Episode 236: From Imposter Syndrome to Feeling Like a Badass with Michael Johnston, MCD, CCC-SLP

Hi and welcome to episode 236 of the Untethered Podcast. Today we have Michael Johnston joining us. Michael's a Louisiana State Licensed Speech Language Pathologist with her Certificate of Clinical Competence through Asha. Michael graduated from the University of Louisiana at Monroe with a Bachelor's of Science and Communication Disorders and earned her Master's Degree in Speech Pathology from Louisiana Health Sciences center in Shreveport. During her professional career, she's worked with a wide variety of populations and disorders. She's gained experience working in private practice, elementary schools, early intervention in homes and daycares, and the pediatric day health care centers for medically fragile children. She's had the opportunity to evaluate and treat children with receptive and expressive language disorders, articulation and phonological disorders, autism, developmental delays, feeding, oral motor and swallowing disorders, down syndrome, childhood apraxia of speech, and other genetic and medically complex disorders. Michael's earned a Certified Autism Specialist certification through the International Board of Credentialing and Continuing Education standards, completed the PEDs foundations of pediatric Feeding and Swallowing Course, AEIOU Feeding Approach Program and SOS Approach to Feeding. Michael's currently leading leading further education in pediatric feeding and swallowing disorders, early intervention and myofunctional Therapy. She recently received Asha's ACE Award for demonstrating her commitment to lifelong learning. Michael's passionate about working closely with families to provide child centered individualized therapy and collaborating with other professionals to best meet the needs of each individual child. As a long life, DeSoto Parish resident, Michael opened a private practice to give back to the community she has called home for so long. In her spare time, Michael loved spending time with her family and friends and traveling.

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I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional Therapy, airway.

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Tongue up, lips closed, teeth apart. Breathe through your nose. Let's get started. Michael, welcome to the podcast.

Thank you so much for having me.

I am super excited to talk business today. It is, like, my love language. And so I want to just, you know, jump right into this conversation because I know, you know, you're a private practice owner, and I want to know, like, at what point, like, where was the pivotal point for you that you kind of were like, I want to own a private practice.

So I feel like I always just had an idea. This is what I wanted to do. I've always been very, I guess, independent and driven and kind of wanted to pave my own way. My mom says since I was literally, you know, an infant outside, thinking outside of the box, doing what I, Michael, wanted to do. And I remember when I graduated from college at Ulm, I left and was like, I'm going to go back home at some point and open up a private practice. So it was always an idea that I had. I guess it was always my dream. And then, of course, after graduation, I jumped right into private practice and started working for two years. So I completed my CF there and then worked for another year, and then I went to the school system, and then I did early steps. So that's Louisiana's early intervention program for home and in daycares, and also worked at pdhc. So every setting that I went into, it was kind of like, okay, I really like how they're doing this, but I don't really love how we're doing this. So I kind of learned how I wanted to not only be valued as a therapist, but also, like, I wanted more mentorship from my. My co workers, from the staff, and I knew how I wanted families to be supported. So that's kind of where the shift really took place. It was always a dream that I had. But after I started to see and get experience across all these different settings, it was kind of like, okay, I really like this, but I really am not too sure about this, so why don't I just create what I want to see happen, essentially?

I love that. I mean, I love that. And it's. I feel like you're telling my story, too. It was very similar. You know, I. I always knew I wanted to have a business. I didn't start, like, as a speech pathologist. I actually started in business, but I, like, didn't do well the first semester. I think I got, like, a C on some of my first tests, and I was like, what is this? I don't need this information. I'm gonna have my own business one day and like, I don't, I don't need this. And I had worked in like another business growing up and ran like events for an event planner and like that was like my weekends. And even through like college and grad school I went back and like worked too. And it taught me so much. And then like you like, I actually signed an agreement to go work in the schools in exchange for them paying for like most of my graduate school program. And so it was a three year contract. I was totally miserable. But my first two years were like in their preschool program. My third year was in early intervention and mcitp, which was their ei. And I loved that because it got me back to working one on one in families homes. And I think if I'd started there, I don't know what my path would have looked like because I really enjoyed that and I really loved the team approach and the team meetings and it was very collaborative. Now it was more of a coaching model and I really wanted more of like a medical model. More like. Yeah. And direct therapy model. So I think I probably eventually would have left anyways. But it kind of brought me back to my roots, which is funny because I'm like two years in and I feel like I have to be brought back to my roots. And I'm so like jaded from working like a school system for two years.

Like that's horrible.

But I, I like quit being an SLP for eight months actually. And at that point I was like, I was doing network marketing and I had replaced my income in the school. So that's how I quit and left. And I kind of was like, I don't even know if I want to do this anymore. And then I really started to miss the kids. So I went to work for private practice for a year. We almost went into business together. We decided not to parted ways. I went out on my own and that was like 2014. I'm like now here we are. Yeah, I'm like nine and a half years later. So yeah, it's, it's so incredible to see like how like things shape shift. But for the same reason that you explained, I was kind of like, okay, I want to be able to deliver a certain level of service and truly help my patients. And I feel like a lot of these other places where I've worked, there's so many restrictions, there's so many things that I would do differently. Like whether it was coaching model and I wanted to do direct therapy or More of a medical model. Whether it was another private practice and you know, I had some freedoms, but, you know, clerically, administratively, I was like, there was other things I'd be doing. Customer service wise, there's other things I'd be doing. You know, it's. Yeah. So it was pretty eye opening, but good experiences nonetheless. I mean, because it really does help you figure out, like you said, like what you want to stand for and who you want to be in private practice.

So you always have to go through what you don't like to really figure out what you do like. Yeah, I agree too. It's so funny because looking back, I think if I would have started in just early intervention, I don't know if this is where I would be. I loved early intervention. Now that was pre Covid too. I got in right when Covid hit and then they were doing lots of teletherapy, so that definitely shifted. And I was also pregnant at the time. So there were so many moving pieces which also helped me to kind of shift away from that. So I think it just kind of all fell into how it was supposed to be, for sure.

Well, and you're also in a rural community, so are there other private practices that do what you do nearby or was it like a huge need or.

Like definitely a huge need. So in our parish there has never been pediatric therapy. So I graduated from one of the schools in our district or parish in Louisiana were parishes in 2012. And at that point there was no pediatric therapy.

Wow.

Which isn't that crazy. It just blows your minds. It is so sad. Which I'll talk about in a little bit. It's also. That was part of what was so hard for me in the beginning. Like her parents going to buy into this. They've gone so long without it. Or did they just think they're okay to not have it essentially. But when we did open, so we announced our grand opening in last October. So I think in three weeks we're coming up on our one year anniversary.

Yay. Congratulations.

Crazy. Time flies. But another local clinic, like right across the street also opened their clinic like two weeks after us. Yeah. Isn't that fun?

Well, you know, went from nothing to double, double the fun, literally.

And I was cannot begin to describe how stressful that was for me. We did not know that that was happening. We have a really well established adult clinic. And so there was a PT who was kind of going through the adult end to launch pediatrics. She didn't know that I was launching. I didn't know that she was launching. So it kind of happened at the same time, but it has not been a damper on our business, which is really good because we have really just worked my tail off to make sure that we were successful in the long run. But that was honestly my biggest fear with being in the rural community is parents not understanding what we have. And, you know, some parents start to believe, well, like, oh, there's something wrong with everybody, or everyone needs therapy, or you're just trying to make money. And that's absolutely not what we were trying to do. You know, we're trying to bring therapy to this community and these families and these kids because it is going to help them. It's going to change, essentially, their lives, their futures. When I look around some days, it literally makes me tear up to think, like, when these kiddos now start preschool or kindergarten or first grade, if we had just a small part or a small role when they were little, like, we are going to change the trajectory of this community. Yeah, it's just crazy.

Did you have any pushback from parents with those, like, kind of peers that you had and bringing this to a rural community?

It took a little while. I mean, we definitely were full, thank goodness. We're trying to find some new therapists right now, actually, to continue to grow. But I do think, like, there was not an immediate. Like, we were not full within a couple of months. There was no wait list because we do live close to about 30 minutes from some of the bigger clinics in the area. And so they were already well established. You know, pediatricians love to kind of have their referral sources. And so they kind of all knew where they were going to send those kids. The families were comfortable. They didn't know who we were or what we were about, which, as a mother, I definitely understand. You get comfortable, your child's making progress, and you don't think that uplifting them and moving them to a new place is in the best interest of the child, which I definitely get. But it also helps that I was from this area. I mean, half the people who walk in my waiting room know me from somehow. Oh, I remember when you were three or four, toddling around, you know, which is also fun when you've grown up with half of the people in the area. But that has definitely helped. I think parents and families respect us more because they know that it's coming from a good place, like, we're doing this for a good reason.

I love that. I love that. And so does your clinic specialize in anything in particular that does also, like, help you set yourself apart from some of the clinics.

So first, we are multidisciplinary, so we have pt, ot, speech and feeding. And that was the most important thing to me. Number one, I went in and was like, I'm not opening with just speech. Not saying that that's not a good option or that it can't be done. But for me, I wanted to focus on treating the whole child, whole body, supporting these families. And, you know, how many kiddos come in and it's really just one. One thing. It's just articulation, or it's just a late talker. Most of our kiddos do have other needs that need to be met, and I want to be able to collaborate with those other therapists. I can't tell you how many times someone will come in and we'll be like, oh, hey, like, can you pop in and just do a screening? Like, let's run out and talk to the mom if they're okay with taking a look at this. And then we'll talk to you some more and see if we need another evaluation. So I think that in itself really makes us kind of stand out. And we are smaller. You know, we're not a mega clinic, so we're very close. We're very comfortable with just saying, hey, can you pop in really fast and take a look? Like, I'm doing a feeding evaluation, but I think we need to take a look at sensory regulation throughout the whole body. Can you kind of see what's going on? Or, hey, I'm working on feeding, but positioning can, like, pt. Can you pop in and take a look at me for me and take a look at those gross motor skills. So that has really kind of helped to set us apart. And then we're also one of the clinics in the area that does feeding therapy. Thank you, Hallie. Kind of fangirling. You literally started my journey. I tell Taylor that all the time. I will never forget signing up for feed the peds and feeling like I was just, oh, my gosh. You said at the beginning of the course to write, hey, like, my name is Michael and I'm a pediatric feeding therapist. And I was like, no, I literally. And I went back and looked. I was like, I don't think I wrote it. I'm such a type A, like, perfectionist. Like, I'm not a pediatric feeding therapist right now, so I'm not writing this. I just. It's just so crazy how it comes full circle. But that really started my journey. I was actually doing early Steps for a family. She medically fragile, complex little girl. I still see her. Her mom family's amazing. She called and was like, can you see her for feeding? She was on a feeding tube. I mean, we were on TPN 24 7. Very much out of my wheelhouse. And I literally was like, no, I cannot. And she was like, well, being in this community, this area, there's not. There was no one else, essentially. And I was like, I know, but I just don't feel like I'm the best for the job. And she was like, I think that you are like, you can do this. I went home, bought your class, and spent the next 12 weeks learning how to care for her. So she has a big role in just my feeding journey too, as well as just taking that class. Literally changed my life. And from those 12 weeks, it was just like, everything after that, I want to learn more and more and more and more. How many seeds can I get? How much continuing education for feeding? I need to know everything, which I know you never will. Like, if a parent has a question, I need to know at least the answer or how to find it. So that also.

Yes. Oh, yeah. I mean, I always say once you start, it's like you fall down that rabbit hole of all things eating and tots and airway and mayo and.

Yeah.

You know, and it's. But I love that because it also sounds like your overall vision for the practice was to be this, like, comprehensive, collaborative place where you truly could kind of do that whole body approach for the patient. And also, like, you know, how you're working towards optimal, you know, health, optimal function, you know, you have function in your name. Like, I just, I love everything about that. And so I think that also, you know, kind of brings a full circle in a way. And so I love that the course was kind of like a jumping off.

Point for, you know, I'm like, right now to see you because it's just so crazy. Like, I always think back to how I started here, and it was like this feed the peds course, signing up, you know, to take on this early steps, baby, when I really didn't know what I was doing. And then just diving in. I signed up for my own method. Like, I am just ready to do all the things.

I love it well. And I think it's, you know, it speaks volumes of you too, because you were able to say to that parent, like, no, I don't think I'm the best person. Like, I'm not ready to take on your child. And the Parent was kind of like, but hey, there is nobody else. So like, it's almost like, hey, if you're interested, like, you know, did they wait for you? Did you get started with them right away? Like, what did that look like in terms of.

Essentially was like, there is no one else to work on feeding. And she was at a point medically where they were really recommending her to get in feeding therapy. Her OT was working with her a little bit, but she didn't really feel comfortable because she did have dysphagia. You know, we're supposed to be the experts in that, but they don't teach you that in school. And so we got a swallow study. That was the first time she had ever had food by mouth was her swallow study.

Wow.

Yeah, it was just so sad. But she's come full circle and she is rocking it and all with your.

Help because you said yes to yourself and then yes to the patient, which.

You know, started immediately. I got in and every single week that I went, I came, I just had a, like a notebook and I would write my questions down and we would work together and we would go back and forth and say, like, how can we do this to the best. I would reach out to therapists that I knew. I would dig in your courses. I would go through the feeding groups online and just say like, can anybody provide me some support? I knew she was safe to eat, but we had such a long row road ahead of us that it was slow and steady, but she's rocking it. I guess it's been about a year and a half and we're taking oral feeds, we're drinking some water, we're drink eating three different textures. She's decreased TPN, I think to 16 hours a day over 24. So she's doing amazing.

Yeah, well, I mean, and you really jumped in full throttle with a medically complex kiddo. You didn't just go, I'm going to pick a computer to start with. I'm going to go full in. I know.

And looking back I'm like, how did I do that?

But sometimes, yeah, they tug on your heartstrings a little and you're like, I just, I can't say, I can't say no three times. I mean, I said no twice and you didn't listen to me.

So I guess like, you can do this. And then I ended up at a PDHC working primarily with medically complex littles, all the way from like a 2 week old infant to 6 year olds with feeding issues. And I was Terrified. But I jumped in, took more coursework. Anytime I have a question, I add a course to my cart and just try to learn as much as I can.

That's amazing. That's amazing. I love it. So. So with all of that you had mentioned, like, you. One of the reasons, too, that you also wanted your own practice was kind of like mentorship and kind of also teaching other therapists was something that you wanted to kind of shift how. How that was working. So have you been able to step into that within your own practice yet?

Absolutely. So I have two occupational therapists who are absolutely amazing. They especially. They've been with me since day one when we first started, and we were just staring at each other like, where are the kids coming? Are we going to be poor forever? Like, just patiently waiting? And they had not done a whole lot of feeding therapy. So we jumped in together. I help oversee evaluations. If they're having trouble in a session. I'm going to the cabinet and pulling out, like, let's try this cookie cutter. Let's try. Here's a food play recipe that you could try. And just trying to encourage them, too. I felt like as a therapist, especially in those younger days, it's like you're afraid to ask questions, but it was more so because the people around you weren't making you feel like you could ask questions.

Yeah.

So always telling them, like, hey, like, it's okay. Any single question that you have is okay. Like, the only way that we can be better is to ask. We can't grow if we're just kind of stuck in this rut of, oh, well, I should know this by now. She already answered that. Well, it's okay. Okay. Because the only way that we're going to be the best therapist that we can be is to continue to ask and to continue to learn. I observe lots of their sessions, so a lot of times, even if I'm just doing some business stuff, I'll sit in the room with them and kind of watch their feeding therapy session. So that way, if they have a question, if they need help, I'm right there. Especially with the little ones, transitioning to solids is my absolute favorite thing to work on. So I'll grab a food diary to send home to the mom, and we'll kind of look at it together, kind of going through patterns with the therapist, working on expansion of diet, what kind of cups, spoons, all that good stuff. Just kind of giving them examples and always supporting them in growing. And then I also have a CF for the first time. Which is exciting. And she is literally been amazing. She has just jumped right in and is such a hard worker and eager to learn. And from day one, like, it's okay to ask questions, please come to me. I don't really feel like I got a whole lot of that either. I learned a lot from my co workers with speech when I was a cf, but not so much my supervisor, which is pretty normal, I hear, but I just want to change that.

But it shouldn't be that way. I mean, let's just be honest, right? You're a clinical fellow. You're on your. You don't even have a full license yet. So, like, checking the boxes to meet, like, Ash's requirements on the CF is not enough. And, like, I've been a CF supervisor once for somebody who was in my practice, and so I saw what it meant to just, like, do the bare minimum. Like, I understood what that meant from an Asha standpoint. And then, then I kind of went like, oh, okay. That's why my experience was like that. I actually had two supervisors when I worked in the schools, and neither of them, I mean, they came and watched therapy and maybe gave me, like, a teeny bit of feedback, but that was like three times during the entire school year that they each came and observed therapy to meet their total hours required. Otherwise, they weren't even located in the school where I worked. They're like, you know, and they would say things like, oh, we're just a. We're just a phone call away. We're just an email away. And I'm thinking, like, but you have your own caseloads and you have, like, your own. I don't.

We have no relationship built. There's no trust, there's no.

And there's just so much else to do in a job. But, like, you're not going to go out of your way to, like, demand more mentorship if it's not being offered to you as a new clinician. Most people are not like that. Even people who are very strong personalities and who have no problem advocating for themselves. Like, you don't even really know that that's something you could or maybe should be doing. And I also don't think that should fall on the new clinician. I think that should just be part of the program. So to have gone through that and then to have been a CF supervisor once myself, I also, like, I completely agree with you. I'm like, there, there is nothing here that's actually supportive. We're just checking boxes and saying, yes, this person can Assess. Yes, this person can do some therapy. Yes, this person, you know, passes and you know, they've completed their hours over the past however many months or year plus. Right.

It's, it's.

Yeah. So just drives me crazy because I'm like, you get letters after your name, but.

And my license is signed on your evaluation report, so.

We'Re going to make.

Sure this is done correctly.

Oh, yeah. Oh, yeah. But that's where I think it's incredible that we have. It feels like I have these conversations a lot and it could be just because that's like who I've attracted to my programs or who has gone through my programs and then kind of had these like eye opening experiences where they're like, we need to be offering more mentorship. We need to not be gatekeeping. We need to make sure that our therapists feel supported so the patients feel supported. And yeah, that does require us to like, step up to the plate and mentor. And. And the thing that drives me crazy is like, there are private practices that will like hire people and say, oh, yeah, I'm going to mentor you. And oh, your case was going to have this, this and that. And then you, you get in there and the ages of the patients you are working with are completely different than what we were promised and the diagnoses are completely different and there's no mentorship. And you're like major to feel stupid if you even ask a question. But that's not what you were sold. And like, here you are now stuck at this job that is clearly not what you signed up for. And I'm not saying that's everywhere. And hopefully that's more, you know, fewer.

No, but it does exist. I have so many friends that are like, oh my gosh, I got this treatment plan and this feeding goal said, xyz, what does this mean? And I'm like, did you, like, did you ask a therapist? They're like, yeah, well, they don't know. And I'm like, well, they wrote it, so we probably should know what that means.

They probably shouldn't be writing that goal if they don't know what it means.

Exactly. And also, I don't know what it means and I'm a feeding therapist, so maybe we should not be doing that.

Right? Yeah. Yeah. That's scary and sad.

So scary.

Oh, man.

Yes.

Yeah. So then beyond that, you know, in terms, because you also mentioned that it obviously took a lot of effort busting your butt to like, get out there, make a name for yourself. And, you know, it sounds like you have community support at this point in time. And you did probably had to do a lot of outreach. Did that take quite a bit of time to kind of like, build those relationships with referral families?

The good thing is I did early steps in this area for about two years. I worked in the school system. So most of the teachers, I've been in and out of some of the daycares, they all know me, they trust me. You know, trust is the most important part of a relationship, and being able to just really gain those relationships before opening this really set the tone. We've had to do a lot of community outreach with pediatrician offices, some other daycare offices, other service providers. Apparently we have a counselor in our town that I did not know about that does pediatrics. So we've been able to really connect and just trying to make sure that our kids are getting literally everything that they need by reaching out to those other service providers. But we also do lots and lots of outreach through the schools. We hand out muffins at the football games. We are in the parade. We are going to trunk or treats. We are doing literally everything that we can. Not just to tell people about us, but we really just want to be a support for these families. You know, I can't tell you how many times people text me or call me or message me. They're not in the clinic. But we just want to help and we want to be a part. So the community outreach and support, especially if anyone is listening that kind of wants to get into private practice, really prioritize, like showing parents that you care about their kids. You know, go to the schools that they're at and hand out some popsicles, like, just be a part. We love to be able to watch these kids grow. We did a back to school event and got to watch all the little ones come in as they were getting ready to go back to school and just being able to kind of meet the needs of where they need to be developmentally as well.

Yeah, no, I love that you're kind of like, humanizing the business. You're like, you know, showing it. Normalizing in a sense, too, because some people see therapy or therapists and they associate that, like you said kind of earlier, like, oh, there's something wrong with my child, or, oh, you think everyone needs therapy, or oh, this, or, oh, that. But I think, like, what you're doing is amazing. You know, I know that we've done, like, certain types of outreach, but not to the extent that you're doing. We're not out handing out, you know, and I also don't live in like a tiny little rural area. I also in this massive city where there's a speech pathology practice every five minutes as you drive, like there is an elementary school behind it. You know, it's like I came from an area that was very highly populated. But that said, you know, I did have my relationships with a number of like private preschools and private schools and things that I was going into also before I opened my practice. And you know, I think because of the things that we did there that we went above and beyond for, I think, you know, and because like you said that trust that you've been built, you've been in there for some time, they know you, they see what you do. You know, one of the things that I've always like coached, you know, different private practice owners on is like when you do go into any type of a school or setting where there's other professionals, because teachers are professionals. Putting yourself on a pedestal and acting like your way is the only way or your way is the best way is the most sure fire way to get yourself booted out of that place.

And you're never going to trust you again.

And I'm like, the teachers are our friends. There are colleagues who, they're an important part of the team, as are the administrators there. And you know, my goal was always, how can I go in and support this child? But also how can I support the teacher? Because if I can support the teacher to support this child, then we know things are actually going to get done. And so I always said to the teacher as I was like, I'm here for you just as much as I'm here for the child.

Absolutely.

That kind of outreach too, in a sense is not something they're used to. They're not used to therapists showing up and being like, hey, how can I help you help this child?

Right.

They're used to people coming in and.

What do you need for me?

Right? They're like, you pick the kid up, you drop the kid off, you plug in, you do your thing, you leave, you drop a note in the backpack. You know, they're not. And look, that could be a personality thing. But I also was like, I don't want anybody to think that I think I'm superior because I'm not.

Absolutely.

I'm, you know, like I might.

Together we're all trying to figure it out.

Yeah. And so I just feel like it's kind of like another extending an olive branch in a sense, you know, in a way that. So I love how you brought that up because I think that gaining that trust and building those relationships in schools is one of the best ways to start a private practice. Because it can be tricky to get in with those pediatricians.

Like, they like to refer. Who they like to refer to.

We're working on it. And truly, you're not in their offices, but you're in the schools. Right. And where the schools are referring to you. You know, if you're not going into the schools, like, my practice, like, you know, it just. The relationship honestly, is different. And it's more ongoing.

Absolutely.

Teacher. Than it is with a pediatrician oftentimes. So I love that. I love that. You should.

We do go into a few daycares in our area, and it's been so nice for them to just, like, stop one of us in the hall and be like, hey, we have a question about this. Like, can you help us? Even if we don't even screen the child, we can still provide them with those recommendations and just show them. Like, we are truly just trying to help you if you're having trouble within the classroom setting, a daycare setting. Like, we're just here to help. Why don't you try this? Or, hey, we're working on potty training. Can ot. Yes, we can give you a handout even if we don't see anyone in here. Like, we're just trying to support and form those relationships.

For sure.

Yeah. No, I love that. That was the same thing, too. I get stopped in the hall or I get a little text or email, like, hey, I don't know if I should refer this kiddo for a screening, but xyz. And I'm like, well, try this first. And then if that doesn't work out, I'm like. And I always kind of open the door too, where I'd say, listen, if you talk to the parent and they have concerns and you're still not sure or they're not really on board with the screening, feel free to connect them with me because if I can maybe educate the parent or talk to the parent, we can decide if we do need to take that next step together. And, you know, not to cut out, like the referral person, but sometimes, you know, that's a conversation that I think we can definitely help with. And, you know, I just. I think there's. There is the one side of the not giving away everything for free and charging what you're worth, and there's also the other side of being a support person in your community and just Being a good human and supporting where support is due. And not everything always needs to have a price point attached to it because it's a two minute kind of like conversation or quote, unquote, consult, if you will, but consultation, right? Exactly. Exactly. I mean, as long as it doesn't turn into like an hour long consultation and you're not now doing, like, free. Where's that line in the sand? How do you draw that line?

Right.

Yeah, yeah, but I think. Yeah, that's. That's amazing. So now going further into the business side of things, Right? So you start this private practice at some point, several months in, you're getting, you know, you've got some patience and everything. At what point did you guys fill up?

That's a great question. So I feel like it's a literal roller coaster of up, down, up, down, up, down, every other day. Right when we first opened, I think I got Covid flu, strep, stomach virus, four sinus infections from stress.

Oh, my gosh.

And I literally remember, like, laying on the couch praying, like, why did I do this?

Well, now that you've gotten everything out of your system and your immune system is, like, ready to tackle the rest.

I lost my mind. Like, why? We were still waiting on insurance contracts. We're in an area where private pay is just not an option. So we do take most insurances. Credentialing was a nightmare post Covid. So we had this lag period, even after opening that we were waiting for insurance to approve. And I remember literally just sitting, like, what have I done? Like, I was working in the school system doing early intervention. I was making great money. I loved what I did. I love my job. I love the families. And I literally thought that I had lost my mind. I guess it was the spring, honestly, probably around May, which is, you know, then summer hits and everyone's canceling for vacations. But this spring, I kind of looked around. We had hired another new therapist. We were starting to fill the rooms. I was walking in the waiting room and seeing parents there who didn't know me, which was the first time that it was kind of like, okay, we're growing. Because when we first opened, I was a person literally introducing to every single parent. I was seeing most of the speech kids. I was handing out all the intake packets. And then when I started to see parents and kiddos who may have not known, like, hey, she is the owner. She opened this clinic. I kind of was like, okay, we're doing this.

Like, it's happening. It's really happening.

And Just started to see, like, the release of pressure from my team. They were literally amazing. They put their kids in daycare, jumped in with me too in October, and we waited. And their kid, they're paying for child care. They weren't having kids. They were contracts, so they weren't getting paid. And us, we all started to feel this just rush of relief that we were making a difference. We were getting. Our caseloads were building. Our parents started to reach out and say, hey, we had so and so tell us that so and so is in therapy and how great they're doing. And that really started to build us up to more to the word of mouth. Started to travel. I think that was also the first time we had some kiddos start to travel to us. So up until that point, we were seeing most of the kids just in our town. But then we had some referrals start to come from Shreveport and they were like, yeah, our pediatrician said y' all were like so good and like we needed to come see y', all, like for feeding. And just started to kind of hear that word was traveling. I know I probably cried. I cry all the time. But I was like, yes, we're doing this so healthy.

As long as Ashley's not telling us to do it in our cars, we're good, right? Oh, my gosh. So, okay, so like six to eight months or so till you kind of were like getting full and got full. And then summer hits, which, you know, they start to learn about all those seasons in private practice. But in terms of all you were doing, because you said you were the person handing out the intake packets and like doing all the things. Are you still doing that? Are you wearing all the hats?

I'm wearing all the hats.

Okay.

Social media, marketing, outreach, intake, scheduling, payroll. I bill parents. Our biller does insurance, billing. She is a literal godsend. I don't know what we would do without Miranda. She is amazing. She actually reached out to me in the beginning and she'll answer questions that I have. She did our credentialing, but other than that, I'm doing everything. I also carry a part time schedule, So I have eight to ten sessions a day. And I also supervise a CF and then I supervise feeding with my OTs.

Oh my goodness. This is like at least a job and a half, maybe two.

And I'm also a mother of a toddler and the wife of a fireman who is gone three nights a week.

Well, there you have it. So.

We'Re carrying all, balancing it all really well, right?

Fire.

And we're just trying to figure it out. Friendship. What are those these days? It's like trying to put 100% into something always means that something's not going to get everything. It has gotten better. And I am in the process of hiring an administrative assistant.

Well, that's exciting. Exciting, exciting. But, you know, that's. I was, I was a type A personality too. Because you shared that earlier on, especially around calling yourself a feeding therapist. In the beginning. Yes. Okay, okay, no worries. You know, I apologize for that. No, but we. Or I was, I was definitely that type A. And then opening a practice, getting pregnant with my first child, like months after I opened my practice and yeah, I guess having the baby actually come, like, while then trying to, you know, still manage the practice.

All the things.

Yeah, I was just like, yeah, you know what? Like, I can't, I can't be a perfectionist anymore because, like, I just gotta.

Let some of it go.

I'm like, I can't be perfect at everything. And I definitely started to shift me into more of like that type B, which I. If you had asked me before, like 10 years ago, are you nuts? Like, I'm always. And listen, there are certain things that I like done a certain way, and I might redo them if it's not done a certain way. Because I look at, you know, how does this look outside of here, outside of me, or outside of this situation? You know, it's. I want to hold the business to a certain standard and it has to match my identity. It has to match the business identity and our values. Right. And so, you know, there are certain things where I might be a little bit more like, picky, likes your name.

Everything at the end of the day has your name on it. And that's what I keep telling myself. I don't think I'm ever going to be able to fully give up, like, the social media and the marketing and the outreach, because that has my name on it. I want to make sure the things that are going out there, you know, I'm, I fully support, you know, I've seen things that are posted and you can tell that it's done by a marketing specialist rather than a therapist. And I'm like, that's not even correct. Like, what tips for communication? Where did you get that? And so I want to make sure that it's done correctly. And anything that I post for OT or pt, like, I'll go to them and say, hey, can you read through this? I need you to help me come up with some you know, great ideas for parents for our social media, but I am ready to give up answer in the fallen.

That. That one was hard for me. That was tricky. I also felt like that was my like, voice, my face, my, like, they, they came to the practice because of that initial conversation with me. And I had a hard time in the beginning. And then I finally hired somebody who was amazing. Everybody, like, sung her praises and I was like, okay, it doesn't have to be me. This doesn't, you know, and we shouldn't be having clinical conversations on an intake phone call anyways.

45 minutes in, it's like, hi, my child is too. And I'm like, okay, well, let's go down this 30 page intake packet I'm the worst of. So that's valuing my time.

Yeah, but you know, but to your point, you know, even in my online business, because I don't really do social media marketing for my private practice. Like at this point with my online business and everything, it's. It says maybe the private practice name on my Facebook page, or at least it used to. I don't know if it still does, honestly, but I'm like, I don't even know. But the information going out is still relevant. Clinically it is. You know, I had a social media team. They were really great. In the beginning I was basically saying, like, but they were not therapists. And I was like, but here is my course. Like, you can pull content from it and they would create things and I had to go in and like approve them. And in the beginning it was great. And then at like year two and a half or so, I was like, this is slipping. Like, one person left the team and I just think there wasn't that same dynamic anymore. And I was like, this is so I was like, the stuff that they're finding is from other people's websites. It is the exact same opposite of what I would say. They've been with me for two and a half years. Like, what is happening? And so, I mean, I loved them, like, regardless. But I kind of cut ties. I brought somebody in house. The person who does it now is, has been doing it since March. And she's not a therapist, but she's really good at. She's been really good at like learning my voice. She's been really good at pulling content and obviously she can pull stuff from. So she's. She knows me at this point. She's creating stuff. I still go in and edit every single post. It doesn't matter if it's. I will Tell you, though, because I actually did this this morning. I edited like the next, I don't know, two and a half weeks of like social media posts. And I was able to do it in like 15 minutes because she's got so good at like, pulling content and creating these visuals that go with it and everything that, you know, occasionally I'm like, okay, tweak this a little bit or I wouldn't say it. That sounds a little funny. Say it like this. The content itself, for the most part is like, spot on. And I'm just like tweaking it a little bit so it sounds like it actually came from me. Because like you said, it's someone else to capture, to fully capture your voice.

No matter what, is that I will not always have to do.

So I'm like, yeah, for me to spend 15 minutes on two and a half weeks of social media content, we have posts go out like five days a week. I'm like, that is a dream. Like, I wasn't there before because it.

Could be like five hours.

Well, and I was paying this team absurd amount of money before and spending hours rewriting posts and things. And I was like, something is wrong with this picture. And I'm spending less because it's in house and spending less time too, because she's just, she's gotten so good. So I feel like that's just the evolution of like a business owner is like, over time and even just, you know, it's not always about resources and how much money you have to spend or not. I think it's partly like what you feel like needs the most attention right now. Right? That's where your energy goes and. And when you have the time to deal with another thing. And even if that means getting something off your plate, the attention goes there when. In due time, you know, so. But yeah, I used to wear all those hats.

My therapists were still like, please don't give up scheduling. We all have nightmares to where we were in places that they would just throw kids on your schedule. You would get up on Monday morning and it's like, oh, I have an eval too. And I didn't know that existed. So I have promised them that I'm going to go in a keyboard in the scheduling hat. We'll see how long that lasts.

But, well, and you know what I mean, the biggest thing you can do, right, is just kind of create a standard operating procedure that has like, when I schedule, here are the things I look at, like here. You know what I mean? You just kind of like, Even record yourself scheduling. So you can actually go and look and see what you're doing and then like put it into like a step by step process. And like, here's what is not okay and here what is okay. I think you could totally be like, this is what's allowed, this is what's not allowed when scheduling. You can't just put people because there, because there's a space and they need, you know, and that's, that's where I think like a lot of us don't. And this was me especially. I didn't have standard operating procedures. I didn't. I mean when I hired somebody to create them and I was like, how do I do this? Like, how do I put this in writing?

I just do it.

I don't know how to tell somebody else to do it. I can have them show me. I could probably like talk to them and walk them through that. But I think having like that tangible like thing to go back and visualize and go step by step by step, like doing that even on my online business has been life changing and I have tailored, I think for a lot of that these last six months. But I'll tell you, like this morning I was like, what, what do I, what do I need to do today? Oh, oh my gosh. I like don't actually have to do anything before my, my podcast, but I should probably review some social media posts for the next couple weeks. I should probably review the emails the copywriters created. I recently for the first time hired a copywriter who is a therapist. She's an slp and it was, you know, it's like to have, I was reading through and I'm like, ah, she gets, it's like wonderful, these emails.

This is the best. I know.

Yeah. But you know, it's all in. I've been in business for three years in the online world and I'm just now like doing some of these things right. You know, I always say, I'm like, it doesn't have to be perfect. Like in the beginning. Like you kind of figure it out as you go. It sounds like you guys are crushing it.

We are. We're about to hit the one year mark and I'm finally able to give up the reins on some things, which I'm very excited about. And I'm ready to get back into therapy. I mean, I see I have a half caseload right now, but I really want to get into doing some more feeding therapy. Ready to take my own method starting next week. Super excited about. I actually had A friend who works at a dentist come up to me last weekend, and I've been praying and trying to figure out, like, okay, what course is going to be next? And I've been, you know, watching, and she came up to me, and she was like, do you do mayo? And I was like, why? She's like, well, we're right down the street, and we really love to refer to you. You know, we'd rather keep it local. And I went home and bought it that night. I was like, done.

You're like, yes, done. But we're scheduling three weeks out, right.

I was like, call me in a month, because I'm gonna be ready.

I love you.

Do it.

I love it. Well. And I also love how, like, you're kind of, like, energetically. I feel like you kind of open the doors and you're like, okay, I do it. You know, what's happening. And then something just comes your way because you invited it in, and you're. And then you take action. Like, you're like, okay, I'm not gonna sit on this.

I'm just.

Just gonna go do it. And I mean, to me, that's the best, like, sign of a business owner. Like, that's the. One of the best things you can do to be successful is listening to kind of what comes your way. Because so many people will shut that down. They'll be like, oh, no, no, no, no. I don't do that. Like, I'm too busy right now. We got full caseload. Like, I'm good. I'm good. Like, you know, maybe later, you know? But you're like, nope. Diving in head first.

Cracks me up, because I just don't know how to say no. A parent could call me tomorrow and be like, I need help with this. And I was like, okay, call me in two weeks. I'll be there. Like, let me start learning now.

Yeah, yeah. But to some degree, right? It's because that's where your heart is. Right. And that's kind of what you want to be doing. And sometimes it's like that external push that kind of goes like, all right, let's do this. Like, I wanted to do it.

Everything is happening for a reason.

Yeah.

So I'll just take it as that.

Yeah. So is there anything that, like, you would have wished you knew, like, when you were getting started that you feel like you've learned during this process?

I wish I would have known how tired I was gonna be. Oh, my gosh.

I.

Especially when I was really in the trenches of those first few months, of kind of giving up. I wish I would have known the joy that it feels when parents are so thankful and so grateful for everything that we do. I could not imagine ever working, not in pediatrics. Some people tell me I'm crazy. A lot of my friends are like, I don't know how you work with kids all day and then you go home to your own. But just the joy for a mom to call and be like, hey, you know, so and so said their first word. So and so just took 4 ounces of their bottle. We're gonna be able to stay out of the hospital. Like, there are so many things that we do on a daily basis. I know that really just are changing these kids lives. And especially in this community, we are literally shifting the generations to come because we're providing this intervention when it never existed. Like, I cannot wait to see in 30 years from now how these kids and these families, everything is changing because of what we're able to do. And I wish I would have known that. I mean, I'm glad I didn't, obviously, because it's just kind of coming to fruition now. But knowing that then would have given me probably a little more sleep. I would have been able to relax a little bit because it has been worth every tear pound that I've gained from stress. All the things, every prayer. We've been relying on that Bible a lot lately and just really taking it all as it comes and feeling like it's really what we're supposed to do. But every other day is, I'm on top of the world. What the hell am I doing on top of the world?

What am I doing? Roller coaster ride.

Yes. Literally, like, what is happening? And then the next day it's like, look what I accomplished. We just took updated pictures Friday and I looked at them and it just was wild to see that there were nine people standing in front of the clinic. And the first one we took, I think had four and two of them are part time. And so it's just crazy to see the growth. It's crazy to see the trust that they have in me and just learning how to trust myself as a leader and to just. I wish I would have known, like, you can do this, you can do hard things. I've always been one to just like jump in and figure it out. But I also wish I would have known that I can be a business owner because business is not my. That was never in my plans. Math, technology, all the things that are required of this. I watch YouTube videos every night, like how to create an Excel document, how to run payroll, quickbooks.com, like CPA, financial advisor. I need y' all to tell me like, step by step. So the fact that I've been able to come out of that to everything that felt like the biggest hurdle. We made it. And then I'm like, we did the biggest things in the beginning, so I know that everything to come is going to be okay.

Yeah. Yeah.

Well.

And I think that's. It's one of those things where I think you see business owners like running a business and it kind of. It's so glorified online. And that's why I always tell people. I'm like, you got, you got to put in the work. Like, is it worth it in the end? Yes. But like, there are many years of my life that I did not sleep very much. Much. It could be four hours one night, six hours, another night. Like, I usually have a cut off of like, I gotta stop. There's only four hours left to sleep because I gotta wake up with my kids so that I will be a wreck tomorrow, which is honestly anything less than seven hours. And I'm kind of like not at my.

On me. I know my brain starts kicking in.

Yeah, yeah. Well, and I, I also am a night owl, so it really works against me because I feel like I do my best work at night when it's tired and I have the like, least amount of distractions and everyone's sleeping. But when you have kids who have to get up in the morning at 6:30 to go to school, that doesn't work so well.

So morning routine interrupted.

Yes. So, you know, but, but I always look at that and I'm like, that's something I chose. I want, I want to be a mother. And I know that with that, you know, and sending my kids to school in certain places, that means X, Y and Z about, you know, my.

Absolutely. I know everyone's like, oh, is you're so lucky you work for yourself. And I'm just literally like, if you understood, like the amount of hours I work per week, it is crazy to me.

Yeah. Yep. It's a lot. It's a lot of hours. It's a lot.

It's a lot of hours.

So one last thing I want to ask you about before we wrap up. So you had mentioned a couple times in the episode, like having imposter syndrome, you know, kind of as a business owner or as a therapist and feeding and whatever. Where are you with that now? Does that still come up for you?

I think it will always come up more so because I am a perfectionist. I. And I am type A. I'm gaining confidence in being a leader. I'm gaining confidence in being a feeding therapist. But I always have. There's always going to be a little bit of doubt and more so of, did I do that in the best way that I could have? Or maybe I should have said this. I go home and I'm still like, oh, I was talking to that parent, and I should have said xyz. So I always feel like I'm not doing enough, But I think that's just because I want to do it all.

Yeah, it's because you care. It's because you care.

And these kids, I love this business. I love this clinic. And I always kind of feel like, why should they trust me at the end of the day? Why should they believe what I have to say? You know, why are they going home and putting all of their eggs in the basket of this clinic of, can you help us?

Yeah, well. And, you know, I feel like that's something that you never want to lose because it's what keeps you at the top of your game. It's what makes you strive to be the best therapist you can be. It's what makes you want to continue taking more courses and learning how to mentor your team and then mentoring your team and collaborating internally and building what you've built and, like, growing what you built. Like, if I ever just, you know, I'm like, please take my business away from me the day that I sit back and I'm complacent, and I'm like, I've done everything I could do.

Like, I'm running it from far. It's not mine anymore.

Exactly. I might as well just sell it at that point because my heart's not in it. It's not what you know. And so that, you know, people ask me all the time, they're like, do you still have a clinic? Because I'm not really working, right? I'm not. I am working. I'm not treating right now. And I'm like, I do have a clinic. I'm not treating in it because I'm now running multiple businesses. And so I may not always be the best person to mentor a therapist. So, like, I've stepped away from mentorship. You know, when it comes to clinical side of things, I'm doing business mentorship. And I. My team is the one who's, like, front and center and present mentoring, whether it's in my private practice or it's online. Business or whatever else, because, again, I just, you know, I'm still there and I can still add, you know, input here and there, but I'm not going to take on like, one on one mentor clients because I'm like, I'm not in the thick of it every day at this point. Which is something that, you know, also.

Shows to you as a therapist. Like, you know, that and how important it is. I feel like when I see someone who's like, yes, well, I'm going to mentor xyz. But like, you're not. You haven't done therapy in four years. Right. So why are you supervising, why are you mentoring and why are you trying to talk therapy? And it's okay. Like, there's a time and there's a place to do all of the things, but don't try to supervise clients or do XYZ when you haven't treated in, you know, four to five years.

Yeah, I'm like, my brain just doesn't function on the same level. And when it comes to, like, patient care, as it did when I was actively treating every day. And it first started where I was like, I'm just going to take a break because I'm launching this online course. Then Covid happened, then we moved to a different state. And at this point, I'm like, I spend so much of my time running businesses that I'm like, I still identify as a feeding therapist, and I still can. You know, it's. I had one of my therapists bring her baby and I did an assessment and I was like, oh, I still got it. It's still there. Right. But also, you know, at the same time, I'm just like, for me, I'm like, my. My heart is more in mentoring, where I feel like I'm working every day. Whether that's going to, you know, clinical or that's business, it's going to everybody. So anywho, all that to kind of just go back. Yeah, I mean, but again, kind of going back to the whole imposter syndrome thing because, like, you had shared that, like, you basically gone from feeling like an imposter to, like, feeling like a total badass in business, like, all the same day at times, right?

Yes.

And, you know, I think that that's. It's part of the roller coaster that we ride. And it never changes, like, no matter how much experience you have, no matter what you're doing in life. But, you know, if you're owning your own business, like, that is a roller coaster that's just going to continue to happen.

Keep on riding.

I love it. I love it. Well, this has been amazing. So tell everybody where they can find you.

Yes. So we are online@fundamentalpediatrictherapy.com we also have a Facebook and Instagram page.

Awesome. And we'll make sure we link everything underneath the episode so they can reach you. And yeah, this has been amazing. Is there anything else that we didn't cover that you want to share?

I don't think so. Thank you so, so much for having me. This is a total like 180 moment for me to just be here with you. You kind of started this for me, so I really appreciate it and it's been really fun being able to chat.

Well, I'm, I'm so glad that you joined me here and that we were able to share this and I, I know that this, that your experience is going to help a lot of other either therapists who want to get into the business or maybe who already have started and are kind of going through some of those early days where they're like, oh my gosh. What, what about you?

It will be worth it. It will be worth it.

Yes. It's always worth it in the end. Well, thank you so much, Michael.

Yes, thank you.

Thanks for listening to this podcast.

If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halle balkin.com or pop over to Holly Balkan on Instagram to get all the latest updates.