The Practice of Therapy

Dr. Brook Choulet: Hi, I'm Dr. Brook Choulet and I'm so excited to be on the Practice of Therapy podcast today where we'll be talking about all the different things related to business and running a private practice.
Gordon Brewer: Well, hello everyone and welcome again to the podcast and I'm so happy for you to get to know today. Dr. Brook Choulet. Welcome Brook. Glad you're here.
Dr. Brook Choulet: Thank you for having me. I'm excited to be here.
Gordon Brewer: Yes. And I think and just the brief amount that we were talking before we started recording, I think we've got a lot to learn from Dr. Choulet. Tell us more about yourself and how you've landed where you've landed.
Dr. Brook Choulet: Sure. So I was born and raised in Cleveland, Ohio lived in San Diego all throughout high school. And then I went to a six year accelerated bachelor MD program in Kansas city where you go through undergrad in two years and then you get your MD in four.
And after that, I was dead set on coming back to the West coast, hopefully back home. And I ended up in Phoenix, Arizona. I met my husband here. I went through adult residency training as well as child and adolescent training here for psychiatry. And then what gets kind of unique about my story is I actually started my group private practice while I was still in training.
So I was hiring certified psychiatrists and therapists while I was finishing up my fellowship so that I had a full time job to transition to when I was done.
Gordon Brewer: Oh, that's, that's, that's impressive to be have that entrepreneurial kind of bent to it. That's so cool. Yeah. Yeah. I know. Yeah, go ahead.
Dr. Brook Choulet: It took a lot of time and effort. I would, I remember waking up at 5 a. m. to work before my fellowship day started and then going to bed at 11 to kind of put together all those nuts and bolts of the business. And because there's, like you probably have experienced, there's not a lot of people out there that are willing to mentor and take the time to teach.
Gordon Brewer: Right. Right. Yeah. So I know one of the things that we had said we, you know, I think is a great topic is just how private practice is changing for folks. And just the fact that there's so many people going into private practice now and just how we see it changing. Tell us what you've got on your mind about all of that.
Dr. Brook Choulet: Yeah. And it's interesting that we covered two different coasts. So I'm curious to hear as well, but at least on the West coast, it seems like a lot of people, although they are venturing into private practice are not succeeding as people once were in the past. I remember when I set out to open a practice, people were like, Oh, just hang a shingle and.
Patients will come. There's such a, there's such a need for psychiatrists, especially child psychiatrists. And I opened and I'm like, no one, no one's coming unless I kind of put out the effort and make this happen and make this a success. So what I've been noticing more and more, at least here with the rise of.
Insurance based clinics and platforms like Alma and Headway, which kind of contract people with insurances is that the cash pay private practice land is really kind of at least in on the West Coast, I think, kind of cut throat in terms of Can you survive? Can you get enough patients? All that because of these telehealth platforms and all these insurance clinics.
Gordon Brewer: Right, right. Yeah. And it's I would say it's changing here as well. Although what I'm finding in at least here where I'm located in kind of the you know, eastern part of Tennessee, we're in a more rural kind of area, that kind of thing. People are preferring to come in person rather than do telehealth.
Absolutely. Yeah, and so I think that's, that's an advantage to some degree and that we can. Do that and then you're right with a with these Kind of tech companies and things like alma and headway and that kind of thing They're kind of setting the prices for people went away. And so I think that's I'd be interested to know what your thoughts are around that and how we get around those kinds of things
Dr. Brook Choulet: Yeah, I'm not sure how your practice is set up, but we're all cash pay and not in network, the insurances.
And so I really try to educate people that I hear saying that they want to do private practice because it's easy to say that when you see a clinic succeeding, right? You're like, well, if they can do it, I can do it too. And what I really try and tell people is if you don't love the administrative side, if that doesn't light you up, if you're not excited by networking events and Local recognition and going after local awards and being the top locally, you're really going to have a hard time.
And I think as therapists and psychiatrists, we all need to practice what we preach in terms of our own self awareness, knowing what our strengths and weaknesses are. So it's, it's been an interesting shift because I've seen even people that have been in private practice for over 20 years. Picking up hospital work now because they're not getting patients like they were before, whereas our clinic continuing to get referrals.
We're continuing to build, even though we are strictly cash pay and the most expensive in the area because I put so much effort into. Local community recognition, community outreach, and being pretty much really well known in different circles of the community.
Gordon Brewer: Right. And so, yeah, I think that's, that's a key, a key thing to, I think for people to remember is my practice is still, we're insurance based and it's mainly because of the, I think the decision I made around that was because of the demographics of the area that we're in.
And so certainly in, you know, you know, depending on the size of the city you're in and that sort of thing, I think there's, there's, it's easier to do cash pay if you're in a larger metropolitan area where you've got the end, people's income is high enough to where that they could, they wouldn't think twice about doing self pay.
But I think as much as. As much as anything with self pay, the difference between self pay and insurance based is you're going to you have to trade the volume that you're going to be willing to say, see, as far as with insurance based with. Putting the time and energy and money into marketing and networking and that
Dr. Brook Choulet: sort
Gordon Brewer: of thing.
Absolutely.
Dr. Brook Choulet: Yeah, I have every Thursday and Friday purely for marketing and networking. And then Monday through Wednesday is my patient care days. And then I travel nationally speaking on sports psychiatry purely just to continue to grow the brand and grow the name.
Gordon Brewer: Right. Right. Yeah. So that's I guess that's another kind of little tangent we can maybe talk a little bit about is the fact that you've kind of diversified the way you do things through speaking engagements and, and that sort of thing.
Dr. Brook Choulet: Yeah. So about three years ago, I entered in the pro sports world and I traveled with an NBA team and I was their consulting team psychiatrist. Worked with the WNBA side too, and I really found that concierge psychiatry and sports psychiatry go hand in hand because a lot of players can't go to an office Monday through Friday, nine to five, it's just not possible with their schedules.
So I was finding myself going to them, to their homes, to their practice facility on the road, and that really led me to kind of niche myself as the performance psychiatrist, and I trademarked that term. Really kind of dug my heels into the sports space. So I think whenever I do private practice consulting, and you're in a competitive market, like Scottsdale, or, you know, Los Angeles, New York, these types of places.
How are you different than every single other person around you? And a marketing expert once told me you have to either be the first, be the best, or be different, or preferably all three. So that's something I always keep in mind when I'm consulting with people when they say that they want to open a general therapy practice or general psychiatry practice.
Is I'm like, I know you're trying to cast a wide net to grab as many patients as possible. But you'll actually do the opposite because I run them through the exercise of let's say I met you at a party. I'm person a, and I say, hi, I'm opening my private practice. I'm a psychiatrist. Please send patients to me.
I really hope to fill up soon. Right? So now you're presenting ambivalence, kind of a lack of confidence and some general. Psychiatry, like who even knows what that means versus person B that maybe says, hi, I'm a psychiatrist. I practice perinatal psychiatry. I see women before, during and after pregnancy.
Here's my card, right? Which one's going to be more memorable. And you need to feed people the types of patients that you want them to send you.
Gordon Brewer: Yes, yes. And that's that's been. Something that I try to impress on people because you know, there's that old cliche, the riches are in the niches, you know, and so being able to make yourself stand out and really kind of establish yourself as a, as an expert in one particular area or another.
I think the other thing is that when people are searching for help, they look, they're searching for people to help them with a specific problem. And the more that you can connect with that specific problem, I think the more it's going to help you in your practice.
Dr. Brook Choulet: Yeah, absolutely.
Gordon Brewer: Yeah, I've yeah, I think the other thing is when you talked about casting a wide net.
I bet you get clients that are not necessarily sports related. You get other people too.
Dr. Brook Choulet: Yeah. So for me, I specialize in business entrepreneur, executives, and then athletes and their families because business world. And in the sports world, there are many of the same problems in different settings.
You have that high pressure requirement. For athletes, it's am I going to get traded for execs? It's am I going to get fired for making a difference? So it's a lot of similar problems in different environments. So for me, that's my passion and those, that's the population I work with. But then in my practice, you're absolutely right.
I have other psychiatrists and therapists that are specialized in other areas so that if someone does call the clinic that we can best kind of pair them to, to who they would fit best with.
Gordon Brewer: Right, right. Yeah, that's so brilliant. So as you were building your practice, what were some of the bigger challenges you ran across?
Or kind of I guess maybe things that you learned, learned about.
Dr. Brook Choulet: Yes. The number one thing was the office space. I knew I wanted to be in person. I was 26 years old when I signed a five year office lease on a personal guarantee that was eight offices. And I was still in fellowship and I was like, I just have to make this work because I have this large monthly payment every month and I can't pay that myself.
So I have to make this company work. So in a lot of ways, yes, that's what propelled me and I think led me to be successful faster is I had this kind of fire burning under me. But on the flip side, too, if I had to go back, I probably would have started with that four office space and built from there, rather than jump into an eight office space.
But there are pluses and minuses to doing it both ways.
Gordon Brewer: Right, right, yeah. So yeah, and so it, as you think about kind of going back to the ways in which, in which our professions are changing, what do you kind of foresee is the future of what's going to happen?
Dr. Brook Choulet: I think there will be an attempt to use AI for therapy.
I, again, attempt, I think there will be an attempt to do that, but I don't think it will be successful. People love relationship building. I've been seeing some of the same people for five years and they send me their prom photos and they send me all these cute things and updates about their lives. And.
You just don't get that with AI. So yes, I think that there will be an attempt for low cost and easy accessibility therapy and that kind of a model. But do I see in person going away? No, I think that's what people want and crave is connection. And so the other thing to add to my office space story is I signed that when COVID started.
So everyone was going virtual and I was going in person. So I think it helped me kind of build a practice quickly. I didn't have kids at the time and my husband worked in the ICU every day. So to me, I was already at risk being at home and having one person sitting across the room from me. wasn't risky, as risky to me as my husband in ICU with people with COVID.
Gordon Brewer: Right. Yeah.
Dr. Brook Choulet: So I did take that risk and I did open during COVID in person.
Gordon Brewer: Yeah. How did you, how do you find the people that you bring onto your staff and that sort of thing? What's, what's that been like for you?
Dr. Brook Choulet: Yeah, I wish I had a better answer for this because this is the truth. I put out one job ad ever for a psychologist and all the other nine clinicians all approached me.
So I never had to put out job ads and interview. I just was getting people that were interested in what I was doing and they wanted to be a part of it. And I'm not sure what it was, whether it was the branding or the marketing or. Or rates or whatever it was, but people wanted to join. So I, I always tell people I don't have a good answer for that because I never had to go through it.
Gordon Brewer: Yeah, yeah, you know, if somebody's interested in private practice, and they're thinking about, should I start my own practice versus going to work for somebody that's already got a practice. How would you help them kind of discern that for themselves? I had that
Dr. Brook Choulet: happen recently. Someone interviewed to join our practice and they decided to go do it on their own and then within two months they're texting me for advice, four months texting me for advice, six months they don't have patience.
And, and it's like, I always try and tell people do you enjoy the admin side? Do you enjoy hustling out there to make yourself known? Do you enjoy branding yourself? Do you enjoy branding? Talking about your your like specialties and what you can offer people. And if you don't like that, then perhaps working for someone else's private practice is better.
For you. And so it goes back to that self awareness people that are in denial or not acknowledging their strengths and weaknesses are going to struggle more than the people who can identify that. So the people that work in my practice, they're like, Brooke, we're so happy you're out there doing this because we don't want to do that.
We just want to show up and see patients.
Gordon Brewer: Yes. Yes, and that I could piggyback on that by saying that that's the exact same situation I've had in my practice as well with the clinicians I have is that they're not really interested in any of the business side, so to speak, of running a practice. And so I think yeah, I think being in private practice, I think probably a lot of us think about it when we're going through our training and that sort of thing, thinking about, oh, someday I want to be on my own, be my own practice, but really kind of understanding what that entails, I think is an important piece.
Dr. Brook Choulet: Right. And that's why I love the environment I've created for the clinicians, because I, it's like they walk into their own private practice. They pick their hours. They don't want to work Fridays. They don't work Fridays. So really, they have the utmost autonomy to make their own decisions, pick their own patients.
I'm, I could make more money by requiring certain hours and requiring them to take all the patients we scheduled for them, but that doesn't breed happy people. So to me, it's more important. Okay. that our clinicians have autonomy and are able to feel like they're running their own practice in this group setting.
Gordon Brewer: Right. Right. Yeah. It's yeah, it's, it's an interesting balance there. And I think even with some of the folks that I've consulted with in the past, you know, I think you've got to, you've got to ask yourself what it ultimately, what is your why? And people hear this from me all the time on this podcast of really looking at.
What is your your ultimate motivation for being in private practice?
Dr. Brook Choulet: Exactly. Yeah. What are you trying to achieve? And if it's autonomy and flexibility, but you don't like the business side, can you achieve that in someone else's practice?
Gordon Brewer: Correct. Correct. Yeah. Well, good. Well Brooke, I'm so glad we got to chat and I've got to be respectful of your time.
Tell folks how they can find out more about you and find out more about the things that you offer.
Dr. Brook Choulet: Sure. Yeah. People can visit my website, which is brookshoelaymd. com and that's Brooke without an E or follow me on Instagram at brookshoelaymd. I'd love to hear from you.
Gordon Brewer: Yes. I'm so glad we connected and I hope to have a conversation with you again here soon.
Dr. Brook Choulet: I hope so too. Thanks for having me on.