Enlightened Practice Podcast
Dr. Ken Braslow and Dr. Kari Kagan, answer a question from our audience: What is the best location for a practice?
Our hosts discuss office considerations when starting a practice or when you’re ready to emerge from your home office and open a public location. There’s a lot to consider before signing a contract like public transportation, parking availability, downtown vs. the suburbs, and whether to sign a lease alone or sublet. We hope to help you make a well-informed decision, so tune in to this new episode of the Enlightened Practice Podcast and enjoy!
If you want your question featured and discussed on the show, send it to [email protected]. We’d love to hear from you.
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Transcript of the podcast
Ken: Hi Kari. Welcome back to the podcast.
Kari: Hi Ken. Thanks for having me.
Ken: So, today we have some questions from listeners about location and office area, office considerations when you’re thinking about starting a practice. And I’m assuming this is applying to physical location now that some of us, hopefully all of us will have the option soon enough to be back in person physically. How do you think about emerging from your home office or other location where you’re doing video? And then, the next step in that is when you’re signing a lease or a sub-lease. What should you be thinking about? And how do you make a decision based on the terms of the contract? So, let’s start off with location. Location, location, location, right, as they say.
I think that applies not just to home values but also to running a viable practice and being in a location that’s attractive. Even if you’re going to do some video from your office, many of my patients have articulated to me that they’re excited about being back in the office physically and that’s going to be really important especially in our field.
Kari: Yeah, absolutely.
Ken: So, curious how you chose your first location and what you were thinking about and in general what would you advise our listeners to be thinking about?
Kari: That’s such a good question and it definitely has changed for me over time, but how I chose my first location was with a business mindset. So, where could I start a practice that I felt I was most successful to the most people? And that was a priority over more like personal considerations like distance from home and that kind of stuff. So, based on that, where I chose to be was in the heart of San Francisco at the time because that was where there were a lot of people. And also there was a lot of public transportation, so that felt like the best place to get started, to get the most amounts of clients, to just be around the most amounts of people. As opposed to, for example, the suburbs.
And because I actually meant making more of like a sacrifice to my personal life, I had more of a commute for people who might be worried about that. It was also possible to transition closer to home after I was more established. So that was a consideration, like once you lay down your roots are you stuck there forever? And I think the answer is, no. But, yes it can be challenging. Especially with more video these days and a little bit more flexibility, and even before the pandemic I made the shift closer to home which happened to be in the suburbs. And I was surprised first of all, at the number of people that I was seeing in the city before who were actually willing to commute to me in a different location or willing to do video as I built in the new location.
So, it didn’t actually result in any client loss that I can recall. So, just for people who are worried that they might get stuck in case it’s not their dream location, it is possible to transition.
Ken: That’s a great point. Or/ and to have two offices.
Kari: Yeah.
Ken: That’s a lot more to think about logistically in terms of your schedule and hours, but it opens up a second population and you could use that to springboard to eventually having your second office become your primary office down the road.
Kari: Yeah.
Ken: Yeah, I just wanted to be where the action was, so, downtown San Francisco as well. And in my practice what I realized was that it was not as convenient for kids and families to come in, even though there was public transportation. Families were more reluctant to come downtown. That is when I set up a second office closer to where I was living, that was in a little bit more of a suburban area. And that was actually a really nice combination. For a while, I was going into the city in the morning and then on my lunch break I would take the train out to my afternoon office and see kids and families. So that worked out pretty well and I’ve that model up until the pandemic for quite some time.
It is a nice blend, even though it is a little bit more cost and a little bit more having to think through logistics. But I was able to typically sub-let out the office I had a lease on and then to be a sub-letter on the office that I was sub-letting. So, I wasn’t stuck with two leases. I don’t think the cost came out to be significantly more and it really allowed me to have a real dynamic practice. I would say in general, if you’re thinking about a new location, you should be thinking about not just public transportation but parking also, that’s really meaningful.
If people can’t get to you they can see you on video, but they want somebody in person then it will affect my work. Thinking about kids and families, what are the parents going to do while you’re seeing their kid? Is there a coffee shop around? Is it a nice area where they can hang out? That is meaningful, if you can get a location with a Starbucks right nearby. I’ll tell parents, go get some coffee and I’ll see you in 45 minutes.
Kari: Yeah.
Ken: I would also say, you have to think about the waiting room situation. I’ve seen people literally put a chair out in the hallway.
Kari: I’ve seen that too.
Ken: That’s definitely cost efficient, but I don’t know if that’s the best experience for being a patient, to be kind of in a chair, in the middle of the hallway, and maybe some HIPPA considerations there. I wouldn’t recommend that. Waiting rooms are square footage just like an office is, so typically it’s folded into the cost or you’ll pay extra. Can you share that cost with multiple therapists? The location I was at, it was like a colony of therapists. So, six of us went in on a waiting room. That was a small office and it really brought the cost down and made it quite efficient.
Kari: Right.
Ken: Kari, you had a couple of factors that you were thinking about that were important also.
Kari: Yeah. When you were just talking about when you were in a building and there was a colony of therapists, I think that should be a consideration, who else is in the building? I think it actually is nice, especially if you’re in private practice where you’re alone a lot of the time with your clients. It can be nice to be in a building with other therapists that you can befriend and they can become colleagues and people you consult with. In my experience, somehow buildings have evolved into like hubs of therapists. I don’t know how it happened but it happened.
Ken: Well, we’re good tenants.
Kari: Yeah. And that’s always been nice, like it gives you the sense that you’re not alone. So, I think it’s something to consider, who else is in the building or the area, or the street, or whatever it is. Another thing I’ve had different experiences with is just accessibility to the office. I’ve had offices with and without elevators. And obviously, just depending on the population you work with that’s a pretty important consideration. And I will say, when I had an office without an elevator it was actually pretty problematic. Like I would find myself having to tell every single new client by the way, we don’t have an elevator. Sometimes it was a problem for whatever reason.
So, if you can avoid it, I would say having an accessible office is probably the most inclusive, but sometimes it just doesn’t exist for whatever reason. In general, especially if you’re sub-letting or even leasing, just considering the general the décor of the office, and if that fits your energy as a therapist in what you want to put out there to the clients you’ll be seeing, but sometimes even the building in general can have its own vibe. It either works for you or it doesn’t and it sounds silly but it’s kind of like a home away from home, so you do want to feel comfortable wherever you end up and it’s worth considering what it looks like and if that works for you.
Ken: Well, your clients will consciously or subconsciously will pick up on that and they will judge your practice by all of those meta-conditions that surround their experience. The other thing that comes to mind is food and unless you’re not human and don’t eat, you’re going to be there much of your work day and is there a kitchenette, is there a way that you can have at least a fridge if not a microwave or toaster oven. And then also, to be mindful that I recall colleagues warming up Indian food which I love, but the very fragrant smell can permeate different offices even if you’re not the one that gets to enjoy the yummy food.
So, thinking about not just own food but your colleagues, and then proximity to a bathroom. One building I was in, I did not even consider this until I was seeing my first patient and about ten minutes into our very deep therapy session, I heard the loudest flush ever. And I was like, okay, got it, that’s where the bathroom is.
Kari: Right.
Ken: On the flip side, in a different location, I was in a big office building, the bathroom was like a couple of football fields around the corner and so I only had five minutes in between patients and I had to sprint a little bit to make it back in time.
Kari: Yeah, a very important thing.
Ken: Yes, the human factor should not be overlooked.
Kari: Yeah.
Ken: Okay. You found your dream location or at least a good enough location. Take me through how you would approach the contract what you would be looking for in the lease or the sub-lease, what’s important to you?
Kari: Yeah, definitely costs. So, does it work for your budget? And just being mindful that you don’t do too far of a reach because you never know in private practice is there slower times. And I think especially early on I would have erred more on the conservative side, and then as I got further into my career I was more willing to take some risks with the cost. But, something to consider is the cost and potential increases over time too.
In health, I’m pretty sure there is rent control, but there’s also like built-in a certain percentage increase over each year I think. It’s something to be aware of. If you start on the higher end it’s only going to go up from there. It’s never going to go down, at least here in California, from my experience. That’s one main thing, and the other thing I’m thinking about too is just the lease term and how long it is. There are pros and cons. There can be one year terms. There can be three year terms. There can be five year terms. I’ve seen it all. The pro of a one year term is if you find that the office just doesn’t work for you, sometimes you’re just trying it out. It’s a year and you’re done.
The downside is, then you might have to renegotiate the terms of the lease the next year as opposed to a three year or a five year where you’re kind of locked into a certain rate with very minimal increase over time. And you just get that sense of stability or comfort in that, but it also means you’re locked in. So, if you end up wanting to change locations for whatever reason, it gets more expensive and tricky, that’s a reminder of another thing to consider. How do you break a lease? Unfortunately, we all learned this in a very hard way which is all of a sudden no one was using their offices and it was a tricky thing to navigate if you keep paying your lease or how do you get out of it. That’s definitely worth reviewing with any landlord, to figure out how do you get out of a lease if you need to and how much will that cost, and all that kind of stuff?
Ken: Yeah, I think that makes sense. I would say, on the cost front, it can be a tricky calculation in that it’s possible that by paying for a more expensive lease you may drive your income higher if the location is that much more amendable to clientele. On the flip side, you don’t know that until you get started, so it’s a little bit of a gamble when you cash flow is lower or none existent and you’re funding your practice in the first place, and you want to keep your expenses as low as possible.
The term, if you want a build-out, so that’s like the landlord’s construction team or building maintenance team, moving the walls or getting things situated in just the way you want them. Sometimes, they’re willing to do that and they’ll bear the cost of is, but they’ll never do it for a one year lease. It would typically be for at least four or five year lease that you could get that done.
So that’s something to be mindful of. And also, I think the building you sub-let. So, most commercial leases will allow you to sub-let, but make sure you get that in writing and that’s really meaningful. If you end up wanting to break away and go to another office part-time, if you can sub-let yours then that really reduces the cost and the risk in that.
Kari: Yeah.
Ken: So, any lease can be reviewed my most general business attorneys and if it’s a one year lease, is it worth paying them a couple of hours? Probably, but if it’s a five year lease it’s really worth paying them a couple of hours because they won’t charge you per year, they’ll just charge you per hour. But you’re going to be locked in with those terms for a long time and you can bet that the management has their lawyers preparing their lease. So, it’s always good to have your own team to help you out.
Kari: Yeah.
Ken: Okay. Well, thanks! I think that covered those questions nicely. And look forward to reviewing more listener questions with you soon. Thanks for coming on today.
Kari: Okay. Thanks.
Ken: Talk to you later. Bye.
Kari: Bye.
