Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.
This episode is brought to you by PAR. The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConnect- PAR’s online assessment platform. Learn more at parinc.com\faw.
Hey, everybody. Welcome back. Glad to be here with you as always. And I am thrilled to be talking with my guest today, Dr. Mandi White-Ajmani. Mandi is a clinical psychologist and the owner of Small Brooklyn Psychology and Neuroscience Assessment and Therapy group practice in Brooklyn, New York. She got her Ph.D. from Suffolk University in Boston and then started her career in clinical neuroscience research at NYU investigating the neuropsychological correlates of serious mental illness, aggression, and family violence.
When she realized that she didn’t want grant applications hanging over her head for the rest of her career, she decided to return to clinical work and opened a solo neuro-psych assessment practice in 2013. She expanded the testing practice to a group in 2018 and then added evidence-based therapy in 2019. And now has a thriving team of 7 clinicians who provide high-quality care to people of all ages. But I have a special focus on kids, teens, and parents.
I’ve known Mandi for several years now and got to meet her in person and hang out at AACN in 2019 and just love her energy and really appreciate and admire the work that she’s done to build this practice.
So, we’re going to dig into all sorts of things related to the journey going from a solo testing practice to a group testing practice. We’re going to talk about finding the why as your practice grows, developing confidence as you build a group practice, discovering the values for your practice, and turning those into reality. We’ll talk about how the practice owner’s role shifts as you move from being a solo practitioner to a group practice owner. And then we also touch on the marketing techniques that worked for Mandi among many other things. So this is a great episode. Like I said, Mandi has a really positive attitude and great energy. I really enjoyed this conversation.
Before I transition to the interview, I want to invite any advanced practice owners. So folks who are thinking about expanding to a group, or maybe already have a small group and want to grow that group practice to consider The Testing Psychologist Advanced Practice Mastermind Group that starts early June. I think June 10th is our next cohort. And this is a small group coaching experience where you’ll get accountability and support and guidance to take your practice to that next level. So if that sounds interesting to you, you can check out thetestingpsychologists.com/advanced and get some more information and schedule a pre-group phone call to see if it’s a good fit.
All right. Let’s get to my conversation with Dr. Mandi White-Ajmani.
Hey, Mandi. Welcome to the podcast.
Dr. Mandi: Hey, Jeremy. Thanks so much for having me.
Dr. Sharp: Yes. It’s so good to see you. It’s been almost two years. I saw you at AACN 2019.
Dr. Mandi: Yeah, AACN. Do you think that they’ll ever have conferences again because it was really my only chance to get away from my kids.
Dr. Sharp: I hope so, if only for that reason. Yeah. Those were my vacations.
Dr. Mandi: I’m dying.
Dr. Sharp: Right. I think we all are. Yeah, I’m hoping. Although, I was supposed to go to The Group Practice Owner’s exchange conference and they canceled it.
Dr. Mandi: All the way? I thought they had another version?
Dr. Sharp: We’ll see where the others end up. But yeah, I miss it. That was a fun conference. I met so many of you in person than I’d just known online.
Dr. Mandi: It was really tremendous. It was really the first time that I got a chance to meet a lot of the other people in the Testing Podcast Community. I know everybody says this, Jeremy, but thank you so much for starting this whole community. But meeting people through a mutual love of the podcast, meeting people through the Facebook group, connecting those faces and personalities to the names has just been amazing. And then for the last two years, and especially during the pandemic, it’s really been quite a source of support for so many of us, including me. We joined one of those pandemic support groups. I hear that ours is the only one that’s still going. It’s been really fun. You’re the originator. Thank you.
Dr. Sharp: Well, thanks. I mean, I can only take one IOTA of credit for that, but y’all have…
Dr. Mandi: A little bit more than one, yeah.
Dr. Sharp: Okay.
Dr. Mandi: I know I make you feel embarrassed.
Dr. Sharp: Yeah, I’m blushing. That’s a good thing we don’t do a video here. It was so cool. When I talk to Rebecca a few podcasts ago, we had a nice extended conversation after we stopped recording. And I had no idea that y’all had continued to meet. And it was such a nice pleasant surprise to hear that all those connections are just continuing and getting stronger among such a great group of people.
Dr. Mandi: It’s wonderful. And it’s really great to have those connections across the country and hear what other people are doing in other regions and other specialties. So, yeah, it’s been really nice.
Dr. Sharp: Awesome. Well, I’m excited to talk with you. I feel like I’ve known of your practice here for a few years now, and I’m really excited to…
Dr. Mandi: Yeah, I feel nervous.
Dr. Sharp: Well, sure. I’m excited to see where things have ended up. So tell me, I always start with this question. Why is this important? So in a business context, it’s maybe a little bit of a different lens to look through, but I’m curious for you, why do you like talking about this? Why is this an important thing for practice owners to know about this expansion from solo to the group?
Dr. Mandi: I think this is a common question that a lot of people have. Many people start a solo practice expecting that they’re only going to be solo practitioners forever. And that’s totally fine. That’s certainly where my head was in the early days. But I think that there are many of us who also always have in the back of our minds whether a group would be a good idea. And if so, when and how and all of that.
I started my solo practice in 2013 and by 2017, I had a moment where I realized that I was booking evaluation six months out. And most of the calls that I would take would end up going somewhere else simply because people didn’t want to wait that long. Totally understandable. And I realized I was losing a lot of business that way.
And having a group early on in my psychology career, when I was actually applying for Ph.D. programs in the first place, I initially thought that I wanted to be the owner and operator of a multi-disciplinary institution that would do clinical work, assessment, research, and then outreach, Psychoeducation. I really wanted to be a community resource in that way. Those are my early pie in the sky before grad school plans that made so many different shifts over the years. And when I finished my degree, I ended up in research. I thought I would stay there for my whole life.
But this idea of being a community resource was always in the back of my mind. And when I really came to learn the Brooklyn market, came to learn what was available and what I was bringing to potential clients and families, and what was still lacking, I felt like that was something I could actually provide. So not only were there not enough neuropsychologists offering evaluations and that’s why I was six months out and people still needed evaluations, but over time, I also came to realize that it was really hard to find therapists who had availability.
New York City is a very heavy psychodynamic-oriented market, but since we were seeing a lot of kids, I really wanted to help them get into more CBT-oriented services. And it is very hard to find a CBT therapist. It’s very hard to find a CBT therapist in Brooklyn in particular. And then the ones that were here were all booked. So again, it was a need that I could see that I could fill. So, that was my path into it.
There’s also another background, my particular piece, which is that I also have an MBA. I happened to get that before I got my Ph.D. It was sort of my back pocket feel-safe measure because I knew it was really hard to get into a Ph.D. program. I was actually working at Suffolk University, which is where I ended up getting my Ph.D. And then while I was working there, I got free graduate tuition. I was like, I guess I’ll just get an MBA while I’m waiting to see if I get into a Ph.D.
So I had a lot of that business knowledge already. And it’s really interesting to come into running your own practice actually having some knowledge of how to run a business. A lot of psychologists talk about this, right? They don’t teach us in grad school how to run a business. And yet I had a little bit of an advantage there that I was able to see things from a little bit more of a business perspective.
Dr. Sharp: Can I jump in real quick?
Dr. Mandi: Yeah, go ahead.
Dr. Sharp: One, didn’t know that about you. That is amazing. I’ve always dreamed about getting an MBA and whether that would be helpful. Two, can you think of specific aspects of that education that you put into play when you were opening your practice that felt like it really gave you a leg up where other people might’ve been doing more research on their own or, doing coaching or whatever. How did that MBA really help you logistically?
Dr. Mandi: I think it helped me logistically and philosophically actually. Ever since getting the MBA, I started thinking about the world and psychology but even before getting my grad degree in just a little bit more of a supply and demand sort of way, in filling a market need sort of way. I think I came to understand a lot more about opportunity costs and sunk costs. And those are results of things that I think really Steiny a lot of people into taking that next leap.
And so I think philosophically being able to think in that way allowed me to take more of that leap into something unknown, knowing that I had a pretty firm understanding of the market, knowing that I was bringing something to the market that was needed. And so I didn’t have as much of that self-doubt, as much of that nervousness about making sure that I knew every little aspect of the planning process. I just had a better understanding of what was needed, how I could fill it, and how to move on.
Logistically, I can read a balance sheet in a way that I couldn’t before. I’m still not perfect at it but that helps. I had a few more contacts in the area to help me with certain things like knowing when to reach out for an accountant and a lawyer and things like that. And I think again, maybe taking a few risks. That is maybe part of my personality too, but I think having the MBA knowledge to allow me to take those risks, to know that there was firm footing for what it was that I was trying to do. So it really was about a mind-shift I think, rather than specific skills that I learned in class. Does that make sense?
Dr. Sharp: It does make sense. Yeah. Well, I’ve said before that a lot of business anxiety and money anxiety can be solved with math. And just having education around some of that stuff and maybe just being familiar with that world and comfort in walking in that world goes a long way.
Dr. Mandi: That comfort is a big part of it.
Dr. Sharp: Yeah. That’s fantastic.
Dr. Mandi: Thanks. I think that comfort piece was actually really key for me. I think that there are a lot of people… so you asked earlier on, why do I like talking about this? And it’s partly because a lot of people see that I have made the jump from the solo practice to the group practice and they want to talk about my experience because they’re thinking about it for themselves. So, what was it that made you dive into it? How did you know it was the right time? And a lot of the things that I think hold people up are a lack of confidence and comfort with diving into a much bigger and more complicated business area. So having had a little bit more of that experience, I think at least gave me the feeling that I could do it, I could trust myself and I could learn some of this other stuff down the line.
But what I do see is a lot of people end up stopping at that jumping-off point because they feel like they haven’t yet learned everything there is to know. And part of the problem is you’re never going to learn everything there is to know. A lot of it, you won’t know until you really dive into it. And then you have to learn it on the fly. And I definitely have so many of those experiences too.
Dr. Sharp: You and me both. I hear you.
Dr. Mandi: Yeah, I know you know what it’s like.
Dr. Sharp: Oh my gosh. I don’t even know what to say. Thinking back to all the mistakes that I made and probably the money that I’ve lost too. These are all things. I was listening to The Group Practice Exchange Podcast the other day, Maureen’s podcast. And she was talking about taking imperfect action. And I think that’s such a good thing to keep in mind. Like you were just saying that sometimes we just don’t know. Oftentimes we don’t know. I would even say the vast majority of the time we don’t know, and you can’t control all those variables. You just do your best and you take the leap with some educated guesses.
Dr. Mandi: Absolutely. And some faith in yourself that you will solve whatever problem comes forward.
We are in the middle of a big kitchen renovation right now. We actually had to move out of our house in order to make this happen. And our architect has been such a tremendous resource. He’s been in the business for 30 years. And we have one of these old houses that were built in like 1906. And so there’s a lot of stuff that’s not straight and not built right and all of that in our house. And so he approaches renovations knowing that there’s only so much that you can plan for. The plans are only going to show so much. There’s just a lot that you’re going to tear into those walls and you’re going to realize, Oh, this thing needs to be fixed and this thing needs to be fixed.
My husband used to definitely plan everything out ahead of time, make sure that you know all of the possible problems ahead of time. And it was really hard for him and [00:15:00] our architect to come to the middle grounds to know that at a certain point, you just have to jump off, start the construction, you’re going to open the walls, you’re going to find things that are wrong. You have to be comfortable with the idea that things are going to come up. You’re going to tolerate the discomfort that comes with it. You’re going to solve the problems. You’re going to move on.
And I do think that is a really key theme in opening any business. So even solo practitioners, I’m sure have experienced this for themselves. It just of course becomes a little bit more complicated when you involve other people in the mix. But it’s so rewarding in so many ways too.
Dr. Sharp: It is. Yeah, I want to put a pin in this idea of what you found in the walls when you started to expand your practice. Okay? Let’s hold that for a second. I want to go back through to some of the beginning stages and just highlight that idea. You didn’t say it this way, but sort of like that finding your WHY for what you’re doing. It sounds like we shared the why of community access like hiring more folks, presumably allows you to [00:16:00] service the community better, right? More access is a big WHY for a lot of people.
Were there other WHYs that you found for growing? And a related question. How did you come to those WHYs? Was that deliberate reflection? Was it just stumbling into it? What did that process look like for you?
Dr. Mandi: Most of my revelations are stumbled into.
Dr. Sharp: Sure.
Dr. Mandi: So, one was that phone call where I realized I had this long waitlist and I was losing a lot of business. I knew that there was something that I could do about it. Actually, bring in my MBA to bear and my market knowledge. And I think it was something that I realized I could do. Client access was another big part of it. Wanting to provide these services for families who weren’t getting it. Really wanting to help build Brooklyn as a place that people could know that they could get good services.
There are so many fantastic clinicians here and yet there’s still a sensibility that if you want good services, you have to go into Manhattan. And so I really wanted people to understand that Brooklyn was a good place to be too. That they could go to a place and trust that they were getting good services here.
There’s also something else I’m sure you’re familiar with, which was that I was so buried in reports all the time. I remember getting towards the end of the school year, which is always my busiest time, I think I was like I don’t know nine reports in the hole or something like this. And you and I have talked about this before. My reports used to be like 25 pages long. I significantly cut that down.
Dr. Sharp: That’s good to hear.
Dr. Mandi: About the quality of life issue. But at the time I just remember thinking this is going to be the rest of my life. I will constantly be under all of these reports. I had dreams of creating a routine where my family and I would just unplug in August. August would be our month that we would either go for some long travel or even just have some staycation or something like that, but I would not work. And the problem is that when you’re a solo practitioner when you don’t work, everything falls apart. There’s no room for you to step back from the business and have some life experience. And I really wanted a way for it to keep going even if I wasn’t there.
So those were a lot of my whys. Business knowledge, really wanting Brooklyn to be a bigger target, and just having that ability to do different things to diversify the job that I was doing. And I love it now. I really only take on 1 maybe 2 evaluations a month, and the rest of the time, I’m really heavily involved in the operations of the business. I’m doing a lot of networking. I’m doing a lot of speaking in the community. And it’s been really fun. I love having all that variety of different things that I get to do and not being buried by reports. It’s amazing. Jeremy, I finished the reports, and then I have like a week or two where I don’t have anything hanging over my head until the next one starts. It’s so great.
Dr. Sharp: It’s incredible.
Dr. Mandi: I wish it on everybody.
Dr. Sharp: I know. It is such a good feeling. Yeah. I’m curious about that. People ask me that a lot as well. What do you do now that you have this group practice? So I’m curious when you say operations and management and that sort of stuff, how are you spending your time now as a group practice owner versus solo?
Dr. Mandi: I’m still doing a lot of the stuff that I could certainly hire an admin to do. I have a fantastic operations manager. She does so much but I am still heavily involved in the billing, collecting money, like staying on top of all the financials. My friends certainly get on me all the time that I’m spending on that. I should be hiring somebody to do that.
I still do a lot of client contact. She usually does the first round of phone calls, but if somebody wants to talk to the doctor or to find out more about what’s going to happen, I’m usually still the person that will do that.
We do a lot of supervision, just peer supervision within the group. We have regular team meetings. We work in a team model from a neuropsychology standpoint because I’m a neuropsychologist and therapist now. So from the neuropsychology standpoint, we really still take a very team approach. So I read all of the reports that go out and we talk about it together. We have supervision meetings that way.
And from a work-life standpoint, I might be working a little bit more. Frankly, if I really come to think about it, I’m probably on my computer, maybe even a little bit more than I was when I was by myself. But it’s the kind of work that I enjoy doing more, kind of have many of the ADHD brains, so answering those emails and talking to people it’s so much more energizing than writing reports for hours and hours.
Dr. Sharp: Yeah, I think there’s a lot to be said for that. I experienced that as well. I don’t know if you’ve experienced this side of it, but it can also be a little bit intoxicating and sort of like a false sense of productivity to just hammer on emails and take care of all these little tasks and feel like you’re… I mean, I love doing that stuff, but every now and again, I have to step back and be like, “Okay, are you visioning for your practice the way that people need you to be doing?”
Dr. Mandi: Absolutely. Or are you still avoiding that one report that you have to work on?
Dr. Sharp: Right. I know it’s so easy to justify. I’m like, well, I have to take care of the practice. Nobody else is going to run this practice.
Dr. Mandi: Yeah, totally. Sounds good. I’ll take care of these 14 small fires in order to avoid the bigger ones. Yes.
Dr. Sharp: I know. It’s such a good point. That’s interesting though. I mean, I think that’s good for people to know. And this is something I found too that I don’t know that I work less necessarily these days. It is very different though. And it is, I would say, more fulfilling. For sure.
Dr. Mandi: Totally agree. So fulfilling. Have you experienced this during the pandemic, you feel you’re working longer hours just because there’s less of that boundary between work and home?
Dr. Sharp: Definitely.
Dr. Mandi: I feel like this year, I’m probably. I need to find some time to bring those hours down because if I’m writing emails at 11 o’clock at night, it’s probably not a good idea.
Dr. Sharp: Right. Let’s talk a little bit more about this whole process. I mean, it sounds like you had a bunch of reasons for wanting to expand. You recognized that the market needed it. The whys were all lining up. So how did you do it? What were those steps? Where’d you start and where to go from there?
Dr. Mandi: I think what I started with was office space. I was in a single-room office at the time and was really only a few blocks away from where my youngest son was in daycare. So it worked out really well logistically for me for a while, but he was about to start school and I knew that I had an opportunity to move to a different neighborhood in Brooklyn if I wanted to. And there’s this particular complex here called Industry City that took these old warehouses and turned them into offices, I guess.
Dr. Sharp: I wish people could see what your face and hands are doing right now. Yeah, that was a very hip head movement. I get it.
Dr. Mandi: I know. But it has this amazing vibe that I’ve always really loved. It feels very industrial but it also feels very creative and there’s just this energy in the space. And so I was really hoping that it would work out and that I could find an office there. And it did.
And I came to view a space. So this is one of the opening the walls issue. From the very beginning, my plan was to hire one neuropsychologist and one administrative assistant. I came to Industry City to view a space that was around maybe 800 square feet, or I could add on another 600 square foot space, but it was small and dark. And really wasn’t what I had envisioned when I was thinking about what this office would look like. And so I asked, is there anything else available, maybe a little bit bigger? And she’s like, well, let’s come look at this 2000 square foot space. And it’s completely unbuilt. It is just a big rectangle. And I walked in and I was like, this is amazing. Big windows in the back and these beautiful wood floors which the other office didn’t have. And I just fell in love with it on the spot.
And then because of that, I guess I have to build a bigger practice. [00:24:00] So many people will tell you, if you’re going to start a business, you need to write out a vision plan, a business plan. You need to have all your finances. You need to do market research and all that. I did not do any of those things. I just went into it.
Dr. Sharp: And fell in love with the office.
Dr. Mandi: And the price was good. And so that really that’s really what started the whole snowball. Once that was in place, I found a lawyer to help me secure it. And then through him, I had already been incorporated actually, but I ended up creating a new corporation to house the lease.
Dr. Sharp: Because you own the building, right?
Dr. Mandi: No, I rent it.
Dr. Sharp: Oh, interesting. Okay. Can you say just a little bit about why you created a separate company to hold the lease?
Dr. Mandi: It was his recommendation that I have an entity that was separate from my profession. So I have a PLLC as part of the small Brooklyn entity, but then to have a separate entity that held the lease meant that if for some… I mean, he was trying to protect me, I guess, against any terrible things happening. If I ever had to walk away from this and default on my lease or something like that, he thought it would be better for me to have a separate thing that wasn’t associated with the actual practice. I don’t intend on defaulting on my lease, thankfully.
But New York is a weird market where most businesses rent their space and they can invest quite a lot in capital improvements on the space, but it’s still not yours at the end of the day. So it’s definitely a risk. And that was one of the things that I was very nervous about because I spent tens of thousands of dollars to build out this office. And I’m so grateful that I did. And it’s such an amazing thing. It feels so good. And I’m really happy with the way that it turned out, but it’s again, one of those risks that you have to take.
Dr. Sharp: Sure. Let me ask you because I know a lot of landlords around the country can roll in the cost of improvement to the lease and you stretch it out over the term of the lease. Did you put it up front?
Dr. Mandi: They gave me five months of free rent while I was building it out. And it worked out well that the construction team that was subdividing these big factory spaces into these smaller spaces still had an open permit. And so they actually did my construction and turned out great. So I still came out. I think it was still useful in the end, but I ended up spending a lot more of my own money in that way.
Dr. Sharp: Yeah. Well, it’s just something for people to know. I don’t know these things. I forget that this is just the way it goes a lot and not everybody’s aware of it, but yeah, if you find a space, you may have to pay to build it out either through the lease or upfront or maybe you get lucky and the landlord gives you an allowance up to a certain amount. I mean, there are all different ways to do it, but that’s something to think about.
Dr. Mandi: Definitely one of those logistical issues. And it worked out really well for us.
Dr. Sharp: That’s great. Yeah. It’s a beautiful space.
Dr. Mandi: Thank you. I love it.
Dr. Sharp: Yes. So let’s see. What are some of the other things in the walls that you found? Well, actually, hold on, I’m getting mixed up in my questions. I am a systematic person and I want to be systematic here. So you started with the office and…
Dr. Mandi: And then I started searching for clinicians at the same time. So I was fairly new to the New York market. Like I didn’t do my training here. I only came here for an internship and really got to know a lot of therapists and things through my solo practice days, but really didn’t get to know a lot of other neuropsychologists. So I didn’t have that group of peers to draw on. So I started advertising on Indeed. I think I advertised on the Pnais listserv and I just got really lucky that I got a few great candidates.
So going back to your earlier question of things on the walls, I had no idea what I was doing when it came to hiring. You know how important it is to use performance validity tests because you should not trust your gut in assessments. I just felt that I could trust my gut in interviews and it ended up working out in so many ways. And then there were some other things that I wished I had done differently. And I think that was definitely a naive point for me to think that I could just meet somebody and talk to them for a few minutes and be like, “Oh, you’re hired.”
Dr. Sharp: I am always amazed, Mandi. We should know this. We should know that interviews are not an indication of how people will do at their jobs.
Dr. Mandi: They are not. There is so much research on this.
Dr. Sharp: We should know this. I know but we like people. Like you make a connection and you can see rainbows and puppies and nothing else, you know? Can you say what some of the things are that you would have done differently?
Dr. Mandi: I still don’t think that I have a great answer for how I would have interviewed differently, but I know that one of my big difficulties at the time was really embracing my role as a business owner. I think that I figured that I could just bring on some people. We would all be peers. We would all know what it was to do a good job. And that would all work out. We just had some growing pains in figuring out how to… I needed to be more clear about what my role was to embrace the fact that I was ultimately the decider and to be okay with that.
I think it took me a really long time to. Even now, I still have trouble pulling the ACE card, I guess, to be able to say, well, no, I get to decide. And I still absolutely have that philosophy with my team is that I really want us to be peers and be a true team as much as possible. And I really want everyone to have as much of a say as they can. But I do think that I have gained a little bit more peace and acceptance with the idea that it’s okay for me to say, no, this is the way that I want.
And so I think there was just a lot of flailing, in the beginning, trying to give everybody their own voice and yet expect that it was going to be my voice, and why aren’t you writing in my voice?
Dr. Sharp: Sure. I totally get it. I totally get it. It’s a tough line to walk. I think you phrased that really well. Like I want everybody to feel independent and autonomous and do things the way that I do.
Dr. Mandi: I feel like I just got so lucky. Go ahead.
Dr. Sharp: Got you. Yeah. Were there any things that you did, any books you read, coaching you pursued, or really anything to help you be a better leader in that regard?
Dr. Mandi: Well, if you remember Jeremy, I was in one of your early masterminds groups.
Dr. Sharp: Well, of course, I remember. I was not pulling for that by the way. As it came out of my mouth, I was like, “Oh gosh, this is terrible. This is a terrible setup.”
Dr. Mandi: No, but it was a tremendous resource. And I actually think that I was doing that in those early months when I was really searching for the office and hiring people. So, it really helped with a lot of that goal setting and just reaching concrete steps. So, thank you very much.
And I think that some of the resources that you had talked about early on either in the Facebook or the podcast. I definitely was on the group practice exchange for a while. I have a stack of leadership books that I intend to read at some point and have never actually gotten around to it.
So that is my little dirty secret. I definitely prefer Escapist fiction. I may not have time to read. So I have all kinds of aspirations to learn to be a better leader by doing those things I have not done.
So there’s still a fair amount of leading by my gut that I really would like to hone a little bit better. This is part of my goal for this year, actually, for myself and for the business is not to have exponential growth this year but rather to get better at the things that we’re doing. And so my own leadership is definitely part of that too.
Dr. Sharp: Yeah. I’m right with you. It sounds like your gut has done you well for the most part so far, which is great.
Dr. Mandi: Yeah. I think I have good intuition and then the MBA definitely helps.
Dr. Sharp: Yeah, absolutely. I feel like leadership is one of those silent growth areas that we don’t really think about. We know there are just so many aspects to growing a practice. You learn the clinical side. You learn the business side. And then all of a sudden you’re confronted with the fact that you are truly managing people as well. And now, it’s not just finances but its emotions, and being a leader is something that I think gets ignored in this process quite a bit.
Dr. Mandi: And let me tell you this year is, I’m sure you’ve experienced it too, to feel responsible for so many people when your business takes such a nosedive, especially in the first part of this pandemic, the emotions that are involved. Oh my gosh. There were so many times in March and April, where I was just like, why did I do this? If I were just a solo practitioner right now, I could have just licked my own wounds, but now I have 6 other people who were depending on me right now. And I have to keep paying their salaries or they’re not getting enough wages or whatever it is.
And so that feeling of ownership is both intoxicating, like you said before, but also so much weight to it that it can be really hard to step back sometimes and make some good rational decisions when you’re feeling so much emotion tied up in it. And that was another I think a stumbling block for me early on. There’s so much emotion of wanting to be a good boss, wanting to provide this home environment for my clinicians. I hope I’m still doing a good job but I think I’ve been able to take a little bit of a step back from that emotion and they can make more logical decisions rather than just always trying to get more and more.
Dr. Sharp: Right. I know for me, I don’t know if this was true for you, but it was a big realization to know that being a good leader doesn’t necessarily mean everyone is happy all the time.
Dr. Mandi: Yes. I have a hard time with that. Sometimes you have to make the hard decisions and sometimes that’s going to piss some people off.
Dr. Sharp: So, what were some other hurdles or challenges along the way that you’ve encountered?
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Dr. Mandi: One of the things is this idea… so I started the business when I felt like I wasn’t addressing enough of the demand. And I knew that I could hire people and address more of the demand.
So one of the hurdles that I’ve really been experiencing the latter half of this year, we are saying this before the podcast really started, right? This roller coaster of this year was such a dearth of business in the beginning, and then this crazy recovery and overwhelming need now. And I know you were talking about how you’ve hired some new therapists to address it. Plenty of other people are doing that in the area, but I really had to come back to my original vision for what I wanted my business to be. And I always wanted to have a small family-like practice where everyone really knew each other or really felt like a real integral part of the team.
And so despite the fact that I could hire more people especially now that we’re virtual, we’re really not even tied to physical space, although we’re bursting out of it as we are, I could` theoretically hiring more virtual therapists and address a lot more of this need but I’ve had to really put the brakes on that. My instinct to just keep getting bigger and getting bigger. That’s always been my personality is to drive bigger, better, and all of that. And so to come back to this theme that I mentioned earlier about let’s not grow in that way, let’s grow as clinicians, let’s grow as leaders, let’s grow as just getting better at what it is that we do. I still have to fight against that instinct every day because every day that I’m saying, I’m sorry, I can’t help you”, other people are saying, “Well, why don’t you just hire more people I have to say, but that’s not what I want. I want a life where I feel like this is a smaller team and a more integral team.
Dr. Sharp: Yes. I’m so glad that you are talking about that. It’s funny. I feel like we are living parallel lives but just on slightly different scales in terms of practice because I’ve been thinking about that a lot lately, and you maybe have seen this. You can continue to grow bigger, but the question is, does bigger equals better or do you just want to do better? I’m really wrestling with that question now as well.
Dr. Mandi: I think my sense is that if it were really all only about making more money, then I could grow bigger. I would make a lot more money. I would probably have a lot more turnover and people wouldn’t feel as connected and I wouldn’t have that same sense of longevity. I decided that trust and collegiality that come from knowing each other and trusting each other’s work was more important to me than more money. And that was definitely a growth too.
I’ve never really made money as a grad student and then early practice. I was never very profitable. And so to get to a place where I’m comfortable with what we’re doing and wanting to get better at it.
Dr. Sharp: Yeah. Well, and for me, that’s why it’s so important to have some sense of your why. I know it can shift over time, but for me, It’s easy to get deluded or distracted. Money is a big one, of course, but also just prestige or respect or whatever you want to call it, or just the sensibility or something. That’s an addictive feeling. So to be able to tune back in like it sounds like you are doing and say, does this align with my why, with the values for this practice?
Dr. Mandi: It has ended up being so tremendously important. And again, I kind of stumbled into it. Again, when people are starting a business, a lot of people spend a lot of time thinking about their business plan and they think of the vision in the beginning, but because I jumped into it with two feet, just having seen there’s office space, I didn’t come around to the vision. It was like I had the gut of what I thought I wanted it to be but I’d never really articulated it.
And it wasn’t until we did this major website overhaul starting in fall 2019, and one of their first planning questions was, what are the three words that you want this website to evoke? And so I really had to stop and think about what are the three words that I want Small Brooklyn Psychology to be defined by. And we came up with, we want it to be warm, competent, accessible. And that has been so instrumental, actually. Having to define those words for me was really now this touchstone in a way that you think, I know we should do that, but I never really did it. But now that I have it, I do find myself coming back to that all the time.
And it really is driving a lot of my decisions going forward so that when I am torn by do I hire 3 new therapists to address this need or do I try to connect them to other services and accept that that’s just the way that it’s going to be, but that helps us to stay warm, competent, and accessible, then that needs to be what we do. So it has been really important. And I would recommend it to everybody.
Dr. Sharp: Yeah. And I think there are a bunch of different ways to go through an exercise like that. It sounds like you had a great web developer who pushed you into that.
Dr. Mandi: They were great. Absolutely. And I think they did a good job of creating that site that evoked that. In fact, Stephanie Nelson was one of the first people to see the website when it was first published. And she was like, Wow, it’s so warm. You look like you really know what you’re doing and you’re approachable.” And I was like, “Yes.”
Dr Sharp: We nailed it. I love that.
Dr Ajmani: Wonderful.
Dr Sharp: That’s fair. Yeah, that’s super cool. I mean, the more that I do this, just this idea of like values. Values are so important and what do we really stand for and what are we working for? And there’s a lot of stuff out there. I don’t know. Kim Dwyer has been on the podcast, she does values-driven practice. There’s so much out there to help folks nail these down.
Dr. Mandi: Yeah. I think that having those three words to guide us and then expanding from there has been really helpful. So when I re-up several employee contracts this year, I made it a point of creating a separate page that was like the philosophy of Small Brooklyn, just to make sure that we were all on the same page to really spell it out.
And I think that those particular aspects were part of what drove that. And then talking about it more in the sense of, Hey, we are here to make a difference in people’s lives. They are not just a case file. They’re real people. And so remembering that warmth and accessibility, and then also being really good at what we do, I think also it helps in those business decisions of course, but then also really infuses the evaluation and the therapy process too. And I’m really proud of that.
Dr. Sharp: That’s very nice. I just want to sit with that for a second. That’s rare that we can say those words, right?
Dr. Mandi: It feels wonderful.
Dr. Sharp: That is so cool. So what’s on your plate now? We talked a little bit about future directions and shaping your practice and things like that, but yeah, what are the important things that you’re wrestling with now?
Dr. Mandi: Well, I think that right now I am wrestling with how to address all of the new business that we have coming in. I think we did a really good job of getting our name out there and now don’t have the space to take on everybody that we would like to. Especially this year, I did so much outreach with a lot of local parenting groups. Parcel slope parents are Brooklyn-based parenting. It started as an email listserv and now they just have their hands in everything.
And we’ve really forged a lot of connections within this year. And it’s provided a ton of name recognition, which has been wonderful. I’ve been doing webinars and things like that. We’ve produced our own series of webinars with Parexel parents and with another pediatrician’s office. I was spending Buku bucks on Google ad-words for a while. I was doing a ton of just general networking and meeting with people. And so, I think that it’s really paid off this year in really wonderful ways. I think that our reputation is strong. And now trying to deal with the fallout of that.
So it’s great that I feel like we’ve achieved our goal in a lot of ways of being an institution that people know of and they trust to do good work, and that feels amazing. And then trying to make sure that we remain worthy of that and also just to continue to help people even when we can’t help them directly. And as a team, we were working on learning more about various niche areas of psychology, of different evidence-based treatments, of different neuropsychology aspects, and really trying to teach each other which has been really great.
Dr. Sharp: How do you deal with that? Is this through consultation meetings within the practice or what?
Dr. Mandi: I mean, maybe you would call them consultation meetings. We do team meetings. And for the past two months, we’ve had a schedule where we plan a particular topic on a given day. One of our psychologists had a background in working with seriously mentally ill kids. And so he talked about his experience. What is it like to treat a psychotic 8-year-old? One of our other psychologists shared just yesterday about space, which is a parent focus evidence-based treatment for anxiety in children. And it’s wonderful.
She’s been doing it for a while, but she really taught us about what that’s like. So, we just have a rotating schedule of different topics to address. And it’s been actually really great. Anytime any of us goes to a conference, we try and bring back some of that knowledge. And I think it’s a good way of sharing the knowledge, but then also spurring the rest of us to learn more and up our game for the next one. Yeah, it’s been fun to support each other in that way.
Dr. Sharp: I love that. Can I back up a little bit and ask you a question about just your experience getting out in the community. So, it sounds like you’ve done a great job building this practice in a community that was relatively unfamiliar to you, right? So, if someone is looking to do something similar, I get this question a lot when I’m consulting with folks, like how do I build a practice in a place that I don’t really know? What was your magic formula between Google ads and networking and whatever else? What really worked for you?
Dr. Mandi: So many little things. People ask me this a lot. It’s very unsatisfying to say that I think maybe 5 or 10 different avenues, all working together. I got very lucky early on that my kids’ pediatrician, I told them that I had opened my own practice and they put me on their referral list, and then I started getting great referrals from them. That was really helpful early on.
This group park slope parents had a really big network of parents that I joined a lot of their groups and would just answer questions, I guess. People would have psychological related questions, I would just answer their questions. And I think I generated some Goodwill in that way. And also some name recognition. I also advertised with them early on because they were really a prime target audience for the kind of work that I was doing.
Dr. Sharp: When you say advertised, I know this is a very granular question, but what kind of advertising? Was this like a paid ad in their Facebook group or like on their listserv or what?
Dr. Mandi: Yeah, so this is an email list. They do have a Facebook group but the email list is much more trafficked. The ones that have paid off the best for you could pay less to get a line in their digest of like a single email that would show up in the digest that I think would get lost. That was my reasoning anyway. Or you could pay more to get a dedicated email that would go out to their entire subscriber list, which was about 5000 or 6000 families. It’s even more now. So, even if it brought in one or two evaluations, it paid itself off very quickly. And I think it helps to increase name recognition.
So in this particular way, it was just like sending out an email to all of their subscribers. I wrote a couple of blog posts for some kid-related networks. I would reach out early on especially when… there’s a separate one different clinician email lists. It’s still mainly emailed; it’s actually rather than Facebook groups. I joined those early on. And when I saw a name that I saw come up frequently, I would reach out to them and ask to have coffee. I have always been the best one-on-one. I just made relationships that way and kept them, which was great.
So, it was a lot of dribs and drabs that took a while to really get going. 2013 is when I officially opened. I actually had a baby in early 2014 and then took maternity leave. So, I started from scratch let’s say in the summer of 2014. But then it really wasn’t until maybe 2 or 3 years later that I felt like I was so full that I could contemplate opening a group. So it wasn’t something that happened overnight. Absolutely.
But I think that the strongest relationships were the strongest referral streams that came out of that were those one-on-one coffees, the ones that I really made a relationship and a friendship with a lot of other psychologists or OTs or psychiatrists, the ones that would end up referring to me, it was just super helpful.
Dr. Sharp: Yeah. Well, I think that’s a good commentary, I suppose, on what it takes. I know there are practices that can be built entirely on Google ads or one thing or another. But yeah, it really is a combination of many factors at least for us and for a lot of others too.
Dr. Mandi: I did do the Google ads too by the way. But it really wasn’t until I started the group and all of a sudden have had a much bigger caseload to fill, that’s when I started at Google ads. And it worked out really well for us too. But I was very happy to turn those off earlier this year. It’s a lot of money month to month.
Dr. Sharp: Yeah. How did you handle that in the beginning when you brought your clinicians on in terms of navigating a caseload that was not full? How did you talk with them about ramping up or did you somehow have them fully scheduled when they started? How did that work?
Dr. Mandi: I actually did pretty well from the get-go. So when I first hired them, we had a salary model that is a little weird. I would pay them a percentage of what we would bring in but it wasn’t a fee for service. That was just the structure of how they would get paid, but they would still participate in team meetings and occasionally do talks and things like that. So I didn’t pay them by the hour or anything like that. And I think that because I already had quite a good weight on my own, I was able to take those clients and then fill those early months. And then we had a pretty good momentum going on.
One of them was only working half-time. She’s with me still. And so I didn’t have as many to fill. And the other was full-time but we still managed to do pretty well through that summer and fall, which is when we first started. It was only in the wintertime where I decided I was big enough, I guess, to raise my rates. And that’s when we started to see more of a drop-off. And I never fully knew if it was because we raised our rates or not, but I went ahead and dropped back down a bit to be just under the leading people so that if somebody was trying to decide between me and say like one or two other people, they would go with a slightly lower person. That worked pretty well for me for a while.
So, there definitely were some times where things were a little slow but they both just took it in stride. It wasn’t easy, but I think that they just knew that that was some of the tribulations of having a private practice job. Now, when the pandemic first started, I had just hired Natashia Brown who is a new neuropsychologist. She was my first salaried full-time person and she literally started the day before we closed the office. That was stressful. But she’s such a trooper. She has been such an amazing part of the practice and just really hanging in there despite meeting everybody once and then not again for a very long time. And it was quite an interesting thing.
Dr. Sharp: Yeah. I mean, it was one of those things you roll with it and you figure it out and use your problem-solving skills.
Dr. Mandi: Oh, yes. I never know what the pandemic is lurking behind those walls.
Dr. Sharp: I think this is a good example though, again, that calling back to what you said in the beginning about, I called it imperfect action, but just rely on your skills and have some confidence to know that things are not going to be perfect and you do it, right? I think clinicians get stuck in that, well, I can’t expand unless I have a full-time caseload for everybody I bring on. The truth is that is not how it works. I haven’t seen many private practices do it that way. Like there’s always a ramp-up period. It’s always a conversation with the clinician, like, hey, it’ll be a little slow for a month and then I think it’ll be fine.
Dr. Mandi: I totally agree. And I think it’s that way anytime you’re starting a private practice. I think there are plenty of people who maybe are transitioning say from a full-time job somewhere else to private practice, and a lot of people do this thing where they work nights in their private practice and they work days at their job until they feel safe enough, I guess, with their caseload to jump into private practice. And I absolutely understand why people need to do that financially, but at the same time, it doesn’t give you a lot of space for really visioning what your practice is going to be for like really getting everything set up. Some of that really does need to be just a leap and getting going. And then in a lot of ways, the business will come once you are fully committed to it.
Dr. Sharp: Right. So let’s see, this has been a great conversation. And as we start to wrap up, hopefully, might end on more of these values talk because your values are I think notable. Warm and accessible are unique.
Dr. Mandi: And competent.
Dr. Sharp: Well, I’m going to leave competent. I think we all want to be competent. But the thing that stood out to me is “the warm and the accessible” And so I’m curious, how does that show up day to day in your practice? Do you see what I’m getting at? Like what do you do or not do? How do clients see that?
Dr. Mandi: I think that being a human is really important. We see people across the lifespan, but we definitely have a real focus on kids and families. And being a parent with a kid who needs extra help is so scary. And the psychology world, if you’re not familiar with it, it’s just such a black hole and very intimidating. And I think that there are clinicians who can be intimidating or at least parents come into it. I think I sort of expect that sometimes.
So to have a human on the other side of the phone talking to you about how scary this must be and how, yes, you’re going to try and really understand everything about their kid and understand that everything about their family, and give them the information they can use in some really accessible but practical way that will actually be worth their time and their money, it just puts everybody at ease so much. In my mind, it makes people more comfortable with us. It makes them more open with us to be able to share information that maybe they would have held back but actually gives a lot of color to the evaluations that we’re doing, the therapy that we’re doing.
I hope it is giving a better sense of or a better impression of what psychology and mental health services can be too. There’s so much of this stigma. Obviously, people talk about stigma quite a lot. And so, knowing that you were talking to somebody who really wants to understand and to help break down barriers. And it can really get a lot of parents who are nervous about this and who are questioning whether this is really the next step for their kid to take that next step and invest the money and the time and trust somebody when they’re nervous about what that really means.
Is this somebody that’s going to label my kid? Is this somebody who’s going to find something wrong when there really isn’t? A lot of times you have one parent who is onboard and the other one who really is not. So, having a warm and accessible person on the other line to talk to that person and help them to see that we’re just not going to find all the things that are wrong with our kid and not look for the strengths and all of that, I think it opens the services in a way that it wouldn’t otherwise.
In addition to just making it a more pleasant experience for them and for us, I love making real connections with families. It’s really one of the most rewarding parts of my job. And really feeling like I’ve made a real difference in a family’s life like that is why I do this. And it’s so wonderful.
So it starts from that first phone call or email. I always try not to use templates. I obviously do email templates and stuff, but I always try and like insert other things that make it sound like they’re really talking to a real person instead of a script. I have a lot of drinks and snacks in the office. I have tried to decorate it in a warm and comfortable living room way. I schedule really long parent interviews. Our parent interviews are scheduled for 3 hours. I know I’m down.
Dr. Sharp: Really, 3 hours?
Dr. Mandi: I know.
Dr. Sharp: No, it’s great. I’m a 2-hour interviewer.
Dr. Mandi: I’m trying to dial it back down to 2 hours and we can usually get in. If you specify it’s going to be 2 hours, there’ll be two hours. If you specify 3 hours, it’ll be 3 hours. But what I like about that is that it gives them more time to just get comfortable and warm-up and really like to tell us some things that maybe they wouldn’t feel comfortable with otherwise.
Dr. Sharp: Totally agree.
Dr. Mandi: I think all of those things. And then also I really put a lot of emphasis in the report about being very clear, very accessible. I really want them to understand that language and not take this weighty tome that’s in a lot of jargon and have no idea what it means or what to do with it next. That would be the worst. What is the point of any of it if we can’t understand what’s in that report?
So this year actually, I have spent a lot of time working on reformatting our reports in hopefully very warm and accessible ways but continuing to use just like very simple and plain language. So, I’m hoping that it’s coming through really the entire process. And it seems to be working so far.
Dr. Sharp: That’s so great to hear. It’s just so cool. I appreciate you talking through all these things. It’s clear that you’ve built something pretty special there. And I just have to say I remember back when you looked at that office space and you were like, it’s got the exposed brick. It’s amazing. And to see now a few years later, everything that’s going on and what you’ve built, it’s incredible.
Dr. Mandi: I feel really lucky. I have an incredible team. I lucked into this amazing office and I’m very proud of the work that I’ve done to get us to this place. I’m really glad to share it with some pretty great clinicians too.
Dr. Sharp: Absolutely. Well, Mandi, thanks so much for coming on. It was great to talk to you. I hope our paths cross again soon.
Dr. Mandi: Hopefully at a conference where I can have a big hotel room to myself sometimes. Thanks, Jeremy. I appreciate it.
Dr. Sharp: Yes.
Thank you all for listening to this episode. I hope you enjoyed it. It’s so cool to see everything that Mandi has put together. And I definitely took some nuggets from that one and will be thinking about some strategies to implement in our own practice moving forward. So I hope you enjoy that.
More episodes are coming up, of course. I’ve got plenty of fantastic clinical interviews and business episodes coming up. Let’s see, Uriah Guilford is coming back to talk about technology and productivity and all other things. I always have dynamic conversations with that guy. Clinically, I’m going to be talking with the guys who developed the SPECTRA. Let’s see, we’re going to be talking with the guys from the Milan family of instruments, the MCMI, the Mackie, and a number of other fantastic guests. So, if you haven’t subscribed to the podcast, now’s a great time to do that. Just make sure you don’t miss any episodes.
And like I said in the beginning, if you’re an advanced practice owner or hoping to be an advanced practice owner, so hiring or streamlining or growing or developing additional streams of income, I would invite you to check out The Testing Psychologist Advanced Practice Mastermind if you’re looking for a group coaching experience to give you some accountability and support in that journey. You can go to thetestingpsychologists.com/advanced and get some more info.
Okay, y’all take care. Take care of your families. Take care of your work. And I’ll talk to you next time.
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