SEVEN THERAPISTS SIT AROUND THE DININGroom table of a house in suburban Maryland one blistering hot Saturday morning in July. All seasoned professionals with an average of 15 years' experience each, they've been meeting together two Saturdays a month now for over a year, but their conversation isn't remotely about difficult cases or a promising new clinical technique or a great workshop someone just attended. Instead, the discussion ranges over lawyers and legal liability, advertising brochures and corporate logos, data bases and form letters, niche marketing and high-tech, multi-feature phone systems. Unhappy about their experience with managed care companies the intrusive micromanagement of their work, rigid time limits, endless paperwork and the struggle to get reimbursed they have decided, like thousands of other therapists in America, to pool their talents and find a way to do together what is increasingly hard to do independently: practice their profession with a reasonable degree of freedom, autonomy and integrity and still make a living.
So far, each individual in the group has already ponied up a fair amount of cash to pay for expert advice from a creative consultant and several lawyers; much more will be required for advertising and administrative costs, not to mention the heavy indirect expense in volunteer time required to establish any new entrepreneurial venture. The members have also gone through several cycles of euphoric highs and depressive lows. At first, just commiserating with each other around their shared fear and loathing of managed care was a wonderfully satisfying bonding experience, but the pleasures of what one member calls the "bitching sessions" soon began to pall. "We were like a bunch of adolescents having temper tantrums," says Maryland therapist Deany Laliotis. "Righteous indignation about managed care brought us together, and it was fine for a while, but righteous indignation wasn't going to keep us together or get us anywhere." The group brought in a marketing expert who told them it was good to know what they were against, but imperative to know what they were for what were they trying to do, what sort of professional identity did they envision for themselves, how did they plan to announce their corporate existence to the public?
"That stopped us dead in our tracks," says Laliotis, "and we went month after month trying to decide what kind of practice, what kind of group identity we wanted to have and who we were going to be, now that we had decided we couldn't just be anti-managed care." Did they want to be a loose referral network? A shared marketing entity? A more closely integrated corporation organized around a few specialties? How large should the group be twenty members? Thirty? Fifty? Unable to come to any settled conclusions, bogged down by uncertainty and internal disagreement, always on the verge of disbanding, they temporarily tabled the identity question to focus on organizational structure. Then began the Era of the Lawyers, as three different law firms were hired, seriatim, to give them the freshman course in Forming Corporations 101. Unfortunately, learning about the Byzantine complexities of corporate law, multitudinous ways they could be sued and bank-breaking liability they were taking on individually by casting their fate with each other sent them farther into a downward spiral of insecurity and paranoia. "Look around the room," Laliotis remembers one
lawyer saying grimly, "and make sure you can sleep with everybody here ."After another lawyer said he wanted $8,000 to draw up limited liability papers for them, which they weren't even sure they wanted, the members decided, says Maryland therapist Carol Heil, "that we'd better stop letting the lawyers organize us, go back to figuring out what kind of practice we wanted to be and then tell the lawyers to make it happen."
The group is only just now standing tentatively on the brink of going …