Death by a Thousand Cuts: The Collapse of a Seven-Figure Practice and the Reality of Clinician Burnout [Part 2]
WATCH THE FULL VIDEO EPISODE HERE!
When a thriving seven-figure practice implodes, it never happens all at once. It happens slowly, quietly, through the small paper cuts that no one warns you about. In this episode, we take you inside a real-time autopsy of a private practice undone by clinician burnout, a broken mental health system, and the relentless weight of decisions made in survival mode. This is what it looks like when success on paper collides with the truth underneath.
We walk through the rise, the unraveling, and the reckoning that ultimately led to selling a medical practice not out of strategy, but out of necessity. And if you have ever wondered how a seven-figure business can still leave you drowning in fear, debt, and shame, this is the episode you have been waiting for. Nothing is sugarcoated. Everything is honest. Because clinician burnout is not a mindset problem. It is a system problem created inside a broken mental health landscape.
Inside this story, you will hear how one founder went from feeling unstoppable to confronting the limits of capacity, leadership, loyalty, and regulation. You will see exactly how the combination of a thousand cuts, clinician burnout, and a broken mental health system created a perfect storm that even a seven-figure revenue line could not withstand. And you will hear what happens after the collapse, including the unexpected freedom that comes with finally selling a medical practice you once thought you would build forever.
What you will hear
• How clinician burnout sneaks up on even the most driven founders and why a broken mental health system accelerates it
• The operational blind spots that create a thousand cuts long before anyone sees the collapse of a seven-figure practice
• The emotional and psychological toll of selling a medical practice when your identity is tied to its success
• Why money alone cannot protect you from clinician burnout, a thousand cuts, or the realities of a broken mental health industry
• The unexpected clarity that emerges after letting go, healing, and rebuilding on your own terms
If this episode hits something raw, share it with the clinician who still believes they have to white knuckle their way to success. Leave a review, subscribe, and stay with us as we continue to expose the realities behind seven-figure growth, the truth about clinician burnout, and what comes after selling a medical practice in a broken mental health system shaped by a thousand cuts at every turn.
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: Okay, part two. This is the rise of my private practice. So this was the fun part. This was, as we were, climbing, scaling, everything started to fall into place. It seemed like there was this stretch from like 2020 to 2023 when I felt unstoppable. In fact, I remember many of my passwords carried the word stride in it, I was feeling good about myself.
[00:00:29] Colleen Long: I was clearing well over 540 KA year, I was completely off the chair. Which was great because I was completely burnt out. I was working very long days, 12 to 15 hours, but I said, well, that's why you make the big bucks. And I was really proud of myself. a kid that had come from small town Indiana into what I felt like was finally success.
[00:00:53] Colleen Long: I was like, okay, I've done it. we had employees, we had an HR department, we had a practice manager. We started to use words like deliverables. We had a wait list for testing that stretched out months, 400 patients a month, I really started to double down in terms of my education. So I was getting every single Mastermind I could get my hands on from Cameron Harold's second in command to EOS Traction Entrepreneurs Organization.
[00:01:25] Colleen Long: I joined, Vistage. I had a business coach. I mean, I just was thirsty to hold on to this thing, maintain it, and get better at doing what I needed to do.
[00:01:38] Colleen Long: I remember meeting with, Casey Compton again, you know, these programs are never cheap, uh, especially when you're working with them one-on-one, but she essentially had. Built what I felt like was where I wanted to be. And they always say, you know, find where you wanna be, who you wanna be, and then just do that thing.
[00:01:58] Colleen Long: Don't reinvent the wheel. And so I went to her and I worked with her and her partner on my practice, was really the first time that I saw someone who understood how to break things down in the numbers. And it sort of blew my mind because it made me realize how little I actually knew about running a business and really just how extremely lucky I got to be even profitable.
[00:02:24] Colleen Long: I had no clue what I was doing. And especially as they were kind of like breaking down numbers and things like that, I just had never thought about my business that way. I mean, they don't teach you that in grad school, right? So they were helping me look at per case. So as a testing, you know, per case revenue.
[00:02:41] Colleen Long: they were helping me look at lead conversion and they were wanting a lot of statistics for me that I could not give them. So like, what's your lifetime value of your client? how do you generate recurring revenue? Well, we, we don't, we are a testing practice. You, you one and done. they would help me think about what's your lead conversion, you know, so of the warm callers that are calling in, how many convert to actual clients?
[00:03:06] Colleen Long: No idea. What's your call answer rate? No idea. that was, I think the beginning of the end, which is ironic because I had the best intentions to get better and do better. But it's almost like when you look under the hood and you pull at a thread, it just starts unraveling and. That's what happened. because I knew more, I came back and I started to look at our conversion rate and it was abysmal.
[00:03:34] Colleen Long: I think it was like in the 30% and for our testing practice with warm leads, it should be like over 70%. So then I looked at our RingCentral Analytics and realized that this person that we had been paying full time to answer our phones was never answering the phone. They were just texting patients, which drives people nuts, especially of the older generation that just wanna talk to someone and make sure that, you know, it's the human on the other end.
[00:04:00] Colleen Long: also my first dose of reality, one of them was asking this person directly, who I had never managed before. I had now a practice manager that was managing this person. hey, can you gimme this login code? I wanted to see how much she was responding to her emails. she said, I'm in class right now.
[00:04:22] Colleen Long: This is someone that was billing us every day for 40 hours a week. And she couldn't gimme a code because she was in class, so not good. And then our call rate combined. So I realized that we had hired someone who was essentially just charging us by the hour, and there was no accountability of this person's role.
[00:04:42] Colleen Long: In fact, there were no KPIs. There was no ROI, there was no, like how is this person, are they even doing a good job? And so then you start to look at the people that manage them and think, what are you doing? And for so long. You have to understand in our organization, our small business, we had two OGs that were running it together.
[00:05:07] Colleen Long: They were essentially like my babysitter. They were sort of like the older moms that were like, no, Colleen, we're not doing that. Nope, we're not doing that. And for the most part, they kept things running. They were mom and dad, they kept things running. They, kept the blinders on for me and just kept going.
[00:05:27] Colleen Long: And when you start questioning things in your organization and start changing things up, you will lose people. I think. Cameron Harold always said, don't hire accountability managers. Just hire accountable people. If you start holding people accountable, the only people you're gonna lose are people who are unaccountable.
[00:05:46] Colleen Long: that's what happened. So I went from someone who was largely checked out in my business. I would phone in for Friday meetings and be like, great, sounds good. Thanks guys. Doing great work. Keep it up to someone who was starting to become a more micromanaging, I would say. I was wanting to know, well, what's the number on that and how are you tracking that?
[00:06:11] Colleen Long: And these two people had never been questioned like that before and I think it was annoying to them to, I mean, be quite honest. They, for the most part, for years had been left alone and now all of a sudden here comes this person who is asking all of these questions and they're thinking, what are you doing?
[00:06:26] Colleen Long: We, we've got this.
[00:06:27] Colleen Long: Meanwhile, I'm in these Vistage meetings and I am in the. CEO group. And the advice that was given to me with Vistage is you're not necessarily gonna have any other like group practice owners in there with you, but everybody that's a leader of the organization is gonna have the same problems, the same pain points, and that's where you learn.
[00:06:51] Colleen Long: And I did, it felt nice to be around other people who were struggling with a lot of the same issues I was, whether it be retention, culture, building, wearing too many hats, staffing shortages, whatever. I felt finally a sense of camaraderie. And in the mental health field in general, it could be super isolating.
[00:07:10] Colleen Long: The issue was that when you're in Vistage, you're with these people that are like CEOs of $700 million organizations. There is no fear that they are going to fall straight on their ass and lose their house. Right. they're good. And for every one of them, there's probably four other CEOs and three other departments and a huge infrastructure built to support them and make sure that they run.
[00:07:37] Colleen Long: was doing it all. I was the face of the company, the social media, the marketing, the hirer, the firer, the accountant, all of these things. And after a certain time, I felt like these people are not living with the same fear that I'm living with. Like nobody's in jeopardy of losing their home I was starting to get resignation letter after resignation letter as we got bigger, bigger problems, more money, more problems. Notorious big said it best, right? So, we would attract Grifters, you know, people that knew how to take advantage of the Massachusetts laws. They would work for us. They'd go on maternity leave and then if we didn't give them their exact position back, they knew how to use the system and go on permanent leave.
[00:08:24] Colleen Long: We've had to pay settlements. we've had people double dip, quiet, quit, and really, really hard to track all of that in a remote landscape. So,
[00:08:34] Colleen Long: in this autopsy of my practice, and I'm sure many other practices, death by a thousand cuts starts with this one, which is. The workforce that we navigate right now, most people are working remotely, at least in our profession, it's very, very difficult to monitor and track time. Now, I did end up adopting Time Doc software, which I highly recommend, and it takes screenshots.
[00:09:02] Colleen Long: It makes sure that the person that you're paying by the hour is not cruising. YouTube. really I found the only people that had security problems with it or privacy issues were the people that ultimately were probably gonna try to cheat the system in some way. So it helps separate the wheat from the chaff in the way that that goes.
[00:09:21] Colleen Long: The issue was that as you start to pull this thread in your practice, you start to see all these things that are going wrong and. For those of you who have kids, I'll use the analogy of you maybe go in their room for the first time after like a couple days and you see it's a mess and you're like, what is going on in here?
[00:09:44] Colleen Long: And you just lose it. What else are they forgetting? Right. That's what happened in my practice is I pulled that thread and all of a sudden I realized, man, no one is at the wheel here. Like no one. I was very much to blame for that because I like to pride myself on being a low key manager. Like I'm not even managing you.
[00:10:06] Colleen Long: Like you just do your own thing. Yeah. It's all cool. And people took advantage of that.
[00:10:12] Colleen Long: Cut two in death by a thousand cuts. As I was in this Vistage group, I started to realize the need for an operator or an integrator a second in command, A COO, an EVP. Call it what you will, but somebody who could reverse engineer the many ideas I had and see them through and while discussed and joy, my practice manager and billers were great at keeping the ship steady.
[00:10:45] Colleen Long: They had no interest in growing. So every time I wanted to scale or get a new contract or work on this new program, there would always be a reason for like why we needed to focus on this first. Right? So. It gets old after a while, especially for someone who has a sort of like visionary mindset according to EOS, you know, it's like you do have a lot of ideas and you start to feel like the gas in there, the brake pedals, and it felt very constricting after a while.
[00:11:12] Colleen Long: So I realized if I wanted to grow, I was probably going to need to grow in terms of the type of person that could support me. I realized you get what you pay for. And so I was willing to take a sizable portion out of what I was making to hire someone that was really sort of, well adept and well versed in what they do in terms of being your operator and coming in and like really getting things in order.
[00:11:39] Colleen Long: We had lots of interviews. We had 300 people apply for the position of COO. a lot of people who were way overqualified and wanted way more than what I could afford. But I found someone who, was essentially doing exactly what I needed her to do for a much larger practice. I thought, well, this is perfect.
[00:12:01] Colleen Long: Went through four rounds of interviews with all of my team, and in reflection now looking back at how I interviewed, it was a lot of feelings, not facts. It was okay. So, and then you feel like you can manage a team of people. Yeah. Yeah, yeah. Yeah. Okay. and then tell me about, when you're developing KPIs for people, are you able to hold people accountable?
[00:12:24] Colleen Long: Mm-hmm. Yeah. That's one of the best things that I'm, I'm the best at is holding people accountable. Okay. All right. All right, all good? Good, good, good. Um, when can you start?
[00:12:35] Colleen Long: That was it, it was like, great, you seem to know what you're doing. I don't even know what you need to be doing because I don't know what I'm supposed to be doing, so I'm gonna give it to you and I could not be more excited for this person to start. I was chomping at the bit, so excited, I was thinking, this is gonna be freedom.
[00:12:54] Colleen Long: Finally. Now, on the other side, I had offers for my practice. I had a lot of sort of private equity firms reaching out, wanting to buy, but the advice that I was given was just make this a lifestyle business and run it. That way and get all your ducks in a row where it's running itself, and then keep on making that money instead of just one time selling it.
[00:13:19] Colleen Long: So that was the goal. Here's what happened.
[00:13:21] Colleen Long: I abdicated, I did not delegate. I essentially said, here's the keys. Let me know if you need anything. Thank you so much. And granted, I paid for invest in your leaders for this person. we had three times a week meetings, and I had a whole onboarding blueprint and all of that, right? I did the whole thing according to Cameron Harold, about how you onboard this person.
[00:13:45] Colleen Long: I abdicated. I did not delegate. I was not telling this person exactly what they needed to do because I didn't know what they needed to do I was not overseeing that it was being done. So what that looked like is that in, the summer, I handed over the keys and I said, good luck. And I went on vacations with my kids I was like, I finally did it.
[00:14:10] Colleen Long: I'm off the chair for good. I have figured this out. Business runs on its own. Here we go. Now this person came in to a system that had been in place for a long time and was disrupting the systems for anybody that is familiar with family systems, it constantly tries to maintain homeostasis. And so this person was coming in disrupting it, and then the other two were sort of kicking back to try to reset balance.
[00:14:40] Colleen Long: Well, eventually I got a resignation notice from disgust from my biller that said, thank you, but I'm, I'll be moving on. This was after seven years. I knew for some time that I needed to get rid of this person because they were emotionally toxic. We were losing a lot of employees. They were unpleasant to work around.
[00:15:01] Colleen Long: They held all the keys to the kingdom in terms of billing. And so the entire time that they had been there the last year, I was saying, can you put this in an SOP? can you put together like a billing bible of all these things? Just because. In case something ever happens to you, we wanna make sure that we can carry that on person was purposely sort of, tightlipped about all of that, and we got very little information.
[00:15:23] Colleen Long: When I got the resignation at the time, I breathed the dec sigh of relief. It was something that needed to happen and I felt like we were finally freed up to build a culture where people felt supported. Again, this person had lost four different practice managers. They had lost four different psychometrist, and it was all just because of the sort of attitude that they had when working with the employees.
[00:15:47] Colleen Long: in my mind, I felt like billers are a dime a dozen. I'll just find another biller, like easily replaceable, not the case. It was probably The biggest reason for why we ended up where we did was losing that biller because that biller built this rickety sailboat with me from the ground up, and unfortunately, she was the only one who knew how to steer it.
[00:16:10] Colleen Long: And once she was gone, it was really, really hard to find someone that knew the CPT codes for testing and the auth process and all that, and the way that we knew it.
[00:16:20] Colleen Long: I also don't want to make this be this sort of like, woe is me look at all these things that happened to me. I'm just this victim of these circumstances because I've done a lot of reflection on where I went wrong, where I can take ownership. And I think what, in hindsight, I would've done better. I am a, an Enneagram type seven.
[00:16:41] Colleen Long: And for those of you that don't know, it's a, you know, just sort of a person that's always like looking for the next thing and says yes to everything and doesn't wanna spend a lot of time in stillness or contemplation and really is like a doer. I am sort of classic entrepreneur. I have an idea every minute and unfortunately I'm acting on most of those.
[00:17:04] Colleen Long: I move quick, I'm a kby quick start. so if we have a problem, I'm gonna fix it. And I'll give an example. So we had a issue with our. Intake process where patients would sign up for an intake, they would self schedule, but then they weren't filling out their pre-screen paperwork. We need all of that paperwork before we see them.
[00:17:26] Colleen Long: And so we had a lot of admin time being spent on people just calling, reminding people to fill out their paperwork. I just switched to Jot forms because Jot forms they could fill out. It was embedded in the website. They filled it out online and they had to do that before they could book their appointment.
[00:17:43] Colleen Long: Solved a lot of issues, disgust and Joy. Did not appreciate that they did not like their cheese being moved. They didn't like this new system just being like, next day we're doing this. for that one time, that happened 20 times a month for, for them. I would oftentimes just go, well, what's the problem?
[00:18:04] Colleen Long: Alright, well let's get this, let's do that. And I would just do it. I've always been of the ilk of, do and beg for forgiveness later rather than beg for, for permission. So that was the slow build, I think for them probably was, it's a lot working with me. It's exhausting. they probably felt like the goalposts were being moved a lot of the time.
[00:18:29] Colleen Long: So in hindsight, what I would probably do is I probably would've worked with them to say, what's a pace that feels good for you guys? Like, we do have to change some of these things. I'd like to do this and if you don't have a better idea by this date, we're gonna go ahead and move forward with this.
[00:18:48] Colleen Long: You know, like there's a middle. So that's what I will take ownership for is that I think I'm a bit nuts to work for, and I understand that I'm not everyone's cup of tea.
[00:18:56] Colleen Long: I am throwing money at these two. Meanwhile, I'm like, I appreciate you guys. You're killing it. We are killing it. They're getting these huge bonuses and this is great. Everybody's great, everybody's happy. Everybody's getting paid. cut to, I'm at a conference. I'm sitting there. It's super boring I'm going through the numbers because if you'll remember from part one of this, my trustee husband pops his head in the office and says, do you know that you're negative 10,000 this month? That was 10 years prior. This time he's are you gonna be able to make payroll?
[00:19:33] Colleen Long: Never a conversation I've ever had, never, ever been worried about making payroll. So something was very wrong.
[00:19:39] Colleen Long: Started to dig into our numbers and I was looking at what is going on? there was one, just, not nearly as much payments coming in from the insurers. I realized our costs were out of control. So there were no caps for our employees, our psychologists, because they did, testing for us, and they, and they did these, they were writing reports.
[00:20:05] Colleen Long: There was no like, okay, for every one report you write, you can bill us up to two hours. It was like. free for all. So you would have one clinician who may be pumped out three reports that week, but they had billed us 15 hours in report writing. There was no way to track that. Well, you're gonna go upside down quickly when there's no cost containment.
[00:20:26] Colleen Long: There were psychometrist who were billing, you know, maybe they saw four testing patients that week. They'd bill us 40 hours. There's no way one testing client takes 10 hours. But there was, again, no oversight, no cost containment. So as you can imagine, when I'm coming in and saying, whoa, whoa, no, for every one patient's report, you finalize, you can bill us up to two hours.
[00:20:49] Colleen Long: for every one patient you test, you have a cap of five hours. You can imagine. People are like, oh, gravy train's done. I'm done. And you know, we had quite a few defect because of that. it did get down our expenses considerably, which was good, but it was too late at that point. after month three of my second in command being in, and I use the term joy, discuss a lot for the practice manager and the biller, but my second in command was,
[00:21:19] Colleen Long: let's call her Jackie. Her name is Jackie. Let's say that, Jackie and I would meet three times a week and I would say, how's everybody doing? How's the team doing? Colleen, I am so impressed with the synergy of our teams, like everybody is just firing on all four cylinders. I am just so impressed and I would get off and sort of pat myself in the back and be like, great.
[00:21:43] Colleen Long: Great. Wonderful. everything's good. meanwhile, the biller she hired quit two weeks into her position. the other practice manager that she had sent an offer to, we found out, had a, pretty bad criminal history so that it didn't work out. then we found out that the two front office staff, that she was paying a hundred hours per pay period.
[00:22:07] Colleen Long: So every two weeks, a hundred hours per pay period had an 89.7% missed call rate on RingCentral. So they were not only billing us full time, but overtime, which is time and a half, and they weren't even picking up our calls. We had six people on Asana essentially saying. Copay due, 2 45 deductible due.
[00:22:29] Colleen Long: Nobody was calling the patient. Nobody's collecting the copay. So we're paying a lot of people to just spin their wheels here. Nothing getting done. Meanwhile, meanwhile, we've got clinicians pushing out services. No prior auths being gotten. The front office is not registering patients in the right way. We aren't getting prior auths.
[00:22:48] Colleen Long: We're doing a lot of services that we don't get paid for. This is how you go upside down.
[00:22:52] Colleen Long: Now, I'll say that Jackie, my second in command that I hired my fancy new EVP, was well healed, well polished, looked every bit the COO that she presented herself to be, and just seemed like this is who we need in charge. As things started to crumble, I would have these sort of come to Jesus talks with her, and she would say, Colleen, stick with me here.
[00:23:17] Colleen Long: I, I've been in a lot worse situations we're gonna be fine. And again, feelings, no facts, no dashboard, no KPIs, no forecasting, just a lot of feelings.
[00:23:28] Colleen Long: The feeling for me was, something's not right, something is very wrong. But I couldn't put my finger on it until I met with my business coach who said, you need facts, not feelings. You need numbers. You need an executive dashboard. This person needs to be able to report to you how that fancy salary of theirs is giving you at least three to five x in ROI.
[00:23:54] Colleen Long: She's not able to do that.
[00:23:56] Colleen Long: I noticed that despite the payer issues that we were having, so I would come to her and say, Hey, we are gonna have to take out a loan to make payroll. She would say, yeah, it's fine. We'll take out a business line of credit. This isn't unusual. We've done this before. it's fine. And then meanwhile, she would hire like a fancy design consultant to work on our logo.
[00:24:22] Colleen Long: So this is where her time was being spent. So I liken this to if you are house is on fire and you hire a fireman and they're looking at your curtains and telling you, let's, let's change those out. Meanwhile, the building's burning. That's what was going on.
[00:24:42] Colleen Long: Now cut three of this. Death by a thousand cuts is the payer landscape here. So the insurance companies started to capitalize on the pandemic and the mental health issues, they simultaneously were engaging in what's called vertical integration. So they became both the payer and the provider. And that's why a lot of times nowadays you'll see your physicians are owned by Optum, right?
[00:25:11] Colleen Long: they set the rates, they can pay the highest because they are the payer and so much easier for them to. Recruit clinicians, physicians at their rates than it is for us who have to negotiate on our own and oftentimes don't get it. at the same time as I am dealing with this sort of infrastructure fire, we're also dealing with a bigger systemic fire.
[00:25:33] Colleen Long: Number one. Optum has this change healthcare breach that, coincidentally, ironically holds up millions and millions of dollars for payers who are relying on those checks, who eventually end up going out of business. Meanwhile then becomes the bank for those providers later to cover the loan.
[00:25:52] Colleen Long: And by the way, they're gonna take a vig on that. that bankrupted most practices who were subject to that. thereby clearing the competition for most of these payers who would then become also the providers. You're dealing with a change, healthcare breach, you're not getting payments, you can't pay.
[00:26:08] Colleen Long: Your providers, providers are getting upset because you can't pay them because you're not getting paid. They don't care about the insurance company. You're taking it on the chin for the insurance company, just the same way you do with the patients. Patients don't care. They think you are the insurance company.
[00:26:23] Colleen Long: So you become the vicarious employee for these insurance companies that are now pretty much engaging in antitrust activities. at the same time, these venture capital firms were capitalizing on the mental health issue and essentially had Uber ified the therapy space. where, five years ago you might be looking for a therapist and have no idea where to start, and you go to some therapist janky WordPress site that it's got, God knows where you're gonna find the contact button or even they're checking their email and then.
[00:26:56] Colleen Long: You've got these VC companies that come in and do these pretty better help Talkspace headway. you've got quick access. And the thing that they did well is that they figured out access for people that were struggling with access to mental health care. The issue is that there is no one waiting on the other side that was gonna give you that quality of care.
[00:27:18] Colleen Long: Therapists aren't uber drivers. You, you don't just like get in a car and then like get out and you're, you're healed. You have to have a treatment plan. You have to go to the right person to treat what it is, and you have to know what it is that you're treating. So simultaneously, these companies are paying therapist pennies on the dime.
[00:27:37] Colleen Long: And so what are you gonna get? You're gonna get the worst of the worst. It's gonna give therapy a bad name to the masses because people are. Getting shitty therapy. Pure therapist that's selling for whatever better help's giving you, you've already decided that you are not valuable, so why would anybody else continue to, go to therapy when they're getting that sort of shitty care?
[00:28:00] Colleen Long: at the same time, because these providers in this tech space are now in bed with the payers, meaning that, Optum might become sch Maum, that's the sister company that then gets these subsidies and also is the provider or their, investment group is investing in these companies. So, lo and behold, you can't get the same rates that these other.
[00:28:28] Colleen Long: Bigger companies are getting because they are the payers and it behooves them to subject to you, to clawbacks, audits, delays, denials, lower rates, lower fees, because then you can't recruit and it narrows the competition for them. Why is this legal? You ask? Because they have better lobbyists.
[00:28:48] Colleen Long: So cut number four. In this death by a thousand cuts is the administrative avalanche that all of us in behavioral health face. So despite being given behavioral health parody or whatever that means, there is no parody, there's no equality. The behavioral health clinicians are treated like they're redheaded stepchildren of the healthcare field, still.
[00:29:08] Colleen Long: for me to be able to do a, uh, neuropsych evaluation for a patient who's concerned with a DHD, let's say a patient who has gone from caregiver to caregiver, provider to provider, medication to medication, inpatient facility to inpatient facility, all I'm gonna do is give you diagnostic clarity and tell you exactly what this patient needs.
[00:29:30] Colleen Long: I need to ask for permission to do that most of the time and. I gotta wait two weeks to do it. And a lot of times I gotta sit and meet with their peer reviewers, who by the way, have never administered a psychological test in their lives to tell me how long that should take me. it's completely humiliating and deflating to have to ask for permission to provide the care that you have trained so long to provide.
[00:29:50] Colleen Long: On top of that, the administrative burden that is ever increasing now on clinicians, just to be able to accept insurance is untenable. So we are drowning in forms, audits, compliance, checklists. Half our day is documenting risk instead of being able to deliver care, we are turning into data entry technicians I mean, HIPAA was written in 1996. so we're out here duct taping these 1996 compliance rules to 2025 technology and then getting dragged online for not texting back fast enough. it's a complete mismatch. and the payer systems that you work with are purposely obfuscated in antiquity when it comes to paying you, when it comes to speaking with a human.
[00:30:39] Colleen Long: But don't you worry when it comes to getting their money back. Extremely high tech. Extremely high tech and in fact, implementation of AI these days. Now, to deny every third claim because most of the time research shows that providers won't go up against it because they don't have the time
[00:30:56] Colleen Long: on top of that in terms of the admin burden. So to be able to deal with these payers and to handle. HIPAA and compliance. We are still dealing with very out of date EHR systems. We used one called insync and it would just, for instance, post payments that were paid by the insurance company as if they were paid to us not reconciling them with a bank account.
[00:31:19] Colleen Long: Our biller discussed. she was not reconciling ever any of these payments and so we were just assuming that patients had paid. Meanwhile, Tricare paid all of their patients directly, so good luck going and trying to chase down your payment from this patient who has cashed their check long ago.
[00:31:37] Colleen Long: Also, combine that with the new laws that do not allow unpaid medical bills to go on a person's credit report, so you have absolutely no leverage when it comes to trying to collect bad. Additionally, because of our ethical obligations, you cannot withhold medical records for nonpayment. So in our practice, we're moving this patient's report right along, right along, right along.
[00:32:05] Colleen Long: Come to find out they've got a deductible that's due. They need to pay that. They say, I'm not gonna pay that. And by the way, you can't withhold medical records. And so I want my report. You are bound to determine to give them that report and you're not gonna get paid. we did start to put better systems in place for that.
[00:32:24] Colleen Long: We would pull someone off the line as soon as there was an outstanding balance so that there was no report to withhold. We just weren't doing further services and interpreting until it was paid. and that did stop the bleeding somewhat. There are numerous ways and opportunities very easily for patients to hurt you as a practice who is bound by, again, HIPAA compliance and confidentiality rules.
[00:32:50] Colleen Long: So if they don't like the diagnosis that they give, if they don't like how slowly you're moving, if they don't like that you're holding them to their deductible, they go right to Yelp and you have very little recourse in terms of being able to respond because you are breaking that person's confidentiality.
[00:33:06] Colleen Long: and in fact, in the field that we're in, and you'll find that for most custody evaluators, forensic psychologist, we're not always giving patients information that they want about themselves. We're giving them deep dives into their personality and their diagnosis. Sometimes they're attached to a diagnosis that they don't have.
[00:33:23] Colleen Long: we're also not dealing with the benchmark of mental health in the mental health field. Mostly we'll get people who are motivated by being upset we'll then take to social media to wreck your business really with very little recourse. In addition to that, we were starting to get patients who would go to the Better Business Bureau, the Massachusetts Board of Psychology, and every single time we get that complaint, regardless if it's unmerited unwarranted, we still have to entertain every single one.
[00:33:53] Colleen Long: And it's not just writing a letter. You have to engage an attorney, you have to file a claim with your malpractice insurance. It is a pain. So every time we had a borderline client who felt like she had an autism diagnosis or she was supposed to be diagnosed with A DHD and she was not, she could file a board complaint and we had to respond to that.
[00:34:17] Colleen Long: And that is a huge. Handcuff on the private practice clinician again. So cut five. Here is just the simple handcuffs that this freedom paper our license was really supposed to provide becomes more of a cage.
[00:34:33] Colleen Long: Additionally, as a person who grew up in the sort of meager beginnings that I described in the first part of this series, I had a soft spot in my heart for people who needed to rely on their insurance, and I knew that testing could be done in a way that's affordable. I'm pretty good with technology and I was able to leverage technology to figure out how to make this work within the constraints that the insurance company would give us, which is not that much, but they would give us maybe, you know, eight to 12 units from.
[00:35:04] Colleen Long: Beginning to end to test the patient, I figured out how to do it. The issue is though, that when you're beholden to insurance companies, you've now got another regulatory body that you are answering to. Not just the board, not just the Better Business Bureau, not just Yelp. Now, not just your patients, not just your employees, but the insurance companies.
[00:35:22] Colleen Long: And anytime a patient's not happy with what you do, they file that complaint again with the insurance company and you're in jeopardy of losing your contract. Meanwhile, our rates, our fee schedules haven't gone up in years. It's the exact same, it was 10 years ago now, I don't know many other professions that work in a job for 10 years without getting an raise, and in some cases, a demotion, CMS cut behavioral health disproportionately this year in terms of our rates.
[00:35:52] Colleen Long: So in a nation that. Bemoans, the fundamental importance of mental health care and mental health and how important that is. We are continuously being undercut, replaced by bots and commoditized in this way, and being sold out to the lowest bidder. You can literally take a coaching course and become a therapist and get some sort of certificate, be paid by the insurance company, and you'll take 37 bucks an hour because heck, you don't have any loans, right?
[00:36:21] Colleen Long: You can afford it and nobody knows the difference. So cut five in this autopsy. Death by a thousand cuts is the insurers cut. Number six in death. By a thousand cuts are the people.
[00:36:35] Colleen Long: As I go into talking about this, I am still sort of haunted by the fear of being canceled, right? And then I remember I don't give a fuck because , I'm not in this anymore. I don't have these employees anymore. And, really who I'm speaking to are the, owners, the founders, the clinicians who are in the very place that I found myself in last year.
[00:36:59] Colleen Long: So I'm gonna be real honest about this. I'm not gonna sugarcoat this. There is a generational divide in our workforce, and
[00:37:06] Colleen Long: I'm technically right on the cusp here between Gen X and millennial. I was born in 1980 I identify more as a Gen Xer for sure. I think we were cut from a different cloth when we were coming up. We certainly were working $4 and 80 cents an hour. Yes sir. May I have another? That was the mentality.
[00:37:23] Colleen Long: You do what you need to do, knows the grindstone, you get it done, you get the piece of paper, you move on. Nowadays you get, if I'm asking someone to be accountable for the time I get, this workplace feels toxic to me. It feels toxic. when I say I need you to be able to get these reports turned around in less than two weeks, I just really feel like the value on work life balance here is just not here.
[00:37:53] Colleen Long: And I just really need you to be understanding that I do have children and I just need bitch. We all got children. everybody's busy. as a leader, I had very little patience for this new zeitgeist that I was seeing unfold. I think that probably the millennials and the Gen Zers are an overcorrection or a course correction to our generation who very much was of the hustle culture.
[00:38:24] Colleen Long: Right. And some of that I think they got right. just realizing that money's not the end all, be all. Uh, they're probably never gonna own a home in their life at this rate. let's figure out how to value the time that we're here. The issue is that the work ethic has not been there. It has been very, very difficult to find the work.
[00:38:46] Colleen Long: I'll pick up the phone and I'll talk to the patient and I'll humanize them. they have not had that level of, developmental curation that they needed during the pandemic, I think, honestly. that's why we ended up with a lot of intake coordinators, front end people who very little human touch and our humans, our patients were getting upset, understandably.
[00:39:07] Colleen Long: So the issue that you also face is that, so then what do you do? You go back and you hire a boomer, right. Or Gen Xer. while they certainly have that work ethic and will get on the phone and talk to the patients, they don't always have the plasticity to navigate the tech. That we find ourselves in, in this day and age.
[00:39:32] Colleen Long: it has been a challenge to find someone that can understand how to operate a remote practice in a tech world with the tech stack that we do. And look, we, we use a lot. We use, uh, Google Workspace, we use Simple Practice. We use Asana. You know, we've got a lot of different systems going on. it's been a real challenge to be able to find that.
[00:39:57] Colleen Long: we have a sort of, entitlement culture here and it's really, really difficult to please everybody. One of the biggest things that I hear clinicians talk about, especially group practice owners, is culture building and the need to build a culture. And there's truth to that and that. Turnover is expensive.
[00:40:20] Colleen Long: And I learned that the hard way, not properly onboarding someone, not making someone feel part of the fabric of your company. not humanizing the person. And, building things in which you see other people as just like humans. And having that connection. You lose loyalty and you're looked at as just another widget for them.
[00:40:42] Colleen Long: If headway can pay them more than you can pay them, they're out the door the next week and there's no loyalty there. But building culture is a full-time job most of us don't have the bandwidth or the margins to. Hire a culture builder, right? So you end up doing it. So another cut, because we are then exhausted with, we are running systems operations, overseeing this, dealing with board complaints, HIPAA patients trying to do patient care, and now we gotta run a, icebreaker party and everybody wear your Hawaiian shirts.
[00:41:17] Colleen Long: And tell me one fun fact about yourself, like who, who can do all of that. that's the other issue that group practice owners are facing. And I say this because most group practice owners, I think stumbled into group practice ownership. it was like a, oh, well, if I could get two clinicians to do what I'm doing, then I can get off the chair.
[00:41:37] Colleen Long: But really what you end up doing is you run payroll and you've just created another job for yourself, and you're not really working on the business. You're still working in the business just at a $25 an hour job that could have been outsourced.
[00:41:47] Colleen Long: simultaneously we are getting blasted by employees, patients raked over the coals. We've got employees that are sort of creating a coup within the organization of, well, have they paid you? Have they paid you as if I'm Jeff Bezos, and I'm keeping this like stack of money over here and counting it on my yacht, which was not the case.
[00:42:12] Colleen Long: And in fact, as you'll find out in one year. Despite it being probably one of the most stressful, longest sleepless years of my life, I made $45,000.
[00:42:24] Colleen Long: As things started to unravel. This was in 2024. Both joy and disgust were gone. At this point. They had both said, enough was enough, and I was left with this person who was my EVP. It was like, if I am a prop plane and I've hired a co-pilot from Delta Airlines who has never had to really steer the ship, can put it on auto control, go back to the back of the cabin, take a nap.
[00:42:55] Colleen Long: Because there's so many other safety guards in place and meanwhile we're, we're flying this prop plane. If you don't get the nose up, we're gonna crash at any minute. You always gotta be on it. So as this person, I'm realizing has no idea what they're doing and is completely not the right person for the role, we are getting just absolutely scorched by our employees and our clinicians.
[00:43:21] Colleen Long: We were using Google Workspace at the time. We used Google Chat for intercompany communication, much like some people use Slack. it became a source of where people could air their frustration against leadership. And guess who that was? I would wake up in the morning with a paragraph long of what a horrible leader I was, how they would do things differently, what I should have done differently.
[00:43:46] Colleen Long: Then I quit publicly in front of the entire company. I would wake up to emails threats. at one point when we let go of the two front office people who were overcharging us, I said, I'm gonna pay this amount, but I'm not gonna pay any more than this. And it's clear that you weren't working these hours.
[00:44:04] Colleen Long: And here's the statistics. at this stage, I was on the phone with my employment attorney every week because there was some issue. Now as we got bigger and the employment employment attorney, essentially their answer every single time was Just pay them. Just pay them what they want. Just pay them what they want.
[00:44:20] Colleen Long: in the state of Massachusetts, if you do not pay them what they want within 48 hours, they can see you for triple, regardless if they worked it or not. So in both Massachusetts and California, the states that I chose to work in are notoriously one of the more difficult ones for employers, and this was an issue I ran into quite a bit.
[00:44:38] Colleen Long: So the sixth cut in this death by a thousand cuts was the sheer entitlement combined with the ease of access to legal means for the employees, and heavily weighted against structures for the employers.
[00:44:55] Colleen Long: Cut number seven in this autopsy, death by a thousand cuts are the patients. So as a mental health clinician, we don't deal with the, the benchmarks of mental health, right? We're dealing with people who are sometimes acutely unstable , who have struggled with maintaining their own relationships, and when they feel like they are not getting the service they're entitled to.
[00:45:19] Colleen Long: when you are working with insurance, you take it on the chin for the insurance company, you become the vicarious employee for the insurance company because it's impossible to get a human on the other end for most of these people. And so who do they complain to? It's us. the sheer toll of hundreds of patients a month calling in and telling.
[00:45:37] Colleen Long: Our front office staff, how awful we were, takes its toll. And it's not a job that many people can hold, especially of that younger generation where, you sort of have to have this thick skin and not take it personally. also on top of that is that one bad Google Review can completely wreck you.
[00:45:59] Colleen Long: And if you're not doing good SEO on your own company, that's what takes the front page when they're searching your name.
[00:46:05] Colleen Long: I've had clients email me treatment suggestions from Reddit. I've had people critique my reports and tell me where they want it to change it. I've had families demanding that I write. Accommodation letters for their kids who don't need accommodations. And as a result, if you don't give them exactly what they think they are entitled to, they'll take to the internet, Yelp, Google.
[00:46:34] Colleen Long: we had patients coming into our office at one point demanding their reports because our front office staff was not answering the phone as the payments started to dry out from the insurance companies. providers would soon leave. Number one, I wouldn't wanna stay around if I'm not getting paid, and we were only paying a percentage of what we were able to get from the insurance company.
[00:46:57] Colleen Long: And then number two. When you are able to just work, come and go as you please, bill as you want, and then all of a sudden you have someone that's like, now we're gonna start doing caps on your hours, your jobs changed. And so, understandably, many of those people were upset and they took their ball and they went home.
[00:47:12] Colleen Long: we are, the psych testing practice is a bit different than a therapy practice is. Now you've got all of these reports that are in motion and no one's there to finish them. And so while I had reached out to these clinicians saying, Hey, can you just finish off on the work that it was billed under your license?
[00:47:28] Colleen Long: No response. And here I was stuck. with having to finish hundreds of reports on my own
[00:47:36] Colleen Long: Cut. Number eight.
[00:47:37] Colleen Long: When I look back at this autopsy of my practice, one very hard learn lesson that I'll never, ever need to learn again is how quickly things can turn upside down and how you need someone at the ship at the helm always looking out for glaciers. We hit a glacier, a big one, and no one saw it coming. So as these payments started to dry up and as cost containment was just not even there, there was no cost containment and our providers and techs were billing whatever they felt like they should bill.
[00:48:12] Colleen Long: I had to take out a business line of credit to make payroll for the first time in years thinking this is just temporary. Until it happened again and again and again. Now keep in mind I'm trying to respond to the Better Business Bureau complaints from the patients who are like, where's my report?
[00:48:31] Colleen Long: Because all of the clinicians have left. I'm trying to entertain the board complaints from said, patients who were upset that they didn't get the right diagnosis further delaying me on the other reports from those patients who are gonna get mad. I'm dealing with the attorney general who is very easily reached, by the way, by your employees if they don't feel like they were paid, all that they need to be paid with a threat that now I owe triple if I don't pay this right away.
[00:48:54] Colleen Long: So I'm trying to manage all of that and at the same time, trying to figure out where our money is. And I'm not a biller. I'm frantically hiring billers at this point, throwing money at six different billers. Please go help me find this money. Meanwhile, timely filing limits are running out. They're saying, so, so sorry you didn't get it in, or send in a paper claim.
[00:49:18] Colleen Long: Now they move the goalpost, they change from this name to this name. Now all of a sudden you've gotta submit through this website, or it's a corrected claim, so you gotta do a paper claim and oh, you didn't do it in 30 days. So unfortunately, it's denied. a patient can change their insurance over the course of the testing process.
[00:49:36] Colleen Long: It's a long process, and so all of a sudden you're building an insurance company where there's no active coverage. these are all the things that started to contribute to me almost losing my home. We got further and further into debt and at one point I had over a quarter of a million dollars leveraged on my home trying to pay all the people to help me figure out where our money was.
[00:49:57] Colleen Long: I was stuck.
[00:49:59] Colleen Long: I could not close my practice. If I closed my practice and went bankrupt, I would have lost my home.
[00:50:07] Colleen Long: And I remember so many sleepless nights thinking, okay, well if we could just figure out this piece here, then maybe we can get a little cash infusion this way and then this way. But it was like whack-a-mole and there was no end in sight. I honestly was trapped. I had no idea what I was gonna do. And not only do people not talk about this in our field, I think it's a source of shame.
[00:50:35] Colleen Long: psychological testing is a horse of a different color, so not many people are familiar with the ins and outs of that. most of the time when I would reach out anonymously on these Facebook groups for clinicians, most of what I got was a lot of judgment from our helpers. So people that said, maybe you should question why you're even in business if you went this far upside down.
[00:50:56] Colleen Long: I had reached out and then I was like, I immediately retracted because I just thought, I'm already so humiliated that this thing failed and I feel like this thing that I was doing really well at. I was so crazy, so bad at business that I ruined it. I took this thing and I ruined it, and it's not like I can just like close the door and walk away.
[00:51:25] Colleen Long: I'm stuck in this thing. And going back to part one of this, I thrived on being a good girl. I was the good student. I was well liked. I never got in trouble I felt like a criminal at this point. I, people were eviscerating me online employees, patients, At a certain point, as a psychologist, you go, well, there's a common denominator here.
[00:51:50] Colleen Long: If it keeps happening, maybe it is you, and you start to feel like maybe you are bad, Maybe that's what this all is, that you just got in over your head and you just are batting out of your league, and you had no business owning a business. All of that in those sleepless nights.
[00:52:08] Colleen Long: I remember in Thanksgiving of last year, I was so sad and so afraid, and around the holidays, I think most of us like to just shift and get in the cozy pajamas, listen to some Christmas music, drink the hot cocoa, and like say, all right, well I've put in a good year. I'm gonna like. Have some time with my family and I could not do that.
[00:52:32] Colleen Long: I was looking ahead towards patient's deductibles, saying, okay, you owe this much and you're gonna owe this much, and please don't schedule this person until they've paid this amount. I couldn't stop. I could not stop. meanwhile, I'm watching my kids grow up and I'm not there. I'm not, I'm not at the slime stations.
[00:52:51] Colleen Long: I'm not volunteering at the fun run because I am losing my hair over what I have done to my family. I'm about to lose my, my home.
[00:53:03] Colleen Long: Cut number nine in death by a thousand cuts autopsy of a practice is the lack of unionization that clinicians experience. So in most large, uh, professions, there is a union where you can go there and argue for better pay, better treatment. But because clinicians are fragmented through state lines and different payers, I think purposely it becomes very difficult to unionize because you're unionizing against 4,700 different employers, right?
[00:53:41] Colleen Long: we deal with this fragmentation. We deal with this purposeful antiquity and obfuscation by the payers. And we have no ability to connect with others and afford the same lobbyists that these payers have. we've been sort of socialized to never talk about a payer or the rate because oh my gosh, they can come after you.
[00:54:06] Colleen Long: That's simply not true. and yet if you are completely going private pay without doing sliding scale, you're somehow accused of being greedy, of being capitalistic, of being in the wrong profession. and so there's this guilt that you carry around with you. But let me give you an example.
[00:54:26] Colleen Long: We aimed to take every single insurer in the state of Massachusetts, and one of the issues with Mass Health and Medicare is that. You cannot charge a no-show fee. So if that patient decides, they wake up that morning and they decide they don't feel like coming, you gotta just keep on rescheduling them until they do.
[00:54:47] Colleen Long: Now you still have to pay your providers to prep for that time, to prep for their test, to prep for their intake or their testing, and you can't charge that patient a no show fee, and you have to keep on accepting them. that alone is part of a broken system that makes it incredibly difficult for quality providers to continue providing care for people who arguably need it the most.
[00:55:08] Colleen Long: Cut 10 in this death by a thousand cuts is the dehumanization loop that clinicians have experienced. We have become the unpaid shock absorbers of a broken economy. We absorb every denied claim, every client crisis, every just one more audit, every peer review, every delay, denial, clawback, or audit,
[00:55:33] Colleen Long: and you're not getting that from the patient. They're taking that out of your pocket, and they can do it years, years later. Meanwhile, if you don't get your claim in within their 30 day timely filing limit window, you can say goodbye to ever being paid.
[00:55:47] Colleen Long: So this is the loop. They overextend you, they underpay you, they overregulate, you repeat.
[00:55:53] Colleen Long: We call it ethics, but it's sadomasochism. We didn't fail the system. The system failed us, and it was engineered that way. We are the people that aimed to set out and help people who really, really need it.
[00:56:08] Colleen Long: And ironically, we are burning out in record numbers. I watched a podcast this morning of a man who was a therapist, who became a bartender that made more as a bartender, instead of helping people get off of substances, he was pushing substances and made more. This is why we have a broken mental healthcare system.
[00:56:32] Colleen Long: clinicians like me are running small empires with the same liabilities as Fortune 500 CEOs, except we can't afford a legal department or PR team, or HR team. When it all blows up on social media, we face audits, board complaints, insurance, clawbacks, staff turnover, inflation, and we're still expected to smile and post a quote about self-care.
[00:56:54] Colleen Long: we carry risk. Without representation, we pay taxes. Like business owners get reimbursed like case managers and sleep like haunted dolls. Meanwhile, insurance companies are vertically integrating mental health services and recording record billion dollar profits, buying up telehealth platforms, hiring clinicians on salary, lobbying circles around us.
[00:57:15] Colleen Long: We're still arguing about whether it's ethical to charge a no-show fee. When I talk to clinicians across states, the story's the same. We have all the responsibility of healthcare and none of the representation we're the workforce that can't unionize because we're too traumatized by HIPAA to share a spreadsheet.
[00:57:31] Colleen Long: Let's zoom out. This isn't just my story. This is what happens when a trillion dollar industry runs on unpaid overtime and moral guilt. Behavioral health has always been the redheaded stepchild of medicine, underfunded overregulated, and expected to heal trauma for the price of a copay. We are the most scrutinized, least protected professionals in healthcare.
[00:57:55] Colleen Long: Our licenses are no longer paper shields, but cages handcuffs. Our ethics codes were written before email, and every innovation somehow means less money and more paperwork.
[00:58:09] Colleen Long: The system doesn't need us, well, it needs us compliant.
[00:58:12] Colleen Long: so here's the part where. I'm gonna do some reflection because yes, there's a lot of odds stacked against us, but there's certainly things that I could have done better, and if I were a different person or had learned these lessons sooner, I think could have subverted some of these, tragedies in the practice.
[00:58:34] Colleen Long: You know, I could make this all about the system and, and yes, the system is broken, but I also broke things. I got cocky. There's a point where I thought, I figured this out. I'm scaling. I'm different. And I wasn't different. I was just moving too fast to notice the fires behind me. I'm impulsive by nature. I have all the buzzwords that sound good in a, in a mastermind, visionary, maverick, quick start, all that stuff. But it's not easy to work with me. If I have an idea on Monday, I wanna implement it by Wednesday, and I forgot about it on Friday. And at 40 plus employees, you can't run a business like that. But I did.
[00:59:14] Colleen Long: I tried. I'm awful with details. I'll roll out a new policy and I'll expect everybody to move at my pace. Then I get frustrated when people aren't moving the same way they can't keep up with the pivots. I abdicate it when I should have delegated it. I threw money and tech solutions at problems instead of just sitting in the discomfort sometimes of solving them slowly.
[00:59:37] Colleen Long: I'm not a phone person. I talk for a living for. 20 years and I loathed meetings and I probably could have had a lot more of those where tone got misconstrued in an email or a text.
[00:59:48] Colleen Long: Some of those conversations, those sweaty back conversations that we need to have as leaders, I didn't wanna have. And instead it was an email or a text that was taken the wrong way. My tone got misconstrued a lot and my tone didn't get misconstrued a lot. A lot of times I was just
[01:00:07] Colleen Long: a tyrant.
[01:00:08] Colleen Long: When I get scared, I don't flight. I fight and I move quick and sometimes. Cutting off my nose, spite my face. An employee would push back and instead of pausing to understand why, I'd see it as betrayal or disloyalty. So I'd make a fast decision to protect myself. I'd fire someone, cut ties and, what do they say?
[01:00:29] Colleen Long: Hire slow, fire fast. That's it. Would all be under the badge of that, right? Burn a bridge. Only to realize later. I didn't have all the information. I didn't know how much of a lifeline that person was in my practice, right? My eyes have always been too big for my stomach, and I don't know that that's ever gonna change.
[01:00:48] Colleen Long: I wanna do all the things at once. I wanna build the practice scale at mentor, teach, innovate. I wanted to create culture, be the good boss, be the visionary. And in trying to do it all, I ended up pissing off a lot of people.
[01:01:02] Colleen Long: Staff who thrived on consistency, got a lot of chaos, and clients who needed stability got a practice in constant transition. And my family got it the worst. They got the burnt out version of me for many years. I am not an MBA, I'm not measured. I'm not groomed to be a CEO. I'm a bootstrap clinician with no formal business training who watched some YouTube videos, read traction, and thought, how hard could this be?
[01:01:34] Colleen Long: And it turns out it's very hard.
[01:01:36] Colleen Long: I didn't even know how to read a p and L until we were already under water. I didn't understand profit margins or runway or even what opex meant. I just hired an integrator thinking she'd fix it. But you can't outsource self-awareness. So when I say the practice died, yes, insurance killed it. The system is rigged, the system is broken, the generational divide and the admin burden, vertical integration, they all play their part, certainly.
[01:02:05] Colleen Long: But I also had a hand in it with my impulsivity, my ego at times, my inability to slow down to compromise, my refusal to admit I was in over my head at times. My refusal to just sit still sometimes take the win.
[01:02:22] Colleen Long: And I think it's easier to be the hero or the victim in your own story. But I was both and neither. I was just a person who cared too much, but knew too little.
[01:02:34] Colleen Long: I was operating the yellow cab in the age of Uber trying to build something sustainable in a system designed for extinction. So what did I learn from all that? Well, speed isn't a strategy. Don't abdicate, delegate.
[01:02:48] Colleen Long: Stop trading your time for money. The system's broken. Visionary without execution is just expensive chaos and that you can't scale a business faster than you can regulate your own nervous system.
[01:02:59] Colleen Long: So here's the thing about this autopsy of my practice and probably so many other people that decided to close their practices. It's not about blame. It's about understanding what went wrong. So maybe the next generation doesn't have to die in the same way. I think as more of us have these open conversations and talk about this as more of us leave the field of insurance and refuse to
[01:03:28] Colleen Long: play their game, yes, there will be a system and a great divide where only those who can afford it will get good mental health care. But then perhaps we'll hit a tipping point where society will demand change.
[01:03:44] Colleen Long: and I hope that I didn't put everyone to sleep. I hope that this was helpful. I hope that if you're feeling alone like I was last year, that you are not feeling alone after this. This isn't a story about failure. It's a love letter to every clinician who has ever wondered if the problem was them, when really it's the infrastructure, it's the system.
[01:04:13] Colleen Long: It's broken, and it's not in our favor.
[01:04:15] Colleen Long: our Rudy esque ending, our fairytale ending.
[01:04:19] Colleen Long: By the grace of God, I found a buyer. I simply put my business on Biz by Sell and had, you know, tons and tons of inquiries. And then of that you'll get, you know, like 2% that are actually really, really interested, vetted buyers. And then I had. Couple people that were seriously moving forward with like an NDA and purchase sale agreement or an LOI letter of intention.
[01:04:46] Colleen Long: Found someone who had way more operational experience than I did, had run a bunch of urgent care centers, and just essentially was exactly what this company needed to, to heal and repair. had the infrastructure, had the capital, and believed in the model and saw that for so long we were profitable. And that's what a lot of these buyers are doing now when looking at your practices, typically they understand that we as clinicians are not great business owners and there's some arbitrage there in their ability to bring their business expertise and knowledge to your business and turn a profit.
[01:05:29] Colleen Long: I will say if you are in a place where you are feeling hopeless or you're feeling stuck like I was, please know that that would be my first suggestion is go on biz buy sell. You can do it anonymously and you can at least get a sense of the pulse of the market and what's out there. I'm also happy to help you in, just consulting with you along these, this process and navigating this process, the m and a deals, and setting up NDAs and all that kind of stuff as I did most of this stuff on my own.
[01:05:57] Colleen Long: it has been a absolute dream. This person had the capital to rebrand, to actually hire a marketing team, to repair the reputation, to hire a good CFO, to hire a team, an entire team of people that renegotiate our rates with the payers. To be able to hire enough staff to get through all of the reports.
[01:06:22] Colleen Long: I mean, yeah, it's amazing what capital will do. And I have every belief in the fact that this person will take this business and absolutely soar with it. And I'm so, so happy. luckily I got, obviously out of the fear of losing my home, which is good. And I was able to sell the practice for seven figures.
[01:06:41] Colleen Long: So, that's something that could never be taken away from me. It's a great data point. It in those moments, those dark, dark moments where you go, am I even intelligent? like, what is wrong? Why are you experiencing all these issues? I always have that now in my back pocket. Like, listen, you. Scaled bootstrap and sold this thing from nothing to seven figures.
[01:07:07] Colleen Long: And that's not something to take lightly. So that has certainly helped me in repairing just my sense of self as a person.
[01:07:19] Colleen Long: Obviously I could sleep much better now knowing that I'm not in danger of losing my home. And the sheer, weight of not having all of the jobs I had before and all of the operations and all the fires and all of that stuff that goes with it has been amazing. while I'm probably not supposed to say much about the deal, I think it's pretty common that most people, have some sort of transition period, which I'm in where I am simply.
[01:07:47] Colleen Long: A consultant for the company. And it has been a dream to feel as an, an employee, like, I provide this thing and then all the rest of the stuff I don't worry about. And that has been such a breath of fresh air. I will say I am doing EMDR right now because I, and I don't even wanna use the word trauma because there are so many other people that have had so, so many more trauma traumatic things happen to them.
[01:08:14] Colleen Long: But I do notice my nervous system is still on fire despite the fire being put out months ago. And I'm not sleeping, I'm not taking care of myself. I'm not eating. I think the sympathetic nervous system is still going. And so I am. Taking steps to address that and you know, obviously understand the importance of that from a mental health perspective.
[01:08:38] Colleen Long: The last thing I'll say is that the biggest piece that has been so cool after the cell and the rise in the fall and all the scorched earth and everything that happened in such short amount of time has been the freedom that has opened up for me to be able to do this podcast and to write books and to be more creative and do all the things that I would keep on doing even if I never get paid for them.
[01:09:05] Colleen Long: So
[01:09:06] Colleen Long: I do think that all of that training that you have as a clinician is not for Naugh. That is a moat, and it's just about learning to navigate a new earth. Where you can leverage technology and modern tools to take your specialty and your skills and do one too many versus one-to-one, whether that be through Etsy, through your YouTube channel, through your podcast, through your books, coaching retreats.
[01:09:37] Colleen Long: But it doesn't have to be the way that we once thought. private practice slugging it away with your shingle out front, just trying to get Doris, your front office manager to turn in a bill. I don't think that works anymore. And I think the sooner that we realize that, the better off we'll be as a field.
[01:09:54] Colleen Long: Thanks guys for listening.
[01:09:55] Colleen Long: If this episode hits something raw, share it with another clinician who's still sprinting. Leave a review because algorithms don't listen to therapy, but they do listen to you subscribe for season two of Off the Chair, the reconstruction where we stop coding, collapse, and start writing the recovery plan.
[01:10:14] Colleen Long: Until next time, rest, regulate and rebel responsibly or not.
