Group practice leadership with Carla D’Agostino-Vigil

Dan King: [0:00] Hello, everyone. It's Dan King here. Today, I am delighted to be joined by Carla D'Agostino-Vigil. She's the founder of Ignite Counseling and the Mental Health Executive. Karla, welcome. Carla D'Agostino-Vigil: [0:30] Thanks, Dan. Good to be here. Dan King: [0:32] Good to have you here. So tell me, how did your parents' plumbing business shape you? Carla D'Agostino-Vigil: [0:39] Well, in so many ways. They are really the foundation of why I have the work ethic I have. I was joking recently with them. of, they taught me so very much, including how to take care of our community. And also, I will never co-own a business with my spouse. So I got to see all of it, the good, the bad, the otherwise. So I think that that really laid the foundation of how I show up as a small business owner, as a leader. So, so very much. I mean, I started as a kid sweeping the floors in the shop, and was a receptionist and kind of everything in between. So yeah, I think that that really laid the foundation for me. Dan King: [1:36] Fantastic. And as a business owner today, there's really two businesses that we want to talk about today. Can you tell the audience about what they are. Carla D'Agostino-Vigil: [1:42] Sure. So Ignite Counseling Colorado, I founded in 2019, towards the end of 2019, and grew it as a group starting in 2020. We all know what was going on at the start of 2020. It's been a wild ride. The mental health executive was something that was also born out of COVID times. Carla D'Agostino-Vigil: [2:09] And that was, I started getting requests from colleague practice owners for support. So I have, this is my encore career, my first career. Carla D'Agostino-Vigil: [2:20] Was in human resources and labor relations so leadership development and I had a good run in that career for a while and this was coming back into my my my passion in my heart space so I knew when I back to graduate school for mental health counseling that I wanted to have a group I wanted to help develop others so my colleagues here locally knew of my business background and And so word got out, and that's how it started. Carla D'Agostino-Vigil: [2:52] And about six inquiries in from colleagues, I thought, it's time to put something more structured together. So that was born. I will spare you the original name of the consulting business. It was very long, and I was super uncreative about it. Very, very long-winded name. and but I had the domain the mental health executive and I started getting feedback like you need to trademark that and that should just be the name of the practice so that's the consulting business so I have this wonderful team of 13 clinicians and a fantastic client care specialist and office administrator at Ignite then I have those that I serve colleagues I serve across the country through the mental health executive. So it fills all parts of my heart. Carla D'Agostino-Vigil: [3:48] I get a chance to serve in some different ways. So that is a little bit about both of those. Dan: [3:55] What do group practice owners often miss about personnel management and leadership? Carla D'Agostino-Vigil: [4:00] Oh, what do we often miss? So topics that we might miss? Dan: [4:04] I would say, what are some things that you wish most group practice owners knew about this area that they don't. Carla: [4:12] Yeah. I think the intentionality of stepping into the role is one where having clarity on our why. And what I mean by that is, why do I want to be a leader in this space? Why do I want to be a people manager in this space? And there is a lot of, like, I kind of fell into it because usually we're not coming into this field with a big business background. For many of the group practice owners, I hear, yeah, I got full. You know, I was known in the community for being an incredible therapist. And then it was icky to start turning people away and referring out. So I thought I would hire somebody. So having some intentionality of why and some realism around what that means to step into that or wear that hat of leader, people manager, a business owner. It's really helpful to have that reflection at the outset, get somebody. I'm a fan of bringing smarter people than me around me that can kind of give Carla: [5:33] me some different perspectives, give me some reflection on my why. And so I think that that's the big one that comes to mind. Dan: [5:41] What does a good why look like? So I think you're bang on that a lot of people fall into this kind of unintentionally. I've spoken to many. There's no question. What does a good why look like here? Carla: [5:51] For me, it looked like a couple of things. One is on the personal side and one is on the professional side. I'll start with the personal side of defining my why. And that was, I had a young daughter at the time. And I knew that I wanted to be able to have absolutely the most flexibility to be present with her. I had one shot at being this parent. And so that was one way that I would be able to do that. At the time, I was a single parent as well. I knew, and with the foundation of watching my folks do it, I think that that was a very big personal why. Just as importantly, I think, on the professional side was, I truly do get lit up watching this team succeed. Like, that is just one of my favorite things, is to help uplift others. And to do it in a bigger capacity where we can impact more of the community than what I could do by myself. And that was also rooted in, you know, the 10 plus years in the field of people leadership in the HR capacity. I had led teams before. Carla: [7:15] And that just really lights me up. Those are important whys. I think ignoring the personal side, of course, there's a personal side to it. So just having clarity on what that is, is important. It's going to look different for each of us. Each of our family constellations look different. Our needs are going to be different. So the first piece I hear when folks are asking, like, well, what is my, what should my why be? because I just want to make more money. Like, yes, finances are important. We have the right, in my opinion, we have the right to a good living. We have a right to build personal wealth. And that's not exclusive of our profession. There's a lot of debate about that. That's my belief system around that piece. So if that's part of your personal life, be clear on that too. And know that in this time and space, it is a long game. If you're looking, if you're primarily wanting to be leaning into your why around building wealth, in this profession at this time, you're going to be looking at long game. Not saying we should poo-poo the idea of finances. We deserve and need to address that. And that can be a big driver and it shouldn't be built away. Dan: [8:41] It's a very interesting perspective. And I definitely agree that mission and money can complement each other. They're not always exactly the same thing. I think there's a very interesting conversation we could have about the ability to build a practice profitable quickly. So I might challenge you a little bit on that. I think the potential can be there depending on the market, depending on some other factors. But I completely hear you on the why. Totally agree with you there. We all need a sense of purpose, right? And if in this industry, you don't have a sense of purpose. It's not good. Because there is a lot of burden that you need to carry as a group practice owner. Dan: [9:23] Could you speak to that? Because I think that surprises a lot of newer practice owners. I'll speak to them and they'll talk about the weight of carrying so many people, so many people's expectations. Can you speak to that a bit? Carla: [9:34] Yes. I think that what I'm about to share with you is I'm hearing myself too. It's just as much uh reiterating to myself because it is it is a it is quite isolating and i had a fantastic member of my team my team is tremendous they're just a group that takes care of each other we take care of the community we take care of the clients it is one of our clinical leaders one of the supervisors and we were having a one-on-one and and they relayed to me because I was having a moment of of some disclosure with them around wow you know we just finished a clinician restoration meeting where we connected I did a lead mindful meditation we did a gratitude tree that we built together. There were some mindfulness exercises. I brought in a chair massage therapist. We just kind of loved up on the team. They were reflecting to me, you know, Carla, it's interesting because for you to lead in the way that you are. Carla: [10:44] You're actually not able to fully participate in the team culture that you curated. I said, that's an interesting thought. Wow, that really struck me and asked them to elaborate. And they said, well, you could engage in the culture. Carla: [11:02] And I view that as I've had some bosses with very porous boundaries, right? where they'll come in and they'll complain about this or that, or they're talking about money stress. And so they were saying, you know, you, you hold, it's gotta be isolating for you because you are, you're holding a healthy boundary where it's not appropriate for you to participate in that way in the team culture. I thought that was really something. And I've been reflecting on that since they shared that with me. So I would say to your question, being mindful that there is a lot of isolation, that the burden can be really heavy. So it is so very important to find your community of reciprocal, reciprocal relationships. Carla: [11:53] And it's usually going to be other group practice owners that kind of get it. I think that that's a really big part of what creates that feeling of being super burdened. And I also feel like that, and it's tied to that piece of finding your community of support that is we have, a lot of us owners are duplicating and triplicating efforts. So do yourself a favor and really look and see all of the beautiful, genius things that have already been constructed and crafted and how you might join up with that. Carla: [12:34] I'm thinking of things like, you know, there is an entity that creates really solid policy and procedure handbook for group practices. So rather than you going and creating one from scratch or having your lawyer create one from scratch, finding something that's legal, up to date, and then having your legal counsel maybe review it, make sure it's appropriate for you specifically. But there's a lot of reinventing, which I think doubles down on our burden. Dan: [13:06] We don't do a wonderful job sharing expertise in general. Mary, if you're open to sharing, where could group practice centers who are interested, where could they find that resource? Carla: [13:16] Well, I have one through the mental health executive. I'm trying to think along the way. The group practice exchange, Maureen Horvath. Dan: [13:26] Yeah, she's great. Carla: [13:27] Tremendous. That's a beautiful wealth. It's a treasure trove of resources that Maureen and her team have put together. So I think of that one off the top of my head for resources. You know, also given my HR background, I'm a member of SHRM, so the Society for HR Management. And with that, so there's a whole library of tools, templates, things like that. But ultimately, I think being able to find your community and be able to ask them, you know, what have you, where have you found this resource? Carla: [14:02] Or can I buy that from you? Or can we do some bartering? And I've got this. I think that we could be doing more of that. And that will, I think, reduce the sense of isolation and burden. Dan: [14:16] That makes sense to me. Do you feel, so I think there's a whole world, there's a whole conversation we can have about that fascinating question that your team raised, right? About you being unable to participate. And that I think can seem tricky because yes, there's a boundary to place here. You are the leader in a sense, right? There is a hierarchy here and you're also one of them, Right. So the law in most states says you have to be the same license or you have to be a similar, let's call it a level of license. Right. To the clinicians that are in your group practice. So you're both peer and leader. And that can be a tricky, tricky line. Carla: [14:58] Absolutely. Yeah. I think that that was a real impetus for me about a year and a half ago to be on the path of creating an intentional leadership team with me. Because you start from the ground up and everybody reports to you as the leader and founder. It wasn't lost on me that even though I do believe that I've created an authentic environment where the team is empowered, they feel supported and safe to come to me, there is still an inherent power dynamic there. So in acknowledgement of that, that was really why I created the leadership team and we've been cultivating that since. So there's some additional safety and support for the team where they're not like, oh, and also Carla, if I bring this to her, I'm still going to feel like a fool. Carla: [15:54] And she's the one signing my paycheck. In acknowledgement of that, I think having these wonderful clinical leads, supervisors, that are part of the support structure for the clinicians has helped with what you just described. Dan: [16:11] Tell us about what your leadership team looks like. Carla: [16:14] We have three. I would say, actually, I'm going to include our amazing client care specialist and office administrator and the leadership team. So on the clinical leadership team side, we have three clinicians. They all carry a caseload. And then they have a division of responsibilities of supervision. So if they have folks under their license who are provisionally licensed, they are doing the traditional clinical supervision. And then we're making our way to becoming a fully licensed team across the board. So we've had another iteration of that leadership team becoming clinical lead for licensed teammates. that looks different. We're in that adjustment right now of that. And so I would say as far as what that looks like, we meet as a leadership team regularly. And that way they are able to meet with their supervindes and be empowered to lead. Carla: [17:21] And we have that structure where there's a lot of good communication that happens. Intentional communication, that's been big. It's an interesting mix of the percentages of their caseload versus leadership work. It's ebbing and flowing all of the time. So this group of leaders are really great at being mentally agile, creative, creative. Carla: [17:49] They're very good at pivoting, thinking outside of the norm. And that's served really well because what worked last year is not going to work this year necessarily. So they're ones that kind of role model for the broader team on change agility, which has been a big part of, I think, their collective success as a leadership team. And they take care of each other a lot. That way, they're all cross-trained so that somebody can take time off and restore and refresh, and they're not coming back to, right? Anybody can pick up on the leadership team to take care of their supervisors. Dan: [18:31] It strikes me that through all this, one of the things that you do that I think few practice owners do is you create systems. And I think this jives with the importance of intentionality. At the beginning, you talked about why, right? So that just can be a very intentional mindset. Dan: [18:46] And if you're going to create systems, you're being very intentional, right? You're predicting what could break down and you're really building a well-oiled machine. Carla: [18:55] Yeah. We have, this was now about a year and a half, going on two years ago, we created an Ignite Intranet. We use a Google site. I'm taking the page from my you know my fortune 500 big big corporation experience where we had intranet we modeled that to really be in a place where all of the team can go and they are empowered with information and we laugh you know there was the joke of like there's an app for that we have an SOP for that so there is a standard operating procedure for just about everything and it's all indexed on the internet. We use that internet also as a place where like we have a internal team recognition, team kudos. So those get displayed up there in the internet. So yes, I think my objective was to make sure if there is a legacy statement, it was I want Ignite to live on. Carla: [20:05] No matter if any one of us needs to step away. And that includes myself. So I got busy making sure that I had a leadership team that are like valued. And we got to documenting as much as we possibly could to empower everybody and to walk the walk of this is hard work. We need to be able to have the opportunity to step away and not feel like we're going to be punished for taking time off, right? Because everything builds up and only me can do that task or make that decision. And so, yes, a lot of intentionality around, I want this to be of service to our community and also be an employment place of choice where people know that they are respected. And not just because it sounds good on our mission statement, right? Like the real piece when it's time to really take care of the whole human, not just the person showing up to provide therapy. Dan: [21:11] I'm sure this has cascading effects, right? If your clinicians feel taken care of as whole humans, so will the patients, right? Carla: [21:18] Yeah. Dan: [21:19] I love it. It makes total sense to me. As we come towards the end of our time together, I'm curious. So if you've been able to create a business that's a machine where at the very least a machine, I don't want to use the word machine too lightly because it's very human, but you've created as well. But you've been able to create a space where hopefully a lot of work is done that enables you to spend time with your family, right? Which was a core why for you from the beginning. Dan: [21:45] So what do you know that you freed up a little bit of space for yourself? What's fun for you when you're not working on either the mental health executive or Ignite? Carla: [21:53] Travel is the first thing that comes to my mind i was mentioning before we started dan about being an exchange student i came back from that with wings on i was ready to see the whole world so i've always been working to be able to travel and experience that and so the exciting piece this year is that my daughter has a passport and so i'm looking forward to more of those adventures together as a family. I'm a Colorado girl, so... Anything outdoors, being out in the mountains, that's definitely fun for me and restorative. So whenever I can, I'm getting out into the fresh air. And that's been a big thing that has been fun. I have now a 12 and a half year old. So there is a fun adjacent quality to my family time of like, where am I taking her now? She's a social butterfly. So there's a lot of, you know, what crafts are we getting into? What project or fun little adventure? So there's a lot of those things that are filling my fun bucket lately. Dan: [23:05] Well, I'm very glad your fun bucket is filled, as is your business bucket. I think some super interesting insights here about different things practice owners can do that are, I think, beyond the norm. So creating an intranet is an interesting idea I haven't heard before. I haven't heard a group practice owner talk about. Creating that opportunity for appreciation, I'm sure, pays real dividends. I think bringing an HR skill set to the table and I would say helping people come up with a why is going to be so, so valuable because, as you say, Dan: [23:37] most group practice owners sort of fell into this. Those are some of my key summary points. Anything else you would add that you think are messages you might want to send to group practice owners or clinicians who work in group practices as we wrap? Carla: [23:48] One thing that I do share with the Ignite team often is really leaning into the support we get when we come together. Whether you're in a group practice, especially I would say in this environment right now, I'm hearing more of we're circling around together as a team. We're leaning in with that. So I think that that's a really big piece. As far as a group practice owner, I guess I can't emphasize enough that the importance of finding your community of reciprocal relationships. I had this conversation with another beloved colleague last week, group practice owner, and he was saying, oh, it's isolating. And I think, Carla, you probably are getting, you're doing a lot of outputs. When you're a therapist, it is unidirectional, right, on behalf of the client. When you're a boss, unidirectional for your team. When you're a parent, right? So finding the equilibrium there means having those that you can drop the leader mask and you can show up and get support, I think is really important for longevity. Dan: [25:06] Beautiful, beautiful insight to end on. Carla, thank you so much for sharing your expertise today. So appreciate it. Carla: [25:13] This was great. Thanks, Dan.