Every one underestimates the challenges of starting a new business. Starting a new business is hard. It is hard even after you read everything you can find and done tons of leg work to lay a good foundation. And it doesn’t matter if you have built a practice before. It is always hard. Every time.
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As a solo practitioner, I started from scratch twice, in two different communities. And additionally I added two new offices to the ‘mothership’ office. In the end we had three offices, a suburban office, a second office in a community transitioning into a suburb, and a third office in a rural community. To be even more specific, over the years, we had an office located in eight different physical addresses, each requiring a lease, a build-out, staffing, and furnishings. And it was hard every . . . single . . . time.
For more on my early years of practice see this post:
From nothing to something: The beginnings of my practice
And I have another post about the early years of building an organization:
From nothing to something: The beginning of an organization
Below I discuss a few of the most challenging aspects of a start-up. As the saying goes “Forewarned is forearmed.” May this be true for you.
Marketing: It takes time to fill the bucket
Everyone overestimates the efficacy of their marketing. That may be a good thing. Maybe we need some self-delusion to take the plunge.
As I see it, we miscalculate in two ways.
First, the process goes like this. We select a marketing event that we hope will make a big splash. The event happens. It turns out to be less of a slash and more of a drop in the bucket. We come away disappointed.
The Truth? With marketing, there are no big splashes. Just lots of drops.
Drops are a good thing but they are not impressive. After all, how many drops does it take to fill a bucket? Does any one drop impress anyone?
Our problem is one of expectation. And we want that bucket filled and we want (maybe need) it filled fast. In fact we want way more than one bucket full. We want to create a flood. And yet each event is just a drop.
Marketing: Delayed responses
Second, we miscalculate how long it takes from the event date until we see the results. I remember coming away from many an event thinking “this will have a big payoff”. . . and then crickets. Oh, the referrals eventually came but not on my timeline and not nearly as quickly as I hoped.
If we really knew how long it would be before the marketing event would pay off, we might not do it. But we cannot give in to this thought. It will kill your motivation.
The reality is that we need to just do it . . . while knowing that each event is only a drop. But isn’t that exactly the point? Because we can only created droplet events, we need to keep doing marketing events, consistently over time. That is how floods occur–lots of drops in as short a timeframe as we can manage
(To read more about how we did our marketing as a group see this post:
A community-based marketing method: Community Connection Plans
Also look at this post for some of my favorite marketing events:
Marketing favorites that are not a big stretch
And for some wonderful marketing failures see this post:
Spectacular belly flops in marketing
Good billing & collections is really tough
When starting, business problems with billing or collections really costs money. If marketing is about getting people to know you exist, billing and collecting are about getting paid for what you did. And given how complicated our current medical insurance systems are, billing and collections must be done correctly or you do not get paid for completed work.
If you think you want to start without insurance, read this post for my thoughts:
One big mistake is believing that billing and collection headaches can be solved by hiring a billing service. Billing services have their place and some are really good. Sadly, in my experience, they will not do the heavy lifting of getting you on insurance panels and keeping you up to date.
And billing services make mistakes. I have some friends who have had good experiences and then there are the others. For example, I had a friend who hired a service but then had to create his own internal system for checking on whether the billing service had billed all the sessions. It did not go well. Maybe it saved some time but the service just did not have the same investment in being sure every session was billed correctly. We kept our billing and collections mostly in house.
But of course keeping billing “in house” is not easy either. It is hard to hire good knowledgeable help. Those that are available may have the expertise but then why are they looking for a job? This leads to the next challenge.
See these posts about Billing and Collections:
Daily business demand #3: Billing
Weekly business demand #4: Collecting
Finding excellent staff is surprisingly hard
Some you people you interview for a job will straight out lie. Most will withhold at least some pertinent info, in order to get a job. To be fair, I probably would too, hoping I could fill in whatever gaps after I got the job. And of course some do not know their limits. Hiring the right people is challenging.
I found that rather than challenge every statement an interviewee makes, I needed to create a good system for training, monitoring, and correcting issues that may come up. That meant starting with the assumption that no employee is going to come with exactly what we needed. We needed to grow good employees. And yes, sometimes that meant going through a few employees to find the ones who have enough expertise and a good enough personality and work ethic to do what we needed. Hiring, firing, training, and managing–this is what it means to be the owner.
I have written quite a bit about these topics, for example:
Recruiting the best employees for your mental health practice
Conducting excellent job interview for clinical staff
Hiring new clinicians: Building a staff one hire at a time
How we used regular meetings for building our culture
How to become a community of clinicians
The training we never had–Managing
Asking too much?
When starting a new business I have always found it most difficult to find the right support staff. And the start-up time is the most vulnerable time in your practice’s life. Clinicians get graduate degrees that theoretically rub off some of the rough edges. But where do support staff get trained?
We ask our support staff to be good at managing all of the following:
- phone calls that need a sensitive response
- phone calls that require forcefulness
- face-to-face interactions with clients and staff
- managing technology and the frustrations that come with it
- staying organized in spite of tons of interruptions
- handling insurance issues that may require both persistence and cooperativeness
- talking about money and schedules comfortably
And of course, they need to get along with everyone.
Why do you think this is a difficult person to find? Especially when most of the candidates for these jobs have not had training in any of these skills. We depend on their having the right personality and then training them to do the rest.
It is hard to keep myself focused on the right things at the right times
But perhaps the most challenging factor when starting a new business is managing ourselves. Owners are the biggest resource for and hindrance to growth. It really boils down to making the right decisions each moment of each day. And the central argument in many of my posts is that the owner must always be willing to do what the business demands.
I have written posts in this area as well. See these favorites:
Learning to manage myself: Solving my self-imposed roller coaster
The dilemma of success: Do it myself or delegate
On your way to starting a new business
Getting organized around marketing/branding, billing/collections, and hiring/managing while managing myself well is a pretty good start. But of course, there are many other details.