As a part of my interview series with prominent medical professionals about “How To Grow Your Private Practice” I had the pleasure of interviewing Jamie McNally.
Jamie McNally is a mental health professional, advocate for quality client care, and compliance enthusiast who is invigorated by helping others — clients and colleagues, alike — overcome barriers to their aspirations and capabilities. Jamie is the Owner and Clinic Director of Sycamore Counseling Services, a group counseling practice with offices in Livonia and Trenton, Michigan, and Owner and CEO of fortifyU, LLC, an online HIPAA-compliance training program for mental health professionals. She is licensed and credentialed as a Limited Licensed Psychologist, Licensed Professional Counselor, and Certified HIPAA Compliance Officer and has trained over 100 mental health professionals during their practicum, internship, and early post-graduate work
Well first things first, I am a Michigander through and though; I always have and always will consider the mitten state my home. The first major pivotal point in the trajectory of my life is my mother being diagnosed with cancer when I was two and passing away three years later. My father committed his life to raising his children — I’m the youngest of six — and never remarried; he never once seemed to consider his own needs before ours. As a family, we struggled a lot, and even at a young age I was acutely aware of serious issues beyond my developmental stage. Doing your part to help out was the norm in our house and I began working full-time when I was fourteen years old.
I worked multiple jobs — often times simultaneously — and in my freshman year of college, I enlisted in the Michigan Air National Guard in the Civil Engineer Squadron’s Structures unit. After spending over twelve years in the military, including deployments in support of Hurricane Katrina and Operation Iraqi Freedom, I was medically discharged due to an injury I sustained while deployed in Iraq.
By that time, my experiences afforded me exposure to a variety of fields, including marketing, construction, design, finance, retail, and corporate team building, culminating in finding my calling in the mental health field. I enrolled in Moody Theological Seminary and in 2013, graduated Magna cum laude with a Master of Arts in Counseling Psychology. I was hired as a Clinic Manager for a graduate-level training facility and had the incredible privilege of running a clinic where I was responsible for training over one hundred counselors-in-training. Even better, my spouse and I married that year and, since he is a counselor as well, we began dreaming together about our future goals, which planted the seeds for our vision of our clinic. Sycamore Counseling Services was founded only a couple years later.
For some, their defining moments tend to be the ones that highlight their good fortune or feelings of love and happiness. Mine happened to be moments that brought me face to face with the darker side of our world, even from a very young age. My struggles with trauma, abuse, near-poverty, and cumulative disadvantage have truly been the shaping forces in my life, playing an integral role in me becoming a mental health professional. I believe that these difficulties forced me to make a choice about the kind of life I was going to live and instilled in me a determination and resilience that has been the catalyst for all that I have accomplished. Importantly, too, I am truly fortunate to have had one safe adult — my father — who was my anchor and hero, and gave me the experience of being loved so that I could choose to fight against the odds dictated by circumstances to forge a better path for myself. My family demonstrated the kind of fierce love that let me know there is good in the world and sometimes we have to make it for ourselves and others. It is this mindset that led me to want to become a counselor and ultimately open a clinic so I could help others see the good in themselves and the world, as well.
During my years as a Clinic Manager, I noticed a trend in the experiences of the alumni entering into the post-graduate world of seeing clients on a professional level. Many of them disclosed to me how discouraged they were; how difficult it was to work in isolation without the support and camaraderie of a cohort of fellow students. Also, most of them wanted to spend their time in therapy and not necessarily figuring out how to start and maintain a practice, which, at the end of the day, is a business, really. I, on the other hand, had extensive experience in leadership and management roles compounded by a strong business background that led me to be drawn to this side of practicing therapy. My husband and I felt strongly that we were called to start a group practice in our community, so that we could address some of these issues and provide a high standard of care for others, along with a culture in which therapists were supported and working in an environment of support, accountability, and growth. We felt that a well-run and legally compliant practice was a standard that had been lowered and that we were equipped to take on this challenge by starting our own practice.
Mental preparation was a key part of this. I launched my practice with ambitious goals, realistic expectations, and a whole lot of grace for myself. Notably, I also made the decision to start my practice as a group practice, as opposed to being a solo provider, which meant I had more space to run the business while other therapists were seeing clients. Notably, too, my success with managing both roles is largely due to my natural traits and personality. We all have natural baselines of energy and motivation, some higher or lower than the average individual. In my opinion, there are people that possess a higher baseline that is often characterized by high levels of motivation and goal-driven behaviors that become adaptive. I believe that I — and likely many entrepreneurs — have this higher baseline and that this allows us to better manage the multiple demands of starting a new business. Others would likely refer to these characteristics as a strong work ethic or Type A personality, but as a mental health professional I like to conceptualize it in the above terms, since it more closely aligns with diagnostic conceptualization. Being both a provider and business owner definitely requires some of these characteristics and a very structured and disciplined strategic plan, otherwise a person will quickly become overwhelmed by the constant demands.
In general, I think a business owner needs to consider what their long-term objectives are. I know some entrepreneurs, particularly in the mental health field, that are content finishing out their career as a full-time clinician and “success” is gauged simply by whether they have a full caseload. These individuals may always want to focus primarily on working in their business. However, if a clinician has long-term objectives for a more flexible schedule and free time to spend with family and friends, then scaling a practice and working on the business is a necessity. Additionally, since we exchange time for dollars, if a clinician is getting burned out due to a high caseload and the financial stressors and constraints, they will no longer be as effective for their clients. This, to me, is the indicator that it’s time to re-evaluate your business plan and make working on the practice a priority.
In my case, this was pretty immediate, due to the overall business plan that I had. In the mental health field there are far more clinicians that are great with clients and poor with business. So I decided to bring together a group of highly talented therapists that I trusted completely to work in my business, thus allowing them to do what they do best. This allowed me to devote my time to working on the business, which is where my strengths truly lie. I still see clients, but I limit this to a small percentage of my time so that the overall practice can be successful. I knew that if I started with a different model it would be much more difficult to make the transition from working in my business to working on my business and the latter is really what my original goal for starting my practice was in the first place. The aim was to scale a practice to allow for others to be in a role where they were able to more fully live out their strengths as a therapist without being distracted by business considerations that they lacked knowledge and passion for.
I believe my upbringing and the challenges that I faced in both childhood and adulthood built up resilience and prepared me to venture out as an entrepreneur. I knew the risks and the possibility of failure was obviously there, but life had given me plenty of experience with “failure” and those setbacks taught me not to be afraid of them. Instead, I felt ready to sprint forward into the challenge and accept that if the worst should happen, it would simply mean a chance to start over and try again. As far as identifiable hurdles go, two in particular stick out in my mind. The first is that I was not entirely prepared for the extensive legal requirements that came along with opening a practice. In school, we learn and develop clinical knowledge and as a result, I felt competent as a clinician. However, graduate programs neither prepare you for business nor for regulatory requirements. I quickly learned that there was far more to these issues than I had previously recognized and I was not willing to put my license, my team, my clients, or my practice at risk because of non-compliance due to neglect or ignorance. This meant I really had to refocus my efforts and I decided to commit a large portion of my time and professional life to learning about the Health Insurance Portability and Accountability Act (HIPAA), which became a passion of mine in the process. I even recently became certified as a Certified HIPAA Compliance Officer (CHCO) and started my own compliance consulting business. Throughout this part of the process, I was shocked to discover the frighteningly high percentage of neglect by therapists in the area of compliance. What’s highly relevant here, is that over the past five years the Office of Civil Rights (OCR) — the entity within the Department of Health and Human Services that enforces HIPAA — is investigating and fining organizations more than it ever has before, which means that healthcare professionals really need to figure out the ins and outs of this law and pay more attention to compliance or risk losing their practice or even their license.
The second big hurdle for me was accepting the truth that, in spite of my slightly naive expectation that those I brought into my team would possess the same gumption, dedication, and willingness to scale the business and take the same risks as I, this was not the case, as it is simply not their role. As the owner, I am the one responsible for leading this team and running this practice and I can’t expect my workforce make the time to learn every bit of the laws and procedures that a business owner in this field should learn. This plays a crucial role, too, in delegating tasks and expectations around the clinic. I have learned that I am far more excited about the hard work required to grow and scale the practice than anyone else and that is okay. My therapists’ number one priority is and always needs to be providing exceptional client care. My number one priority needs to be retaining top talent by operating a desirable, compliant, and successful clinic.
Witnessing other professionals burn out and leave the field because they were unable to pay their bills or because they needed to maintain an unrealistically high caseload may be the biggest influence in helping me overcome the struggles associated with monetization. I try to remind myself that my team and I will not be able to help anyone if we cannot pay the bills or if we try to function beyond our capacity. It also helps to remember that I have spent a lot of time and money to obtain a Masters degree, a level of education that only about 9–10% of the U.S. population can say they have achieved. I am now pursuing my Ph.D., a level of educational achievement that only about 2–3% have completed. This level of education requires a significant investment of time and money that I have sacrificed for and that I will still be paying for many years to come. In addition, the mental health field and other healthcare professions require continual study and investment to ensure one stays current with the evolution of the field. Fees for licensure, continuing education via classes and conferences, malpractice insurance, professional development, HIPAA-compliant processes and procedures, and other professional fees can be exorbitant. The way I have (mostly) overcame the hurdle of monetization is by reminding myself of all of these things and practicing what I preach in therapy — that sometimes it is necessary to put healthy boundaries in place. Not everyone will understand or respect those boundaries and that is okay. For those that do and for the clients that I work with, in return for paying a reasonable fee, they will receive my full dedication and exceptional care. Being responsible for a staff of people needs to be just as high a priority for me as anything else, as well. It’s not just me that thrives or fails with the business. If I want to retain top talent, I have to be able to compensate them so that they can make a living and be accessible to help those in need.
I usually switch to another project. There are always various things that demand attention, so sometimes I simply shift my attention elsewhere. By getting out of the task that is causing that overwhelming feeling, I can refocus and still be productive. However, if I truly need a break, I try to be intentional and self-aware of this and will usually take a break to spend extra time with my husband and dogs or, to be honest, watch Netflix (yes, I am a Stranger Things fan.) I also enjoy listening to music, coffee, refinishing furniture, coffee (yes, I said it twice), sitting in front of the fire in the winter months, or laying in the hammock in the summer. These activities are all really rejuvenating to me. Often times, taking a break or shifting to a different task can even afford me a fresh perspective on the task that overwhelmed me; sometimes all it takes to get over that hump is a few moments away so you can return to it with fresh eyes.
To be honest, Yitzi, I haven’t had much mentorship in my life and I may be a bit of an anomaly here. My father had really been the only safe and supportive adult in my life for many years, but he was also sick for much of that time and there was a sort of reversal of our caregiving roles. My older siblings have all been inspirations to me, though, due to our collective family-of-origin circumstances and cumulative disadvantage. They too have all needed to work incredibly hard to support themselves and their families and this, by default, means that there is less time to spend together and less constant support. For many years, I was largely on my own. This is why I am so fiercely independent (and stubborn). Over the past seven years, though, I have truly learned the importance of fellowship and community and have been blessed by some amazing peer support and friendships. My husband, Sean, has been the most notable source of encouragement and strongest relationship in my life. Quite honestly, I feel that my resilience may have given way and that Sycamore and my other accomplishments would not have come to be if it were not for him and his constant support and faith in me. So while I wouldn’t categorize anyone in my life as a mentor, I would say that I have had key people who came alongside me in the journey and who have loved me well. The lesson that I have learned here, however, is that it truly does make a world of difference to have an older adult that mentors you, speaks into your life, and supports you, because life is a whole lot more difficult without this. For many years, I’ve wished for that in my life, while also wondering, because I am so accustomed to being without it, if I would even know how to accept it, let alone have the wisdom to do so. For those who can relate to not having a mentor, I think it is important to remember that quality peer-support and being okay with leaning on friends and family now and then can be a powerful substitute.
Podcasts were an incredibly beneficial source of information for me and early in the business planning process, I utilized every second I could to absorb episodes. Brushing my teeth, driving my car, cooking dinner, getting dressed, waiting in line somewhere (don’t worry I was respectful and used headphones); I would listen to podcasts literally every second I was not doing something else that required audio or verbal communication. I’m also kind of a nerd, so instead of reading fiction for fun, I would instead research and study anything I felt I may need to know. Thankfully, I had a diverse background of work experience and knowledge from which to start. I believe that every entrepreneur has an available amount of time and money; some of us have more of the first, others have more of the second. I just happened to have more of the first, so I used that time well and was frugal and discerning about where to spend the latter. This worked well for me. For others, the opposite may end up being true. I think a challenge of being a business owner is constantly revisiting this dual-resource question and ensuring that the choices being made align with the quantity you have.
The worst advice I received was to use Google Voice. I heard this advice from multiple sources and it really is terrible advice in my field. Google Voice may be a great service in general, but it is most certainly not a great resource for healthcare professionals because it is not HIPAA-compliant. It is not just Google Voice, though; there are many tools, apps, and devices that come recommended by others and promise inexpensive efficiency, but in the end are not compliant. Many people do not truly understand what it means to be HIPAA-compliant and many peers give advice that, whether they realize it or not steers others towards unethical or even illegal processes. Initially, I heeded the advice to use Google Voice because I trusted that other professionals knew what they were talking about. However, when I realized it was not a compliant service, it cost me several hours and tons of energy to revamp our processes and transition to a better medium for communicating with clients. The greatest takeaway here is that a business owner is ultimately the only one responsible for operating in legal and compliant ways and, ultimately, the success of their practice. It is great to get advice from others, but my caution is to not simply adopt policies and procedures on the recommendations or practices of others. Joining the company of hundreds or even thousands of others that are doing it illegally is going to cost you and not knowing you were operating illegally is not a defense.
There are many books that I would recommend that are more specific to my particular worldview or professional interests, but one that I think is universally appealing and beneficial would be The Alchemist, by Paulo Coelho. It’s an easy and enjoyable read that would speak to everyone from the casual reader looking for a good story, to the deep-thinker seeking to unpack the ample existential messages about life, belief, discovery, and purpose. It’s one of those rare gems that you can read multiple times and yet somehow seems to meet you in any season of life, with powerful, impactful relevance.
For other incredible interviews, please check out our podcast: Healthcare Heroes.
A special thanks to Jamie again! The purpose of this interview series is to highlight the entrepreneurs, innovators, advocates, and providers inside Healthcare. Our hope is to inspire future healthcare providers on the incredible careers that are possible!