STP 15 |
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James Marland: Welcome to the Scaling Therapy Practice. This is James Marlin with Dr. David Hall. Hello, David. How are you?
David Hall: I'm doing well,
James Marland: James. In this episode, we're gonna talk about when scaling fails and the, uh, what to do when that happens. Uh, but first we're gonna talk about our tool tip or tech of the week, and I'll go first.
James Marland: And I like using the program descript. It's something that I discovered a couple months ago for editing audio and video, Dave. Did you suggest this
David Hall: to me, David? Did you I think so. Like, I, I think I was the, the originator of it at least. No, no. Gordon, lemme, lemme clarify for you. I think I was the, like I heard about it from, uh, the online course guy Online course show, podcast, and I started using it around the same time for a different project and I, it's really cool.
David Hall: It, it's quite, um, intelligent.
James Marland: Yeah, and I might have talked about it before, but I, I just , I use it every day basically cuz I'm doing some content creating and I really like it for the ease that I can. Upgrade the audio. The, the way that I can edit, uh, video and add quickly, add little flares and, um, video.
James Marland: It has a video library I can put over top of me talking . I did that recently. Or if I, if I make mistakes, I can easily edit the text. It transcribes the things that I say and then I. Transcribe it. And I think one of the features I didn't talk about maybe was called overdub, which it learns my voice and if I say something wrong, I can select the phrase and type out a new phrase and it rerecord my voice right over top of the messed up part and it.
James Marland: pretty good. I mean, if you're just listening to it and you didn't know it was over dubbed, you would have a hard time saying, oh, a computer recreated his voice.
David Hall: It sounds more like it's good for snippets, like I've seen people do it for like longer sentences. Yeah, it's not, not the same. Yeah. Not, not quite the same.
David Hall: It, it feels, it makes me think a bit about, for those who remember the nineties movie, men in Black and. Vincent Donofrio's character as an alien inside a person's body. , it's kind of stilted in that sense, is what it, what it makes me think like. But the, uh, anyway, yeah,
James Marland: so Ben Script is my Techer of the week.
James Marland: It is, it's pretty great. And if you're creating content, it's a wonderful tool. Not super expensive. Mm-hmm. . All right. What's your, what's your tip or tech? My,
David Hall: my tip. And it's related to what we're gonna talk about today.
David Hall: when you have any idea, it might feel pretty original to you and it may be fairly original, but if we explore enough, usually there's somebody, if there, if we're thinking about something we wanna do, there's somebody who's done something similar. Mm-hmm. . And if you were looking at a new venture, make sure to take time.
David Hall: to find and talk to somebody who's done something or in the closest approximation that you can, and talk to them and ask questions. And because this is, we're gonna talk today about when scaling fails. And I have a story about that, a big one. And that was something I, I, I went into the thing with a lot of research.
David Hall: I researched a lot. I, but what I didn't do was talk to a person. Hmm. And ask the questions of, Hey, I'm thinking about this. I see you've done something similar. I would've asked the questions like, what's been great about this? What are the things that you didn't know before you went into it that you wish you would've known?
David Hall: Now? What are the things you regret? What are the things? And it may have been a lot of work to find a person to be willing to have that conver, to have that conversation with me. It, it would've involved finding a pretty unique person and then then being willing to talk with me and that. required, uh, some time, but it would've been invaluable, uh, in that.
David Hall: So it great whenever thinking about something to scale, seek out other people as you can. Learn information, as you can find blogs or articles or YouTube videos or whatever it is, that's helpful, but. when you can actually talk to a person. Because if, if somebody has a YouTube video on a topic, they're usually often trying to sell the idea, right?
David Hall: And part of talking to a person is you need to be able to, to hear about like, what about this was harder? What about this didn't work? The stuff that doesn't often get included. In pitchy courts material. So anyway, that's my tip. Good. Uh,
James Marland: yeah, that's, that's, uh, see, see what is working for somebody else and figure out what, what they're doing that made it work.
James Marland: And also the, the situations, um, It's really hard to take somebody's idea, you know, from a, even from a YouTube video or something and put it right into your company or to your place because there are unseen forces that you don't know about it. Your culture that, uh, That can play either a, a, like a sale or an anchor to the new idea.
James Marland: So it's good to talk and dig a little bit. So that kind of leads us to our main topic when scaling fails. You were talking, we've had a few conversations about this, uh, where you wanted to add another product or a product line to your business as a psychiatrist. Right. and, um, I'll get us started and just ask, ask a couple questions about that.
James Marland: And you tell your story and I'll keep asking, you know, what, what were some of the decision points you made, but yeah, you, you had a group practice, right? And you decided you wanted to add a. Psychiatrist, is
David Hall: that the kind of that It's funny that, that is, um, I think for people who are in this situation, that probably would be the starting point and the natural starting point.
David Hall: I actually was in reverse. And, uh, but if, if you're listening, you know, that could be part of what you're thinking. You have a group therapy practice, uh, counseling, psychotherapy, practice, and Well, if I, I want to add a medical provider to add some complimentary services, so m. Way of getting there is a bit more circuitous.
David Hall: Okay. And not, not typical, but it was, so I worked, I was an employee for a group therapy practice. This is how it starts. I already had a teaching business and I was doing some consulting already at this point. But my role as a therapist was, as an employee. I, I worked for another group and I, um, because of other opportunities I was presented, I, I was presented with some startup capital.
David Hall: To try something. I had been working, uh, in a startup process for a drug and alcohol, uh, treatment center, residential treatment center. And that had gone, started well, and we were looking to start something, uh, as a co, as a companion program to that, that I was going to lead, uh, as, as, uh, as a executive director sort of thing And mm-hmm.
David Hall: That, uh, ended. not happening because of the, the partnerships involved. It just didn't come together. Okay. But I had already kind of earmarked to start something and then the, I was given the opportunity to say like, well, this thing we thought we were gonna do isn't gonna work. What, do you have any other ideas?
David Hall: And I had a few different ideas I presented, uh, to the investors and, and one of them was a psychiatry practice. And they said, oh, I like that. Yeah.
James Marland: Why did you think that was gonna work? Like what was the, the,
David Hall: the thought behind as a, as a group, as a, as a therapist in the community that I was in, I often would need psychiatry referrals.
David Hall: Okay. And, uh, not all the time, not for a lot of my clients didn't need to see a psychiatrist, but enough did. And I knew how hard it was to get a psychiatry. for sure. Connection. It was, there was a lot fewer of them in the community. The, there were a handful of ones that I would send people to, but it would sometimes take weeks and weeks and weeks.
David Hall: Sure. Yeah. To get them in. And so that kind of showed me that this was a high demand industry and at the time, this was around 2015 that this was happening. And, um, The, it's in, at the time we're recording this in 2023, I, I feel there's a lot more available in psychiatry, at least in my community for what is called mid-level.
David Hall: So commonly nurse practitioners. Hmm. So not physicians, but, uh, nurse practitioners or physician assistants. And there was fewer those available at the time, but I knew that was an option. that I felt was being underutilized. And so I had this idea of what if we start a psychiatry practice that's very nurse practitioner forward in a lot of the, the providers.
David Hall: And we can scale that way because nurse practitioners, there were more programs locally producing them in, um, with the mental health psychiatric specialty. And I had a friend that worked it as a psychiatric nurse practitioner. I thought, well, I could put this together. So, but to your question, James, I saw a.
David Hall: Yeah, and I had worked in an adjacent sorts of things. I never worked in anything medical directly before, outside of mental health of, of non-medical mental health. But I thought, I, I, I see the need, I have some relationships. I think I could put it together. So I presented that and, and the, the decision maker said, I like that idea.
David Hall: Let's go with that. So that's how I ended up. So I did not have a group practice.
James Marland: Okay. Well, it seems like a solid idea just from my experience working in psych, uh, in men, uh, mental health. Mm-hmm. , it, it always, people were always looking for psychiatric services. In fact, when the program I managed was, uh, assisted psychiatric evals, Where a master's level person would take a lot of data and do most of the paperwork, and then present the case to the psychiatrist so that they could see more people and, and just do their psychiatry stuff.
James Marland: Not the paperwork, not the uh, the, the referrals. We did a lot of like co coordination of care things for them. Mm-hmm. so that they could get in rapidly. And that has just been my, I've never. I, I don't know. Have you ever been to a place where they have too many psychiatrists, uh, or medical practitioners? I just have never, I've never heard of it, so it seems like a solid idea just from the, out, from the outset.
James Marland: And I will say
David Hall: it was, it wasn't that the idea Uhoh wasn't solid, it was my ability to step into it and lead well. in, in certain ways. And so like, yeah, for those, considering that as an option, I will say I feel very confident now of how to guide somebody into adding psychiatry into their practice, particularly if they have an established practice.
David Hall: I've, I actually thought about doing a course about it, just haven't set the time for it and, and we'll see, but the, in the future, but I, I feel pretty confident in knowing how to do it now, and so it, it wasn't a bad. .
James Marland: Okay. So that's where the idea came from and, uh, what, what came next?
David Hall: So I, I started doing research and as I started with my tip of the day, the one thing I didn't do was find somebody who was already doing it, but I did find people at least, or I did find people that were doing it, but not, um, I never had a conversation.
David Hall: I would like look people up online. I was, I was doing research data and there was about, um, four or five months of myself and another, Individual who was an mba, had worked, who was helping, who was working the startup process with me. And we spent a lot of hours just doing, you know, uh, the legwork of looking at other models.
David Hall: Yeah. What, what
James Marland: is, what is some of that legwork when you're
David Hall: thinking about It? Was, I was looking up of, You know, other psychiatry practices throughout the country. And so I was trying to look at models of how people advertise, but also like, what were the rates people were charging? Right? What was the, uh, when I, I teach people when they're coming up, when they're wanting to do workshops or retreats or things like that, which is something I teach, the first thing I, I encourage people to do is come up with a comp list, a a, which comp stands for comparables, and put it in a spreadsheet where you look at like things side by side.
David Hall: Okay, what are the, the measurements that we're looking at, you know, what are, how many providers does this place have? Uh, what's their market like? What community city are they in? What are they charging? . So
James Marland: look like digging a little deeper, not just like looking at the surface, but seeing where, where these different practices successful and maybe non-successful stack up mm-hmm.
James Marland: with, with some of the data that would be useful to you. How many do they see? What are they pay? Yeah. What are the, what are the prices? What is the marketing? Yeah.
David Hall: Um, and some of that too was I was looking at, of hiring, like, what, what should I expect to pay for somebody? in this, but you were talking to James about care coordination.
David Hall: That was part of my idea was I thought, Hey, let's have some care coordinators. That's what we called them. Mm-hmm. . Mm-hmm. people that were, um, a far less, uh, expensive per hour. Oh, for sure. That basically they did the case management sort of thing and just, you know, tee things up for the, for the, mm-hmm.
David Hall: prescriber, and that was my idea. It was a great. , but the, I still think it was a great idea, but, but the implementation, so you
James Marland: gotta find the right, I mean, you gotta find the right prescriber for that. Mm-hmm. , because, uh, there were some prescribers that came through the department who liked the model and liked seeing the rapid people, and they felt like connected.
James Marland: And there are other ones that were like, well, I miss, you know, those ancillary things. I miss doing that. and they, they weren't the best fit for that type of program. But that's a, that's an aside. Some people don't want any of that stuff and they just wanna see the people and other people like to take an extra 20 minutes or whatever to, to really wrap, wrap it out.
James Marland: So anyway, that was my,
David Hall: it was, I, here's where it, it didn't, so I think the, the concept was good. Here's, I'll, I'll highlight the things that didn't work and the pivot from that. Sure. First level things that didn't work was, uh, high level, uh, leadership, myself included. And I'm, I want to be mindful here cause I don't wanna be throwing anyone under the bus or.
David Hall: Or speaking, ill beca, but, uh, it was myself. Uh, then I ended up finding a psychiatrist and the idea was that the psychiatrist would, would lead the medical team and that most of the work would be done by psychiatric nurse practitioners. And that was the mm-hmm. the goal? Mm-hmm. , um, and then also hired a, a practice manager, somebody who had worked in the medical side of things in the past.
David Hall: And, you know, for these other people, they were in different phases of career. Some of it was early in our startup phase. Uh, we had some quick turnover. The, the person I was working with in, who was kind of the coo, the b a mm-hmm. , uh, they ended up leaving the project pretty early in the. Gestation of it because they had an part of it was, is they were in a new relationship and their, their soon-to-be spouse was looking to live somewhere else.
David Hall: Mm-hmm. . And so someone was just family related, had another job opportunity. So it just shifted. And so that kind of created some, some things and then, but we still had. What on paper should have been enough of an executive level team?
James Marland: Uh, the, the question that comes to my mind, is there anything you can do to prevent those types of things or to prepare for staffing changes?
James Marland: Because it sounds like that was pretty disruptive. And when, whenever I was running my company, staffing changes were, they were, they were , they were the devil. I, I don't know what to say.
David Hall: They were just like, yeah, it is, it's, it's one of the most expensive things, the media to
James Marland: your, yeah. To your earth.
David Hall: Yeah.
David Hall: So it was one of the most expensive things in any business is staff turnover. Yeah. And, um, you know, that's an interesting question, Jay. I, in this situation, I don't think so, right. And. But I could have pivoted better. And, and that was, but basically what it was is I came in with, I've not, I had not led anything like this before.
David Hall: Like I said, I had gone from being an employee to, I had led my own teaching business, but that was a very low, like, I didn't have staff for that. That was just me. Yeah. So that was a really solopreneur sort of, . Mm-hmm. , I didn't have experience in leading a team, and a lot of my foibles, a lot of my shortcomings get really highlighted in this.
David Hall: And, and so some of it for me was, and I've said this in episodes before, I'm not a great manager. I, I'm better at it than I used to be. Sure. But some of the, some of the things that make me not a good manager is I have a hard time, uh, in holding. , uh, I'm a people pleaser or I'm, I'm inclined to that mm-hmm.
David Hall: Mm-hmm. until I get just fed up. And that's just, that's a different thing. But I, I'm, I can overly accommodate and part of that is I don't always set good boundaries. And there's, and this is a job that needed that because I was dealing with a lot of staff and a lot of, and, and, um, a lot of personalities.
David Hall: And I needed to set better boundaries and hold people to. ,
James Marland: so that goes to agency. Do you feel like you were so, so, I, I fall into this trap too, where I, I fall into the people pleasing rather than working for the business and making the best decisions for the, the company. I'm an agent of the business. I like you as a person.
James Marland: Mm-hmm. , but there's something I gotta either address or bring up or mm-hmm. have some sort of conflict rather than saying, Not basically avoiding the conflict and saying nothing. So where does, does that hit
David Hall: anything about? It does absolutely, like there's some of that, and part of it was my, I, I was inclined to take on the responsibility for whatever needed to be fixed on my own, uh,
David Hall: Yeah. And, and so that meant I was putting in effort and extra hours and doing things. , uh, of, and so there was a lot of that. Um, I, there was poor payment models. Part of it was as I looked at this model of like, what does a nurse practitioner make? And so I was paying people on salary, which was a huge mistake.
David Hall: Mm-hmm. , um, Because we were doing that before we even had patients kind of coming in, and so we were running at a deficit from the beginning. From the beginning, yeah. Uh, my, my goal was, is how do I close it quick enough? The problem was, and I, I, here's, here's, I guess a to, so number one thing that, that I failed out was, uh, my capacity to lead, uh, uh, accompanied this complex staffing-wise was not, I did not have the experience of maturity.
David Hall: and honestly, it's not something I would choose now in this sort of way because there were, there were too many moving pieces of, there were medical providers, there were support staff, care coordinators, there was receptionists. Now part of it was that I was looking for these other leadership positions to manage those differently than they did.
David Hall: Mm-hmm. , and there was, I wasn't the only one deficient in my managerial
James Marland: duties. It sounds like you grew really fast without the supports to. The strong, the strength to, uh, sustain
David Hall: it. There was that, so there was, there was the deficiency there. Uh, one was, um, I had. I, I miscalculated how quickly we could grow.
David Hall: Cuz I looked at like, Hey, there's a big need for psychiatry in my community. There aren't enough providers will be full in no time.
James Marland: You, you open the doors and you'll have to beat the people away.
David Hall: And the truth was we did get referrals starting at the very beginning. But here's some a model I didn't realize.
David Hall: I had only worked the model as a outpatient counselor. And looking at like, how many new clients patients do I need as a counselor to get full? And for medication management in most outpatient settings, it works at a very different scale. Whereas I will take on a new client and see them weekly or maybe every other week, but usually not less than that.
David Hall: So what it takes for me to fill up a week doesn't take a lot of clients. Yeah, yeah. But a med provider will do an assessment and maybe like, I'll see you in two weeks and then after that six weeks, and then the fall appointments are for 15 minutes, not an hour. Yep. So I did the math and it was something like one.
David Hall: Full-time scheduled medication provider on the model we worked, which was, you know, average follow-up appointments being 15 to 20 minutes, so three an hour based on the general frequency that they did. One nurse practitioner, if every one of their patients saw a therapist, one nurse practitioner would've a caseload to fill 70.
David Hall: The.
David Hall: It was highly disproportional, so, yeah. Yep. What that meant was, is like when I would have three nurse practitioners, four nurse practitioners, one of my main roles in the business was to, uh, go out and drum up work. I, I was the main marketer. I was going out, uh, I was delivering edible arrangements. That's one of the big things I did to like, uh, different.
David Hall: Mm-hmm. , provi. Mm-hmm. . I mean, I was the one meeting. Counseling center owners and other referral partners. I did a lot of marketing and I will say I did not fail at that. What I didn't anticipate was how many referrals we need to be generating to fill out the providers we had. So
James Marland: it sounds like you had multiple providers.
David Hall: We did, because part of it was is that, uh, we would bring in people and we would, we would look at like, okay, well if we're gonna grow, I kept on, it's like Amazon. , like, we're not profitable yet, but we've gotta get our capacity there. And so I was bringing on people. We never reached profitability. We never, and you know, we were generating tens of thousands of dollars a month.
David Hall: uh, for, I, I, I developed contracts for us. We, we had general patients, but then we also, uh, we started doing telehealth contracts, and this was in 2016, 2017. That's pretty early, early, and we were really on the, the edge for telehealth contracts and we were providing in different states and. Anyway, it was a, it was a big process.
David Hall: And, but, so the first bit was managerial. Second bit was, I didn't realize how much we needed, how much it needed to be fed. Mm-hmm. to really kind of get it going. And then, uh, the third thing, and this is the, is that when stuff wasn't working, this I could go back to managerial. When Steph wasn't working, I wasn't willing to walk away.
David Hall: I felt like I just, I'll just put in more energy. . And again, some of it was the other leadership in fed some poor expectations. You know, it would be like, well next month, you know, in two months we'll get it, or something like that. And, and that wasn't the case. And I don't know if, if it was their own wishful thinking or what other things were, but um, I had this idea of why I don't wanna quit.
David Hall: I don't wanna be a quitter. Right. And here's, here's a reflection on James, like you. , I, I needed to be a better manager and hold people accountable. E even not being a naturally good manager, I, going back now, I would've needed to hold accountability for sure. For people in that differently. I needed to have better expectations of what growth was going to look like.
David Hall: Mm-hmm. The third was, is I, I needed to, when it wasn't working, I needed to, and I wouldn't let myself do it. I could have, cuz in the end it ended up being a huge financial loss for, uh, the people that, that backed me in it. We never made money in it. We never, um, and by the time I reached the end, I knew enough at that point how to turn it around, but I was exhausted.
David Hall: Mm-hmm. , I did not have the capacity to do it anymore. And so I, and I'll say part of the silver lining is the company I started still. I, uh, I, we, we did a transfer of ownership to the employees, the, the high level people. There was, uh, the, so the, the other executive level people went on to go do something different, but at that point we were serving thousands of patients Wow.
David Hall: In our community and the nurse practitioners. Um, we had one particular nurse practitioner who had worked as an, as a director level position in previous jobs, and so they had experience in that and they said, Hey, we wanna keep. . And so we, we allowed them to kind of take over the business and we, we did kind of a, a transfer of ownership where they assumed certain liabilities and mm-hmm.
David Hall: uh, and, uh, uh, oh, I can't think of the word, but like the, the, uh, made us non liable for things. Mm-hmm. for, for certain things, but, uh, it wasn't a, it wasn. You know, this wasn't like a sale. It wasn't like we, we yeah. Did something, but it allowed the business to keep going. And I felt, I feel very good about that because the business is going now and is successful, but it needed to run very differently than how it was being run at the time.
David Hall: And it needed different people in decision making and leadership, holding other people accountable. And, and, but I think the biggest lesson I was, is for myself. I didn't have, uh, I learned a lot about myself in the process. . Mm-hmm. . I learned a lot about the industry that I didn't know about, that some deeper conversations would've been, and I needed, but looking back, I look at like, I should have pulled the plug on this sooner and would've lost less money if I had done it sooner.
David Hall: I, or I should have made harder, pivot sooner, but I had my identity wrapped up so much in the successor failure of this. Yeah. and that's what needed to stop. And that, that's the, um, whenever you try anything, anyone listening, whatever idea you have, your idea might work, but you'll have lots of ideas that won't, that's the nature of any sort of creative endeavor or the version, even your ideas that do work, oftentimes it will not be their first draft.
David Hall: You'll go through some iterations of it before it really works, and that's okay. That's not failure. . That's right. Yep. It, that's the learning process of scaling.
James Marland: Well, my, and, and I've lived with this for a long time. I, I want to make things right, so I. Research and plan, but don't always get started and you can't do your best thing if you don't do your first thing.
James Marland: Mm-hmm. , you gotta, it's like one of the, one of the mantras of being an entrepreneur is you gotta get out there and start something and try something. And, and we've talked about this in the past, the identity thing is so key because if you see your, if you're, if. Worth rises and falls on how good you do.
James Marland: You're gonna ride the rollercoaster of your life, or you're just gonna say, I'm not even gonna get on and I'm just gonna go straight. But you're not guilt getting anywhere. Yeah. So, yeah. Uh, that identity and getting ready to start or start something and see yourself as the, the scientist, right? The, the one that does the experiment.
James Marland: And you look at the data. Did it, did it prove my hypothesis? Did it give me more data or did it. Did, did it fail completely? Uh, there, I read a book, the Startup J Curve, it talks all about like how there, there's, uh, there, there's that cycle that you go through, so mm-hmm. ,
David Hall: you know, and it, that was for me and I learned so much.
David Hall: It was, it was a hugely valuable education for me. I became a much better business owner. But what happened at the end of that? I needed to do something at the end of that as, and so that's when I started my group counseling practice. Wow. And, and part of it was at the same time I had been doing some adjunct teaching and I had two of my students from grad school who were graduating and were looking for jobs and I was a supervisor.
David Hall: And so that was how group practice started was I was leaving the, the psychiatry business. Mm-hmm. and. I needed to do something. And honestly, it was a huge real. So I, again, it, I did it backwards where I started something much harder and then moved into group practice. And group practice was way easier because I had far fewer variables to manage.
David Hall: Mm-hmm. , I had, I had been marketing for medication providers and then helping psychotherapists market was way easier. I needed, we needed a lot fewer patients to make that a full schedule. Uh, but I was a much better. Group practice leader having gone through the failed startup. Mm-hmm. , I would've loved those lessons more cheaply, , and with less heartache.
David Hall: But it's how it came to me. But what I, I look at, it's not that like I, I feel I didn't like determination. That wasn't where I struggled. I, I lacked boundaries. I lacked realistic assessment in certain area. and you have to be willing to walk away and, because anything, any number of things, you're gonna try.
David Hall: Any there. It could be business partnerships, it could be product lines, it could be, there's a, it's like Kenny Rogers talks about in the gambler. Mm-hmm. gotta gotta know when to walk, walk away, and you gotta know when to run . But like, it's the, uh, because if you, if you're too, you know, you can have passion for what you do.
David Hall: But it's important I think to have a certain level of indifference, of cultivating indifference is something I talk about. Indifference does not mean not to care. Indifference means not to personally identify with, right? You are not your business. You are not your right practice. You are not like you are.
David Hall: You work in your practice. You work in your business, but it's not you. And to have that identity differential creates a lot of freedom. because if I had had more of that, I would've, I think, looked at it differently to say like, this isn't really working. How do I pivot to either change how it's functioning and, and part of the reason it was my codependent slash poor managerial things that kept me from pivoting.
David Hall: Cuz there were certain things I felt needed to be different, but it would've involved moving some people out of the business and relationally I wasn't willing to do that. Mm-hmm. . But I didn't save anything. In the end. It was in the end, those relationships moved that way. Anyway, yeah, that
James Marland: makes, yeah, it happened.
James Marland: Anyways, just a little bit further down and a little more expensive. Absolutely. . Yeah. And, and I think Mike Mccolo talks about this in one of his books about, uh, you're gonna have to make those decisions eventually, and the best thing to do is to prepare people. Rather than being like, one week you can't pay anybody.
James Marland: And now everybody.
David Hall: And that's what it, I mean, it would be, yeah. It was an intense period of stress. I was deeply unhappy. Mm-hmm. Um, Core people in my life could see it. My family saw it. My, my wife saw it, my, you know, it was, but I, I was just so stressed and I just felt like, and, and one of my business advisors asked me, Tor right before it fell apart.
David Hall: He asked me, he goes, well, are you having fun? And that it, that, that irritated me to go in that question because I said, who said this was supposed to be fun right now? Like, I'm not trying to not have fun, but like, this is, I'm just trying to keep this alive. Mm-hmm. and. and to do business isn't gonna be fun in every moment, but there was no joy anywhere at, at towards the end.
David Hall: I was just constantly feeling like I would, I, I know one of the key things was, this was towards the end of the cr, the life cycle of this endeavor was I had just secured a telehealth contract with a guaranteed income of, it was something like $40,000 a month of like, of a, of a contract. And that was on top of other things we were.
David Hall: And I worked really hard in negotiating the contract. It was a lot of like back and forth, and I'm not an attorney, but I had a, I was writing up the contract and all the details and things like that, and, uh, and they agreed to it. They got, I got the end, got this deal where it was a guaranteed additional income, and my wife asked me, she goes, aren't you happy?
David Hall: and I wasn't really mm-hmm. because I just felt like I could see the bucket that this was being poured into, and it didn't fill the bucket yet. And I thought, this is, I'm, this is bad when I can add this much revenue on top of what we're already making, whatever. Yeah. And it's still not enough. And, and because I also knew that like the, the, uh, knockdown effect of this contract would be, New expenses would come up.
David Hall: The people I was working with would want new expenses to pay for. And it was just, anyway, it was, um, I, I'm, I'm very happy though not to do that anymore. Uh, if, if you're considering to do it now, I'll end with this. If someone says like, cuz I don't wanna dissuade people from doing medical service if they have a vision for it, but here's how I would've done it differently.
David Hall: Yeah. Um, I would've done it much, much slower. .
James Marland: Yeah. It sounds like, yeah. That you came to that realization after the fact.
David Hall: It was, it was building it all at once and you know, I would, I had the mantra in my, in my mind from the movie Field of Dreams, if you build it, they will come. . Yeah. And that wasn't a helpful mantra.
David Hall: It was. Uh, I, I've become a much, uh, firmer believer of the lean startup. Mm-hmm. , most things I do right now, I try to take a lean startup, uh, mindset of how to do this in the most economically. Efficient way
James Marland: possible. Isn't that a book, the Lean
David Hall: Startup? I think so. It's talked about it in a lot of different people, and I think it probably is a book, but the, uh, so much firmer believer that if if what I was would be doing up, if, um, if I had a group practice, like a group counseling practice, which I do and was looking at this, I would look at having one part-time person mm-hmm.
David Hall: and see what that would. and, and, and I would take notes like, how long did it take for them to get full? How long to like, and some of, one of the things would happen, I would hire people because good candidates would come up and I would be fearful that I would lose them. So I would, I would make hires before we were really ready financially because it's like, well, mm-hmm.
David Hall: and I, I should've let those things go. I should have been, and that's something I've learned even as a, as a group practice owner, as a therapy practice. that I have to let good candidates pass on by sometimes because if it's not the right timing for the business, trying to force it to work outside of the right timing just doesn't work.
David Hall: But I would've done it much more slowly allow it to build much more organically because I was scrambling all the time cuz I, I had multiple providers I was trying to keep full. . And, and one of the things too is, is even for the providers, they got used to getting, making their salaries by only seeing like, you know, a third or half of right patient load.
David Hall: And one of the things that happened is we got Fuller, they wanted more money, because they were used to like, well, I made this much money when I was seeing this many patients. Now I'm seeing twice as many. Right. I should make more money. And I'm just like, this is, I went through this backwards. I should have, um, I wouldn't have, I wouldn't pay people's salary if I was starting.
David Hall: Again, I, I would, I, I wouldn't have been able to get full-time people right away, but I would've But the
James Marland: business couldn't sustain the full-time people. No. It was all
David Hall: debt. Not out of the gate. No, it was, it was at the beginning. It was just all debt. Yeah. Of, of just kind of coming in and, um, and, but that's because I would not have let myself develop that debt.
James Marland: So is that your, is that your one thing, the one thing you want people to remember, or do you have another one thing
David Hall: that you want? That's probably the one. The one thing is, is that, , lean and slow is great. There's, there's any number of ideas. If you have a different idea of what to start. There's so many things you could spend money on.
David Hall: If your vision is to start an online course, , uh, James and I have been in this process as James has been starting that for the first time, and there's so many tools and tech and subscriptions that you can buy at the beginning. Yep. So many, and you can justify it sometimes in the moment, but my encouragement, whatever you're starting, start at the leanest way possible.
David Hall: You can always spend money, more money later, but it's easier to be successful and spend more money than it is to scale back. Mm. because sometimes you get dependent on their systems and, uh, uh, scaling backs harder.
James Marland: Great. Uh, so my one thing is, uh, is embrace reality. I think, uh, we, we talked about looking at the data and then making the needed decisions.
James Marland: I, uh, one of, one of my problems I think was running a business was like, Running on ho. Hope you know, instead of running on the data in reality's, one more client, one more month. One more great staff, one more, you know, big contract. And then, then we'll be, we'll be, be um, ahead instead of like looking at, well maybe we're spending too much money on this resource now.
James Marland: Build, you know, as you said, build up to it. So look at the data, embrace reality and make some great choices. Sound good? Absolutely. That's good. All right, so this is Ben James Marlin with Dr. David Hall. Thank you for joining us. We'll see you next time and I'm gonna stop recording.