Why I Only Hire W-2 Therapists (W-2 vs. 1099 part 3)

I've noticed that private practice therapist tend to hire additional therapists as 1099 contract employees. Reasons frequently cited for choosing to hire therapists as 1099 employees is that they don't have to pay the therapists taxes. While it may be more "affordable" to hire therapists as contractors, in my experience, there are also "costs." (For an summary of the difference between W-2 and 1099 employees read part 1 in this series. To hear about my employment tax audit adventure read part 2.)

According to the IRS website, the general rule for classifying 1099 independent contractor is "if the payer has the right to control or direct only the result of the work and not what will be done and how it will be done" (italics added). It also states that an employee is not a contract employee if the services "can be controlled by an employer (what will be done and how it will be done)" and if "the employer has the legal right to control the details of how the services are performed."

In consulting with therapists around the U.S. I've heard about some of the "costs" of hiring 1099 employees. Some of the costs high turnover rates due to the part-time and often temporary nature of contract employee relationships. Some of those "costs" include lack of control over how and where therapy is done, inability to require specific paperwork, inability to require attendance at staff meetings or trainings, inability to request that therapists network and participate in community outreach to boost referrals.

Here are the four main reasons I only hire therapists as W-2 employees:

1) Overall Cohesiveness

My vision for Wasatch Family Therapy has always been to build a cohesive team with a shared long-term vision of providing excellent clinical services to clients across the lifespan from an attachment perspective, not just have a group of therapist doing any kind of therapy they choose.  Now that we have grown into a clinic of 18 therapists at 3 locations cohesiveness is even more crucial. When therapists are hired as 1099 contractors employers are not supposed to tell the contract worker how to do therapy, or make other specific requirements of the worker, such attendance at trainings.

2) Higher Level of Quality Control

If a therapist is going to work under my name and my practice name or "brand", I want to be able to have a say in how, where, and when they do the work.  I've spend over 10 years building trust, credibility, and presence in my region and I want to be able to be able provide mentoring, direction, and training in how my clinical team provides services.

3) Ability to Require Certain Activities

I want to be able to require certain activities from my team members that hiring them as 1099 workers does not allow me to do. We have streamlined forms for notes and documentation in our EHR system. I require each therapist to engage in at least one outreach or networking activity each month in order to create strong referral sources. I require attendance at two monthly staff meetings, and a certain level of professional appearance at the office.

4) Implication of Long-Term Relationship

I am not interested in hiring temporary therapists to provide services. Hiring 1099 workers generally implies a short-term relationship. I am interested in hiring therapists who have a shared vision and who I can invest in long-term, and who will invest in building the practice long-term. I want to build mutually beneficial relationships not just provide services. Hiring therapists as W-2 employees shows a greater long-term commitment to them to build their practice for the long haul. I also allows me to expect a greater commitment from them.

Private Practice Marketing Made Easy

Last week I spoke to group of local therapists on "Marketing Your Private Practice" and a record number of people attended the presentation. Why? Because therapists in private practice feel ill-equipped and uncomfortable with the business aspects of private practice. It's rare that a marketing course is included in a mental health graduate school curriculum, and few internships and practicums offer marketing mentorship. In my graduate program in social work, just the words "private practice" were treated as "bad words," as if making money while helping people was somehow morally wrong.

For some therapists  the word marketing brings up feelings of anxiety, even dread. "I am not comfortable with self-promoting," I've heard many therapists say.  "I'm not in this for the money so I hate to think that I have to market my services."

Over nearly 10 years in private practice I've learned that marketing isn't as difficult or scary as it sounds. Most therapists already have the relationship skills that make marketing effective. You're already good at building relationships and communicating. You just need to apply your skills differently.

 Build relationships of trust

You already know how to market, because marketing is simply building relationships of trust in a different way. Marketing requires reaching outside of your therapy office, and often beyond your comfort zone. Whatever strategy you use: talking to strangers, talking to friends and colleagues, meeting with physicians or schools, or finally getting a website, it's all about building relationships of trust.

Let 2 simple questions guide all of your marketing

• Who is your ideal client? Identifying your ideal client is  not just getting clear on the demographic and diagnoses that you like to work with, but also the characteristics, values, and traits that you look for in a client.
• What is your basic practice message? This is a simple message that focuses on one aspect of your work and emphasizes the benefits of your services in layman's terms.

Talk to everyone and anyone about what you do

In graduate school you learned how to communicate, build rapport, and put people at ease. Building relationships of trust isn't just limited to talking with your clients. Effective marketing is simply applying all of the skills you know to a broader group of people. Talk about who you want to work with what you do with strangers in the grocery store, neighbors, extended family members, or online communities, media contacts, or other professionals.

Remember you're promoting your passions, not yourself

Effective marketing isn't about pushing yourself on others, but about letting the things that you're passionate about shine through in every conversation, every blog post, every interview, an every page of your website.

It only takes three

According to private practice guru Lynn Grodski, it only takes a few "practice angels" to have a full practice-three people who will consistently refer your ideal clients to you. You probably already have three referral sources ready to refer to you. All you need to do is warm the connections you already have.

How do you feel about marketing your practice? What works and what doesn't? Share your comments below

photo credit: Hen3k Hen3k