patient. A lot of times mean, obviously anyone listening knows just how hard some sessions can be and just how draining they can be. We could be not just drained, but we could be crying in between sessions and really affected. And so those few extra minutes give us that time that we need to process through things like that and reset ourselves so we can still be there for the next person who needs us.
Thank you for sharing that, Alena, I think that's very important. And it also helps with preventing burnout and compassion fatigue and all those things that come along with being a professional counselor. I like to hear a little bit more about your practice, what services are being offered and what innovative things you're doing and what makes your practice unique?
Yeah, absolutely. So, the things I mentioned I feel like are things that do make it unique in terms of from that employment perspective, but as far as the patient experience perspective that that is important too. One of the things that I think the first innovative thing I ever did, well, I don't know, it wasn't too innovative, but it was something that was very different at the time from what other practices were doing, was providing teletherapy. Now that's just normal, but I started doing that in 2016, well before the pandemic, and so that was a really unique thing for patients to be able to receive online sessions. It also helped in terms of cancellations and no-shows because if your car breaks down, well, you can hop on your phone and still have a session. So that was the first thing.
Then one day a patient and I were talking, we were like, oh man, it would be really nice to be able to go on a walk and talk instead of sitting here. And while I was in solo practice, I worked out of my home, so getting out and going for a walk was just going out and walking around my neighborhood. It wasn't like we were walking around busy streets of a city. And I started thinking about that. I even googled it and I could find only one person who mentioned walk and talk therapy, and he was in New York City, and so it was funny. So all these years ago now it's a bigger thing, but when I started doing that, that was pretty novel. When I expanded into the group practice, I dedicated a room to indoor walk and talk therapy. So I bought two walking treadmills that have an integrated desk on them.
And so that way therapists and patient, if it's raining outside or it's really cold or too hot, they can just get on those walking treadmills and go at a slow pace, but be moving and talking at the same time. Let's see, what else have we done that's really innovative. I guess the, oh, that's right, beach and talk therapy. I almost forgot, especially once COVID started and I was staying home more and I was blessed to live near the beach, it's Coastal Light Counseling and the office is very close to the beach. And then I was living close to the beach. And I still wanted to see patients but didn't want to get sick obviously. And so we started offering beach and talk therapy where patients would meet us at the beach and we would either just walk along the beach and talk or I would have a couple of beach chairs and we would sit six feet apart and have our session.
Now of course, doing things like that, like walk and talk therapy, beach and talk therapy, even the indoor, they all require special disclosures and getting specific permission, all things that are separate forms that I created and uploaded into simple practice and sent to each patient. And I think from a business perspective, that's an important piece to keep in mind. So if anyone wants to start doing any of those things, make sure you're protecting yourself legally because the last thing you want to do is get sued because someone falls and breaks their ankle or get in trouble because someone sees another person that they know. And so then they start talking about, oh, you've violated my confidentiality. So addressing all of those things up front and giving patients an idea of what the risks are basically and getting their permission for that.
So those were a couple. I think those are probably some of the best examples. I keep talking about experience. Each of my therapist has a very specific teletherapy set up, so they have backgrounds that are consistent with our branding. I make sure that they have lights and good sound and the sound quality is not echoey. It's in a really nice private location in order to provide that experience for patients that otherwise it's really distracting, and you want them to just get lost in therapy so that way they can really start opening up and revealing themselves and finding themselves. And when you sit in front of a camera and only half your face is visible or there's a horrible echo or you hear people in the background, then that's distracting and it's hard to really have a good therapeutic experience. So I don't know how innovative that is, but that's an important part of the practice and the service that we provide.
Yes, very creative, innovative, and it sounds like you are building an experience, a setting that's calm, relaxing, and comfortable, and I'm sure your clients as well as the providers appreciate that setting that you're building.
Yeah, absolutely. Can you speak a little bit about the cost and financial considerations of starting and owning a private practice? It's a huge investment and something that we don't talk about as much as managing your income as you transition, some of the dos and don'ts, mistakes made and even how to pay yourself while managing this huge investment. Can you talk a little bit about the financial considerations?
Yes. So it's funny you say and paying yourself, yeah, don't even bother going into business if you're not going to pay yourself. So many therapists feel like they feel guilt around making money, and that seems to be a big part of our culture, and it's something that unfortunately is not addressed in grad school. But I think it's a really, really important part. And I think I was blessed because I'm just naturally more business minded, but most therapists I come across are not. And so there is that guilt, there's that fear based mentality of, oh no, am I going to look like I'm greedy or I only care about the money. And feeling like in order to show that I care about patients, I can't also care about the income that I'm earning. And I think that we can care about both. I think that part of setting boundaries and modeling boundaries for patients is setting boundaries around your fees and making sure you're actually collecting your fees and you are collecting your no-show and late cancellation fees.
And yes, it's really uncomfortable, but that's something to work through in yourself and normalize and not just set the boundary with the patient, but set the boundary with yourself and make a promise to yourself because your time is worth money. That's one of the things I like to share with people when I'm consulting about private practice, is figure out what is your time worth? Because it's worth something. Maybe think about, okay, how much am I getting from a session? And then that's how much the rest of your time is worth. If that's how much you can be paid from one session, then all your administrative time is worth that. Any other time you give to others is worth that amount of money and to not be afraid of asking for that and getting that. So that's just a small piece of it.
But when it comes to what are the expenses, there are a lot of expenses, I'm hoping you'll be able to include a link to, there was an article I wrote for Pollen, which is a magazine by a SimplePractice that gets into understanding the costs of owning a private practice. And I talk in there a little bit about the differences between the costs for solo private practice versus group practice. Of course, the costs really skyrocket for group practice because there are certain expenses that are dependent on number of practitioners and that go up significantly the more practitioners you have, some expenses don't and they just are fixed like rent for a building, but it can definitely get up there. I think it's really important to make sure that all the expenses, and that's why I really like this article is because I did my best to include everything that I could think of because you want to know what you're going to face before you go into it so you can be prepared.
And again, not from a fear-based place, but just because being prepared helps you run a smoother business. It helps you not experience as much anxiety. So one of my major goals in life is to live in love instead of fear. And so that means as little anxiety as possible and being prepared and knowing these things ahead of time helps with that. But things like a healthcare business attorney, they're very, very expensive. You're talking, in my experience, at least $300 an hour and that adds up quickly. But that's one of those expenses that you have a lot more of in the beginning and then a lot less of at the end. But make sure you don't skimp out on these important things because again, it goes back to what I was saying earlier about the legal aspects of it and making sure that you're not breaking laws, violating HIPAA, breaking our ethical code and sticking with all of those working within those parameters that have been set.
So while speaking of not breaking HIPAA, I didn't do this at first, but eventually once the group practice had been going for a little while, I did eventually hire a HIPAA consulting firm to help make sure that we were following all the things because I've had everything, all our systems, all my programs, devices, everything has been HIPAA compliant. But then if you don't track certain things and if you don't document certain things that the HIPAA laws require, you're in violation. So very, very surprising things. So reaching out to them, an accounting firm is expensive. Then you have your EHR, if you have a group practice payroll, a payroll company, you don't really necessarily have that with solo private practice.
But then you have your little things like internet service, your website domain, website design service like Adobe if you use Adobe, although be careful with that because you only want to use programs that are HIPAA compliant. If anything that touches PHI gets even close to those programs. For example, I make sure that none of us have Microsoft products, sorry, Microsoft, but I make sure none of us have those on our MacBook computers, everyone's even required to have a MacBook because it's more secure and less risk of software that can make it vulnerable to bring in viruses. So anyway, so yeah, so keeping things very tight around that. I feel like I could go on and on about all the expenses, but we could have a whole podcast on that.
Yes, and that's been great. You've added a lot of great tips and we'll be sure to share that resource as well for our listeners. So as we prepare to close out, is there any advice that you would give to a practitioner that would like to start their own practice or even branch out into a group practice?
Yes, so I think I have probably three points to make for that. So number one, I'd say definitely listen to your inner voice and follow whatever path comes from love versus fear. It's so easy to let fear, not only influence, but control our decisions, especially when you're running a business and you have so much at stake, such as the financial future of your family. And if you own a group practice, you have everyone who works for you, their families' financial future relying on you too. But as long as you listen to that voice of fear, you're going to hold yourself back and you are not only going to miss out on achieving great things that you otherwise feel driven to achieve, but the world is going to miss out on benefiting from those great things that you have the capacity to do.
Number two, most private practice owners I've come across online share business advice based on their experiences. And so many of them mentioned that they wish they had hired help sooner. And I mentioned earlier that I designed my systems around not having administrative support, and it did work for a while. Eventually I hired, two years ago, I hired a practice manager. And she's amazing and she's my right hand woman and can now do everything that I do. But while other practice owners will encourage new practice owners to seek that help sooner, and I've been tempted to do that in the past as well, but I'm actually really glad that I didn't because it forced me to know every single aspect of my business from the inside out.
And there's a comfort level, a confidence that comes from that. I know I can tell if I've hired someone, a consulting firm or the accountants or, I don't know, a lawyer, if something isn't in line with what I know how it's supposed to be run, I'm well aware of that and I wouldn't have that knowledge and that confidence had I not had my hands in every little aspect. But I definitely think when you start getting overwhelmed, then start reaching out for that help. And number three, my final one is probably really, well, it's for everyone, but for group practice owners, always remember that you are serving three things, your patients, your employees, and yourself. And when you maintain that mindset, you keep your priority straight. But I think it's also important to remember that serving and sacrificing are two different things. And this ties into what we were talking about earlier with making sure that paying yourself.
You do not have to sacrifice yourself, your time or your profit for the sake of serving others. It's healthy to maintain a balance of all three, the serving of the patients, the employees, and yourself. You have worked for so many years, not just... You've worked really all those years in grad school, then your residency and then your licensure time, and who knows how long. If you've been in solo private practice and you're going to group practice, all of that time. You have worked so many years and so hard that you have earned the right to make a good living and don't minimize your worth.
Alena, this was such an insightful and fruitful conversation. Thank you again for joining me today. Before closing out, would you mind sharing your social media handles or website information for our listeners that are interested in following you and learning more about you and your practice?
Yes. So if you are familiar with Linktree, you can go to Linktree, and then my handle at the end of that is my first name dot last name, so it's Alena Scigliano, so A-L-E-N-A. S-C-I-G-L-I-A-N-O. And that is one location that you can go to to access everything that I have. So that will take you to the Coastal Light Counseling website. That'll take you to AlenaScigliano.com website, which is focused on narcissistic abuse. It'll give you the link to the article that I mentioned earlier and any other number of resources that I have. So that's probably the easiest one if you're just an Instagram person at Alena.Scigliano. And then just straight to my website is alenascigliano.com.
Great. Thank you so much. And thank you to our listeners. Be sure to subscribe to the Voice of Counseling on Apple and Google Podcast. You can also follow ACA on social media. To join the ACA and get exclusive access to all the member benefits, check out www.counseling.org. Thank you and have a great day.
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