• Visit Alex’s website and connect on Facebook, Instagram, YouTube.

Books mentioned in this episode:

• Alex Howard – Why Me
• Alex Howard – Decode Your Fatigue
• Alex Howard – It’s Not Your Fault: Why Childhood Trauma Shapes You and How to Break Free

Every single phase of private practice has its own unique challenges and its own unique opportunities. Whether you’re starting and growing a solo practice, getting a group practice going, whether you’re already a group practice boss, or you want to go big and go national with the skills you have, every phase has its challenges.

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Again, that’s practice of the practice. com forward slash memberships.

This is the practice of the practice podcast with Joe Sanok, session number 1149.

I’m Joe Sanok, your host, and welcome to the new year. Uh, we are doing the even better year series, you know, with the mindset that it’s not maybe going to be the best year ever. We don’t know how that’s going to go for you. Um, but are there small steps that we can take in the right direction to make this even better for you Then the year before, even if things come your way that are unexpected to have mindsets and ways that we think about the world and that we kind of interact with the world, um, to make it a little bit of a step in the right direction.

So we do that through helping you build a thriving practice. You absolutely love, but. We talk about all sorts of life things and, um, things within clinical research as well. Um, that, so for example, the next episode, uh, is with Dr. Lori Brado, who’s talking about sexual health and research. So that’s in the next episode, uh, right around the corner.

So we have all sorts of great things planned for you this month. Um, and that’s why I am super excited to have Alex Howard. Alex is founder and chairman of the Optimum Health Clinic, one of the world’s leading integrative medical clinics with a team of 25 full time practitioners supporting thousands of patients in 50 plus countries.

Alex has published academic research in publications such as British Medical Journal, Open, and Psychology and Health, and is the author of the books Why Me and Decode Your Fatigue. Alex’s latest book, It’s Not Your Fault, Why Childhood Trauma Shapes You and How to Break Free is out now. Alex, welcome to the Practice, Practice podcast.

Joe, thank you for having me. Excited to be here. 

Yeah, I’m excited to have you here. Um, I always love, um, talking with other practice owners that, um, are doing, um, similar but different things. And so, um, we’d love to hear about your integrative practice. Um, like when did you start it? And then let’s talk about some of just the business building side.

Yeah, I started, uh, 20 years ago. So 2004, uh, 20, 21 years ago, nearly. Um, and, I started the Optimum Health Clinic having had my own journey with, um, uh, chronic fatigue or ME, um, kind of fatigue based condition. And having suffered with that for seven years, I really wanted to create the organization that hadn’t existed that I’d wanted to exist in those years that I’d been ill.

And, um, You know, at that time I was a recently qualified, um, practitioner. Um, I’d never had a paid job. I did, I did have a paper round of delivering newspapers as a kid and I did stack shelves in a health food store in my teenage years, but I never had a proper full time job. Um, and so mostly driven by just this deep sense of purpose of wanting to do something that I felt was important.

Um, at, um, 24 years old, I embarked on starting my own clinic and, um, I’m grateful to say that still have two decades later. 

Now, as you started to add people to the practice, uh, I know for a lot of folks, when they first kind of get their practices going, the first say five hires or so feel like a huge jump for them.

Um, those early hires, what did that look like for you? 

Uh, chaos, I think what happened was, um, I, I started the clinic out of, um, a little, um, two bed apartment that I was living in with my then girlfriend, who was the, um, was a nutritionist and I was working on the psychology side. And, um, I used to go out there and do public talks, talking about my own recovery journey and the things that had helped and the things that we offered within the clinic.

And we had a few articles that were published around that time. We did a couple of, um, paid adverts in a couple of, um, of magazines, more like printed newsletters that went to people that suffered from complex chronic illnesses. And it just. I mean, it’s, it’s kind of hard to describe. I mean, I remember we had a, uh, an article that came out and, um, we had one phone line into the apartment and it was just the kind of a home phone number that was on the article.

And every time you answered the phone, you put it down, it rang again. Um, and it was the kind of, the kind of thing that in a way dreams are made off, but also then chaos, uh, ensues from, because, um, you know, we hired our first couple of, um, admin people. Actually, one of them was a, was a recovering patient.

Um, another one that was a trainee, um, nutritionist who had been training with, um, um, my, my colleague. And. We didn’t, I look back now at the sort of, uh, the sort of sophistication of the process of the systems that we’ve created. And back then, you know, it was like paper records. Um, it was, um, a lot of things happening by post obviously email, um, starting, um, lots of mistakes in terms of trying to hire the right people and how to manage those people.

Um, particularly we had challenges when we started to scale, um, the clinical team, because initially it was myself, Um, Nikki, who was the nutritionist, and then soon joined by, um, um, Anna Doshinsky, who’s been, um, sort of my partner in crime on the psychology side now for, you know, 20 years. And the three of us had very shared values.

We had, um, a deep sense of, of commitment to what we were doing. We were, we were very kind of talented. I think it’s fair to say practitioners and then we would bring as we became too busy for the three of us, we would bring other practitioners in and it was very challenging to scale that that quality of the work that we did, but also, um.

Those real deep, shared values of, you know, the patient comes first. It’s a relationship with the patient and how you really cultivate that relationship. Um, it took us many years to figure out how to do that at the sort of scale we do now and to do it really well. 

To get to 25, you kind of have to walk that line of clients coming in and filling people up.

And then, you know, sometimes having too many staff and you don’t have enough clients coming in. Walk us through how you think through that balance of clients coming in and when to hire. 

It’s incredibly difficult. Um, we’ve had many times over the years where we’ve got busy, we’ve hired too many practitioners, not had enough work for them.

And then those people are sort of, you know, drifted away. And then we would get busy again and not have enough practitioners. Um, practitioners will be keen to take on more work and then you’d have to protect them from taking on too much. Otherwise they start to burn out in the process of doing it. Um, sort of, you know, 20 something years later, we have, we really know our numbers.

We know how many clients a practitioner can take on. Um, we know roughly how many inquiries we get a month. We know what percentage of those roughly we convert to, um, to, to, to be clients. So there’s a lot more stability these days. Um, I really don’t like big ups and downs. You know, when you, if you suddenly have a big surge, it’s much more difficult to manage than just having steady year on year growth, which is what we’ve seen in more recent years, which has been much, much easier to manage effectively.

So are you then kind of letting the client load kind of build up and have there be. Like demand. And then you hire someone so that you’re constantly filling someone because you don’t want the ups and downs. 

Yes. And also if we know that someone’s going to move on at some point, then we’ll certainly hire to, to fill that.

We, we typically try to have one or two people kind of in the wings, as we would say, like we kind of, you know, they’re trained up or we’re training them up or they’re sort of shadowing some consultations, um, that being trained in the protocol, um, you know, You know, the sort of level we are now with 25 practitioners in an average year, maybe there’s, you know, a couple of people that might leave a couple that might come in, we might have to leave three or four might come in.

Um, and so, you know, there’s a certain amounts of predictability to that. It takes us from the point of view of recognizing we need a new practitioner. It’s a, the fastest we can do it is about three or four months to, you know, find someone quickly and then sort of three months or so of training and onboarding.

Um, And, you know, there are times where we are booking out new consultations, two, three months ahead. Um, and you know, that’s obviously not ideal for us or ideal for the, for the client. And so we do the best we can to manage it. I think we do a reasonably good job now. Um, but you know, I remember back in the day, a few times we’ve had, you know, big press articles that have come out about what we do, and then we’d have sort of, you know, three, four X inquiries in a month and, You know, it’s great that people are finding out about us, but that that’s not, that’s not typically very easy to manage in an effective way.

Yeah. Yeah. Now with you guys serving so many countries and having, um, 25 full time practitioners, um, Are they primarily online? Is it primarily in person? Like, uh, what, what’s the breakdown in regards to in person versus online? 

Uh, these days we’re a hundred percent online. Um, we started out and we were probably 80 percent in person.

Um, we had a clinic in central London on a street called Harley Street, which is the sort of, um, sort of famed medical street in, um, in London. Um, that gradually reduced down for a couple of reasons. Firstly, um, a lot of our patients are chronically ill and therefore, even if they live relatively near, traveling is, is not easy and can, um, You know, obviously, as they work with us, hopefully they make significant progress.

And then, you know, that becomes easier. Um, but that’s certainly been a factor. And then having a lot of international patients has also been a factor. Um, come, uh, 2020 when COVID came, we still had a few clinic rooms. In our head off link to our head office, which was then in North London. Um, when we came back from COVID, um, other parts of our organization.

So we also have a business running, um, quite large online conferences, um, that had grown dramatically, um, during that period. So we ended up. Um, basically stealing the clinic rooms and turning that into, uh, management offices. Um, and we actually haven’t had in person clinic rooms since, um, 2020. Um, I do because I work in the head office.

Um, I do sometimes still see patients, um, in person. Um, but at this point, pretty much a hundred percent of what we do is, is online. 

Wow. So what are some of the, um, So I guess one thing I’m thinking about is that when you don’t have an in person office, which that’s how practice of the practice is also, you know, probably two thirds of our staff are in South Africa and the rest are throughout the United States and Canada.

Um, you have to have really strong operations, really strong project management tools, ways that you, you talk to each other. So like we, in the last, um. So, uh, in the last year really implemented Asana and Slack as our main areas of kind of where we’re communicating and where we’re looking at projects. How do you keep people aligned if you’re 100 percent online?

Uh, it takes thought, takes care. Um, we, so we do have, um, a head office for the, for the group, which, um, a few of the staff for the OptumHealth clinic work from. Um, a few times a year we get together the whole, the whole group, which is typically, um, it’s about 60 people of which about 40 or 50 or so will be in the UK.

And so we do, we can get, can host everyone in our, in our main office. Um, but we, we, so we have a few different tools that we use, um, in the, in the wider part of the group, less so in the clinic, but we use Slack. Um, we use Monday, which is a sort of similar tool to Asana. Um, we, um, we have a, a quite elaborate CRM system, UK based company called Workbooks.

And we’ve done a lot of work to customize that and adapt that. And a lot of our business processes are driven through that. So for example, um, someone requests a free information pack that goes into that system. Our email marketing system will then send out an email sequence, um, driving them towards a discovery call.

If they book a discovery call, that will come in as a, what’s called an opportunity record into that system. And then kind of each step of that process, the person that’s responsible for that step, when they complete that, it naturally moves it to the next person that needs to be responsible for the next piece.

And so we’ve divining, just defining those business processes and having sort of the right. Quality of people that can a supervise and be used those processes. Um, that’s also played an important role in things like patient retention and making sure that practitioners have good visibility of their client load, where people are at, where people may need following up.

If people have sort of drifted off for a while that we have ways of having touch points to follow up with them. Um, But we also, you know, I speak a little candidly and I, nothing I wouldn’t say to my own team, but I would sometimes, I sometimes find that the team within the clinic are less tech savvy than the team that, for example, work in our kind of internal agency, you know, of our kind of marketing team and our video team, our tech team, where using sort of.

Tech tools to, um, improve project planning and workflows is quite second nature. We have not rolled all of those out within the clinic because when we’ve rolled things out in the past, we found we’ve had a fair bit of friction in the process. And so it’s, it’s, it’s having that one central tool that really works trying to standardize process that people follow.

Um, but also recognizing there are individual differences about how people want to sort of do those things. But we, you know, we also have to be careful when you have a team that starts to go rogue. And, you know, for example, having a clinical team that go, right, we’re going to start using Dropbox. We’re like, hang on, everyone else is using Google drive.

We’re already paying for that. So it’s definitely a, it’s a balancing act of trying not to be too rigid with people, but also wanting to make sure we have, you know, Consistency in terms of how we approach things. 

Yeah, I love that.

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Now, I’d love to kind of shift into you as an owner, as the owner, what are mindsets that you had to overcome or change or challenge over the years as you grew into a larger practice? 

I would define my business journey as making lots and lots of mistakes and, um, Hopefully not making mistakes so severe that I can’t learn from them and recover from the move forwards.

You know, I, I’m quite instinctive in a way as an entrepreneur, and that is, that has good sides and bad sides. I think it’s more of an annoyance for people that work with me as a business gets bigger and I can have to slow myself down sometimes to not want to jump three steps ahead when I’m dragging other people down, down that path, which may be interrupted with the things that they’re trying to focus on.

I think it’s been. You know, one of the things I wrestle a lot with is I, I’m very driven and I love what I do. I love the impact that we have. I love the people that we get to serve, but also making sure that we’re not trying to do too many things at once. And we’re not spreading so thin that we ended up doing lots of things to a kind of.

You know, seven out of 10, as opposed to doing less things and doing them as a 10 out of 10. And so it’s that kind of balance of, of breadth of things that we do, but also making sure that we maintain that quality and that depth. So that’s something that I, I think about a lot, you know, at this stage of my career, one of the things that I would say in the last five years or so has been a big learning journey is I think up to a certain point as a business, You can get away with quite a lot by being really passionate about what you do, being good at what you do and having loyalty in the people that, that work closely with you.

But I, you know, we reached the point sort of four or five years ago where. Those things alone are not enough. And you’ve actually got to bring in really good people. You’ve got to find those people. You’ve got to empower those people. You’ve got to invest in the relationship with those people, bring in much more sort of organizational structures, processes, and as someone who, you know, has just been learning along the way.

There’s definitely been a lot of headaches, is one way of putting it. Challenges and opportunities is another way of putting it. Um, but mostly I’ve really liked that journey. The thing that I, the thing that, that I don’t enjoy is feeling like we’re going around in circles, facing the same problems again and again.

As long as the problems are getting more interesting and more challenging, then mostly I feel pretty energized by that. 

Yeah. Yeah. Now, when you think through your goals for the business, um, I know a lot of people we work with as they start to build a business. You know, it’s chaotic at the beginning, like you explained.

Then you start to get some good systems in there and it’s clicking along. Um, and then oftentimes those owners want to level up in different ways than what the business can offer. So they may go into podcasting or keynotes or different types of things when you’re evaluating your personal next steps.

Yeah. As, as a business person, um, what are you thinking through? How are you thinking through that decision? 

You know, it’s, it’s funny. I, one of the things I have to be kind of mindful of in myself is I’ll, I’ll see people that are absolutely crushing it on social media. And I think I want to give more energy to my social media.

And then I’ll see other people that are really crushing our marketing funnel. I go, right, I think I deeper on that piece. And then someone else is really crushing it with, with just one amazing flagship products and like a very, very simple product suite. But that one thing is absolutely kind of nailing it.

And so. It’s, it’s making the right choices in terms of where, where energy is, is placed. I’ve tried to work more in recent years on my personal brand. So for a long time, I sort of, my personal, I would do what I needed to do to not limit the growth of the businesses, but I wasn’t using my personal brand and I wasn’t building a personal brand and then using it as a leverage to help grow the businesses.

And that’s something that I’ve tried to work on. I’ve given more attention to in the last couple of years. And, um, and that’s been, I would say it’s harder to find the ROI on that. You know, I know if we do paid advertising, we generate X number of leads, Y number of discovery calls, and sort of Z number of, of, of clients.

And that that’s something we have reasonably well dialed in, but I, you know, I’ve enjoyed, you know, Trying to, trying to get better at doing social media. Um, I, I realized that it’s very easy to look at things that people are doing, that they make look really easy and seem really easy. And sometimes we even sit in judgment around, around those things.

And then you go and try and do it and you realize it’s like the things that look effortless or, or, you know, a simple, there’s, there’s huge amounts of little touches and nuance that actually are why those things have become successful. 

Yeah. Yeah. So when you think about the next steps for the business, um, how do you, how are you thinking through growth of the business?

Like, I like your idea early on of predictable growth, not big swings up and down. Um, so how are you maintaining that and thinking about the next year? 

So we moved, uh, Conference business of online conferences to a subscription model a couple of years ago that, that was a really good move for us, um, that, you know, we would do a million revenue in a month and then have no revenue for four or five months sometimes.

And, and the sort of ups and downs of that as the overheads climbed was, was, was a, was a challenge. So building in, in that part of the business, in other parts of the business, more, more stability. in terms of sort of peaks and troughs is one of the things we’re definitely looking at. Um, I’m really keen to grow our professional training business.

So we have, um, uh, a proprietary, um, framework called therapeutic coaching, which is a sort of, um, integration of a psychotherapeutic approach with a solution based coaching methodology. Um, we acquired the on that, the U S trademark on that about six or seven years ago. And I feel that that’s one part of our business, which is, is, is an absolutely outstanding product that, you know, it’s doing well.

We, we, we, we have, um, coming through our sort of first year training around a hundred, 120 students a year. Um, but I think there’s, there’s a lot of. Potential in that. So that’s something that I’m very keen to give more energy to to grow. And yeah, I’m also keen to continue growing my own sort of social media personal brand.

I have a YouTube series called in therapy where we film people’s therapeutic journeys. And it’s quite, it’s quite a unique series. And in that sense that we follow people over sort of sort of three months or so of their, of having, um, weekly therapeutic or eight sessions over roughly three months of therapeutic work with me.

So I’m keen to grow the audience of that. So yeah, that’s some of the things. And, you know, I had a plan to write a book every two years and I did, um, two books in four years. And if I continue with that plan, I’m supposed to deliver a book, um, in the coming months and let’s just say that’s not going to happen.

So that’s something else that I’m also keen to keep to find more time for. 

Yeah. Oh, you know, one thing that. In Thursdays, the new Friday I talked about is slowing down and how that helps us be more curious, more creative, have better ideas. Um, I always love when I’m talking to business leaders to hear how do you balance your, your work, your big goals for the world, the change that you want to see with.

Slowing down, going after hobbies. Like, what does that look like in regards to kind of what you’re putting emphasis on outside of work? 

Yeah, that’s a good question. Um, I have, I have three kids between, um, seven and 13. So my, my, my two dogs, sometimes more work for the kids. Um, my, you know, my wife’s been really good in the sense that in the early years, we, we had kids very quickly in our, in our relationship and, you know, You know, I, I’ve always worked very hard and I’ve always really loved my work and kind of early in those early years, I look back, I know she was quite frustrated, partly because I just, I was under a lot of pressure at the time, but she’s been really good over the years that sort of making the point that, you know, when you’re working, Go as hard as you want, but when it’s time to be with the family, we want you present.

You need to be here. And I’ve, and I, again, over the last sort of, uh, four or five years, I’ve, I’ve, I’m not going to say I’ve mastered it because I don’t know. I don’t think I get to make that claim, but I’ve certainly got better at it. Um, I really don’t like working Um, doing scheduled work at weekends. I might think about things.

I might, um, you know, I might do kind of catch up on reading and, and stuff. And I sometimes do a couple of hours on a Sunday evening to prep for the week. But I turned down quite a lot of invitations to speak at conferences and events because, you know, the kids are at school in the week. And if I want to have that family time, it kind of has to happen at the weekends.

Um, so that, That line I’ve been pretty firm with, there are things that I say yes to, but there’s got to be a very compelling reason why, why I do that, you know, I, I, one of those people that I think one of the things that’s a real blessing in my life is I seem to do really well with task shifting. And what I mean by that.

Is if I spend too long doing one thing, I can get drained by that thing. But if I switch it in something else, often I can find that I get, I get a kind of new lease of energy. Um, so like for example, I spend too long in sort of business meetings and often I do those in the mornings. I kind of get to a point where I get a kind of decision fatigue and I get a sort of bit irritable at sort of the stuff that I need to sort of get my head around.

And then I might do two or three hours of patience, or I might spend two or three hours filming in the studio. And I kind of get a new energy from doing that. And then, you know, I might leave the office. I typically sort of leave at quarter past six to come home. I cycle home. I hang out a little bit with the kids.

You know, I have a shower, have some supper, and I sometimes get a new lease and I can sort of do more creative writing stuff. And so I find that It helps me to, and I work quite a lot with my assistant on this, to manage my schedule in such a way that I’m not over indexing too much in any one day on one thing, which then means my productivity goes down.

Um, exercise is really important. I recently started exercising during the day. I typically used to exercise at the end of the day, you know, I cycled to and from the office. Um, but then I started having gym sessions with a trainer on a Monday and Wednesday at lunchtime. That’s made a big difference in terms of, of that kind of afternoon lag that can happen.

So I, you know, I sort of felt like over the years, I’ve, I’ve got to know my body. I’ve got to know sort of how I, how I can maximize my output. And there are still those days in those weeks where, you know, there’s multiple fires going in different parts of the business. And it’s like, which one am I going to have to put out first?

And you know, that still sucks, but it definitely happens less than it used to. 

Yeah. Uh, the last question I always ask is if every private practitioner in the world, we’re listening right now, what would you want them to know? 

I think one of the most important things to master as nearly all of us that go into this work, we go into it because we love being a clinician.

I love, it’s the one of the, it’s probably the thing I love most about, about all the things that I do. One of the reasons why I think I’ve become as, as sort of skilled as I hopefully have become as a clinician is I also got good at the business of being a clinician, which meant that in the early years of my clinical life, I could generate more clients than I ever had the time to see, which meant that I constantly got to master the art of working with people.

And I see a lot of practitioners that have. Real potential. They’ve got all the raw ingredients. But they’re only seeing a few clients a week because they haven’t mastered the business of getting clients, which means not only do they not achieve that sort of, you know, financial potential, but they also never really become the master they could become because they don’t ever get to do the volume of work, you know, the sort of the classic 10, 000 hours you need to do with something.

To start to really get mastery. And so I think people think about the business of being a practitioner as somehow being in competition with, you know, it’s like artists that are like, you know, the business of art somehow is, is the, you know, it is, is against the sort of true creative piece for me in the, in this world, as long as one is, is doing that marketing, you know, for me.

I love doing our marketing because basically our marketing is putting out high quality information into the world for free. You know, we do, you know, for with six online conferences this year with, you know, hundreds of interviews, they’re free for the week, for the week that they’re live. You know, we’ve had tens of thousands of people go through my decode your trauma, decode your nervous system, decode your fatigue.

So I want my decode series, but mastering Communicating what you do actually helps you become better at what you do. 

So good. Uh, if people want to connect with you, if they want to follow your work, maybe work with your clinic, where should we send them? 

The best place to go is my website, which is alexhoward.

com. Um, you find, you’ll find signposts there for the optimal health clinic, um, for therapeutic coaching, which is our practitioner training program. We’ve Um, you can sign up for, um, my decode series, um, you can find, um, signpost to my in therapy, YouTube series, and also information on my various books. So that that’s definitely alexhowell.

com is definitely the best place to go. 

Uh, so awesome. Thank you so much for being on the show today. Thanks for having me. I appreciate the conversation.

I would love to hear what you’re doing with what you’re learning on this show. Uh, feel free to drop me an email, you know, drop me a DM on whatever your favorite social media is. Uh, we are helping you and particularly our members, um, every single day. You know, we have three live meetings a week and our memberships, you can read more over at practice of practice.

com forward slash memberships. Uh, that’s a great way to get connected. And also we could not do this without you. Without our sponsor and today’s sponsor for the podcast is the receptionist for iPad. The receptionist for iPad helps you tackle some of those pre appointment apprehension by having a digital client check in system when visitors come to your appointments.

Start a free 14 day trial over at the receptionist. com forward slash practice. Again, use the receptionist. com slash practice. Thank you so much for letting us into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for that intro music. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered.

It is given with the understanding that neither the host, the producers, the publishers, or guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.