WP178 | Caring for the Vulnerable While Building a Sustainable Practice with Susan Melendez Doak
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What does it look like to care for vulnerable clients without burning out your team or compromising the sustainability of your practice?
In this episode, I’m joined by Susan Melendez Doak, LPC, a group practice owner in rural Oregon who has built a practice centered on serving her local community, including Medicaid clients and other often-overlooked populations.
Susan shares how she created a model that reflects her values while still making financial sense. We talk about the real challenges of serving high-need clients, what makes this work sustainable, and why alignment matters so much when you’re building a practice that’s meant to last.
We also talk about diversifying payer sources, supporting clinicians who do heavy trauma work, improving access to care, and creating a practice culture that attracts people who care deeply about the mission.
This is a thoughtful conversation about business, faith, values, and what it means to build a practice that serves people well.
In this episode, we cover:
Why Susan chose to build her practice in a rural community
Common misconceptions about working with Medicaid clients
How to create a financially sustainable practice model
Ways to support clinicians working with complex trauma
Why values alignment matters in hiring and retention
How increasing access can transform who your practice reaches
If you’ve ever wondered how to run a healthy practice while staying connected to the heart of the work, this episode is for you.
The Tension Every Practice Owner Feels
There’s a quiet tension many practice owners carry.
You want to build something sustainable. Profitable. Structured. A business that supports your life.
But you also got into this work to help people. Especially the ones who don’t always have access to care.
So what happens when those two things feel like they’re pulling in opposite directions?
When Your Community Needs You
Susan didn’t start her group practice because she had a perfect business plan.
She started it because she realized something simple and powerful.
Her community needed her.
Instead of commuting into a larger city, she chose to bring resources into her rural area. What started as a solo practice quickly turned into a group practice because the need was so high.
That decision shaped everything that came after.
The Misconception About Medicaid
There’s a belief in the private practice world that Medicaid equals burnout, low pay, and instability.
But that’s not always true.
Reimbursement rates vary by state. In some cases, they’re actually competitive. And unlike commercial insurance, those rates are publicly available.
The bigger issue isn’t necessarily the rate. It’s how you structure your practice around it.
Sustainability Is About Strategy
Susan doesn’t rely on one payer source.
She diversifies.
Higher-paying insurance plans help offset the realities that come with Medicaid, like no-show policies that can’t be enforced with fees.
That balance allows her to continue serving vulnerable populations without sacrificing the financial health of the business.
It’s not about choosing one or the other. It’s about building a model where both can exist.
Why This Work Still Matters
There’s something else that stood out to me in this conversation.
Susan genuinely loves working with Medicaid clients.
Not in a surface-level way, but in a deeply values-driven way.
She talked about how this work keeps her close to people on the margins. How it challenges her faith. How it reminds her that these aren’t just policies or systems. These are real people with real stories.
And that kind of alignment changes everything.
The Role of Values in Your Practice
Not every practice needs to take Medicaid.
But every practice should be aligned with something deeper than just revenue.
For Susan, that alignment comes from her faith and a calling to care for the vulnerable.
For you, it might look different.
But when your work is connected to your values, the hard parts don’t disappear. They just become more meaningful.
Preventing Burnout in Heavy Work
Working with complex trauma and vulnerable populations can be exhausting.
So sustainability has to go beyond finances.
Susan builds this into her practice culture.
Her team takes vacations. They consult with each other. They pursue advanced training so they feel confident in their work.
They don’t operate as isolated clinicians carrying everything alone.
They function as part of a larger system of care.
And that makes a difference.
You Don’t Have to Do It Alone
One of the most important shifts is moving away from being a “one-person treatment team.”
Some clients need more than therapy.
They need medical providers, school support, family involvement, or community resources.
When you recognize that, the weight of the work becomes shared instead of overwhelming.
Hiring for Alignment, Not Just Skill
Susan’s hiring process isn’t just about credentials.
It’s about values.
She attracts clinicians who want to work with a mix of clients. People who care about serving both high-income and vulnerable populations.
That alignment creates stability.
People stay longer. They’re more engaged. And they’re invested in the mission of the practice.
Creating Access Changes Everything
Sometimes access is the barrier.
Not interest. Not need.
Just access.
When Susan added bilingual services, clients immediately began reaching out.
The need was always there. The pathway just wasn’t.
And when practices make those adjustments, it can transform who they’re able to serve.
A Practice That Reflects What You Believe
What I keep coming back to from this conversation is this idea:
Your practice is a reflection of what you value.
For some, that might mean private pay and a highly specialized niche.
For others, it might mean creating space for people who otherwise wouldn’t have access to care.
Neither is wrong.
But being intentional matters.
What Sustainability Really Looks Like
Sustainability isn’t just about making more money or seeing easier clients.
It’s about building a practice that you can actually sustain as a human.
Financially, emotionally, and spiritually.
For Susan, that includes diversifying income, building strong community connections, supporting her team, and staying grounded in her values.
And that combination is what makes the work last.
Sponsor Wise Practice Community
Running a private practice can feel lonely. You’re making big decisions, trying to grow, and wondering if you’re doing it right.
That’s why I created the Wise Practice Community.
It’s a membership for faith-based practice owners who want support building a healthy, sustainable practice. Inside, we focus on marketing, hiring, systems, finances, and leadership, with live trainings, accountability, and a community that gets it.
We’ve recently revamped everything to make it simpler and more effective.
Enrollment opens March 25th and is only open for three days.
If you want more clarity, support, and connection, this is for you.
Join at wisepracticeconsulting.com for $89/month.
Meet Susan Melendez Doak, LPC
Susan Melendez Doak is a licensed professional counselor, clinical supervisor, and the group practice owner at Newberg Counseling & Wellness in Newberg, Oregon. Susan and her team provide compassionate counseling services with a mission to empower our local community with the skill and the courage to handle the challenges of life.
Susan’s Resources
Links and Resources
Join the Wise Practice Membership Community (Doors close March 27th)
Learn More about Wise Practice Consulting
Connect with Wise Practice on Instagram
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Caring for the Vulnerable While Building a Sustainable Practice with Susan Melendez Doak, LPC _ WP 178
[00:00:00] Whitney Owens: Before we dive into today's episode, I wanna share something exciting with you. Over the past several years, one of the biggest things I've heard from practice owners is that running a private practice is lonely. You're making big decisions, trying to grow your practice, stewarding your finances, and also wondering if you're doing it the right way.
So that is why we have created the Wise Practice Membership Community. It is a membership for faith-based practice owners who wanna grow a healthy, sustainable private practice. Inside of the community. We focus on the business side of things like marketing, hiring, systems, leadership, but we also recognize the role that our faith plays in the work we do.
Members receive live business coaching, accountability groups, practical resources and community of faith-based practice owners who. Understand the journey. I'm especially excited right now because we have spent the last several months completely revamping the community, simplifying how it works, creating clear learning paths, depending on your stage of practice, expanding the resources available to members and improving the accountability groups so it's easier to build real relationships with other practice owners.
Enrollment for the Wise Practice community opens tomorrow, March 25th and will only be open for three days through Friday the 27th. So if you've been wanting more clarity in your business, encouragement from other faith-based practice owners and practical support to grow your practice, this community is for you.
Membership is only $89 per month. You can learn more by heading to wise practice consulting.com. And remember the doors close on Friday, so don't miss out. We will not be offering this again until August. We look forward to seeing you in the community. Hi, I'm Whitney Owens. I'm a group practice owner and faith-based practice consultant and I'm here to tell you that you can have it all.
Wanna grow your practice, wanna grow your faith? Wanna enjoy your life outside of work, you've come to the right place. Each week on the Wise Practice Podcast, I will give you the action steps to have a successful faith-based practice while also having a good time. Now let's get started.
[00:02:08] Jingle: Where she grows your practice, A sheet on.
She does business with a twist of faith. It's Whitney Owen and Wise Practice Podcast, Whitney Owen and Wise Practice Podcast.
[00:02:27] Whitney Owens: Well, thank you for joining me on The Wise Practice Podcast. Today is a different kind of episode. Azure. If you're watching this, uh, you know, on your YouTube, but then you're seeing that I'm actually not in my recording studio, which is really just my office today, I'm in my bedroom.
So this is the second time I've recorded a podcast from my bedroom and it's gonna be awesome. And I'm really excited. I've actually had to reschedule this podcast interview multiple times and unfortunately 'cause life is crazy, y'all, you all know it. So I am getting over the flu. Still, I have been sick for over a week.
Um, my guest, Susan, has been so gracious and kind to reschedule multiple times with me, but it's also pouring down rain and there's like a tornado warning going on. But this episode is so important to me that I was like, I've gotta make this happen. Y'all know things and you're practicing in your life that you just know it's important.
You, you feel it in your gut, you're excited about it. So. I'm really thrilled about this particular episode today, and as you know, we've been doing a series of wise practice community members and people that are doing really cool things in their practice. So I encourage you if you miss those episodes earlier in the month of March, to go back and listen to those.
I had someone come talk about getting rate increase letters with insurance companies. We also talked about niching down in your practice, and we talked about multiple locations. And today we're gonna be diving into how we can care well for the vulnerable and weaken our populations and communities. But when we hear that, I know it's kinda like, oh, how do I do that in a way that's sustainable for me and for the people I hire?
And so we're gonna be jumping into that today, so I'm excited to welcome Susan doke to the show. Susan, how are you today?
[00:04:02] Susan Melendez Doak, LPC: I am so excited to be here, Whitney, this is like really fun and I'm glad we're pushing through. You're just so willing to like make this happen. So, um, yes. Thanks so much for having me, Whitney.
[00:04:14] Whitney Owens: Yay. Well, wonderful. Before we jump in and, uh, talk about your practice, I'm gonna read it your bio here. Susan is a licensed professional counselor, clinical supervisor and group practice owner at Newburgh Counseling and Wellness in Newburgh, Oregon. She and her team provide compassionate counseling services with a mission to empower our local community with the skills and courage to handle the challenges of life.
I love it. So Susan. Do you know? Well, first of all, I've known you for a while.
[00:04:45] Susan Melendez Doak, LPC: Mm-hmm.
[00:04:45] Whitney Owens: We go way back.
[00:04:46] Susan Melendez Doak, LPC: Yeah.
[00:04:47] Whitney Owens: But there was a moment where you really stood out to me for your compassion. You, I mean, yes, I see that a lot, but after one of the summits might have been two or three summits ago, you left a gift for me, and I can't say that members attend the summit very often and leave gifts.
But I didn't know about it till I got home and I was unloading all the supplies and this gift, gosh, I feel emotional talking about it. This gift comes out and it's tea and a card about just the gift of caring for yourself and what I had done to put Summit on. So you like, you had the forethought before you got to Charlotte.
I believe it was the Charlotte one and had a gift ready. And there was so much kindness and love and that was, I already knew who you were, but there was something about that moment that who you were really shined in the way that you care for people.
[00:05:42] Susan Melendez Doak, LPC: Aw. Oh, I'm, I'm glad that was meaningful for you, Whitney.
And it just takes a lot to do that summit, doesn't it? It does. And I just like had this, this in my imagination. I just thought of, okay, at some point all of that prep and hard work's gonna be over, and I hope sit, I hope Whitney just gets to sit down. Just make a cup of tea and just sit down and just stare out the window and have some calm downtime when you're not running around solving all kinds of problems.
And, and I hope you got to have that moment.
[00:06:11] Whitney Owens: I did. I did. So thank you for that. Well, let's talk about you though. Tell us kind of how you became a therapist and got into the work and started your group practice.
[00:06:21] Susan Melendez Doak, LPC: Yes. So I have been a therapist for over 21 years now, and I live in Newburgh, Oregon now. And I started a group practice in 2018.
And the reason I started the group practice, um, is that. I had this moment of realization where I realized that I was taking my, my resource as a clinician and I was, I was going towards, the population center for us is Portland, Portland, Oregon. So I was, you know, going towards Portland and um, going to work out there, commuting to work, and, um, but I actually live.
About 25 miles outside of Portland in a more rural community and an agriculture community. And, and I really came to this realization that my, my community actually needs my resource. And so I decided to start a practice and then we just, I had so many referrals coming in 'cause there was so much need that I, I started a group practice really about seven months later, or eight months later.
So it happened pretty quickly. And, and my goal was to bring some of the resource, even counselors from Portland to actually kind of pull some resource out towards my people, to give them more opportunity, um, to have counseling, um, in a place close to where they live and to work with providers who, who understand them.
Um, and that's been a fun journey and, and part of that has meant. Working with, um, local Medicaid provider, uh, working with our, our coordinated care organization, um, just locally in our county and getting to know people out here.
[00:07:59] Whitney Owens: Yeah. Now, in your area, are there many group practices or access to services, or is it harder to fund.
[00:08:07] Susan Melendez Doak, LPC: It's becoming easier. I think so much changed after COVID with, with telehealth services. And I think also there's just kind of an expansion of the urban area that is, is moving out this direction and, and there's more counseling services here than there ever has been. Although I actually think that we were a part of that growth.
I think we were a part of setting that trend, uh, and really. Still, there's still a need. So when I see new providers coming to our area, I'm not like, oh, no more competition. My thought is, oh great. Like we actually have so much need, um, that we would, we would love to have more of us and we would love to talk to each other and work together and, and provide something better for people out here.
Yeah.
[00:08:50] Whitney Owens: So you went, when did you go from being a solo practice owner to a group practice owner?
[00:08:55] Susan Melendez Doak, LPC: 2018. Um, and it went, I went from just, just me to then hired three therapists kind of at the same time.
[00:09:02] Whitney Owens: Wow.
[00:09:03] Susan Melendez Doak, LPC: Okay. And we just, and we just kind of went for it. I am part, I am partly an insurance based practice where you could even say that I am an insurance based practice.
We also have private pay. Um, folks as well. And then we see people who are on commercial insurances as well as people who are on Medicaid for our area of Oregon. Um, and so there's kind of a balance there of, of different kinds of people coming in the door.
[00:09:31] Whitney Owens: Yeah, so like a, I think a lot of therapists, uh, get a little fearful when they hear Medicaid, right?
They're, they're worried of, well, I make enough money and will they show up for treatment, and how can I bill for this? Or even the cancellation policy. I know it can be a challenge where. If someone doesn't know this already, you know with Medicaid, a lot of states you can't bill when they don't show up for a session when those clients will show up.
So it makes it challenging. So could you talk a little bit about when, how did you make the decision to get on Medicaid and how have you been able to make it sustainable for your practice?
[00:10:02] Susan Melendez Doak, LPC: Sure. So I love my Medicaid clients. And the thing about, I guess the thing that kind of led me in that direction is that since the very beginning of my career, I've always worked with Medicaid clients in some capacity and they've always been my favorite.
And I think that might just be because I also do a lot of work with complex trauma. Mm-hmm. Um, and I've, I've always enjoyed also just being a little bit closer to. To people who are marginalized. So I have a, uh, I'm my, it kind of challenges my faith to kind of get a little bit closer. I think sometimes in our socioeconomic status, we're business owners, we can have a lot of separation.
Um, from people who are truly vulnerable in this world.
[00:10:48] Whitney Owens: Mm.
[00:10:48] Susan Melendez Doak, LPC: And so having, especially having, uh, Medicaid as a part of my practice has meant that we're closer. So we are so much closer to people who are on the margins. And, and so when, you know, you hear in the news like, well, there's this bill being passed about Medicaid, or this is happening.
They're real people and real faces that we see. In, in our minds of people that we know. Um, and that's, that's been interesting. I think the other, as you were saying, Whitney, there's, there is a misconception out there that you cannot make any money, um, as a practice owner and take Medicaid. So I think there is a little bit of a misconception out there that, uh, Medicaid doesn't pay well.
In some states it actually pays rather well. Um, it really depends on the state that you're in. And the good thing about Medicaid rates in your state is that you can actually look them up. Um, unlike commercial insurance rates. Um, they hide those from us. They, they actually publish a Medicaid rate. So you can just go right into AI and say in your state what kind of, you know, what's the reimbursement rate?
And you can even put your CPT codes in there and find that out. So that is published. Um, the same is true for, for Medicare rates too. I don't take Medicare. Um, but, and. You know, I think that there is, but like you were saying, there is can some differences in what we're allowed to do and not allowed to do.
So, for example, we are not allowed to charge a cancellation fee. So if someone cancels last minute. We are not allowed to charge them a fee to try to make up for that lost income. So there are a few things like that as well as some rules around, um, making sure we're providing acts timely access, so timely access to care and that we know, um, we can get clients in, in a certain amount of time that we can attend to our clients who are in crisis quickly.
Um, that's also one of the expectations that we have as well, as well as with commercial insurance. So it's act in that way. It's, it's really not all that different as well.
[00:12:56] Whitney Owens: Mm-hmm.
[00:12:57] Susan Melendez Doak, LPC: Yeah.
[00:12:58] Whitney Owens: Hmm. As I'm listening, reflecting, I'm thinking about the challenges. You know, you said, I love my Medicaid clients, I love complex trauma.
And I was like,
oh,
complex Strava. Like that's, I love it, but I can't do it for more than one. Or, um, you know, talked about being a business owner. I was even just thinking, it's like as, as I grow as a business owner, and even as I do consulting with practice owners, I'm totally being vulnerable and just saying the stuff here, but it's like, wow.
We encourage practice owners actually to. See the clients that pay the most see the clients that are the easiest because you're running your practice and, and I think there's something to be said for that, but then I'm listening to you and I'm thinking, it's almost like we're getting away from the heart of what we're doing.
Mm-hmm.
Right? At the same time, like how do we stay in that place of sweetness and and vulnerability to our clients and to the world and its pain while we're also running a practice? That's sustainable.
[00:13:57] Susan Melendez Doak, LPC: And I, I really do think that part of the sustainability matrix is also that we're doing something that's really values aligned.
That is really actually aligned with our values. And I think that's where it really like ties into to the faith piece for me. Like when, you know, when we look, when we look through the Bible and there are so many passages about taking care of the poor, the widow, the orphan, the foreigner, that's the, those four that I just mentioned.
They might call that in, in theological circles, the quartet of the vulnerable. And so like these people are mentioned over and over again, and we are as, as Christ followers, even just mandated repeatedly in the Bible to serve these people. And, and I think, you know, we can, we can decide to if, if that's something that we need to do in our private practice or if we're doing that in our personal lives, you know, or in some other capacity.
It doesn't have to be something that your practice is doing. But I do think that there is. A place for, you know, for us to really listen to God about like, are you call, who are you calling me to? Uh, and that's been I think a challenge for me to also know that, um. That it is often hard work or difficult work, but it's so meaningful that it, it, there's a, there's, it gets offset.
So like whatever we see as being like some of the cost is offset. So I also offset by meaning, but I also think that there's something to, uh, doing what I call kind of diversifying your, your insurance portfolio or we just say diversifying your income portfolio. So, so if you as a practice owner. Want to see Medicaid clients, I don't necessarily recommend you building your entire practice on them.
And here's why. It's because, uh, we, we live in a tumultuous time, right? Our government's kind of doing all kinds of crazy stuff. There's a lot of uncertainty around funding. And so I don't necessarily recommend that. I actually don't recommend you build your practice on any one insurance. Don't do it with Blue Cross Blue Shields.
Don't do it. Just, you know, diversify and be, and the reason for that is that you're gonna have all these. Various situations where you need certain things to offset one another. So I also, so for example, I know that I might sometimes, um, lose some money over here with serving Medicaid clients with just cancellations.
I have another, another insurance that I work for over here where I get a really high, high reimbursement rate. And so I can kind of work with both of those together. Um, the high one over here kind of offsets some of my costs over here.
[00:16:49] Whitney Owens: Yeah.
[00:16:50] Susan Melendez Doak, LPC: And you know, and so that's one of the things that we do and even have done as we've heard, just new information coming out about Medicaid changes in 2027 that are coming.
Um, that. We said, let's just add another couple of commercial insurances to just kind of broaden, broaden our scope and make sure we have a lot of diversity in the types of income that are coming in the payers. Mm-hmm. And how they work. So, so that's kind of how we offset that a little bit. And it, you know, and, and Medicaid is it.
The other thing that I think is interesting is that. I have Medicaid clients come to me all the time and they say, this is so special to me. This is so special because the alternative for me is going to my county, like my county office, where I might get to be seen once a month.
[00:17:45] Whitney Owens: Yep.
[00:17:46] Susan Melendez Doak, LPC: From someone who has a caseload of a hundred clients.
And you see me every week, you know, you make me a cup of tea and we act and, and I'm in a, a, a homey environment. Um, and they, I have so many of them come back to us and just say, this actually means so, so much to us to be treated in this way. So, mm-hmm. So that's always just really stuck with me.
[00:18:10] Whitney Owens: It's beautiful.
Yeah. And I love the point you're making, that it's about your alignment with your values. You know, where, where's the energy coming from for the work you do? Like God sustains that within us. I, I think that when we talk about energy, we're talking about where's the Holy Spirit moving, you know? Yeah.
[00:18:28] Susan Melendez Doak, LPC: Yeah.
[00:18:28] Whitney Owens: And it's figuring out how do I serve these people? Whatever context I'm in, you know? And even though like I'm a very different practice in a very different area, you know, private pay, but like I also offer sliding scale or we have some pro bono or we are able to do fundraising events and provide finances for people that are in need.
And so it's all in how you can feel called to that within your model. And they're all gonna look so different.
[00:18:55] Susan Melendez Doak, LPC: They are gonna look different and it's gonna look different depending on your location too. Yeah. Um, you know, you're, I know Whitney, you're more based in the city and I'm kind of based out in the country and you know, and it's just also depends on what are the other.
Other resources around you in that area? So one of the, so I was just looking up some stats about, um, about Medicaid specifically and 24% of rural America. Is on Medicaid and then close to 50% of kids in rural America. So this is all over the US are actually on Medicaid. So I, I was just really surprised by that.
And there's been so much, I, I think there's just been a little bit more attention, like paid to like where, you know, state and federal funds are going and, and Medicaid is actually a mix of both, is, it's a mix of both state and federal funds that go to that. But that is 50% of kids. That's a lot of kids.
[00:19:54] Whitney Owens: Mm-hmm.
[00:19:54] Susan Melendez Doak, LPC: Um, and and also the other piece to that is 34% of people who are on Medicaid are also disabled. And so having the ability in our private practice to do more work with people who are disabled and so also adjust our practice to make that possible, to adjust our practice. Also, to make it possible to work with people who, who don't speak English or who speak English as a second language or a third or a fifth language because they speak long languages.
Um, just making some of those, even just adjustments around access to care for people around language has been super interesting. Um, Medicaid in our state also has some funding for doing counseling with interpreter services. So I have done family therapy with interpreters and so we have done it with.
I've actually, I've done it with Spanish, Japanese, uh, American sign language, Cantonese, over just over the years. And I have loved it. And you may have high at just how much good work actually can be done. Can you imagine? Family therapy and there's also, uh, an interpreter in the room, but how much good work can really be done in those types of situations.
So it just, it challenges us in some different ways.
[00:21:14] Whitney Owens: Hmm. I love it. I think you were in the same talk at the summit about Spanish speaking clients. Were you in there?
[00:21:21] Susan Melendez Doak, LPC: I was, yes.
[00:21:22] Whitney Owens: Okay, Louis. Okay. And that unfortunately there were, there should have been more of us in there. Yeah. Um, but we were, we were chatting about it and I was sitting there like I remember saying.
We don't have any Spanish speaking clients at my practice, and I was embarrassed. I don't know if you remember. I was like, oh my gosh. Like what can we do? Susan? A month later we hired a girl that's Spanish speaking, and at the time she was like, am I gonna be able to see Spanish speaking clients? I was like.
I'm so sorry. We don't get any of those. I hope it works out, but we don't. Oh, immediately they started flooding in. It's like, it's like the gates opened. As soon as God was like, here you go. And this girl loves the Lord. She is so passionate. Anyway, we had to like redo all of our paperwork. What you're saying, it's like we had to make accommodations to be a Spanish speaking practice overnight and uh, good for you.
Yeah, but now she's got like seven or eight clients. I was like, this is so cool.
[00:22:12] Susan Melendez Doak, LPC: It is. And I think like. Though that means a lot to those clients that you would make. Oh yeah. Accommodations too. And, and also just a fun thing to know about, especially about Medicaid with, um, with bilingual therapists is if you have a therapist who speaks another language and they take Medicaid, there's also often a, um, an increase in the insurance reimbursement that you would get or that you could get.
So you can do, um, a modifier add-on. That might be that that clinician or that your practice gets about 20 to 40 more dollars per session because that's great. They're doing that session in another language and they have, that clinician also has that specific skillset to do bilingual therapy and so like how Yeah, how cool and exciting that is that you, you just, that's actually pretty fasting around that.
You just added that to your practice. That's
[00:23:05] Whitney Owens: so
[00:23:05] Susan Melendez Doak, LPC: cool.
[00:23:06] Whitney Owens: Yeah. Tell us a little bit about sustainability, so. How do you have a practice that's sustainable and seeing so many Medicaid clients? I know you talked a little bit about the financial part, and if there's more to say about that, I want to hear about it, but also just the, the emotional, the burnout that therapists experience, especially group practice owners keeping therapists in their practice.
You're working with the tough population, like how do you create that sustainability?
[00:23:32] Susan Melendez Doak, LPC: Yeah. I'm glad you asked that, that question. Um, so I really care a lot about. How much space, um, our clinicians have to be able to do some, some self care and consult with one another around really difficult cases. Um, and so I think it's just, it's important sometimes to even build in some space and time, or at least have a culture where there there's some buffer that we are not always just running, that we are also taking some time to slow down and reflect or insisting that we have vacations.
Like we, we take vacations, um, we take time away from all of. That complex trauma and all of those heavier caseloads to really nourish ourselves as well as get training. So I have some clinicians who are really involved right now in getting training in EMDR, internal family systems and, and just are getting the training that they feel like they need so they can feel confident when they approach, um, some of those more difficult cases.
But also that, just remembering that we're a part of this larger system, so. I have a personal relationship with our, our county leadership, um, in Medicaid. And, and I actually know of all of our resources in our area. And so like, there's this, there's this bigger system of actually really caring people, um, that we're, we're just like, we're a piece of that and we're not, like, we're not an island.
We're not the only one. Um, there are so many of us who are doing that work together. So I think like just having this knowledge and knowing that, that this is a system. Of care around people. Um, sometimes it's a whole treatment team. So I always say to my, for people that have a, a really difficult or complex case, like.
I say to the, to those clinicians, you know, you don't wanna be a one person treatment team. It sounds like that client actually might need a medication provider also. Or maybe this kid, we need to involve their school counselor, or we need to make sure their grandma's involved. Yeah. There are just other that we're not the.
Only people who are sort of holding responsibility, liability or, or even just making, making clinical recommendations, um, for mm-hmm. For a case, if there are, there are maybe more than one set of eyes on that case. Um, yeah, so that's, those are just some ways that we try to, to build that into, make it a little bit more sustainable for people.
I have also find, found that it changes my hiring. So I hire clinicians who want to work with a variety of clients that they, they, they are, enjoy working with people on private insurance, maybe people who can pay out of pocket in our area. They all live up on the mountain. There's a mountain and, and everybody who could pay out of pocket lives up on the mountain.
And I love the idea of mixing people in my waiting room. Oh, maybe who are super high income can come and sit in the waiting room next to a kid in foster care. And I think that's absolutely wonderful. I love that. Um, but our clinicians are often attracted to our practice because we, we want to actually serve a vulnerable population as well as others.
So I have had, it has actually been helpful to me in my hiring. Most of my clin clinicians have even, especially recently, they just kind of come to me. Um, I don't tend to do a lot of outward looking for clinicians on indeed. They kind of have heard about a practice and they say, I actually also really want to work with these populations.
Do you have a spot open? Um, and so it's been a way of actually attracting and retaining. Clinicians who are, um, values aligned with us. Yeah. Um, who really care about what we care about. Um, so in that way it has actually been, I've been able to build a stronger practice financially, um, because of that stability that we've been able to maintain.
Yeah.
[00:27:35] Whitney Owens: Now, do you overtly talk about being a faith-based practice?
[00:27:39] Susan Melendez Doak, LPC: I do not. Yeah. So, um, and I, I do hire clinicians who are, are not coming from, from that background. However, I think the values piece is really important. So that's what we kind of come back to, what those values are and, and people are able to, I have found that that has actually worked out pretty well and I think it.
It makes a difference in the cohesion of the group. Um, when we're all, you know, we're all working around the, the same values. We care about the vulnerable people and we also care a lot about integrity. Just, I've noticed that, or especially around, around money. You know, we as clinicians can just get really, you know, really uncomfortable.
Um, but the integrity piece, um, with how we bill insurance, um, what we count and what we don't count. The things that are covered that actually really matters that we're not calling something, something that it isn't. Um, we're not billing things that are actually insurance fraud and, um, that we're just being honest.
That part's really important too.
[00:28:43] Whitney Owens: Mm-hmm. Totally agree. Yeah. I. I had a realization sometime last year just about values over faith alignment. I used to just really look for, does this person say they're a Christian? Do they attend church? What does that look like? You know? And then finally I was like, it's not about that.
It's about our values. And these values are. Christ, I mean, your values of caring for the vulnerable and integrity, these are Christ-centered values. And so instead of saying the words, let's actually do them. You know? Yeah. And that's what you're, that's what you're living out there through your practice, and I love it.
[00:29:21] Susan Melendez Doak, LPC: Yeah.
[00:29:21] Whitney Owens: Susan, what's next for your practice? What big dreams do you have?
[00:29:25] Susan Melendez Doak, LPC: What is next? We're actually, we are just trying to do a service to our community. Right now we're offering a free group about nervous system regulation. So our, I saw that. We've been, actually, our community's been through a lot and in a lot of different ways.
Some of that is, is political. Some of that is, um, just some crisis situations that our community has gone through. And so, so that's something that we're doing. We are. W I'm a part of a, a group called Counselors Connect. So we are a group of about 80 counselors in our c our area who we just get together and support one another.
So we have a, it's a networking group where we, we do self-care activities together. Um, we have done painting and yoga. We also do trainings. And so that's also been something where we've seen a lot of, a lot of really fun movement where we can refer to each other, um, and we can find just like supports in the community for our clients.
That's great. So a lot of good stuff going on there.
[00:30:33] Whitney Owens: Aw, I love it. Well, Susan, you are a part of the Wise Practice Membership community, so could you take a minute or two and talk about what it is that you love about the community and how you find it helpful?
[00:30:45] Susan Melendez Doak, LPC: Absolutely. So I just got out of our accountability group, um, just a couple of hours ago and, um, I have really enjoyed, especially being a part of this group where we are other practice owners in the same place in our practice, and we all have about the same number of clinicians, and we go to each other with questions, concerns, prayer needs.
And just can track with people who are really in going through some of the same things. But I have found so much wisdom in this group. I often sit in the group and I'm just like, Jo, I'm writing notes the whole time because there's so many good ideas and so much wisdom to take away from just that one hour.
Um, but I also. I love, I just love the other parts of the group. I love being able to get on circle. Um, I put out a question even recently when I went on a vacation abroad, what do I do, you know, to try to make sure my practice is taken care of while I'm overseas. Had some really good input about that or, and then it's just a summit.
I love the summit. I love going to the summit every year. I find that I get a lot of clarity. And I think that there's so much as a practice owner kind of spinning around in your head about things you're supposed to do, but I think it's a good opportunity to just like slow down, meet, meet some people who are also kind of in the same place, um, learn some really great things, but also like discern like, what is God asking me to do?
What is God asking me to do? Not everybody else. Yeah. And then where do I go from there? And like actually setting some goals to like, follow through on what I, not only what I feel God is calling me to, but what I've already committed to and the things that I've said are really important. So I just, I always find that it's a good time for me to get centered and I walk away with, like, I, I have a notebook where I walk away and I can look in that notebook and say like, am I doing these things?
Because this is actually the path. That I feel is, is the right path for me. So I appreciate all the work that goes into it, Whitney, and, and it's always just fun. It's actually really fun to, to meet other practice owners and laugh together. And sometimes we cry together. We, we sometimes sit in a sweaty room together and learn some amazing things from someone.
Um, I'm sorry that we didn't know, and I just always feel blessed by that time, Whitney. I really do. Mm. And I set aside time on my calendar every year.
[00:33:17] Whitney Owens: Oh, I love it. I love it. And, and I love that you brought up the summit, even though I was asking about the membership community, because when I envision it.
The summit is when we get to be together in person. That's like the sweet moment. And being online is beautiful too. I mean, we have some great conversations when we're meeting every week, but it is really special when we get to be together in person. And so, um, looking forward to, already looking forward to October of this year and being in Nashville.
So
[00:33:43] Susan Melendez Doak, LPC: yes, the same. Yeah, the same. And then when you go to the summit, if you're part of membership community, you can see some people in person that you've seen online. Those are real. Those are relationships that you will carry that will actually be, these are people that will be a part of your life. And then when you actually get to see them in person, I think it just solidifies those relationships even more, and it just makes 'em really meaningful.
[00:34:07] Whitney Owens: Yeah, definitely. Well, Susan, this has been a treat. I appreciate your time and your commitment to the work that you do in sharing that with us today.
[00:34:16] Susan Melendez Doak, LPC: Thank you, Whitney. It's a joy to be with you.
[00:34:21] Jingle: So click on follow and leave a review and keep on loving this work we do with Whitney Owens and The Wise Practice Podcast, Whitney Owens and The Wise Practice Podcast.
[00:34:39] Whitney Owens: Special thanks to Marty Altman for the music in this podcast. The Wise Practice Podcast is part of the Site Craft Podcast Network. A collaboration of independent podcasters focused on helping people live more meaningful and productive lives.
To learn more about the other amazing podcasts in the network, head on over to site craft network.com. The Wise Practice podcast represents the opinions of Whitney Owens and her guests. This podcast is for educational purposes only, and the content should not be taken as legal advice. If you have legal questions, please consult an attorney.
