From solo telehealth to a group that runs without you.

This isn’t “scale a solo practice.”

The proposal made the case for an acquisition engine. This document is the rest of the vehicle — clinical hires, supervision, EHR, payer mix, fees, and the financial sequence that lets the engine run.

Twenty years of clinical depth. EMDR-certified. ASD specialist. Bilingual English and Spanish. Licensed across New Mexico, Oklahoma, and Colorado, with PSYPACT expansion latent in the credential. That is not a solo therapist who has stayed small. That is a category founder who hasn’t built the company around himself yet.

The move from solo to group is rarely a marketing problem. It is an operating problem with a marketing engine attached. Bruno needs new clients showing up at a pace clinicians can absorb. He needs clinicians who fit the practice’s clinical center of gravity (trauma, ASD, bilingual, identity transitions). He needs a fee architecture and payer mix that protects margin while the panels unwind. And he needs the math to tell him when each new clinician earns the practice the next one.

What follows is the sequenced version of that build. Three phasing options on speed, one recommended default, and the decisions to make on the call.

Eight axes of the practice. Today and at full build.

The current and post-engagement state across the dimensions that move first.

How fast do you want the group to exist?

Three sequencing options on the same destination. The middle path is what we’d recommend, but the call is yours — and depends on cash reserve, risk appetite, and how much of Bruno’s next year you want spent hiring.

A note on multi-location (physical clinics). Worth flagging because it’s the version of “multi-clinic” most people first hear. Telehealth-first is the practice’s DNA — three-state license stack, EMDR delivered virtually, bilingual care reaching clients no single-city brick-and-mortar would. A physical clinic is a year-three optionality if you want a flagship location (Albuquerque or Santa Fe most likely), not a near-term move. We’d revisit at month 24.

Who you hire, in what order, and what they cost.

The hiring sequence is downstream of the practice’s clinical center of gravity — trauma-informed care, EMDR, ASD specialty, bilingual reach — not a generic associate roster.

The four hires, in recommended order

Supervision model

• Group supervision. 90 minutes weekly, all associates. Case consultation, modality refinement, ethics. Counts toward associates’ supervision hours where applicable.
• 1:1 supervision. 60 minutes weekly per associate, especially in the first 90 days. Drops to 30 minutes biweekly once an associate is established.
• EMDR-specific supervision. Bruno’s EMDR certification supports modality supervision for associates training into EMDR. Verify scope for each state board (NM, OK, CO) before formalizing.
• Director time. ~6–8 hours per week of Bruno’s calendar dedicated to supervision, hiring, and practice direction once two associates are on. This time is non-billable but is what keeps clinical quality and culture intact.

Compensation architecture

• 1099 contractor structure for first associate (lowest setup overhead, fastest to onboard). Move to W-2 employee structure once two associates are on and benefits become competitive.
• Starting split: 60% to associate, 40% to clinic in months 1–6 of an associate’s tenure. Industry standard for telehealth group practices.
• Tenure split: 65% / 35% once an associate has been on six months and is filling a full caseload. Optional 70% / 30% at the 18-month mark for top performers.
• Caseload guarantee: none in months 1–3 (associate builds their own with funnel support). Soft target of 18 sessions / week by month 6.
• No-show and late-cancel policy. 100% to clinic — covers the slot cost. Documented in associate agreement.

Recruitment channels

• TherapyDen, Headway / Alma associate boards, Psychology Today “practices hiring” section. Highest signal for specialty fit.
• LinkedIn outreach to EMDR and ASD specialty groups. Targeted DM to early-career clinicians who’ve listed specialty training.
• State association job boards. NMCA, OCA, CCA — small but high-quality candidate pools.
• Alumni and supervision networks. Bruno’s 20-year network is itself a recruitment surface. Ask, don’t just post.
• Working-interview process. Final candidates do two paid trial cases under supervision before offer. Catches clinical fit issues before the offer lands.

The systems that make a group of four feel like one.

Telehealth-first practices die from too many systems, not too few. The stack below is deliberately small and integration-forward.

• EHR & client portal: SimplePractice. Telehealth-native, cleaner client portal than TherapyNotes, supports group-practice billing and supervision logging. Single source of truth for clinical notes, appointments, and billing.
• Telehealth platform: Integrated within SimplePractice — avoid Zoom-as-shadow-system. One link, one client experience, one set of HIPAA controls.
• Intake & assessment: The specialty-matched assessment from the proposal lives on the website (Webflow or Framer). Submissions route into SimplePractice with specialty tags pre-populated.
• Scheduling: SimplePractice’s self-scheduling, with consult slots reserved on each clinician’s calendar. SMS + email reminders at booking, 48 hours, and day-of.
• Billing & cash-pay default: Card-on-file at booking. Superbill provision for out-of-network clients seeking reimbursement (one-click PDF generation in SimplePractice).
• Insurance bridge (transitional): Headway or Alma — they handle credentialing, billing, and direct-pay for the panels you keep. 30–40% take, but they absorb the admin burden during the transition.
• State licensure stacking: PSYPACT for psychologist license portability where applicable; for LPCs, check Counseling Compact eligibility per state. Add one to two states per year as PSYPACT-eligible associates are hired.
• Communications & ops: Email on Google Workspace (HIPAA-eligible plan), Slack for internal team comms, Notion or Coda for the practice playbook (intake protocols, supervision notes structure, hiring scorecards).
• AI ops layer: Carried over from §10 of the proposal — pre-consult prep briefs, no-show recovery drafts, broadcast email drafts. All AI output reviewed by Bruno (or, later, the practice manager) before send.

Cash-pay default. Sequenced exit. No fire drills.

The fee architecture and the panel-exit sequence — designed to protect cash flow through the transition rather than break it.

Fee architecture

Panel exit sequence

• Months 1–3 · Triage the panels. Rank current insurance panels by reimbursement rate, admin burden, and proportion of caseload. Identify the two or three lowest-yield panels for immediate exit. Verify contractual notice requirements (typically 60–90 days).
• Months 4–6 · Notice the bottom tier. Submit 90-day exit notice on lowest-yield panels. New clients booked on those panels go to a 30-day waitlist with private-pay offer or referral. Existing clients on those panels notified and offered transition to private pay or referral.
• Months 7–12 · Migrate the middle tier. Move mid-tier panels to Headway / Alma where viable (they keep insurance flow without you handling credentialing and billing). Continue full direct billing only for the highest-reimbursing one or two panels.
• Months 13–18 · Hold or exit the top. By month 18, decision point: continue the one or two highest-reimbursing panels via direct contract, keep on Headway / Alma, or fully cash-pay. Most practices land at “Headway for some, cash for everything else.”

The cash-flow buffer

Plan for a three-month cash reserve equivalent to current monthly take-home before the first panel exit notice goes out. The transition period creates a ~15–25% revenue dip in the worst month before the AYMI funnel compensates. The buffer is what lets the transition happen on the timeline you choose, not the timeline forced by short-term cash pressure.

What our piece does, sized to feed the group.

The Growth System engagement from the proposal, tuned to deliver the booked-shown consult volume each phase requires.

What scales with each hire

• Funnel volume. Each new associate adds 25–35 booked-shown consults / month of clinical capacity. We size paid spend to fill that capacity at the right cost-per-shown.
• Specialty routing. Assessment logic evolves as each new specialty associate comes online — the trauma-track hire opens a trauma-specific routing path, the bilingual associate opens a Spanish-language assessment variant, and so on.
• Creative refresh. 4-week cycle. Each clinician gets at least one creative variant featuring their specialty wedge once they’re past month two of caseload-building.
• Lifecycle expansion. Welcome series, no-show recovery, long-decider nurture, post-first-session retention — all the lifecycle infrastructure that pays for itself within a quarter at this LTV.

The acquisition engine is the recommended Growth System (★ Recommended) tier from the proposal. The investment is held for the scoping call — we’d rather agree on phasing first, then size scope to match.

When each hire pays back. When the group pays you.

The math at a single-associate level, then rolled up to a four-clinician group. Numbers are illustrative defaults; we’ll calibrate to your actual fee mix on the call.

Per associate — at steady state (month 6+)

Breakeven on each hire

Onboarding cost for a typical associate (recruiting, credentialing, training time, ramp-period subsidy) lands at $8–12K. At ~$5K/month net contribution per associate at steady state, breakeven is roughly three to four months from a fully-ramped associate’s start. The funnel is what determines ramp speed — and the AYMI engine’s job is to compress that ramp.

Group rollup at full build

Numbers assume Bruno’s own caseload is intentionally capped at ~22 sessions / week (down from a full 30+) to preserve Director time. The clinic margin grows even as Bruno’s personal billable hours come down — that is the structural shift.

What ships, and when.

The default sequence (Option B). Compresses to Option A by overlapping milestones; extends to Option C by spacing them out.

What can break this, and how we don’t let it.

Five named risks. Each one is manageable on its own; together they argue for the measured-phasing default.

• Supervision scope & liability
  Risk: NM LPC supervision rules constrain which credentials Bruno can formally supervise (LPCs in training vs. LCSWs vs. PhD candidates). Out-of-state associates working under PSYPACT or Counseling Compact have their own supervision requirements.
  Mitigation: Verify per-state-per-credential rules with the NM Board of Counseling and equivalents in OK / CO before extending any associate offer. Document the supervision arrangement in the associate agreement. Carry adequate professional liability insurance scoped to a group practice (not solo).
• Cash-flow dip during panel exit
  Risk: 60–90 day insurance receivables run out before private-pay momentum compensates. Worst-month dip of 15–25% revenue is plausible.
  Mitigation: Three-month cash reserve in place before the first exit notice. Sequence the exits — bottom-tier panels first, mid-tier via Headway / Alma — so the dip is shallow and brief.
• Hire quality
  Risk: A bad clinical hire damages client trust, supervision bandwidth, and team culture in equal measure. The cost of replacing a wrong hire at month four is meaningfully higher than waiting six weeks for the right one.
  Mitigation: Working interviews (two paid trial cases under supervision before offer). Reference checks with prior supervisors. 90-day probationary period in the associate agreement. Hire slow, fire fast.
• AYMI funnel ramp time
  Risk: Paid acquisition takes 60–90 days to optimize to target cost-per-shown. First two months may run hot on cost while we learn the audience.
  Mitigation: Engagement structured so the first quarter is a measured ramp, not a full-volume sprint. Creative variants tested weekly. Cost-per-shown benchmarked against psychology-category norms, not generic lead-gen.
• Credential representation
  Risk: Marketing copy, directory listings, or any client-facing surface that names Bruno as “Dr.” or “psychologist” before the PsyD is conferred creates state board, FTC, and ethics-board exposure.
  Mitigation: All marketing, web, and assessment copy uses Bruno’s currently-conferred credentials only: LPC · EMDR-certified · ASD specialist · Bilingual EN/ES · Licensed NM, OK, CO · Founder & Clinical Director. Quarterly QA pass to confirm. PsyD is not used in any client-facing surface until conferred.

Five decisions that move us to kick-off.

If we land these on the call tomorrow, the rest is execution.

1. Phasing option. Which of the three timelines fits your cash position, hiring appetite, and how much of your next year you want spent building rather than seeing clients?
   Options · A 12mo sprint · B 18mo measured ★ · C 24mo conservative
2. Insurance exit shape. Clean break (cash-pay-only from day 30), staged exit (bottom tier first, then mid-tier via Headway / Alma), or hybrid hold (keep one to two high-reimbursing panels indefinitely).
   Options · Clean break · Staged ★ · Hybrid hold
3. First-hire profile. Trauma-track associate (closest fit to your core practice) or bilingual EN/ES associate (scales the rarest specialty earliest, at higher recruiting cost).
   Options · Trauma-track ★ · Bilingual first
4. AYMI engagement tier. Confirm Growth System (★ Recommended in the proposal) — paid acquisition, lifecycle, content engine, and AI ops — versus stepping down to Foundation or up to Full Practice OS.
   Options · Foundation · Growth System ★ · Full Practice OS
5. Kick-off date. When do we start? The 90-day clock begins on day one and the first associate hire lands inside it.
   Options · Within 2 weeks · Within 30 days · Within 60 days