How to Build Referral Relationships to Grow Your Therapy Practice with Dr. Brian Dixon

Dr. Brian Dixon [00:00:00]:

Most good referrals, in my opinion, come from other therapists. There are more therapists than psychiatrists and primary care docs and blah, blah, blah. So I would say focus on engaging your peers and then grow the size of the pie. Go out and talk about the importance of mental health. And as people perk, their ears up and go, hey, I want to get care whether they come to you or not, you are increasing the revenue, the referral stream, and that is just really important.

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Michael Fulwiler [00:00:30]:

This is heard business school, where we sit down with private practice owners and industry experts to learn about the business of therapy together. I'm your host, Michael Fulweiler. Running a successful business isn't easy, especially when you're dealing with the added complexities of mental health care. My guest today is Doctor Brian Dixon, a triple board certified psychiatrist, therapist and entrepreneur from Texas who's navigated these challenges head on. He's faced substantial obstacles, from financing issues to structural barriers in the healthcare system. In our conversation, Doctor Dixon shares his journey from a perspective general practitioner to embracing psychiatry fully. He recounts the lessons learned from a failed software venture aimed at mental health care and how he pivoted to establish a thriving private practice and administrative company, simply psych. We discussed the importance of learning from failures, the necessity of delegating tasks to avoid burnout, and his strategic use of anger and frustration as motivators.

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Michael Fulwiler [00:01:35]:

Here's my conversation with Doctor Brian Dixon. Enjoy. Doctor Brian Dixon, welcome to the show.

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Dr. Brian Dixon [00:01:43]:

Thank you so much for having me, Michael. I appreciate it.

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Michael Fulwiler [00:01:47]:

Looking forward to this conversation. First, because I just enjoy hanging out with you as a human being. Second, because you are a psychiatrist and you are the first psychiatrist that we've had on the show.

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Dr. Brian Dixon [00:02:01]:

Yay. Absolutely.

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Michael Fulwiler [00:02:02]:

So no pressure. You're representing all of psychiatry here. I have a lot of questions. First, as a psychiatrist, do you also identify as a therapist?

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Dr. Brian Dixon [00:02:12]:

I do. So your mileage may vary. Y MMV. Right. So I trained with a whole bunch of psychologists and therapists and counselors, and they taught me some of the tricks of the trade. And so now I incorporate that into what I do. And so, yes, I do consider myself to be a therapist.

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Michael Fulwiler [00:02:30]:

I wanted to set the record straight there. I've seen discourse online. I'm sure you're aware as well. You know, psychiatrists, they're not therapists. They just prescribe medication, and that's not the case. I imagine there are psychiatrists who don't do talk therapy. Is that true?

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Dr. Brian Dixon [00:02:45]:

Correct. That is also correct. It just depends on who you talk to. Psychiatrists are as different from, from each other, as any other specialty, any other industry.

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Michael Fulwiler [00:02:54]:

So I'm curious what the breakdown is for you in your practice as a psychiatrist between behavioral health therapy and medication management. What does that look like?

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Dr. Brian Dixon [00:03:05]:

I always say, physician, know thyself. So spend some time figuring out who you are and what you like and what you don't like. And so I really like working with folks up to a certain point, and so once they get better, I'm like, see ya. Bye, get off my schedule. And so the idea of, like, that, you know, the lay on the couch for years, that psychoanalytic approach. Oh, my gosh, no, I don't want to be seeing you for the same thing over years and years and years. So, breakdown. I'd probably say I do something weird, but it's like 50 50.

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Dr. Brian Dixon [00:03:38]:

So, you know, 50% of the folks that I work with, we're mainly focused on meds, and I infuse a little bit of therapy, and then the other 50% is mostly therapy, and I infuse a little bit of medication. So that's my cop out answer, 50 50.

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Michael Fulwiler [00:03:52]:

That's still a great answer. You're from the great state of Texas. You went to Baylor for undergrad, Texas A and M for medical school, still live in the Dallas Fort Worth area. Was psychiatry always the plan for you when you went to medical school?

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Dr. Brian Dixon [00:04:09]:

Absolutely not. I'm old, Michael, and when I was your age and younger, I remembered a show called Doogie howser, Md. I don't know if you remember that one, but, yeah, no. Okay.

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Michael Fulwiler [00:04:20]:

Before in my time, I think.

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Dr. Brian Dixon [00:04:23]:

Well, this guy, he was like a boy genius, and he knew all the right answers. Of course, it was tv, but back then, you believed everything you saw on tv. And so I was like, oh, my God, that's so awesome. I went to medical school to be a general practitioner. I wanted to know a little bit about everything. But when I actually did the rotation, I hated it because they had to work so fast. Not only do they have to know everything, they had to work so fast. You know, they had to see patients in five minutes and fix things in five minutes.

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Dr. Brian Dixon [00:04:49]:

And then a lot of the folks were kind of repeat, I wouldn't say customers, but, like, repeat for the same thing again and again. And I was like, I don't. This doesn't make any sense to me. Like, why are you coming back in? And so I did my psychiatry rotation and saw that with a little bit of talking and insight, oh, my gosh, people can get better. And the appointments were much longer. They were much longer than five minutes, so fell in love with psychiatry and did that for, decided to do that for a career.

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Michael Fulwiler [00:05:18]:

For our listeners who may not be familiar with how medical school clinical rotation process works, can you explain how that works?

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Dr. Brian Dixon [00:05:26]:

Yeah, so we go to undergrad. So that's where I did the Baylor thing. You get a four year degree and technically you don't have to have a degree to go to medical school, but it definitely helps you apply to medical school. Medical schools are three to four years depending on where you go. At the end of your medical school career, you basically audition for a job. That's what they call residency. So you go around and you interview at lots of different places. If they like you and you meet their skill set, you get to do residency, which is basically intense on the job training.

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Dr. Brian Dixon [00:05:56]:

You do 60 to 80 hours a week for three to seven years, depending on what you're doing. And then after you finish residency, you can go out and practice in the specialty that you trained in. So that's essentially the, the course.

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Michael Fulwiler [00:06:11]:

And if you're further specialized, my understanding is you could do a fellowship as well. So that process could even be longer.

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Dr. Brian Dixon [00:06:19]:

Yeah. So the traditional psychiatry program is four years. You can do an extra two years to specialize in working with kids. You can do an extra year for forensics, which is like the legal side of things. You can do a year for consult liaison, which is working in hospital. You can do a year for geriatrics, which is old people. You can do a year for addiction. So, yeah, if you want to do, you can in residency probably for like twelve years, but that would be a.

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Michael Fulwiler [00:06:44]:

Terrible forever, sounds like. Yeah. What path did you take then?

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Dr. Brian Dixon [00:06:49]:

Yeah, so I did a wonky path. I did a combined program from the beginning. So it combined two years of pediatrics, 18 months of adult psychiatry, and 18 months of child psychiatry. So altogether was five years. And so technically, I'm a pediatrician and a child psychiatrist and an adult psychiatrist all kind of rolled into one.

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Michael Fulwiler [00:07:11]:

Interesting. And that's what it means when you're triple board certified, correct? Basically three types of doctors.

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Dr. Brian Dixon [00:07:20]:

Yeah, in a sense, yeah.

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Michael Fulwiler [00:07:22]:

So for the typical therapist, so say psychologists, mental health counselor, marriage and family therapist folks that we've interviewed on this show, there's a few paths that they can take. Post grad school, they can go work at a community mental health agency. While they're working on getting licensed, they can work at a group practice. Some folks will go work in a nonprofit, and then once they're licensed, they have the option if they so choose to go out on their own and start a private practice. Is it the same for physicians in particular? For psychiatrists? My sense is that most folks go work in, like, a hospital setting. Is that accurate?

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Dr. Brian Dixon [00:08:02]:

Oh, 100%. So, yeah, anything they can do, we can do the same. It won't be better, right? Yeah. So we can be in the same spaces as all of those folks. The hiccup is the money, right? So I spent 80 grand on my college education. I spent a hundred grand on my medical school education. So I left with $180,000 worth of debt, basically 100. Basically $200,000 worth of debt.

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Dr. Brian Dixon [00:08:31]:

So when I come out, my first job was with a community mental health agency, a federally qualified mental health center, and they paid what they paid, but I had to take a job that's kind of commiserate to being able to pay off all that stuff. And so it would be really rare for doctors to go into job possibilities where the money doesn't make any sense. So, yeah, most doctors will then go work for a hospital or a big health system because they need that guaranteed salary.

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Michael Fulwiler [00:09:01]:

And I imagine for most doctors, setting up an office, getting equipment, that kind of stuff just is expensive. Whereas as a therapist, if you're opening a telehealth practice, the expenses are actually relatively low. You don't even need an office nowadays. You can work from home. For psychiatrists, is that the case, or do you have to meet with patients in person if you're going to be doing medication management?

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Dr. Brian Dixon [00:09:29]:

Yeah. So technically, it's the same as any other therapist or counselor or psychologist. The caveat is, yes, there is a current law that says, or that is being suggested that says that you need to see a person in person to be able to prescribe a stimulant as of right now, which is, this is mid 2024. It's not set in stone. So the DEA is deciding if they want to set that in stone or not. But the cost of running a practice, because you're a physician, you have to carry malpractice insurance, which is way more expensive than any other therapist has to do. You have to maintain your licensure, which I think is also way more expensive. Like in Texas, the initial license is like $800, and then I think renewal is like $400.

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Dr. Brian Dixon [00:10:16]:

And then your DEA, which gives you the ability to prescribe certain things, is like $800 every two years. So, like, it's just the cost of being a doctor is more expensive, but the actual infrastructure in the practice is basically the same. Like, I, you know, I can you know, Sublett a space, I can get a Google domain or just a domain name and do all the same things that a traditional therapist would do.

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Michael Fulwiler [00:10:37]:

So at what point did you go into private practice? It sounds like you took a job out of residency. Yeah. And how long did that take before you realized, hey, I don't want to work for someone else?

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Dr. Brian Dixon [00:10:50]:

It took me three years to realize I was a shitty employee. I just. I'm really bad at working for people, especially people that I either don't like or don't respect or if I think they're idiots, it just doesn't work well. And so, yeah, so it took me three years. I worked in a federally qualified health center, loved my patients, loved my colleagues, but the way that they are funded created a kind of perverse incentive. And so it meant that we had to. They were trying to get us a double book, and that's no bueno. Super bad.

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Dr. Brian Dixon [00:11:22]:

So left that one, went to a multi specialty group, you know, again, loved my patients, loved what I did. But office politics, or office politics, it feels like regardless of where you are, culture matters, right? Your corporate culture matters, and so didn't fit in there. So I said, you know what? I'm going to go and I start a system and build a culture that I would like to work for. And so that's what I did back in 2014. So we're now selling. We're going into our 10th year. Hooray. We're still here.

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Michael Fulwiler [00:11:51]:

Congratulations.

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Dr. Brian Dixon [00:11:52]:

Yeah. Thank you.

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Michael Fulwiler [00:11:53]:

What were the steps that you took to start your business?

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Dr. Brian Dixon [00:11:57]:

Step number one is to be pissed off at the alternative, right? Because, you know, I think I love working with folks who start a practice because they're like, oh, you know, I want to make a difference in the world. And I'm like, I don't know that that's going to get you through the shitty times. Right. Anger and frustration is what propelled me through all of this. So, yeah, so that was the first step is be mad. Second step is do the basics, right? So, you know, basically you need to have a company that protects you so that you're, if something bad happens, you don't get sucked into the badness. So, you know, incorporate or do whatever you need to do. And then the second part is just be very confident that you know what you're doing with your treatment.

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Dr. Brian Dixon [00:12:40]:

With the clinical side, the business side, you can figure out over time, you can hire people to help you, but, you know, you have to be confident that the therapy that you're given, your modality, your niche, is like on point, because if you doubt yourself, man, this job will eat you alive.

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Michael Fulwiler [00:12:57]:

How were you able to acquire patients and clients initially? And has that changed over time as you've grown your practice?

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Dr. Brian Dixon [00:13:05]:

Oh, so much. This answer could take hours. But I'll give you the 15 2nd short, which is, I initially used the pre established networks that I already had. So I was working in the multi specialty group. My name was out there to them. And so when I left, people found me. So there was that created a website, and then I did the traditional networking. I took cards and went out to different places.

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Dr. Brian Dixon [00:13:31]:

The key is you need to know where to look. And that's the mistake that, that I kept making for years until I talked to marketing type people who go, yeah, you need to identify your target audience and figure out who you want to work with and then go find them. And I was like, oh, well, shit, that was easy. But I didn't know that at the time.

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Michael Fulwiler [00:13:51]:

Right. Well, no one teaches you that at all. So it sounds like you did get some external help. How did you find those people, man?

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Dr. Brian Dixon [00:14:01]:

Lots of different ways. So I played in a volleyball league, and the guy whose set me all the time, because I'm an outside hitter. I know you can't tell Michael from my. But, yeah. Oh, I get it down. And so we were talking, and he was a business coach for me for years. I ran across another guy who started a different company, and he was the one that introduced me to the traction entrepreneurial operating system, Eos. And then from there, I jumped into the entrepreneurs organization.

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Dr. Brian Dixon [00:14:30]:

Once I qualified for that, so I got business coaching through there. And then I have a really good friend of mine who got her MBA in HR. And so she was my. She's kind of like my HR guru and helps me manage all things, you know, just a sounding board. So, yeah, I have a lot of people around me that I can go, hey, I have this question about X, Y and Z. And generally there's somebody around to say, hey, this is what I've done before.

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Michael Fulwiler [00:14:53]:

Could you explain what the. Did you say entrepreneurial operating system? I haven't heard that before.

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Dr. Brian Dixon [00:14:58]:

Yeah, so it's called eos. Full disclosure. I'm not getting paid by them. I wish I did, because I have reach out. Oh, my gosh. Absolutely. Gina Wickman, I'm your dude. Speaking of which.

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Dr. Brian Dixon [00:15:09]:

So Gina Wickman is the guy who created it. He's on LinkedIn. He actually replied, or maybe his handler did, I don't know. But it's basically a conceptual way of arranging your business so that you can scale it more easily. And it's based on the seat model. Right. So there's five seats. In any company, the goal is to put the right butt in the right seat, so find the right person to fit the right job description.

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Dr. Brian Dixon [00:15:33]:

And so that's the two second dial down version. But his book is called Traction, and I recommend it to everybody that I work with.

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Michael Fulwiler [00:15:41]:

How have you handled hiring over time? Have you thought about building your business? Are you hiring therapists? Are you hiring other psychiatrists? How do you think about the team that you're. That you're building around your practice?

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Dr. Brian Dixon [00:15:54]:

Yeah. So there's two different iterations. So when I first started my practice, I had a. Between non clinical people and clinical people, all in the same company. That was bad for me because I'm a nice guy, or at least I think I'm a nice guy. And hiring people, you don't need a nice guy. You need somebody that's, like, thorough and knows how to actually hire and interview and do accountability and that sort of thing. And I was terrible at all that stuff.

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Dr. Brian Dixon [00:16:20]:

And so when I split the two companies apart and made a clinician side and then a non clinician company, it helps streamline things. And so for the clinician company, I look for people like me that want to minimize medication, that have an interest in therapy. I do. Not. For that company, I no longer hire outside of MDs and Dos. It's just because the business model is too hard. Right? I've hired pas, ph, physician assistants. I've had offers from nurse practitioners.

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Dr. Brian Dixon [00:16:52]:

I've had offers from. From therapists, you know, lcsws and stuff like that. It's just that I don't know their model. I don't know they're fully. How they're trained. And so I said, you know what? Let me just stick to what I know. So I'm just going to stick to the MDs and DOs and just keep that as that company. And then in the other company, which is called simply psych, which I'm sure we'll talk about at some point, that's all the non clinical people.

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Dr. Brian Dixon [00:17:12]:

And again, I'm terrible at all those things. And so I hired really good people to do the hiring for me and the accountability for me, and then I'm totally fine being the terminator. So I will tell people, hey, this isn't working out. I'll see you later in a heartbeat. But I don't. I can't do the rest of the stuff. I'm not good at it.

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Michael Fulwiler [00:17:32]:

Let's talk about simply psych. I was going to go there next. Can you talk about, you mentioned you broke apart the two businesses. Like, why did you do that initially?

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Dr. Brian Dixon [00:17:40]:

Yeah. So through business coaching, I recognized that there was only so big that I could grow my clinical side. So in other words, I can only find so many doctors, I can only see so many patients, and it's capped because my license is state based. If I truly want to be able to scale and make money at a larger economy of scale, then I need to do something different. And so, yeah, a friend of mine mentioned breaking those into two different companies. Take the second company, the administrative company, and go out and basically do back office for every therapist psychiatrist in the country. You know, there's 100,000 clinicians out there, if not more. If all of them are in private practice, or even just a fraction, that is something that I can do and scale and make a lot more money and most importantly, do a lot of good, because when therapists burn out, when psychiatrists burn out, bad shit happens.

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Dr. Brian Dixon [00:18:36]:

And I don't want bad shit to happen, I want good stuff to happen. So, yeah, so that's where that second.

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Michael Fulwiler [00:18:42]:

Company comes in, very much aligned with that mission. It's the same mission we have at Heard supporting therapists as business owners. Could you talk about the types of services you provide and how you decided to offer those particular services over other services?

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Dr. Brian Dixon [00:18:59]:

Yeah, the rule that I always use is do what you're good at, don't do what you're not good at. Right. And so I'm not good at finance, which is why I have a finance contractor similar to her, but probably not as good, because when I started all this, I didn't realize that you all were existing. So we'll have to talk offline. And so with operations. So operations, the way that we define it is all the back office stuff that you typically don't want to do that goes unseen. So scheduling, rescheduling, or lead management. Right.

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Dr. Brian Dixon [00:19:30]:

So closing the sale, making sure that that person gets their questions answered and gets scheduled, that payment is on the books, and then all the interim stuff, forms and letters and stuff that you just hate to handle. But we're not marketing in the traditional sense. So coming up with ideas of how to get your brand and your exposure out there, we don't do that part, but we can help with the kind of operations of marketing. Hey, how do I post things? What software do you use? Who do you recommend for XYZ? We do the operations of marketing. We do true operations. And then we leave all the finance stuff to guys like you. So that's, that's what we do.

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Michael Fulwiler [00:20:10]:

What type of businesses do you work with? Do you work with new practices? Do you work with more established practices? And at what point do you feel like is the right time to start to outsource and get help?

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Dr. Brian Dixon [00:20:24]:

If you're a therapist, this is another very important lesson. So when we first started, we worked with everybody. We took all comers, and we quickly learned that our niche as a practice management company, support company are the practices that are already established. So yes, we can do some startup stuff. Like if you're still contemplating on starting a practice, we can try to help, but that's not our forte. And so we refer over to folks like therapy flow and Joshua Brummell and, you know, amazing people like him. So, yeah, so if you're already established, that's key. That super helpful, it'll save you a lot of money.

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Dr. Brian Dixon [00:21:00]:

And then we work with all mental health clinician entrepreneurs. So if you're a therapist, behavioral support specialist, RBT psychiatrist, whoever, as long as you're in the mental health industry and you can't take insurance, if you do take insurance, then we can only help you so much because the insurance model is, is very complicated. So most of the folks that we work with don't take insurance or they have some type of workflow where they are handling the insurance verification process and explanation of benefits and billing because we don't do any of those three things.

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Michael Fulwiler [00:21:36]:

I want to come back to insurance because I know you have some feelings about it. As someone who has built a practice and has helped other clinicians build their practices, are there certain challenges that you've observed or mistakes that therapists have made as they've built their businesses that would be good for listeners to learn about before they go down that path?

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Dr. Brian Dixon [00:22:02]:

Yeah, I think the hardest part is the marketing part. Operations kind of runs itself once you set up the infrastructure. And so I'll be at the conference this October and tell you all about operations because that's our forte. But the marketing part, I think, is where most people are afraid. Most therapists and even psychiatrists, myself included, feel very icky with sales, quote unquote sales. S A L E S. Right. Sales, sales.

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Dr. Brian Dixon [00:22:29]:

They're like, oh my gosh, you know, I'm, you know, I'm begging for money or, you know, I'm making somebody, you know, do something that they don't want to do. And what I remind people all the time is that as a therapist, you are selling during the session itself. Right. So when you say, hey, I believe in you, and do you notice that when you do x, y, and z, this happens. What happens if you tweak that and do something else and you give that option to that person? That person goes, hey, let me try that. And it works. Well, you just sold them on the importance of insight and introspection. You just sold them on the idea of personal empowerment.

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Dr. Brian Dixon [00:23:06]:

So it's the same thing. So, yeah, so why not get paid for it and put a monetary number on it? And so that's the biggest hiccup is the sales part and then the marketing part. Being able to say, this is what I'm good at and I can do these other things, but that's not my forte. Most of us are so afraid of not having a full schedule that we will go out and we will go. We're the end all, be all therapists for everybody. Send me everybody. I can do everything. And then the result is burnout and lots of resentment.

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Dr. Brian Dixon [00:23:38]:

So those are the two biggest hiccups.

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Michael Fulwiler [00:23:40]:

I see related to marketing. One of the best ways for therapists to get clients is through referrals. And therapists are told, network with physicians. Doctors are a great referral source, but I feel like there's not a lot of helpful information out there about how to actually do that. And so as a physician, I'm curious your perspective on how can therapists effectively network with doctors and physicians so they actually get referrals?

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Dr. Brian Dixon [00:24:11]:

So you can go to networking events and if doctors happen to be there, great. Otherwise, don't worry about the doctor. I would instead engage the gatekeeper. So every office has some type of gatekeeper, some kind of administrator, and that's the person to engage. It could be the front desk person. If you physically walk in and hand them your cards. Hey, this is, I'd love to meet with doctor so and so, but I'm sure they're busy. Let me just leave my card and then, or, hey, can I, you know, schedule a lunch or something? Or, you know, is there a good email address for that person? So the gatekeeper doctors, for all intents and purposes, are really busy and we do what our trusted advisory people tell us to do.

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Dr. Brian Dixon [00:24:54]:

Right? So I've hired all these folks. If they come to me and go, oh, my gosh, you know, Susie therapist dropped by these cars and she was super nice. Then I'm going to go up, susie, the therapist is higher on my list. I will think about her. Right. But if nobody comes, then I won't think of anybody. So the key is engage the gatekeeper. Most good referrals, in my opinion, come from other therapists.

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Dr. Brian Dixon [00:25:13]:

They're more therapists than psychiatrists and primary care docs and blah, blah, blah. So I would say focus on engaging your peers, and then grow the size of the pie. Go out and. And talk about the importance of mental health. And as people perk their ears up and go, hey, I want to get care whether they come to you or not, you are increasing the revenue, the referral stream, and that is just really important.

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Michael Fulwiler [00:25:38]:

What about actually going to a doctor's office? So you stop by, you say hi to the person at the front desk. Should you have business card? Should you have flyers? Should you bring them cookies? Like, I mean, what's. What works, actually?

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Dr. Brian Dixon [00:25:54]:

So it's really funny because the research is pretty clear, because drug reps have been doing this for years. The research is very clear. If, you know, the higher the hair, the closer to heaven. I mean, the more you do, you know, if you bring an edible arrangement, you know, or a steak dinner. Yeah, I mean, that stuff is very memorable. I'm of the mindset, though, because, again, most of us feel like, that's very weird. I'm of the mindset. You just show up, hey, I've been dropping my cards by think of me.

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Dr. Brian Dixon [00:26:18]:

And if you do that, like, once, a quarter, once I've seen that name three, four, or five times, that helps. And so I'm more of repetition rather than spending money. And then I do go, me personally, I do go to networking events because of just who I am, and I know how the system works. And so the key to good networking, in my opinion, is don't give me everything, because I can only remember so much stuff. But when you say, yeah, I'm the therapist that I really like to work with. You know, couples that fight. Oh, okay, couples that fight, great. I know a shit ton of people who that qualifies for.

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Dr. Brian Dixon [00:26:53]:

And your name is Brandy. So, Brandy. Couples that fight that I can remember. What I can't remember is when Brandy goes, yeah, you know, I do ifs system work and Gottman. And no, you've already lost me because I don't have the brain bandwidth to keep up with that. So keep it short, keep it sweet, and then repetition.

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Michael Fulwiler [00:27:12]:

I'm glad you brought that up. That's where I was going to go next. I think the key to getting referrals is having a clearly defined niche, because if I stop by your office, I told your person at the front desk, I have availability. But I work with everyone, or I work with people who struggle with anxiety, some general practice. I'm not going to be top of mind when someone comes in and you're thinking about who to refer that patient out to. Right. But if someone comes to you and they're looking for help with an eating disorder, and I specialize in eating disorders, I'm going to be top of mind for you. Right.

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Michael Fulwiler [00:27:51]:

Especially if I've stopped by more than once or we've met more than once. So I think the more that you can not just define that niche, but communicate it as well, the more referrals that you're going to get.

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Dr. Brian Dixon [00:28:02]:

And be real. Normally I don't carry my mug around, but be memorable. So a friend of mine, she's a therapist, she actually gave me this and now I use it all the time. And I love most people. Emphasis on most, but yeah, and be memorable. So find a way to not be forgotten.

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Michael Fulwiler [00:28:23]:

Do you want to talk about insurance?

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Dr. Brian Dixon [00:28:24]:

Yeah, it's the worst idea. It's all a scam, dude. The whole industry is a scam. So I don't even know. Where do you want me to start?

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Michael Fulwiler [00:28:32]:

You don't take insurance?

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Dr. Brian Dixon [00:28:33]:

I do not. Because it's a scam.

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Michael Fulwiler [00:28:35]:

Can you explain why?

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Dr. Brian Dixon [00:28:36]:

All right, so health insurance is weird because, so you have a hundred percent chance of needing something in the healthcare industry, period, end of sentence. Because you're going to get sick at some point, either. Depression, anxiety, break a leg, I don't know. Something's going to happen. And so why insure against something that you know is going to happen? Just go ahead and just save your money and pay for it. So that's my 30,000 foot view of insurance. The reason why I don't take it as a clinician is because the reimbursement rates are terrible, number one. So in other words, insurance companies do not pay therapists and psychiatrists at the rate that they do, the medical people, because of some glitches in the matrix.

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Dr. Brian Dixon [00:29:15]:

So back before insurance became big, some person sitting at some table decided that cutting on people is worth more than talking to people. And then that has reverberated over the last 70, 80 years into the social experiment where we are now. The other hiccup with insurance is that insurance companies are companies. Their goal is to make a profit, which means that they want to keep as much of their money as possible, which means they're not going to give it back to you or to anybody else. And so they create lots of rules to get around that they give rules about how many buttons you have to click on the computer, how many questions you have to ask, ask how much time you need to spend, and that hamstrings my ability to treat the person in front of me. Back when I was in the insurance game, I would say, I don't need to see you for six months. I mean, I'm not doing anything with you, but because of the way the insurance contracts were written, I had to see them every three months, which meant that I couldn't get new people in because I'm seeing all these wonderfully stable, awesome folks. And I was like, this is stupid.

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Dr. Brian Dixon [00:30:13]:

I mean, it's just that dumb. So it's a dumb scam. And I say we need to get rid of the entire thing.

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Michael Fulwiler [00:30:21]:

What about patients who can't afford to see you out of pocket and need to use their insurance that they get from their employer in order to get health care?

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Dr. Brian Dixon [00:30:33]:

Yeah, so a couple different things. So if you are in a position where you have employer based healthcare, you can afford care, period. End of sentence. Because the bulk of what your employer is paying, if your health bill is $100, your employer is paying two thirds of that, and then you're paying the other third. So theoretically, the money is there. It's just the employer is not giving the money to you. The employer is giving the money to that guy over there. In a sense, if you wanted to, you can go to your employer and say, hey, I don't want your shitty insurance.

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Dr. Brian Dixon [00:31:05]:

Just pay me more so that I can go and take care of myself. That is an option. People can do that. Another option is you just go ahead and see me anyway. You pay me directly, and then I'll give you a super bill, and then you can submit that receipt to the insurance, and hopefully they will reimburse you. Now, if your insurance company is shitty, which most of them are, they're not going to give you any money because they're shitty people. And so. Yeah, but that's not my fault.

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Dr. Brian Dixon [00:31:32]:

Like, I'm sorry you have shitty insurance. You should probably choose different. The last part is mental health care is an investment. And this is where I try not to. I try not to spend other people's money, and I try not to pass judgment on folks. But I think the research shows upwards of, I think it's like 60 or 70% of Americans have a smartphone, and these things are not cheap. Like, none of them are cheap now, and Internet access is not cheap. And even if you do wi fi, like, they're what I'm gonna say is the money is there.

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Dr. Brian Dixon [00:32:06]:

And if you are serious about your mental health care, you will make the investment. And on the flip side, and I tell people this all the time, I may look very expensive, but I work with every individual that I see to make sure that I'm being a good steward of their finances. So I will tell them now, I'm like, yeah, upfront, I'm going to cost you a pretty penny because number one, I need you to be invested. And number two, I think I'm worth what I'm worth on the back end. I'm going to make sure that I work myself out of a job because my goal is to get you out of my office. If I can get you out of my office, you can message me for free, as much as you need to. That keeps your cost down. In the grand scheme of things.

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Dr. Brian Dixon [00:32:46]:

That's what I do with my people. And I think it works because people keep referring me, other people. So I guess I'm on to something.

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Michael Fulwiler [00:32:53]:

Clients may not realize that if they do have insurance, they may have out of network benefits as well. And doctors or, you know, therapists can provide what's called a super bill that they can submit to their insurance company. So they may be able to cover part of the cost that way.

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Dr. Brian Dixon [00:33:08]:

Yeah.

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Michael Fulwiler [00:33:08]:

Still operating within the system. Right. We'd like to get away from.

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Dr. Brian Dixon [00:33:12]:

Correct.

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Michael Fulwiler [00:33:12]:

It sounds like. But at some point it's like, you know, what, what can you do in the short term as well?

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Dr. Brian Dixon [00:33:16]:

Well, and the really funny part, again, I just, I love when people submit their own super bills because you get to see firsthand how much your insurance company hates you. You get to see it plain and simple. Right? Because right now insurance companies project that onto the therapist. Oh, well, you don't take insurance, so you're a bad person. I go, no, no, no. Go and experience your own insurance company. You're paying a premium every month. Go experience your own insurance company.

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Dr. Brian Dixon [00:33:43]:

Submit the bill and then wait and see what they do. See the runaround that they give you, because that runaround and that obfuscation that they give you is exactly what they do to us and eats us alive. So most people then, when they do it at least once, they go, oh, I get it now. Yeah, my insurance sucks. I still need it because of X, Y and Z, but I get it now, and then we never talk about it again.

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Michael Fulwiler [00:34:04]:

I'd love to switch gears here and talk about representation in psychiatry. So representation across the industry is a problem in psychiatry. The statistics that I've seen say that 2% of psychiatrists are black. So as a black psychiatrist, what does it mean to you to be part of that 2%?

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Dr. Brian Dixon [00:34:25]:

It's very lonely. No, I'm kidding. Once you live the life that I live, used to it. It means that we're missing out on some treatment opportunities. Now, here's the funny part. And again, this sounds weird. The majority of people in boardrooms are white dudes. Like, y'all are everywhere.

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Dr. Brian Dixon [00:34:45]:

Y'all, like, run everything. You have all the monies, right? And I think to myself, and I laugh about.

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Michael Fulwiler [00:34:52]:

Not me personally.

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Dr. Brian Dixon [00:34:53]:

Well, I don't know, Mike, but I think to myself, and I'm looking at the demographics of the people that I've worked with over my twelve years of doing this, however long I've been. 13 years that I've been doing this. And I have a ton of white kids and these kids. And again, I work with brilliant kids of all backgrounds, but these little white guys are going to become business owners and CEO's. And so my presence as the 2% means that 30 years from now, yeah. Things are going to be different because we're going to have CEO's that had black psychiatrist 30 years ago. Right. And so.

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Dr. Brian Dixon [00:35:26]:

And that's going to be awesome. What it means right now is that I have to spend an inordinate amount of time recruiting. So I'm doing a lot of mentorship. I'm trying to let people know the importance of being black, of having black therapists, black psychiatrists. And then I think the studies are pretty clear that say that some of the outcomes are just better. You know, if you have a. If you're a person of color and you have a psychiatrist or a clinician of color, the outcomes tend to be better because you resonate with the person that you're working with. So, yeah, so it's multifaceted.

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Dr. Brian Dixon [00:35:58]:

My goal is to just not give up. Right. To not stop. So I'm going to keep talking about it. I'll make you uncomfortable when you need to be uncomfortable. I hope you resolve your discomfort, hopefully in a very progressive, thoughtful way. And then we just keep building.

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Michael Fulwiler [00:36:13]:

I read an article that you wrote on why there isn't more black thought leadership. And the takeaway was like, you're busy, you're working, right? Like, you look at the podcast and the media, it's mostly white men on these shows that are having these conversations.

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Dr. Brian Dixon [00:36:32]:

Yep. Y'all have a lot of time. Good for you. At the end of the day. Yeah, we're just. We're really busy. It's really hard to have your cake and eat it, too, as a. As a blessing black person, as a black entrepreneur, as a black mental health entrepreneur, it's just really, really hard because I wish I could turn off that empathetic side of me.

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Dr. Brian Dixon [00:36:53]:

Right. And I do a decent job in the clinical setting, but it's hard not to take certain things personally. For example, number one, the rule is the best time to ask for a loan is when you don't need it. So all you heard, listeners hear me clearly. If you are doing well and you're making money, go get a loan now. Don't wait for the bottom to fall out. And the summer, the. What is it, the summer squall or whatever they call it, where you don't have any people coming in and summer slowdown, slow down.

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Dr. Brian Dixon [00:37:20]:

Yeah. Make sure you go get money now before that happens. It just gets really, really hard. It's very difficult to not take it personally because I'll go and ask for stuff and I'm like, I'm good for it. You know, I'm making six figures. I'm employing, what, 14 people between two companies now? And I'll still go to the bank and they'll be like, yeah, your p and l's don't match what I think they should match. So we're not going to give you X, Y and Z. Yeah, this shit still happens.

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Dr. Brian Dixon [00:37:48]:

And at first I'm like, well, you know, did I do something wrong? What's wrong with me? And I was like, no, no, no. There are actual structural things built into the financing system. That means that I will forever have to pay higher interest rates, and that money is going to cost me more, and it's going to be, you know, was it debt to income? Your debt to income ratio? Yeah. All these things are just going to keep plaguing me until I die. So I just go, you know what? That's a shitty system. I'll do what I can with what I got, where I am, and I'll keep moving on.

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Michael Fulwiler [00:38:23]:

You are an entrepreneur. You're a business person, which is something that we've connected about. You've started your practice. You also have simplis, like, you started another company that didn't work out. So I'd love to talk about that as well. Could you talk about that business and any lessons learned?

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Dr. Brian Dixon [00:38:44]:

Yeah. So for all of you Heard listeners, if y'all can crack the code of how to manage referrals and get the right people to the right places, you win. Right? So I tried to do that with software, me and a friend of mine, his name is Matt. So Matt is a software coder person, and we've been friends since forever. We developed a software, we got people on the platform. We had a great name. It was called guide. We had great colors, the whole nine yards.

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Dr. Brian Dixon [00:39:11]:

The hiccup became the operating system. So he operates in a very different mind space than I do. And it's not wrong. It boiled down to grass tops versus grassroots. Grass tops is the belief that you go after the heads of organizations that have your target audience, and then grassroots is you go after your target audience, the actual end user. And we just had a fundamental difference about which one to target. And so we yelled and screamed and tried to figure it all out, and it was just like incompatible with a functioning company. Right.

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Dr. Brian Dixon [00:39:50]:

And so we said, you know what? Rather than lose our friendship, let's just dissolve the company. The idea is still great. Hopefully at some point somebody will make something awesome, because I'd much rather prefer you as a friend then lose you as a, you know, let the business ruin, ruin all that. So, yep, he's still out making software and he lives up in Nashville area, so I get to see him at the conference. So maybe I'll invite him and you'll get to meet him too. But yeah. So the moral of the story is sometimes businesses just don't work out, and that's okay. At least you tried.

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Michael Fulwiler [00:40:23]:

I still think the idea is great. I always have. I think part of building a business is identifying a pain point. And there's this idea of selling a painkiller, not a vitamin, and it's always easier to sell a painkiller. People are motivated to solve that problem versus maybe someone who is more preventative. How therapists make referrals to each other we've talked about referrals between therapists and doctors. The way that therapists make referrals to each other is not efficient. I've talked to therapists who they'll get an inbound request.

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Michael Fulwiler [00:41:01]:

The client may not be a good fit or their practice is full. And they then go on psychology today and try to find a therapist. And they're the ones who are reaching out on behalf of this person who's not even their client. So I think whoever can solve that problem, I think it's great. But also I think a great takeaway here to your point, is that sometimes you try things and they don't work out and that's okay, too. And I think it's just about taking at bats and taking swings and you're going to hit it at some point.

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Dr. Brian Dixon [00:41:34]:

And pivot. Right. That term came out of the pandemic, and I was like, holy shit, this is, like, the best term of entrepreneurship is learn how to pivot. And so, yeah, so pivot. If it's not working, pivot. Pivot. Pivot. It doesn't mean abandon.

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Dr. Brian Dixon [00:41:49]:

Sometimes you abandon, but most times you can pivot and try something else. Pivot. Try something else. And the fifth iteration may be completely different from your first, and that's okay.

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Michael Fulwiler [00:41:58]:

Heard is a testimony to that. Heard actually started as a form of a therapist directory, matching therapists with clients. And we realized that just wasn't the business that we wanted to build. But through extensive customer interviews, what kept coming up was accounting, bookkeeping, taxes. There wasn't a great solution for that problem. And almost every therapist, unless they come from an accounting background or have owned a business previously, is going to have to learn how to do that. And so just through talking to therapists and really understanding that point, that's when the pivot happened. And that was over two years ago now.

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Dr. Brian Dixon [00:42:44]:

Wow. And then look at you now.

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Michael Fulwiler [00:42:49]:

What are some challenges that you're experiencing today, either with your practice or with simply psych?

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Dr. Brian Dixon [00:42:56]:

Yeah. So, practice wise, right now, the summer slump, or whatever you call it, hits us all, no matter if you're psychiatrists or therapist or whatnot. So I heard on a yemenite interviews, it was a, I think, clinicians of color kind of panel. And one of the panelists said their business coach told them, sometimes you have more time and sometimes you have more money. And this is one of those times where I have more time, because this is summer slump. So rather than focus on, oh, my God, I don't have any money, I'm going to focus on what do I build to deal with the influx of people who will be coming in in August, September, because that's just how it works. So that's the practice side, the private practice side. The biggest hurdle for us in getting new clients to sign up is helping people understand what we do and that they're doing it badly.

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Dr. Brian Dixon [00:43:46]:

Right. Because, again, going back to the seat idea, there's five seats in every business. If you're going to scale, you need to only be in one, maybe two seats, is essentially what the theory is. And most therapists are sitting in all five of the seats and probably doing a decent job, but there's no way that they're going to win in the end. And so being able to swoop in and say, hey, let her do the finance seat. So that's then you're down to four seats, and then let simply psych do the operation seats so that you're down to three seats. You know, just getting people to let go a little bit, that's the hardest part. Unless they're close to burning out and quitting.

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Dr. Brian Dixon [00:44:22]:

And so that's. That's our niche, is we swoop in right before all hell breaks loose. So there you go.

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Michael Fulwiler [00:44:30]:

Why do you think people struggle to let go?

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Dr. Brian Dixon [00:44:33]:

Because they think that they're supposed to be able to do it themselves. I tell my patients all this all the time. It's part of my shtick is you're a terrible therapist for yourself. You're really bad at it. Don't try to be your own therapist. And in this regard, there are certain things in the practice that you're bad at. You may think you're good at it, but that's your blind spot. You're bad at them.

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Dr. Brian Dixon [00:44:54]:

So in operations, most times, people can do it because we're all trained to, you know, insert round peg into round hole. Right? That's. We can all do that. But do you like to do it? No. So then I have a whole team of people that love that stuff, so let us off board. That same thing with taxes like y'all's. People like that shit. I can't stand it.

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Dr. Brian Dixon [00:45:15]:

I, like, I just. I put money in the bank account. I work as hard as I can, and I go, please, just make sure my bills are paid and that I don't go to jail for IR's things. And then I run off and go do something else. And then miraculously, right now, my contractor sends me a report that I don't read, but, you know, it's whatever.

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Michael Fulwiler [00:45:32]:

There's something very powerful. And you've mentioned this in this conversation about identifying what you're really good at and what your zone of genius is and really just focusing on that and letting go of the rest of the stuff that you're not good at because you're just at that point, you're wasting your time, right? Or you're not spending your time in.

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Dr. Brian Dixon [00:45:49]:

The most efficient way, literally burning your time up. You're setting yourself on fire to keep somebody else warm. And that is not sustainable. So stop it. Give it up. Give somebody a job. Go Heard.

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Michael Fulwiler [00:46:01]:

We'll cut that. We'll make that a clip. We'll post. As someone who owns multiple companies, how do you manage your own burnout? And what does self care look like for you?

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Dr. Brian Dixon [00:46:12]:

Yeah, so I sing. So I love singing. I love music. And so I sing with a men's course here in Dallas. So I do that, that I work out at least two to three times a week because I'm old and my body doesn't work the way that it's supposed to anymore. And so that helps. I'm a passion planner again. These people aren't paying me anything, but I'm a passion planner guru.

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Dr. Brian Dixon [00:46:33]:

I use this to keep track of all the just insane amount of shit that flies through my head because I find that that leads people to burnout. Like, when you can't find that file or you don't remember the day you did something, who you talk to. Yeah. Physically write it down. Not digital, because there's. There's too many inboxes, too many drives and clouds is physically write things down. And then I think the other part is just, you know, get adequate sleep, which most of us don't do. Yeah.

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Dr. Brian Dixon [00:47:00]:

And don't eat bad stuff. Like, if you're going to do. If you're going to indulge, do it, you know, ever so often, but don't overdo it. Like, if you wake up tired and sluggish is probably because you're overeating and not sleeping enough. And that can, that can lead to make burnout worse. Yeah.

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Michael Fulwiler [00:47:17]:

I'd say not medical advice, but you are a doctor, so.

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Dr. Brian Dixon [00:47:21]:

Yeah. Yes. This is not medical advice. Yes. And let things go. Like, you're not going to win everything and not everybody's going to like you. Oh, my gosh. There's so many people who don't like you.

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Dr. Brian Dixon [00:47:30]:

Like, even. Even though you haven't done anything to them, they still don't like you. So you just go, eh.

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Michael Fulwiler [00:47:35]:

Oh, well, we're coming to the end of this conversation. We like to end with a segment that we call the footnote. You just shared some great advice, but is there one thing that you would want therapists to take away from this conversation? And if so, what would that be?

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Dr. Brian Dixon [00:47:50]:

The one thing that I want therapists to take away from her business school is keep going. Okay. So you will succeed if you keep going, period, into sentence. If you want to fail, stop. And sometimes that's appropriate. Failure is a lesson. It's not a moral implication of who you are, but if you want to win, you just keep showing up. Do a little bit every day.

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Michael Fulwiler [00:48:17]:

Love that quick plug for the mental health marketing conference that's happening in October of this year, Steve Turney. Excuse me. If you're listening, shout out to Steve, the organizer of that event happening in Nashville, as well as online. Both myself and you will be there. So excited to hang out in person. Where else can folks find you and connect with you online in the meantime?

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Dr. Brian Dixon [00:48:43]:

Yeah, so I am on Facebook, but don't hit me up there because I don't talk to anybody. Instagram. If you look for find mindful on Instagram. If you look for simplisyc on Instagram, we are there. We do. I'm gonna start a TikTok. It's. It's created.

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Dr. Brian Dixon [00:48:59]:

I just haven't done anything with it. Oh, wow. And then most of my. I'm like, I don't know if I should sing or dance or sing a dance. I don't know. We'll see. And then most of me is on LinkedIn, so I think it's the safest, cleanest platform. And so if y'all are other entrepreneurs and y'all are being thoughtful about stuff, hit me up on LinkedIn.

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Dr. Brian Dixon [00:49:19]:

Just Brian J. Dixon. There's another white dude. His name is Brian J. Dixon. But, yeah, I think mine is like Brian J. Dixon, Md. So look up Brian J.

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Dr. Brian Dixon [00:49:27]:

Dixon, MD and not the other white guy.

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Michael Fulwiler [00:49:29]:

Gotcha, doctor Brian, thank you so much for your time. Really appreciate you coming on the show. This has been fun. Thanks for listening to this episode of Heard Business school, brought to you by Heard, the financial back office. For therapists, visit the Heard resource Hub at joinheard.com to support you in your journey as a private practice owner. And don't forget to subscribe on YouTube, Apple, Spotify, or wherever you get your podcasts. We'll see you in the next class.