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Your schedule is full, your team is working hard, and you’re spending your days solving problems. But when you look at your bank account, you’re not sure your practice is where it should be. Do you need more clients? Another clinician? Better systems? Figuring out what to address first can feel overwhelming when every part of the business needs your attention. In this episode of the Wise Practice Podcast, Whitney Owens talks with James Childress, CPA and founder of CAC Advisors, about how practice owners can use their data to understand what’s happening and create a clear plan for improvement.
A Personal Commitment to Helping Therapists Thrive
James’s work with mental health practices grew out of his own experience in therapy. After spending years as a CPA serving different industries, he sought therapy and found answers to questions he hadn’t realized he needed to ask. That experience changed his life and eventually led him to work with his first mental health practice client. Following the loss of his mother and brother in 2021, his commitment became even more personal. Helping therapists build sustainable businesses became a way to support the healing they make possible in their communities.
What Would It Look Like to Diagnose Your Practice?
Therapists are familiar with listening carefully, identifying patterns, and developing treatment plans. Whitney wonders what might happen if practice owners could bring that same process to their businesses. Rather than responding to whichever problem feels most urgent, they could understand what’s causing the difficulty and decide how to address it. James describes his app, Bearing, as a way to support that process by bringing practice information together, identifying areas of concern, and helping owners determine their next steps.
Why Financial Statements Don’t Tell the Whole Story
James emphasizes that financial information is only one part of understanding a practice. Accounting shows important results, but EHR, payroll, and marketing data help explain how those results came about. A practice owner might know that revenue is disappointing without understanding whether the issue starts with inquiries, scheduling, client retention, or staffing expenses. Looking at these sources together can reveal connections that are difficult to see when each system is reviewed separately.
The Hidden Cost of Gaps in Your Intake Process
An inconsistent intake process can affect both access to care and the financial health of a practice. When someone reaches out but never gets scheduled, the impact extends beyond one missed appointment. James explains that looking at lost clients, potential sessions, and profitability per session can help owners estimate what those gaps are costing them. He shares that one client saw a significant change after hiring an intake coordinator simply because someone was consistently answering the phone. Understanding where potential clients drop out gives owners a specific process to improve.
What Client Retention Can Reveal
James also discusses looking at clients who leave early in therapy. Patterns in early departures may point to an area that deserves closer attention, such as the initial connection between a clinician and a client. Examining whether a pattern appears with one team member or across the practice helps owners decide where to investigate and offer support. The goal is to understand the context behind the numbers so that any response addresses the actual concern.
Hiring More People May Not Solve the Problem
Hiring is one of the most common challenges James sees in growing practices. Owners may add clinicians or administrative staff before the business can comfortably support the expense. Whitney adds that timing can be difficult in both directions: some owners wait too long to hire their first support person, while others bring on leadership roles too early as they expand. Feeling overwhelmed is a reason to examine what the practice needs, but it doesn’t automatically tell you which position to add or whether the practice can afford it.
Improve Administrative Systems Before Expanding the Team
James shares an example of a practice with five administrative employees supporting five clinicians. Each time the administrative team struggled to keep up, the owner hired another person. The underlying processes, however, hadn’t been sufficiently examined. He encourages owners to work with their teams to identify duplicate tasks, unnecessary work, and responsibilities that might be better handled by outside professionals. Reviewing how the work gets done can help clarify whether the practice needs another employee or a more effective process.
Turn Information Into a Clear Next Step
Identifying a problem is useful, but owners also need to know what to do about it. James describes a guiding principle for his app: “no dead ends.” The goal is to help users understand what’s happening, where the issue began, and what they can act on next. For example, a low cash balance might prompt a closer look at profitability or administrative wages. Connecting the symptom to its source can help owners prioritize their efforts and decide whether they need additional consulting or advisory support.
Support for the Complexity of Group Practice Ownership
Running a therapy practice involves competing demands, from insurance payment delays to recruiting clinicians and maintaining a steady flow of inquiries. James acknowledges that mental health is a complex industry, even compared with the many other businesses he has served. Bearing is currently focused on group practices, with particular relevance for practices with more than five clinicians. For owners who want additional help interpreting the information or implementing changes, James’s team also offers advisory services alongside the app.
A Special Offer for Wise Practice Listeners
In the episode, James shares an offer for listeners who mention the Wise Practice Podcast: 20% off the first three months of the app, with the onboarding fee waived for the first 20 people who sign up and mention the show. He also explains that services are month-to-month.
Meet James Childress, CPA
James Childress is a CPA and the founder of CAC Advisors, a firm built for mental health practice owners who have outgrown basic bookkeeping—and want to stop making expensive decisions in the dark. James and his team believe therapists are healing the world one session at a time, and that financials are never enough. That is why they connect the four major sources of practice data: accounting, EHR, payroll, and marketing. Together, this reveals where a practice stands today, what is driving its performance, and what it will take to get where the owner wants to go. James lives with his wife and two bossy cats in what he jokingly calls “the town of Wyoming.”
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[00:00:00] Whitney Owens: Building a thriving faith-based private practice isn't easy. It takes courage, wisdom, and commitment to lead your business without compromising your faith and values. I'm Whitney Owens, the owner of a seven-figure multi-location group practice and founder of Wise Practice Consulting. Every week on the podcast, I share real strategies, lessons, and conversations that come from actively leading my own practice, helping practice owners across the country do the same.
Whether you're building a solo practice or growing a team, this podcast is here to equip you, empower you, and remind you, I believe in what God's called you to. You don't have to do it alone. Welcome to the Wise Practice podcast. Let's get started. Hello, friends, and welcome back to the Wise Practice podcast.
I appreciate you letting me into your hearts and ears today. If you find this podcast helpful, please take a moment and share it with another practice owner. We want more faith-based practice owners growing their practices and helping one another and joining the community. I have loved these past few weeks of interviewing experts, bringing them on the show, hearing about these really cool products.
I've often thought to myself, "What would it be like to have someone diagnose my practice?" Yeah, it feels a little scary, just like clients probably feel a little scared when they come in your office and you diagnose them. But, like, what would it be like to actually know what's the problem in my business, and how do I go about fixing it?
So I'm really excited to share with you today, um, my friend James has created an app called Bearing, and it helps you diagnose what the problem is in your practice, going through all the different components of your practice. So it's kinda like a practice audit with solutions attached. Pretty awesome. So even though this is getting recorded after the summit, he is gonna be at the summit sharing the app, so I'm really think that's really cool, and if you're interested after you hear the show, you can do a demo, book an onboarding, and get to know it.
So I think it's gonna be a really helpful app for our world, and I look forward to you getting to know it on the show today
Welcome to the Wise Practice podcast. I'm looking forward to you getting to know my new friend, James Childress, and he is a CPA founder of CAC Advisors, a firm built for mental health practice owners who've outgrown basic bookkeeping, and they wanna stop making expensive decisions in the dark. James and his team believe therapists are healing the world one session at a time, and that financials are never enough.
That is why they created the four major sources of practice data: accounting, EHR, payroll, and marketing. Together, this reveals where a practice stands today and what's driving its performance, and what it can take to get where a practice owner wants to go. James lives with his wife and two bossy cats in what he jokingly calls the town of Wyoming.
You're funny. Welcome to the show.
[00:02:46] James Childress, CPA: Thank you, Whitney. Very glad to be here.
[00:02:47] Whitney Owens: Yeah. Awesome. Awesome. Okay. Tell us a little bit, before we kinda get into it, just a little bit about your story and why mental health matters to you
[00:02:57] James Childress, CPA: Oh, yeah. Very glad to. So yeah, I've been a CPA for over 20 years. I've done a variety of different work, you know, with a lot of different industries.
But, uh, a lot of my work was focused on actually governmental entities and nonprofits before we decided to dive into mental health. But the, the real big game changer for me was about six years ago, I decided that I wanted to experience therapy, right? Like, I'd heard about it, you know. Like, I'm, I'm like... I was like most people, where it's like you just see it in movies and hear people talk about it on the radio and stuff like that or whatever.
But, uh, I wanted to see what it was for real, and frankly, it changed my life. I found answers to questions I didn't even know I had, and it was a game changer for me. And so, uh, because of my, my life and my family life, obviously everyone has, you know, their story, but because of what was going on for me, I didn't necessarily see some of the things that had happened very clearly in my life, and the impact, and therapy just changed it.
So I started telling everyone I know, like, "Hey, you gotta check out therapy. Like, it's not it's not what you think. Like, it's way better." Um, and so someone I knew said, you know, they had a cousin they knew was a psychologist, and they thought I might wanna work with them and help them with some of the issues they were dealing with in their practice, and that was our first, uh, mental health practice client.
And we helped her double her practice in about two years, and it felt really cool. And so but the, the things really changed for me when, honestly, when in 2021, my mother and my brother passed away that year, and it became pretty clear to me that they would have had better lives and maybe had longer lives if they'd had the experience I had in therapy.
And so frankly, at that point, you know, I was all in professionally, but I was also all in personally. And I, I really do believe, you know, what I say there in my bio, which is I think we're at this critical time in the world where people are actually starting to look inside themselves, and there, there's a chance, I think there's a real solid chance for the world to, to heal and like, and become better, and I really strongly believe in that.
And because of that, we've been basically like a dog with a bone with these practices, trying to find every thing that we can do and everything that we can contribute to help them do better and help them succeed. Because, you know, a 20-person practice has 400 people they're helping heal and be better people and all those things, and that, that mission aligns with us, and so we're on board.
And so, you know, we've pivoted recently in our work- To do this, uh, app called Barren, which, uh, puts all this stuff together, and I think that we were hoping to talk a little bit about that today. Yeah.
[00:05:40] Whitney Owens: Yeah, definitely. Well, you know, when we first met, you did tell me some of your story, and I just, I can hear the passion and the authenticity around this, and, uh, that you wanna help practices not just for the bottom dollar, but because you want people to get healing.
But you also know that a business can't function without paying attention to the finances, which is what you, you help with that and many more things. Um- Yeah ... but you know, oftentimes as a therapist, I will sit with my clients, you know, and, and we diagnose. You know, we listen to the problems. Yeah. We put things together.
We've been doing it for years, and we diagnose the problem. Then we come up with our, you know, treatment plan, and we go through the- Mm-hmm ... treatment plan, and we bring healing to clients. But oftentimes I have wondered, and I feel this some in my business consulting, like what would it be like to diagnose my practice, right?
[00:06:30] James Childress, CPA: Yeah.
[00:06:30] Whitney Owens: And that is basically what your app does, diagnoses the practice and gets it to where it wants to be.
[00:06:38] James Childress, CPA: Yeah. That's the whole point of it. Like, you know, we've been working with practice owners for, like, six years now, and a lot of the same questions come up. They just... They, they come up in different orders, right?
Sometimes, like ... And the, the timing of them can be different, but we're always asking questions like, "Can we hire?" We're always asking questions like, "Are we collecting what we should be collecting?" You know, "Are the clinicians productive enough, profitable enough?" Like, and the list kind of goes on. And frankly, most of, most of the time practice owners are feeling this, like, huge burden of all of these things they sort of have to think about and look at.
And l- my... one of my slogans, I guess, is that the financials are not enough because they're only one part of the puzzle. And so every practice owner has an EHR, they've got marketing stuff, they've got payroll information, they've got accounting information. The only way they can figure out what they need to do now is if all this stuff comes together, and that's what we've been working so hard on.
[00:07:35] Whitney Owens: Yeah. Yeah. Yeah, okay, so how does someone go about diagnosing their practice?
[00:07:43] James Childress, CPA: Yeah. So the first thing we do is we get all of their data together, right? So we collect information from the EHR, from their accounting system, from their payroll system. We collect their marketing data or, or help them build marketing data if they don't have it.
And basically we put it onto our system, and we run all of the calculations, right? A lot of these things are just kind of formulas. To give you one example of, like, you know, one way that this works is, you know, a lot of practices sort of lose clients because their intake process is a little bit, uh... it's not quite hitting the mark.
We can tell them the impact that has. So session or clients lost equals sessions lost equals profitability per session, and then we add that up, and we know the financial impact of that. Well, we do that- Across the whole practice, right? So we can tell them, like, as another example, if they have clinicians who are kind of struggling with that rapport phase of therapy, there's an early churn sort of loss of- Yep
of clients. Well, again, we can put profitability perception to that, and we can figure out how much that's costing them per clinician, per team, per practice, you know, practice-wide. And then we can, you know, take all of these things we've figured out, we basically just put them in a list of numbers, and then we give them guidance on each of those major sections on what to do.
Mm-hmm. So this hasn't become this thing where it's like, "I don't know what to work on now." It's right there at the top of the list. That- that's been the goal.
[00:09:19] Whitney Owens: Yeah, so if I understand it correctly, it's kind of like a software that's tracking everything for a therapist to help them.
[00:09:26] James Childress, CPA: Yeah, tracking everything and putting them in a list, and giving them the kind of details so they can go from kind of high level all the way to sort of what's actually going on, so they can figure out, you know, the context if they need to.
Mm-hmm. And then of course they can figure out sort of in some of these cases, is it isolated to, like, one team member where this issue's happening, or is it kind of team wide? And then, you know, do they have the resources to maybe hire a consultant to fix this particular hiring issue, marketing issue, intake issue, or do they need to instead kind of pivot and find some ways to fix it on their own?
You know, it's guiding them into those solutions. Yeah.
[00:10:08] Whitney Owens: Yeah. So it reminds me of when my daughter got her autism diagnosis. So I went to the psychologist, and she did all the evaluating, right? Two days of evaluating. "Here's your daughter's diagnosis." And she kind of had some recommendations, but not really.
She didn't even really tell me very much what I was supposed to do, and I felt like I was in the dark. Like, how do I follow up? Oh, my God. How do I care for her? It... Yeah. I mean, we got there, but it was after lots of phone calls and figuring out, do I do OT, and do I do ABA, and do I do speech, and how many times, and does the school system provide this?
It was, like, all these questions I had. Right. So I kind of, like, make that analogy to your app it sounds like, because a practice owner gets that. But you actually go further and you say, "Hey, here's where each problem is, and here's where you find a solution to it."
[00:10:55] James Childress, CPA: Yeah. It's, you know, another motto we have is no dead ends, right?
'Cause like-
[00:11:00] Whitney Owens: Uh-huh ...
[00:11:01] James Childress, CPA: we, what we, again, we're, we're trying we're trying to get them there, right? So, like, the idea is, yeah, you get some sense of something that's an issue, but then with w- the way the app is designed is we always want them to have an understanding of why that's going on, you know, what happened, and then what they can do about it.
And so, and some of the answers, a lot of these answers come from the system itself, right? Mm-hmm. So a- as an example, like we make deciding, like, where they're at financially very simple. We use just some basic cash position descriptions. But if their cash is kinda low, then we can see, like, okay, is it a profitability iss- issue?
Are they spending too much on their admin costs, admin wages? Like, and you can see how some of that is just sort of formulaic. Like, they don't need to necessarily pay me to sit here and, like, talk about all this stuff, um, because we can put something together that basically says, "Here's your problem. This is where it started, and this is the thing, like, furthest upstream for you to do to fix it, and this is what you can act on now."
Like, so yeah, that's one of the things that we're very serious about is because we don't want this to be- You know, to a certain extent, like dashboards and information like this needs to have a little bit of an entertainment quality, otherwise it, it's very hard to, like, engage in, right? But if it stops there and it's just visually appealing and that's...
It doesn't give you traction, so, like, it's got to go all the way and actually give you some answers, and- Yeah ... I'm sorry to hear that in, in that setting, like-
[00:12:31] Whitney Owens: I know ...
[00:12:31] James Childress, CPA: you know,
[00:12:32] Whitney Owens: you did get through it. I, I did get answers eventually, and my daughter's doing very well. So That's
[00:12:35] James Childress, CPA: wonderful to hear. Wonderful.
[00:12:36] Whitney Owens: Yeah. Are practice owners usually really surprised by what their diagnosis tells them?
[00:12:42] James Childress, CPA: Well, a lot of the clients we're working with right now have been on advisory with us for quite a while, you know, our beta clients right now. So they've... They're seeing things that we've already been telling them. But when we start getting into the weeds and they start seeing some of the data, they start, uh, what is it, you know, some of the things that I'm saying go from opinion to fact, you know?
Uh-huh. Where it wasn't just a hunch, you know, when I was thinking they had this challenge or, like, whatever, because they've got it, and it's in the context of everything else. And like, you know, all of it's kind of there and laid out. So it makes sort of the confidence of deciding better because you have better quality data, and it's more relevant.
And you can say, "Okay, those are my people. I see that that's what they're doing, and I see it all adds up to this." And, and so they know, they know the right thing to do. So but there are some surprises in there, especially when, you know, we start actually quantifying some of these things. You know, one of the big surprises is how much some of these areas are costing them.
[00:13:43] Whitney Owens: Yeah.
[00:13:43] James Childress, CPA: Yeah.
[00:13:43] Whitney Owens: I'm curious, are there, the top three or five that you're like, "These are the most common diagnostic issues within your practice that we see"?
[00:13:52] James Childress, CPA: Yeah. I... You know, one of the things that's really big, and I, I've seen this the entire time I've worked with clients, is they hire too fast. They really hire too fast.
They hire too fast on admin. They hire too fast on clinicians, and I see that creating a lot of turbulence, you know? So and, uh, that, that's one thing that's really big. The other thing I do see is I see a lot of the intake process being lax, and that creating a lot of sort of sluggishness kind of in their business.
Mm-hmm. And, um, you know, one of my clients hired an intake coordinator, and it just changed her whole practice just because someone was answering the phone, you know? Yeah. And then, you know, I, I see that a lot of their compensation can get stale. And the conversation around compensation and career track and everything with their clinicians can kind of get lost in the lurch a little bit.
And so yeah, those are big things I think I talk about a lot with them. Yeah.
[00:14:51] Whitney Owens: It's an important one, yeah.
[00:14:52] James Childress, CPA: Yeah.
[00:14:52] Whitney Owens: Yeah, it's, it's so interesting the hiring thing because oftentimes when people are starting a group practice or they're hiring their first admin, they're too slow. They should have hired them a long time ago, right?
'Cause they're overwhelmed with clients, not getting back to people. But then when I see someone growing, then I sometimes notice that they hire too quickly 'cause the practice center's overwhelmed, so they wanna get that clinical director in or that COO in or whatever, and they're just not ready. You know, and they hire anyway, and then they don't have the money for it.
I see both of those.
[00:15:21] James Childress, CPA: Yeah. And I think one of the things that sometimes happens is they don't refine the administrative process while they hire.
[00:15:30] Whitney Owens: Oh, good. Uh-huh.
[00:15:32] James Childress, CPA: Right? So like the worst example I ever saw this was a client came to me once and they said, "Hey, I think I've..." You know, she was a little bit embarrassed, but like she was like, "I think I have too many admins."
And I said, "Okay, how many admins do you have?" And she said, "I've got five admin people." And I said, "Okay, how many clinicians do you have?" She says, "I've got five clinicians."
[00:15:54] Whitney Owens: No.
[00:15:55] James Childress, CPA: No, don't even. And I was like, I was like, "Okay. Well, I don't really have to look at the numbers. I do think you've got a challenge there and you're gonna have to downsize somehow."
But what had happened, like what was kinda behind that, was she brought someone on and they said, "I just can't keep up." So she hired again, and they can't keep up. They hired again, they can't keep up. And so the thing is, is like it's almost like there's another business inside the business, which is the admin, right?
And it's gotta be this tight, you know, highly productive, efficient machine, and it's got to continuously evolve to be more so of that. And you do that by working with the admin team to strategize what they're doing, eliminate redundancies, eliminate things they're not supposed to do, as opposed to, "Too busy?
We'll add another person." That's not the best solution. So on the admin side, that's a lot of what I see, is they sort of get these symptoms. They get these symptoms of like, whoa, there's a lot going on, and like people can't keep up. The solution isn't necessarily to hire. It's to sort of triage the work, dig into like what they're doing and, and think about are there parts that can be pulled away that belong to maybe outsourced professionals or things they shouldn't do at all and things like that.
Yeah. Yeah.
[00:17:10] Whitney Owens: But having to diagnose the problem and fix all the things, that's a lot of work.
[00:17:15] James Childress, CPA: For the whole practice. I mean, and it's true, you know, like people will say this is a complex industry. You know, I've, I've worked with construction and governments and non-profits and real estate and like I've worked in a lot of industries- I can say with a lot of objective experience, this is a very complex business.
You know, when you think of sort of the, the way insurance just sort of belligerently does what it does sometimes, and the competition for talent is fierce, and the, the lag in payment is an issue, and trying to market is challenging because you've gotta do it because you kind of... It's one of those few businesses where you really sometimes hope your clients just do their thing and leave, you know?
Um, they graduate and they accomplish what they wanted, and then maybe they don't need to come back again, as opposed to others where it's like they never let go of their customers, you know? So yeah, it's, it's complex, and there's a lot to diagnose. There's a lot to review. It really is difficult to sort of decide each day what to work on.
[00:18:16] Whitney Owens: Yeah. Yeah. Certainly. And so when people, uh, access the app, is it really just for group practices, or solo practices benefit as well?
[00:18:25] James Childress, CPA: Right now we're focusing on groups.
[00:18:27] Whitney Owens: Okay.
[00:18:27] James Childress, CPA: And, and it was a, it was just a place for me to start because I was feeling I had the most, you know, client impact, in- indirect sort of-
[00:18:36] Whitney Owens: Mm-hmm
[00:18:36] James Childress, CPA: client impact on, you know, on a practice that's got, you know, 10 to 20 or, you know, over five clinicians is probably a great place to start. But yeah, for the most part, we're starting right now with group practices. We'll probably move into a solo, but I wanna be very careful about how we do that because I want the cost benefit to be there for them.
As a solo practitioner, things are, I would say, in some ways very challenging, and so we wanna be mindful that it's not just a different version of what we're doing now. It's really a whole different approach- Yeah ... I think so. Yeah. But-
[00:19:07] Whitney Owens: That's great. Well, it certainly sounds like an asset to help a practice diagnose what's going on, come up with a game plan, and then you point them in some directions for recommendations to kind of meet these needs, I'm guessing?
[00:19:20] James Childress, CPA: Yeah. Again, like, our goal is no dead ends, and so- Right ... we've constructed the app to- Answer as many things from within the data that we have, which it's a lot, right? When you think about the marketing, the HR, and the payroll, and the accounting, like that alone is a lot of data to figure out what they need to do next.
'Cause often the issue is somewhere else in the practice, right? Um, and priorities and things like that. So yeah, no dead ends ideally, but, uh, you know, if a client ever, you know, is working in the app and they really just wanna move more quickly or they want things to be more clear, then we are still, you know, offering an advisory service on top of the app, and we can do so now at a lower price point because the app is doing a lot of the work.
[00:20:02] Whitney Owens: Oh, nice. Nice.
[00:20:03] James Childress, CPA: Yeah.
[00:20:03] Whitney Owens: Well, I was just checking on the special deals that you're offering to our listeners, which is very kind.
[00:20:08] James Childress, CPA: Yeah.
[00:20:08] Whitney Owens: Um, it looked like, uh, waiving the first 20 people's onboarding fee.
[00:20:13] James Childress, CPA: You got it. Yep. For that. You
bet.
[00:20:14] Whitney Owens: Yep. Get the app and mention the podcast, and then 20% off the first three months of the
[00:20:18] James Childress, CPA: app?
20 per- yep, 20% off the first three months, and with everything we do, it's always month to month. So we try to make it as easy to start as possible. In this case, for the folks listening to the podcast, we've made it even easier, I hope.
[00:20:30] Whitney Owens: That's great. That's great. Yeah. Yeah, but it sounds like it's an app that would be very useful and helpful, so I encourage listeners, check out the show notes so you can grab access and just it can't hurt to check it out and see where your practice lands.
[00:20:42] James Childress, CPA: Sounds great. Thanks so much for your time today, Whitney.
[00:20:44] Whitney Owens: All right. Thank you, James.
[00:20:45] James Childress, CPA: You bet.
[00:20:46] Whitney Owens: The Wise Practice podcast is part of the SiteCraft Podcast Network, a collaboration of independent podcasters focused on helping people live more meaningful and productive lives. To learn more about the other amazing podcasts in the network, head on over to sitecraftnetwork.com.
The Wise Practice podcast represents the opinions of Whitney Owens and her guests. This podcast is for educational purposes only, and the content should not be taken as legal advice. If you have legal questions, please consult an attorney.
