Episode 247: The Hard Work Is Worth It with Abbie Gacke, M.A. CCC-SLP, CLC, IBCLC

Hi and welcome to episode 247 of the Untethered Podcast. Today we have Abby Gach joining us. Abby is a speech language pathologist, feeding specialist, International Board Certified Lactation Consultant, IBCLC private practice, owner and mom of three young boys aged 5, 3 and 8 months. She has specialized experience in treating children, adolescents and adults with complex medical diagnoses heavily impacted by feeding and swallowing disorders, speech and language disorders, and orofacial myofunctional disorders. Her professional experience began in the suburbs of Chicago where her passion for pediatric feeding and swallowing disorders began. Moving back to Iowa five years ago, she began a unique opportunity of starting a speech program within an ENT private practice. This experience provided her with more specialized experience in the airway and myofunctional therapy space. In 2021 she transitioned the speech department to her own private practice, Childworks Therapy Clinic in Sioux Sioux City, Iowa. She now has five other speech therapists that work for her and enjoys being able to serve more and more families with her growing clinic. In 2020, she also started her professional Instagram page at Feeding Babes Underscore SLP where she enjoys sharing tips and tricks for little ones at meal times, breastfeeding and bottle feeding support, real life motherhood moments, and her passion of empowering families to feel confident in feeding their child through all phases of life. Abby has taken many hours of continuing ED in the areas of pediatric feeding and swallowing, orofacial myofunctional therapy, lactation, infant feeding and motor speech disorders. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untether Podcast. I am your host, Holly Vulcan. 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, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019. Thanks for being a loyal listener as we jump into today's episode. Remember to listen with correct oral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Abby welcome to the podcast.

Hello.

I'm excited for you to join us today. And, you know, I know that you. I call it the perfect trifecta. You have credentials in pediatric feeding, in myofunctional, you know, therapy space, airway, and when I say peed feeding, you have it both in, like, you know, the therapy side as well as the IBCLC side. So I would love for you just to speak. Speak to, you know, how you got into that and, like, what threw you into this trifecta of credentials, if you will.

Yeah, yeah, absolutely. So, you know, I, in grad school, had kind of a cool opportunity that one. Well, two, I should say, of my professors. One of the two, he spent a lot of time in the nicu, so he. He was a sweet old man, super sweet professor that I just really loved and adored. And so he kind of gave that perspective of being in the nicu, that kind of stuff, and that obviously intrigued me. And then I had another dysphagia professor who trained under Logoman, so she knew her dysphagia stuff, and it was, like, the hardest course ever. But I was all about it, all about the medical side of things. And so I knew for my internships and, like, going out into my career, I was super hopeful that I could be in, like, the feeding space, infant space. And I think, you know, you've maybe heard this before, but, like, you know, everyone wants to be in the nicu, and I'm like, I'm gonna be in the nicu, all this stuff. So I did get a cool opportunity in my internships to work at a children's hospital or to be an intern at a children's hospital and be in their feeding clinic and then also do one day a week of observing in their nicu. So I did get a lot of great, like, internship experience. And then after grad school, my husband's job took us to the suburbs of Chicago, and kind of by accident, I just started sending my resume out to different clinics. All the things of, like, I just need a job. I just graduated, and pediatric private practice that was owned by a speech pathologist interviewed me, and she was like, you know, we do a lot of feeding therapy here. And I was like, oh, awesome. Like, that's what I want to get into. That's what I want to do. She's like, great. Well, we're going to, like, hit the ground running. So I started with her, and she was a really awesome mentor. She kind of led the way of, like, showing me how to do things, how to work with really complex, like, medical diagnoses of kids, like, within My CF year, like, I was working with kids that had, you know, feeding tubes and trach and vent, things like that. So we had quite. I had quite the experience as a cf, like, diving right in. And I kind of laugh because I kind of had to fake it till I make it. Maybe that's not a good thing to say as a therapist, but she threw me in and was super supportive, but.

I was like, well, we're doing it.

I can't really turn back now. And what was cool was being in the suburbs of Chicago is. I feel like, comparatively to, I guess, maybe where I grew up, it's a very progressive place, or there's a place where there's a lot of different specialists, but also specialists that can have their own niche or specialization. And so I got to work with, you know, a variety of professionals, whether that was ENTs, GI doctors, airway specialists, like myofunctional therapists, dentists. Um, we gotta work with, like, such an array of specialists that, like, helped us with seeing these really complex kids. Um, and then, you know, again, in grad school, I feel like very few of us get that experience of understanding, like, tethered oral tissues, airway concerns, all of that. So that is also something that she really, like, challenged my mind and my thinking of, like, no, Abby, we need to understand why the child is aspirating or why the child is having difficulty feeding. We're not just, you know, putting a band aid over it. Like, she was one that was like, we're referring. We're doing this. And so I feel very lucky that I kind of got the experience I wanted, like, right out of grad school. And so with that, obviously, too, with her seeing that I had some experience with infants, she also was like, let's start doing infants, like, bottle feeding, breastfeeding. I'm like, yeah, let's do it. Well, that's obviously very, like, complex world, too. And then while I was there, I had my first son. And I know you can relate to this, too. But then, obviously, becoming a mother and then having a child that has their own breastfeeding difficulties really just kind of lights your fire even more for wanting to help more families and moms and babies. So that really motivated me. My first son, yes, he had a tongue tie. We had difficulties with breastfeeding. We kind of went through the whole gamut. And so, again, having that knowledge as a mom and also a professional, I just was ready to. To kind of take off and help more parents. And so then that kind of led into, I was, you know, Feeling really confident, really excited where I was at. And then my husband's job moved us back, or he got promoted to a position that brought us back to where him and I were both from, which is more northwest Iowa, which is a very rural place comparatively to the suburbs of Chicago. So technically we do live in a city in Iowa. I say it like that. And it is decent size, for sure, but not, you know, the same kind of population when we were in the suburbs of Chicago. So that's what then brought us back here. And I realized, wow, there is just not as many resources for families around here, but there's just as many babies and moms and children with difficulties as there was in Chicago, but there's just way less resources. So that's what then kind of motivated my track here in Iowa to kind of taking the path that I did.

That's amazing. It's like we all have, I feel like our own journeys and everything. But it's so rare that I hear somebody say, oh, I was expecting. Exposed to X, Y and Z, you know, related to either feeding, dysphagia, whatever, in grad school. And like, right out of school I got like my dream job where I really just got thrown into the fire and had the mentorship and support to also, like, allow me to do that. Like, and so that. That's just incredible because it's rare. It's really rare. Yeah, I had a professor too, who. Dr. Barbara Sunnies, who was very, like, well esteemed and established in the dysphagia space, but more with like adult dysphagia. And I think at the time that. So she taught an undergraduate course and I think she was teaching. I think I took my first course with her when I was an undergrad student at Maryland, her dysphagia course. And like, you know, the whole swallowing system, anatomy, physiology.

Right.

So I remember that being like a really hard course. And I was like, this is a grad level course being taught to undergrads. Like, she was a phenomenal surgeon, but, like, very much so, like, I think in tune with like graduate level study kind of, you know, so for undergrad it was. It was really challenging. You know, Long story short, I actually became a teaching assistant for her when I was in graduate school and became the TA for that course and created an entire, like, anatomy lab around her course when I was in graduate school, which was. That was cool. I loved that. I was like the beginning of my teaching career apparently.

Right.

But it was, you know, because I was kind of like, oh, well, I.

Wish that I had something that was.

Like, more hands on and, you know, we had like, a lab related to the material so that there would be more of a connection between what we're learning and, like, what actually, you know, an application because we're not working with patients yet as undergrads. And so that was. That was fun. But my experience also was all adult. Like, there was no pediatric feeding anything in my graduate, graduate program. And of course, nothing to the oral tissues. And airway was only like the lower airway stuff, you know, and trachs and dents and that kind of stuff, not upper airway that we learn in the Maya world. And so, yeah, it's. It's so interesting to see and, like, hear. And I would just be so curious for somebody, like, to like, actually go out to every university and be like, what is covered in these different topics and just see, because I know. I feel like we can count on less than two hands how many actually teach pediatric feeding, if they even teach PED feeding. I think most of it's all adult focused, if that's even part of the curriculum.

So. So, yeah, mine was mostly adult focused, I think, because I just had expressed to both of them kind of like, oh, I'm just so interested in, you know, the pediatric world. They thankfully were just super supportive of, like, providing me resources and then also helping me to hopefully get an internship that would support that passion or that interest area. So I was lucky with that too. But again, ours, I would say, like 80%, 75% of it still was adult course. And even that just not even the kind of stuff that. What you were just saying, like, that now we're in, I guess, investigating more and more with that, like, upper airway space.

Yeah, no, I remember too. She had, like, she ran like, the radiology floor at nih, I think, at the time. And so she had like, our graduate class because at the point I was in graduate school, she had us come out and actually go to radiology and sit, like, in the chair where they do the swallow studies. And, you know, she. We didn't actually do the swallow. The study. And she, you know, she's like, I'm not gonna expose you all to radiation and everything for no reason. But she was, you know, she. I remember she used me as like, the guinea pig too. She's like, hallie, why don't you go sit in the chair? I was like, okay. So, I mean, it was really cool. I got some really cool experiences, right? But it's like, we know that. It's so, so Very different when you're dealing with, like, adult dysphagia patients versus the pediatric cases. And then there's even the bigger differences between diagnoses, ages, you know, whether they're breast bottle fed versus, you know, on solids. And that whole transit, like the infant year, is like its own whole, you know, gamut of nuances.

Yes.

Oh, yes. Oh, for sure.

Oh, for sure. Yeah.

Yeah. But so you've also, you know, built out a program too, with an ent. Now, is that where you are now, or is that when you were in Chicago suburbs?

Yeah, so actually, I'll kind of translate it. So we moved back to Iowa and Sioux City, and. And in coming back, there was not any, like, medical jobs really available. And I just felt so passionate that I wanted to stay within outpatient medical. I was not really wanting to have to go into the schools. And that's obviously no disrespect to them, but I just was so passionate about what I was previously doing. And so my mentor, the owner of the private practice in Chicago, she was like, abby, just reach out to, like, do they have an ENT in your city? Do they have, like, a GI in your city? Like, maybe they'll just want you to work for them. And I was like, okay. So she helped me kind of draft up some emails that I sent to. There is an ear, nose and throat, or ENT private practice here in Sioux City, and I think I sent one to a GI too. And thankfully, the ENT private practice messaged me back. They're like, you know, it's something we've always thought about. Yeah, why don't you come in and, like, talk to us about it? And I was like, like, okay, yeah, let's do it. So I went in and I met with them kind of about, like, what I had been doing in Chicago and how I thought I could be a good asset to their team. And, you know, thankfully they were like, that sounds great. I feel like we. We need you. You see everything that we pretty much treat. So, yeah, like, why not? And so they hired me, and they were kind of like, you know, build it. I guess there was, like, not a lot to it, which I will say, I think I was, like, two and a half years into my career, maybe three, so it was a little daunting. Like, like, yet I, you know, I kind of, you know, put on the big show that I did. And I, you know, I felt really confident in my skills, but also, like, to build a whole program from scratch felt super daunting as well. But I Accepted the challeng. And it kind of started with her like, let's start with you doing one day a week and see if you can kind of build that up. And then, you know, as you build more, then you can add on more days. And so I did that. And it was funny because the first I would say like three months. They're referring me just a lot of, you know, older adult dysphonia. And I. I should preface this too. So there's four ents within this private practice and they are general ents. You know, people maybe that don't understand. They see everything in anything really. If there's certain specialization of certain procedures, they will refer out to like Omaha or Sioux Falls or like Des Moines or kind of areas if there's like more of a specialized entity that patients need. But mostly they're general entities. And so they see infants all the way up to like, you know, geriatrics. And so I was getting all of these like 60 to 80 year old patients that had just like dysphonia, voice disorders. And that's just who they were kind of referring to me, which, you know, then also stepping out of my box and like, well, I've been mostly doing peds feeding and speech and stuff, and I have not done adult voice in a while. But hey, let's dive in. Let's figure out how to do adult voice. But again, I kind of consulted my mentor and she was like, abby, they just might not know what a speech pathologist can do and see, like, talk to them about like everything that you see and like what you're passionate about. So I sent them, all four of the ENTs, an email that said, hey, just kind of want to, you know, tell you about me a little bit more and like, who are patients that you can refer to me? And so I listed off, you know, infants, feeding issues, airway issues, you know, late talkers. They were having so many kids that come to their office to get hearing tests done because their pediatrician, you know, noted that they were a late talker or having speech and language difficulties and said, well, let's go get a hearing test. And so they'd have a hearing test and it'd either be, you know, normal or abnormal. And they'd be like, yes, and that's kind of where it would stop. And so I'm like, send those kids to me, you know, like, you know.

The kids who have like, you know, chronic ear infections and you're putting tubes in their ears. You might want to send them to me too.

Yes, and so I kind of was literally like, everything that you, you treat, I treat pretty much. And it was awesome. Like the response they were like, oh my gosh, we had no idea, you know, that you could see all like, they were like, abby, we have so many patients we could be sending to you. I'm like, I know.

You're like, I thought that's why you said yes to this.

But you know, that kind of goes to my point too, of like sometimes I know us as professionals in this airway space or myo space can sometimes feel frustrated with providers that are like, you know, like not seeing the way we want them to see or you know, like specialize in what we specialize. And I don't always think it's because they're just hard headed or don't want to be in our space. I think it's that again, the aunties I work with saw a variety of things. You know, they did thyroid, they did hearing issues, they do airway, you know, they do cancers, head and neck cancers. And so sometimes when we're like, this patient is really important, you need to look at their airway. I'm not saying that they're not saying no, but they're seeing a whole gamut of patients throughout the day of different things that they need to also be specialized in. So I think taking the time to collaborate with those professionals, or at least like I did talk to them, be like, hey, did you know we can do this?

Or like we educating them for sure. Yeah.

Patients off your hands. And I thought that the ents were so accepting of that too. And the fact that they're like, oh, we don't have to always prescribe medication. It'd be so nice for us to send them to you to try voice therapy first. Because again, being in a rural area, I think there wasn't as many, there's not as many speech pathologists like myself or just speech pathologist, specialized myofunctional therapist in general in this area. So they didn't have a lot of people to refer to. So then I think they also got closed minded that it's like, well, I have to then be the only person that helps them fix this problem. And that is probably, you know, medication or a surgery or that's kind of about it. And so I think they also were like, oh wow, that's so great that we can refer to you and not always have to just have those other things be the number one answer and try other outlets first. So that, that's how I got into the ENT space. And what was awesome is, yeah, after that email, things just kind of took off, and I built the program to being full time. And then we also ended up hiring a second SLP as well, so. Really cool. And then I think we'll kind of, like, dive into that. But the. The speech program kind of outgrew itself, and with me getting really invested in lactation and infants and feedings, that was more of, like, a specialization or a niche that I wanted to see more and more of. But again, within their practice of seeing general population, we were getting a whole slew of patients, which was great to kind of broaden my skills and horizons, but I was kind of just, like, really wanting to see more and more of those babies. So I was super nervous and scared because they. Honestly, I had such a great experience with this practice, with this ents, and had such a great relationship with them, but I wanted to do more. And they also kind of were at max capacity for us just having two SLPs. And I'm like, I think that we can help more families and more speech therapists and all this stuff. So I presented to them transitioning their speech department to my own private practice. So I'm not affiliated with them at all. But, like, I kind of took their program and made it my own. And they were actually 100% on board with that, which was shocking and phenomenal and great, because, as you probably know, too, like, I didn't want to damper that relationship because they are a huge referral source for me and likewise. So if that wouldn't have gone well, that would have been really hard. So I now have a private practice called Childworks Therapy Clinic here in Sioux City that I have five other therapists now that work for me. And, yeah, we've been open two years, so that was a long story. But, no, I love it. I want.

I have so many questions like. Like, every. Okay, so, because we're here right now, let's talk about the transition into the private practice more, because I feel like, okay, that's great. They were, like, fully on board. But, like, I would just love for you to share, because there's other private practice owners. Like, were there any things you. Anything you learned, anything you would have done differently? Was it all, like, you know, rainbows and unicorns? Nothing ever is. So, you know, I'm just gonna throw that out there. I also want to. We'll talk about this, like, after. But I. Like you had said, like, you really realize that the Ents just didn't know, right? And it really took education and that's even with you being in their office. And so, you know, I'm just so curious to know too, like, were there things you learned from them? Whereas, like, I just feel like it seems like such a beautifully mutual, like relationship that I feel like we talk about that need for collaboration all the time. So we can come back to that later. Let's talk about the private practice first. But yeah, I'm just, just that transition, like how was that? Like whatever you're willing to share.

It was difficult. And before I even presented obviously the idea to them, I needed to get my ducks in a row and you know, know what that was going to look like. So what I had to do a ton of research on and in was obviously insurance. So because all the patient, if I was going to transition the program, I thought I had to accept insurance because everyone that was seeing me at ENT was we were able to bill their medical insurance. So I obviously needed to dive into that world and understand what did that look like? What does it look like to get credentialed, to be a network to bill insurance, all of that. Because I wasn't really having to do a lot of hands on things with that besides obviously understanding codes and that kind of thing. And so, you know, obviously this is very state specific, insurance provider specific. But luckily in Iowa, a lot of insurance companies reimbursement for speech and feeding was actually pretty good. And so I was, I was really nervous obviously to be like, okay, I'm going to transition the speak department but only take private pay. But you're used to being able to use your insurance. So that was like, I don't know if I can do that. And thankfully, I think thankfully I didn't have to because the insurance reimbursement rates were pretty good for us. But that was just a lot of a learning curve of learning. Like again, how do I credential understanding the billing, you know, all of that kind of stuff. So that was a learning curve. And then yeah, so they let me work literally up until two weeks before I opened my own. So behind the scenes of working full time, I also was trying to get my own like clinic space. So I did get like a brick and mortar, like clinic space ready. And thankfully, I should say to the other SLP that we hired, I had her come with me as well. And so she took a chance, I love her. She took a chance on me and doing this. And so yeah, we were getting all of that stuff ready and then I took two weeks off and then we Opened our doors. So, yeah, there's been a lot of learning going on. I'm sure you can relate.

I.

It is so much hard work, but it's hard work for yourself, and it's hard work for something that you want and you love and it's for you. So I feel like the hard work is worth it. You know, I think my husband was someone that has, from the beginning been like, you should do this. I'm like, it's not that easy. It's not that easy. Stop saying that. He's more business minded. And he was like, no, you should do it. You should do it. And, you know, I think it was him who's like, you've never, like, turned down hard work before, so why is this something like, you know, if you work hard at it and it's something that you want to be successful at, I think you will. And that's kind of stuck with me because, yeah, I don't want it to fail. Not that I couldn't ever, I guess, but I don't want it to fail. So I'm working my butt off, but it's for me, and it feels good. Any person that's, like, nervous about that, I guess I just, like, would want them to reflect on, like, if this is for you, like, I think, you know, that you'll work, you know, your butt off to. To make it work and to make it your own. And yeah, it's blood, sweat, tears, money, all the things, but I'd rather work hard for this than to be driven into the ground by something I can't control or productivity rules that don't have my best interests at heart. So that. Yeah, well, and I think that's.

I think that's great advice. And I think it's also realistic advice, too. Right. Because it's like, I think going into it, a lot of people kind of, you know, and I mentor private practice owners, and a lot of them will say to me, well, I got into this because I wanted to make my own schedule. I got into this because I wanted the control. I didn't know when I got into this that I was going to be working more now as my own business owner than I did for anybody else. And so there's always, like, the pros and cons to everything. Right. And kind of like what makes the most sense for you. And so I love that you highlighted, like, blood, sweat, tears, money. Like, it's not. It's not easy. Like, sure. Can you try to do certain things to make things easier for yourself? Absolutely. But Starting a business takes work. It takes time, it takes money, it takes energy, it takes dedication. Like, you need to be so clear and, like, what you're wanting at as, like, the end result, like, you may not know how to get to that result right, but it's like, you just need to kind of know what you're doing because you kind of go into it blindly with, like, oh, I just want to work for myself. Because that seems like a fun little gig. You're going to be severely disappointed.

Like.

Do you have any other advice now as someone who's gone through this that you wanna. I mean, again, it's not to, like.

Think, you know, in, like, I guess my realm kind of, like I said, was always to, like, help more families. Like, I feel like, because we're in more of a rural space. Like, that's what was killing me is that not many families were getting these resources. Maybe they had heard of them, but no one around here was doing it. So my goal always was, I guess, to hopefully be able to expand my private practice, to have more therapists that have the skillset I have or even their own unique skill set too, so that we could help more families. So my goal also with my private practice was to grow. But again, that takes a lot of time. Blood, sweat and tears. But with that, now that I'm two years in and have myself and five other therapists now I'm able to put systems in place where I can take days off, where I can work less, or now I do get to drop my oldest son off at kindergarten every morning. And so, you know, two years feels like a long time, but it's not. So I know able now to put more systems in place to support me being able to have more flexibility and time or, you know, to be able to do things that I want to do because I have a supportive staff and I have things in place. But. So I guess I will say, like, it takes time, but you can get to a place of having that flexibility. But, yeah, I think that first year to two years to five years can be a grind and. But then you can set yourself up for how you envisioned it.

Yeah, yeah. No, I. I love the reality sharing. I always tell people, like, I will never sugarcoat things because I'm like, a part of it is like my identity, my own reputation. I don't want you to, like, think this is going to be easy. And then you come back and be like, hal, you lied to me. Like, no, like, let's talk about the realities of owning businesses and the Ish. That happens as a business owner. How many fires you have to put out every week? You know, it's like things happen and sometimes look, you're like, okay, everything just seems to be like free flowing right now. Everything is good, it's in a good place. And I'm always like, I'm going to ride this way for as long as I can because you never know what's going to happen, you know. And one of the things that I tell everybody though is like it's, I always say it's like the universe testing you. Something happens, you feel like there's like fires that put out. I'm like, okay, universe, like what is the lesson in this? Like, what are you trying to teach me right now? And like I, I'm someone who's like.

I'm not a quitter.

So most of the time, you know, my, my response is going to be not how do we fix this? But like, there's always a solution. So what is the solution? What is the best case scenario? Let's weigh all of our options here. Let's kind of figure out how to push forward, right? And I encourage people to like go in with the mentality that, you know, anything you do in life, right? It's if it's something you want badly enough and if the mission is larger than you, like it's always worth it in the end. And that's. It's been true for me in everything I've done. And I feel like it's kind of mirrors what you said where you were saying like, okay, now you've got the team, you got, you know, amazing people who are there basically running the show and the therapist treating the patients. And now you're able to put systems in place and carve out that time that you desire. And that's again, the whole reason why you did this was, you know, to do something for yourself. And I know a lot of us like echo that whole, I want to do something for myself. I want to be able to decide when I am there and when I'm not there. I want to be able to take my child somewhere and drop them off at school if that's what I want to do. Right. And so I love that. And because, you know, two years is. It sounds like a long time, that's actually amazing that you've built this that fast and that you've been able to shift things in your schedule to allow you to not have to be at the office all the time and to take your child and drop them in kindergarten in the morning. And you know, there are people who are 10 years into this that would dream of that. So, you know, I, I don't want to like downplay what you've done because I think it's, I really think it's incredible. And you know, kudos to you because again, you know, the other thing you said too, it really sounded like you spoke to your team and being able to have team members and you know, that's why I love keeping my private practice. I tell people, I'm like, my private practice is not anywhere close to being the money producing thing that my online business is. But I keep it because I'm like, it makes me some money. I'm like, but I keep it because I love being able to offer those services, those specialty services. I love my team. I love being able to have a team that gets paid well for the work that they're doing, that enjoys the work they're doing. It's like that mission is just like so much larger than me at this point that I'm like, you know, I'm not saying I'll have a private practice forever. I don't know, maybe I will, maybe I won't. I don't know. I never like to say definitive. So I'm like, you never know what's going to happen tomorrow, right? But again, it comes back to that larger mission at hand and I'm like, if we can be part of that change, that's to going providing these so desperately needed services and I can make sure that they, you know, are available and that people who are giving them love what they're doing and they're highly qualified and you know, yada, yada, whatever. I'm like, and I get to pay them really well to do it. I'm like, that makes my heart happy. It's self serving too. But larger mission.

Yes, for sure, for sure. And I will say a little off of that is, you know, I. We all went through an adjustment period during COVID right? So I had a baby. This is when I was still at the ENT private practice. I had a baby two weeks into Covid. And you know, all of us were home a lot and also we weren't able to go to the doctor as much or go to specialist as much unless it was absolutely necessary. And that was also so heartbreaking for me that again, so many moms and families, especially breastfeeding or bottle feeding, but babies weren't getting the support like maybe they were before or especially now during this time. And I even felt that way like A little bit isolated, and I do this for a job, and still, like, was trying to navigate a newborn during COVID And so that is where I did decide to start my Instagram page. The. My feeding babes underscore SLP as, like, a way to try to. It was kind of like a passion project outlet, but also it was trying to be like, parents. Here's some things you could try while we can't go to the doctor, while we can't, you know, go to specialists about this. Like, here's some tips and tricks, and I love doing that. Like, I loved it. And so I've continued to share, but I feel like that also is what kind of set the stage for me going into private practice as well, because more families are reaching out to me, and we're like, you know, how can we see you? Or how can we consult with you? Or how can we. And I'm like, well, you know, you can call this number or. And I just felt a little limited with how I could actually truly help them, you know, besides just my Instagram page. So with how much, like, support and excitement I was getting from that, it kind of like, I guess spun me into feeling more confident in starting my private practice. So I don't know if that's a tip or trick, not just start an Instagram account, but, like, sometimes there's a way to, I feel, like, dabble or dip your toes and see, like, is this really what I want or not? And how does it. How is it received? How does it take off? And in my case, it was super well received. And so I think that also gave me the confidence that people were trusting me or understanding that I was more specialized in these areas and wanted my services. And so I felt like it kind of helped to validate that. Like, I can do this. Like, people do want to see me, they want my services. Like, I can do this.

Yeah, well. And so with the ents, so obviously, like, you were in there, you got yourself into that office, built a whole program. Like, it's amazing for people who are like, okay, well, you know, I want to start my own private practice, or I want to collaborate more with ents, but, like, that's. That opportunity is not present because I have a job already, or ents are not interested in having me in their office, just having been in an ENT office. Do you have any, like, advice on how professionals like SLPs or IBCLCs or. Or OTs, or whoever?

Right.

On how maybe they can, like, reach out to ents and offer to Collaborate with them. Because, you know, I think in some instances, like, we all just assume ego gets in the way. And I do think there are really great professionals on all sides that want to collaborate. They don't want to tell be told what they, you know, what they know or don't know. Right. But, like, what. Do you have any advice, like, having been in that office on how to maybe even approach ents?

I think you kind of hit the nail on the head. Like, I think all of us have a little bit of an ego thing. Right. Like, we think no one wants to.

Be told, like, what to do. Right.

What we do. And we don't want to be told that we're not or that we have to be doing it a certain way. And I will say with working in that office, that's how I did try to always present it of, like, hey, you know, this kid that I'm working on, him advancing his diet, but, like, we are choking and gagging a lot, and his tonsils are. Are enormous. So. And not saying that. That's the only reason, obviously, we know there's, like, lots of different. Yeah, but kind of like, I guess again, I lucked out because I was in the office, but being able to have a conversation of like, you know, I'm seeing this, and I think, you know, that would be really helpful if you could help me look into it and more in a way of like, here's what I'm seeing, here's what I'm trying to do to help the patient.

But I need your help.

So doing it, in a way, I'm like, how can you help me? And I felt like that really helped my relationship building, that I wasn't coming in there and was like, you know, this kid has large tonsils. I need you to take them out.

You know, I'm not saying anyways, but. Yeah, exactly.

But, like, I get what you're saying, that there are professionals and, you know, the entities have even expressed that to me, that sometimes there are, you know, different dentists or even different myofunctional therapists that have come about in the area that will send a letter, you know, with their patient, which I don't think is necessarily a bad idea, but it'll be very much like, you need to do this, this, and this. And I think, you know, as surgeons who went to years and years and years of school, and just as a professional, no one likes to be told how to do their job right. So I think if you can present information, if there is a way to actually collaborate on the phone, I think that's the best way to actually hear someone's tone of voice. That's what I've learned, is emails are interpreted wrong. Sometimes letters are interpreted wrong. I know it's not always the reality, but if there is a way that you can actually meet in person or have a phone conversation, I think that those conversations go way better, and you can hear the other person's tone and understand where they're coming from. And so that was my biggest thing, is I always was like, here's what I'm working on, but I think I need your help. Do you think you can help me with this aspect of it? And I felt like they were much more open to, like, oh, yeah, Abby, I'll look into that for you. You know, instead of telling them, like, again, how to do their job.

It's psychology, right? It's sort of like the ego protects us. So you start to tell someone how to do something or what you need, and they're like, you think you know better than me, right? Versus you being like, hey, this is what we're working on. Like, I really need your help. And it's like the ego is kind of like, oh, okay. What can I do for you? Like, you know what I mean? It's like, all about kind of like. So I love that.

Yeah.

Yeah.

That's amazing. I think, you know, same with speech pathology. Like, we. I've been lucky. And you, too, Holly. And, like, that we have been able to specialize, but our occupation also is very vague. We see a very whole host of things. And that was the other thing with learning about the ents, like I was saying, is they are. They were general ents. So sometimes my, like, super important thing for them, they're like, okay, but, like, how is that going to help them? Or, you know, and we are passionate about this area. So I feel like I'm always looking at the latest research and things like that, but I don't know the latest research in regards to, like, laryngectomies or, you know, things like that. And so they have to know a whole host of information. And so I thought that they were very open, too, and I'd be like, hey, like, this is what we're learning, you know, about tongue ties and how it's affecting, like, airway and the palate and airway development. And it was funny because one of the older ents, he was the one that originally started it, he was like, oh, yeah, we talked about that, you know, at the very beginning of med school, he's like sometimes I forget about that. Or you know, like we had five.

Minute discussion around that. Right? Okay, I haven't talked about that in 30 years, but let's have a conversation.

Yes. Or like one of the ents, she had to like take a continuing ed course or some sort of like test to kind of of get some credits or something. And she texted me, she was like, Abby, what the heck? I have a true or false question that says there's a study that shows that myofunctional therapy, it couldn't be more effective than a cpap. And she was like, I put false and it said that it's true. And she was like, what the heck, I should be sending more patients to you for myofunctional therapy versus prescribing the cpap. And I'm like, you know, haha, yes, but. And so she was like, oh my gosh, like there's just so much more I need to understand about myofunctional therapy. Like we should, you know, have coffee again sometime. And this is like out when I.

Wasn'T working there anymore.

But I just love that she can like, you know, text me about those things. Relationship building to it and you know, same with, I feel like, because again, I was so lucky that I was in the space and we could like have conversations in real time, in real life. You know, just recently I had a baby who, you know, they had a tongue and lip tie, but also their. Was it their chiropractor I think was concerned that they also had buccal ties. And so that was before they had seen me like went and saw the ENT, one of the ENTs I work with and she texted me and she was like, Abby, you know, I don't feel like there's a lot of research to support that right now, but I know this is ever evolving. So I'm interested in learning more. But I'm just going to tell you I don't feel comfortable releasing those in those patients. But I'm not against it if you think that they need to go to a dentist that does do it. So I even thought that that was like cool, like huge. Hey, I don't, I don't really feel super comfortable with this and I'm not saying that it's wrong. I just feel like there's not enough research yet for me to feel comfortable doing it and I haven't done it yet. So I don't think you want this patient to be my first one to do it on. I was like, I appreciate that. Thank you very much. So I just feel like, again, I have a very unique, cool situation where I'm able to have super open conversations with these ents, and they respect my opinion and I respect theirs.

Yeah, well. And, you know, I'll share, like, one story.

We have an ENT that we finally.

Found after years and years and years in the D.C. metro area where one of my therapists treated the child of that ent, and all of a sudden that ENT was like, wait, why aren't there more Ents doing this? Why are they not, like, aligning with you? Why are they not? And, you know, truly, we've tried educating and, you know, you're not going to win everybody over, right? So there is that side of this conversation, too. And then sometimes you win people over or they take the courses or they seem to know what they're doing, but then their treatment plan is not matching the education that you think they have have and the conversations that you're having. And you're kind of like, obviously, I'm not an ent, so I can't tell you you're doing your job wrong. But what was the point of us even referring the child to you? Because we're kind of still here at square one or back to square one. So, you know, so to have this individual, right, and to have some conversations with him and to, you know, he was like, send me. Send me some things to read, like, send me. I mean, I feel like there are those people out there, like you said, who are one interested in relationship building, not just for referral purposes, but because they want to learn more. And I truly think that's what makes the best doctor, clinician, therapist. Right. It's the person who is ever evolving and who recognizes that what we were doing five years ago may not be relevant anymore today. And what we're doing today may change five years from now. And those are just completely, you know, random numbers. But we do know, like, research takes 17 years to appear published in a journal. And so if we're so behind, I think that recognizing that what's happening in practice right now may not come to light for a very long time on a more global scale. Right. It's like, that's where I had just such an appreciation for these providers, regardless of what profession they're in, that are kind of like, okay, like you said, like, I don't really know enough about this. What, like, what should I read or what courses should I take? Like, I love that. And I also love when they can say, okay, I don't disagree with this. But also, I have no experience, so I'm not comfortable doing this versus the one that'll say we've had them where they're like, well, I don't really see a tongue tie, but I'll release it anyways. And I'm like, ah, no, you won't.

Hold on.

Yes, step away from the patient. I mean, so you. You hear all kinds of things, right? I mean, it's just like, it's all over the place. But I think it comes back to relationship building, being able to put an ego aside. Like, noticing when your ego is kind of like playing a role and. And look, or ego, like I said.

It keeps you safe.

So we need it. But we also need to know, like, when to kind of say, hey, ego. Like, I feel. Still feel safe even though I know nothing about this. Like, you can sit over here while I go take a course or have a conversation with a colleague. Right. And so I just like, I'm always like, more of that, please.

Exactly. And I will say, like, I'm kind of making it sound like it's been the perfect scenario, but no, there's been a ton of learning on their side and my side and, yeah, finding that because there was four of them, each one of them had their own personality and perspective and way of, you know, treating some of these things that I was sending them to. So that was something that we. I had to navigate and understand and, yeah, work through that too. So it wasn't all, like, perfect and pretty all the time.

Will you talk more about that? Like, some of the things that you. You learned from ents that you feel like would be beneficial to our listeners, other providers.

So, you know, I think with it. So one thing that comes to mind, I think too, is the insurance world. And I hate to bring that into this, but sometimes I know us on the outside and I accept insurance, so I kind of get it. But like, we think it's easy to be like, well, I'm referring to the ent. He has enlarged tonsils or adenoids. Like, why can't we just take him out? Or like, you know, they have enlarged turbulence or all this sinus stuff. And unfortunately, sometimes their hands are tied a little bit too in the way that, like, you have to prove to insurance that they need a procedure or they need a surgery. And I'm not saying, like, I force patients to go do that. I'm not saying that. But, you know, like, sometimes they had to prove that they've had strep throat four times before, actually. Like, insurance would approve them to take their tonsils out. So sometimes, too, we can be angry or, like, frustrated that, like, they're humongous. Why can't they just take them out? But unfortunately, sometimes there's, like, a process with some of that. So I had to learn some of that, too, because, yeah, I would get frustrated with sometimes making a referral of, like, oh, my gosh, this kid's airway. Like, I. We need help. And it would be like, you know, let's wait and see, or, let's do another round of antibiotics or things like that. And so those were kind of tough conversations where they enlightened me that, like, we see what you're saying, Abby, but sometimes there is a process we have to follow or also, like, we're getting them in our office, and then the parent says to us, like, we don't want them to have surgery whatsoever. Things like that. But yet the parent wouldn't share that with me or, you know, and I think I'm making it sound like I'm telling every patient to go get their tongues. That's not the case. But.

No, no, we know you're not. Just an example. Just an example.

Examples of, like, like, you know, things that, like, you know, I would maybe have a conversation with. With the parent, and I thought that it went really well, and then that parent would maybe, you know, get in their chair and say something completely opposite. Yes, yes. Or, you know, or maybe interpret something I said and then present it in a way that did sound very, maybe, like, demeaning or egotistical. And so those were sometimes hard conversations that, you know, they would come and be like, so you told this patient that they should do this? And I was like, oh, whoa, no, no, no. And so that's. Again, I was super lucky that we were in the same office, so I could just go in there and talk to him about it. But those are, you know, a few examples of. Of things that, like, I didn't always understand, or when you send a patient to a specialist, you know, sometimes we're frustrated with, like, the recommendations they make or how they're not listening to us. And maybe that's the case, but sometimes I feel like there can be more to it and it's more out of our control and less about us. Them not respecting our recommendations or our referral reasoning.

Yeah, no, I think that's. That's actually a really amazing share, because I'm sitting here going, yeah, actually, okay, so maybe it's not about us, and our ego is putting us at the center of this conversation going, they don't. They don't respect us. They don't care about our opinion. We're not saying do surgery. We're saying, like, this is not enough. Like, we need more. Right. And. And, you know, and I've been through it with my own kids, right. So I've seen some of the process. And I'm like, so maybe that. That anger, that frustration is misdirected. Maybe it needs to be towards the American medical system, which I think a lot of us are frustrated with too. Right. You know, I. And I've seen this where they. I've been told about, like, you know, well, first they have to try several rounds of medication, and then they might have to do this. And, you know, and I think that's where it's like, okay, people who are super fired up, maybe you should go create a action committee and go, you know, go straight to, like, cms. Maybe you should change how things are done. Because I know, like, now, for example, if a child can go for a sleep study and it can demonstrate sleep apnea, then they can go right for tonsillectomy, if that is the prescribed procedure and route. You know, the parents are on board and the ENT recommended and all that, you know, so I know that I think things are changing in that way, but I almost, like, as you're saying this, my. Huh. Maybe if you're one of those people's, like, super fired up about this, maybe.

You should be thinking about how do.

We make change on a more like, global level? Like, when I say global, I mean more like, you know, United States of America. Not globally on the map, but with our medical system. Because that really, I think, drives the ship in many ways. And I sure, you know, I'm sure you can appreciate that more than me just being in network with some insurances. But yeah, that's. That I know, is such a big thing. And the relationship building. Like, I've had cases where it's like, well, this parent said this to my therapist and then, you know, said this to the dentist and told us this about the dentist, told the dentist this about us. And I was like, nip it in the bud. Like, I don't know what is happening right now. I don't know if this is intentional or not intentional. I don't care. But this is my relationship I built with the dentist. So I'm gonna go reach out to that person right now and say, hey, do you have five minutes to discuss what's going on here so that we can just And. And I will tell you, every single time, we have been told different things. And I'm not judging. I am not judging, because it could also just be that person's comfort level with a dentist versus you. It could be that they respect you and they don't want you to feel disrespected by disagreeing with something. And maybe we read the situation wrong. You know, it does fall back on us as well. You know, maybe they feel more comfortable in the dentist's office because they're going to go there a couple times and never go back there. So now they're just over here saying a completely different, different thing. You know, who knows? Who knows? At the end of the day, it doesn't really matter. I feel like at the end of the day, it is our responsibility, right, as medical professionals and adults, to basically put on our adult pants that day, have a conversation that sometimes may feel kind of icky with a referring provider or with, you know, a provider we refer to and basically just kind of like, lay it all out there. And I will tell you that those conversations always end well. In my experience, it's never like, you know, because sometimes they'll even say to.

Me, I didn't really think that you.

Would say that, but I wanted to give the patient the benefit of the doubt out, because why would they just make that up? You know? And I'm like, I don't know. And I know we don't need to rationalize this one way or the other. Let's just have a unified approach together so that we either can help the patient and we make sure we're all on the same page, and we give them a safe space to explore what feels right for them, and we support them in that, you know, and. Or they don't like us, and they go a different route, which is fine, too. You know, it's like, we're not for everybody. So, you know, I think it's just people don't realize, like, when even though you're in medicine, like, these conversations are still very critical, especially in situations where you're getting this, like he said, she said, and nothing's matching up.

Yes, yes, absolutely. And I think, yeah, exactly what you said is sometimes all of that is what kind of makes it messy, and it shouldn't be messy. But I also think you kind of said the same thing with the ENT you've collaborated with. Like, I feel like I've been lucky in that, you know, my work or my therapy has also kind of spoken for itself. Like, you know, I'M able to help these patients. The patients are providing positive feedback to these providers. And so then that's also helped me build my network beyond ENT is also dentists in the area. You know, like I've been able to, when I first moved here, I don't know if there was a ton of dentists really looking on the airway side of things or even I think there's one dentist that was performing, you know, like tongue tie releases and now we've built a pretty awesome network. And I think it's, you know, been like the patient is like, hey, my dentist said that they have this overjet because they keep pushing their tongue out. And I'm like, okay, let's talk about this. And you know, and you're like, the dentist isn't wrong. But I don't know if the dentist understands all, you know, this specific, specific one understands. Maybe you know, like how can I help you with that? But then also how can they help me with that? And so I think that yeah, in a awesome way too. My specialization and the, the good outcomes that a lot of my patients have gotten has been like, I guess positive word of mouth that more professionals have been reaching out to me and like, hey, like can we collaborate? And I think that's, that's really awesome if you know, I'm sure you agree, like we more people that are like minded and all thinking the same way. That also makes it easier for change to happen in the medical or dental space.

100%. You know, I think a lot of us talk about the need for collaboration but then when it comes down to it it's like, but how? And so I love that we kind of dove into that today because I think it's a necessary conversation. But I think you also hopefully, you know, shed some light for some providers on the nuances in collaborating and not just building those relationships, but continuing those relationships too. Because a lot of times it's like, well, how do we find the referral sources? Well, once you do find them, you have to nurture them like just like you would in any. It's a business, you're in a business, they're in a business. Just if, you know, like in my online business, like people have to be nurtured. They have to know that you care and they have to know that like you really want the best. And yes, we can assume that about everybody but unfortunately we live in a time where like you have, have to constantly remind people of that too. So you know, it's, you know, and genuinely. Right. I'M not saying go do this if you don't actually care, but, like, if you genuinely do care and you generally want to, like, keep those relationships and you enjoy, like, what you're doing and how what you're building and helping with, like, that is a very, like, nurturing relationships is a critical part of any business, whether it's a private practice, a medical office, you know, in a hospital, which is even harder there. But you know, there are certain nuances too, right. That make it very challenging to do this in certain places. But this has been amazing. Is there anything that we haven't covered that you want to share?

I don't think so. I think besides more so I guess getting to more just really quick, the IBCLC side of things and kind of going off of what you just said. I think that if you are treating babies and you can make a lasting, positive impact with parents or moms, that is also a very awesome way to like, gain business. Because moms that are helped during postpartum or feel supported or feel confident that part of my business is just exploding in a positive way, which is what I always wanted because I love the babies, like, give me the babies. And that has what has kind of built my, like, brand or caseload is. And I know you can relate. I can relate. As a mom of three boys, when you walk into an office and as a mom, you feel like you are being heard and you're being supported and loved and that provider wants what's best for you and your baby. You know, moms talk about that, mom groups, mom get together, family members, all of that. And so I will say that area of my practice more than anything has just really exploded. And I, I think it's just because, like, being able to be specialized and be collaborative has just helped so many of my moms and babies get best care and best outcome. So I just kind of wanted to touch on that. Yeah.

Now those word of mouth referrals, they will carry you any day, every day. I've never done paid advertising, like, in my private practice. I think I tried it like once I put like $150 that I got for free from Google, like, into like some ads and I got no calls. And I was like, I don't really need this. I mean, I get all these word of mouth referrals. Everyone's tagging me in the Facebook groups. And I think that really speaks to like, some of the other things we've talked to. Like, you know, yes, you're hearing the patients, you're, you're the moms, you're. You know, they trust you. They feel supported. They don't feel like you're just taking their money and doing what you feel like you need to do. You're actually asking them, how can I help you? And really, you know, listening to them, and that's.

That's huge.

And it's a skill that's actually unfortunately lacking in a lot of private practices out there. And so, you know, to any private practice owner in any realm, if you want to build your business, like, maybe take a good look, hard look in the mirror and ask if, like, 1, are you aligned with what you're doing? Do you actually want to be doing it, or is it just something that you feel like makes you money so that's why you're doing it? And then two, like, could you just ask your patients, like, how can I help you today? Like, what's going on? And just, like, be silent and let them respond to you. Be like, how are things going? How was this past week since I saw you last? Like, when you ask these, like, open questions and you actually listen to. Listen. Not listen to respond, but, like, listen to actually help. Help figure out what to do that day in the session and how to help them, like, continue making progress going forward. It's very different than, like, picking up your papers and being like, step one said this and step two said that. So I'm gonna ask them if they did their homework and how the last week was. But then we're gonna jump into step three. Like, no, none of that.

Yes. And I love that. I will say, I feel like that's some of the best feedback I get about my private practice. Beyond me. Even just my own therapist is like, you know, so many of our families feel like they have a relationship with their therapists, and I'm like, that's what we want. Like, that's. You know, because as you know, we are doing the 30 to 45 minutes a week with you. The. The parents are what has to help us implement everything we want. And if they're on our side and they respect us and they can come to us, outcomes also improve and increase. And yeah, so I. I agree with you 100% that that relationship is. Is one of the biggest drivers to helping, I feel like, private practices be successful.

Yeah. Well, this has been amazing. I know we could talk private practice all day long. I love everything. Business. I love what you've done.

This is.

And this is very cool. Thank you for sharing your perspective. Also, just having been in an ENT office, and then also just, you know, maintaining those relationships, but also building outside, you know, relationships with other professionals outside of that too. Because I know that's, that's a big pain point, I think, for a lot of private practice owners. So thank you.

Yeah. Well, thanks for having me on. This has been fun.

Yeah, this is awesome. 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@halliebalkin.com or pop over to alliebalkin on Instagram to get all the latest updates.