From Social Worker to Practice Owner with Brent Metcalf

Brent Metcalf (00:00):

I think when you're in the thick of it, at least for me, the thinking about the business side of things kind of just went on the back burner because then my social worker hat really is what kicked in and like we got to help people because these are our people. This is our community. They need it.

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Michael Fulwiler (00:18):

This is Heard Business School where we sit down with private practice owners and industry experts to learn about the business of therapy together. I'm your host, Michael Fulwiler. This week I'm joined by unofficial Heard president Brent Metcalf. Brent is a trauma therapist and owner of Tri-Star Counseling specializing in accessible mental health care for Appalachia. He's also a mental health advocate and active member of the Heard Customer Advisory Board. In our conversation, Brent shares his journey growing up in rural east Tennessee and how that shaped his approach to therapy and community care. We explore the challenges and rewards of building a private practice in Appalachia, the importance of accessible mental health services and the realities of expanding into a group practice. Brent opens up about the impact of natural disasters on his community and how his practice stepped up to provide trauma support during difficult times. His insights into balancing business and clinical work, plus his commitment to doing good in his community. Make this episode both practical and inspiring. If you haven't met Brent, you're going to fall in love with him just like we haven't heard. Enjoy Brent Metcalf. Welcome to the show.

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Brent Metcalf (01:36):

Thanks for having me. I love the intro. Honorary president.

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Michael Fulwiler (01:40):

Yeah, I added honorary there because we do actually have a president, although she is out right now on maternity leave, so I guess you're the acting president.

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Brent Metcalf (01:50):

I'm

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Michael Fulwiler (01:50):

Filling in her shoes.

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Brent Metcalf (01:51):

For the time being. Yeah. How does that feel to be the president of Heard? I feel like I've earned it. It's great. I'm ready to sign some people's checks, make some good policy decisions, so just send me whatever I need to do. I'm here to give my stamp of approval.

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Michael Fulwiler (02:05):

You're joking, but you're not joking because you've given us so much of your time and feedback over the years. I'm sure you've referred a bunch of therapists as well, so we're really grateful for you, Brent, and I'm excited to have this conversation and learn a little bit more about your background.

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Brent Metcalf (02:22):

Yeah, I'm looking forward to it. I keep telling people sometimes I feel like I'm my walking billboard for her, even when I'm not wearing the shirt. I just talk about everything that you all have done for me in my practice over the years. So always sending people to her.

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Michael Fulwiler (02:36):

Well, we appreciate that. For folks who are just listening to the audio, I'll describe to you, Brent is wearing a Heard– He has a Heard mug as well for the folks watching YouTube. You can hold that up. Yep, there you go. This is not a paid sponsorship, probably should be, but thank you to Brent. Okay, so you were born in Greenvale, Tennessee, which is rural east Tennessee. What was that experience like growing up?

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Brent Metcalf (03:01):

Yeah, born in, I like how you put the emphasis on Ville and it's just Greenville. Greenville, excuse me. Yeah, sorry. It's spelled Greenville, but it's Green Bull, very southern and Appalachian ish. Yeah, born there and then went back and forth between there and Jonesboro. Tennessee's oldest town. It was a very, wish I shared with you other day. We're just southern folks, great time to be alive type deal. Just enjoying things. Now, share the story that I share with you with the people on the podcast about my a high school, very country southern named after David Crockett and Tennessee's greatest volunteer. He was just born right down the road where I grew up, county rival high school named after Daniel Boone, and then

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Michael Fulwiler (03:46):

It's like something out of a Hallmark movie,

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Brent Metcalf (03:50):

And I wish I was saying I could make it up, but definitely not. And then they would play each other in football. It was called the Musket Bowl, and literally the winning team would run around the field with the musket over their heads and then hang it in our cafeteria for the remaining school year until the next year's sall. Yeah,

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Michael Fulwiler (04:14):

That's incredible. Went to Carson Newman University, did my research, which is a small Baptist university. You double majored in religion and human services. Was social work becoming a therapist at some point? Was that on your radar at that time in undergrad?

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Brent Metcalf (04:31):

Yes and no. So I originally was going to Carson Newman and declared religion as my major because I was going to go into ministry, do ministry things, but then I'm like, well, I'm here. Might as well make the most of my college experience and get the most I can. So double majored. I'm like, well, what goes hand in hand with ministry? We didn't have a social work department. The next thing was human services. I'm like, we'll go with that. And then from there I went from internships with different social work teams, like our local department, children services, and I've been in social work ever since.

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Michael Fulwiler (05:06):

Interesting. I didn't know that you were actually interested in becoming a minister. Did you grow up around the church?

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Brent Metcalf (05:13):

Yeah, in the south. Of

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Michael Fulwiler (05:14):

Course I did.

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Brent Metcalf (05:14):

Yeah. Excuse me. Yeah, we have a church, multiple churches on every corner here. Yeah, grew up in church. Yeah, I don't know of a time where I've not really been out of church, honestly. Yeah, I grew up in it, loved it. It's always been a huge part.

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Michael Fulwiler (05:32):

Yeah, no, it's interesting. I was sharing this with you in the pre-production that when I think of Tennessee, I think of Nashville, I think of big city. I don't necessarily think of Tennessee as the south. When I think of the south, I think of Alabama or Louisiana,

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Brent Metcalf (05:55):

But

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Michael Fulwiler (05:56):

Deep south you're right there too. Yeah, I guess that's deep. Yeah. You have south, sorry, not to offend any southerners here, but we're setting the record straight there. So after undergrad you said that you had internships and was it Child Protective Services? How did you get into that?

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Brent Metcalf (06:11):

Yeah, so it was part of my undergrad, had to do an internship. I started out at the Department of Children's Services doing Child protective services intern. Shout out to my folks in the Smoky Mountain region, and it got bit by the CPS bug and fell in love with it. What about it? Oh, just honestly, I feel out sometimes it just like the adrenaline rush of just going and protecting children. I mean, there was even one time, I dunno if I should probably show this story, but I'm going to anyway, I wasn't doing a high speed chase. We're not even police officers, we're just trying to track down these parents to remove their kid. They leave the scene, so we follow them somehow. We get behind a car that has pulled over and we're like, Hey, we need your kid. Completely wrong vehicle. So yeah, just fun times like that. I'm like, okay, that was great. Busted meth labs before. Sometimes I even busted a meth lab on accident. I was at the wrong house place, went in, found meth.

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Michael Fulwiler (07:20):

Wow, great.

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Brent Metcalf (07:22):

That's how good I

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Michael Fulwiler (07:23):

Am. Intense. And then you went back to school. So you went to the ut. What led to that decision to go back to graduate school?

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Brent Metcalf (07:32):

So I knew I wanted to get my master's and I was still playing around with the idea of still doing ministry. I was going to go to Baylor because they had a dual degree program where you could do an M div, master's, divinity and Master's social work at the same time. But then DCS had a program where they would pay for my master's degree. I just owed them two years of my life talk. Wow. Weighed the options, go to debt for two degrees or get one degree basically for free. So we went that route and I liked what I did at DCS, so it made sense.

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Michael Fulwiler (08:10):

What is DCS?

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Brent Metcalf (08:11):

Department of Children's Services. Oh,

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Michael Fulwiler (08:13):

Okay. Gotcha. And were you doing that during your master's or was that after?

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Brent Metcalf (08:19):

No, we were doing during, yeah, so I graduated from Carson Newman. I think I even had a job interview at Carum and the day I graduated, I literally walked across the stage, had lunch with my family, went to a job interview and then worked there, worked for my master's degree with them the entire time. Graduated from my master's, worked for them for two years, and then transitioned to Vanderbilt as a mental health consultant for the Department of Children Services. So I've been in with department children services for a hot minute.

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Michael Fulwiler (08:49):

How was that at Vanderbilt? What was that experience like?

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Brent Metcalf (08:52):

It was a fun time. I would basically do assessments or help CPS workers and foster care workers do assessments and complete assessments on the children coming into custody. So I was constantly attending just child and family team meetings, assessing the needs, mental health needs of even just the families, the children, that sort of thing to make sure everybody's doing the appropriate services and care that they needed. I was there for about a year and then while I was there, I was also getting my LCSW, so I was working at Vanderbilt. I think I was doing some part-time work at one of our local community behavioral health agencies there. Then I started my own practice. Once I got my LCSW part-time, then the phone kept ringing and I got super busy and stressed out and couldn't do both. And my financial advisors, you got to go into private practice this time. I don't know. I don't know that I'll be full or how it's going to work. I was a nervous wreck, but my lovely wife and financial advisor, they always push me to do the things whether I'll go to the bathroom during a meeting and I'll come back and like, Hey, Brendan, this is what you're doing now. It's great. So yeah, so then I went full time and growing.

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Michael Fulwiler (10:09):

Yeah. What was that process like? When you say I started my own practice, what were the initial steps that you took?

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Brent Metcalf (10:18):

Well, funny enough, the initial step was probably hiring her. I knew I needed an accountant. I'm a social worker. I don't do math. I do good to count to 10. I like the idea of having someone who specialized in therapy practices and her was, it actually met Andrew, he was my lead accountant for a while. I bounce ideas off of him. He helped me grow and the rest is history as far as my relationship with her. That's how I became president. I just got in with the CEO and

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Michael Fulwiler (10:50):

You just stuck around the longest you were working with Andrew. So for folks who don't know, Andrew is our CEO. And so if you're working with him directly, you're probably one of our early customers, early adopters.

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Brent Metcalf (11:03):

He says, I'm an og.

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Michael Fulwiler (11:04):

Right. And Heard has evolved and changed over time. What has that experience been like for you as Heard has grown?

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Brent Metcalf (11:15):

I mean, it's been fun. I still get all the things that I liked. I just missed at times hanging out with, I used to hang out with Andrew once a quarter and we would do, now we get to, yeah, right, actually, so it's even better. Sorry, Andrew. Yeah, so it's been a good time. All my needs have always been met just in a different way because before I would send a message in the Herb platform, and I think it was just basically Andrew that was responding all the time, but now someone else responds because it's more of a teen approach, which is fine. Yeah, it's still good, just different.

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Michael Fulwiler (11:53):

And the reason that I bring that up is over the years as our business has grown and evolved and changed, I think it has been difficult for some therapists who are part of that group who joined at the beginning and they were used to working directly with the CEO, but just at this point, it's not realistic for that to continue to be the case. So

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Brent Metcalf (12:16):

Oh, I was definitely one of them. I was on the bitter side at first. I think I even called Andrew one day. I'm like, I don't like this. And I threw a temper tantrum, but it's been fine. I'm not going anywhere. Yeah, did you feel heard? Yeah. He's like, I hear you. We're trying to find out how to give it that personal touch still, but it's just the business is growing. We can't, like I understand. I'm just sour about it, but it's okay. Yeah. I'll

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Michael Fulwiler (12:42):

Also be your friend. We appreciate that. And feedback is something that we take very seriously. I feel like a lot of companies say that, but we actually do. We have a customer advisory board. We're constantly talking with therapists and all the reviews that come in, both the positive and the negative. We read all of them, we share all of them internally. And so I think that has been just a fundamental piece of our culture since I've been with Heard for the last three years, is just being really close to therapists, listening and growing together is the goal.

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Brent Metcalf (13:21):

Yeah, I would agree with that a hundred percent. I think you all do an excellent job of listening to the feedback, good, bad, and ugly. And actually when I'm even talking to people about Heard, when they ask me who do I use for my accounting and bookkeeping, that's kind of one of my selling points of why you should join Heard because they really value their customers and customer feedback. Some of the things like I asked for, again back when Andrew was my lead account, this would be great in the platform. I'm starting to see it now and I'm like, I've been waiting. It's great. And it's finally here

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Michael Fulwiler (13:56):

And sometimes it takes a while. I'm not a software, I'm engineer, but it can take some time to build out features and things like that. But just again, really appreciate all your patience with us and it really means a lot I know to the team. So you mentioned that you had a financial advisor. So was this a person that you had before you went into private

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Brent Metcalf (14:18):

Practice? And also, funny enough, his name is Andrew as well. So I have a team of Andrews that I surround myself with. So if you're not on Andrew, you don't get to help me make any decisions. Sorry, Mike.

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Michael Fulwiler (14:29):

You heard it here?

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Brent Metcalf (14:31):

Yeah, but I had a financial advisor before I started my private practice. I think even before I went to Vanderbilt, we were still at UCS. My wife and I had just got married, and so I'm like, well, I'm getting married now. I should probably start doing adulting type things and planning for retirement, and I don't know how to do that either. Again, I'm a social worker and don't do math. So my realtor who sold us our house when we got married, her husband does financial positive. We got connected with him and game changer. So if you don't have a financial advisor, folks that are listening, I highly recommend it. I even recommend it to my clients. I see in therapy the amount of people that I'm referring to, financial advising is insane.

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Michael Fulwiler (15:14):

What are some types of things that you talk to your financial advisor about?

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Brent Metcalf (15:18):

Well, it started out as just kind of retirement and that sort of thing. And then as I got my LCSW and we were even before the LCSW, the goal was probably try to at least open a part-time private practice and the steps to do that. So the hesitancy around going from transitioning from part-time to full-time, that was a huge conversation with him. And he's like, it'll be fine if you're worried about income or whatever, we will stack cash that way. You have an emergency fund if you need it. And luckily I didn't. And then even with him, it was transitioning from full-time solo practice to group practice. That was even scarier for me, and that was one of the times where him and my wife tag teamed against me and we're doing it. And so yeah, the rest is history and now I'm leasing a space.

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(16:15):

I knew at some point I wanted to either own a building or build and he said, well, let's put it in the financial plan. This is what it looks like. And we mapped it out. And that's one thing I I love about financial advisor, Andrew, is he knows I'm very visual, so it's not uncommon for me to leave with literally a sheet of paper where we're having to draw maps, how the money flow and things going to work. Bam. We mapped it out and he's like Two years, hopefully we should be able to get you a building because I just found a two year lease and my lease is up and hopefully we'll be closing on a building in a few weeks.

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Michael Fulwiler (16:56):

Congratulations.

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Brent Metcalf (16:57):

Yeah, thanks. So I'm going from a four office suite to building with 20 offices, so plenty of room to grow. Wow. You're taking over

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Michael Fulwiler (17:08):

Trying to, I want to get to the expansion into a group because I think that is an important conversation. Before we even get to that, I want to bring us back to you're going into private practice, you're making that decision. Sounds like, were you building the private practice on the side initially as a part-time?

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Brent Metcalf (17:33):

Yeah. I started out just part-time gig just for kicks and giggles, just vacation money because bills were paid by Bandee, but who doesn't like to go? My mom likes to go to Disney World, and that's what the private practice was for and to our Disney World Fund, and I fell in love with therapy, which I knew I loved therapy when I was at the community Bay Health stuff, graduated, took a break working on my clinical hours. I really like it. At one point I was just going to be a macro policy guy. I did child protective services at DCS, but then I also transitioned to doing continuous quality improvement at the department as well. Before Vanderbilt, they're like, I just really miss one-on-one stuff with clients and seeing closure so much like the CPS stuff, I could just see closure from times. So we started out and then the phone kept ringing and I'm all about helping my people in Appalachia. That's why I started my practice to provide quality and affordable mental health care. I think a lot of times we get overlooked here and don't have a whole lot of resources. Why do you feel

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Michael Fulwiler (18:46):

Like it's so important for your community to have access to those resources?

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Brent Metcalf (18:52):

Well, one, it's just because, again, we lack them quite a bit, especially to think about just kind of Medicare and Medicaid cuts that are happening off and on in the government. People can't afford therapy a lot of times. So that's one of the reasons why I take insurance is because I want people to have access to care. So the insurance pay me great, not always, but I'm meant to provide quality care. So yeah, I think just the Appalachian region alone is just often, and it's just throughout Appalachian history, often overlooked. Not a lot of resources misunderstood people and I'm here to change the script on that.

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Michael Fulwiler (19:37):

I love that. For folks who aren't aware, where is the Appalachian region located? So

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Brent Metcalf (19:44):

Appalachia, actually, it's very big. It basically stretches across 14 states, basically like Georgia, almost up to Maine. But when I'm talking about Appalachian, I'm usually talking about southern Appalachia. So Virginia, North Carolina, Tennessee, Georgia. Yeah, east Tennessee. It's not all of Tennessee's in Appalachia, Kentucky, West Virginia. Yeah, usually all the southern states is basically

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Michael Fulwiler (20:09):

Appalachia. When I think about Appalachia or Appal Appalachia, which is No, no, it's not. Correct. Yeah. If I was to say it incorrectly, that's what I would've said,

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Brent Metcalf (20:20):

But I get very offended. Offended real quick.

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Michael Fulwiler (20:22):

I'm glad I didn't say that at pal. Yeah, so that to me is like North Carolina, West Virginia. It's like the national park or the forest, right? That's where Gray,

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Brent Metcalf (20:33):

Smokey Mountain,

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Michael Fulwiler (20:34):

Exactly. Asheville, North Carolina. There's quite a few therapists who we've had on the show actually who are based in Asheville. Alison per year is one I love following her on Instagram because she always posts videos of bears just in her neighborhood or walking down the street. Do you have bears where you are?

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Brent Metcalf (20:54):

Yeah, so I'm actually just in an hour from Allison. She's just over the mountain from me. We have bears, we have deer, possums, raccoons or trash pans, whatever you want to call them. So we have two dogs. My wife and I, we went to dinner and whatnot, and there's some condos behind our house that just older retired people live in, and we came back and there was just a piece of paper that just had, that was taped to our gutter of our house. I'm like, what is going on? And I look and it says, check dogs. There was a bear. Oh my God. Yeah, it was a bear cub. It was fine, but our neighbors were a little overdramatic and this older guy, he was just walking around the neighborhood telling everyone we saw bear. Yeah. Yes, all the time.

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Michael Fulwiler (21:44):

There's gear.

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Brent Metcalf (21:45):

You got it all.

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Michael Fulwiler (21:46):

That's very jarring. So bring us back. You mentioned the phone kept ringing, people kept calling. Why do you think that was the case? How were people hearing about, how are people hearing about you?

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Brent Metcalf (22:03):

That I don't know because I literally just had a very crappy website that did not have a lot of SEO. I was blogging like crazy, but that can only do so much for you when you first start out. I think part of it was the tail end of COVID when I started my practice and I mean I think COVID really just opened the can of worms of and exposed people need therapy and at this point people were tired of being stuck in their house forever, and so I think that helped and they just somehow either found on Psychology Today or Google or some friends were like, oh, well my friend Brent just actually just started a therapy practice. He's great, super nice person. You should go see him. And the rest is history and then client for referring their friends. And I'm just raining.

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Michael Fulwiler (22:56):

What is the saturation of therapists where you are? Were you one of a few therapists in your area in a more rural area? Do you think that plays a part?

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Brent Metcalf (23:08):

So at the time when I first started, my office was in Johnson City. I was subleasing a space and Johnson City is getting more and more saturated. A lot of people are actually starting to move to Tennessee. We don't have a state income tax here and people love that also really great. But yeah, Johnson C is growing and we're getting more and more therapists here too, so it's getting more and more saturated at the time. Again, just we ripped that bandaid off and there was just enough, there's more than enough people to go around. So it's like we're constantly in competition with each other. No, I'm not going to share clients with you. No, please. I'm full. Who can I refer to?

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Michael Fulwiler (23:48):

Yeah, yeah, yeah. I've wondered about the difference between an urban practice like New York City or San Francisco versus a more rural practice and how marketing is different. And I'm curious for you being someone who's in a more rural area, are there certain marketing techniques or strategies that have been effective for you that maybe wouldn't be as effective in a more urban setting?

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Brent Metcalf (24:18):

So I think for me it's really focusing on the aspect of family and really getting family members to talk to family members about their mental health and therapy. I was actually just having breakfast with another social worker this morning. We were talking about how Appalachia, there's one in general outside of Appalachia, there's stigma around mental health. No one wants to admit we have mental health concerns. Then in Appalachia we definitely are not going to talk about it. And because the rule is we keep our stuff within the family. We don't do help outside of family. We might do friends, but our tight circle is where it's at. So I think that for me, if I can get in with a family member and make these drastic improvements, oh well now my dad needs help. He's not really a therapist guy doesn't believe in therapy. I even have one client, good old country boy, one of my favorite clients that is my go-to population is the good old boy country guy.

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(25:31):

He sat on my couch and he's like, I'll tell you what doc, if you would've told me 20 years ago I was going to be coming to therapy on a weekly basis, I would've told you you were crazy. He goes, but I love it. I love it. I said, I'm glad that's what I'm here for. So yeah, so we're just trying to change the game and Appalachian, again, it starts with family because I think his daughter was going to school to be a therapist and that's how he got in with me. She strongly encouraged him to go and find someone.

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Michael Fulwiler (26:03):

That's so interesting, the cultural dynamic. Do you think that that's like an Appalachian thing? Is that a southern thing? Where do you think that comes from?

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Brent Metcalf (26:12):

Yeah, it's definitely an Appalachian thing for sure. I would imagine it's also, first, part of the South as a whole, but definitely Appalachia because again, we have to depend on each other for the longest time to get things done. Even with Hurricane Helene that came rolling through and just wiped out our area, the biggest supports was family and friends and just your community helping each other. The government showed up for a bit that really is family community that was helping out and the boots on the ground, getting things done and organizing stuff.

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Michael Fulwiler (26:49):

Being a therapist is about helping people, not crunching numbers, but when you're running your own practice, managing finances can feel like a full-time job when you never trained for. That's where Heard comes in. Heard is the financial management platform built just for therapists. No more cobbling together spreadsheets, DIY software or expensive accountants with Heard, you get bookkeeping, tax support and financial insights all in one easy to use platform. Heard was started by an accountant and a software engineer who understand the challenges you face as a business owner. Our mission is to make it incredibly easy for therapists to manage their practice as a business, build wealth and stay focused on what matters most. Their clients join thousands of therapists who trust Heard with their finances. Schedule a free consultation today at join her.com/consult. Yeah, I'm glad you brought that up. I wanted to go there. What do you remember that Hurricane Helene, even just from the beginning, you heard this storm was coming or was it just something that was kind of unexpected in terms of how bad it actually was?

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Brent Metcalf (28:03):

Yeah, so we were just watching the news. We knew the hurricane had hit, we should be expecting some storms to be coming through. We get hurricane storms all the time as they go up the coast. No big deal, and I think that was the issue. There was no way to prepare for it because I read this situation was something that happens once every 1000 years. We're in the mountain and you're in the woods

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Michael Fulwiler (28:28):

In the mountains. You're not on the coast?

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Brent Metcalf (28:31):

No, we are in the mountains surrounded by bears. We don't get hurricanes up here. Our bears don't swim where they're not alligators or anything like that and just hit hard, like wipe out Asheville. You mentioned Allison and I think she posted her neighborhood just had trees and everything just down and could hardly get out. My family members and my family members went without water for a while. We just didn't know what to expect and it happened and then the community rallied

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Michael Fulwiler (29:07):

And you responded through with your practice on what did you guys do?

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Brent Metcalf (29:10):

Yeah, so we knew it was going to be rough. Just a lot of trauma, natural disaster stuff wasn't expected it, we saw just a lot of deaths and things from the hurricane, whether that came through a lot of property damage. Some people lost everything. One of my clients that I had, his car floated down like three counties. His car went missing and they found it three counties over. That's how much water and flood damage that we had and it just took everything away. But to respond, we offered free therapy sessions for a while. So again, trauma and despair had hit. We were even having people dying by suicide because they lost everything and despair hit what was the point? What's the point? I don't have a house anymore. I'm living in my car. This is no way to live. And we couldn't have that. So we offered free therapy sessions. We think we gave 'em folks like five free therapy sessions. Then even then at that point, if they didn't have funds, we could either talk about more pro bono stuff or refer them to free health clinics for that or get them more information about their insurance, EAPs, that sort of thing. So the therapy could continue.

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Michael Fulwiler (30:35):

How were you able to do that financially? Did you not take a paycheck or the therapists that were offering those sessions pro bono, were they still getting paid by the practice?

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Brent Metcalf (30:45):

Yeah, everyone's still getting paid and it wasn't necessarily, thankfully it wasn't just on us alone to have to do with the honest, all the therapists in that area, we all came together and said, here's the need, let's make it happen. So yeah, that was great. Then there were still people who they said, I can afford it. I have insurance. I don't want to take the pro bono stuff. So yeah, we had a lot of people. Appalachia very, were prideful and we're not going to just take handouts and things if we don't have to. So I have insurance, I can afford therapy. I'm just going to use that. Let the pro bono stuff go to the people that actually need it. Yeah,

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Michael Fulwiler (31:22):

That's amazing. And how was it received by people? Did people take you up on it and were appreciative

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Brent Metcalf (31:29):

Of it? Most definitely. And we even had one company who lost basically their entire business from the flooding reach out and say, we have so many employees, can you just bring them? It's fine. We'll sort it out and they need the help. We'll see them.

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Michael Fulwiler (31:49):

Wow. It brings up a question for me. How do you think about profitability and the business side of running a therapy practice but also supporting the community, especially during times of such despair?

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Brent Metcalf (32:04):

So I think when you're in the thick of it, at least for me, the thinking about the business side of things kind of just went on the back burner. Then my social worker hat really is what kicked in and got to help people. These are our people, this is our community. They need it and at some point they're going to end up taking care of me by either coming and seeing me once they can afford therapy again or referring friends and family of, oh, well, Brent's practice helped me when I lost my house and helped me get through the grief of losing grandpa call or whatever it is, and now their friend needs a therapist to go check out, trust our counseling.

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Michael Fulwiler (32:43):

Yeah, it's always a good idea to do the right thing. That was advice. I remember Elizabeth Shaw shared on season one. She's a group practice owner in the Philadelphia area and she's, her advice that she shared with us was just do the right thing. Pay people on time. Don't lie. If you do the right thing as a business owner, good things will happen. When you start to cut corners and not do the right thing, that's when you start to get yourself into trouble and sounds like that's what you're talking about at least when it comes to supporting the community and showing up for people.

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Brent Metcalf (33:22):

One of the things that always stuck with me in my time at Carson Newman in undergrad, my human service professor, Tonya Ramsey, she would always say, go tilt the world in a better direction than what you found it. And that has always just stuck with me. So I'm constantly thinking and trying to see how can I just keep tilting the world in a better direction.

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Michael Fulwiler (33:44):

I love that. I want to come back to something else that you said said that your financial advisor encouraged you to expand your practice into a group, and you said that was very scary. Why was that scary?

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Brent Metcalf (34:02):

Because in my mind, again, I got to take care of my people. I'm now no longer responsible for feeding my household, but now I have this other person who is depending on me to pay them so they can also eat and pay their bills, but I have to get them clients because they're W2 employees. They don't do the marketing. That's me. So that was very stressful and overwhelming of oh my gosh, how am I going to get them clients? I have clients, but I also have to keep me full too. So how do I pick and choose who's going to wear and how many clients do I keep and send to them and how many clients do they get? Very, very stressful. It worked out.

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Michael Fulwiler (34:47):

It sounds like it is a responsibility for someone else's livelihood as an employer, and that's a lot. When you say it worked out, what happened? How were you able to work through that?

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Brent Metcalf (35:03):

Yeah, just announced we moved. I was in the new office, so I was in a four office suite by myself for about two months before I brought anyone on because I kept just overthinking and getting anxious about, I don't know that I'm going to be able to feed another person. And then, yeah, my financial advisor and my wife, I just do it already and just put something out on social media that you're hiring. My first hire Tanya, we actually went to, she was working on her master's in social work and I was doing a graduate certificate program in Ful Alcohol and Drug, and we clicked in grad school, and I think I even told her in a chat on Zoom in class of we're going to work together one day. So it's like this self-fulfilling prophecy that was spoken into existence. And so we had just connected and we had a mutual friend who was telling me that she was looking about starting her getting her clinical hours for LCSW, and then she messaged me on Facebook and said, Hey, it's been a minute, but I think I hear that we need to talk.

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(36:06):

I said, yeah, let's do it. So we had coffee and clicked once again and she started a month later and we just posted Tanya's here and we filled her up. The way that it kind of helped was because insurance can be a pain with provisioning licensed folks. Not everyone will let you bill for them is I had my rate, but my provision only licensed people had a reduced rate. So I always had a sliding scale when I was solo practice. And then now with provisionally licensed folks, I don't really offer sliding scale anymore. They kind of are my sliding scale. So if you don't have insurance, can't for myself pay, go see my provisionally licensed person and usually that's really how I get most of my provision. Lawson spokes full now I have five therapists including me and only two were fully licensed and they're in bra full and I need to hire someone else.

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Michael Fulwiler (37:06):

Yeah, you got to

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Brent Metcalf (37:06):

Fill that big office. Yeah, I got to fill up my 20 office.

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Michael Fulwiler (37:10):

Do you do all of your own insurance credentialing and billing? How have you managed that part of the business?

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Brent Metcalf (37:17):

Yeah, so I try to be a minimalist as much as possible. I think that's probably part of the reason why when you're mentioning profitability, I've done fairly well and because I just do a lot of the things myself. For the longest time, I did all my credentialing for me. When I brought on another fully licensed person, I did all their credentialing, didn't hired out why not sure I can pay someone, but if I'm in network with 10 insurance companies and I'm having to pay 400 bucks per insurance company, well that's a lot of money and I don't want to have to do that, so I'll just take on the burden and do it. And then for the longest time I was even doing all of my own billing and submitting claims for us and then to change healthcare fiasco happened and navigating that for a group practice and not having a biller. It was such a headache, but we got through it and it worked, worked out.

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Michael Fulwiler (38:18):

What happened for folks who were unaware, didn't experience it themselves.

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Brent Metcalf (38:22):

So change healthcare basically. You got held hostage by some cyber attack ransom company for, I can't remember how long it was. It seemed like forever, but it impacted a whole lot of therapy practices because change healthcare was the clearing house that our EHRs would use. So you couldn't submit claims without going through change healthcare if you were using your EHR to submit your claims. So people were still providing therapy but not getting paid. And again, I'm freaking out because I'm a group practice owner of I have mouths to feed, including my own. I can't pay them unless I have money coming in. So now I've had to go to each individual payer portal and submit claims by hand, basically one line at a time throughout that entire, how long did that last? Two, three months, something like that. It feels like maybe more. It was such a headache and my therapist told me the other day, she's like even the headache or the stress of that, we never felt that stress because you just took the ball and you did what you needed to do. We didn't even know there was any delays in payments or anything just because you did what you need to do in order to make sure we were fed, taken care of and the business was running.

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Michael Fulwiler (39:48):

It's a big part of being a business owner is what happens behind the scenes that people don't see, which can be hard. People don't really know what's going on. It's good for the team, but it can be difficult for you as the owner.

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Brent Metcalf (40:05):

Right? Yeah. I tell people a lot of times I'm all about making friends that with other group practice owners, I'm not making friends with other therapists. It's fine, we all get along. But being a group practice owner, I did not realize how much of a lonely place that is because I'm constantly doing all the things working around the clock. It feels like, look on watch, she'll probably get mad at me for saying this part, but sometimes she gets mad at me. I'm working around the clock. I don't see clients on Fridays. But then Fridays that have become networking with either other group, practice owners, other therapists, marketing meetings, proving notes, whatever it may be. Like you're always working. I'm like, my job doesn't stop when I stop seeing clients. There's so much more to do, having to sign up and improve on all the pre-loss therapists notes and treatment plans and all the things while also doing the money side of it too.

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Michael Fulwiler (41:04):

Absolutely. That's something that we also deal with at Heard in a different capacity. When you're building a startup, it also feels like it's all the time. I was just thinking as you were saying that recently you sent me an email the other day at 12:30 AM 1:00 AM and I was still up and I was on my phone, so I responded, and then you wrote right back and I was thinking, why is he working? And then I was like, why am I working? How do you manage that though? How you kind of teeter that line between working all the time and putting in the hours that are needed to run a business without going too far and burning out?

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Brent Metcalf (41:45):

Oh, I'll suck at it if I'm being honest. Suck at it. I will. I'm the type of person where I know what my limits are, but I'm going to keep going basically until my body runs out. So all the things I tell my clients not to do, I do. Recently, I've tried to make at least one day throughout the weekend of literally I've tried to do absolutely nothing. I become one with the couch. I have a dog beside me and we're just Netflix and chilling. One with the couch so much that when I get up, leather is also attached to my back. I'm not moving.

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Michael Fulwiler (42:26):

Even that can be difficult for folks who are used to working all the time. They feel like, well, I'm wasting time. I'm not being productive. I should be doing something. And as a therapist, it's important to have that time

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Brent Metcalf (42:41):

And occasionally I'll get that mindset too. When I'm trying to do nothing is okay. I need to be somewhat productive so it'll make me feel better. I'll still be one with the couch, but I will livestream a CU from my computer onto the tv that doesn't count down as a rest, so we'll just watch someone tell me how to do therapy while I've had the dog and she's like, oh, you're so stressed. And yesterday my social emotional support animal. Thank you for being here.

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Michael Fulwiler (43:08):

Oh, that's funny. I had a question about insurance billing. So someone asked me this recently and actually didn't know the answer. Have you ever renegotiated your rates with insurance companies in order to negotiate a higher reimbursement rate

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Brent Metcalf (43:27):

Every year?

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Michael Fulwiler (43:28):

How do you approach that process? What does that look like?

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Brent Metcalf (43:32):

So usually I will write a letter. Sometimes I get told no and I get upset and pound about it and then actual or an email. So I will top out an actual letter like on a typewriter. Yes, I'll get out my type. Yeah. In high school, that's right.

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(43:55):

I went to Crockett. Let's get it right. David Crockett High School. Yeah, that's right. So I will, I'll get on my good old Google Doc, top out a letter saying, really also looking at realistic numbers too of this is the amount of clients that I see who have whatever the insurance is, this is what we charge, this is what you're currently paying. I need, I'm requesting an increase for this, and this is, I just justify it by, I provide this service, this service, this service. I'm one of the only practices in the area that provide X, Y, and Z. And then at the end of basically say I give them a deadline of you have 24 hours short spot, not necessarily 24 hours, but I give them a deadline and they either write me back and then I'll attach to an email and send it to whoever's supposed to get to it. And they say, yeah, here's a couple cents. Is that what the increase typically is? You usually not a lot. I think with one payer in particular, they will typically give me two bucks. Wow. And so I would drop you in a heartbeat if you are not the biggest payer for, or the payer for the biggest employer in my area.

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Michael Fulwiler (45:07):

That's helpful. Thank you for answering that. Something I've been wondering, Brent, we're getting to the end unfortunately. I have a few rapid fire questions to close it out. You ready?

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Brent Metcalf (45:20):

Let's go.

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Michael Fulwiler (45:20):

Alright. You already shared this with me camera. Who are the top three people in your life?

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Brent Metcalf (45:28):

Oh, gosh. So I'm going to have to list my wife, talk three people, my wife, of course by default, number one, she'll tell you she's not number one that she's number one. She'll tell you that my brother is my number one. As we are very close. My brother's definitely up there, so wife, brother. And then honestly, on the business aspect of it, I'm looping them together like my team of Andrews because I would not be where I am. I was talking to someone about her the other day. They had questions and they knew I was a Heard member and I just told them I would not be where I'm today if it was not for my financial advisor and my accounting folks at Heard.

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Michael Fulwiler (46:16):

Appreciate that. One piece of advice you have for therapists who are going into private practice,

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Brent Metcalf (46:24):

Don't overthink it, but don't underestimate it either. Find the balance. I think some people, we usually typically fall into two camps when they're starting a private practice of I got to do all these things and overthink it and they stress themselves out, but while it's difficult, it doesn't have to be that difficult. And then there's the camp of, oh, this is easy. I just hang a sign up and people want to come to me. And that's not how it works either, so you got to find the balance. Yeah, I like to quote Ms. Frizzle from thematic school bus, take chances, make mistakes and get messy. And that's what I tell my social work students when I teach. So you're going to make mistakes. It's going to happen, but that's how we learn and how we grow.

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Michael Fulwiler (47:03):

I love that. That's great advice. What's the best part of being a trauma therapist?

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Brent Metcalf (47:10):

Seeing growth and healing. I love it when I can see the block bulb moments go off in my office and really see people like their PCL five score. What we use to gauge PTSD symptoms go through the roof to not even meeting the criteria for PTSD anymore just gives me butterflies and things in my stomach. I love it.

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Michael Fulwiler (47:37):

What's the most difficult part of being a group practice owner?

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Brent Metcalf (47:41):

Again, probably just balancing all the things and the loneliness of it, of also being a therapist. If you're still providing therapy while being a group practice owner, being a therapist, being the boss, also being the biller. If you're doing that, being the marketing guy, if you're doing that. Also, being hr, balancing all the things while also trying to balance personal life too, so you're not having to email friends at 1230 in the morning.

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Michael Fulwiler (48:08):

If you do, they'll respond. Finally, what's one thing that you want therapists to take away from this conversation?

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Brent Metcalf (48:15):

Always do good, do good. Support the community. Be there for your people and really keep your why on the forefront of your mind, because as long as that's at some point you're wanting to get burnout, like why in the heck am I doing this? It's reach back to why you started it in the first place.

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Michael Fulwiler (48:36):

Well said. Brent, thank you so much for coming on the show. Thank you for giving us so much of your time over the years. For folks who are interested in connecting with you, maybe they're looking for a job to fill one of those offices. Where can they you?

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Brent Metcalf (48:51):

Yeah, so we can reach us at our website www.trytri-starcounseling.com, or they can always send an email to info@trycounseling.com and we'll love to get connected falls on LinkedIn, Facebook, Instagram, whatever social we use out there. I don't think we're on the TikTok, but

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Michael Fulwiler (49:14):

The TikTok not yet maybe soon.

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Brent Metcalf (49:18):

Yeah,

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Michael Fulwiler (49:18):

Love to get you on the TikTok. You're also on LinkedIn as well, so I am, yeah. Recommend connecting with Brent on there. Brent, thank you so much. Really appreciate it. Yeah, thanks for having me. Thanks for listening to this episode of Heard Business School, brought to you by Heard, the financial management platform for therapists. To get the class notes for this week's episode, go to join her.com/podcast. And don't forget to subscribe on YouTube, Apple, Spotify, or wherever you listen to podcasts. We'll see you in the next class.