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Dr. Jeremy Sharp (00:00.568)
Hello everyone and welcome to the Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.
Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I just keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com slash therapy notes and enter the code testing. This episode is brought to you by PAR. PAR offers the spectra, indices of psychopathology.
a hierarchical dimensional look at adult psychopathology. The Spectra is available for paper and pencil assessment or administration and scoring via PARICONNECT. Learn more at parinc.com slash spectra. That’s S-P-E-C-T-R-A.
Hey folks, welcome back to the podcast. I’m glad to be here as always with you. And today’s guest is a professional, a colleague, a friend, someone I’ve spent in-person time with, which makes it all the more special. I’ve got Julie Harris from Green Oak accounting here to talk about profit first and beyond is the way I think of it. So I think many of you have probably heard of profit first as a financial management or accounting system for your practice. So
We talk about profit first, then we also go beyond the basics and talk about what happens if you’ve maybe mastered profit first or just mastered the finances in your practice and you have good money problems and you need to figure out what to do about that. So we do a beginning section where we talk about kind of basics of profit first and financial management and things like that. And then we flip the script and talk about more advanced strategies, things to think about.
Dr. Jeremy Sharp (01:59.288)
When things are going well, we talk about expanding into a group practice. We talk about the stakes that people make when hiring. We talk about the expected profit margin for different stages of practice. We talk about what to pay people and compensation. So there are a lot of great points and pieces of information to take away from this podcast as usual, but Julie really, really brought it today and think you’ll really enjoy this one.
So if you’re a practice owner, you know the drill here. If you’d like support in your practice, feel free to reach out. At this point, my mastermind groups are closed, but I am offering strategy sessions, which are one-off hours to drill deep into a particular question or two and give you some support to get you on your way. So you can go to the testingpsychologist.com slash consulting and book one of those strategy sessions if you would like. But in the meantime, check out this info.
with Julie Harris from Green Oak Accounting.
Dr. Jeremy Sharp (03:17.272)
Julie Hey, welcome to the podcast.
Hey hey, good to see you!
Yeah, good to see you as well. I feel like I’ve been thinking about having you on the podcast for a really long time and have seen and heard and hung out with you and read your book and all these things. And people talk about profit first all the time. But yeah, this has been a long time coming. Thanks for being here.
I’m really glad we could make this work.
Yeah, likewise. Well, I’ll start with the question that I always start with, which is of all the things that you could be doing with your life. Why focus on this?
Julie Herres (03:51.694)
Yeah, well, I am an accountant, right? First and foremost, I like to joke with my team that my superpower is numbers and specifically seeing the story within the numbers, right? So when I look at a profit and loss or a balance sheet or any kind of financial report, I see, like I vividly see what is happening in a business. And I think that is a superpower in a lot of ways. And so helping business owners
with their businesses, make sure they have a profitable business, increase their profit, right? I see that as a service to the business owner, their communities, their teams, their clients, service to everyone around them. And yeah, that’s my jam. I grew up in a house with a mom who was a serial entrepreneur. We did not understand the financial side of running a business. And so I’m probably very cautious because of that, but the numbers can really help you.
in whatever you’re doing in business.
Yeah, yeah, I love how you frame that and saying that you like see a picture in the numbers or see a story in the numbers. I don’t think that a lot of people have that superpower, but it’s very descriptive. Yeah. I like it.
That’s how I see it in my brain at least, right? Some people like hear colors or something like that. We’re like, this is my thing.
Dr. Jeremy Sharp (05:13.524)
Yeah, yeah, yeah. It’s like a special version of synesthesia, right? Yeah. We’ve already piqued the audience’s interest and thinking about what’s going on in your mind. Yeah. So tell me just a little bit about the focus with mental health folks and Green Oak, you know, as your firm, of course. how did you come to dial in on mental health folks specifically?
Yeah, well, initially when I started my firm, I was a generalist, but I realized really quickly it’s just challenging to work with all different kinds of businesses, right? A mental health practice versus a restaurant versus a car dealership. Like they’re all very, very different in the challenges that they face, like all the other little pieces. And so I knew really early on that I wanted to focus on one specific.
area and then at that point that I was really kind of making that big decision, I had several therapist clients and they were all just so, so lovely. I just really, really enjoyed them and they had all come to me through referral, right? So I started with one and then it turned into five and probably 10. And so here are the characteristics that I just really loved. They were all obviously highly educated, very smart people.
But really with a lot of insecurities when it came to money, managing the financial side of the business, but they were also very receptive to the information they wanted to learn. They were keen to understand what was going on under the hood of their practice. And they were also willing to do the work of changing things and adjusting and actually listening to the advice. And I will say, I can’t think of a single client that implemented everything we ever said, but they were generally willing to do the things.
And that created a lot of positive impact. And I just find that very, very fulfilling. I tend to really like that educational relationship where we’re kind of working together. Like, we’re going to do the work for you, but I want you to also understand what is happening and why we’re doing what we’re doing. And the mental health community was just really receptive to that. And so that just became our main area of focus. And then the farther down that path we went, the more we realized like we can
Julie Herres (07:30.178)
really make a big impact because we know how to run a private practice so well at this point, right? Again, on the financial side, but still that’s a big, big piece, right? Cash flow and taxes and how to hire people, like those are really big important parts of running a practice. And so that’s why we ended up sticking with that. And to this day, that’s all we serve. We only work with private practices and their.
kind of related adjacent businesses, right? Like there’s a lot of real estate transactions that happen with that or maybe coaching businesses that are just adjacent, but we don’t take on any clients that are not therapists.
Right, right. It’s like a parallel with our own clients for those of us who do therapy. You want to work with folks who are receptive to what you are putting out there and open to change and self-reflective. Yeah.
Yes, I imagine that that is what you would want. That’s definitely also what I want as well.
Yeah, good general qualities. Yeah. Do you find, I don’t know, feel, and talking to a lot of businessy folks kind of outside our field, seems like healthcare people, whether it’s physicians or dentists or therapists or psychologists or whatever, have less, I don’t know, less of a mind for the practice management side, the financial side, than say a restaurant person or a car dealership person. But I don’t know, would you say that’s true?
Julie Herres (08:58.178)
Yeah, I guess I would personally disagree. think, and that’s just from my lived experience, right? Not, you know, any specific data other than that. But I think in any industry there can be folks who are really financially minded and there’s plenty of doctors that are, doctors, dentists, restaurant owners that are. There’s also in every industry plenty of people who are not. So I think
therapists specifically tend to give themselves the label of like, I’m not good with numbers, I’m bad with math. And usually it’s just because you haven’t really tried yet, right? And you are very capable of understanding and it’s just, sometimes maybe it’s just a story they’ve told themselves or they were not good at math in school, but like there’s very little actual calculating or multiplying or any of that in the financial side. It’s really just like looking at what is happening.
and course correcting, right? And that’s just a skill that you use a lot in as a business owner period, right? What is happening? How do we adjust, right? You’re always kind of moving. There’s never a status quo for too long. And so it’s a very transferable skill. And I think most therapists are very capable of learning and getting to that point as well. There’s also plenty of doctors and dentists that are very bad with their money.
Yeah, that’s fair. That’s fair. Yeah, I think there’s an emotional component involved with everyone probably, but money is pretty emotional and can be something to be avoided or revered and any number of things in between.
think maybe also doctors and dentists perhaps get away with, know, people think they do better with it because they generally tend to make more money, right? That is a service that is more valued by health insurance companies, by, you know, society. I’m not saying that that’s a good thing, but in general, right, a doctor can go out there and make multiple, generate multiple millions of dollars per year in revenue, whereas one single therapist can typically not do that. So I think the
Julie Herres (11:04.546)
the doctors and the dentists of the world maybe can just out-earn their lack of knowledge sometimes. It doesn’t show quite as keenly, yeah.
Hmm
Mm-hmm. Mm-hmm. Yeah. Yeah more money can hide yeah mistakes sometimes
Absolutely can. You can outrun the bad financial decisions.
way to put it. Maybe we’ll come back to that at some point. Yeah. Yeah. This sounds good. This sounds good. So I do want to talk a little bit about profit first. This is not, I really don’t see this interview as a profit first primer necessarily. I mean, your book is great for that. I’ve recommended it to a million people and you know, there’s the general profit first book, of course. So there’s a lot out there on profit first. So I don’t want to go super deep into it, but for anyone who may not have heard of it,
Dr. Jeremy Sharp (11:51.02)
have some, you know, any idea what we’re talking about here. think it is probably important to lay a little bit of groundwork. So can you do just a high level overview of this profit first system and what, what it is?
Well, so yes, profit first is the general premise that we are building in profit into your practice from the very beginning to make sure that there always is profit, right? And in the mental health industry specifically, there’s a lot of guilt often around profit. They’re like, oh, well, I’m not in it for the money. I’m in it to help people. And that’s very kind and generous and noble, but…
In the real world, if you need money to live, which most of us do, right, to pay the bills and support yourself and your family and put food on the table and gas in the car and all the things that need to happen, making a profit is something that is necessary for a business to survive, right? There’s not this mythical pot of money where you’re going to just go grab extra cash because you’re running your business poorly, right? There’s a point where the business fails.
It closes, it does not survive, and then it helps no one. So in order to help your clients, you have to have profit in the practice. So within Profit First, we turn the traditional accounting equation upside down. So instead of looking at income minus expenses equal profit, the Profit First equation is income minus profit equals expenses. We are building in profit, and that means you have less available to spend on expenses, but that means that you’re always building in profit. And typically,
what most business owners do in that case, when there’s less available for expenses, you typically are going to get creative and naturally you will spend less. Because you know, like this is what I have available, right? It’s just like, when you’re a kid, if your parents give you an allowance, that’s what you have available to spend. So you have to figure out how to make that work. Or I don’t know about you Jeremy, but my parents, if I went to them and said like, I already spent my $10, like I need more. They would say like, that’s a you problem. That is not, like we’re not giving you more.
Julie Herres (13:53.11)
Money, were you in that same boat?
yeah, a hundred percent. I I literally, I said that to my kids three days ago.
Yeah, it’s like, that sounds like you need to go do some tours or do something else, right? Yeah. And really the business is the same, right? When there’s no more money to spend in the current economy, it’s easy to go out there and get like credit cards and loans and all that. But like really when there’s no money left in the business, it’s the business telling you like something is going on. Something is wrong that you need to fix. You can’t just keep doing the same thing.
borrowing money and hoping that it will magically get better. Like you do need to course correct. So in a nutshell, Profit versus a System that gives you buckets of allocations of money to spend on various things in your business. So there are five of those things. So one is operating expenses. So your overhead, right? Like your rent, your software, your liability insurance, like the things that it takes to run your company. Then there is your payroll.
If you have a group practice, you will have payroll. It will likely be the single largest expense on your P &L. So that is for your clinicians, for your admin, for your leadership. Then there is an owner’s pay bucket. So how much do you pay, do you save to pay yourself for the hard work that you do in the business? There’s a tax bucket or allocation, and then there’s a profit allocation as well. So we assign a specific percentage to each one of those things depending on the
Julie Herres (15:24.28)
size of the practice and on the specifics, but that means that it’s really easy to know at a glance how much you have available for each thing, where is there opportunity, and where can you no longer spend anything. So that’s the nutshell version of it.
Yeah, yeah, that was a great summary. think a lot of people probably have some idea of Profit First and what it is, or they’ve read one or both of the books and get excited about it and then get overwhelmed by it. I’m sure you’ve heard this 10 times, 100 times more than I have, but it’s do I really have to open five bank accounts?
Yeah, that’s a question that comes up often because a lot of business owners remember the first time you go to the bank to open up your business bank account, it’s a pain. I will admit, it is a pain, right? And in part, that’s because of banking regulations, right? Anti-money laundering, they have to make sure that you are who you are and who you’re supposed to be. But opening additional accounts is usually a much, much, much smaller lift, right? It is usually a 10 minute visit.
or even a phone call instead of like a 90 minute situation. And so I just want to put that out there because adding accounts is not as big of a deal. But Jeremy, there’s something really powerful about seeing the money in the different bank accounts that doing profit first kind of on paper or in a spreadsheet or in your head does not.
When you’re doing it on a spreadsheet, it’s really easy to say, well, like, oh, this is not quite working, so I’m just going to like change this number over here. I’m like, oops, oh, look, now there’s plenty of money for all the things, right? Where you’re kind of borrowing, and I’m using air quotes here, borrowing from your tax account for something else. You’re like, well, because you’re not actually going through the pain of logging into your bank and transferring money from your tax account to your payroll account.
Julie Herres (17:29.122)
Because that doesn’t feel good, right? It feels like, why am I having to do this? But that’s the point. That is the system telling you something is up. Why are you having to use your tax money to make payroll? What is happening? Right? And it won’t fix the problem, right? Profit First won’t fix the project magically, but it will tell you there’s a problem and it’s over here, right? Go look over here. This is the account that’s giving you a problem. And so something has changed, good or bad, right? Sometimes it is.
Like, hey, why is there no money coming into the practice? Like, is there a billing problem or did you hire more admin than you really can afford? Did you increase leadership at a rate that doesn’t make sense? Is overhead increasing exponentially faster than your income, right? Like something is up and it will point you in the right direction so that you can, as the business owner, make the best decision for your business.
Mm-hmm. Yeah. Yeah, that’s one of the things that I really love about it. And just, you know, full transparency, we’re not running profit first to 100 % fidelity. And this idea of knowing where the money should be going in general, I think is a lovely idea. And it can throw up those red flags, because like you said, there’s information in the numbers. And if you have a sense of where the money should be allocated and how much should be in each place,
If it’s not there, that’s a real sign that something is going wrong and or going really well. Sometimes it goes in the other direction.
I mean, that’s true. Like, yes, and I love those scenarios way, way better. And I also live in the real world, right? Because like, I own an accounting firm and we work with hundreds of clients. And so we see the reality of like, sometimes you just have to take the tax money to run payroll. Like sometimes that is the situation that you are in.
Julie Herres (19:24.632)
but because it’s not all commingled, you are so much more aware as the business owner that like something is up and we cannot keep going in this direction. And that in itself is really, powerful. I was just working with a team on a new to us client who like took on a ton of debt in the last year. And we all collectively were like raising the flags, right? Of like, this is not a healthy situation.
we have to be able to course correct this in a very short amount of time or else there’s a day very soon where there are no more loans to be had, right? Like there is no one else who will loan you money. And if you haven’t stopped the bleeding before that point, that could be the end of the business, right? And there’s plenty of scenarios where we catch a practice early enough that we can help with that course correction. And there are some cases where it’s just so far in that we can’t move fast enough.
to do that. And I absolutely hope this is not that kind of situation, right? But there’s a lot of changes that have to be made in a very short amount of time to get this back on track. And that’s often a painful process for the owner, right? Because there’s changes in the business. There’s also usually changes personally that have to be made as well, right? Like there’s often
some personal spending that has ballooned or something else has been going on, right? Like the personal expenses have expanded faster than the profit of the business. like there’s, it’s not an easy scenario to be in, yeah, Profit First can help. It cannot save a practice, but it can help like get back on the right track.
Yeah, yeah, certainly, certainly. Yeah, there’s a lot of shame wrapped up in money, I think. I’m sure you see that a lot, is people being afraid to share things with you or, you know, be totally transparent. And it’s complicated. Yeah. lot of respect for the work that you all are doing.
Julie Herres (21:31.832)
Well, listen, I could never do what you do. This is my jam, but the numbers don’t lie, right? Once we look, we see what’s going on, and these are not easy conversations to have, as I’m sure you can imagine. But there’s a lot of power in just saying it out loud sometimes, like, hey, here’s what we’re seeing. Does that feel true to you?
Feel like we’re explaining what you’ve been feeling but not necessarily able to put into words. And that can be a relief to actually know and have someone on your side helping you.
Sure. One of the things that I like about Profit First is that it is pretty clear about different stages of practice and what allocation of your revenue should be going to different places like overhead or profits or owners pay and taxes and so forth. One of the questions that people ask me that I don’t totally know the answer to is how do you arrive at those percentages? Like how do we know that those are, you know, accurate quote unquote?
How are they acting? Yeah, or like, how do we know you’re not full of it, Julie? Right?
health practices.
Dr. Jeremy Sharp (22:49.43)
Right, right, right.
Yeah, so we do a lot of research internally every single year and have come up with these allocations based on many, many years of data. when we work on this, this is not just what the top 5 % of practice owners are doing or the bottom 5%. We kind of exclude, like we look for statistically relevant
practices, right? So we can’t, if someone had a loss of $200,000, we cannot include them in here because it’s going to skew the averages just so much more. Also, there’s some practices out there that are just like insanely profitable and that’s amazing for them, but like that is not the average. So we exclude those as well. So we end up kind of in this middle of like, are, what are most people able to do realistically? Like what is a realistic, reasonable expectation? And, and we,
So we arrive at averages, we look at the median and the mean, and then look at like, do most people, do kind of 90 % of our middle fall in that range? And typically that is possible, that is the case. And so we actually have not changed the profit first allocations since 2023 because they still continue to be relevant. Now, I do often get some pushback of like, oh, that’s not possible. Like you can’t possibly make that much money, right? Or like, you can’t have…
20 % profit margin, if you make $5 million a year. And I would say if you were telling yourself that, then it’s probably true for you, right? If those are the words that you were using for yourself, you’re probably making that true for yourself. But we have these numbers because we know that they are possible. obviously, we cannot share that. We can’t share that data. for every size of practice, we have dozens of practices doing just that.
Julie Herres (24:47.69)
And so we know that it’s possible and we know that adjustments are sometimes need to be made to arrive to that. And if you’re willing to do that, you can do that too. And if you’re not willing, well, you can choose to have a lower profit margin. That is a choice that you can make, but I’m going to advocate for profitable practices until the day I hang up my hat because that is in service to everyone.
I like your use of the word choice and choose. I think we get locked into, we get locked into things. We get locked into, have to have this much admin support. I can only charge this much private pay or I have to take insurance or I have to pay for this EHR or whatever. And choice is a big part of this. There are a million choices that we can make along the way with how we’re spending and making money in our practices. So I just want to highlight that and
I folks to always have the possibility of choice on the table.
It’s so interesting to hear business owners feel like they are trapped. I have to give them a raise or they’re going to leave. But are they? Sometimes that’s true, but if you’re building a business that does not rely on one specific person, including you in the best case scenario, then it’s
absolutely does suck to see someone leave, but it’s really not the end of the world. And you have to make the decisions that are best for the business. And that’s kind of, that’s what the gig is, right? When you’re the business owner is sometimes you have to make a decision that’s going to be not good for one specific person, but that is for the benefit of the whole team. And if you’re kind of throwing off all of your, your ratios or paying someone a dollar amount that does not make financial sense for the practice.
Julie Herres (26:41.026)
that is to the detriment of the entire business and everyone that it supports. And sometimes you have to make that hard call, say like, actually, I feel like I can’t and I’m gonna lose them, but I still can’t, I can’t do that.
You’re bringing up so many good points and I am going to highlight two things that are maybe basic-ish and then we can move on to like more advanced kind of stuff. But one thing people always ask, what is my profit margin supposed to be? This is, you know, it’s become like a measuring stick, I think for practices and a point of pride and so forth. So just for the record, can you share some information about
quote unquote typical profit margin for a testing practice. You know testing, you work with a bunch of testing practices now. But what should we expect for, you know, a solo practice, maybe somebody with an employer too and a little admin support, we can take each of those.
Yeah. Well, so we actually, we look at testing practices on a regular basis as well. We don’t have enough solo testing practices to have a recommendation. So it is not statistically significant. And so we cannot, I cannot make a pronunciation when it comes to general mental health, what we typically see as a solo practices around 30 to 50 % of income.
Right, so that should be around your take-home pay. It can go, it can absolutely go higher than that, but that’s kind of where we see most regularly, right around 50%. When it comes to a small group with like maybe one clinician, an admin, something along those lines, that is usually closer to 30%. It just keeps going down just because you do tend to have, you have to pay other people, right? And so that’s going to change. And in a small group,
Julie Herres (28:40.43)
the owner’s still doing a significant amount of the work as well, right? And so 30-ish percent is what we will often see. It’s not possible really to have a group where there’s like one or two part-time clinicians and the owner’s not seeing clients. Like that’s not a thing. There’s not enough revenue coming into the practice to support that. Then as we grow towards like a million plus dollar practice, we usually see specifically in testing 20 to 25 % profit margin. And in that I’m including
owner’s pay and profit margin, right? So not necessarily from a profit first standpoint, but I’m looking at like the total kind of taxable income that the owner reports. So if they have an S corporation, for example, that will be their owner’s wages and benefits that directly benefit them plus the profit margin. If they had a single member LLC or PLLC, that would be just the profit on the profit and loss, right? So however you
like whatever mechanism or vehicle you use to take that money home, like I’m combining all those to compare apples to apples. But yeah, 20 to 25 % is typically what we see. Whereas for like traditional mental health practices, we actually see a number that’s lower than that. So there is the opportunity for more profit in a testing practice, which came as a surprise to me, honestly.
It is surprising because the overhead is higher, I would think, right? Because we have to buy materials, whereas therapists don’t buy materials. Do you have any hypotheses about why that number is higher, the profits higher, even with the higher overhead?
Yeah, the overhead is higher. However, we typically see clinical payroll be lower in general. in part because of the way the services render where there’s theoretically more technician hours than like direct one-on-one from a, know, master’s level therapist. because of that mix, clinical payroll tends to be lower.
Dr. Jeremy Sharp (30:47.586)
That makes sense. So if there’s anybody out there listening, thinking about taking on a psychometrist, it is more financially viable.
Yeah, it is. But okay, I guess I have to turn the table on you a little bit. Have you found that to be accurate in your practice?
well, sure. Yeah, yeah. mean, we compensate psychometrists less than licensed clinicians, certainly. So yeah, from a financial standpoint, psychometrists are a great choice for a testing practice. There’s some debate about the clinical accuracy, but that’s a debate that we don’t have to get into.
I am not completely for that piece of it. But so we generally see testing practices have payroll, clinical payroll that’s around almost 10 % less than a traditional mental health practice. Yeah. So that’s where the difference is. Like, yes, you are higher in overhead, but you compensate for that in the reduced payroll.
I could see that. I could see that. I wonder, I could be totally missing this, but I wonder too, if the, there’s something around like the private pay rates for testing can typically go higher than for therapy and then, you know, payroll as a percentage of income might appear, might be relatively lower because the income’s higher, the fees are higher. So you can maybe pay people a little bit more and it’s still not as much of payroll. that was.
Julie Herres (32:25.694)
That’s a really, really great point. I always find that it’s just a little bit harder to track directly, right, for testing practices because it’s usually like, we’re going to do all of these things. the way they get, like if there is insurance involved, the way they get, you know, submitted to insurance, like it’s just a little bit less obvious. It always feels like it’s not just, okay, this hour was for this code, right? It’s like multiple codes.
all the time. It’s just a little bit harder to trace.
I’ll look for tears. I hear you. hear you. So the other thing I was going to ask you about that we were kind of touching on is I know there are people out there who are listening and they’re like kind of on the edge of their seat about like, I doing okay? So I want to, like, do you, are there any, I guess, four red flags that people need to be aware of? Like if they’re looking at their numbers or if they’re even looking at their bank accounts or whatever, you know, in running their practice, like money issues that
that you can identify, like, hey, if this is happening, you should probably take some action and do something different.
talk to someone. Okay, a couple of things. first of all, if you are hit with NSF fees, non-sufficient fund fees on a somewhat regular basis, something is up, right? Like you’re spending more than you make. Obviously, if you have negative profit on a regular basis, but sometimes you don’t even get to that point because you’re just not looking, right? And so the NSF fee is kind of a better…
Julie Herres (34:03.502)
canary in the coal mine. Okay, there’s not enough money in this bank account, especially if there’s just the one bank account that tells you something, right? Something is up and it’s not always what you think. Sometimes the thing that is up is you’re spending way more personally than you thought you were. Like you were taking so much out of the business that you are putting it at risk. I’ve seen that happen plenty of times. Sometimes it is, I mean, it could be so many things. It could be fraud. It could be
a team member that’s getting paid for way more hours than you expected that they were. An administrative team member, it can be just so many different things. could be Blue Cross has stopped paying you or you’re united, but you just haven’t noticed yet. It could be your biller disappeared. It could be a million and one different things, but if cashflow is really tough, you probably need to take a really close look.
at what is going on. If you have a hard time paying for taxes, paying either your tax due with your return in April or your quarterly estimated taxes, it is also a sign that something is up. Because if you are looking at the financials, if you’re saving on a regular basis for taxes, you should be in the ballpark, right? Like plus or minus a little bit, but you should be, like, it should not be a surprise. It should not…
be an unexpected thing because taxes are never unexpected. Like we know they’re coming. We know it’s going to happen. And so that probably just means you’re not looking closely enough. And I say that with absolutely no judgment, but tax issues, like one year of a really big unexpected tax payment or tax bill can set you back for literally years. can take years to catch up from that. So the more
proactively, you can take a look at that, the better off your practice will be. And then you’re not accidentally spending your tax money. I am using air quotes again, even though some of you might not be able to see it. Sometimes it can feel like there’s money in the business that you can take out, but what you’re actually taking out is tax money because you just haven’t been thinking about it or planning ahead for it. It was never your money to start with, but it’s already gone. And so what do you do?
Julie Herres (36:31.01)
What do you do now? Those are two big items. If you’re stressed out every time you run payroll because you’re not sure if the checks are gonna clear, something is going on also, right? It’s time to take a cold hard look at what is happening. If you find yourself writing manual checks because you it’s gonna give you a couple of extra days, that’s not good, right? And so again, without any judgment,
Those are just signs, those are flags that your business is waving saying like, help me, help me, I need something else from you at this point in time. So those are all kind of some signs that I can think of.
Great, great, that sounds good. And maybe we wrap this basic intro section just with, you know, folks are hearing some of these things and they’re like, I want to take some step to be better about this. Is there like an easy sort of intro to profit first or a way to get started?
Yeah, well, reading the book is a very accessible way to get started. Just hear more about it. There’s paperback, audio, and an e-book as well. So those are some items. I do think it’s better to read the book or have some kind of knowledge before starting so that you actually set it up correctly.
I am very much okay, and I say this in the book, if you feel overwhelmed by the whole thing, start with a profit account and a tax account. Just add those two. Maybe you don’t go all in. Again, no judgment, but just those two things, having a little bit of money in a profit account that serves as a reward and an emergency fund for your business and starting to put some money in tax. It’s not going to maybe cover your whole tax bill, but something is always better than nothing.
Julie Herres (38:28.078)
or a good way to gently ease your way into it.
Great. That’s very doable. Very doable. It’s totally, it’s so easy. So I do want to flip the script a little bit. And this is a big part of reaching out to you is that I think there’s a lot of basics out there and books, like I said, but I would love to talk about what happens next. Like what if it’s actually going well? What are some more kind of advanced strategies for, you know, folks out there who
Easy enough,
Totally doable.
Dr. Jeremy Sharp (39:01.678)
feel like they have a pretty good handle on the basics. we can, I mean, maybe we just start there with a general kind of open question, which is like, yeah, let’s say somebody’s running profit first and or just has a good, a good handle on their finances. They are pretty consistently hitting that 20 % profit margin. What happens next in terms of like optimizing cashflow or like advanced fun things you could do with the money in your practice?
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Dr. Jeremy Sharp (41:23.086)
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I love that. Okay, there’s a couple of different options and I kind of want to just blurt them all out. So there is like expansion, there is living your best life and really replacing yourself or kind of the three top things. So one is like things are going really well. Okay, do we want to do more of this? Right? And there’s no right or wrong answer in my mind. It’s just what do you personally want?
It could depend on your age, on your family situation, on just where you are in your life. Are you loving the business in this stage? You want to just keep doing this? In which case, you could add, for example, an expansion bank account where you don’t really need to take home more money. You just start stockpiling money over there in this expansion account. We have several clients who do this, and when they get to a specific amount, then they start looking for a new location.
For some that’s 50,000, for some it’s 100,000. Like, okay, there’s 100,000 in this account. Let me go look at where are we going next? Is there a new city, another city close by that we want to expand into and open up a new office there? Sometimes it can be like a building, right? Generally, there’s a lot of practice owners that also own the real estate. I think you have to be in a really strong personal financial position for that to make sense.
Just because you don’t want to contort your practice to fit the real estate. And that often happens when you own the building, right? I think you should just go wherever, to whatever location is going to be best for your business versus the other way around, right? Like restricting the business to fit in the real estate that you already own. But that can be, like if you’re in a good financial position,
Julie Herres (43:41.154)
You’ve got the 20 or 30 % down that a commercial real estate deal is going to require. You’re doing retirement savings, you’re doing other things already. This is another great way to just diversify your portfolio. Go for it, do it. But sometimes that could be a different kind of real estate deal that’s not commercial. Maybe you want to buy residential real estate or a second home or whatever, a home that you’re going to Airbnb. Cool, go ahead and do that. Save money to do that.
There are other cases where things are going so well, you decide maybe I love this business and it’s going well and I’m willing to take a little bit less money home. I’m gonna replace myself in this business and I’m going to take a more passive role because I have this other cool project that I wanna go work on over here or I just wanna like golf or I don’t know, play pickleball or whatever that may be. And again, like.
I just don’t think there’s a right or wrong answer. It’s just based on what do you want to do with your life? All of those are options when you have a cashflow positive business, which is a great, great place to be. Yeah. Which one of those resonates with you? I’m curious, which one would you pick out of those scenarios?
Hmm. They all sound appealing. I, gosh, that’s a tough question. You’re not allowed to ask questions, Julie. I’m the one that asked the question.
I know that’s, I like to turn the mic around for a second.
Dr. Jeremy Sharp (45:12.114)
Yeah, yeah, yeah. It’s a good one. I think the place that I’m at right now, I would honestly buy back time. I would, maybe that’s replace myself. Maybe that is just not doing any more clinical work. I don’t do a ton, but just, you know, gaining five or eight hours a week would be helpful. I might kind of funnel some to my personal life to hire like, I mean, I’m just being direct, like maybe a chef or like.
Like an executive assistant or something. Yeah biggest Precious commodity right now is time and so anything I could do to like buy time would be amazing
So you are not in the golf and pickleball place, like, you know, buy back time for just yourself maybe.
Yeah, yeah. And then maybe I would play pickleball. Yeah, buying back time would be, would be amazing.
There you go. Yeah, please
Julie Herres (46:04.578)
Yeah, and that’s often not as expensive as people think it will be, right? Where sometimes it’s just a time audit. What are you spending your time on? And could you hire an assistant that can do five hours a week of that stuff that you no longer have to do? And sometimes it’s a much deeper hiring of a…
a clinical director who’s really stepping into your leadership shoes as the owner, whether you’re seeing clients or not, right? And just really replacing you where you are acting more as an advisor to them. And they are really leading your company and you’re maybe in it a couple hours a week. Like we have multiple clients who are now in that situation as well where it’s almost like a semi-retired position. And there’s a lot in between those two things as well, right?
Yeah, I’m in the stage of life where my kids are all in school and I’m realizing just how quickly they will be out of the house. I just have a handful of precious years. So I’m in the same boat as you where I want to be around and work a little bit less and have dinner with my family every night and travel a little bit less and all of that. yeah.
Yeah, I think we’re in a similar place. I think our kids are similar.
Our kids are almost the same age. Yeah, so I had my oldest will be a high schooler next year Which feels like the clock is ticking right like that’s years will go so fast
Dr. Jeremy Sharp (47:35.502)
Absolutely. It really will. Yeah, we sat down, my wife and I probably two months ago and, you know, just mapped it out and turned and mapped out all the school breaks between spring break and summer. We get a Thanksgiving break and yeah, we figured out we essentially have like 15, maybe 18 opportunities to take a trip with our kids before they move out. And you know, that’s
That is home. that’s, yeah, I’m in the same boat. That really drives a lot.
Yeah, I 15. That just hit me right in the heart.
my gosh, I didn’t mean to. To an existential dilemma. Yeah. Yeah. So I love those options. love those options. Again, it gives people choice if things are going really well. I want to maybe detour a little bit into the expansion question. Cause I feel like that is where a lot of people sort of default to if things are going well and a solo practice and the money is pretty good.
No, that’s a- that’s
Dr. Jeremy Sharp (48:43.298)
then a natural question is, okay, now do I have a group practice? Do I hire someone? Do I go that direction? What have you seen, what have you seen people mess up essentially, like in that transition to a group, especially from a financial standpoint? There any things that jump out when you see people start to hire and expand?
Well, a lot. If I had a nickel for every time I’ve heard, want to start a group practice because I want passive income. I wouldn’t have a lot of nickels. there is nothing passive about a group practice. There’s nothing. It is so much work. It is absolutely worth it. And you can make money, but it is 0 % passive. There is so much work to get done before that point of passive revenue.
to be able to step away from your practice, you will typically need to be making at least $3 million a year, if not more. The practice generating that kind of revenue. Before that, you really just cannot afford all the pieces and all the bodies to replace the work that you do. You will not have enough systems that you can truly step out, and definitely not enough redundancy, not enough overlap. You can maybe step out.
temporarily for a few weeks. But if your biller quits, like there’s one biller and so guess what, you’re back in that seat, right? So it’s not long term, you’re not long term out. So to have enough of seats at the table to be able to truly step away, takes a pretty large, a pretty large group practice. So the passive piece though is kind of number one, like expecting that you’re just gonna hire someone and then magically you’re gonna make a lot more money.
Practice owners also underestimate how many clients they are going to need to see when they hire someone. Like if you’re seeing a full caseload and you hire one part-time clinician, guess what? You still have a full caseload. Like you cannot, you can afford to reduce by zero clients. There’s just, there is no room. And I often get that question from, you know, small groups or they have like two part-time clinicians, like, hey, can I stop seeing clients? Absolutely not. There’s not.
Julie Herres (51:06.434)
Like there is not the math doesn’t math, you can’t, right? And, and it, know it’s hard though, because that’s kind of the hardest, like that small group practice where you’re just kind of getting your sea legs and figuring out your processes and procedures and your handbook and your policies. Like that is by far the hardest part. And it is the least rewarding, right? You are working so hard, you’re wearing so hats and you are making marginally more money. If, if any, there are plenty of cases too, where you’re making less money.
than before. And so we often see at that inflection point that a decision needs to be made. Either you’re going to stick with this and keep growing where you have enough sessions, enough revenue to be able to afford a bill or an intake, right, like additional services, or you have to make the decision that this is not for you and go back to solo and manage everything yourself. I remember I had a group practice client years ago.
who had like 12 clinicians and was still herself doing all of the intake, literally from 7 a.m. to 7 p.m. for 12 clinicians. Like never, it was never seven days a week also. Like that was probably too long, right? She did that way too long. And one of the first thing we told her was like, please hire an intake court. Like you can afford it, please go ahead.
my gosh.
Julie Herres (52:34.06)
If you made $50,000 less next year, would that be okay with you to get your life back? And yes, that is absolutely what you wanted. But that in between part, like you are as the owner filling all of those seats out of necessity because there is not enough just money to add a lot of things. And so…
I think it absolutely can be worthwhile, but you have to go in with a clear head and clear expectations. And if you’re not willing to put in the work to get to the other side of that, then maybe it’s not for you or maybe now it’s not the right time for you. And all of those things are completely okay. But if you know what you’re getting into, it makes it a lot easier.
Yeah. Yeah. I appreciate you saying all that. The 3 million number is interesting. I’ve never heard that kind of threshold as far as what you would actually need to, to step away. I don’t know how I came up with this, but a few years ago I was, I had it hit pegged at like seven X your individual income would allow you to have some kind of passive. I don’t know. It’s not as precise, but it’s, but that kind of makes sense. Actually. mean, 3 million is yeah.
That’s only right.
300 to 400, which kind of kind of maths. But yeah, I think that’s good to know.
Julie Herres (54:00.334)
That’s not a perfect science number either, but it’s more of like, are the, you know, is there a clinical director in place? Like, at the three million mark, there probably is, right? You probably have, if you have multiple locations, a site supervisor for each site because you’re not there as the owner every day. And that site supervisor is seeing clients, right? But they’re not seeing a full client load. Do you probably have a three million, like,
one to two intake, one to two billers, right? Like you kind of have those redundancies in place so that even if someone’s on vacation, like you’re not the one being tapped on the shoulder to cover those pieces, right? There’s multiple layers at that point. There’s good systems in place. It’s hard to grow to $3 million a year without, so you know, have systems around hiring and recruiting and like the things are working.
like clockwork in many ways, it’s never perfect, things are gonna break, but there’s generally a way to do things that other people know.
Right, right. Yeah, it’s good. Systems are so valuable.
So bye.
Dr. Jeremy Sharp (55:11.79)
Yeah. So speaking of the group, last question I’ll ask about expanding into a group is the compensation. You know, people, the 60 % number is floating around everywhere. It’s like, you know, we need to pay our clinicians 60 % of revenue. And I would love to get your perspective on the range of compensation. We’ll stick to W2 for now just to keep it simple, but the range of compensation that can be reasonable.
My recommendation is for a fully licensed clinician that they should be paid somewhere between 45 to 60 % of the revenue they generate. 45 to 60 includes wages, payroll tax, and benefits. So that doesn’t mean a base wage of 60 % because that’s going to cost you really closer to 70, 72 % all in with payroll tax and benefits.
Yeah, that means it has to be lower than 60%. And I’m sticking to it. That’s my line in the sand. I get a lot of pushback on that. And my response to that is generally, you are the business owner. I’m going to make my recommendation. You can do whatever you want. That doesn’t change my recommendation. If you decide you want to go higher than that, that’s great. You will have decisions to make as far as where are you going to go lower?
If it’s nowhere else, then that means your profit is going to be low. And that’s a choice you’re allowed to make, but not one that I’m gonna recommend. Yeah.
Very reasonable. Yeah. So that’s, just want to double click on that. 60 % is the top of the range for you. Yeah. Inclusive of benefits and.
Julie Herres (56:55.32)
Including benefits, yes. all time. And so that also means though, can’t, like if you make the offer when you’re hiring someone at the very top of that range, guess what? There’s nowhere to go. Because that is kind of all in, right? Unless you’re able to increase your rates or pay them with some other like magic money that’s coming from somewhere else. Like at some point that is going to cut into your profit margin. It just is.
20 % turns into 14 and then 11 and then seven and they’re like, oops, we’re not making any money anymore. And so there is unfortunately a cap, right? And I do wish things were different. I wish reimbursements were higher. I wish mental health was valued more, right? I do wish for all of those things. And yet the reality is that the math has to make sense and
If you’re going to hire someone and pay them more than they generate for your practice, you might as well not hire someone you would be better off financially to not hire them because you or someone else in the practice is going to have to work harder to compensate for that. There are plenty of situations where a clinician is making more money than they generate and that doesn’t make sense. There is an end to that because at some point you can’t sustain that long term.
Yeah. What are some of those situations? That’s, can maybe see it with a leadership position or someone who’s not seeing as many clients. When are you seeing people being paid more than they’re generating?
Yeah, have seen, I’m going to detour a little bit. In a leadership position, those are typically going to be break-even positions, right? So like that site supervisor, I’m usually looking for them to at least bring in enough revenue to cover their wages, payroll, tax, and benefits, right? That means you have to have enough other people on the team to contribute to overhead admin, right? Like all the other expenses to the business, but…
Julie Herres (59:00.174)
usually for a leadership position, if they can at least break even, we’re usually in pretty good shape as long as the rest of the practices is healthy. But I have seen, I mean, I’ve been doing this for a long time at this point, I’ve seen 85 % splits, which 85%, if you add payroll tax and benefits to that, you’re right up against 100%. But I have seen, the highest split I’ve seen is 100%.
where they were getting 100 % of the revenue they generated, they were doing a couple of additional duties in the business, plus payroll tax and benefits. So that’s just digging a hole that gets deeper and deeper and deeper. These are few and far between, but it does happen. It also can happen if you’re paying for admin time. So if you are paying a clinician for the work that they do, right, let’s say you’re paying 60 % base.
and they’re seeing three clients a week and you’re paying them for eight admin hours. So guess what? There very little profit margin that there was in that, it’s gone.
Yeah, that brings back memories. That was one of my biggest mistakes. When we had therapists on our staff was paying for admin time. Not to that, but paying for admin time was a big income suck.
Yeah, if someone is pulling their weight, right? Seeing 20 clients, three admin hours, that’s probably not as big of a deal. especially with those very part-time clinicians, there’s so little margin already in someone who’s very part-time. And then you add that on top of it. You’d do better off just not having the mental load of having that person on your team.
Dr. Jeremy Sharp (01:00:45.87)
Sure, these are, I think there’s a lot of nuggets in this conversation and almost like throw away lines, but they’re important. They’re important. You know, something like that, just that, that willingness again, to make the choice. You don’t have to have that person on your team. Like there is a point where an employee becomes profitable for the business and when they’re not profitable and you know, sometimes we overlook that. I have to bring this person on or I have to keep this person even though they want to reduce their hours or whatever it may be.
Not always the case.
Yeah, if we have time, I generally find that 10 sessions per week is usually the break even for most practices. Where if you have a clinician who’s seeing four or five, six sessions per week, by the time you cover just all those software expenses that don’t change whether someone’s seeing one or 18 clients per week, right? Your EHR, your phone, like all the things, and then your support systems as well.
below that, they’re not even contributing to your overhead at that point. so what I also find though, is that the mental load of managing someone who is seeing five clients a week and 20 clients a week is very similar, if not almost more for the five hour week person. Because if the owner, especially if they’re in that intake seat as well,
If you’re always wondering, well, can I schedule them? Are they here that day? Can we make this work? It’s more work than someone who you just know is going to be there. You have their schedule. They’re always available. Whatever it says in the EHR is accurate. And so I think the mental load is often not considered enough. If someone’s not contributing to the bottom line, not really around the
Julie Herres (01:02:40.108)
and it’s taking you a lot of mental energy. Like, why are we doing this?
Why are we doing this? Yeah, that makes me think about the just being deliberate in this whole process. I have run into, gosh, don’t get me wrong. I made a lot of decisions that were not as deliberate or thoughtful as they could have been. And I think a lot of us, especially with hiring, it’s almost reactive and a lot of it happens without being deliberate and considering everything that entails.
I have made these mistakes too, right? Like I am, you know, tough with numbers, but I’m also human. And sometimes you have someone on your team that you really like and like, I just want to keep making it work. And it just doesn’t work. Sometimes it just doesn’t work anymore. And it’s a sad and tough decision to make, but sometimes you’re just better off for it.
True. So let me see, I may ask you one or two more questions and then we can wrap up. This has been great. You you talked about debt a lot in the beginning and how that can be a bad thing, right? I mean, typically people are sort of over leveraged and borrowing to cover. Is there any situation that you have seen where taking on debt can be helpful?
Sure. I’m not anti-debt. am just, because of my story of origin, I am just financially cautious is how I would call it, right? Like mom kind of went into these business ideas with abandon and not really with a consideration of like, are we going to pay for any of this? Like how is this all going to work? And so I just tend to be a little bit more cautious because of that. And really when you’re taking on debt, you are spending tomorrow’s money today.
Julie Herres (01:04:27.566)
That is ultimately what we are doing. And so it is possible for that to make sense. There are lots of folks who have started businesses by taking maybe a small, like $10,000 SBA loan, right? Just to get them kind of over the hump and then get the systems in place and have the time and space to get everything lined up to start. But when you are doing that, I think you have to have a clear
path to return on investment with that money, right? It can’t just be, well, let me take on this loan and maybe I’m going to pay myself with it and maybe I’m going to do this with it, right? Like you have to have a good plan and you should be spending on money, that money on things that are going to make you money. So like we’re taking out a loan to go buy throw cushions for our, you know, for our route. Like that’s not going to make you money, right? What is going to make us money? A strong website where
People are able to find you easily right with good SEO That’s going to make it very clear who your ideal client is right? Like that’s a good event that will make you money But having so having that clear vision Can be can be really helpful And will suggest kind of a in-between step I am generally a fan like if someone is borrowing To start a business. I would love to see them
save up first, save up money and then have some money saved up for themselves and then supplement that with a loan versus just a loan. Because the ability to save up money means like, okay, you have carved out part of your budget already and we know that you have this money available for the business, right? Because when you borrow money, at some point in the short future, you have to start making payments on that.
And so if there’s not even a plan for like, how are we going to make these loan payments? You can end up in a more difficult financial situation after the loan than before the loan. But if you’re able to start saving money, right, and have maybe $5,000 saved, and then you take on a loan for some of it. So you’re spending some of your own money, which feels different always when you’re spending your own cash and you the loan. So you not only have a smaller payment, you know, you know, you’re able to save that you were able to save that money. So you can take that same amount.
Julie Herres (01:06:54.574)
and work that towards the loan payment. So that’s my more like cautious in between recommendation. Also for expansion, I feel the same way when it comes to expanding the business, like if there are $0 available for you to save for expansion, you probably shouldn’t also take out a loan to expand because in a time of expansion, usually there’s a six to 12 month period where you are actually going to make less than before. And so if there’s today,
no money to even save a little bit, what makes you think during this expansion, somehow that money’s gonna appear? It usually doesn’t.
Right. It’s like having a baby at seven marriage.
Yeah. Yeah.
Maybe that’s too intense.
Julie Herres (01:07:42.08)
I mean, yeah, babies are intent and babies are so expensive too. I was thinking about it. yeah, that’s something. Yeah. Yeah.
us.
Dr. Jeremy Sharp (01:07:53.438)
Babies do make everything harder. Yeah. Have you heard that Jim Gaffigan joke? We love Jim Gaffigan the nerdmouse, but he’s a comedian and he has this joke that says, what’s it like to have five kids? He said, well, it’s like you’re drowning and then someone tosses you a baby. This resonates.
I think I’ve read that he lives in New York City in a small little apartment with his five kids, Something like a very challenging sounding situation.
Yeah, yeah
Dr. Jeremy Sharp (01:08:26.603)
Yeah. It’s a whole story. Yeah.
Yeah, and then you decide to have another baby, like someone throws you another baby. Yeah. Sure. Sure. All right, this is fine.
Yes. So anyway, if you’re going to expand, have some money saved. Um, this is great. I’m going to close with a question, a personal question maybe that hopefully we’ll wrap this up. And I am curious. So I know that for me, the way that I’ve approached money in my practice and in my life has changed pretty significantly, I think over time. So I’m curious for you being in this field, doing the work that you do, seeing all these practices, diving into the numbers.
How has your own financial perspective changed over the years? yeah, anything that you have learned along the way as a business owner yourself.
Yeah, I would say I’m less debt-averse today than I was 10 years ago in the sense that I think more practice owners should have a line of credit and should get it when things are going really well. When things are going well, we’re thinking, everything’s always going to be fine. In business, what I’ve learned is it’s not a question of if something will go wrong, it’s really a question of when. At some point, something will go wrong.
Julie Herres (01:09:43.894)
And I just go into every day expecting, just knowing that, right? Like at some point something’s gonna go wrong this year. And so preparing yourself when things are going really well can serve you when things are not going so well. So I have a line of credit for my business, which I did not have 10 years ago. And I always prefer not to use it, but I really like knowing that it’s there just in case. Yeah.
I also, it’s always very interesting to see the financials and then make those kind of micro decisions behind the scenes. Like, I don’t want to do things that way. Or, maybe I should try, you know, maybe I could be a little bit more aggressive because this has worked really well in this situation, right? So I think I’ve just evolved, evolved over time, just like I have evolved hopefully as a parent, as a mom, and as a leader of the practice. Like I hope that
I’m doing things in the right way and the right way might change over time. But at least I know that I’m doing it in a way that feels true, true to me and to who I am. And I try to do things in a way that help me sleep well at night and I sleep really well. So I feel like if I know my team is okay and everyone is protected and my family is gonna be okay, then I can sleep well.
I like that gauge.
Yeah, and that includes like life insurance and you know, just all of the things that go with that emergency funds and the business, line of credit, like all of those things kind of help like pad everything. So that’s my perspective on it.
Dr. Jeremy Sharp (01:11:28.216)
I appreciate you sharing them. Well, this has been a great conversation as expected. How can people find you if they want to talk to you or work with you or any of those?
Yes, I also have a podcast called Therapy for Your Money. So I would love for you to find that. I talk about all financial topics specifically for mental health, therapy for your money. And my firm is Green Oak Accounting. So feel free to check us out, green oak accounting.com. You can just lurk and see all the fun. We have a lot of fun resources available there on the blog, but you can also schedule a free consultation.
with the team and CFR services might be a good fit for you. And you can also find my book, Profit First for Therapists on Amazon or wherever books are sold.
Fantastic. Thanks again. I’ve really enjoyed it. All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out. If you like what you hear on the podcast.
Thanks so much.
Dr. Jeremy Sharp (01:12:42.39)
I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.