Andrew Burdette 00:00:00  The grower Group Practice Podcast is part of the practice of the Practice Network, a network of podcasts to help you grow, manage and promote your business and yourself. To hear the other podcasts like The Practice of the Practice Podcast, go to practice at the Practice Network. You are listening to the grower Group Practice Podcast, a podcast focused on helping people start, grow, and scale a group practice. Each week you'll hear topics that are relevant to group practice owners. I'm Andrew Burdette, a practice owner, and I love to hear from people. Their stories and real life experiences. Let's get started. Hello and welcome back to another episode of the grower Group Practice Podcast. Today I'm here with Doctor Liana montesano, who's a clinical psychologist and founder of Montesano Psychological Center. Welcome to the show.

Dr. Liara Montesano 00:00:59  Thank you. Happy to be here.

Andrew Burdette 00:01:02  So I always invite people to give a little backstory about themselves and their career. And so how did you end up, getting to where you are today, doing what you do?

Dr. Liara Montesano 00:01:14  Well, that was a long journey.

Dr. Liara Montesano 00:01:17  I, actually got my start, believe it or not, in mental health as a translator while I was still a high school student. so translating in, therapy sessions because there was a shortage in that. And that actually motivated me to, go into the mental health field. And since then, I, made the resolution that I wanted to work in, every major field of mental health. So for me, that meant, I did training in community mental health, psychiatric hospitals, medical hospitals, the emergency room, schools for children with behavioral issues. outpatient. And then I ended up in private practice. After trying a little bit of everything. that being said, by trying all of those modalities, what I aim to do in my practice is to incorporate the things that I felt were crucial in each program for the success and outcome of the clients. And again, this is subjective from my experience. Community mental health became a bit of a passion. having worked with the like the Florida Assertive Community Treatment Team, which, you know, I joke that they're a hospital without walls.

Dr. Liara Montesano 00:02:52  That work they do is amazing and outstanding. And I love the being able to be in the community and help those that need mental health care the most. And unfortunately, because of the world we live in community, mental health, private practice and finances. They do not align with each other. I can And so, you know, my goal has been to take that passion for community mental health and then try to incorporate as best as I can to my private practice as a way for mental health to be affordable and accessible in ways that may not traditionally be so for a private practice.

Andrew Burdette 00:03:43  Well, cool. I do have one question that's a little off topic. So you mentioned just now mentioned being a translator and starting that really young. That's a really unique role in healthcare and in particular our field being talk therapist. So can I ask you to talk a little bit about what it's like to be in that translator role in a mental health setting, to then help bridge that communication gap?

Dr. Liara Montesano 00:04:08  Well, that was a very interesting experience because it was an unofficial role.

Dr. Liara Montesano 00:04:15  and it came about because a family member of mine was seeking mental health services in, in the area that we lived. At that time, there was no one that could translate or interpret during the therapy session. And since I was the person in the family that was the most fluent in English, they allowed me somehow. I'm sure I signed many release forms that I don't remember at this point, because that was a very long time ago. but that allowed me to really, listen to both sides and try to be impartial and really try to stay as objective as I possibly can within the session. And I do think that that experience not only led me to my career, but it also very early on gave me a skill set that takes quite a while to build, which is allowing yourself to be present in the room in the moment and to not, bring your own issues into it. so because then we're dealing, you know, as you know, with transparency and transparency and all of these other things that can happen in that type of situation.

Andrew Burdette 00:05:37  Yeah, it seems like it would be really easy to kind of lose your neutrality in that, especially if it's with a family member, which it sounds like was how you got introduced to it. Yeah. Well thanks for sharing that, that that's just a really unique perspective to have a unique set of experiences. Because you don't often run into many translators within the field of mental health that have, that have done that at some point. So thanks for sharing. one of the things that you really wanted to talk about and developed, it sounds like, is how to introduce and create training programs to serve communities in a way that's financially accessible.

Dr. Liara Montesano 00:06:21  Absolutely. and that that is something that, was probably born out of that experience of being a translator. because at that point in time, we were struggling immigrants, and that's how I ended up in the situation of being that the translator, which I'm very grateful for. but it also allowed me to see the need. And we were fortunate enough that our community did have affordable mental health because they had a wonderful community based program.

Dr. Liara Montesano 00:06:59  And so using some of those concepts and then later on, while actually working in community mental health as a clinician, trying to bring those elements that I felt were very helpful into the private practice in the, in the means of creating a training program, not just for staff on the learning how to be supervisors, but for students within the community that actually do need those opportunities so that they can, move forward in their training programs at various institutions.

Andrew Burdette 00:07:43  So how did you how did you start with this concept and then start the process of implementing and creating it.

Dr. Liara Montesano 00:07:53  so the the process actually started quite nonchalantly. I was hired at a private practice as a clinician, and I told the owner I've been supervising students at various settings. previously, I would like to do that again. is that something that you would allow me to do? And fortunately for me, she was basically said, go for it. So that's how I created my first training program. So I went on Google. I figured out who all the directors of clinical training were in all the local universities.

Dr. Liara Montesano 00:08:34  And I called, called and sent emails and knocked on doors saying, hey, we have this private practice here. I have supervisory experience. What do I need to do to meet the requirements that your university has set in place in order to train mental health students? And, that was met with a lot of enthusiasm because the schools, they're always looking for institutions and practices that are passionate about training the students and then receiving experience, whether that's a primary practicum or a secondary practicum. Therapy assessments. They're great opportunities all around. And so, with that initial assessment, then I started over time really building in the infrastructure of okay, what what is the training program. What does it need. What is my role in it. and that turn it Only in to me creating that director of clinical training at that private practice. And so by the end of my tenure there, it was, a medium sized training program where there were other supervisors as well. And, we were seeing about three students each. and we can talk about financially, what that could mean.

Dr. Liara Montesano 00:10:16  And of course, every practice is going to have unique overhead and all of that. But the that I'm the gimmick here, I suppose, is how do we help people that need help? How do we pay our therapists, fair wages. So that is a balancing act that you're always, trying to, engage in when you're in this position. And so, I'll start with the. What does the Director of training do in a psychology program at a private practice? And so for me, and then for whoever came after my, tenure was done. It's, you design, implement, and then evaluate the goals for the year. Over time, you will find out that every cohort of students has a there's a set of what is meaningful for them and what are their areas of weaknesses, and doesn't seem to really matter how long you've been doing this. Every cohort will have areas of expertise and areas of weaknesses. And so part of that is how do we address those areas of weaknesses. And one of the ways that I addressed that was by building a didactic curriculum.

Dr. Liara Montesano 00:11:45  So we would meet, initially it was every other week. Then it became monthly over time based on their needs and address those weaknesses. And so they're essentially not just coming to a lecture, but as the program progresses and they are able to increase their sense of mastery over these topics that they were struggling with, then they're presenting and they're teaching themselves and they're teaching their peers. And that's something that they found very meaningful and also was appreciated by the schools, which is another aspect of the training program. If you want your practice to be successful, you need to not just meet the needs of the students, but you need to make life easier for the schools. And if they're having students that are returning and then they are, placing doing better on their test, they're getting better internships, they're passing their board exams on the first try, etc. that makes you look good as a training program, and therefore you're more likely to receive more applicants the next year. So there's quite a few spinning plates with this.

Dr. Liara Montesano 00:13:11  another of the things that we addressed were, how, do we select students? So what are the needs and what are the attributes that we want our students to have? diversity was something that we were very interested in. And it's we want individuals that want to be involved at a community level. We want individuals that wants to work with diverse populations and diverse diagnoses, and not come in with a bit of the stereotype of private practices, only caters to a certain section of the population, because that's not what we were about at all. We were more of, a community center in terms of all of the cases that we saw. which, you know, was great. the practice owners also had a background in community mental health. So it was a very good, match up. And, and so by, you know, slowly building that infrastructure of we have group supervision, individual supervision, the didactic training, we're meeting regularly with the schools to make sure that their standards are being met, that the ethics of that particular profession are being met, and all of the other standards that may not be, the first thing that comes to mind, for example, hours.

Dr. Liara Montesano 00:14:55  Each program that I work with has had vastly different requirements for the students. som wanted about a client's per week to be seen by the students. Others were closer to 20. So there is a big range that you are constantly trying to, juggle and schedule for the students, etc.. Then even the the training goals for a master's in counseling student, it's going to be different than someone that's getting a master's in mental health counseling or a master's in counseling psychology or clinical psychology, all of those little nuances in our professions and orientations. they create training issues, not issue in a negative, you know, sense. But we have to accommodate and grow and address what those needs are at every given point. that being said, another part of, the training program that is often overlooked is finding, supervisors and your director of training that's overseeing everything and working with the students on a day to day basis. It's are they committed to this type of work? Because this is not the type of work that you clock in, do your paperwork and you clock out.

Dr. Liara Montesano 00:16:32  You are on call 24 over seven 24/7, 365 days a week, 365 days a year. Not a week. and so having that commitment is something that can be challenging when you're running the practice and dealing with potential burnout by, the clinicians that are supervising part time. so to that, I actually advise that it's a better, strategy if the supervisors are actually supervising. full time once you get the training program to be large enough to accommodate that. because there is a lot of invisible work that goes behind the scenes, where you're constantly on the phone, answering emails, meeting with schools. And unfortunately for the practice, those are what we would call non billable services. so anyone listening to the podcast will be asking the questions, well, how would I get compensated for that? Because this doesn't make sense. You're just talking about doing a lot of work, being on call all the time, and not just being on call, but actually being available. Because once you're supervising a student, they're not licensed.

Dr. Liara Montesano 00:17:57  They're learning things. If something comes up in a session or after hours, you are the first line of defense. so that can lead to burnout with, individuals that are not used to that, that lifestyle.

Andrew Burdette 00:18:15  Yeah. So how do you. I guess first up, are you. Is your private practice mainly training focused, or is it a mix to where you have fully licensed people, maybe some professionally licensed people, an associate level or whatever the terminology is in your state, and then also having students that do the training side of things.

Dr. Liara Montesano 00:18:37  Yeah. So that is a great question. I am a mix. So I have my full time license clinicians and then I have, right now, a student that's working with me and then, two postdocs coming on next month. And so I'm gonna actually elaborate a bit more on that, because this kind of shows how when you're supervising students, you're not just supervising students for the year. Oftentimes, this ends up being relationships that grow over many years. two of the postdocs that are coming on, one in July Lie and the other one in Argos.

Dr. Liara Montesano 00:19:31  I actually supervise during their first practicum years ago, and so once that they were in there, a clinical psychologist side. Internship, and they were going to be graduating with their doctorate. They, they reached out. And they said, we want to work with you again. Would you be willing to work with us? And they were fantastic students. So I said, of course, come aboard. So they're going to be the postdocs. And this is something that, happens all the time. I, you know, used to remind the students when I was supervising them and giving them autonomy to make their own clinical choices, so long as they're ethical and they make sense with that particular client, of course. I would say I'm giving you this autonomy and this freedom. Because what you're doing, first of all, is is safe. It's appropriate. But also, I don't want to patronise you because today I supervise you. Tomorrow you're my colleague. And I don't want when that shift in dynamic happens for there to be resentment as to me being the scary supervisor, that was mean and hard on them.

Dr. Liara Montesano 00:20:58  And I'm sure we've all had a supervisor like that at some point. And the question is, would I want to go back, or would they want to go back and work with me? If I embody the negative traits of supervisors I didn't like, I wouldn't. I'm sure they wouldn't either. And so that that is something that also needs to be explored when you're doing a training program, you know, leave your ego at the door because it has no room in supervision. It's about growth and teamwork and then becoming the best possible version of themselves. And as a result, you grow as a supervisor, so everybody wins. And then the clients, which are why we're doing this, they get two individuals looking at their case instead of one and being able to consult at multiple levels throughout the week. So when clients, call in and maybe they don't have insurance, or maybe they're on Medicaid and they're having a very difficult time, connecting with services. And, they're told, you know, we have availability that matches your schedule perfectly, which we all know that that is a big issue in private practice.

Dr. Liara Montesano 00:22:27  Does your availability match my availability question mark? and there we have this post, doc. Or we have this intern or we have this practicum student, that are able to see you. There's that uncertainty of, well, do they know what they're doing? Am I going to receive good mental health care? And the answer is yes, because when you're working with a student, doing a practicum or an intern or a postdoc, they're in session with you. But then when they're out of that session, they are talking to their supervisor. they're consulting in group supervision with multiple clinicians that have been working for however long in the field. And so I often say, actually, the client's seeing the students and probably get more oversight onto their care than anybody else in the practice. because of all the consultations that are constantly happening. so that is something that I like to demystify, because the quality of care matters is why we're trying to address this.

Andrew Burdette 00:23:50  That quality of care does matter. And that is one of those things that I've often in the past pointed out, even when I was still doing the associate level stuff here.

Andrew Burdette 00:24:00  So I'm a professional counselor in North Carolina. Well, I'll CMHC because they've made our names too many letters long. But, you know, we basically do a two year like postmasters like apprentice period is roughly it. And, you know, 3000 hours and and explaining to people, you know, I have a clinical supervisor. It's basically I'm getting counseled on how to be a counselor. It's counseling about being a counselor and not counseling necessarily, your work and our work together. But it's about how can I do a better job serving you and helping, again, demystify things about I'm going to take the time, an hour a week to work with somebody about how to be more effective at providing you services, and are you okay with that for one? And then two, can you see how this is kind of you getting some extra bonus because you have somebody that's been doing this for much longer than I have, that from time to time, we'll probably have some input about how well I'm helping you.

Dr. Liara Montesano 00:24:55  Absolutely.

Dr. Liara Montesano 00:24:57  not only that, but when we would do, the end of services, surveys or literally call, call clients, how is treatment going? I'm the supervisor and introduce herself most of the time. They already knew me because part of the program was, that there is live supervision that happens and from time to time. And so we'd be in the room with the client and the student. Not every week or anything like that, but they would have glowing reviews. And something else that there's some research to back it up. Newer clinicians actually tend to be more eager to please than actually, you know, counselors are going to get mad at me for saying this, but they pay attention more closely than clinicians that have been doing this for 20, 30, 40 years because we've heard it all. And for the students, it's the normal experience. So they do hang to every word. They might not have perhaps all the skills just yet, but the amount of attention they're getting and then they're grabbing those tools for Support from the veterans in the practice and bringing them into the therapy room.

Dr. Liara Montesano 00:26:22  And so it really is a good experience for the clients that need treatment and to be heard and cared for.

Andrew Burdette 00:26:33  Yeah. one of the things you were talking about was creating a training program that can support different licenses, because, again, all of our training is different. There's like a different emphasis on, you know, there's going to be some consistent things like, you know, say theories of counseling, like what CBT is or therapy in general. sorry to use counselor specific terms. It's in my training. So it's, you know, the word I'm using there. But, it's been really interesting as a group owner learning about the different requirements that different boards have, and then just the diversity among like ethical codes. And we're all relatively on the same page. But how things are worded and maybe some of the things that are emphasized there, How do you end up navigating that in a training program that sounds like it serves more than one degree type?

Dr. Liara Montesano 00:27:22  Yes. you are correct. And that is something that, we figured out.

Dr. Liara Montesano 00:27:31  so I always say step one for a supervisor. Figure out what your students training programs are. Because as you just pointed out beautifully, the ethics codes, there's going to be 90% overlap. We're going to talk about the same principles, but we are going to name them different things. And then for things that are timed, we're going to have different time frames as to what's acceptable and not acceptable, depending not just on that, but on the state as well. and so what I've learned as a society licensed clinical psychologist is I can supervise my master's in counseling psychology. Mental health counseling. PhDs in psychology. PhDs in counseling. And obviously the studies in psychology. I cannot supervise social workers in the state of Illinois. so being aware, where does your license end? And for Illinois, that is social work, because our skill sets, are a bit more, more different. Yeah. And so when my advice was to figure out what degree your student has and then go and download their code of ethics, because I may have read the APA's code of ethics many, many times, especially while preparing for the AP, etc..

Dr. Liara Montesano 00:29:12  but It might not be as familiar with the American Counseling Association's. And so read that. Highlight things that you feel are different. And then, consult with the schools on things that you might not know the schools are. you know, I can speak for every school out there, but all the schools I have worked with, they have been more than happy to have a conversation and to have, an exchange about the growth of the students and even their own requirements, because that is something else that when I'm training someone, from one school and then my other two students or three students are from three different institutions, we're talking about completely different standards of training. And so it becomes kind of a diplomatic mission of, to be fair, we need to incorporate everything from all of those schools. Let's find the stuff that they have in common and, you know, easy enough. We'll address that. And then we'll address the things that might be unique per school. And then everyone's ends up getting more than they bargained for in a positive way because they're learning, things and being exposed to, techniques and ethics goals that they may not have had the opportunity to be familiar with.

Dr. Liara Montesano 00:30:50  And as a side effect, we create a better rounded, more diverse clinician. So once again, my goal is like, how can I make sure that everyone involved wins? And that that was my strategy that I'm now, doing on my own on private practice.

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Andrew Burdette 00:32:04  Trust me. Don't waste any more of your time and try therapy notes. So again I'm an llc, MHC. My code of ethics is the ACA Code of Ethics. as of last year, I expanded to, I know, a half a couple of different social work, licensed individuals. And what I've learned to have to do is to say that the practice is going to follow the ACA code of ethics. First, like this is what we're going to default to. And sometimes it does involve a little communication about, hey, over here, we emphasize maybe discussing finances with a client a little more than maybe the social work board emphasizes, and these other things. And so do you. Have you had to in setting up the training program? Have you had to kind of pick a primary baseline we were going to as a foundation? We're going to be here. We'll be as accommodating as possible. But if we still have questions at the end of it, you know, do we land on the APA's code of ethics?

Dr. Liara Montesano 00:33:06  Good question.

Dr. Liara Montesano 00:33:07  So what I've done in the past is, there's the, of course, the APA Code of Ethics, which is my primary code given my profession. but my policy was we see what both codes of ethics have to say about the particular situation, and then we go whichever one is the most stringent. If assuming that it's a particularly tricky situation, then it's like, what does the state say? And what does the United States as a country say about this? So we go with the federal level, state level, then also our professional levels and their professional level. so whatever situation we go, what is the most conservative? Because safety and risk management are the top priority for me. And that's another one, of those unseen things that I always, mentioned with the director role is you are mitigating risk on many different levels at all given times, and so are you comfortable with that? It's, I think you have to really care about wanting to grow clinicians, and be there for them and support them and teach to being that role because it is very demanding, you know, ethically and in terms of liability.

Andrew Burdette 00:34:47  Yeah. You were you were taking on a lot of it's a different level of liability when you go from being just the administrative or employer side of supervision to the licensure level supervision, or in the case of people that having don't qualify for a license yet or are so new. They were literally in the training wheels of things to maybe offer some like ease, some of the anxiety some listeners may be feeling about that. Again, going back to the fact that for our program, we had a three hour weekly, you know, group supervision class on campus. We would do an hour of supervision, triadic on site. We would have some individual supervision through the school as well. And then the internship site, I was also had a group supervision thing. So if you were there that day you also got that as well. So I mean, as a student, my program, you had a minimum four hours a week of supervision, more like five most weeks and depending on your site maybe up to six.

Andrew Burdette 00:35:49  And so that was a lot of accountability and training on how to not be a big risk or liability to others. You know.

Dr. Liara Montesano 00:35:57  Absolutely. I was similar in my training program. I had three individual supervisors that I met with on a weekly basis. so that's three hours. Then I had supervision of supervision and then I had group supervision. We had the didactic training. so I'm already at six, so I lied at seven. and then, there was a family counseling supervision that was specifically to address cases that involve family dynamics. so no one's at this alone. but it is something that, it's always running in the background because they're all they're unlicensed. So especially in a large program, you are, reducing that liability by having multiple clinicians, work with the same students, but in smaller practices or when you're first starting out, it's not financially viable. So you might realistically have two clinicians working with all the students. primarily for like the formal individual and formal group supervision. And then they're they're receiving, supervision throughout the week.

Dr. Liara Montesano 00:37:27  That's live supervision, which is the best quality, of the clinicians, like dropping in on sessions, or in between clients debriefing. Okay. What went on. So it's unofficial, but they are in fact actually receiving quite a bit of oversight.

Andrew Burdette 00:37:48  So one of the things we haven't talked about yet, but it's definitely, I'm sure, a question people have is there's the logistics of creating the training program. So here's the structure, here's how many students we're going to have. Here's the kind of relationships we're going to have with schools, how the supervision component comes into play. But how does one in private practice make this financially viable to do?

Dr. Liara Montesano 00:38:12  Yes. So that is what we're here for right. And so there's a couple of different ways to do this. And this becomes a a question of one, are you comfortable with sliding scale fees and the other, are you comfortable with, accepting Medicaid, getting panel going through that process and being, very detailed in your notes because that is a realistic issue.

Dr. Liara Montesano 00:38:52  with Medicaid, you have to follow very precise formats. They can change over time, and you might not even be aware that they have changed the things that they require, requiring you to include in the notes, which can have, financial effects like denying of coverages for sessions, etc.. And so, I advise for the practices knowing that the, the care is going to be provided by the students, unless the students are, in an internship or a postdoc, they're not receiving a salary because their compensation is that they are actually there to learn this is part of their schooling component. It is not free labor, as you know, some people, will say and say, this is unfair. No, this is a very necessary part. Heart of the profession. We are apprentices. We're learning other under the supervision of others. and so because the students are able to provide the services. without counting a salary for them as overhead, it allows us to more comfortably be able to figure out what is a reasonable sliding scale or if you can't do a sliding scale, a reduced B session.

Dr. Liara Montesano 00:40:30  and that number is going to be different per practice. Like I couldn't tell you, you need to do a reduced fee session of this many dollars because it's not realistic. I you don't know what you're dealing with in terms of overhead. and then there's situations where certain clinicians, Nations that you'll work with will say, you know, I, I'm happy with what I'm making. At the practice, I love community mental health work, so I'm willing to see X amount of clients a week at this very reduced fee. that that happens honestly quite often. Most people, went into this field to help others, not to become rich. We just want to be comfortable and take care of our families. That really is the goal. And so you can have those conversations. and then we go into we're going to return to the students rather than the clinicians that are willing to do reduced fees, but being able to market and, Accept those either Medicaid or the reduced fee. And then for the individual that's doing the all of this work behind the scenes of things that are, as we say, not billable.

Dr. Liara Montesano 00:42:09  It becomes of oftentimes like a percentage of the fees being collected by, the students. So if the students are bringing in most training programs, regardless whether they're masters or side D, that ranges between ten clients a week that students are required to see all the way up to 20, if they're an intern, which being an intern actually complicates things that we're not going to for the purpose of, this part, because we're not going to deal with interns because then you have to go through APA accreditation, and that is a whole different podcast. we, you just calculate a percentage of what's being brought in. An example that we'll use if you're dealing with a practice that is able to accept, Medicaid clients, which is the clients that need oftentimes the most, help and also have the hardest time finding clinicians that are able to accept their insurance. I'm going to give you some numbers here. So before overhead and obviously any other expenses, one student seeing an average of ten clients per week at the current reimbursement rate, of Medicaid in Illinois, which is, I believe, around 120.

Dr. Liara Montesano 00:43:49  20. That student is bringing in 1200 a week, which translates into 4800 a month, 60,000 annually, assuming they're taking off two weeks out of the year, for holidays and such. And so exponentially that grows. so, you know, two students that are in the training program would be bringing in. And once again, I'm seeing ten clients a week because that is the low end of the range of what the schools actually require for the students. We don't set that number as a practice. The school sets that we're at 120,000 a year now. five students, 300,000, ten students. Now we're talking 600,000. And we did this while actually providing a very valuable service to the Without community. And so, Then the conversation is with the individuals that are doing the supervision or the person that is, the director of, of the program is what does compensation look like for them? And that's gonna look differently for different individuals and what they might feel that their time is worth. And a big component is do they enjoy that type of work? and so I've seen this very a lot, in the terms of what percentage of the revenue generated by the students goes to the supervisors for the practice.

Dr. Liara Montesano 00:45:40  Realistically, though, the practice not getting hurt. The practice, actually, earning quite a bit by doing a valuable service for the community. So it's another situation where, everyone wins the supervisors, the practice and the clients because everyone's getting their needs met, and that's being facilitated by the students, and they're getting their needs met by gaining the clinical experience they need before they're out in the world and they're licensed.

Andrew Burdette 00:46:19  Yeah, there's I don't know the details. It was just a question I got asked recently when meeting, a North Carolina employment attorney. She asked if I was planning to have students or not, because compensation with students is complicated and there's rules at the federal level around can you compensate students or not? And again, you know, there's there definitely needs to be better financial supports for students, period, that do not involve borrowing money to become educated, to then serve the community in the greater good. And thinking about the amount of training, I mean, we were talking about the number of supervision our students receiving a week.

Andrew Burdette 00:46:58  That's a lot of hours. You know, if you think about, let's just say you charge a flat $100 for supervising anybody clinically. I mean, if you get if the students getting seven hours of that a week, that's 700 hours of clinical supervision time that they're getting for free. Right. As part of this. So there are there are trades that are going on, but they don't necessarily look financial. And and everybody does benefit. There's there's a greater amount of value created in doing all of this I think than than not.

Dr. Liara Montesano 00:47:31  Yeah. Yeah. No there is. And it's about figuring out the numbers because they vary a lot per practice. Some practices have very little overhead because they're primarily, virtual or they're at a smaller office in, with not a lot of, square footage. And there's luxury offices with 2000ft², which are a lot of their, overhead is literally just paying rent. So that's where it becomes, tricky. And I would say bringing the bookkeepers an accountant so they can figure out what makes sense.

Dr. Liara Montesano 00:48:17  And I think the point that you brought up about the students in compensation, it's a really good point. When I was working on both my master's and then my doctorate in psychology, we were literally not allowed to be financially compensated. If I were to be financially compensated for any of the therapy work that I was doing. I would want. Those hours would not count towards my educational experience. And two, I would get threatened, possibly with getting kicked out of the program. And, that dialogue is changing currently in the state of Illinois. And I want to say, I don't know, how this is changing. in the other states. Student compensation is not really yet on the table there. The schools are currently, asking practices in institutions if they have, some kind of a stipend, but it is on a voluntary basis because they don't have the expectation that the students are going to be, I'm getting paid. And then from a licensing perspective, it complicates things quite a bit. And I'm guessing that that might be what the attorney was, talking about.

Dr. Liara Montesano 00:49:56  the clinical hours may not, depending on what state you're in. count if you're being compensated because that might be looked upon as you have a job as a clinician at this hospital or practice. You're not there. You're there to perform a job, not there to learn and be an apprentice. So there's a bit of a reframing shift that, actually should happen because being a student is difficult enough and the cost of living does keep increasing. So they do need better options out there.

Andrew Burdette 00:50:37  Yeah, I think the employment attorney was just commenting on. There are rules around paying students that are different than your typical labor laws. my counseling program had it explicitly stated that, you know, there was there was some wiggle room sort of in there to maybe get compensated for what you were doing as an intern. But the way they distinguished things was, if it's required for you to be an intern to do the work. The only way the liability kind of gets covered correctly is if you are classified as a student, which would be defined as unpaid.

Andrew Burdette 00:51:17  So there's a like a health care kind of basically along the lines of like practicing without a license. If you're getting paid to do the work kind of thing. It was they they articulated it much more clear than I'm doing right now. But it was there was a distinction between performing therapy services as a student in turn, being distinctly different than working as a professional in a non volunteer capacity, which would be paid for the same thing. And that was kind of something along the lines there. Yeah, it's these are all really complicated things. And they are again. I think overall we need a a more flexible, financially supportive system for health care across the board, including for students.

Dr. Liara Montesano 00:52:02  I agree. because it's it's just hard. You know, I have a lot of empathy for them and it's really hard. And, you know, if you were to ask me, do I think that we can have both, have the students receive some kind of a stipend and, the supervisors, getting paid and the practice make a profit? I would say, yes, there is room for that.

Dr. Liara Montesano 00:52:35  but it all comes down to creating, that balance. and, you know, as I'm sure you know, is your core team needs to be aligned with the same values that your practice has in order to make things like that, work.

Andrew Burdette 00:52:57  Yeah. So for listeners out there, do you have any key takeaway points you want to make sure that they remember?

Dr. Liara Montesano 00:53:05  I think my, key takeaway points, would be a training program is something that it's a lot of work, but I do think it's something that is needed as our own way to improve that profession and help usher responsible, individuals that are passionate about the community, and the only way to really, do that is to have individuals working in the community getting to know, the people in the community so that they can see them as real people with real problems and not something in in a textbook. And, you know, the finances also matter because everybody, you know, there's a roof over their head and we need to be able to pay our bills, get food, and go on vacations because mental health equals high burnout rates.

Dr. Liara Montesano 00:54:20  And so we just have to find a way to balance it all and collaborate and see the students as our future colleagues, because I do believe that is key. they are a wonderful resource for the community, but then also for the practice, where they will be your colleagues. I cannot emphasize that enough. So let's be kind and fair to them. and it's a way to actually grow your own clinicians. So when I was supervising, a lot of our master's level, clinicians, students in training, I knew that they were on a terminal master's. So I would be always saying, okay, after you're done, this can be a job opportunity for you. What are your goals? so a lot of individuals at the, practices that I've worked of before making these kind of training programs, actually stayed after they were done being practicum students because they were treated well.

Andrew Burdette 00:55:37  One thing I thought of earlier, and this fits in with what we're talking about right now, is just you could look at taking on students in a training program as like a year to a year and a half long interview process.

Andrew Burdette 00:55:49  And you also get the benefit of knowing that they are trained to the standard that you want them to be trained in because they stuck around and you provided that education for them.

Dr. Liara Montesano 00:55:59  Absolutely. So there's, I think, a deeper level of trust with the clinicians. You train yourself. doesn't mean that the other clinicians coming in are not as effective or anything like that. It's just you have skipped over the stage of getting to know a new person, because you've been getting to know them for a couple of years. Or like my postdocs. I'm one of them. I have worked as a supervisor with her in one capacity or another through various, practices and positions for probably like five years at this point. so it that relationship doesn't end there. And then years later, you get an email with updates or letters of recommendations. And it is a very rewarding experience being like, oh, that's one of my little baby birds out there in the world.

Andrew Burdette 00:57:02  I know all grown up, right?

Dr. Liara Montesano 00:57:05  Yeah. Yeah.

Andrew Burdette 00:57:07  Well, thanks for being on if people want to get Ahold of you. Is there a good way to reach them and or reach you? And we'll have this linked in the show notes as well for listeners.

Dr. Liara Montesano 00:57:17  Oh. sure. I think the easiest way to reach me would be, with, my email. doctor Liara at Montesano. Psych. And, Any questions? Feel free. if you would like a consultation about, a training program you're trying to build or anything like that, feel free to reach out as well, because I love talking about this and we can get really specific about what are the issues that you're encountering, or are the schools being difficult? Okay. What is the hill that you really want to make a stand on? Yeah. because it's a lot of personalities when you're dealing with large institutions.

Andrew Burdette 00:58:10  Well, cool. Well, thank you so much for all the information and being a guest on the show. And listeners be sure to, to reach out if you have any questions about setting up your own training program.

Andrew Burdette 00:58:20  And thanks for being a guest.

Dr. Liara Montesano 00:58:22  Thank you. Have a great day.

Andrew Burdette 00:58:30  Thank you so much for listening to this show today. We could not do this show without our amazing sponsor therapy notes therapy notes as the best electronic health records out there. You can go over to Therapy Notes. Com and use promo code Jo at checkout. That's going to help get you a couple months off for free. It also helps let them know that their podcast sponsorship is working. Thanks so much for hanging out with us today on the grow Group practice podcast, and we'll talk to you soon. If you love this podcast, please be sure to rate and review. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guest are rendering legal, accounting, clinical or any other professional information. If you want professional, you should find one.