ADHD and burnout for group practice owners with Gabrielle Juliano-Villani

Dan King: [0:24] Hello, everyone. It's Dan. I am really delighted today to be joined by Gabrielle Giuliano Villani. She is a consultant who works on group practice coaching, on Medicare and Medicaid consulting, and she does retreats to help therapists and practice owners recover from burnout. Gabby, how are you doing? Gabrielle Juliano Villani: [0:44] Hey, I am doing really good. Thank you for having me, Dan. Dan King: [0:47] It is always a pleasure to be with you. So, I am curious, what percentage of Dan King: [0:53] practice owners, if you had to guess, what percentage are ADHD? Gabrielle Juliano Villani: [0:57] Oh my god, probably like more than half. Maybe even more like 80%, or maybe that's just the people that I surround myself, but I think a very large percentage probably are. Dan King: [1:11] How does it help and hinder group practice owners? Gabrielle Juliano Villani: [1:14] Well, we were chatting a little bit before we started recording. And I am late diagnosed. So I was just diagnosed about two and a half years ago. And that was after I had sold my practice. And I was telling you how it would have been really helpful to know that I had ADHD during that process because it absolutely impacts us so deeply. burnout does. And burnout looks different for us. So I think it helps group practice owners because we're creative. We think outside of the box. We are really good entrepreneurs. We get excited about building and scaling and taking risks. I think it hinders us because we sometimes take those risks without really planning and just being very impulsive. I think sometimes we may struggle with loose boundaries. We obviously struggle with either not focusing or hyper-focusing. And I think the analysis paralysis and the executive dysfunction plays into all of that too. Dan King: [2:20] There is so much to unpack there. Gabrielle Juliano Villani: [2:22] Yes, there is. Dan King: [2:23] You said that burnout looks different for us. And I asked partly out of curiosity because I'm ADHD as well. What looks different about burnout for us? Gabrielle Juliano Villani: [2:31] This is something that I learned again, like after I was diagnosed, Gabrielle Juliano Villani: [2:34] I just kind of thought everybody operated this way. But usually for neurotypical people, burnout is is just about work or just about the one thing. But when you are neurodivergent, being alive can just be really exhausting. We are have a lot of sensory stuff that we're taking in. We're overstimulated. Just having conversations with people and doing our day to day like tasks can be really overwhelming. So I think because we're taking in so much more of everything that's happening around us and not noticing it, that we are definitely more prone to burnout. And, you know, I always got to bring in nervous system stuff. We don't want to go into it. We're not really paying attention to the signals that our bodies are giving us. So we, our body may have been telling us for a long time, I'm tired. I can't do this anymore. But by the time our brain catches up, it's too late. Dan King: [3:31] So you think we tend to pay less attention to our bodies. It's ADHD people. Gabrielle Juliano Villani: [3:36] For sure. We don't have good interoception. So if you're thirsty, you've probably been thirsty for quite a while by the time you notice it. Dan King: [3:47] Where do we place our attention? If we're not placing our attention in our body, where does our attention tend to go? Gabrielle Juliano Villani: [3:51] I saw, I think it was a TikTok video, and she called it the bees were buzzing. And she kind of recreated what it sounds like in her brain. And again, I was like, oh, I thought everybody's brain was like this. She was talking about the orange sticky note over there and then the dishes that need to be cleaned over there and then like some sort of weird vocal stem over here that was replaying in her head and then the laundry over there. So I think we're just always taking in everything that's happening around us and spiraling, thinking about what's next, what's next, what's next, instead of noticing what's happening right now. Dan King: [4:25] So that sensitivity to all these things you mentioned can also be a benefit as a practice owner. So we see possibilities that others don't, right? Gabrielle Juliano Villani: [4:34] We do. And I think we're highly empathetic, which is important, right? I mean, there needs to be a line. We don't want to be some cold, distant asshole, but we still don't want to overfeel and be codependent and people please our employees either. But I think it is helpful that we think about our employees and our clients and what would be best for them. Dan King: [5:00] It's a beautiful segue to something else you said, which is that ADHD people often have boundary issues. Gabrielle Juliano Villani: [5:06] Yes. Dan King: [5:07] That's so important as a group practice. I'm highlighting group here, owner. Why do ADHD people often have boundary issues? Gabrielle Juliano Villani: [5:15] We were also talking about the collective unconscious, which I think also plays into this, that we often, I mean, there's so much nuance to this, right? And like, obviously, I can't speak for every single ADHD person. But there tends to be a lot of codependency and people pleasing, which makes it hard to set boundaries because we have a fear of being perceived. A lot of us struggle with RSD, which stands for rejection-sensitive dysphoria. So we don't want to be rejected because it's not—we take it personally. If somebody rejects us or there's conflict, it's not just something we can get over. It's like a deep wound. Dan King: [5:56] That rejection sensitivity is really interesting as a business owner because at the core of being a business owner is sales, right? So you sold your whole practice. How did rejection sensitivity play out during that journey, if at all? Gabrielle Juliano Villani: [6:10] I have a very good specific example of that, actually. I mean, there were many, which I had to take back to my mentor slash one of my best friends who really helped me through some of this and my broker, too. But one thing that I remember so vividly is when we were going through due diligence. And if you're not familiar with due diligence, it is where they come in, as they should, and look at every single thing in your business, because they need to know, right, what they're buying, what they're getting into. I just remember that I'm just asking questions for clarification, right? Like, what was this check for? Why did you spend so much money over here last year? What's this? What's that? And every single time, I would get so upset. Like, how dare you ask me that question? Clearly, we're a group practice. Of course, I'm going to be spending money on blah, blah, blah, blah, blah. So my friend who, like, thank God for her, was like, they're just doing their job. Just think of it from their perspective. Don't take it personal. It's nothing about you. They just need to understand, and they're trying to understand what all this stuff is that they're walking into. Dan King: [7:23] Yes. So if you were to summarize that journey, maybe let's move back a little bit. You know, folks know that you built the practice and sold it. Why did you decide to sell it? Gabrielle Juliano Villani: [7:33] I was very burnt out, was the high level theme of why I wanted to sell. I was like, I'm burnt out. I don't want to do this anymore. The thing that I learned through all of it and over the last couple of years is that, it was not aligned with my values and how I wanted to work anymore. And I didn't really figure that out until afterwards, actually, which is interesting because I couldn't see that in the beginning. But I was burnt out. And the other part of it, too, is that it's so interesting to think of my mindset back then. I was very much scarcity-based, and I was very fearful. And it was a hard time, to be fair. It was right after the pandemic, I guess we were kind of still in the pandemic, but my practice was mostly Medicare and Medicaid-based, and Hedway and Alma and Sondermind were happening. I had lost a lot of clinicians. I wasn't sure if Medicare was going to keep covering telehealth, which most of my practice was. There were a lot of very scary unknowns and I didn't want to be the one to take the risk for all that anymore. Dan King: [8:42] It's a huge burden, right, to wear on your shoulders. Dan King: [8:46] It makes me think about why we get into business in the first place, right? And as an ADHD person with rejection sensitivity, that alignment is so, so vital. When did you first notice that you felt misaligned? Gabrielle Juliano Villani: [9:01] I think the spring of 2021 is when I started noticing that. And it was one of those things where, of course, I was afraid. And I was like, stop giving me this information brain. I don't want to hear that. Okay, I got shit to do. I got things I need to bill for. I'm trying to hire another person. Leave me alone. But I basically had like a coaching session with my friend slash mentor that I've mentioned. And she was the one who really pointed out to me that first of all, I was doing way too much. She's like, you need to delegate. And so I did. And I thought that would fix everything. But then the person I delegated to didn't want to do the things that I didn't want to do either. And that was also a learning lesson. I just chose somebody who I thought would be good for it, but I really should have dug a little bit deeper, right, and found somebody who was truly aligned with the vision and was going to take accountability for that. I didn't think of it that way. I just thought of more like, get this off my plate. I don't want to deal with it. They'll deal with it. And that was not the greatest way to make a decision, but it's what I did. And it sort of worked, but it just kept causing more problems. And then I just realized like I don't like to manage people. Gabrielle Juliano Villani: [10:15] And it just felt like a lot of burden and draining on my own system. Dan King: [10:20] So let's say I'm a practice owner. I feel misaligned at the moment, or maybe I do feel aligned and I want, you know, some kind of either partnership or some kind of sale. How do I find a buyer? And how did you find a buyer? Gabrielle Juliano Villani: [10:31] So mine happened in a way that happens to a lot of group practice owners and they will email me or message me on Facebook and they'll be like, this is so scammy. It's not real. And it is real. And the buyer contacted me. So they had reached out to me. I was actually on vacation. And they left me a voicemail and said, you know, we represent who we represent. And they're interested in acquiring their practice. Call us back. So I, of course, was like, I'm not going to respond to that. But my friend was like, No, these are these things happen. You need to respond to first Google and make sure they're legit, which I did. And then we had the meeting. And that's who ended up buying my practice. So I will say, if you get those kinds of messages, don't ignore them. Never close a door. You have no idea what could be what that conversation could lead to. The other thing is how a lot of other deals happen is that you can work with a broker and they are responsible for finding a buyer for you. So they'll list your practice and they have their own network and strategy, how they'll get connected. Or you can do what the buyers do to you and you can go out there and message people also and take it into your own hands and then you don't have to pay a broker commission. Dan King: [11:48] Absolutely. Very few do it, and you can totally do it. What was it about this particular buyer? We don't need to get into who they are too much, but what was it about this particular buyer that seemed interesting to you? Why did you pick them? Gabrielle Juliano Villani: [11:59] It was interesting to me because they really valued Medicare, and my practice was mostly Medicare. So that was one big green flag, I guess I would say, that was interesting. And I appreciated that they were already familiar with Medicare. They knew the types of clients that we were working with and that was really important to them is to just kind of keep it how it was and keep growing it. I mean, they were different for me, but the other things that I liked is that they were very open and transparent throughout the whole process. Any questions that I asked, they were very clear about it. I didn't feel like anything was being hidden. They flew me out there. I met them. I met everybody on the board. I met the clinical director who I became really close with. And they were also very, I guess, transparent too, but flexible. So they asked me what I wanted. So if anybody's listening to this, and if you're thinking about selling, like you, if you sell the whole thing, you're still going to have to stay on for a transition period. I think that's like 98% of the time that's required. So just have that expectation. But they were very flexible with me. They kept asking me, what do you want? What do you want this to look like? What do you want your job to look like? What don't you want to do anymore? Because we'll take it off of your hands so that you can do the things that you like doing. Gabrielle Juliano Villani: [13:21] And they did not change. They didn't want to rock the boat, right? So they kept everything the same with my clinicians. No different productivity goals. Nobody's pay changed. And because we were going under a larger entity, they actually got better benefits and more PTO and a 401k with a higher match Gabrielle Juliano Villani: [13:40] and things like that, too. Dan King: [13:41] So if you were to take a step back from this journey, and I know today a lot of the work you do leverages some of these experiences, what was most important from that process that you learned, that you bring to the world in your work today? Gabrielle Juliano Villani: [13:54] One thing that sticks out to me is really the emotional roller coaster. So I think that's the piece that people, they think, okay, I got the logistics, I got an attorney, I got a broker, I'm good. All my financial statements are good. I got really strong operations, like all of that stuff. And you just think it's going to be like, hand it over. And there's a lot of emotions. There's a lot of stuff that comes up. You really need to know what you want to do afterwards. That's very important, I think. There's a lot of ups and downs. Things can just go like sideways. And like one day, it's like everything is fine. And the next morning, some like shit show explodes in your email and you're like, what? I had no idea this was going to happen. And something my broker told me that also really helped me throughout this was he was like, you have got to zoom out. You were just thinking so like day to day, narrowly focused. You need to think about your entire life. And what do you want at the end? The end of this book, what is the goal? Selling your practice is the stepping stone to get to the next thing. And that very simple way that he put it really changed everything for me. Dan King: [15:12] Going through that experience, selling a business is a very unique experience to have. I've sold a business too. And I think we so often view it as an end in itself, as opposed to a means to a broader journey, right? Yeah. And there's so many stories across the internet of founders selling businesses and feeling this blankness afterwards. Words it's a bit like veterans who you know who come home from serving overseas and they end up in blankness they've gone from so much togetherness to like Gabrielle Juliano Villani: [15:44] Yeah like. Dan King: [15:46] You're staring into a void Gabrielle Juliano Villani: [15:47] I totally relate to that and my friend she was also selling her business at the same time i was that was kind of nice that i had like a buddy and she sent me this article from the atlantic that i still think about a lot. And it just, I think it has a lot to do with the dopamine too. But it talks about people who have had very big achievements in their life and how after you have that achievement, you also usually feel that blankness or that numbness or nothing. That's totally how I felt when it was done and I signed it and the money was in my account and everybody was like, How do you feel? Like, I don't do anything. I feel totally numb. And it's still like just blows my mind sometimes that I actually did that. So it's, yeah, it's very surreal to me. Dan King: [16:37] Something to still celebrate and congratulate yourself for. Gabrielle Juliano Villani: [16:41] Yes, thank you. Dan King: [16:42] Let's talk about the retreats. So we've talked a little bit about Medicare, Medicaid. We've talked a bit about, you know, what you might have done differently if you knew what you knew today in growing your practice. Tell me about the retreats piece of what you do. Gabrielle Juliano Villani: [16:55] I think the retreats were always kind of like a pipe dream, like a daydream kind of a thing. I kept seeing people do them. I was like, that would be cool. I want to do something like that, but I don't know how. A lot of that fear that tends to come up when I step into things that are unknown. Gabrielle Juliano Villani: [17:12] And then I went on a retreat and I was like, I could totally do something like this. And I also saw the transformation that happens on retreats and what had happened for myself. And I think that's really what pushed me as I was like, you think a couple of days or a week away isn't going to change anything, but it actually is very transformational. And as I kept growing my platform and my audience, the people I was working with, I was getting so many people who were practice owners or entrepreneurs who were burnt out. And obviously burnout is a very big buzzword right now. And that's why I like to talk about it because everyone's talking about the fluffy and the boundaries and get a massage. And I'm like, I have ADHD. I need deep. I need to go deep and I need to understand the how and the why. So that's what I do. And I love doing it. I'm a sound healer. So we do sound healing. We do deep, creative, expressive arts activities for nervous system regulation. And then sometimes we end up doing a little business coaching, too, since we're already nice and regulated and in a good grounded place to think about our visions and our goals. Dan King: [18:27] What does the ADHD nervous system need that it can get on a retreat? Gabrielle Juliano Villani: [18:31] The right kind of stimulation. No doom scrolling, although that can still happen, right? But when you're getting a sound bath, there's no way to do that. I think a lot of us who are ADHD feel like we need to go, go, go. And I've actually found for myself and a lot of my clients that I work with that when we do slow down, we're more regulated. So when we come back and we've done the work on a retreat we paid attention to more of what our body needs of that stillness of being in a deeper meditative state where you have access to that inner wisdom that's not coming from fight or flight that when you get back because you are more regulated you you're not stressed and you have those coping skills and you're not making those decisions from a place of fear or worry or impulsivity that you're starting to pay attention of like, actually, my body feels a little uncomfortable right now. Maybe I need to take a break. Or, yeah, it's true. I have been trying to start this task and I can't. I wonder why. Instead of shaming myself and being like, God damn it, you're so lazy. Why don't you just do this? It's only going to take you two minutes. You're regulated so you're able to access that self-compassion a lot easier. Dan King: [19:50] There's something magical that happens when you start to just watch whichever behaviors you can put in that fight or flight camp, right? Gabrielle Juliano Villani: [19:59] Yeah. Dan King: [19:59] I used to, when on important phone calls, pace around the room. So I would have my cell phone and I would pace around the room, right? And I got to a point where I just noticed, man, this doesn't feel good. I don't really feel like myself on these calls. I feel so flighty. And what I started doing was sitting for an important call and feeling my feet against the ground. Feeling grounded, right? Feeling that connection between my feet and the ground. And there's just such a solidness that comes from that. Gabrielle Juliano Villani: [20:30] Yeah. Dan King: [20:30] It's such a slowness and peaceful groundedness is the way I would put it. Gabrielle Juliano Villani: [20:35] It's funny, right? Like we think that's so small. but having that, like actually being grounded, feeling your feet on the ground instead of when you are pacing, right? Like you're still there, but you're not here and present and in the moment. And I do the same thing when, not when we spoke together, because we were on a panel and we were sitting, but if I'm speaking and I'm standing up, I never wear shoes. I always, always, I'm barefoot and I need my feet to touch the stage. Dan King: [21:06] Yes, it makes immense sense. And I find the groundedness deepens if you feel different parts of your body. So if as ADHD people, we have a tendency not to feel our bodies, one antidote to that is when in these moments of pressure, actually just feeling your body, feeling your heart, right? In that moment of pressure, feeling your heart, feeling it beat. Maybe it'll beat a little bit faster, but your connection to it is also a way to induce peacefulness. Gabrielle Juliano Villani: [21:37] Mm-hmm, yes. And we often, as ADHDers, we don't want to feel that. I don't want to feel my heart racing. I don't want to feel the tightness, but that's the only way to understand it and to move through it. And to your point, like, I do the same thing, and now I know, okay, I am nervous. That's okay. Like, just sit with it. That's okay. It's going to be fine. I'm going to live. Don't push it away. Use that energy, like especially when I'm speaking because I get really nervous. I'm like, I'm just going to use that energy to propel me and push me forward. Dan King: [22:10] Any retreats coming up? If I'm a practice owner and I find this really, really intriguing, I haven't done a retreat before. I like the kind of concept that you're talking about here. Are there retreats coming up that I could participate in? Gabrielle Juliano Villani: [22:21] There are two private rooms left in Costa Rica this November 2nd through the 7th. So you can join us there. So that's about, what, six days a week, all-inclusive. You just need to get your flight to Costa Rica. You get continuing education. We're going to do a little speaker showcase on the last day. So if you are a practice owner and you're thinking about doing speaking engagements or training, you get 15 minutes to practice. And my social media manager will capture that content. And then you get to use it on your social channels and your website. And you get to say you're an international speaker. And then there's also two spaces left for beyond private practice. I'm co-hosting with my friend Patrick Casal in New Zealand in March 2026. So if you want something a little bit more adventurous, you can join us for that too. Dan King: [23:14] Very cool. So as we come towards the end of our time together, are there any insights that you'd want to lead group practice owners or clinicians at group practices with? Takeaways that you think it would be great for them to get from this conversation? Gabrielle Juliano Villani: [23:27] I just hope that if you're listening to this and you're in that place of burnout or stress or you don't know what to do, really slow down. Think about your values. Write them down. Again, very small, right? I have mine on my computer, so I'm looking that way. And I also have a vision board over there. That is, you need to see those things every single day. Because if you are not working in alignment with your values, you're absolutely going to be burnt out. And you should know, like, how does the group practice support those values? How, what is my North Star? What am I trying to get to? And how is the group practice going to help me get there? What do I need to do to implement, to change, to make sure that this continues Gabrielle Juliano Villani: [24:14] to run the way I want it to. Dan King: [24:15] I'm not a clinician, but my understanding is with ADHD, we can actually focus more on the things that excite us. It's harder for us to do the things that are not in alignment. But when it comes to the things that are in alignment, it's so inspiring. It's easier for us to focus like mad people, right? Gabrielle Juliano Villani: [24:33] Yep, it absolutely is. So find those things out. What does excite you? And the things that don't excite you, delegate them. And if you're not to that point yet, just remember that there are lots of systems Gabrielle Juliano Villani: [24:47] and automations out there that can help support you now, too. Dan King: [24:50] Let's end on a human note. So when you're not doing Medicare, Medicaid consulting, helping group practice owners, running retreats, what is fun for you? What do you do in your spare time? Gabrielle Juliano Villani: [25:00] I love to travel, obviously. And I also am a Zumba instructor, so I teach Zumba, and that's really fun for me, too. I love to read, but only a very specific genre of psychological thrillers. And I love to surf, which I don't get to do enough because I live on the wrong side of Florida. And then my goal for this year, which Dan is my accountability partner, is to get better at learning Spanish. Dan King: [25:28] Yes, you got it well. You could solve both of those issues if you lived on the right coast of Florida. Gabrielle Juliano Villani: [25:33] You know, just a couple hours away. Dan King: [25:36] Always lovely to be with you, Gabby. Thank you so much. So appreciate the journey you've been on and the insights that you've been able to share from it. So thank you. Gabrielle Juliano Villani: [25:44] Thank you again, Dan. Thank you for listening to your group practice. If you're involved in building, expanding, or managing a group practice, make sure to subscribe so you don't miss any future episodes. Until next time, thank you for tuning in.