Episode 141: The Journey to Private Practice: Taking Strategic Risks [featuring Jorge Fernandez]

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Transcript

PATRICK CASALE: Hey, everyone. You are listening to another episode of the All Things Private Practice podcast. I am joined today by Jorge Fernandez. He is an LCSW in Connecticut, a first-generation Cuban American, a private practice owner. He is the owner of Nuevo Dia FW. And has been in private practice now for six years, I believe. And-

JORGE FERNANDEZ: It's been six years, yeah.

PATRICK CASALE: Congrats.

JORGE FERNANDEZ: Thanks. I appreciate it.

PATRICK CASALE: I'm excited to have you on today. I think we're going to talk about some cool stuff. You've had a really cool kind of career trajectory. It looks like you were in Little Havana, and then you were in New York City doing a lot of community-based work. And then you found your way to Connecticut, where you are now in private practice.

So, tell us a little bit about who you are and kind of what you've got going on right now. What's the driving force here in terms of private practice ownership, too.

JORGE FERNANDEZ: Sure. And again, thank you for having me, Patrick. This is an honor to be on your podcast.

Yeah, I mean, my road right now is, I am beginning my sixth year owning my own solo private practice here in Connecticut. I'm a fully Spanish, bilingual private practice doing both in-person and telehealth, pretty much, you know, serving our small state, the 48th largest state in the country, working with individuals, couples, and families. I'm also now getting more into the supervision and consultation end of things with other therapists, which I really, greatly enjoy, and really wanting to expand upon that.

And you know, and six years in the field, I'm ready to diversify into new areas in the coming year, which I think is, you know, one of the reasons even why I found you because you have such experience in that.

As far as how I got here, you know, I think you said it well. I never shied away from doing the difficult things. You know, my first therapy job in the field was, basically, walking the streets of Little Havana, you know?

And, you know, on one block I might have four clients, and my three o'clock is at this house, and my four o'clock is at that house. And you know, it was quite the learning experience. Then went and continued, you know, to do the same thing in New York City and all five boroughs of New York City, really never shying away from doing the hardest work for those who need it the most. I continued doing that as an administrator for 14 years after that. And eventually, there was no way that I could interview for one more middle-management mental health job. And that was when I made the decision that it is time to jump to a private practice. But I have not regretted that decision.

PATRICK CASALE: Yeah, that sounds like such an interesting career in a lot of ways because, you know, I have a lot of negative to say about community mental health, but it's much more about the bureaucracy and just the dysfunction. But the people that you're serving in those environments, like, they wouldn't be able to access services anywhere else, and you're really meeting people where they're at in terms of, like, "Hey, this is what we can do. We have to get creative. We have to think outside the box in order to support people."

So, it sounds like a lot of cool experiences. You kind of mentioned, like a lot of a lot of "war stories" too.

JORGE FERNANDEZ: Yeah. I have some crazy stories, for sure.

PATRICK CASALE: I think that is like going hand in community mental health when you're [CROSSTALK 00:05:00] like, out by yourself, just in the community. Like, some days you're like, "Should I have been in that environment? Should I have done this thing? Like, I don't even know if I felt safe in this situation." So, lots of cool relationships get built, too.

So, with that being said, those moments in your life, right? Like when you're walking the streets in Little Havana, then in the boroughs, to then opening a practice, is there ever like the, "Oh shit" moment where it's like, "I don't know how to be a business owner, so how will this ever work?"

JORGE FERNANDEZ: Absolutely, you know, I am that person that organization's never been my strength. You know, my strength has been what I'm doing right now, which is talking to people. So, keeping a business afloat when it is literally all me. You know, what I tell my clients is, I am the answering service, I am the cleaning person, I am everything has always been a challenge.

You know when you say that oh shit moment, it reminds me of when I sat here in this office with the first client to walk through my door in private practice, and it was the first time in 14 years that I had had my own clients, my own long-term clients. You know, I had done nothing but administration for 14 years, and just really sitting there in front of this person realizing, do I still know how to do this? And do I still know how to do this in a manner that isn't where I'm not following, you know, the evidence-based model and having, you know, to wrap it all up in three to five months, etc. It was almost a panic moment. And thank God that I figured out, yeah, I can still do this, and I can do this much better than I thought I could.

PATRICK CASALE: Yeah, I think that's so common for us to, like, transition out of mental health or something that feels like this is how you're supposed to do the thing, where you're doing a lot of case management, you're putting out a lot of fires, you're doing a lot of crisis management intervention to help people just get their basic needs met. And then for someone to walk into the door of your private practice, and sit across from you, and you're like, "Oh, shit. How do I even help this person? What if they present like they've got it all together? Then what do I do?"

So, there's so much existential questioning going on when you open a business because you're like, like you said, I'm everything, but I don't also have the training to be everything because most of us didn't get any business training. So, it's like, now what?

So, I think a lot of it is like figuring it out as you go. When you feel anchored into that though, and you finally are like, okay, deep breath, you do know what you're doing, it is amazing how things start to shift and how things start to fall into place.

And I think the first year or two is really just figuring that out, like your policies, your procedures, your schedule, you may have overbooked yourself, you may have forgotten to charge a client, you may have forgotten to submit an insurance claim. Like, the things that people beat the hell out of themselves for on these Facebook groups I'm like, "This is so normal. Like, this is what it's like when you do have to wear all of the hats in a business."

JORGE FERNANDEZ: One of the things that I, you know, decided initially, you know, for example, you know, the idea of hiring a biller, or outsourcing anything, I, at times, have had a biller. I currently don't. But it was so important to me before I decided, other than credentialing, when I did hire somebody do my credentialing it just felt like too muchness at the time. But before I outsource anything, I want to know how to do it myself.

PATRICK CASALE: Yeah.

JORGE FERNANDEZ: You know, before I have somebody else do my billing, I want to know every piece of how to do my billing. I want to know who the contacts are. I want to know what to do, you know, in case something goes terribly wrong.

And it's something again, on the groups, and I do admin one group here in Connecticut, you know, it's something I see over and over therapists who are running their own businesses, but are scared to take on huge aspects of that business themselves. And that is something for me. You know, if I could impart something to every therapist that varies. Learn every bit of your business so you are not afraid, then make the decision whether you want to bring someone else.

I hired and fired a biller. You know, I thought it would be easier. And then when I realized that I was working entirely on their schedule, and then not on mine, and then it was no longer easier. And it actually has been easier to do it all myself.

So, you know, I hope that people are able to make those decisions for themselves, you know, and not feel beholden to having to have somebody [INDISCERIBLE 00:10:23] part of it.

PATRICK CASALE: Yeah, that's well said. And I think that's a good reminder for people is like, this doesn't have to look one specific way because so often we're, like, asking for advice on what would you do? But that doesn't always take into account our own processes, or our own preferences, or our own strengths, either.

And I like the mentality of knowing how to do everything because if you do outsource, which I encourage a lot of outsourcing because I was that person who's like, "I want to do it all. I want to figure it all out."

And I almost had a hard time relinquishing control. And I think a lot of therapists do have that issue. But if you know how to do everything, it means that if your biller steps away, if they ghost you, if they quit, etc., you're not left like scrambling to figure out, "How do I get paid for the last two months of the work that I've done?" Because no therapist wants to spend hours of their week on the phone with the claims department of Blue Cross, Blue Shield. Like, nobody wants to do that. I don't even know of the people who might want to do that.

So, having the understanding of the mechanism of like this is how the business works, I know the ins and outs, it allows you to then train people if you bring someone in saying, like, this is what I want done, this is how I want it done. Because that's another issue people have when they hire is like, I don't know what to hire for, or I don't even know what expectations and roles to offload. And then it's like, "Well, I'm frustrated with this person because I wasn't really able to train them, because I don't even know what I'm training them on."

It's a whole thing. So, like, I agree. And if it makes your life easier to not have those mechanisms in place, then I think you just want to really know the ins and outs, like you said, and kind of get really inundated with the processes. I think we shy away from processes a lot of the time because it's like, the way less sexy side of business ownership is like the foundational stuff.

JORGE FERNANDEZ: Right. We believe that all we have to offer is our face in therapy, you know? This is why I'm doing this, do therapy. I'm not here to do the other stuff. Well, that's not the case anymore. You know, it is your business, it is your face, it is your name, it is your ass, and you know, you have to protect that, and you have to manage that. And you know, saying that you're only in it to be a therapist and not a business owner, once you take the step, you know, it's not realistic. And to me, it's like you should have some knowledge of how to do every single bit of it then choose whether you want or don't want to do it. Then choose whether you don't want to take insurance or not. Like, you know, know both sides before you do it.

PATRICK CASALE: Yeah, I agree. And I think if you are accepting a fee for service, then you are a business owner, right? So, like this whole mentality of, I'm just going to bury my head in the sand, and I'm not going to, like, learn any of the other things that need to happen in order to keep a business running or sustainable kind of screams ignorance to me because it's like, if you're charging a client for a session, then you are a business owner. If you're paying taxes for the work you're doing, you are a business owner.

So, like, we can work so much more effectively. We can change the culture, and the narrative, and the perspective that the mental health counseling community has if we could just understand a couple of basic things so that we don't feel like we're this profession that feels so fragmented, and so disjointed, and so discombobulated, and so cluttered with like all the noise. Because it could be so much easier, but I think we make it so much harder.

JORGE FERNANDEZ: Yeah. I mean one of the things that's unique, somewhat unique about when I started my practice is that I started a full-time practice from scratch. You know, I was not in part-time private practice. I had never had a private client in my life, and I decided I'm going to go do this full-time. Like, there was very little that, you know, I had the good fortune to have some money put away in the time to carry me through the first three four months. But I really did sit here in those first four to six months trying to take in everything that I possibly can and really giving thought to how I wanted to put myself out there, what I wanted my office to look like, what I wanted my logo to look like. You know, I didn't want a branch in trees, you know, for my logo. Yeah, I did something completely different. But just really-

PATRICK CASALE: Do you have stacked rocks on your website?

JORGE FERNANDEZ: No, no.

PATRICK CASALE: Good.

JORGE FERNANDEZ: No, no, never. I have not. I think they're cool, but it's been done. No, it really is, but you are selling yourself as a professional that can help people, and it takes a lot.

PATRICK CASALE: It's is. It's a lot. I feel like it's an understatement to even say that like, but I think knowing the nuances of like, the ins and outs is so important. And I think we get so hung up on these details that don't really matter. So, that's why in my Facebook group people will say, like, "I'm ready to open but I can't figure out my business name." I'm like, "Who cares?"

Like, honestly, at the end of the day, if you find a name that really speaks to you, great. However, you're probably going to come up with the variation of like 20 different names that are used constantly, using like, resilience, empowerment, creative, healing, etc., etc., etc. At the end of the day, clients don't care. They just want to know that you can help them. That's all they wanted.

Like, if Nike wasn't Nike, would we know what the swoosh symbol means? Would we know what any of their messaging meant? Of course, not. So, like, similarly to any business opening up a restaurant, a movie theater, a small business in general, a private practice, it is going to take time. It's going to take a lot of intentionality. It's going to take some failures. It's going to take some mistakes along the way to kind of get your process smoothed out. And I do think that there is an ebb and flow of being a small business owner that feels like a roller coaster at times, where at times you're like, "Oh, this is amazing. I'm so glad I did this." And there are days where you're like, I have no idea what I'm doing, and I just want to throw in the towel.

JORGE FERNANDEZ: They still happen, too.

PATRICK CASALE: Yeah, yeah, six years later, I mean, every day.

JORGE FERNANDEZ: As any therapist who accepts insurance, you know, what January is like, [INDISCERNIBLE 00:18:33].

PATRICK CASALE: Last day of January, so [CROSSTALK 00:18:37] hopefully smooth sailing beyond that. But, you know, I think embracing the hard times important too. So, like just acknowledging, I think about this a lot. I think that my worst day in private practice is probably 100 times better than my best day when I worked at my agency job. And the reason I say that is that I get to have all of the control and autonomy behind everything I do, and you can't really put a price on that.

JORGE FERNANDEZ: Every day, like I am betting on myself. So, every day, no matter what is going on, I have to put my best foot forward. I have to do the best I can for every single client, you know, and for every single person who I come in contact with.

PATRICK CASALE: And there's risk, right? Like, there's risk in that, but I would rather have that risk and take that risk than not try at all, or prevent myself from starting because my perfectionism, my impostor syndrome, whatever, is saying, like, you can't do this, you don't know how to do this. Like, most of us didn't know how to do this, but we do know how to help people. We do know how to, like, build rapport. We do know how to validate, and affirm, and listen. So, the other stuff is just like the ticky-tacky check this off the list, or this out, and ask for help. And I think that's really a big part of this process.

JORGE FERNANDEZ: And you also, like, listen, like, six years in I don't know how much better I am at organization than I was six years ago, you know? But it all happens. And it all happens reasonably well.

And again, it's how much do you want to get in the weeds as far as how much you're making, how much you're averaging per session, you know, what your percentages are? So, you don't have to get that in the weeds if you don't want to. And I think that's important as well. Like, yes, like, we need to stay on top of our businesses, but we also don't have to be perfectionists about every single little detail as well, you know? I will never own a group practice because I wouldn't be good at it, because I don't feel like I would, you know, that my organizational skills really apply to that. But I feel very comfortable doing a doing a solo practice.

And I think, you know, for people who worry about their own ability, you know, to do this on their own, like, yeah, you should invest in it, but you also don't need to be a perfectionist about it.

PATRICK CASALE: Yeah, that's very well said. So, circling back to your [INDISCERNIBLE 00:21:21] health journey.

JORGE FERNANDEZ: Sure.

PATRICK CASALE: What was kind of the final straw where you were just like, "I'm going to do my own thing and I'm getting out of this world."

JORGE FERNANDEZ: It was after 14 years of doing, you know, middle managerial, supervision, directorship, kind of job. So, I'm finding myself potentially on the job market again and saying that moment where I said to myself, I cannot sit there for another middle management interview again. I cannot do this to myself.

And it took an hour for me to think about, "Well, then what does that mean?" And at that point, it was, you know, well, that means I'm going into private practice. And you know, when I had that moment, I didn't look back. Three days later, I was looking at space.

But just, you know, watching myself those last couple of years, I'm running an evidence-based program, never making executive management happy, never making… You know, I was done. It was it. It ate all of my soul there was left for it to eat. And there was no way that I could find my hamster wheel. So, yeah, it was a very easy decision for me to make.

PATRICK CASALE: I didn't spend as much time in community mental health. Found myself in middle management a lot, and I was going to say soul-crushing, sucking is a good verb or adjective to describe that because you can never make everyone happy. Your staff never have enough support. The executive team always wants more productivity, just like this just doesn't work. I'm sick of being on call. I'm sick of, like, having to make everyone else happy or pacify them, another stupid meeting where we don't talk about anything. And then we just schedule a meeting about meetings. Like, this is pointless. So, yeah, that was my breaking [INDISCERNIBLE 00:23:35]-

JORGE FERNANDEZ: You know, and even when we do great things, you know, there are many things that I'm very proud of from those years. You know, I think that I was responsible for bringing one of the first free yoga for kid's groups to East New York, Brooklyn. You know, where nobody was taking time to, like, "Let's help these kids do yoga. Let's teach…"

You know, you know, we were doing things like that. You know, we were having community parties at like parks that were basically abandoned, you know, in these parts of Brooklyn, and drawing thousands of people safely, you know, and having fun, and, you know, those things bring you nice PR, but, you know, they didn't bring in outcomes. And was enough, but there's a lot to be proud of from those days.

PATRICK CASALE: Yeah, absolutely. I think we can hang our hats on a lot of those things. For those of you listening, I'm sure you have had similar experiences where-

JORGE FERNANDEZ: I fail to forget those.

PATRICK CASALE: But there are moments where this was definitely worth it, and there were relationships that were built, and formed, and yeah, those things really are the things that keep you going in those moments because it's certainly not the pay. So, yeah. Regrets about that at all? Do you feel like launching six years later, here we are?

JORGE FERNANDEZ: I mean, regret that I didn't do it sooner, yeah, you know. Yeah, I think I spent a good two, three years there, burnt out. And, you know, I should have listened to that inner voice. But those fears, you know, those fears of, you know, having to go get your own health insurance. Or, you know, why would people actually want to see me, you know? And not having that every two weeks' paycheck, you know, kept me in that place.

And so, there was not much to worry about. It was all far easier than I feared. At the time, there were people who supported me. You know, for anyone else thinking about doing it, if they feel they're ready, clinically, there's people like me and you ready to support them. You know you are extremely giving with your help. You know, as am I. No, there's plenty of people out there who can absolutely support you through these hard parts.

PATRICK CASALE: Yeah, it's well said. And thank you. Yeah, I think that's the kind of stuff that shouldn't prevent us from starting is the stuff that prevents us from starting. And like you said, oh, it was a lot easier than I ever let it.

And that would be the same thing I would say, like, this is, what are we in? 2024, so I left my community mental health job in 2016. And so, I think my regret is not starting sooner. I think it was also the same, like, coming up with a list of reasons why I wouldn't be successful. Like, who would pay me? Why would anyone call me? I don't have enough letters behind my name. I don't know how to use my EMR that I'm going to choose. Like, all the things.

At the end of the day, it's like, just get started. Like, just start the process. Because we hold ourselves back for so long when we have so many examples of like, the times we were creative, you know, the times we figured things out, when we didn't think the answers.

And I think we have to anchor into that stuff in order to be successful as a small business owner, because, like, we talked about ups and downs. And I think that's just a normal part of the process.

JORGE FERNANDEZ: Yeah, sure.

PATRICK CASALE: Any other advice or things you want to just share with the audience that feel important for you right now?

JORGE FERNANDEZ: You know, I think we've covered a lot of the good stuff, like just not be afraid. You know, when I named the supervision part of my practice, I named it fearless clinical consultancy because of exactly the reasons you said, they're just so many fears.

And again, we see it on the groups. It's not just a running the business, it's also what if I'm faced with a tough clinical decision on my own, how do I handle risks? How do I handle clinical risk? How do I handle, you know, ruling out clients? You know, there's so much fear and anxiety about these things.

And I'm actually developing a training right now with a colleague of mine, Alex Solomon, on how to work with acute risk in private practice, but really going at it from the perspective of demystifying a lot of these fears folks have about liability, you know? And getting folks out of that we need to assess, assess, assess. You know, we need to do every single assessment possible out of fear of getting sued when something happens, you know?

So, it is, you know, again, these things that you are afraid of, you have communities of people out there who have dealt with them, who are actively dealing with them, and can help you. You're going to get through it.

PATRICK CASALE: Absolutely. I love that. It's great kind of message for everyone listening. And I think that sounds like a really wonderful resource. So, please let us know when that's available. I'll happily promote that and share that.

JORGE FERNANDEZ: Yeah, thank you, thank you. We are working on it. Hopefully, we'll have something ready to go live and have people in front of us by the summer, hopefully.

PATRICK CASALE: Okay, well, that sounds good. Jorge, it was great to meet you like this. You're always fun to hang out with on social media.

JORGE FERNANDEZ: Thank you, Patrick.

PATRICK CASALE: Please tell the audience where they can find more of what you're doing.

JORGE FERNANDEZ: Sure, I do have a website. It's nuevodiafw, so N-U-E-V-O- D-I-A-F-W.com. My office, my bio, all that is up there. I have a profile up on Zencare. I recently switched over everything I do to them, so you can always check out my profile. There's a free video of me there. I do have a Facebook presence. And I also am part admin of the Licensed Mental Health Professionals of Connecticut group. So, no if you are a mental health professional in the state of Connecticut, we would love for you to join us really do some good networking.

PATRICK CASALE: Awesome. All of that information will be in the show notes so you have easy access to everything Jorge just mentioned coming on. I appreciate it.

JORGE FERNANDEZ: Thank you, Patrick.

PATRICK CASALE: And to everyone listening to the All Things Private Practice podcast, new episodes are out every single Saturday on all major platforms and YouTube. You can like, download, subscribe, and share. Doubt yourself, do it anyway. We'll see you next week.