Having consulted with folks from around the globe about building a practice of their dreams I have learned many things. First, dream practices vary greatly from person to person, which is great for the dreamer and the client as it allows for such a wide array of options. Second, funding opportunities vary globally, regionally, and locally so it is a sound practice to investigate options that may be unique to your particular area as no one expert can know it all. In some cases, a town may have money available should you qualify. Third, there are people who are willing to spend a great deal of money buying gimmicks and even more people willing to sell them. Please be sure to do your own homework to help you decide before you buy. Much of what is being sold can be found for free with just a little legwork.
A case in point is that of sample documentation. There are tons of places that are happy to charge you upwards of $1500 or more for a set of sample documentation but you can view and print free versions at sites as well. https://www.docwarren.org/clinician-resources happens to be my page but there are many more to be found as well that also have free information and samples.
There are many reasons for starting your own practice, one of the most common is the desire to offer the public something that is lacking in your area. A chance to make your mark while giving back to your area can help give one the drive needed to tackle such a large task. For this writing, the focus is on developing the key framework for the design of the practice. Future writings will cover documentation, selecting the right space, is it better to buy or rent, maintaining safety in small and large practices etc.
What is your dream?
The first step for most of us is trying to figure out just what it is that you want your practice to look like. Will it be corporate, will it be rural, will it offer a sterile, stainless steel and concrete environment or more of a down home feel; the options are almost limitless. For me, I typically ask people to think about the practice that they personally would want to go to. What would it look like? Start sketching things out. Once you know what your dream place to go to treatment would look like, think about the population you prefer to work with. Would the two be compatible? If not, what would you need to do to modify it to work? What would be your dream environment to work in? Would this blend in well with the population you wish to serve and the type of place you would want to go to? The more commonalities you find, chances are the closer you are to your dream practice. Don’t be afraid to go outside your normal comfort zone and do not hesitate to do things differently than you are used to. Innovation often takes risks and so long as you stay within the bounds of laws, ethics and consider best practices you should be fine.
As you continue to build that dream practice and have a general idea of the treatment setting you would prefer it is important to make sure you find an area where there is a need. It will be very difficult or nearly impossible to succeed if you open your practice in an oversaturated area. Do some homework. Consider the population you are targeting, the overall population of the area and the number of providers. Though some very large cities appear to have a provider every few feet, the dense population allows for them all to grow their practices but take a small town and add more clinicians and you may find that covering your costs, let alone excelling may be beyond difficult.
Some folks find that relocating will be the best option for them once they flesh out their dream practice. If this appears to be your best option as well, consider the costs of relocation in your start up projections. You need to remember that, making ends meet during the first several months to the first 5 years of your practice can be problematic. The first five years of any business can be viewed as the “bloodletting” stage as the business will have some of its highest outlays of cash and its lowest influx of funds during the time (some exceptions may apply).
Sadly, we have all likely seen some very talented clinical professionals go out on their own only to run out of funds before they are able to lay the proper foundation. Some of the equipment and supplies that are in use at the programs I run have come from “fire sales” held by other programs that failed to thrive. In most cases it had nothing to do with the quality of care provided but more to do with the financial realities that the founders were ill equipped to deal with. (I’ll be writing about budgeting a practice in later blogs).
Before opening a practice it is important to look at your credentials to make sure you meet the statutory requirements for private, group or community based programs in your province. Some folks have grown comfortable working for other programs and fail to realize that credential requirements may have changed for independent or other programming and that they may not meet the requirements. Should this happen to you it is important to remember that you have options. You may find that you simply fall a few credits short of the credential needed and can take the classes prior to opening or you may be able to hire someone to join your program that has the credentials needed. Whatever the case, be sure that you only practice in a capacity that is allowed in your area.
One of the biggest issues found in new programming is that you get a dedicated clinical professional that decides to open a practice or that is promoted in an existing one to a supervisory role but they lack any training or education in this area. Being a good clinician does not mean one can be a good administrator. Getting training, education and experience in this area can make the difference between success and failure when supervising others. To this writer, a credential as a supervisor is as important to a clinical supervisor as a credential in counselling is to a clinician.
You have a rough idea of the practice that you want. You are ready to write your business plan when you realize that the initial outlay of your practice greatly outnumbers the available cash that you have for this endeavor. Feeling discouraged at this level often leads folks to abandon their dream practice and either stay where they are or to look for a job at another facility. It’s often far easier to work for someone else than it is to build something from scratch and it often costs far more to try to buy an existing program and to make it your own than most clinicians can afford. Here again is where creativity can lend a hand. Can your dream practice be built in stages? Look to what a bare boned plan would look like for you and your dream practice. What can you do to get started on a shoe string budget and what would you need to do to see it blossom in time? Are you willing and able to make the necessary sacrifices? Can you negotiate rates that you can afford to pay your expenses? Think. What do you absolutely need before you open your doors? What can you get after your practice starts to collect fees? Do you know how to break thins down to manageable pieces? If not, this may be a good time to find a fairly priced consultant to help you flesh things out. Do be careful on how much you pay them however as it will likely be coming out of your already limited war chest.
Case study: Community Counseling Centers of Central CT Inc. – Pillwillop Therapeutic Farm.
I’m writing this as I take a break between cutting wood and doing clinical sessions at the therapeutic farm that I founded and that is owned by the charity that I created in 2005 with a war chest of just seven thousand dollars. From the founding of the charity we knew that we wanted to incorporate nature with our therapeutic work and hoped to one day get land to do it on. For the start however we settled for the first floor of our home which I had remodeled into an office (the house is set up much like a two family home. I removed the kitchen and reconfigured the rest of the first floor to work as an office. We still use it till this day). Years before I built a second floor onto the house so we were lucky enough to have a space at the ready for this endeavor, if we did not, we would have had to be more creative.
We did not select this space at first however, as we looked at several options but found ourselves always comparing it to what we already had. Once decided, we used that seed money to do all the paperwork and pay all the fees required to be a charity. I researched the requirements and with the help of a colleague or two I wrote the bylaws and filled out the legal documents. I had a lawyer review them prior to submission. Thankfully, this lawyer had served on a committee with me previously and reviewed the documents on a pro bono basis.
We started with mostly old furniture and a computer that I had used for school. We lacked a fax machine or a fancy office type phone system and instead used a decent home system that allowed for up to 6 cordless phones. We bought a small sign for the front and sent out some press releases that we had opened. Other than cards and pens, we never did any real advertising: we still don’t actually.
Over the years we have changed some of our focus client wise but overall we are true to the day when the plan was first drafted. As income came in we upgraded furniture, bought a fax machine which was required to have by some of our insurance plans and spruced up the office as needed. We always kept costs low and did most all of the construction and remodeling work ourselves.
As time went on we tried to lease or buy land but were often too late. Developers often bought the land before we could get the financing in place. Cash can be king as they say. Still, we were undaunted. In time we had outgrown our space even though we had added to the original floor plan. We needed a second, larger location.
A family farmer had been thinking of making his farm a nonprofit and we attempted to help him make it happen. After a time he approached us with an offer to sell us his farm one deed at a time. He was more interested in seeing the farm that had been in the same family since 1860 go to the right buyer than to the buyer with the deepest pockets. The farm was overgrown due to a lack of available hands but it had good bones. We bought the first section that was about 25 acres, give or take and it also had a large shell of a building that had been started in the 1990’s but never finished. That would one day become our main space, offering about 7800 square feet of space. We began by cleaning it out, framing the offices, building a bathroom, fixing the electrical that was there and adding a great deal of new as needed. In time we insulated, sheet rocked, painted and did flooring. We started off with electric heat and then added a pellet stove while finding funding for our HVAC system. We added a well, two seasonal high tunnels (greenhouses) and some equipment.
We opened the offices when we had just one small section ready and we’ve added areas as they were completed. We now have 6 clinical offices including one that also doubles as an art based therapy area (about 900 square ft). We have two large shop areas and a community hall that is awaiting insulation and sheet rock as we speak.
The program has much left to do before we call it complete, the list actually grows as we check off items. Plans for a large pavilion and additional hiking trails are in the works as our plans to add additional fruit groves and Christmas tree fields. As of today, our attorneys are working out the final details for the purchase of 25 additional acres that are part of the farm. The original farm house and 2 acres of land will be the final purchase that we make from the original owners. Who knows what we may add in the future.
There have been many steps and several setbacks but we are as close to our original plans as we could possibly be. One of the best parts is that we are not mired in debt. In fact, other than our mortgage, we have less than fifteen thousand dollars of debt and that is due to the fact that we recently purchased 4 new furnaces, ac units and ductwork.
Never let the reality of low funds prevent you from building your dream practice…
Be safe, do good
-Doc Warren
”Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, clinical & executive director of Community Counseling of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). He is internationally certified as a Counsellor and Counsellor Supervisor in the USA and Canada (C.C.C., C.C.C.-S, NCC, ACS). He can be contacted at [email protected]
*The views expressed by our authors are personal opinions and do not necessarily reflect the views of the CCPA