Collaborative group practice growth with Stuart Kaplowitz

Dan King: [0:00] I am very, very happy to be here again. This time I'm going to be joined by Stuart Kaplowitz. He is the founder of Serene Pathways Counseling up in California. Stuart, welcome. Stuart Kaplowitz: [0:11] Yes, we're down here in Chino, California, Southern California, just on the outside of LA and the outside of Orange County. Dan King: [0:19] Excellent. A beautiful part of the world. Tell me the basics about Serene Pathways. How many clinicians are you? What kind of work do you do? Stuart Kaplowitz: [0:27] There are about 45 of us here, more licensed than associates, but we do have associates as well. All master level clinicians, MFTs, LCSWs, and a few LPCC. So all of our work revolves around therapy. We don't do testing. We don't do med management. We do connect with other practices for those supports. Dan King: [0:52] Tell me, how did you get here? Why did you get onto this group practice journey? Stuart Kaplowitz: [0:56] Oh, wow. And quite honestly, not my plan. I was a then intern in Huntington Beach private practice many, many years ago. I loved the clinical work. I found it a bit isolative. There were just a few of us there. And in continuing my work, I ran school-based, which I really liked, worked in group homes and runaway shelters and had all these neat experiences, a lot of which were county Medi-Cal And what I really appreciated there was the teamwork. Like I had a psychiatrist down the hall to consult with, psych testers, TBS workers. It was great. But the paperwork, the spending so much time, documentation, the county audits, things like that, I didn't love it. When I had the chance to kind of reflect on what I wanted to do at that point, I thought, wouldn't it be great if I could take that good clinical work of private practice and even again, the county stuff, but with the team that the county, the Medi-Cal programs offered. And I thought I could maybe make my own little group at that point. Stuart Kaplowitz: [2:02] And I started with an intern and then a couple. And that was my thought of just, hey, I was going to have associates. And I made this neat team. Like I was seeing one family member, one of the associates was seeing another, a third was seeing, and it was great because we're connecting, we're learning, we have our consents and releases. So we're helping the clients go farther because we know more. We're working in the community, the doctors and the schools. But then a couple of them at the same time got licensed. And I was like, rut row, I don't want to lose them. Ah, shoot, what do I have to do to start hiring licensed clinicians? And I can't say I knew a lot at that particular point. And there we went. We had more associates who became licensed. And here we are today. My now program coordinator was that first intern just over 15 years ago. But never the plan. It was just to have a nice core to be able to offer some Stuart Kaplowitz: [3:00] of that best of both worlds, good clinical work. Dan King: [3:03] Very, very common in the group practice world that people kind of fall into it. Tell me, how much did you know about the trials and tribulations of entrepreneurship before getting into this? Stuart Kaplowitz: [3:12] Nothing. And even today, I say I'm not the best business person, businessman. I didn't have the knowledge, the support. I did not know where to go. I was fearful of all the attorney costs or HR costs. And so nowadays, when people reach out and they say, hey, I'm thinking about starting a group, I'm going to be the first one out there to say, Stuart Kaplowitz: [3:33] hey, if you're in California and legally employing, I'm going to help you. There is no charge. I'm giving back because I wish I had. Dan King: [3:39] That is so kind of you. What would you tell that version of yourself 15 years ago? Now, having all this knowledge that you've built over running a group practice now, a pretty sizable one. What would you tell that version of yourself 15 years ago? if you could communicate with him? Stuart Kaplowitz: [3:53] Ooh, well, like with those items where I would say sweating the small stuff, thinking about the employment attorney, 400 and whatever an hour, I would go, oh my God, I don't want to do that. HR, half of that cost. To be able to say, don't sweat these things. It's not like I'm having these costs every day or even every month. Knowing, however, that those supports are there is so helpful in difficult moments to remind myself, I'm doing it the right way. I got support. We know how to handle this situation. Because there are so many blips that happen along the way and hiring or firing or things that you would never imagine or want to have to deal with needing to be dealt. Dan King: [4:36] One of the things that surprises people, if I were to tell them, even though typically starting a business doesn't have the highest success rate. Starting a group practice actually has a pretty high success rate relative to other businesses. And part of the reason why is, especially in this moment, unfortunately, we have a mental health crisis on our hands. So the demand for mental health is just incredibly high in this moment. And so as much as your typical clinician hasn't trained for business, the reality is your chances are pretty good if you believe in yourself and the team that you're building. So you decide, all right, I'm going to hire some more licensed folks. And how do you decide who to hire? Because I know that this is a constant question I get from a lot of practice owners. How did you decide who you were going to hire? Stuart Kaplowitz: [5:22] Good one. Well, and you know, many times, even things like that change over time. I remember thinking like, okay, well, what a lot of people, and even today, Dan, are nervous about getting into private practice. Hey, I'm at this job. I don't love it. but it's, you know, county, you know, whatever it is, stable money. I know I'm going to get the same paycheck. And from what I understand, right about private practice, there's buildup ramp up time. It can be different. And I said, absolutely. So yeah, what was that? What were the best things? And even now, I mean, I know how that's changed over time. Stuart Kaplowitz: [5:58] I remember thinking at first, oh, it'd be great to have a staff in at five to 10 weekly session. Well, nowadays, fiscally, that doesn't work. We know we invest so much time, effort, finances into our training and just everything we offer. We need people to see two to three times that. 18 is our minimum. That changed right over time, just realizing our values and the investment we put in to kind of say, oh, okay, well, we need at least this kind of investment back. But thinking back then, it would not have made sense for me to say, oh, I'm only going to hire someone that's going to give me 18 or full-time because it took forever for us to fill them up. We didn't have the resources. We didn't have the supports in the community, all of the referrals, all of the contracts to get there. So certainly that has morphed over time. But I've always looked for people that genuinely care, are invested in helping the clients, are invested in learning, acknowledging limitations. And that can come across very well or not in the interview process. Stuart Kaplowitz: [7:02] And then we check references and not just, you know, a formality. We want to know the candidates areas for growth. We're looking for candid struggles that hopefully we can then support and help with. Dan King: [7:14] Are you usually with the solicited references? Are you usually able to get good, good candid feedback? Stuart Kaplowitz: [7:19] If it's a newer clinician, we expect we're not going to hear a lot of great, you know, clinical, you know, because maybe that candidate has only been at the agency. Maybe it was sort of traineeship or whatever, a few months. But we can probably get more into their personhood. What kind of people are they? Are they dedicated? Do they care? How did they show that? And so forth. Dan King: [7:44] Do you, to this day, do you still do the interviews yourself or some of the interviews? Stuart Kaplowitz: [7:49] Yes, I'm part of the process. These are, we have a first line and a second line. So if I'm not in the first, I'll be in the second. Dan King: [7:55] What have you learned over the years, 15 years of doing these interviews? What have you learned about how to interview candidates well? Stuart Kaplowitz: [8:01] Well, and I'm sure there's an even better process. But again, I'm looking for that connection, their motivation to learn, their motivation to help, their understanding that. And we try to model this right from the beginning. Even though people come in as licensed clinicians, we know whatever processes we have are going to be different from where they were. So how amenable, how open are they going to be to the process of things are probably going to be a little different. How are they going to manage that? Will they look to just do it on their own, but not necessarily do it well? Will they reach out for help? How open will they be? Are they appearing like, okay, they want to be part of the team? Because I think that's what's helped make us as special as we've become, the staff and that connectedness and wanting to work together and grow. So I'm scouting that in these meetings. Dan King: [8:51] It feels like a word that's coming up for me is humility, because these folks have to express a desire to be part of something. And then you said reaching out for help. Dan King: [9:00] Being a part of something and reaching out for help really requires humility. Stuart Kaplowitz: [9:04] Yes. And I will share. There are moments where even I say, you know what, here's what I'm thinking, but I'm not 100 percent sure I'm going to consult. We'll call camp. I mean, even in group supervision, I'm saying that's a great question. And the supervisors, we can't come to one firm answer. Let's consult. Get additional feedback and support. Dan King: [9:23] Makes sense to me. So you mentioned, especially at the beginning, it would take a little while to fill new folks up, to build those referral sources in the community. This is so, so important because for your typical group practice, referrals are the most important way to find customers, right? And so how did you go about building those referral relationships? Stuart Kaplowitz: [9:45] Yeah. And I like what you said. I can think back in the day and, you know, joining like a panel or two seemed to bring in a lot of referrals. And yet over time, what I've noticed is that I think there are so many more therapists on panels that doesn't do it. You have to make those connections. I love, again, interconnecting. I see myself as part of the clinical puzzle to help the client. So if a client is seeing a doc, their medical issue, the client's seeing a psychiatrist, right? They're getting medications. I need to know what's going on. We assume, I think, too often that we're all on the same page. Everyone knows what's going on. We all have the same information. And yet, frequently what we find out is that the doc doesn't know about your heavy drinking. Uh-oh. That could come into play as you're taking all these medications, right? Thyroid issues? Oh, help me understand that. Tell me more. oh, you're not taking your Medicaid. It's like, oh, one doctor had come up a couple of different times here in Chino. I remember reaching out. Nice. Just really seemed connected with his patients. And I remember saying at the end, hey, I don't know if you have other clients that need counseling. Please keep us in mind. And he said he worked very closely with an agency locally. And I thought, hey, cool. So be it. Another client of mine saw the same doc into the future. I I reached out and then for whatever reason, I don't know if his relationship with the other agency changed, but he started referring. Stuart Kaplowitz: [11:12] And he's part of the Pomona Valley Hospital. And we went out, we met with some of the other doctors he introduced us to. And now we get hundreds of referrals each year from these docs and we can get them on the phone. And that is like incredible to know that, again, like I tell the therapist, it doesn't matter if you're a brand new therapist or you've worked with the client for a long time. The doctor is the expert on the medical issues. If we're not reaching out, I don't know all these diagnoses, right? They're all these diagnoses. We have the DSM. We need their insight. And sadly, the client's not telling the doc everything because I've had clients say, why would I tell the doc about my depression? I said, because it affects your mind. Are you kidding? Dan King: [11:56] Yeah. Stuart Kaplowitz: [11:57] So it just kind of went from there, connecting with the schools. That took forever. And yet again, if we didn't persevere and keep connecting as we had information and they found helpful, I don't know where we would be today, honestly. Dan King: [12:10] So it sounds like, I mean, a couple of key principles in your referral building approach, persistence is a big one, but another is supplying information to folks. So they may have folks in their community that could benefit from your services, but there's an education gap sometimes. Dan King: [12:26] When is the right time to bring in, when is the right time to refer to a group practice? And so it sounds like education as well as perseverance are core to your referral building strategy. Stuart Kaplowitz: [12:35] Yeah. And for us, I mean, it's just a basic matter of we are not going to have all that information, right? We don't go thoroughly into, you know, one's medical pass. And rarely does the client necessarily share everything. So I say, listen, if they're being referred by the doctor or the psychiatrist or whomever, you know, there's a lot of information there that you just want to get the release and have access to. What's the doc thinking? They probably have their own ideas for treatment plans. Notoriously, clients will leave some things out. They forgot, they didn't see it as much of an issue. I mean, our defenses are strong as individuals. We might not be ready to address things, but here's the doc or the psychiatrist Stuart Kaplowitz: [13:20] saying, no, no, no, this is important to talk about. Dan King: [13:23] This stigma around getting therapeutic and mental health support shows up in every part of the journey, right? Stuart Kaplowitz: [13:30] Oh, sad. So strong. I can't tell you how many clients over the years I've heard and continue to hear. I should have been here 10 years ago, 20 years ago, 30 years ago, and I smile. Like the rest of us. Dan King: [13:42] But better late than never, right? So what is it like talking to doctors? How do you convince doctors that you're good at what you do? Stuart Kaplowitz: [13:50] Well, I don't think that's a problem anymore just because again we we get a good number of referrals but i i think in just the idea of sharing what you know why would i be reaching out hey doc i'm seeing john seen him a few times here's what i'm picking up i'm curious he's not taking medication but he shared with you he says about his depression can you share with me have you had thoughts have you had other recommendations what are those how can i help from your you know estimation and many times again just hearing that the doc will say oh i didn't know x y and z shoot clients never told me that and vice versa as i'm hearing and i'm like and then many times the doc will say hmm maybe i should have the client come in and kind of ask more of these questions that i say that would be wonderful i think. Dan King: [14:43] It's a brilliant answer to my question because you're show you're helping the doctors do their job better, right? It's in their interest for patients to get better. It's in their interest to have a deeper understanding of what their patients are struggling with. So by supplying that, I think that's one of the key ways you show them you're good at what you do. And of course, some doctors, the reality is just like some therapists are more motivated to serve their patients than others. The same is the case with doctors. And so it sounds like you want to find doctors that are really, really committed, that really deeply care. They're going to be better Stuart Kaplowitz: [15:14] And it is a sad reality there too. I mean, we can, there's a name of a local hospital where whenever I hear it, I think, oh God, they're not going to communicate with us. But we've had them tell us we're too busy. Our doctors are too busy to get on the phone. I'm like, oh geez, you've got to be kidding me. I don't know how you would operate without our information. I get it. They're busy and they don't see it as much of a priority. It's sad. Dan King: [15:38] Yeah. So you built up this practice over 15 years. We've got 45 clinicians. What does the future look like? As you think about what you want to build Serene Pathways into, do you have a vision of the future? Stuart Kaplowitz: [15:49] Wow. Well, I've had all kinds of ideas, including, again, revolving around the team approach. I never try to be or think I'm going to be the end-all be-all. We have a great internal team of program coordinators as well as supervisors. A year ago, March, I hired a director, a clinical director who was just incredible. So she's been able to pick up more of what I was doing. I've been able to cut back from 15, 20 sessions a week down to five. And a lot of my time now is spent behind the scenes. Either I have a couple of supervisions. I've done individual and group supervision, as well as just meeting with the coordinators or the supervisors and seeing how else we can help and train less of the everyday. Stuart Kaplowitz: [16:36] Again, it has to be all of these things and more of just little pieces, which I prefer. As far as the company, we cannot hire fast enough. I like to believe that is because we're doing that good clinical work. People hear about us in the community. We're active in social media. I love giving back. So we just started our fifth year as camp and BBS approved as CEU providers. Every presentation we've ever done is free. So it's a great way to kind of connect with people. And it's been a great way to get additional speakers because many of the speakers then, you know, were attending a previous one and are willing to help in that particular area they're in. and then we all benefit from that. So the staff love it, the community benefits, and again, we're just helping our own cause connect more in the community, the clinical. Dan King: [17:29] I think it's so easy when you're running a business and the typical considerations of running a business are top of mind to forget that you're embedded in a community here, right? This community is super important and will ultimately be a big part of the healing process. And so Another thing that strikes me about your approach is you really see Serene Pathways as part and parcel of a community. Stuart Kaplowitz: [17:52] And I appreciate that. I also interconnect within California. There are not quite 450 of us legally employing through the state. We just had a get-together last weekend, in fact, down in Orange County. The support I've gotten there, I mean, again, the learning, the ideas, and many times it's just, Ooh, I did this. It didn't go so well. And then we all learned from that. So I don't know where I would be without my peers and their support. Dan King: [18:20] So reaching out to peers for support, especially when you're early in this group practice journey, you really don't have to figure it all out yourself. Right. Stuart Kaplowitz: [18:27] And I, I think sadly, there's the idea of like people won't help. People would be uncomfortable reaching out. I shouldn't, I should know it myself. I think that's where I was. I didn't know who to reach out to. And I was thinking like, Oh, they'll think I'm an idiot. But the fact is, we're all learning. We didn't learn any of this in our programs. Most of us went to school, Stuart Kaplowitz: [18:48] psychology, counseling. There was no business part of the program. Dan King: [18:52] I often wonder if there could be business education here. I wonder if we could build like an industry association or some kind of, because we're so fragmented, some kind of centralizing force that can supply the common set of business principles to folks and encourage them to do entrepreneurship because so many clinicians actually become exceptional entrepreneurs once they build some confidence and get past some of the initial barriers. Very cool, Stuart. So I'm curious as we come towards the end of our time together, we've been talking about building practices in mental health. We've been talking about hiring well, building referral relationships, Dan King: [19:28] and participation in the community. When you're not doing all of that important work, what do you do for fun? Stuart Kaplowitz: [19:33] Ooh, we. Well, I'm very happy to say that my wife and I had recently gotten a place in Baltimore. I get asked that all the time. Why Baltimore? Do we have family there? No, my parents are from the Bronx. I'm not a Yankee fan. But I am a huge Orioles fan. And a couple of years ago, I was able to go back for the first time and catch games there at home. That was just a wonderful experience. So we have been slowly working on it, a little place out there. We were out three weeks. This is our first three-week adventure this last month, in fact. And we'll go out for two more weeks in September. So I'm really looking forward to that and to the just kind of future of, again, not working as hard. Dan King: [20:21] I love it. And why did you become an Orioles fan if you're not from Baltimore? Stuart Kaplowitz: [20:25] First football team, 1976. Dan King: [20:27] So my Cal Ripken Jr. references are way too modern. Stuart Kaplowitz: [20:31] Yes, yes, yes. A good player. Good one indeed. Dan King: [20:33] Stuart, it's been a pleasure to connect with you in this interview. Really, really enjoy your humble approach to building a good practice. And I think there'll be lots of good insights here for practice owners and group practice clinicians that like to learn from. So thank you so much. Stuart Kaplowitz: [20:48] Absolutely. Happy to help them.