[JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, session number 807. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast, where we cover how to start, grow, scale, and exit your private practice. I hope you’re doing awesome today. Killin’It Camp, just wrapped up. That was in Cancun, Mexico. We were there from October 20th to October 23rd. So at the time of, not this recording, but of when this airs I will be relaxing and staying in Cancun for a couple extra days to just enjoy the sun before I have to come back and be on daddy duty again. I hope you’re doing awesome today. I hope you’re rocking out private practice and that you’re thinking differently. That’s one of the things about whether it’s Killin’It Camp or this podcast or other things that we’re doing, is we’ve been handed something through graduate school, through society of what a therapist, what a counselor, what a psychologist is. Oftentimes, that’s, you work for somebody else, you work at a hospital you work for community mental health. Maybe you start a private practice and you limp along but that’s what the average story and we don’t want you to be average here. We want you to rock out private practice. We want you to go after big things. We want you to disrupt the industry in a way that is just completely different than maybe how other people would. So that could be that you’re starting a podcast, it could be that you’re writing e-books, it could be that you’re doing courses. It could be a lot of different things. Really, you’re creative energy is your only limit. I remember in college, my dad they had allowed me to use this Subaru of theirs. It was this the old boxy Subaru and I was a creative, I am a creative person and I asked my dad if I could hand paint the car like a hippie car. It was older, they didn’t care. They said, sure, you can do a little bit here and a little bit there. So I did some smaller pieces on the car and finally I said to my dad what limits do I have in regards to painting this car? He said, your creative limits are your only limits. This car, I painted it head to toe. I had it for years. It was this painted car. That’s what you can have in your private practice. You can have a head to toe painted practice, however you want it to be. That’s what I’m so excited about with Dr. Brian Dixon, who’s joining us today. Dr. Brian Dixon is an award-winning psychiatrist, author and speaker who believes in the power of entrepreneurship and self-empowerment, overcoming poverty to educate patients, colleagues, and society about income and wealth inequality. Dr. Dixon owns Mindful, a direct care psychiatry practice in Fort Worth, Texas. Brian, welcome to the Practice of the Practice Podcast. [DR. BRIAN DIXON] Thank you so much for having me, Joe. I’m super, super stoked to be here. [JOE] Oh, I’m so stoked to have you here. Also, just knowing you’re in Fort Worth just down the road from LaToya, one of our consultants and knowing that you’re influencing that area of the nation is incredible. So now we know at least two amazing people down there. I’m sure there’s way more than two amazing people in Fort Worth, so awesome. Well in your, in your intro you mentioned right in there overcoming poverty, and we’d love to hear just a little bit of your personal story, because that informs so much of who we become as professionals and our mindsets and what we have to overcome as professionals to think differently. Tell us a little bit about your story of how you got to this point. [DR. DIXON] Yes, so I’m originally from east Texas, so a small town called Lufkin that most people have never, ever heard of. Growing up I we didn’t realize that we were poor. It was one of those things where I think our parents were working multiple jobs to make ends meet and we didn’t know any different. I didn’t know any different until I went to school and filled out the FAFSA and had to get my mom’s information. I learned that she was making $25,000 a year raising a family of five, six, including herself. So we were on food stamps and government assistance, and again, I didn’t know any of this stuff. I just knew that there were some hard times growing up. So yes I’d never learned anything about entrepreneurship or business and once I finished all of my training, it made me harken back to that time when I was younger, thinking, wait a minute, how was she so resourceful to make ends meet, and how do I duplicate that so that I can live my best life? [JOE] So you become a psychiatrist. Do you start a practice right away, or do you do like some, I know a lot of people do like hospital work or residencies and all that. How’d you end up in private practice? [DR. DIXON] Oh, Joe, I learned the hard way that I can’t work for anybody. [JOE] Me too [DR. DIXON] Exactly. So yes, I finished training in 2011 at the University of Kentucky. I did a combined program, pediatrics, child psychiatry and adult psychiatry. I finished and I had only been taught how to work in systems and so when I got my first job out of residency, I worked at a community mental health, a federally qualified mental health center in Texas. I was, I mean, I thought I was the bomb. I thought I was the shk. I’m doing my due and I’m seeing lots of people and I start to feel that creep of burnout because of the way that the finance system is structured in an FQHC. It’s all encounter based, so whether you spend 15 minutes or whether you spend an hour and a half, it’s counted as one encounter. Quickly my schedule got full and I got burned out. So I said, well, maybe it’s just a situation so I went to a multi-specialty group practice and worked there for two years and realized, nope, it’s not, it’s not them, it’s me. I can’t work in a system that doesn’t make sense, that doesn’t make financial sense where I don’t have any autonomy. So I quit all of that stuff in 2014 and started a private practice and just and have grown it since. [JOE] Wow. Now I feel like one thing, and I want to talk about, you have this mental health ecosystem system that I want to make sure we get into, but before we do, how do you think through your business, because I think especially psychiatrists, counselors, so much of its billable time. So a lot of times what I see is just like attorneys or other folks, if you don’t show up, you don’t get paid. So in a lot of ways you’ve given yourself a job, not a business. So how do you think through income, how much you work multiple streams, and maybe we’ll get into that in regards to the ecosystem, but how does, like, because I feel like psychiatrists, the typical model is you’ve got like 15 minute sessions, boom, boom, boom. You’re just like pushing pills. You don’t have that deep time with people, and it’s just a lot of billable hours. How do you think through all that? [DR. DIXON] My calling is to educate and most times I can do that education in the form of an appointment. So during my training, I got used to doing 30-minute follow up visits, working with families and adults. Then my new patient appointments were 60 to 90 minutes because I like to hear people’s story. That’s why I do what I do and if I could if I could get paid to do it why not? So that’s where that impetus came from. I don’t like the idea of just pushing pills. As one of my attendings said no kid is born with a Ritalin deficiency. They’re not missing something. You use a medicine to bridge from one place to another and the mysteries in the history, so figuring out where people come from and where they’re going is really important. So I said I want to be able to hear those stories, but I also have to keep the lights on and provide a some measure of standard of living for myself and my family. So when I first started, I just pulled a number out of the air as to what to charge. I knew I didn’t want to take insurance because insurance literally keeps you from doing what you need to do for your patients. It dictates what you have access to. I was like shit that, excuse my French, screw that shit, I didn’t want to do that. Instead I said, I want to be able to treat the patient that’s in front of me and support the patient that’s in front of me. That’s where it all started and as I then learned business, I was like, oh, I’m undercharging because the horribleness of payroll taxes, I always would, I’d misjudged that for years and trust me, I got more than my fair share of IRS letters, like, oh, you owe all this money back. I was like, what the hell? I don’t know what I’m doing. I’ve learned a lot since then. But the key, especially when you’re starting to practice, is just pick a number out of the blue talk to your friends, talk to other therapists, pick a number, and then go from there. [JOE] Now, I love hearing that you’re private pay. I think for a lot of people in the medical side of things, sometimes that’s a little more common in the counseling world, but for so many people it’s like, well, I have this benefit, why wouldn’t I use it? So how did you overcome that in regards to educating your patients on the value of private pay, what they could use in regards to HSAs, flexible spending, out-of-network benefits. How did you get people to even say yes to that? [DR. DIXON] I was blessed. I’ve always been blessed to really believe in myself. I think that’s the very first part, is you have to believe as a private practitioner that you are bringing value to whoever you’re working with, whether you call them a client or a patient. I have a very specific skillset, I’m really good with kids who throw fits and kids who are acting a fool. That’s my jam. [JOE] It’s so funny because at Mental Wellness Counseling, I helped angry kids, frustrated parents and distant couples. So angry kids have been my jam as well but you just say kids that throw fits, like, yes. [DR. DIXON] It is a niche and every therapist and psychiatrist should have one. That’s what I went on. So I started my practice focusing on that, which meant there was a whole bunch of people that I did not work with and as a result, it took me a lot longer to fill my practice. So there were a couple touch and go times when I was living off my credit cards. But the key is you literally have to go out and network. You have to let people know you exist. At the time, I didn’t know anything about Google AdWords and all that stuff, so I was literally just going to different doctor’s offices, I was going to Chamber of Commerce events, I was letting people know that I am here and available and taking new patients. Then I made sure to put my fees up front. I don’t like awkward money conversations and so I made sure from day one, I said, here’s my fee schedule, here’s how much I cost. Here’s what the expectation if you work with me. Being able to say that with my full chest was really helpful and letting people know who I was. [JOE] Now, did you get much pushback from, say, primary care doctors in regards to being out-of-network? [DR. DIXON] Oh, absolutely. I still get pushback, and I’m eight years into this thing. I think it’s mostly because people have a fundamental misunderstanding of how insurance works. Insurance is a, it is a financial product. It is not there for actual healthcare. I’m sure we’ll get lots of hate mail about all this, but the insurance is very limiting so when I explained it to PCPs and other folks, I say, y’all, it’s either time or money. So if I take insurance, which I totally can, you’re going to get a five minute appointment because insurances do not pay psychiatrists to do therapy and I do lots of behavioral therapy. That is what I’m good at, but they’re not going to pay for it, so, yes, I can give you a five minute me check but everybody goes, but that’s not, my patients don’t want that. I don’t want that. I go, great. Well, then the money has to come from somewhere. So either I make it up in volume and I see as many people as possible in an hour, or I just charge what I know I’m worth and you just pay what the worth is and then I work really hard to keep you out of my office. Like, my job is to work myself out of a job, and if I can see you twice a year, then that’s the goal and that way the financial burden is not as high on my families. I’m here to tell you, Joe, people will pay for it. I’ve had people who are on public assistance who save their money to come and see me because they know I work really, really hard for them. [PILLARS OF PRACTICE] We brought together all of our checklists, videos, and other free things in one spot, so you don’t have to opt in all over the place just to get another checklist. We’ve put it all together over at pillarsofpractice.com. Whether you’re just getting started or have an established group therapy practice, we have a free e-course for you as well. We have eight-minute experts, which are short eight-minute videos around specific topics, completely free. If you want to take your practice to the next level, head on over to pillarsofpractice.com to get access to our free e-courses. Again, that’s pillarsofpractice.com to get all of those free e-courses. [JOE SANOK] I remember early on when I started consulting there was a lady who was really good at helping people that had narcolepsy. She was charging like $120 a session, and she was pushing back on bumping up to $175 a session. She had a wait list, and we walked through, okay, how fast typically do people start, having a regular sleep schedule? It was within like three or four sessions. I said the average therapist, how long does it take? She’s like, oh, 12 to 15 if they even help solve this thing. So we ran the numbers on, okay, so if someone has narcolepsy, they’re probably not going to drive themselves to the office, so you have to have someone with you. So you have two people taking time off their work to drive to your office, maybe a half hour commute with parking. She was in a big city and when we ran the numbers of her value, it was like $800 or $900 an hour. When she saw that jumping to $175 was like a no-brainer because she saw her value finally and just realized, okay, like, I am saving people so much time here by doing it. So I love that you think about, hey, if you have to come once or twice a year for like an oil change type session, awesome. Let’s do that. Well, walk us through your mental health ecosystem. I love the title of this, I don’t know what it is, so I want to hear about how you think through entrepreneurship, how you think through private practice, the mental health ecosystem. Walk us through that. [DR. DIXON] Yes, so any ecosystem has multiple components. It’s you have a part that feeds another part, and then is the circle of life, water and soil and animals and that sort of thing. So that’s the biological system. Well, other sectors, other industries have that so when you look at the financial sectors, financial services industry, they already have an ecosystem. When you look at pharmaceuticals, they have an ecosystem. They know distributors, and they have all these different levels. Well, in mental healthcare, we have an ecosystem that’s just really broken and siloed because anytime people say, okay, you have a mental health issue, they think of Mening Clinic, or they think of Mayo or Massachusetts General. They go, oh, those are big hospitals. Or they will hear about TMS or ECT or they’ll hear about Dr., what is his name, Dr. Phil, all those things. Well, at the end of the day, there’s a whole level that we’re missing, which is the outpatient level, outpatient meaning somebody to be able to see once a week for a certain number of time, certain amount of time. We are getting overlooked because all of the emphasis is on either drugs or big systems and the outpatient level is the most important level of the mental health ecosystem. We need to make it more robust. We need to give it more infrastructure. We need to find a way for private practice psychiatrist, therapist, counselors, to communicate with each other, to refer to each other better, to then run their practices as fiscally responsible and profitable as possible. Because every single time a private practice goes out of business, it reverberates and it ripples to everybody else in the community. I want to stop that. I want to make sure that therapists feel supported, that they can pay their taxes on time, that they can live their best life, and then that they can refer between each other really well. So that’s why I’m building, I’ve built three companies in this space. [JOE] Three companies in this space, what companies other than your private practice? [DR. DIXON] Yes, so the private practice is the actual execution, so it’s the B2C the business to consumer, or in this case the business to patient. Then we have two B2B companies. Simply Psych is a practice management company, so it teaches folks, not teaches, it also supports private practices in running whatever they’re doing, so whether you need a full service thing, like you don’t have a website, you need to manage your leads, you need to do your marketing, you need to collect money, accounts receivable, all that stuff, we can do that. Or if you just need that one off, hey, here’s that business plan. I need to figure out if private practice is for me. We can do that as well. That’s the B2B practice management side. Then me and a friend of mine, we created a guide called, an app called GIDE, G-I-D-E. What GIDE does, it’s a closed database where we can refer and send referrals between therapists. Because one of the funny parts about all of us therapists and mental health clinicians is we love lying on the internet. So whenever you go to a clinician’s website, everybody treats everything and you know, Joe, and I know that that’s not the case. There are certain things that we’re really good at, but the problem is, marketing wise, you cannot go out and market what you’re not good at. For example, I’m really good at kids who throw fits but for your people who are suffering from depression, I’m probably not the best fit because of lots of different reasons but I can’t go out and market that because if I do that would be bad. As a result the key is to have a closed system where we can refer to each other a lot easier without showing all of our cards to the rest of the public. That’s what GIDE does. [JOE] Wow. So how do you, well, before we move away, are there other parts to the mental health ecosystem before I ask some other questions? [DR. DIXON] I’m mainly focusing on the outpatient part because I’m on a private practice podcast but the other part is we have to stay in communication with agencies. So I sit on the board of two other community mental health therapy companies. We have to stay in contact with folks who do inpatient so I’m always talking about how to improve communication within like hospital systems, both private and public. Then we also have to make sure that we continue to fight stigma. So the ecosystem is truly a pyramid. It’s all levels of care, all different types of clinicians, regardless of what your licensure is. So yes, I’m doing those things as well, but I really focus on the private practice because I think that’s where we get the most pain for our buck. [JOE] Yes, I’m always interested in entrepreneurs that have multiple things going on. How do you manage your time and your creative energy so that your businesses get your best ideas and it’s not just the leftovers or the burnout or that you resent the companies that you own? [DR. DIXON] The key is you do what you’re good at and you don’t do what you’re not good at. Anytime I’m mentoring someone, that’s what I coach them on because that’s what I truly believe I am super, super bad at financials, which is why we have a great CPA and we have an account clerk and they do all that stuff because I just, I hate budgets and spreadsheets. Then I’m not the best operations person. So I hired a really good CEO and we have a chief communications officer who they can keep all the balls in the air so that I can focus on what I’m good at. I’m a big fan of the business organizational strategy called Traction and EO and I’m a member of the Entrepreneur’s Organization. So yes, I like Gino Wickman’s idea about the seats and getting the right butts and the right seats and that’s allowed me to scale all of these companies. All combined, we have grossed over a million dollars last year and I’m just looking to grow those further and help more people. [JOE] Now when you think about what gets in the way of people being successful in private practice, what do you notice? [DR. DIXON] Oh man, a couple different things. Number one like I said earlier, you have to believe that you are the person to do the thing that you’re doing. I know I’m called to work with kids. I know I’m called to run this particular company because I believe it. So I’d say that’s the first hiccup is people have to get out of their own way. Then the second hiccup, and this is just again, talking equity, which is access to capital, so I’m a black guy and the studies have shown that black people, especially black women we just don’t have access to capital to start a business. So I’ve had to basically bootstrap or self-fund everything when I started. That is, it’s super hard because we also disproportionately have higher rates of interest on all of our debts, so our student loans and our credit cards and our automobiles and our house loans are all higher than our white counterparts. So, yes, the deck can be stacked against clinicians of color and it’s not fair. I mean, I go out and I try to talk about all that stuff, but those two things, believe in yourself is one, because I want everybody to believe in themselves, but then we also have to live in the stark truth that it is fiscally harder for some of us. So trying to find avenues to get funding is challenging. [JOE] When people hear this and they say, wow, I have some privilege, I want to use that privilege to help push back on these inequities, what can people with privilege do? [DR. DIXON] Yes, privilege is all in my, to distill it down, it’s all about money. I tell people all the time, make sure you’re putting your money where your feelings and your mouth is, so find a black business, buy their t-shirts, find a black business, buy whatever they’re selling, find a black business, sign up for whatever the service is, whether you need it or not, give them cash. I mean, you can also Venmo, as long as it’s less than $600. I’m kidding. But yes, in a sense, put your money into the business. It’s not about a handout or even a hand up, it’s literally just use their business. If they do marketing, if they do coaching, whatever it is, just use them so that then they can increase their revenue. That’s what I would say. It’s not, don’t pity them because every black business owner that I know, they’re working their ass off and so just patronize them with your money. [JOE] The last question I always ask is, if every private practitioner in the world were listening right now, what would you want them to know? [DR. DIXON] If every private practitioner was listening, I would say it’s all about growing the pie. So when I started my private practice my business coach said don’t worry about your slice of the pie, just grow the size of the pie. For the longest time, I didn’t really understand what that meant until I did and now I realize that I don’t have competition. There is no competition in the mental health space because our ecosystem, our infrastructure is so 50 years behind that anytime you do anything, it reverberates, it scales by itself as long as you stick with it. And don’t think about competition. I could absolutely give a shit if you started a private practice right next door to me. It does not matter. I don’t care if you’re a psychiatrist or otherwise, there is no competition. We have a responsibility, especially living in today’s age of misinformation and disinformation, we have a responsibility to put out good stuff and as long as you’re working at an agency and feeling like you’re not valued, you are making the situation worse. So speak up, write that ebook, write that blog, do that consulting, do whatever you need to do to get good information out there because our world literally is hurting for it. So yes, there is no competition. Put yourself out there. [JOE] Love that so much. If people want to follow your work, if they want to check out your app, your website, any of that, where should we send them? [DR. DIXON] The two main sites, and I have lots, but the two main sites, so drbriandixon.com, d r b r i a n d i x o n.com. That’s my personal website where I talk about a whole bunch of stuff. Then my business website is Simply Psych, so www.simplypsych.com. Yes, and then I’m all over the social medias and all that, even though it’s the begining of my existence. It’s a necessary evil so yes, simplypsych.com and drbriandixon.com. [JOE] Oh, so awesome. Well, Dr. Brian Dixon, thank you so much for being on the Practice of the Practice Podcast. [DR. DIXON] Thank you so much for having me, Joe. [JOE] I love that there’s no competition. I remember early on I wrote an article about sushi and how if there were sushi, there was one sushi place here in Traverse City 20 years ago it was okay, but if they had said what, there’s only a handful of people that like sushi, like we need to be anti-sushi with other people you really would’ve realized the limits of sushi. Whereas as people taste the deliciousness of sushi, then more sushi places can open up and it’s in your grocery store now. It’s at restaurants that maybe aren’t even a sushi restaurant, which I’m not sure I would eat sushi either, but to just see how it was the awareness of the deliciousness of sushi that made things expand. So I love that idea of expanding the pie, not the pieces of the pie. Yes, I’m, I’m so, like, I don’t care about competition either. When you’re yourself, when you are creating things that are unique in the world, what you’re doing is you’re the differentiator. No one can be Joe Sanok, no one can be Dr. Brian Dixon, no one can be LaToya Smith. So really finding how you can embrace that uniqueness in your business, in your life, in all those different ways. We couldn’t do this show without our sponsors today. Our sponsor is our Pillars of Practice e-course. It’s totally free. We have a track that’s for you when you’re just starting a practice. Then we have another track for if you already have an established practice, you want to grow it within it. We have these eight-minute experts where it’s eight-minute conversations, I literally have a timer and I interview people about websites, I interview them about bookkeeping, about all sorts of things private practice. So you’re going to get that. We put all of our checklists that we used to give away, one at a time that you had to opt in individually. They’re all in there, so many things totally for free. Head on over to pillarsofpractice.com, sign up for whichever of those free e-course you want to do. Thank you so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.