Autopsy of a Practice: How Scarcity Mentality and Fear-Based Decisions Took Down a Seven-Figure Clinic [Part 1]
WATCH THE FULL VIDEO EPISODE HERE!
This one is personal. In part one of our deepest dive yet, we begin the autopsy of a seven-figure practice that rose fast, broke even faster, and exposed what happens when the realities of a broken mental health system collide with raw human limits. This is not a business teardown. It is a confession, a reckoning, and a mirror for every therapist pushing through clinician burnout while trying to hold an entire organization together with grit and fear.
We unpack how early conditioning shaped a lifelong scarcity mentality, how that scarcity mentality fueled a grind that looked like ambition from the outside, and how scarcity mentality quietly infected every decision behind the scenes. The result was a domino effect of fear-based decisions, the kind of fear-based decisions that feel logical in the moment but corrosive in hindsight, the type of fear-based decisions that eventually collapse even the most profitable seven-figure systems.
We name what clinicians are rarely allowed to say out loud. We name what happens when clinician burnout becomes an invisible job requirement. We name what happens when the broken mental health infrastructure pushes good providers into survival mode. And we name the emotional cost of carrying all of this while trying to convince yourself you are fine inside something that looks like a thriving seven-figure business from the outside.
This is part origin story, part accountability, and part solidarity with every therapist who ever wondered if they were the problem when in reality they were operating inside a system that is fundamentally the problem. If you feel the weight of clinician burnout, if you have made fear-based decisions out of desperation, or if you are navigating the fallout of a broken mental health landscape, this episode will land exactly where it needs to.
What you will hear
The early imprint that wired a lifelong scarcity mentality and how it shows up in leadership
How clinician burnout becomes an identity instead of a warning sign
The quiet ways a broken mental health system shapes everything from hiring to ethics
Why fear-based decisions masquerade as responsibility and feel impossible to avoid
The moment a seven-figure practice revealed its fault lines in real time
If you are in the thick of it, you are not alone. And you are definitely not the only one trying to survive inside something that was never built to support you.
Connect with us!
Website: www.offthechair.com
Instagram: @offthechairpodcast
YouTube: @offthechairpodcast
Colleen Long, Psy.D.
Website: www.claritypsychologicaltesting.com
LinkedIn: Dr. Colleen Long
Jennifer Politis, PhD, LPC
Website: www.wellnesscounselingBC.com
Instagram: @wellnesscounselingnj
TikTok: @wellnesscounseling
LinkedIn: Jennifer Politis
Erika Bugaj, MA, MSW, LICSW
Website: www.dandelioncounselingcare.com
Instagram: @dandelioncounselingcare
LinkedIn: Erika Bugaj
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[00:00:00] Colleen Long: They said, build a practice you love. I did. It died. Private practice didn't die in one big dramatic explosion. It wasn't a heart attack, it was a slow bleed, a death by a thousand cuts. And if you've been in this field long enough, you can probably name every single one of them. I'm Dr. Colleen Long psychologist accidental, CEO and recovering perfectionist. I built a practice. I loved it died. Anyway, but here's the thing, before I could understand why it failed, I had to perform an autopsy, not just on the business, but on myself, on The scared kid from small town Indiana who grew up with a scarcity mindset on the overachiever who sold her body parts to pay for grad school. and on the clinician who confused exhaustion with ethics, it got worse.
[00:00:51] Colleen Long: Today I am doing a two-parter confessional. It's a series on the rise and fall of my own group practice two intentions here. One is just, I think it's gonna be therapeutic just to process what happened. Two, I think this will be incredibly helpful for many of the clinicians right now who are suffering in silence, we are not really allowed to talk about our own personal burnout or our struggles for fear of the licensing board coming after us and saying we need to take a break.
[00:01:24] Colleen Long: Right. We don't have stethoscopes that we can hang up. At the end of the day, our instrument is our heart, mind, and soul. if that is in some way compromised, we run risk of someone taking away our livelihood. I am now removed from all of that and my livelihood does not hang on that piece of paper, which is my license, that I work so hard for anymore, I feel more at liberty to talk about a lot of what happened to me candidly.
[00:01:51] Colleen Long: And I hope that this reaches some people who were maybe in the position that I was last year and the years before, and are just feeling really alone. And I want you to know that it is not you, it is a broken system. okay, so I'm gonna hop into this, two or three parter series. It's called Autopsy of a Practice, and we are going to dissect how this thing that I built, bootstrapped from the ground up into seven figures, collapsed, was rebuilt and sold.
[00:02:23] Colleen Long: Spoiler alert, this ends Rudy esque sort of. I eventually sold to someone who actually knew what they were doing from an operational side. the person had 20 years of operational experience, real capital and actual infrastructure, all the things that I was white knuckling on my own for many years. But getting there, that was the hardest part because selling wasn't the win, it was the surrender.
[00:02:47] Colleen Long: I had to learn to call Survival. Welcome to Off The Chair, where we are taking matters into our own hands in a system built to silence and enslave us. Ironically, in a world where everyone cries out the fundamental importance of mental health, now more than ever, there's no coincidence that if you treat the providers like workers in a Chinese sweatshop, everyone's mental health is only gonna get worse. In today's two-parter, I share my story. It's a personal one, but one I'm sure will resonate with many.
[00:03:19] Colleen Long: I'll also reflect on my part in the collapse and where I think I could grow from this.
[00:03:24] Colleen Long: we as mental health professionals are experiencing what physicians experienced a decade before. And if you want a crystal ball, just look to that field. Over 60% of physicians were in private practice in 2012, that number has now dropped to under 40% in 2024. And I think probably less so than that.
[00:03:48] Colleen Long: I think there's just not a lot of people that are reporting, the various sort of private equity ownerships and things like that. I'm gonna start this off with an origin story of just context, to understand who I am, how I got here. I think for anyone who is in mental health and has clinical training, it will give you some context and maybe to some of the decisions that I made right or wrong, and, um, just how it informs who I am and who I was as a leader and practice owner and clinician after the origin story.
[00:04:29] Colleen Long: Uh, if you're not interested in that, you can fast forward to the rise and the fall, which is going to be, um, we're gonna do it from an autopsy perspective, death by a thousand cuts. And we're gonna talk about the systemic cuts that happen in our field and what so many of us are facing, but two really underwater to even talk about.
[00:04:51] Colleen Long: So, uh, let's begin. 1980s was when I was born. I, uh, I am, oh wait, let me back up. I'm gonna preface this with, I am still angry. I am really resentful and I hate carrying that resentment, but as I am doing my own work on just trying to unpackage what happened in the last couple of years. We all know that anger is a secondary response to the primal emotion or primary emotion, which is fear.
[00:05:37] Colleen Long: And that fear for me, I think you'll start to understand where that comes from. As I explain where I came from, I think I carry a lot of anger, resentment, guilt, because in some ways this still feels like a failure where I'm at right now, and I know that all endings are just beginnings in disguise, but I haven't a hundred percent figured out what that is, what that looks like.
[00:06:07] Colleen Long: And so I'm in this weird intermediary phase where I don't know how I'm making sense of all of this. And maybe it's for this, maybe it's to help other people who. Are struggling like I am, and I wished I would've had somebody out there talking about this then. So maybe that's the purpose of all of this.
[00:06:29] Colleen Long: But right now, all of that training that I did, all of the work in grad school, you know, you do four years in college, you do three years for your master, and then another three years for your doctoral degree. So 10 years, and then you're still not done because you have to get your hours and licensure. So when you come out, you're in your thirties, you're six figures in debt, unless you were independently wealthy and you're still starting off, usually working under someone else.
[00:07:08] Colleen Long: So by the time you actually hit your stride, you're in your forties. And all of that happened for me to now be in a really. Confident place that I will never work in a clinical capacity again. And that's a real mind fuck when you think about how much of my life was spent working towards this thing that I have just completely moved away from.
[00:07:44] Colleen Long: So I wanna start with that because as you hear the other podcast episodes and you hear me, I think there's probably some definite undertones of anger and resentment, and hopefully this will help give some light into where that comes from.
[00:08:04] Colleen Long: So I'm a good student. I've always been a good student. I was good at school and I learned really quickly that. Being all as, being aachi and an achiever was what got the attention. The gold stars. That's what got my parents' attention approval. I thrived on approval first born kid. I think a lot of that was just sort of inherent in the fabric of my DNA.
[00:08:33] Colleen Long: Um, I grew up in a really small town in southern Indiana, close to Louisville, Kentucky. And most people did not go to college. Most people got married out of high school, had kids, and um, was just sort of, um, kind of small town life. Right? I knew I wanted something bigger than that, but I didn't know what that looked like.
[00:09:02] Colleen Long: And at the time, when you're coming up in the eighties and nineties, really it's like doctor or lawyer. Those are like your two sort of. Path to success. I was good at school and I knew that those two things were things that I could get if you're good at school. I did not like the law. I'm not a details person.
[00:09:22] Colleen Long: And so I went doctor route. Um, so
[00:09:39] Colleen Long: growing up I grew up with a, uh, single mom and my parents got divorced around the age of seven. It was really, um, I would say probably looking back on it, we were sort of lower middle class. I remember I going door to door and fundraising for cheerleading uniforms. Um, and there were other kids whose parents could just write a check, but you also had the option to fundraise.
[00:10:03] Colleen Long: And that's what I did. And one just poignant story that I hope. This isn't like a, like a poor me story. This is just to give you context that I remember I could not raise enough money for one of the uniforms, and my coach benched me because I couldn't afford it, and I didn't really think anything of it at the time.
[00:10:32] Colleen Long: But then when my mom found out, she raised hell and was really upset. And, and looking back as a parent, now I understand why that would enrage parents, but just to give you context of like how scarce things were is that we just, you know, it wasn't as though we were wondering where, where our next meal was coming from.
[00:10:55] Colleen Long: And we had a roof over our heads, but money was tight. And when money's tight, when you grow up in families like that, money is talked about all the time. Everything is, do you know how expensive this is? Uh, there's fear. There's a lot of fear. And the other poignant moment for me was, um, watching my mom sit on the ground.
[00:11:16] Colleen Long: Uh, my father had, uh, been leading sort of a double life and the woman he was having an affair with had called my mother and said that her house is in disarray and she would be calling CPS to have her children taken away. And I remember as a little kid, I mean, I was probably six or seven years old.
[00:11:44] Colleen Long: Terrifying, absolute terror. So I say all that because there's these key pivotal moments where I think that fear became the feel for me to. Always make sure that I never got there again, and as I became a parent that my kids would never get there again. Um, and so that's what a lot of, I see some of my really bad moves and bad decisions in the practice that you'll hear of come from is this sort of scarcity mentality that I grew up with.
[00:12:28] Colleen Long: I mean, I'm not at risk of being homeless anytime soon. Even if we lost our house, we would find another one. We would be fine. There's many, many layers that would have to happen for our family to be homeless. Yet I wake up and my brain feels like that's the next step. So that's really what I think sort of drove my drive for success and always will, is just that sense of safety need for safety.
[00:13:10] Colleen Long: So in a divorce, as you know, you're going between two homes, you have two Christmases, and I just remember a lot of loneliness, a lot of loneliness, a lot of fear being alone for a lot of the time. I remember sitting and playing Linky logs a lot and just feeling like there's gotta be more to this. And I would see other families as I grew up, and realize that there was something to the, uh, success of those families and their happiness.
[00:13:51] Colleen Long: There was a correlation and it was perhaps the wrong inference to draw, but there. A million studies out there that show that there is a curve of linear relationship with money. And while money doesn't directly make you happy, there is a certain point at which you need to be able to pay your bills. So I remember in that uncertainty, school saved me.
[00:14:15] Colleen Long: School was structured. I did well in school. I didn't really need a lot of help. I got a lot of accolades. I remember getting in these gifted programs and we were making wontons, which I don't really know what that has anything to do about being gifted, but that's what I remember from the gifted programs.
[00:14:33] Colleen Long: And that's what saved me was the academics. So later on I got in the National Honors Society. I was, I got a scholarship to college. Um,
[00:14:50] Colleen Long: as I was in college, I remember being in a stats class and. Really, really tunnel focusing in on it, and then people coming up to me and asking me to tutor them. This is sounding a little like self-congratulatory, but, but I promise you I'm getting there. So I learned that the teacher was telling other students to, uh, come to me because I had the highest grade in class, which is.
[00:15:54] Colleen Long: Alright. Sorry about that little call. Okay,
[00:16:14] Colleen Long: so stats class, people coming to me for tutoring. I felt really good. College was really the first look at like, whoa, there's a whole world out here of possibility. And I was good at this gateway to that new world. And so I went full pre-med track and was just gonna be a doctor and, uh, thought that there's my, my ticket to freedom.
[00:16:46] Colleen Long: And so cut to, um, taking the MCATs and going through the admissions process and all of that. I'm reading a book by a psychiatrist, um, because I knew that's what I wanted to do. I wanted to work in psychiatry or psychology, and it was already starting to talk about just how different the field is and essentially how.
[00:17:14] Colleen Long: You were being reduced to a pharmacist. There wasn't a lot of incentives to do therapy as a psychiatrist. There was no other real medical profession that I wanted to do because I didn't like blood. And so I pivoted last second to grad school. Got into grad school. Fast forward. So this is where I am. I'm in, I'm in, uh, grad school.
[00:17:38] Colleen Long: I'm just head down as we all do, going through going, getting the next thing, the master's, the doctoral, the license, the practice. Um, and, uh, let me, let me back step here. So
[00:18:00] Colleen Long: I'm on the pre-med track now. At this time, I am already starting to engage in some of these entrepreneurial stuff. No idea what I was doing. I created a company called Freud tv. It was. Like a PR agency for psychologists and other doctors who wanted to promote like their books or whatever, and, um, get on national media spotlights and things like that.
[00:18:27] Colleen Long: Now, I had no business doing this. I had no idea how to create a business or even how I was gonna market to get these people. I just had an idea and unfortunately, given my personality, I just execute. So I spent lots and lots of money and mistakes on building websites, expensive websites, hiring people that were sort of predatory.
[00:18:50] Colleen Long: And, um, I, I say all that just because as you, as you get to know me and in these podcasts, I definitely, I think the entrepreneur was always central to who I was. I have always had the ideas. It's just. Never really the grooming to see it through in the, in the right way. So, um, I am in college, I get into NYU, go to NYU system Shock for a girl from Indiana.
[00:19:30] Colleen Long: Um, and that was my first bout of depression. So as you're listening, you're like, wait, where are we going? I thought we were autopsy, but practice. Now we're talking about depression. But I tell you this because I think a lot of these things that happened to us throughout life, we at the time were like, why is this happening to me?
[00:19:54] Colleen Long: And later, there's so much meaning and perspective from some of those things that seem like a curse, that actually become a gift. So first bout with depression first love, uh, first boyfriend, all of that. The one that got away, um, died suddenly. I was 19 years old. And it rocked my world. It rocked my world.
[00:20:21] Colleen Long: Um, and I experienced depression for the first time. I didn't understand what it was. It was beyond sadness. It was, it was clinical. It was, uh, it felt like there was this dark cloud everywhere I went and I was scared. I couldn't eat, I couldn't swallow. Um, I look back at pictures of myself. At the time I was really, really thin and just not doing well.
[00:20:55] Colleen Long: I was not doing well. Um, and I say all that because. At the time, I would call my mom and say, I don't understand what's going on. Is this how adults feel? Is this how I'm gonna feel for the rest of my life? And that was really, really scary. And she said, well, you're studying to be a psychologist. Maybe this is meant to help you have empathy and compassion for the people that you treat.
[00:21:19] Colleen Long: And she was right. That was, uh, a hundred percent where this began, was having that empathy and compassion for people who truly struggle with depression and helping validate for them. Depression is not just run of the mill sadness. It is, um, just the sort of never ending storm cloud. And the first time you experience it and you don't know that time will heal and things will get better and it will ebb and flow.
[00:21:49] Colleen Long: It can be really, really scary. So, um, combine that with, as I'm now going through. Um, I'm, I get into grad school. I am encountering well before I get into grad school. So let's take a step back. Uh, as I'm going through this depression, this is my first brush with this draconian sort of academic ideology, which is that there was really this sentiment in the early, well, late nineties and early two thousands of like, just, if you can't do it, then you can't do it.
[00:22:31] Colleen Long: You're just not cut out for it. And nowadays, no one would ever get away with that. But, uh, being depressed for the first time in my life, I could not get out of bed. I couldn't make it to class. Um, it was like I couldn't, I could not get outta my own way. And I was watching myself fail. Getting like C's and had never done that before.
[00:22:58] Colleen Long: I think from under the depths I reached out to a professor there and I remember talking about how I'm really, really struggling with depression and what could I do to make up the grade. And it was just sort of a blank stare. Like, I mean, I don't know what you want me to say. Like, you've missed the last two classes and you didn't take your exam.
[00:23:21] Colleen Long: Um, maybe this isn't for you. Right? And, um, eventually I just got through it. And then again, that theme repeats itself when I'm in graduate school. Um, and I don't know if this is the case now, but it was essentially an exploitation model of us working for free, providing a lot of mental health care in really, really poorly run community centers.
[00:23:54] Colleen Long: To get our hours. And so it was a grind. You're doing that on top of graduate school work. And I remember this is, uh, now fifth year of grad school. I'm getting ready to graduate. It's my pre-doc and I'm working on my dissertation. I am in a skilled nursing facility and there is a supervisor there who I think thought he was a doctor or at least wanted everybody else to be convinced that he was a real doctor.
[00:24:27] Colleen Long: He wore a full physician's white coat, long jacket, everything, and would fly through the hospital and, um, was just absolutely, uh, abusive and again, would never get away with that in, in today's world. But at the time it was. Really, really bad. And I just got through it like I did with a lot of things in grad school.
[00:25:00] Colleen Long: And I remember, um, at the time we would go in and we would talk to these patients. They either had acquired brain injury or traumatic brain injury. And so they're in this skilled nursing facility and I'm doing the moca or the mini mental status exam or Wisconsin card sort. So I'm constantly doing assessment and I saw this patient who was in a net bed, um, and it, for those of you that don't, aren't familiar with that world, it's like a, it almost looks like a cage that's over the patient in their bed essentially, so that they don't fall out again and reinjure themselves.
[00:25:37] Colleen Long: I had had no training on this whatsoever. I just was doing the work that I needed to do and my clinical intuition. Was this person is acting like an animal because they are being treated like an animal. So I'm gonna unzip this net bed so that I humanize them and talk to them. And by the end of it, it was great.
[00:25:57] Colleen Long: She was calm. She was like, I really like you. Are you coming back again? It was great. What I didn't know is I left that net bed unzipped, and it was a huge safety risk because she could have fallen out. Now, I hadn't been given any sort of training or onboarding or any of that. Um, and I think in today's day and age, they would've just sort of like slapped you on the wrist, written a, a pip, and then been on with it.
[00:26:22] Colleen Long: But, uh, this doctor, uh, my, my supervisor who was somewhat power hungry, um, contacted my entire grad school committee and said he was concerned about my ability to matriculate. And it was like a firing squad. And I had to meet with all of the professors from my graduate school along with him as they discussed whether or not I had what it takes to be a psychologist.
[00:26:52] Colleen Long: In my fifth year, I was now six figures in student loan debt and all of it was getting ready to be thrown away. So, um, that was traumatic. Uh, I got some great advice from a, uh, attorney slash psychologist who said, Colleen, I don't know why these graduate institutions are so draconian, they just are. My advice to you is do whatever they ask you to do, get that cheap skin and just forget about it.
[00:27:18] Colleen Long: And that's what I did. So why am I talking about all this? I'm talking about all this because it's such a. Grind to even get to where we are as clinicians to get that master's degree, that doctoral degree. Then on top of that, to get the hours that you need and to pass the exams and to get certified with the boards, it's such a lift and so disproportionate to how we are valued and continually undervalued as a profession.
[00:27:55] Colleen Long: And I'm sure that as I'm saying this, there's probably thousands of other people who could recount their own stories of this, just hazing that you go through to get into this field to help people. Ironically. So as I go through this origin story, you're gonna see these o other themes, which are, uh, just a little bit of a hustler.
[00:28:24] Colleen Long: I am figuring out life as I go along. Again, parents did not have a college fund set aside for me. So I am just on borrowed dimes right now. Right? I'm just racking up student loans. So, uh, when I was in college, we, uh, me and my, uh, boyfriend at the time had found a loophole in these online gambling casinos.
[00:28:47] Colleen Long: And, uh, every time you had a new credit card, you were considered a new person. You got the online gambling, um, uh, whatever it was, it was like the bonus, right? So you deposit a thousand dollars, you get 25%, and as long as you make that money in bets you could pull out. So I never dipped into my own funds. I only played with the bonuses.
[00:29:08] Colleen Long: There was 240 of these online offshore casinos, and you do the math. I was writing $36,000 checks to NYU for my own tuition At that point, did not need to have a job because I was making it on blackjack and. Eventually, eventually we were banned because, uh, they got smart and started to hire, I think, uh, systems that would detect when people were not losing money.
[00:29:37] Colleen Long: And so, uh, that was over. But it was a good couple years that we were able to just essentially, I was able to focus on school and, uh, not have to work at Steak and Shake. Right? So that was, uh, one just sort of fortuitous thing that I felt like was a god wink with the online gambling. I don't know. Um, and then I discovered egg donation and I saw that you could get paid to be an egg donor and um, especially if you had really good grades and things like that, they would pay more.
[00:30:18] Colleen Long: So, uh, at the time. I think there's more regulations on this now, but at the time you could just set whatever your rates were and I would just say like, uh, 40,000. And there were people that would pay it. Um, and it, I think they would pay it because it was the highest. And so sometimes people just want the thing that costs the most.
[00:30:38] Colleen Long: So all of this is these sort of like fortuitous moments that help me get to where I am. I don't really honestly know how I would've gotten through grad school without these things because, uh, the lockdown inpatient unit I was working in as a postdoc in San Diego paid us $4 an 80 cents an hour. So to be able to even live, you know, it's impossible.
[00:31:04] Colleen Long: And I say all this because gosh, the odds are stacked against you. You have to work so hard and have so much tenacity to get on the other side of this. And then. Look what waits for you on the other side. And I think that's where a lot of this resentment and anger comes from. So, um, so I'm funding my education essentially with my body parts.
[00:31:27] Colleen Long: I am selling my body parts to get through school and to be a clinician.
[00:31:40] Colleen Long: At the time, I was also creating another venture called Peer Perceptions. Um, the idea was to provide, uh, reviews on local businesses, things like that. And now it's Yelp. But to think that I could create something like Yelp on my own was just wild. And unfortunately, I have a wildly misplaced sense of self-confidence and, um, that Mark Twain quote.
[00:32:13] Colleen Long: All you need is ignorance and confidence and successes. Sure. That's sort of my motto. So, tried peer perceptions. It was, uh, got a little spotlight in the local newspaper. People were saying, this is gonna be the bathroom wall of the internet, you know, and then shortly I just moved on to the next shiny ball and didn't get into it.
[00:32:36] Colleen Long: But again, you'll see this theme of just like always like thinking about what needs to be done and okay, I'm the one to do it, but really no idea how to roll that out.
[00:32:53] Colleen Long: So fast forward, I'm out of grad school. I have, uh, gotten all my hours, earned my stripes. I did my postdoc indentured servitude. And I'm now licensed, right? I'm ready, ready to kill, ready to go out there, hang up my shingle and let's go. And I am living in probably one of the highest cost areas of the country at this point.
[00:33:24] Colleen Long: So I'm living in Manhattan Beach, California. Um, and I'm just seeing like a bunch of rich people that have rich people problems, but not, I mean, light years away from what I was dealing with only a year before in a lockdown mental health facility where I was seeing true schizophrenia, true bipolar, all of that.
[00:33:47] Colleen Long: These people, I mean, I actually had one session where someone was like struggling with whether or not she should use her Capital One points for her vacation or not. And I was like, how have you gotten here? So I'm doing couples therapy and therapy with people who can afford it because at that point I didn't know how to even get on insurance panels, and I was just charging like two 50 an hour and people were gladly paying it.
[00:34:14] Colleen Long: Recipe for burnout. You're seeing people back to back. I mean, at that point it was, I was seeing 20 clients a week. You're, you can't get anything else done. Right, because you're just in session and it takes its toll when you're constantly carrying everybody's file in your system for weeks and weeks and years at a time.
[00:34:36] Colleen Long: I started to dread therapy. I was, I think one, I'm just an introvert, so my battery runs thin after a while and at the end of the day I was not feeling energized. I was like, oh my God, just three more days till the weekend. But this is what I trained for, so like what am I gonna do? Right. This is, this is it.
[00:35:01] Colleen Long: Um, I met a great guy. We got married, we had three kids. We realized we gotta move somewhere else because it's not sustainable to live anywhere close to la. We moved to Boston for a lower cost of living, which is not the case. Boston was not a lower cost of living. Um, and I took a step back, stay-at-home mom, and, uh, just decided to, uh, raise my kids.
[00:35:29] Colleen Long: I had twins at the time who were two years old, and I had an infant baby that was only 17 months behind them. And, um, I just thought, okay, well my husband's gonna take the will now, and I'll like, I'll be a stay at home mom. That lasted for about three minutes. I do not have. Whatever the, the fabric is to be the stay at home mom.
[00:35:58] Colleen Long: I remember schlepping through the snow in Boston, new England weather, Sub-Zero temperatures with a triple stroller. My Honda minivan with salt crusted on the side thinking, what am I doing? What is this life? This is not what I wanted. And so I slowly got back into private practice. Now as when I was a post doc, I sort of cut my teeth on bariatric evaluations, so pre-surgery, if, uh, someone's getting gastric sleeve bypass, that sort of thing.
[00:36:36] Colleen Long: I would do all the pre-op evaluations and I loved it. I loved the black and white of the assessment. I loved, like there's like, I'm gonna see this person and then we're done. There's not like week to week, there's not like. I have 30 clients that all have to decide to hire me again next week for me to be in business.
[00:36:58] Colleen Long: And I love just like having a really sort of like straightforward day. So I started to do that again and that's how the kindling started for this Boston practice that would soon become a seven figure practice.
[00:37:17] Colleen Long: I was still doing therapy at the time and remember thinking the days that I had therapy, I mean, first off, if you've ever lived in New England or experienced New England, it's just gray. Most of the time it's just gray. And I got seasonal effective depression really, really bad. I was using like sun lamps and trying to deal with all that.
[00:37:40] Colleen Long: And I remember just going into work, pulling up at a Dunking Donuts and being like, alright, let's just fuel up. Let's just get through today. And like in my head I'm like, okay, so. That's a hundred. That's a hundred. That's a hundred. So I'm gonna see six, that'll be 600 today. Like literally, that's how I would make money and figure out like how I was gonna, like we were gonna live that week, right?
[00:38:06] Colleen Long: And I was exhausted. I was so burnt out. I remember like it was client six and this guy, it was always a mix of like therapy and, and evaluations. And this guy was going in for a spinal cord stem pre-op evaluation. And I had done so many of those that I could do them in my sleep. And I got through his thing and then I would set them in the lobby and they would fill out the self-assessment inventories while I was seeing another patient.
[00:38:37] Colleen Long: And I got his forms and I remember him saying, wake up
[00:38:49] Colleen Long: and. He had picked up on the fact that I was just checked out. I was just kicking the can and it hit, um, so cut to, I'm still in Boston. I'm on 29 com ave. It's a really, you know, sort of swanky area of town. I'm still seeing these sort of really, um, smart executive type people. Um, but still at the end of the day I'm like, oh man, alright, I got two more days and then I'm done with this.
[00:39:24] Colleen Long: And that was like how I was planning on going through the, the profession. Now I started to do more evaluations and I noticed that the days that I was doing evaluations, I really enjoyed it. I was looking forward to it. I liked doing all of that and giving someone a tangible result at the end. CMS cuts rates for psychologists doing, administering their own testing, which at first I was losing my mind thinking, well, there goes my business model.
[00:39:58] Colleen Long: And, uh, as you'll see many themes here of me just thinking, oh my gosh, the world is imploding. And really it was all in my favor because what that did is it opened up psychologists to be able to use psychometrist or techs much in the way that physic physicians now use PAs and nps, and you could be in more places at once.
[00:40:19] Colleen Long: So it allowed me to scale really quickly when I was able to start to use psychometrist for those codes to administer testing. Um, so I went fully full bore into the testing thing and I started to realize that I was not actually, um. Gonna, I was gonna, not gonna grow just doing this still. I'm still capped.
[00:40:50] Colleen Long: There's a ceiling on the day. So I started to hire more psychometrist, notice that the revenue's increasing. Then I hired my first couple clinicians who were doing therapy for me and helping me with the intakes of these testing patients. And still, I'm on the phone with insurance companies calling about a prior AU that was denied or trying to get approved for a certain code or whatever.
[00:41:15] Colleen Long: And
[00:41:19] Colleen Long: it was extremely frustrating. I started doing more of the admin work than the actual clinical work and thought, what, what am I actually doing? And my husband, another ongoing theme in this is the, the voice of reason that pops his head in the door one night and goes, Hey, um, did you know that you made negative $10,000 last month?
[00:41:44] Colleen Long: So as busy as I was, I had no clue of my business operations, what was going on, uh, what like how to, how to make sure that there was an ROI on what I was doing and who I was hiring. So the first thing I needed to do, I realized is to hire some sort of biller or practice manager. That was a stumbling block for me because, I mean, at the time, this was 10 years ago, they're starting off at $65,000 a year, and that was barely as much as I was making.
[00:42:18] Colleen Long: So how could I reason hiring that? I read Tim Ferris's four hour work week, and it was one of those moments because. He was saying, look at your time, what it's worth. If your time's worth $150 an hour as a clinician and you're doing a 25 hour, a $25 an hour job, you can outsource that so that you can get that time back to make that 150 an hour.
[00:42:46] Colleen Long: So with that, I hired my first person and
[00:42:56] Colleen Long: our revenue quadrupled. That was the catalyst for, I mean, at one point we were between 40 and 50% profit margin. So
[00:43:12] Colleen Long: as we got into this, uh, one, one of the best decisions I ever made was to hire someone that was a practice manager and a biller. And it wasn't lightning in a bottle of first hire. There was plenty of hires that were not the right fit, but the one that I found. Sort of built this rickety sailboat with me from the ground up.
[00:43:36] Colleen Long: The problem was, is that she was the only one that knew how to steer the ship and had the, all the keys to the kingdom. And I had no idea anymore how to steer the ship or how much was involved in steering the ship behind the scenes. So what I mean by that is, uh, she had built these systems from the ground up in terms of understanding which payers required prior auth, which payers required certain codes wait times, um, just certain procedures, how to log into different portals, all of that and really was top notch in terms of talking to patients and doing the practice management aspects, but then also billing and.
[00:44:26] Colleen Long: Was really the, the, um, I think the driving force to taking me from a very, like small practice that was barely profitable to a practice that was then being sort of courted by all of these private equity firms and things like that because of the profitability of the model. Also, we were one of the few practices in Massachusetts that accepted pretty much every single payer by that point.
[00:44:54] Colleen Long: So, uh, and we did neuropsych testing, so it was a niche and, uh, the demand was high, so we would have probably 400 inquiries a month and we had no marketing whatsoever. So, um, business was booming and, uh, the only hitch in that point for me was that I was miserable in Boston. Uh. I had no friends, no social life.
[00:45:26] Colleen Long: I was a stay-at-home mom at this point. That was also like doing a private practice that was burning her out. And every day was gray and cold and dreary and it just, I felt like I was dying. I felt like I was dying. And I was California dreaming for sure. And my husband would just sort of say, yeah, well, we'll look into it.
[00:45:51] Colleen Long: We'll look into it. Well, three years later I finally said, Hey, I found this QME position. It's a qualified medical evaluator, and I'll just fly out to California and I'll do that. And then I'll fly back. And in my mind I thought, best of both worlds, I don't have to uproot my family. I can get my California fix.
[00:46:11] Colleen Long: Great. And he said, we'll move back. And so I. One of the happiest moments of my life was moving back to California. And, uh, I, despite all the craziness of politics here and the taxes, man, I, it's a, a slice of paradise. Um, so I say that because I think sometimes when you hear my story, you might say, well move to a different part of the country that doesn't cost so much.
[00:46:46] Colleen Long: But being here really makes my life better. The sun being outdoors, um, the people are all transplants. So you have instant friends. People are used to making friends quickly, and the innovation in having Tahoe and Vegas and all these places that are really close to us is just, I love it. And so I do choose to live in one of the highest cost areas of the country, orange County, California, but.
[00:47:18] Colleen Long: There's no doubt in my mind that this is where I'm supposed to be.
[00:47:31] Colleen Long: So cut two, 2019, we moved to California and um, I am at that point thinking I'm gonna have to close down the Boston practice, my practice manager and biller. I let her know, and she said, well, what do you wanna do? And I said, well, let's see if we can keep this going. Because at that point we had a bunch of clinicians and we had other people, so I didn't necessarily have to be there and I could run it from afar.
[00:47:58] Colleen Long: 2021, whenever the pandemic. It just was like cooking with gas now all of a sudden everything went online. It was just, it was a perfect fit and I was able to keep the practice going. Now also add to that, that more people than ever were experiencing mental health issues because of the pandemic. Um, families needed their kids assessed.
[00:48:24] Colleen Long: They need a diagnosis to get their kids in school versus remote learning. And so our practice had was just, it hit an all time high. Uh, Massachusetts had a huge, or still has a huge opioid epidemic. A lot of the doctors were being cracked down on. And so referring to us as a first line of assessment was really a sort of cover your ass move, but good for business for us because we had to do all of these assessments then for sort of the prescribing doctor's insurance policy.
[00:48:54] Colleen Long: So all of that to say that demand was not an issue at this point, and it really felt like. Uh, a cash crab supermarket sweep, trying to get all of the patients that needed us at that time because we just really didn't know what was happening with the world. Um, and I think this was the beginning of burnout for me because it just didn't stop.
[00:49:19] Colleen Long: So we had a wait list, stretching months, I mean a four month wait list for testing. Um, at the time then TikTok was sort of coming up and creating this generation of armchair diagnosticians. So, you know, there were people on there that were, uh, you know, if you like big spoons, you have autism. If you like velvet, you have autism.
[00:49:47] Colleen Long: And um, and so we had a resurgence of people that were wanting autism testing and really attached to that autism diagnosis. And I did see myself as a gatekeeper because I have a son who's on the spectrum. Um, I also know a lot of kids who are on the spectrum, and I felt a sense to protect the kids that truly had autism because if we dilute the pool and everyone's neurodivergent, then who is actually who's not neurodivergent, right?
[00:50:30] Colleen Long: And so, I mean, people that just honestly were experiencing social anxiety and didn't get the normal, uh, soci, um, they didn't get the normal socialization that you get. During those crucial developmental periods because of the pandemic. And so it became harder and harder to interact with other people. But that didn't mean that all of a sudden you develop autism at 17 years old.
[00:50:59] Colleen Long: And yes, I know that we have more of a, a understanding of what autism is, and so we're having a higher incidence of diagnosis, but not at the rate that it is right now. And so
[00:51:16] Colleen Long: I just had no patience for this trend that I had had saw, uh, five years prior with A DHD where everybody was, was demanding that they had a DHD and um, a lot were med seeking. And so that's what I loved about the testing is that we have objective, uh, diagnosis. We have DSN criteria to say like, you don't meet this.
[00:51:42] Colleen Long: And unfortunately, people that come in with this preconceived notion of what they have. Based off of, you know, whatever expert they're listening to on TikTok get really upset if you don't give them the diagnosis that they want. So being in this field alone also carries with it some of the drawbacks of, um, you're not developing a therapeutic relationship with a client like you are in therapy and being in an evaluator position can often make you the bad guy.
[00:52:31] Colleen Long: So this is the rise of the practice. This was the Roman Empire, the Renaissance, the, you know, it was just this. Beautiful synergistic thing. There was this stretch between 2020 and 2023 where I felt unstoppable. I was like, oh, I've hit my stride. This is great. I figured out how to do it. Maybe I am gonna be successful.
[00:53:10] Colleen Long: I had gone from a clinician making, you know, $52 an hour from UBH to A CEO that was making over 540 K in one year. I remember and thinking, I never thought that this was possible. I had employees, I had a biller, I had an HR team, a practice manager. We had a wait list. Um, I was like. Okay, I've hit my stride.
[00:53:44] Colleen Long: This is, this is what I was built for and I really enjoyed it. I really enjoyed this thing that I had created from nothing. So I doubled down. I was listening to these podcasts about scaling. I was reading Traction, EOS, um, I was, any book I could get my hands on, really, I was joining masterminds. I remember one year I spent over $50,000 in my education of just masterminds, Vistage Entrepreneurs Organization, EOS, uh, Cameron Herald's, second in command.
[00:54:22] Colleen Long: Invest in your leaders. I had a, uh, business mentor slash coach who was not cheap, and I was like trying to get the equivalent of an MBA essentially in three months. I was reading the Rockefeller Habits, scaling for Success, uh, you know, all of these things about what needed to happen and starting to realize, ooh, we are so far from being where we need to be.
[00:54:56] Colleen Long: First off, we had no SOP, I didn't even know what an SOP was, a standard operating procedure. So every time someone new came into the company, we would have to like retrain them again on what the thing was. And it was like a game of telephone. Um, we had no KPIs, so nobody knew what defined success for their role.
[00:55:15] Colleen Long: No cost containment. I had no idea how to even run a p and l. So for many years I was just winging it. And as long as there was money in the bank, at the end of the day, I was like, great, we're doing good. We're flush. And I really didn't understand my numbers and I really didn't understand how much we were making per case.
[00:55:37] Colleen Long: What a clinician was worth, what a psychometrist was worth what. Retention was worth and what turnover cost us. And so these were all things that you don't know what you don't know until you start learning about it. And then you feel like I have so much further to go. So like anything, I just fully powered into learning how to be a CEO, learning how operations run and how great businesses scale.
[00:56:13] Colleen Long: Um, I had at that 0.2 people who were sort of my wing women in this practice. So the one who had built it with me from a ground, from the ground up in Boston, and then one that had started as my sort of personal assistant out here, but worked her way up and they were like thick as thieves Now. I'm not gonna use their real names, but I will call them for the, uh, purposes of if you've ever seen the movie Inside Out.
[00:56:45] Colleen Long: One was Joy in my phone and was very much like, it's fine, we're fine, we're all fine. And then the other one was disgusted and just annoyed at every single thing. And you'll see that that takes its toll on you. And I remember my mentor saying that somebody who's emotionally toxic, that is a key stakeholder in your organization, you'll earn every penny of that person.
[00:57:15] Colleen Long: And I, I did, um, we had employees defect, we had a big turnover problem because this person, essentially, she's really, really good at what she did, and she expected the same standards from everybody and had really very little patience. And sort of the mass hole mentality, which if you've been to Massachusetts or you know anybody from Massachusetts, there's a little bit of a mass hole attitude.
